202 results on '"Lofgren, A."'
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2. Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery
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Woon-Seok Kang, Lars R. Lofgren, Bradley J. Stringer, Carter Lybbert, Kai Kuck, Natalia P. Melendez, Gregory J. Stoddard, Michael Van Tienderen, Natalie A. Silverton, Isaac E. Hall, and Spencer B. Shumway
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medicine.medical_specialty ,business.industry ,Urinary system ,030232 urology & nephrology ,Acute kidney injury ,Urine ,030204 cardiovascular system & hematology ,medicine.disease ,law.invention ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,law ,Anesthesia ,Cardiopulmonary bypass ,medicine ,Risk factor ,Complication ,business ,Prospective cohort study - Abstract
Background Acute kidney injury (AKI) is a common complication of cardiac surgery. An intraoperative monitor of kidney perfusion is needed to identify patients at risk for AKI. The authors created a noninvasive urinary oximeter that provides continuous measurements of urinary oxygen partial pressure and instantaneous urine flow. They hypothesized that intraoperative urinary oxygen partial pressure measurements are feasible with this prototype device and that low urinary oxygen partial pressure during cardiac surgery is associated with the subsequent development of AKI. Methods This was a prospective observational pilot study. Continuous urinary oxygen partial pressure and instantaneous urine flow were measured in 91 patients undergoing cardiac surgery using a novel device placed between the urinary catheter and collecting bag. Data were collected throughout the surgery and for 24 h postoperatively. Clinicians were blinded to the intraoperative urinary oxygen partial pressure and instantaneous flow data. Patients were then followed postoperatively, and the incidence of AKI was compared to urinary oxygen partial pressure measurements. Results Intraoperative urinary oxygen partial pressure measurements were feasible in 86/91 (95%) of patients. When urinary oxygen partial pressure data were filtered for valid urine flows greater than 0.5 ml · kg–1 · h–1, then 70/86 (81%) and 77/86 (90%) of patients in the cardiopulmonary bypass (CPB) and post-CPB periods, respectively, were included in the analysis. Mean urinary oxygen partial pressure in the post-CPB period was significantly lower in patients who subsequently developed AKI than in those who did not (mean difference, 6 mmHg; 95% CI, 0 to 11; P = 0.038). In a multivariable analysis, mean urinary oxygen partial pressure during the post-CPB period remained an independent risk factor for AKI (relative risk, 0.82; 95% CI, 0.71 to 0.95; P = 0.009 for every 10-mmHg increase in mean urinary oxygen partial pressure). Conclusions Low urinary oxygen partial pressures after CPB may be associated with the subsequent development of AKI after cardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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- 2021
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3. Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study
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Sarah M Lofgren, Leander Ankunda, Andrew G. Flynn, Paul Kirumira, Nathan Wamala, David B. Meya, Robina Komuhendo, Carolyn M. Porta, Sharon Tsui, Alisat Sadiq, Lynn Atuyambe, Noeline Nakasujja, Diksha Srishyla, and Katelyn A Pastick
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Male ,medicine.medical_specialty ,Health (social science) ,Social Psychology ,Social Stigma ,Psychological intervention ,Stigma (botany) ,Alcohol abuse ,HIV Infections ,Article ,Social support ,Health care ,medicine ,Humans ,Uganda ,Qualitative Research ,business.industry ,Public Health, Environmental and Occupational Health ,medicine.disease ,CD4 Lymphocyte Count ,Alcoholism ,Family medicine ,Domestic violence ,Female ,business ,Contact tracing ,Qualitative research - Abstract
Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) “ART-experienced” or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count 350 cells/uL “early presenters”. In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.
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- 2021
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4. Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic
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Glasbey, James C, Omar, Omar, Nepogodiev, Dmitri, Minaya-Bravo, Ana, Bankhead-Kendall, Brittany Kay, Fiore, Marco, Futaba, Kaori, Gabre-Kidan, Alodia, Gujjuri, Rohan R, Isik, Arda, Kaafarani, Haytham MA, Kamarajah, Sivesh K, Li, Elizabeth, Loeffler, Markus W, McLean, Kenneth A, Outani, Oumaima, Ntirenganya, Faustin, Satoi, Sohei, Shaw, Richard, Simoes, Joana FF, Stewart, Grant D, Tabiri, Stephen, Trout, Isobel M, Bhangu, Aneel A, Siaw-Acheampong, Kwabena, Benson, Ruth A, Bywater, Edward, Chaudhry, Daoud, Dawson, Brett E, Evans, Jonathan P, Heritage, Emily, Jones, Conor S, Khatri, Chetan, Khaw, Rachel A, Keatley, James M, Knight, Andrew, Lawday, Samuel, Mann, Harvinder S, Marson, Ella J, Mckay, Siobhan C, Mills, Emily C, Pellino, Gianluca, Picciochi, Maria, Taylor, Elliott H, Tiwari, Abhinav, Venn, Mary L, Wilkin, Richard JW, Bhangu, Aneel, Smart, Neil J, Gallo, Gaetano, Moug, Susan, Pata, Francesco, Pockney, Peter, Di Saverio, Salomone, Vallance, Abigail, Vimalchandran, Dale, Griffiths, Ewen A, Evans, Richard PT, Townend, Philip, Roberts, Keith, McKay, Siobhan, Isaac, John, Edwards, John, Coonar, Aman S, Marchbank, Adrian, Caruana, Edward J, Layton, Georgia R, Patel, Akshay, Brunelli, Alessandro, Ford, Samuel, Desai, Anant, Gronchi, Alessandro, Almond, Max, Tirotta, Fabio, Dumitra, Sinziana, Kolias, Angelos, Price, Stephen J, Fountain, Daniel M, Jenkinson, Michael D, Hutchinson, Peter, Marcus, Hani J, Piper, Rory J, Lippa, Laura, Servadei, Franco, Esene, Ignatius, Freyschlag, Christian, Neville, Iuri, Rosseau, Gail, Schaller, Karl, Demetriades, Andreas K, Robertson, Faith, Alamri, Alex, Schache, Andrew G, Winter, Stuart C, Ho, Michael, Nankivell, Paul, Biel, Juan Rey, Batstone, Martin, Ganly, Ian, Vidya, Raghavan, Wilkins, Alex, Singh, Jagdeep K, Thekinkattil, Dinesh, Sundar, Sudha, Fotopoulou, Christina, Leung, Elaine, Khan, Tabassum, Chiva, Luis, Sehouli, Jalid, Fagotti, Anna, Cohen, Paul, Gutelkin, Murat, Ghebre, Rahel, Konney, Thomas, Pareja, Rene, Bristow, Rob, Dowdy, Sean, Rajkumar, Shylasree TS, Ng, Joe, Fujiwara, Keiiji, Lamb, Benjamin, Narahari, Krishna, McNeill, Alan, Colquhoun, Alexandra, McGrath, John, Bromage, Steve, Barod, Ravi, Kasivisvanathan, Veeru, Klatte, Tobias, Abbott, Tom EF, Abukhalaf, Sadi, Adamina, Michel, Ademuyiwa, Adesoji O, Agarwal, Arnav, Akkulak, Murat, Alameer, Ehab, Alderson, Derek, Alakaloko, Felix, Albertsmeiers, Markus, Alser, Osaid, Alshaar, Muhammad, Alshryda, Sattar, Arnaud, Alexis P, Augestad, Knut Magne, Ayasra, Faris, Azevedo, Jose, Bankhead-Kendall, Brittany K, Barlow, Emma, Beard, David, Blanco-Colino, Ruth, Brar, Amanpreet, Breen, Kerry A, Bretherton, Chris, Buarque, Igor Lima, Burke, Joshua, Chaar, Mohammad, Chakrabortee, Sohini, Christensen, Peter, Cox, Daniel, Cukier, Moises, Cunha, Miguel F, Davidson, Giana H, Drake, Thomas M, Edwards, John G, Elhadi, Muhammed, Emile, Sameh, Farik, Shebani, Fitzgerald, J Edward, Garmanova, Tatiana, Ghosh, Dhruv, Gomes, Gustavo Mendonca Ataide, Grecinos, Gustavo, Grundl, Madalegna, Halkias, Constantine, Harrison, Ewen M, Hisham, Intisar, Hutchinson, Peter J, Hwang, Shelley, Jonker, Pascal, Keller, Debby, Kruijff, Schelto, Lawani, Ismail, Lederhuber, Hans, Leventoglu, Sezai, Litvin, Andrey, Loehrer, Andrew, Loffler, Markus W, Lorena, Maria Aguilera, Modolo, Maria Marta, Major, Piotr, Martin, Janet, Mashbari, Hassan N, Mazingi, Dennis, Metallidis, Symeon, Mohan, Helen M, Moore, Rachel, Moszkowicz, David, Ng-Kamstra, Joshua S, Maimbo, Mayaba, Negoi, Ionut, Niquen, Milagros, Olivos, Maricarmen, Oussama, Kacimi, Parreno-Sacdalanm, Marie Dione, Rivera, Carlos Jose Perez, Pinkney, Thomas D, van der Plas, Willemijn, Qureshi, Ahmad, Radenkovic, Dejan, Ramos-De la Medina, Antonio, Roslani, April C, Rutegard, Martin, Segura-Sampedro, Juan Jose, Santos, Irene, Sayyed, Raza, Schache, Andrew, Schnitzbauer, Andreas A, Seyi-Olajide, Justina O, Sharma, Neil, Shu, Sebastian, Soreide, Kjetil, Spinelli, Antonino, Sund, Malin, Tsoulfas, Georgios, van Ramshorst, Gabrielle H, Vimalachandran, Dale, Warren, Oliver J, Wedderburn, Duane, Wright, Naomi, Allemand, C, Boccalatte, L, Figari, M, Lamm, M, Larranaga, J, Marchitelli, C, Noll, F, Odetto, D, Perrotta, M, Saadi, J, Zamora, L, Alurralde, C, Caram, EL, Eskinazi, D, Mendoza, JP, Usandivaras, M, Badra, R, Esteban, A, Garcia, JS, Garcia, PM, Gerchunoff, JI, Lucchini, SM, NIgra, MA, Vargas, L, Hovhannisyan, T, Stepanyan, A, Gould, T, Gourlay, R, Griffiths, B, Gananadha, S, McLaren, M, Cecire, J, Joshi, N, Salindera, S, Sutherland, A, Ahn, JH, Charlton, G, Chen, S, Gauri, N, Hayhurst, R, Jang, S, Jia, F, Mulligan, C, Yang, W, Ye, G, Zhang, H, Ballal, M, Gibson, D, Hayne, D, Moss, J, Richards, T, Viswambaram, P, Vo, UG, Bennetts, J, Bright, T, Brooke-Smith, M, Fong, R, Gricks, B, Lam, YH, Ong, BS, Szpytma, M, Watson, D, Bagraith, K, Caird, S, Chan, E, Dawson, C, Ho, D, Jeyarajan, E, Jordan, S, Lim, A, Nolan, GJ, Oar, A, Parker, D, Puhalla, H, Quennell, A, Rutherford, L, Townend, P, Von Papen, M, Wullschleger, M, Blatt, A, Cope, D, Egoroff, N, Fenton, M, Gani, J, Lott, N, Pockney, P, Shugg, N, Elliott, M, Phung, D, Phan, D, Townend, D, Bong, C, Gundara, J, Frankel, A, Bowman, S, Guerra, GR, Bolt, J, Buddingh, K, Dudi-Venkata, NN, Jog, S, Kroon, HM, Sammour, T, Smith, R, Stranz, C, Batstone, M, Lah, K, McGahan, W, Mitchell, D, Morton, A, Pearce, A, Roberts, M, Sheahan, G, Swinson, B, Alam, N, Banting, S, Chong, L, Choong, P, Clatworthy, S, Foley, D, Fox, A, Hii, MW, Knowles, B, Mack, J, Read, M, Rowcroft, A, Ward, S, Wright, G, Lanner, M, Koenigsrainer, I, Bauer, M, Freyschlag, C, Kafka, M, Messner, F, Oefner, D, Tsibulak, I, Emmanuel, K, Grechenig, M, Gruber, R, Harald, M, Oehlberger, L, Presl, J, Wimmer, A, Namazov, I, Samadov, E, Barker, D, Boyce, R, Corbin, S, Doyle, A, Eastmond, A, Gill, R, Haynes, A, Millar, S, O'Shea, M, Padmore, G, Paquette, N, Phillips, E, St John, S, Walkes, K, Flamey, N, Pattyn, P, Oosterlinck, W, Van den Eynde, J, Van den Eynde, R, Gatti, A, Nardi, C, Oliva, R, De Cicco, R, Cecconello, I, Gregorio, P, Pontual Lima, L, Ribeiro Junior, U, Takeda, F, Terra, RM, Sokolov, M, Kidane, B, Srinathan, S, Boutros, M, Caminsky, N, Ghitulescu, G, Jamjoum, G, Moon, J, Pelletier, J, Vanounou, T, Wong, S, Dumitra, S, Kouyoumdjian, A, Johnston, B, Russell, C, Demyttenaere, S, Garfinkle, R, Abou-Khalil, J, Nessim, C, Stevenson, J, Heredia, F, Almeciga, A, Fletcher, A, Merchan, A, Puentes, LO, Mendoza Quevedo, J, Bacic, G, Karlovic, D, Krsul, D, Zelic, M, Luksic, I, Mamic, M, Bakmaz, B, Coza, I, Dijan, E, Katusic, Z, Mihanovic, J, Rakvin, I, Frantzeskou, K, Gouvas, N, Kokkinos, G, Papatheodorou, P, Pozotou, I, Stavrinidou, O, Yiallourou, A, Martinek, L, Skrovina, M, Szubota, I, Zatecky, J, Javurkova, V, Klat, J, Avlund, T, Christensen, P, Harbjerg, JL, Iversen, LH, Kjaer, DW, Kristensen, HO, Mekhael, M, Ebbehoj, AL, Krarup, P, Schlesinger, N, Smith, H, Abdelsamed, A, Azzam, AY, Salem, H, Seleim, A, Abdelmajeed, A, Abdou, M, Abosamak, NE, AL Sayed, M, Ashoush, F, Atta, R, Elazzazy, E, Elhoseiny, M, Elnemr, M, Elqasabi, MS, Hewalla, Elsayed ME, Elsherbini, I, Essam, E, Eweda, M, Ghallab, I, Hassan, E, Ibrahim, M, Metwalli, M, Mourad, M, Qatora, MS, Ragab, M, Sabry, A, Saifeldin, H, Elkaffas, Saleh Mesbah Mohamed M, Samih, A, Abdelaal, Samir A, Shehata, S, Shenit, K, Attia, D, Kamal, N, Osman, N, Abbas, AM, Abd Elazeem, HAS, Abdelkarem, MM, Alaa, S, Ali, AK, Ayman, A, Azizeldine, MG, Elkhayat, H, Elghazaly, MS, Monib, FA, Nageh, MA, Saad, MM, Salah, M, Shahine, M, Yousof, EA, Youssef, A, Eldaly, A, ElFiky, M, Nabil, A, Amira, G, Sallam, I, Sherief, M, Sherif, A, Abdelrahman, A, Aboulkassem, H, Ghaly, G, Hamdy, R, Morsi, A, Sherif, G, Abdeldayem, H, Salama, Abdelkader I, Balabel, M, Fayed, Y, Sherif, AE, Bekele, D, Kauppila, J, Sarjanoja, E, Helminen, O, Huhta, H, Kauppila, JH, Beyrne, C, Jouffret, L, Lugans, L, Marie-Macron, L, Chouillard, E, De Simone, B, Bettoni, J, Dakpe, S, Devauchelle, B, Lavagen, N, Testelin, S, Boucher, S, Breheret, R, Gueutier, A, Kahn, A, Kun-Darbois, J, Barrabe, A, Lakkis, Z, Louvrier, A, Manfredelli, S, Mathieu, P, Chebaro, A, Drubay, V, El Aamrani, M, Eveno, C, Lecolle, K, Legault, G, Martin, L, Piessen, G, Pruvot, FR, Truant, S, Zerbib, P, Ballouhey, Q, Barrat, B, Laloze, J, Salle, H, Taibi, A, Usseglio, J, Bergeat, D, Merdrignac, A, Le Roy, B, Perotto, LO, Scalabre, A, Aime, A, Ezanno, A, Malgras, B, Bouche, P, Tzedakis, S, Cotte, E, Glehen, O, Kepenekian, V, Lifante, J, Passot, G, D'Urso, A, Felli, E, Mutter, D, Pessaux, P, Seeliger, B, Bardet, J, Berry, R, Boddaert, G, Bonnet, S, Brian, E, Denet, C, Fuks, D, Gossot, D, Grigoroiu, M, Laforest, A, Levy-Zauberman, Y, Louis-Sylvestre, C, Moumen, A, Pourcher, G, Seguin-givelet, A, Tribillon, E, Duchalais, E, Espitalier, F, Ferron, C, Malard, O, Bork, U, Distler, M, Fritzmann, J, Kirchberg, J, Praetorius, C, Riediger, C, Weitz, J, Welsch, T, Wimberger, P, Beyer, K, Kamphues, C, Lauscher, J, Loch, FN, Schineis, C, Albertsmeier, M, Angele, M, Kappenberger, A, Niess, H, Schiergens, T, Werner, J, Becker, R, Jonescheit, J, Pergolini, I, Reim, D, Boeker, C, Hakami, I, Mall, J, Liokatis, P, Smolka, W, Nowak, K, Reinhard, T, Hoelzle, F, Modabber, A, Winnand, P, Knitschke, M, Kauffmann, P, Wolfer, S, Kleeff, J, Lorenz, K, Michalski, C, Ronellenfitsch, U, Schneider, R, Bertolani, E, Koenigsrainer, A, Loeffler, MW, Quante, M, Steidle, C, Ueberrueck, L, Yurttas, C, Betz, CS, Bewarder, J, Boettcher, A, Burg, S, Busch, C, Gosau, M, Heuer, A, Izbicki, J, Klatte, TO, Koenig, D, Moeckelmann, N, Nitschke, C, Priemel, M, Smeets, R, Speth, U, Thole, S, Uzunoglu, FG, Vollkommer, T, Zeller, N, Battista, MJ, Gillen, K, Hasenburg, A, Krajnak, S, Linz, V, Schwab, R, Angelou, K, Haidopoulos, D, Rodolakis, A, Antonakis, P, Bramis, K, Chardalias, L, Contis, I, Dafnios, N, Dellaportas, D, Fragulidis, G, Gklavas, A, Konstadoulakis, M, Memos, N, Papaconstantinou, I, Polydorou, A, Theodosopoulos, T, Vezakis, A, Antonopoulou, MI, Manatakis, DK, Tasis, N, Arkadopoulos, N, Danias, N, Economopoulou, P, Kokoropoulos, P, Larentzakis, A, Michalopoulos, N, Selmani, J, Sidiropoulos, T, Tsaousis, V, Vassiliu, P, Bouchagier, K, Klimopoulos, S, Paspaliari, D, Stylianidis, G, Baxevanidou, K, Bouliaris, K, Chatzikomnitsa, P, Efthimiou, M, Giaglaras, A, Kalfountzos, C, Koukoulis, G, Ntziovara, AM, Petropoulos, K, Soulikia, K, Tsiamalou, I, Zervas, K, Zourntou, S, Baloyiannis, I, Diamantis, A, Gkrinia, E, Hajiioannou, J, Korais, C, Koukoura, O, Perivoliotis, K, Saratziotis, A, Skoulakis, C, Symeonidis, D, Tepetes, K, Tzovaras, G, Zacharoulis, D, Alexoudi, V, Antoniades, K, Astreidis, I, Christidis, P, Deligiannidis, D, Grivas, T, Ioannidis, O, Kalaitsidou, I, Loutzidou, L, Mantevas, A, Michailidou, D, Paraskevopoulos, K, Politis, S, Stavroglou, A, Tatsis, D, Tilaveridis, I, Vahtsevanos, K, Venetis, G, Karaitianos, I, Tsirlis, T, Charalabopoulos, A, Liakakos, T, Mpaili, E, Schizas, D, Spartalis, E, Syllaios, A, Zografos, C, Anthoulakis, C, Christou, C, Papadopoulos, V, Tooulias, A, Tsolakidis, D, Tsoulfas, G, Zouzoulas, D, Athanasakis, E, Chrysos, E, Tsiaoussis, J, Xenaki, S, Xynos, E, Futaba, K, Ho, MF, Hon, SF, Mak, TWC, Ng, SSM, Foo, CC, Banky, B, Susztak, N, Aremu, M, Canas-Martinez, A, Cullivan, O, Murphy, C, Owens, P, Pickett, L, Akmenkalne, L, Byrne, J, Corrigan, M, Cullinane, C, Daly, A, Fleming, C, Jordan, P, Killeen, S, Lynch, N, McCarthy, A, Mustafa, H, O'Brien, S, O'Leary, P, Syed, WAS, Vernon, L, Callanan, D, Huang, L, Ionescu, A, Sheahan, P, Balasubramanian, I, Boland, M, Conlon, K, Evoy, D, Fearon, N, Gallagher, T, Geraghty, J, Heneghan, H, Kennedy, N, Maguire, D, McCartan, D, McDermott, EW, Prichard, RS, Winter, D, Alazawi, D, Barry, C, Boyle, T, Butt, W, Connolly, EM, Donlon, N, Donohue, C, Fahey, BA, Farrell, R, Fitzgerald, C, Kinsella, J, Larkin, JO, Lennon, P, Maguire, PJ, Mccormick, P, Mehigan, BJ, Mohan, H, Nugent, T, O'Sullivan, H, Ravi, N, Reynolds, JV, Rogers, A, Shokuhi, P, Smith, J, Smith, LA, Timon, C, Bashir, Y, Bass, G, Connelly, T, Creavin, B, Earley, H, Elliott, JA, Gillis, A, Kavanagh, D, Neary, P, O'riordan, J, Reynolds, IS, Rice, D, Ridgway, P, Umair, M, Whelan, M, Carroll, P, Collins, C, Corless, K, Finnegan, L, Fowler, A, Hogan, A, Kerin, M, Lowery, A, McAnena, P, McKevitt, K, Nizami, K, Ryan, E, Samy, A, Coffey, JC, Cunningham, R, Devine, M, Nally, D, Peirce, C, Tormey, S, Hardy, N, O'Malley, S, Ryan, M, Macina, S, Mariani, NM, Opocher, E, Ceretti, Pisani A, Ferrari, F, Odicino, F, Sartori, E, Cotsoglou, C, Granieri, S, Bianco, F, Camillo', A, Colledan, M, Tornese, S, Zambelli, MF, Bissolotti, G, Fusetti, S, Lemma, F, Marino, MV, Mirabella, A, Vaccarella, G, Agostini, C, Alemanno, G, Bartolini, I, Bergamini, C, Bruscino, A, Checcucci, C, De Vincenti, R, Di Bella, A, Fambrini, M, Fortuna, L, Maltinti, G, Muiesan, P, Petraglia, F, Prosperi, P, Ringressi, MN, Risaliti, M, Sorbi, F, Taddei, A, Tucci, R, Bassi, C, Bortolasi, L, Campagnaro, T, 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O., Mendoza, Q. J., Bacic, G., Karlovic, D., Krsul, D., Zelic, M., Luksic, I., Mamic, M., Bakmaz, B., Coza, I., Dijan, E., Katusic, Z., Mihanovic, J., Rakvin, I., Frantzeskou, K., Gouvas, N., Kokkinos, G., Papatheodorou, P., Pozotou, I., Stavrinidou, O., Yiallourou, A., Martinek, L., Skrovina, M., Szubota, I., Zatecky, J., Javurkova, V., Klat, J., Avlund, T., Harbjerg, J. L., Iversen, L. H., Kjaer, D. W., Kristensen, H. O., Mekhael, M., Ebbehoj, A. L., Krarup, P., Schlesinger, N., Smith, H., Abdelsamed, A., Azzam, A. Y., Salem, H., Seleim, A., Abdelmajeed, A., Abdou, M., Abosamak, N. E., Al, S. M., Ashoush, F., Atta, R., Elazzazy, E., Elhoseiny, M., Elnemr, M., Elqasabi, M. S., Elsayedhewalla, M. E., Elsherbini, I., Essam, E., Eweda, M., Ghallab, I., Hassan, E., Ibrahim, M., Metwalli, M., Mourad, M., Qatora, M. S., Ragab, M., Sabry, A., Saifeldin, H., Saleh, M. M. E. M., Samih, A., Samir, A. A., Shehata, S., Shenit, K., Attia, D., Kamal, N., Osman, N., Abbas, A. M., Abd, E. 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N., Schineis, C., Albertsmeier, M., Angele, M., Kappenberger, A., Niess, H., Schiergens, T., Werner, J., Becker, R., Jonescheit, J., Pergolini, I., Reim, D., Boeker, C., Hakami, I., Mall, J., Liokatis, P., Smolka, W., Nowak, K., Reinhard, T., Holzle, F., Modabber, A., Winnand, P., Knitschke, M., Kauffmann, P., Wolfer, S., Kleeff, J., Lorenz, K., Michalski, C., Ronellenfitsch, U., Schneider, R., Bertolani, E., Konigsrainer, A., Quante, M., Steidle, C., Uberruck, L., Yurttas, C., Betz, C. S., Bewarder, J., Bottcher, A., Burg, S., Busch, C., Gosau, M., Heuer, A., Izbicki, J., Klatte, T. O., Koenig, D., Moeckelmann, N., Nitschke, C., Priemel, M., Smeets, R., Speth, U., Thole, S., Uzunoglu, F. G., Vollkommer, T., Zeller, N., Battista, M. J., Gillen, K., Hasenburg, A., Krajnak, S., Linz, V., Schwab, R., Angelou, K., Haidopoulos, D., Rodolakis, A., Antonakis, P., Bramis, K., Chardalias, L., Contis, I., Dafnios, N., Dellaportas, D., Fragulidis, G., Gklavas, A., Konstadoulakis, M., Memos, N., Papaconstantinou, I., Polydorou, A., Theodosopoulos, T., Vezakis, A., Antonopoulou, M. I., Manatakis, D. K., Tasis, N., Arkadopoulos, N., Danias, N., Economopoulou, P., Kokoropoulos, P., Larentzakis, A., Michalopoulos, N., Selmani, J., Sidiropoulos, T., Tsaousis, V., Vassiliu, P., Bouchagier, K., Klimopoulos, S., Paspaliari, D., Stylianidis, G., Baxevanidou, K., Bouliaris, K., Chatzikomnitsa, P., Efthimiou, M., Giaglaras, A., Kalfountzos, C., Koukoulis, G., Ntziovara, A. 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V., Cosimelli, M., Folli, S., Gennaro, M., Giannini, L., Guaglio, M., Macchi, A., Martinelli, F., Mazzaferro, V., Mosca, A., Pasquali, S., Piazza, C., Raspagliesi, F., Rolli, L., Salvioni, R., Sarpietro, G., Sarre, C., Sorrentino, L., Agnes, A., Alfieri, S., Belia, F., Biondi, A., Cozza, V., D'Amore, A., D'Ugo, D., De, S. V., Gasparini, G., Gordini, L., Litta, F., Lombardi, C. P., Lorenzon, L., Marra, A. A., Marzi, F., Moro, A., Parello, A., Perrone, E., Ratto, C., Rosa, F., Saponaro, G., Scambia, G., Scrima, O., Sganga, G., Tudisco, R., Belli, A., Granata, V., Izzo, F., Palaia, R., Patrone, R., Carrano, F. M., Carvello, M. M., De, V. A., Di, C. F., Ferreli, F., Gaino, F., Mercante, G., Rossi, V., Spriano, G., Donati, D. M., Frisoni, T., Palmerini, E., Aprile, A., Barra, F., Batistotti, P., Ferrero, S., Fregatti, P., Scabini, S., Sparavigna, M., Asti, E., Bernardi, D., Bonavina, L., Lovece, A., Adamoli, L., Ansarin, M., Cenciarelli, S., Chu, F., De, B. R., Fumagalliromario, U., Mastrilli, F., Pietrobon, G., Tagliabue, M., Badellino, E., Ferrero, A., Massobrio, R., De, M. G. A., Federico, P., Maida, P., Marra, E., Marte, G., Petrillo, A., Tammaro, T., Tufo, A., Berselli, M., Borroni, G., Cocozza, E., Conti, L., Desio, M., Livraghi, L., Quintodei, V., Rizzi, A., Zullo, A., Baldi, C., Corbellini, C., Sampietro, G. M., Cellerino, P., Baldini, E., Capelli, P., Isolani, S. M., Ribolla, M., Bondurri, A., Colombo, F., Ferrario, L., Guerci, C., Maffioli, A., Armao, T., Ballabio, M., Bisagni, P., Gagliano, A., Longhi, M., Madonini, M., Pizzini, P., Baietti, A. M., Biasini, M., Maremonti, P., Neri, F., Prucher, G. M., Ricci, S., Ruggiero, F., Zarabini, A. G., Barmasse, R., Mochet, S., Usai, A., Incollingo, P., Mancini, S., Marino, C. L., Sagnotta, A., Fruscio, R., Grassi, T., Nespoli, L. C., Tamini, N., Anastasi, A., Bartalucci, B., Bellacci, A., Canonico, G., Capezzuoli, L., Di, M. C., Ipponi, P., Linari, C., Montelatici, M., Nelli, T., Spagni, G., Tirloni, L., Vitali, A., Abate, E., Casati, M., Casiraghi, T., Laface, L., Schiavo, M., Arminio, A., Cotoia, A., Lizzi, V., Vovola, F., Vergari, R., D'Ugo, S., Depalma, N., Spampinato, M. G., Bartolucci, P., Brachini, G., Bruzzaniti, P., Chiappini, A., Chiarella, V., Ciccarone, F., Cicerchia, P. M., Cirillo, B., De, T. G., Fiori, E., Fonsi, G. B., Franco, G., Frati, A., Giugliano, M., Iannone, I., La, T. F., Lapolla, P., Leonardo, C., Marruzzo, G., Meneghini, S., Mingoli, A., Ribuffo, D., Salvati, M., Santoro, A., Sapienza, P., Scafa, A. K., Simonelli, L., Zambon, M., Capolupo, G. T., Carannante, F., Caricato, M., Masciana, G., Mazzotta, E., Gattolin, A., Migliore, M., Rimonda, R., Sasia, D., Travaglio, E., Cervellera, M., Gori, A., Sartarelli, L., Tonini, V., Giacometti, M., Zonta, S., Chessa, A., Fiorini, A., Norcini, C., Colletti, G., Confalonieri, M., Costanzi, A., Frattaruolo, C., Mari, G., Monteleone, M., Bandiera, A., Bocciolone, L., Bonavina, G., Candiani, M., Candotti, G., De, N. P., Gagliardi, F., Medone, M., Mortini, P., Negri, G., Parise, P., Piloni, M., Sileri, P., Vignali, A., Belvedere, A., Bernante, P., Bertoglio, P., Boussedra, S., Brunocilla, E., Cipriani, R., Cisternino, G., De, C. E., De, I. P., Dondi, G., Frio, F., Jovine, E., Mineo, B. F., Neri, J., Parlanti, D., Perrone, A. M., Pezzuto, A. P., Pignatti, M., Pinto, V., Poggioli, G., Ravaioli, M., Rottoli, M., Schiavina, R., Serenari, M., Serra, M., Solli, P., Taffurelli, M., Tanzanu, M., Tesei, M., Violante, T., Zanotti, S., Borghi, F., Cianflocca, D., Di, M. G. S., Donati, D., Gelarda, E., Geretto, P., Giraudo, G., Giuffrida, M. C., Marano, A., Palagi, S., Pellegrino, L., Peluso, C., Testa, V., Agresta, F., Prando, D., Zese, M., Aquila, F., Gambacciani, C., Pieri, F., Santonocito, O. S., Armatura, G., Bertelli, G., Frena, A., Marinello, P., Notte, F., Patauner, S., Scotton, G., Fulginiti, S. F., Sammarco, G., Vescio, G., Balercia, P., Catarzi, L., Consorti, G., Di, M. F., Fontana, T., Daiko, H., Ishikawa, M., Ishiyama, K., Iwata, S., Kanematsu, K., Kanemitsu, Y., Kato, T., Kawai, A., Kobayashi, E., Kobayashi, K. M., Moritani, K., Nakatani, F., Oguma, J., Tanase, Y., Uno, M., Al, A. M., Ayasra, Y., Qasem, A., Abu, Z. F. J., Fahmawee, T., Hmedat, A., Ibrahim, A., Obeidat, K., Abdel, A. S., Abdel, J. R., Abouchaar, M. K., Al-Masri, M., Al-Najjar, H., Alawneh, F., Alsaraireh, O., Elayyan, M., Ghanem, R., Lataifeh, I., Alkadeeki, G. Z., Al, M. F. S., Aldokali, N., Senossi, O., Subhi, M. T., Burgan, D., Kamoka, E., Kilani, A. 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M., Rodrigues, M., Ruivo, A., Santos, E., Silva, M., Simoes, J., Valente, D. C. A., Almeida, A., Cavaleiro, S., Devezas, V., Faria, C. S., Jacome, F., Magalhaes, M. M., Nogueiro, J., Pereira, A., Pereira-Neves, A., Pina-Vaz, T., Santos-Sousa, H., Silveira, H., Vaz, S., Vieira, P., Gomes, D. C. A., Lobo, A. I., Pinto, J., Tojal, A., Cardoso, N., Cardoso, P., Domingues, J. C., Henriques, P., Manso, M. I., Martins, D. S. G., Morais, H., Pereira, R., Revez, T., Ribeiro, R., Ribeiro, V. I., Soares, A., Sousa, S., Teixeira, J., Amorim, E., Baptista, V. H., Dias, B., Fazenda, A., Melo, N. J. P., Policarpo, F., Sampaio, D. N. G. M. I., Veiga, D., Andrade, A. K., Bandovas, J. P., Borges, N., Branquinho, A., Chumbinho, B., Correia, J., Fidalgo, H., Figueiredo, D. B. I., Frade, S., Gomes, J., Maciel, J., Pina, S., Rodrigues, A., Silva, N., Silveira, N. I., Sousa, R., Ascensao, J., Azevedo, P., Costeira, B., Cunha, C., Garrido, R., Gomes, H., Lourenco, I., Mendinhos, G., Miranda, P., Nobre, P. A., Peralta, F. M., Ribeiro, J., Rio, R. L., Sousa, F. M., Galvao, D., Soares, A. C., Vieira, A., Patricio, B., Santos, P. M. D. D., Vieira, P. L. A. C., Cunha, R., Faustino, A., Freitas, A., Martins, A. B., Mendes, J. R., Parreira, R., Rosa, J., Teves, M., Abreu, D. S. A., Claro, M., Costa, S. D., Deus, A. C., Grilo, J. V., Borges, F., Corte, R. J., Henriques, S., Lima, M. J., Matos, C. P., Brito, D. S. F., Caiado, A., Fonseca, F., Angelo, M., Baiao, J. M., Martins, J. D., Vieira, C. T., Messias, J., Millan, A., Salgado, I., Santos, P., Baia, C., Canotilho, R., Correia, A. M., Ferreira, P. A. P., Peyroteo, M., Videira, J. F., Bezede, C., Chitul, A., Ciofic, E., Cristian, D., Grama, F., Pirtea, L., Secosan, C., Bonci, E., Gata, V., Titu, S., Ginghina, O., Iordache, N., Iosifescu, R. V., Kazachenko, E., Markaryan, D., Rodimov, S., Tsarkov, P., Tulina, I., Litvina, Y., Provozina, A., Agapov, M., Galliamov, E., Kakotkin, V., Kubyshkin, V., Alshahrani, M., Alsharif, F., Eskander, M., Al, R. R., Majrashi, S., Mashat, A., Akeel, N., Alharthi, M., Aljiffry, M., Basendowah, M., Farsi, A., Ghunaim, M., Khoja, A., Maghrabi, A., Malibary, N., Nassif, M., Nawawi, A., Saleem, A., Samkari, A., Trabulsi, N., Al, A. S., Alghamdi, M., Alnumani, T., Nasser, M., Said, B. A., Alhefdhi, A., Almalik, O., Alomair, A., Alotaibi, N., Alresaini, F., Alsalamah, R., Alsobhi, S., Mahasin, Z., Othman, E., Velagapudi, S., Ghedan, S., Alharthi, R., Awad, S., Sharara, M., Abdelrahman, S., Althobaiti, W., Al, H. H., Alkarak, S., Alqannas, M., Alyami, M., Alzamanan, M., Cortes, G. D., Elawad, A., Alaamer, O., Alriyees, L., Alselaim, N., Abdulkareem, A., Ajlan, A., Akkour, K., Al-Habib, A., Al-Khayal, K., Alatar, A., Alburakan, A., Alhalal, H., Alhassan, B., Alhassan, N., Alobeed, O., Alsaif, A., Alsaif, F., Alshammari, S., Alshaygy, I., Barry, M., Bin, N. A., Bin, T. T., Bokhari, A., Elwatidy, S., Helmi, H., Madkhali, A., Nouh, T., Rabah, P. D., Zubaidi, A., Paunovic, I., Slijepcevic, N., Aleksic, L., Antic, A., Barisic, G., Ceranic, M., Galun, D., Grubac, Z., Jelenkovic, J., Kecmanovic, D., Kmezic, S., Knezevic, D., Krivokapic, Z., Latincic, S., Markovic, V., Matic, S., Miladinov, M., Pavlov, M., Pejovic, I., Tadic, B., Vasljevic, J., Velickovic, D., Zivanovic, M., Perovic, M., Srbinovic, L., Andrijasevic, S., Bozanovic, T., Cerovic, P. 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W., Lieske, B., Galis, B., Simko, K., Almgla, N., Bernon, M., Boutall, A., Cairncross, L., Herman, A., Hilton, T., Jonas, E., Kloppers, C., Malherbe, F., Mugla, W., Nel, D., Rayamajhi, S., Van, W. T., Vogel, J., Castano-Leon, A. M., Delgado, F. J., Eiriz, F. C., Espino, S. -I. M., Esteban, S. O., Garcia, P. D., Gomez, P., Jimenez-Roldan, L., Lagares, A., Moreno-Gomez, L., Paredes, I., Perez, N. A., Sanchez, A. G., Santas, M., Fernandez, R. P., Paniagua, G. S. M., Sanchez-Santos, R., Vigorita, V., Acrich, E., Baenasanfeliu, E., Barrios, O., Golda, T., Santanach, C., Serrano-Navidad, M., Sorribasgrifell, M., Vives, R. V., Escola, D., Jimenez, A., Cayetano, P. L., Gomez, F. L., Artigues, E., Bernal-Sprekelsen, J. C., Catalabauset, J. C., Collera, P., Diaz, D. G. R., Farre, F. R., Flores, C. R., Gomez, D. C. J., Guardia, N., Guariglia, C. A., Osorio, A., Sanchez, J. R., Sanchon, L., Soto, M. C., Albi, M. B., Garcia, V. J. E., Alonso-Lamberti, L., Assaf, M., Baeza, P. 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A., Robinson, A., Ross, E., Sehgal, T., Dixon, J., Dunning, J., Freystaetter, K., Jha, M., Lester, S., Madhavan, A., Thulasiraman, S. V., Viswanath, Y., Curl-Roper, T., Delimpalta, C., Liao, C. C. L., Velchuru, V., Westwood, E., Belcher, E., Bond-Smith, G., Chidambaram, S., Fasanmade, K., Fraser, L., Fu, H., Ganau, M., Gore, S., Graystone, J., Jeyaretna, D., Khatkar, H., Lami, M., Maher, M., Mastoridis, S., Mihai, R., Piper, R., Prabhu, S., Risk, O. B. F., Selbong, U., Shah, K., Smillie, R., Soleymanimajd, H., Sravanam, S., Stavroulias, D., Tebala, G. D., Vatish, M., Verberne, C., Wallwork, K., Winter, S., Bhatti, M. 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A., Asaad, P., Brown, B., Collis, J., Duff, S., Khan, A., Moura, F., Wadham, B., Warburton, H., Elmoslemany, T., Jenkinson, M., Millward, C., Zakaria, R., Mccluney, S., Parmar, C., Shah, S., Allison, J., Babar, M. S., Collard, B., Goodrum, S., Lau, K., Scott, R., Thomas, E., Whitmore, H., Balasubramaniam, D., Jayasankar, B., Kapoor, S., Ramachandran, A., Elhamshary, A., Imam, S. M. B., Kapriniotis, K., Lindsay, J., Rakhshani-Moghadam, S., Beech, N., Chand, M., Green, L., Kalavrezos, N., Kiconco, H., Mcewen, R., Schilling, C., Sinha, D., Pereca, J., Chopra, S., Egbeare, D., Thomas, R., Combellack, T., Jones, S. E. F., Kornaszewska, M., Mohammed, M., Sharma, A., Tahhan, G., Valtzoglou, V., Williams, J., Eskander, P., Gash, K., Gourbault, L., Hanna, M., Maccabe, T., Newton, C., Olivier, J., Rozwadowski, S., Teh, E., West, D., Al-Omishy, H., Baig, M., Bates, H., Di, T. 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F., Di F.G., Furbetta N., Gianardi D., Guadagni S., Morelli L., Palmeri M., Tartaglia D., Anania G., Carcoforo P., Chiozza M., De T.A., Koleva R.M., Portinari M., Sibilla M.G., Urbani A., Fabbri N., Feo C.V., Gennari S., Parini S., Righini E., Ampollini L., Bellanti L., Bergonzani M., Bertoli G., Bocchialini G., D'Angelo G., Lanfranco D., Musini L., Poli T., Santoro G.P., Varazzani A., Aguzzoli L., Borgonovo G., Castro R.C., Coiro S., Falco G., Mandato V.D., Mastrofilippo V., Montella M.T., Annessi V., Zizzo M., Grossi U., Novello S., Romano M., Rossi S., Zanus G., Esposito G., Frongia F., Pisanu A., Podda M., Belluco C., Lauretta A., Montori G., Moras L., Olivieri M., Bussu F., Carta A.G., Cossu M.L., Cottu P., Fancellu A., Feo C.F., Ginesu G.C., Giuliani G., Madonia M., Perra T., Piras A., Porcu A., Rizzo D., Scanu A.M., Tedde A., Tedde M., Delrio P., Rega D., Badalamenti G., Campisi G., Cordova A., Franza M., Maniaci G., Rinaldi G., Toia F., Calabro M., Farnesi F., Lunghi E.G., Muratore A., Pipitone F.N.S., Bambina F., D'Andrea G., Familiari P., Picotti V., De P.G., Luglio G., Pagano G., Tropeano F.P., Baldari L., Beltramini G.A., Boni L., Cassinotti E., Gianni' A., Pignataro L., Torretta S., Abatini C., Baia M., Biasoni D., Bogani G., Cadenelli P., Capizzi V., Cioffi S.P.B., Citterio D., Comini L.V., Cosimelli M., Folli S., Gennaro M., Giannini L., Zweroncy A., Guaglio M., MacChi A., Martinelli F., Mazzaferro V., Mosca A., Pasquali S., Piazza C., Raspagliesi F., Rolli L., Salvioni R., Sarpietro G., Sarre C., Sorrentino L., Agnes A., Alfieri S., Belia F., Biondi A., Cozza V., D'Amore A., D'Ugo D., De S.V., Gasparini G., Gordini L., Litta F., Lombardi C.P., Lorenzon L., Marra A.A., Marzi F., Moro A., Parello A., Perrone E., Ratto C., Rosa F., Saponaro G., Scambia G., Scrima O., Sganga G., Tudisco R., Belli A., Granata V., Izzo F., Palaia R., Patrone R., Carrano F.M., Carvello M.M., De V.A., Di C.F., Ferreli F., Gaino F., Mercante G., Rossi V., Spriano G., Donati D.M., Frisoni T., Palmerini E., Aprile A., Barra F., Batistotti P., Ferrero S., Fregatti P., Scabini S., Sparavigna M., Asti E., Bernardi D., Bonavina L., Lovece A., Adamoli L., Ansarin M., Cenciarelli S., Chu F., De B.R., Fumagalliromario U., Mastrilli F., Pietrobon G., Tagliabue M., Badellino E., Ferrero A., Massobrio R., De M.G.A., Federico P., Maida P., Marra E., Marte G., Petrillo A., Tammaro T., Tufo A., Berselli M., Borroni G., Cocozza E., Conti L., Desio M., Livraghi L., Quintodei V., Rizzi A., Zullo A., Baldi C., Corbellini C., Sampietro G.M., Cellerino P., Baldini E., Capelli P., Isolani S.M., Ribolla M., Bondurri A., Colombo F., Ferrario L., Guerci C., Maffioli A., Armao T., Ballabio M., Bisagni P., Gagliano A., Longhi M., Madonini M., Pizzini P., Baietti A.M., Biasini M., Maremonti P., Neri F., Prucher G.M., Ricci S., Ruggiero F., Zarabini A.G., Barmasse R., Mochet S., Usai A., Incollingo P., Mancini S., Marino C.L., Sagnotta A., Fruscio R., Grassi T., Nespoli L.C., Tamini N., Anastasi A., Bartalucci B., Bellacci A., Canonico G., Capezzuoli L., Di M.C., Ipponi P., Linari C., Montelatici M., Nelli T., Spagni G., Tirloni L., Vitali A., Abate E., Casati M., Casiraghi T., Laface L., Schiavo M., Arminio A., Cotoia A., Lizzi V., Vovola F., Vergari R., D'Ugo S., Depalma N., Spampinato M.G., Bartolucci P., Brachini G., Bruzzaniti P., Chiappini A., Chiarella V., Ciccarone F., Cicerchia P.M., Cirillo B., De T.G., Fiori E., Fonsi G.B., Franco G., Frati A., Giugliano M., Iannone I., La T.F., Lapolla P., Leonardo C., Marruzzo G., Meneghini S., Mingoli A., Ribuffo D., Salvati M., Santoro A., Sapienza P., Scafa A.K., Simonelli L., Zambon M., Capolupo G.T., Carannante F., Caricato M., Masciana G., Mazzotta E., Gattolin A., Migliore M., Rimonda R., Sasia D., Travaglio E., Cervellera M., Gori A., Sartarelli L., Tonini V., Giacometti M., Zonta S., Chessa A., Fiorini A., Norcini C., Colletti G., Confalonieri M., Costanzi A., Frattaruolo C., Mari G., Monteleone M., Bandiera A., Bocciolone L., Bonavina G., Candiani M., Candotti G., De N.P., Gagliardi F., Medone M., Mortini P., Negri G., Parise P., Piloni M., Sileri P., Vignali A., Belvedere A., Bernante P., Bertoglio P., Boussedra S., Brunocilla E., Cipriani R., Cisternino G., De C.E., De I.P., Dondi G., Frio F., Jovine E., Mineo B.F., Neri J., Parlanti D., Perrone A.M., Pezzuto A.P., Pignatti M., Pinto V., Poggioli G., Ravaioli M., Rottoli M., Schiavina R., Serenari M., Serra M., Solli P., Taffurelli M., Tanzanu M., Tesei M., Violante T., Zanotti S., Borghi F., Cianflocca D., Di M.G.S., Donati D., Gelarda E., Geretto P., Giraudo G., Giuffrida M.C., Marano A., Palagi S., Pellegrino L., Peluso C., Testa V., Agresta F., Prando D., Zese M., Aquila F., Gambacciani C., Pieri F., Santonocito O.S., Armatura G., Bertelli G., Frena A., Marinello P., Notte F., Patauner S., Scotton G., Fulginiti S.F., Sammarco G., Vescio G., Balercia P., Catarzi L., Consorti G., Di M.F., Fontana T., Daiko H., Ishikawa M., Ishiyama K., Iwata S., Kanematsu K., Kanemitsu Y., Kato T., Kawai A., Kobayashi E., Kobayashi K.M., Moritani K., Nakatani F., Oguma J., Tanase Y., Uno M., Al A.M., Ayasra Y., Qasem A., Abu Z.F.J., Fahmawee T., Hmedat A., Ibrahim A., Obeidat K., Abdel A.S., Abdel J.R., Abouchaar M.K., Al-Masri M., Al-Najjar H., Alawneh F., Alsaraireh O., Elayyan M., Ghanem R., Lataifeh I., Alkadeeki G.Z., Al M.F.S., Aldokali N., Senossi O., Subhi M.T., Burgan D., Kamoka E., Kilani A.I., Salamah A., Salem M., Shuwayyah A., Abdulwahed E., Alshareea E., Aribi N., Aribi S., Biala M., Ghamgh R., Morgom M., Aldayri Z., Ellojli I., Kredan A., Bradulskis S., Dainius E., Kubiliute E., Kutkevicius J., Parseliunas A., Subocius A., Venskutonis D., Rasoaherinomenjanahary F., Razafindrahita J.B., Samison L.H., Ong E.C., Hamdan K.H., Ibrahim M.R., Tan J.A., Thanapal M.R., Amin S.N., Hayati F., Jayasilan J., Sriram R.K., Subramaniam S., Che J.A., Hussain A.H., Mohamed S.A.S., Mohdyunus M.F., Soh J.Y., Wong M.P.K., Zakaria A.D., Zakaria Z., Fadzli A., Fathi N.Q., Koh P.S., Liew Y.T., Tang C.Y., Teoh L.Y., Wong W.J., Yahaya A.S., Alvarez M.R., Arrangoiz R., Cordera F., De L.R.A.M., Gomez-Pedraza A., Hernandez R., Maffuz-Aziz A., Posada J.A., Becerra G.F.C., Alfaro-Goldaracena A., Buerba G.A., Castillejos-Molina R.A., Chan C., Dominguez-Rosado I., Medina-Franco H., Mercado M.A., Oropeza-Aguilar M., Pena G.P.E., Posadas-Trujillo O.E., Rodriguez-Covarrubias F., Salgado-Nesme N., Vilatoba M., Arkha Y., Bechri H., El O.A., Oudrhiri M.Y., Derkaouihassani F., El A.N., Amrani L., Belkhadir Z.H., Benkabbou A., Chakib O., El A.B., El B.Y., Essangri H., Ghannam A., Majbar A.M., Mohsine R., Souadka A., Hompes R., Meima-Van P.E.M., Pronk A.J.M., Sharabiany S., Grotenhuis B., Hartveld L., Reijers S., Van H.W., Baaij J., Bolster-Van E.M., De G.M., Sloothaak D., Van D.P., Posma-Bouman L., Derksen T., Franken J., Oosterling S., Konsten J., Van H.M., Fidelis L., Sholadoye T.T., Tolani M.A., Olaogun J., Egbuchulem I.K., Lawal T.A., Ogundoyin O., Olulana D.I., Abdur-Rahman L., Adeyeye A., Aremu I., Bello J., Olasehinde O., Popoola A., Massoud J., Massoud R., Sorour T.M., Jamal A., Kerawala A.A., Memon A.S., Nafees A.R., Rai L., Ayub B., Hassan N., Martins R.S., Ramesh P., Butt U., Kashif M., Khan W.H., Umar M., Warisfarooka M., Wasim T., Ayubi A., Rashid I., Waqar S.H., Falcon G.M., Robles R., Jocson R., Teh C., Bobinski M., Kotarski J., Rasoul-Pelinska K., Azevedo C., MacHado D., Mendes F., De S.X., Fernandes U., Ferreira C., Guidi G., Leal C., Marcal A., Marques R., Martins D., Melo A., Tenreiro N., Vaz P.R., Vieira B., Almeida J.I., Correia D.S.T., Costa M.J.M.A., Fernandes V., Ferraz I., Gil C.G., Lima D.S.C., Lopes L., MacHado N., Marialva J., Nunes C.M., Pedro J., Pereira C., Reis R., Ribeiro A., Santos R., Saraiva P., Silva R., Tavares F., Teixeira M., Almeida A.C., Amaral M.J., Andrade R., Athaydenemesio R., Breda D., Camacho C., Canhoto C., Colino M., Correia S., Costa M., De B.J., De O.L.A., Duque M., Garrido S., Guerreiro P., Guimaraes A., Lazaro A., Lopes C., Martins R., Nogueira O., Oliveira A., Oliveira J.M., Rodrigues M., Ruivo A., Santos E., Silva M., Simoes J., Valente D.C.A., Almeida A., Cavaleiro S., Devezas V., Faria C.S., Jacome F., Magalhaes M.M., Nogueiro J., Pereira A., Pereira-Neves A., Pina-Vaz T., Santos-Sousa H., Silveira H., Vaz S., Vieira P., Gomes D.C.A., Lobo A.I., Pinto J., Tojal A., Cardoso N., Cardoso P., Domingues J.C., Henriques P., Manso M.I., Martins D.S.G., Morais H., Pereira R., Revez T., Ribeiro R., Ribeiro V.I., Soares A., Sousa S., Teixeira J., Amorim E., Baptista V.H., Dias B., Fazenda A., Melo N.J.P., Policarpo F., Sampaio D.N.G.M.I., Veiga D., Andrade A.K., Bandovas J.P., Borges N., Branquinho A., Chumbinho B., Correia J., Fidalgo H., Figueiredo D.B.I., Frade S., Gomes J., MacIel J., Pina S., Rodrigues A., Silva N., Silveira N.I., Sousa R., Ascensao J., Azevedo P., Costeira B., Cunha C., Garrido R., Gomes H., Lourenco I., Mendinhos G., Miranda P., Nobre P.A., Peralta F.M., Ribeiro J., Rio R.L., Sousa F.M., Galvao D., Soares A.C., Vieira A., Patricio B., Santos P.M.D.D., Vieira P.L.A.C., Cunha R., Faustino A., Freitas A., Martins A.B., Mendes J.R., Parreira R., Rosa J., Teves M., Abreu D.S.A., Claro M., Costa S.D., Deus A.C., Grilo J.V., Borges F., Corte R.J., Henriques S., Lima M.J., Matos C.P., Brito D.S.F., Caiado A., Fonseca F., Angelo M., Baiao J.M., Martins J.D., Vieira C.T., Messias J., Millan A., Salgado I., Santos P., Baia C., Canotilho R., Correia A.M., Ferreira P.A.P., Peyroteo M., Videira J.F., Bezede C., Chitul A., Ciofic E., Cristian D., Grama F., Pirtea L., Secosan C., Bonci E., Gata V., Titu S., Ginghina O., Iordache N., Iosifescu R.V., Kazachenko E., Markaryan D., Rodimov S., Tsarkov P., Tulina I., Litvina Y., Provozina A., Agapov M., Galliamov E., Kakotkin V., Kubyshkin V., Alshahrani M., Alsharif F., Eskander M., Al R.R., Majrashi S., Mashat A., Akeel N., Alharthi M., Aljiffry M., Basendowah M., Farsi A., Ghunaim M., Khoja A., Maghrabi A., Malibary N., Nassif M., Nawawi A., Saleem A., Samkari A., Trabulsi N., Al A.S., Alghamdi M., Alnumani T., Nasser M., Said B.A., Alhefdhi A., Almalik O., Alomair A., Alotaibi N., Alresaini F., Alsalamah R., Alsobhi S., Mahasin Z., Othman E., Velagapudi S., Ghedan S., Alharthi R., Awad S., Sharara M., Abdelrahman S., Althobaiti W., Al H.H., Alkarak S., Alqannas M., Alyami M., Alzamanan M., Cortes G.D., Elawad A., Alaamer O., Alriyees L., Alselaim N., Abdulkareem A., Ajlan A., Akkour K., Al-Habib A., Al-Khayal K., Alatar A., Alburakan A., Alhalal H., Alhassan B., Alhassan N., Alobeed O., Alsaif A., Alsaif F., Alshammari S., Alshaygy I., Barry M., Bin N.A., Bin T.T., Bokhari A., Elwatidy S., Helmi H., Madkhali A., Nouh T., Rabah P.D., Zubaidi A., Paunovic I., Slijepcevic N., Aleksic L., Antic A., Barisic G., Ceranic M., Galun D., Grubac Z., Jelenkovic J., Kecmanovic D., Kmezic S., Knezevic D., Krivokapic Z., Latincic S., Markovic V., Matic S., Miladinov M., Pavlov M., Pejovic I., Tadic B., Vasljevic J., Velickovic D., Zivanovic M., Perovic M., Srbinovic L., Andrijasevic S., Bozanovic T., Cerovic P.R., Dokic M., Janjic T., Jeremic K., Kadija S., Ladjeviclikic I., Mirkovic L., Pantovic S., Pilic I., Radojevic M., Stefanovic A., Vidakovic S., Vilendecic Z., Antic S., Dunderovic D., Jelovac D., Jezdic Z., Konstantinovic V., Kotlar B., Kuzmanovic C., Lazic M., Petrovic M., Popovic F., Pucar A., Romic M., Sumrak S., Vujanac V., Bascarevic V., Bogdanovic I., Grujicic D., Ilic R., Milicevic M., Milisavljevic F., Miljkovic A., Paunovic A., Scepanovic V., Stanimirovic A., Todorovic M., Jotic A., Milovanovic J., Trivic A., Bumbasirevic U., Dzamic Z., Kajmakovic B., Prijovic N., Zivkovic M., Buta M., Cvetkovic A., Djurisic I., Gacic S., Goran M., Inic Z., Jeftic N., Jevric M., Jokic V., Markovic I., Milanovic M., Nikolic S., Pejnovic L., Savkovic N., Spurnic I., Stevic D., Stojiljkovic D., Vucic N., Zegarac M., Karamarkovic A., Kenic M., Kovacevic B., Krdzic I., Milutinovic V., Chan C.W., Lieske B., Galis B., Simko K., Almgla N., Bernon M., Boutall A., Cairncross L., Herman A., Hilton T., Jonas E., Kloppers C., Malherbe F., Mugla W., Nel D., Rayamajhi S., Van W.T., Vogel J., Castano-Leon A.M., Delgado F.J., Eiriz F.C., Espino S.-I.M., Esteban S.O., Garcia P.D., Gomez P., Jimenez-Roldan L., Lagares A., Moreno-Gomez L., Paredes I., Perez N.A., Sanchez A.G., Santas M., Fernandez R.P., Paniagua G.S.M., Sanchez-Santos R., Vigorita V., Acrich E., Baenasanfeliu E., Barrios O., Golda T., Santanach C., Serrano-Navidad M., Sorribasgrifell M., Vives R.V., Escola D., Jimenez A., Cayetano P.L., Gomez F.L., Artigues E., Bernal-Sprekelsen J.C., Catalabauset J.C., Collera P., Diaz D.G.R., Farre F.R., Flores C.R., Gomez D.C.J., Guardia N., Guariglia C.A., Osorio A., Sanchez J.R., Sanchon L., Soto M.C., Albi M.B., Garcia V.J.E., Alonso-Lamberti L., Assaf M., Baeza P.N., Carabias A., Garcia-Quijada J., Huertas F.M.A., Jimenez M.J., Jimenez V., Jover J.M., Landeoaguero S.A., Leon R., Martin S.M., Perez S.V., Ponce S., Rodriguez J.L., Salazar A., Valle R.A., Aguado H., Aldecoaansorregui I., Bravo I.R., De L.F., Di S.A., Diaz-Feijoo B., Ensenat N.J., Fabregas N., Ferres A., Gil I.B., Gonzalez S.J., Gracia I., Hoyos C.J., Lacy A.M., Langdon C., Momblan D., Morales X., Oleaga L., Otero A., Pedrosa L., Poblete C.J., Reyes F.L., Roldan R.P., Rumia-Arboix J., Tercero-Uribe A.I., Topczewski T.E., Torales J., Torne A., Torne R., Turrado-Rodriguez V., Valero R., Valverde S., Anula R., Cano-Valderrama O., Del C.M.M., Diez-Valladares L., Dominguez I., Dziakova J., Garcia A.M., Garcia R.E., Gomez L.L., Muguerza J.M., Pizarro M.J., Saez C.P., Sanchez D.P.C., Sanchez-Pernaute A., Sanz O.G., Sanz-Lopez R., Torres A., Garces-Albir M., Lopez F., Martin-Arevalo J., Moro-Valdezate D., Pla-Marti V., Beltran D.H.J., De A.A.B., Gomez S.T., Jezieniecki C., Nunez D.B.H., Ortiz D.S.A.F., Romero D.D.A., Ruiz S.M., Trujillo D.J., Vazquez F.A., Lora-Cumplido P., Sosa M.V., Gonzalez-Gonzalez E., Minaya B.A., Alonso D.L.F.N., Cazadorlabat M., Cecchini L., Espinosa C.A., Jimenez T.M., Lopez C.A., Mancebo G., Martorell P., Munarriz M., Grau-Talens E.J., Martin-Perez B., Benavides B.J., Carrasco P.M., Fernandez P.V., Fernandez-Lopez A., Garcia E.D., Garcia P.V., Garcia S.V., Gimenezfrances C., Gonzalez V.F., Gurrea E., Lopez-Morales P., Marco G.A., Martinez A.J., Medina E., Munoz C.J., Parra B.P., Pena R.E., Ramirez F.M., Ruiz-Marin M., Sanchez R.C., Valero S.M., Estaire G.M., Fernandez C.A., Garcia S.E., Jimenez H.E., Martinez-Pinedo C., Munoz-Atienza V., Padilla-Valverde D., Picon R.R., Redondo C.F., Sanchez-Garcia S., Sanchez-Pelaez D., Colombari R.C., Del V.E., Fernandez M., Lozano L.P., Rey V.C., Steiner M.A., Tudela M., Zorrillaortuzar J., Alcaide M.F., Garcia P.J., Troncoso P.P., Mora-Guzman I., Abellan M., Achalandabasoboira M., Jorba R., Membaikuga R., Olona C., Sales M.R., Cavalle B.P., Gavaldapellice M.G.P., Salinas P.J., Aragon A.E., Barbier L., Cajavivancos P., Gainza A., Garcia G.J., Mallabiabarrenaormaechea G., Marin H., Martin P.P., Melchor C.I., Prieto C.M., Rodriguez F.A., Villalabeitiaateca I., De A.O.U., Duran B.M., Fernandez P.F., Ibanez-Aguirre F.J., Sanz L.A., Ugarte-Sierra B., De L.H.R.A., Di M.M., Garcia S.J., Martin-Perez E., Munoz D.N.J., Calvo E.P., Guillamotruano P., Colao G.L., Diaz P.D., Esteban A.E., Galindo J.P., Gutierrez S.M., Hernandez B.M., Serrano G.J., Alonso P.A., Dieguez B., Garcia-Conde M., Hernandez-Garcia M., Losada M., Chiesa-Estomba C.M., Gonzalez G.J., Larruscain E., Sistiaga-Suarez J.A., Alvarez E., Chavarrias N., Frias L., Gegundez S.A., Gortazar S., Gracia M., Guevara J., Hernandez G.A., Loayza A., Maria D.D., Marti C., Melendez M., Moreno-Palacios E., Perez Y., Prieto N.M., Ramos-Martin P., Rubio-Perez I., Saavedra J., Sanchez-Mendez J.I., Siegrist R.J., Urbieta A., Zapardiel I., Cantalejodiaz M., De M.A.M., Duque-Mallen V., Gascon F.I., Gonzalez-Nicolas T.M., Gracia-Roche C., Herrero L.M., Jariod F.U., Lanzon A., Martinez G.A., Matute M., Redondo C., Sanchez F.N., Sanchez-Rubio M., Santero-Ramirez M.S., Saudi S., Simon S.M., Uson-Bouthelier T., Blazquez M.A., Diez A.M., Garcia-Loarte G.E., Garcia-Moreno N.F., Gutierrez C.A., Hernandez P., Lasa I., Mendoza-Moreno F., Morales P.N., Ovejero M.E., Vera M.C., Acebes G.F., Bailon M., Bueno C.A., Choolanibhojwani E., Marcos-Santos P., Miguel T., Pacheco S.D., Perez-Saborido B., Sanchez G.J., Tejero-Pintor F.J., Alconchel F., Conesa A., Gil M.J., Gutierrez F.A., Lopez A.A., Nicolas-Lopez T., Ramirez R.P., Roca C.M., Rodrigues K., Ruiz M.J., Soriano A.I., Cano A., Capitan-Morales L., Cintas C.J., Gomez-Rosado J., Oliva M.F., Perez S.M., Rio L.F., Torres A.C., Valdes-Hernandez J., Cholewa H., Domingo S., Frasson M., Lago V., Marina M.T., Martinez C.C., Sancho-Muriel J., Landaluce-Olavarria A., Lecumberri D., Abad G.A., Abad-Motos A., Martinez-Hurtado E., 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I., Lofgren N., Sund M., Arigoni M., Bernasconi M., Christoforidis D., Di G.M., La R.D., Mongelli F., Chevallay M., Dwidar O., Gialamas E., Sauvain M., Klenke F., Kollar A., Kurze C., Bachler T., Crugnale A.S., Giardini M., Guglielmetti L., Peros G., Solimene F., Aghayeva A., Hamzaoglu I., Sahin I., Akaydin E., Aliyeva Z., Aytac E., Baca B., Dulgeroglu O., Ozben V., Ozmen B.B., Uras C., Arikan A.E., Bilgin I.A., Bozkirli B., Ceyhan G.O., Kara H., Karahasanoglu T., Celik H., Meydanli M.M., Akilli H., Ayhan A., Kuscu E., Onan M.A., Akgor U., Dincer H.A., Erol T., Gultekin M., Orhan N., Ozgul N., Salman M.C., Soyak B., Alhamed A., Ergun S., Ozcelik M.F., Sanli A.N., Uludag S.S., Velidedeoglu M., Zengin A.K., Bozkurt M.A., Kara Y., Kocatas A., Cimenoglu B., Demirhan R., Saracoglu K., Azamat I.F., Balik E., Bugra D., Giray B., Kulle C.B., Taskiran C., Vatansever D., Gozal K., Guler S.A., Koken H., Tatar O.C., Utkan N.Z., Yildirim A., Yuksel E., Akin E., Altintoprak F., Bayhan Z., Cakmak G., Capoglu R., Celebi F., Demir H., Dikicier E., Firat N., Gonullu E., Kamburoglu M.B., Kocer B., Kucuk I.F., Mantoglu B., Colak E., Kucuk G.O., Uyanik M.S., Goksoy B., Bozkurt E., Citgez B., Mihmanli M., Tanal M., Yetkin G., Akalin M., Arican C., Avci E.K., Aydin C., Demirliatici S., Emiroglu M., Kaya T., Kebabci E., Kilinc G., Kirmizi Y., Ogucu H., Salimoglu S., Sert I., Tugmen C., Tuncer K., Uslu G., Yesilyurt D., Karaman E., Kolusari A., Yildiz A., Benson O., Lule H., Agilinko J., Ahmeidat A., Barabasz M., Bekheit M., Cheung L.K., Colloc T., Cymes W., Elhusseini M., Gradinariu G., Hannah A., Kamera B.S., Mignot G., Shaikh S., Sharma P., Abu-Nayla I., Agrawal A., Al-Mohammad A., Ali S., Ashcroft J., Azizi A., Baker O., Balakrishnan A., Byrne M., Cotter A., Coughlin P., Davies R.J., Durrani A., Elshaer M., Fordington S., Forouhi P., Georgiades F., Grimes H., Habeeb A., Hudson V., Irune E., Jah A., Khan D.Z., Kyriacou H., Liau S., Luke L., Mahmoud R., Mannion R., Masterson L., Mitrofan C.G., Mohan M., Morris A., Murphy S., O'Neill R., Price S., Pushpa-Rajah J., Raby-Smith W., Ramzi J., Rooney S., Santarius T., Singh A., Tan X.S., Townson A., Tweedle E., Walker C., Waseem S., Yordanov S., Jones T., Kattakayam A., Loh C., Lunevicius R., Pringle S., Schache A., Sheel A., Rossborough C., Angelou D., Choynowski M., McAree B., McCanny A., Neely D., Tutoveanu G., Ahad S., De L.C.M.M., Mosley F., Oktseloglou V., Alanbuki A., Patel M., Shabana A., Perera E., Raveendran D., Ravi-Shankar K., Thiruchelvam J., Arrowsmith L., Campbell W., Grove T., Kontovounisios C., Warren O., Rolland P., Aggarwal A., Brown S., Jelley C., Neal N., Clifford R., Eardley N., Krishnan E., Manu N., Martin E., Roy M.S., Serevina O.L., Smith C., Bordenave M., Houston R., Putnam G., Robson A., Tustin H., Emslie K., Labib P.L., Miller D., Minto G., Natale J., Nwinee H., Panahi P., Rogers L., Abubakar A., Akhter R.M., Ko K.Y.K., O'Brien H., Sasapu K., Woodun H., Inglis R., Ng H.J., De G.R.A., Ghazali N., Lambert J., Markose G., Math S., Sarantitis I., Shrestha D., Sultana A., Taggarsi M., Timbrell S., Vaz O.P., Vitone L., Day A., Dent H., Fahim M., Waheed S., Hunt A., Laskar N., Gupta A., Steinke J., Thrumurthy S., Massie E., McGivern K., Rutherford D., Wilson M., Hardie J., Kazzaz S., Handa S., Kaushal M., Kler A., Patel P., Redfern J., Tezas S., Aawsaj Y., Amonkar S., Blackwell L., Blake D., Carter J., Emerson H., Fisher A., Katory M., Korompelis P., McCormick W., Mustafa A., Pearce L., Ratnavelu N., Reehal R., Kretzmer L., Lalou L., Manku B., Parwaiz I., Stafford J., Abdelkarim M., Asqalan A., Gala T., Ibrahim S., Maw A., Mithany R., Morgan R., Sundaram V.G., Ang K., Chowdhry M.F., Mohammad A., Nakas A., Rathinam S., Boal M., Brown O., Dwerryhouse S., Higgs S., Boyd E., Irvine V., Kirk A., Bakolas G., Boulton A., Chandock A., Kumar M., Agoston P., Bille A., Challacombe B., Fraser S., Harrison-Phipps K., King J., Mehra G., Mills L., Najdy M., Nath R., Okiror L., Pilling J., Rizzo V., Routledge T., Sayasneh A., Stroman L., Wali A., Fehervari M., Habib N., Hamrang-Yousefi S., Jawad Z., Jiao L., Pai M., Ploski J., Rajagopal P., Saso S., Sodergren M., Spalding D., Laws S., Hardie C., McNaught C., Alam R., Budacan A., Cahill J., Kalkat M., Karandikar S., Kenyon L., Naumann D., Ayorinde J., Chase T., Cuming T., Ghanbari A., Humphreys L., Tayeh S., Aboelkassem I.A., Bichoo R., Cao H., Chai A.K.W., Choudhury J., Evans C., Fitzjohn H., Ikram H., Langstroth M., Loubani M., McMillan A., Nazir S., Qadri S.S.A., Robinson A., Ross E., Sehgal T., Dixon J., Dunning J., Freystaetter K., Jha M., Lester S., Madhavan A., Thulasiraman S.V., Viswanath Y., Curl-Roper T., Delimpalta C., Liao C.C.L., Velchuru V., Westwood E., Belcher E., Bond-Smith G., Chidambaram S., Fasanmade K., Fraser L., Fu H., Ganau M., Gore S., Graystone J., Jeyaretna D., Khatkar H., Lami M., Maher M., Mastoridis S., Mihai R., Piper R., Prabhu S., Risk O.B.F., Selbong U., Shah K., Smillie R., Soleymanimajd H., Sravanam S., Stavroulias D., Tebala G.D., Vatish M., Verberne C., Wallwork K., Winter S., Bhatti M.I., Boyd-Carson H., Elsey E., Gemmill E., Herrod P., Jibreel M., Lenzi E., Saafan T., Sapre D., Sian T., Watson N., Athanasiou A., Bourke G., Bradshaw L., Coe P., Costigan F., Elkadi H., Johnstone J., Kanatas A., Kantola V., Kaufmann A., Laios A., Lam S., MacInnes E., Munot S., Nahm C., Otify M., Pompili C., Smith I., Theophilou G., Toogood G., Wade R., Ward D., West C., Annamalai S., Ashmore C., Boddy A., Hossain T., Kourdouli A., Gvaramadze A., Jibril A., Prusty L., Thekkinkattil D., Askari A., Cirocchi N., Kudchadkar S., Patel K., Sagar J., Shaw S., Talwar R., Abdalla M., Edmondson R., Ismail O., Jones D., Newton K., Stylianides N., Aderombi A., Andaleeb U., Bajomo O., Beatson K., Garrett W., Mehmood M., Ng V., Al-Habsi R., Divya G.S., Keeler B., Al-Sarireh B., Egan R., Harries R., Henry A., Kittur M., Li Z., Parkins K., Soliman F., Spencer N., Thompson D., Burgess C., Gemmell C., Grieco C., Hollyman M., Hunt L., Morrison J., Ojha S., Ryan N., Abbadessa F., Barnard S., Dawe N., Hammond J., Mahmoud A.F., McPherson I., Mellor C., Moir J., Pandanaboyana S., Powell J., Rai B., Roy C., Sachdeva A., Saleh C., Tingle S., Williams T., Manickavasagam J., McDonald C., McGrath N., McSorley N., Ragupathy K., Ramsay L., Solth A., Kakisi O., Seebah K., Shaikh I., Sreedharan L., Youssef M., Shah J., Ameerally P., McLarty N., Mills S., Shenfine A., Sahnan K., Abu J., Addae-Boateng E., Bratt D., Brock L., Burnside N., Cadwell-Sneath S., Gajjar K., Gan C., Grundy C., Hallam K., Hassell K., Hawari M., Joshi A., Khout H., Konstantinidi K., Lee R.X.N., Nunns D., Schiemer R., Walton T., Weaver H., Whisker L., Williamson K., McVeigh J., Myatt R., Williams M.A., Kaur R., Michel M., Patil S., Ravindran S., Sarveswaran J., Scott L., Edmond M., King E., Bhangu A., Breik O., Cato L.D., Griffiths E., Idle M., Kamal M., Kisiel A., Kulkarni R., Mak J.K.C., Martin T., Parente A., Parmar S., Pathanki A.M., Phelan L., Praveen P., Saeed S., Singh J., Vijayan D., Geddes A., McCaul J., McMahon J., Khan A.H., Khan F., Mansuri A., Mukherjee S., Sarigul M., Singh S., Tan K.L., Woodham A., Adiamah A., Brewer H., Chowdhury A., Evans J., Humes D., Jackman J., Koh A., Lewis-Lloyd C., Oyende O., Reilly J., Worku D., Cool P., Cribb G., Shepherd K., Bisset C., Elson N., Faulkner G., Saleh P., Underwood C., Brixton G., Findlay L., Majkowska A., Manson J., Potter R., Bhalla A., Chia Z., Daliya P., Goyal A., Grimley E., Hamad A., Kumar A., Malcolm F.L., Theophilidou E., Bowden J., Campain N., Daniels I., Fowler G., John J., Massey L., McDermott F., McLennan A., Ng M., Pascoe J., Rajaretnam N., Bulathsinhala S., Davidson B., Fusai G., Hidalgo S.C., MacHairas N., Pissanou T., Pollok J.M., Raptis D.A., Soggiu F., Tzerbinis H., Xyda S.E., Beamish A., Davies E., Foulkes R., Magowan D., Nassa H., Ooi R., Price C., Smith L., Solari F., Tang A., Williams G., Al-Tamimi Y., Bacon A., Beasley N., Chew D., Crank M., Ilenkovan N., MacDonald M., Narice B., Rominiyi O., Thompson A., Varley I., Drake T., Harrison E., Linder G., Mayes J., McGregor R., Skipworth R., Zamvar V., Hawkin P., Raymond T., Ryska O., Baron R., Dunne D., Gahunia S., Halloran C., Howes N., McKinney R., McNicol F., Russ J., Szatmary P., Tan J.R., Thomas A., Whelan P., Anzak A., Banerjee A., Fuwa O., Hughes F., Jayasinghe J.D., Knowles C., Kocher H., Leal S.I., Ledesma F.S., Minicozzi A., Navaratne L., Rahman R., Ramamoorthy R., Sohrabi C., Thaha M., Thakur B., Venn M., Yip V., Baumber R., Parry J., Evans S., Jeys L., Morris G., Parry M., Ahmadi N., Aresu G., Barrett-Brown Z.M., Durio Y.H., Gearon D., Hogan J., King M., Peryt A., Pradeep I.S., Adishesh M., Atherton R., Baxter K., Brocklehurst M., Chaudhury M., Krishnamohan N., McAleer J., Owens G., Parkin E., Patkar P., Phang I., Aladeojebi A., Ali M., Barmayehvar B., Gaunt A., Gowda M., Halliday E., Kitchen M., Mansour F., Thomas M., Zakai D., Abbassi-Ghadi N., Assalaarachchi H., Currie A., Flavin M., Frampton A., Hague M., Hammer C., Hopper J., Horsnell J., Humphries S., Kamocka A., Madhuri T.K., Preston S., Singh P., Stebbing J., Tailor A., Walker D., Aljanadi F., Jones M., Mhandu P., O'Donnell C., Turkington R., Al-Ishaq Z., Bhasin S., Bodla A.S., Burahee A., Crichton A., Fossett R., Pigadas N., Pickford S., Rahman E., Snee D., Yassin N., Fountain D., Hasan M.T., Karabatsou K., Laurente R., Pathmanaban O., Al-Mukhtar A., Giblin A., Kelty C., Lee M., Lye G., Newman T., Sharkey A., Steele C., Sureshkumar S.N., Whitehall E., Athwal R., Baker A., Jones L., Konstantinou C., Ramcharan S., Vatish J., Wilkin R., Ethunandan M., Sekhon G.K., Shields H., Singh R., Wensley F., Lyons A., Abbott T., Anwar S., Ghufoor K., Chung E., Hagger R., Hainsworth A., Karim A., Owen H., Ramwell A., Williams K., Baker C., Davies A., Gossage J., Kelly M., Knight W., Hall J., Harris G., James G., Kang C., Lin D.J., Rajgor A.D., Royle T., Scurrah R., Steel B., Watson L.J., Choi D., Hutchison R., Jain A., Luoma V., Marcus H., May R., Menon A., Pramodana B., Webber L., Aneke I.A., Asaad P., Brown B., Collis J., Duff S., Khan A., Moura F., Wadham B., Warburton H., Elmoslemany T., Jenkinson M., Millward C., Zakaria R., McCluney S., Parmar C., Shah S., Allison J., Babar M.S., Collard B., Goodrum S., Lau K., Scott R., Thomas E., Whitmore H., Balasubramaniam D., Jayasankar B., Kapoor S., Ramachandran A., Elhamshary A., Imam S.M.B., Kapriniotis K., Lindsay J., Rakhshani-Moghadam S., Beech N., Chand M., Green L., Kalavrezos N., Kiconco H., McEwen R., Schilling C., Sinha D., Pereca J., Chopra S., Egbeare D., Thomas R., Combellack T., Jones S.E.F., Kornaszewska M., Mohammed M., Sharma A., Tahhan G., Valtzoglou V., Williams J., Eskander P., Gash K., Gourbault L., Hanna M., MacCabe T., Newton C., Olivier J., Rozwadowski S., Teh E., West D., Al-Omishy H., Baig M., Bates H., Di T.G., Dickson K., Dunne N., Gill C., Howe D., Jeevan D., Khajuria A., Martin-Ucar A., McEvoy K., Naredla P., Robertson S., Sait M., Sarma D.R., Shanbhag S., Shortland T., Simmonds S., Skillman J., Tewari N., Walton G., Akhtar M.A., Brunt A., McIntyre J., Milne K., Rashid M.M., Sgro A., Stewart K.E., Turnbull A., Aguilar G.M., Talukder S., Boyle C., Fernando D., Gallagher K., Laird A., Tham D., Bath M., Patki P., Tanabalan C., Arif T., Magee C., Nambirajan T., Powell S., Vinayagam R., Flindall I., Hanson A., Mahendran V., Green S., Lim M., MacDonald L., Miu V., Onos L., Sheridan K., Young R., Alam F., Griffiths O., Houlden C., Jones R., Kolli V.S., Lala A.K., Leeson S., Peevor R., Seymour Z., Chen L., Henderson E., Brown K., Fleming D., Heron C., Hill C., Kay H., Leede E., McElhinney K., Olson K., Osterberg E.C., Riley C., Srikanth P., Thornhill M., Blazer D., Dilalla G., Hwang E.S., Lee W., Lidsky M., Plichta J., Rosenberger L., Scheri R., Turnage K., Visgauss J., Zani S., Farma J., Clark J., Kwon D., Etchill E., Gabre-Kidan A., Jenny H.E., Kent A., Ladd M., Long C., Malapati H., Margalit A., Rapaport S., Rose J., Stevens K., Tsai L., Vervoort D., Yesantharao P., Dehal A., Klaristenfeld D., Huynh K., Brown L., Mullinax J., Gusani N., Hazelton J., Maines J., Oh J.S., Ssentongo A., Ssentongo P., Azam M., Choudhry A., Marx W., Fleming J., Fuson A., Gigliotti J., Ovaitt A., Ying Y., Abel M.K., Andaya V., Bigay K., Boeck M.A., Chern H., Corvera C., El-Sayed I., Glencer A., Ha P., Hamilton B.C.S., Heaton C., Hirose K., Jablons D.M., Kirkwood K., Kornblith L.Z., Kratz J.R., Lee R., Miller P.N., Nakakura E., Nunez-Garcia B., O'Donnell R., Ozgediz D., Park P., Robinson B., Sarin A., Sheu B., Varma M., Wai K., Wustrack R., Xu M.J., Beswick D., Goddard J., Manor J., Song J., Fullmer T., Gaskill C., Gross N., Kiong K., Roland C.L., Zafar S.N., Abdallah M., Abouassi A., Almasri M., Kulkarni G., Marwan H., Mehdi M., Aoun S., Ban V.S., Batjer H.H., Caruso J., Abbott D., Acher A., Aiken T., Barrett J., Foley E., Schwartz P., Hawkins A., Maiga A., Laufer J., Scasso S., Zweroncy, A., Glasbey, J, Omar, O, Nepogodiev, D, Minaya-Bravo, A, Bankhead-Kendall, B, Fiore, M, Futaba, K, Gujjuri, R, Isik, A, Kaafarani, H, Kamarajah, S, Li, E, Loffler, M, Mclean, K, Oumaima, O, Faustin, N, Sohei, S, Shaw, R, Simoes, J, Stewart, G, Tabiri, S, Trout, I, Bhangu, A, Siaw-Acheampong, K, Benson, R, Bywater, E, Chaudhry, D, Dawson, B, Evans, J, Heritage, E, Jones, C, Khatri, C, Khaw, R, Keatley, J, Knight, A, Lawday, S, Mann, H, Marson, E, Mckay, S, Mills, E, Pellino, G, Picciochi, M, Taylor, E, Tiwari, A, Venn, M, Wilkin, R, Aneel, B, Smart, N, Gallo, G, Moug, S, Pata, F, Pockney, P, Saverio, S, Vallance, A, Vimalchandran, D, Roberts, K, Isaac, J, Edwards, J, Coonar, A, Marchbank, A, Caruana, E, Layton, G, Patel, A, Brunelli, A, Ford, S, Desai, A, Gronchi, A, Almond, M, Tirotta, F, Sinziana, D, Price, S, Fountain, D, Jenkinson, M, Hutchinson, P, Marcus, H, Piper, R, Lippa, L, Servadei, F, Esene, I, Freyschlag, C, Neville, I, Rosseau, G, Schaller, K, Demetriades, A, 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T., Tang C. Y., Teoh L. Y., Wong W. J., Yahaya A. S., Alvarez M. R., Posada J. A., Becerra Garcia F. C., Buerba G. A., Castillejos-Molina R. A., Mercado M. A., Pena Gomez Portugal E., Posadas-Trujillo O. E., El Ouahabi A., Oudrhiri M. Y., Belkhadir Z. H., El Ahmadi B., El Bouazizi Y., Majbar A. M., Meima-van Praag E., Ajm P., Van Houdt W., Bolster-van Eenennaam M., De Graaff M., Van Duijvendijk P., De Bree R., Van Heinsbergen M., Sholadoye T. T., Tolani M., Egbuchulem I. K., Lawal T. A., Olulana D. I., Sorour T. M., Kerawala A. A., Memon A. S., Nafees Ahmed R., Martins R. S., Khan W. H., Waris Farooka M., Waqar S. H., Falcon G. M., Machado D., De Sousa X., Vaz Pereira R., Almeida J. I., Correia de Sa T., Mjma C., Gil C. G., Lima da Silva C., Machado N., Nunes Coelho M., Almeida A. C., Amaral M. J., Athayde Nemesio R., De Barros J., De Oliveira Lopez A. L., Oliveira J. M., Valente da Costa A., Faria C. S., Magalhaes Maia M., Gomes da Costa A., Domingues J. C., Manso M. I., Martins dos Santos G., Ribeiro V. I., Baptista V. H., Melo Neves J. P., Bandovas J. P., Figueiredo de Barros I., Maciel J., Silveira Nunes I., Peralta Ferreira M., Rio Rodrigues L., Sousa Fernandes M., Soares A. C., Pmdd S., Vieira Paiva Lopes A. C., Mendes J. R., Abreu da Silva A., Costa Santos D., Deus A. C., Grilo J. V., Corte Real J., Lima M. J., Matos Costa P., Brito da Silva F., Baiao J. M., Martins Jordao D., Vieira Caroco T., Correia A. M., Videira J. F., Escobar P., Maldonado Santiago M., Kassir R., Sauvat F., Iosifescu R. V., Al Raddadi R., Al Awwad S., Al Habes H., Cortes Guiral D., Bin Nasser A., Bin Traiki T., Rabah P. D., Cerovic Popovic R., Ladjevic Likic I., Chan C. W., Van Wyngaard T., Castano-Leon A. M., Delgado Fernandez J., Eiriz Fernandez C., Espino Segura-Illa M., Esteban Sinovas O., Garcia Perez D., Perez Nunez A., Sanchez Aniceto G., Fernandez Rodriguez P., Paniagua Garcia Senorans M., Baena Sanfeliu E., Sorribas Grifell M., Vives R. V., Cayetano Paniagua L., Gomez Fernandez L., Bernal-Sprekelsen J. C., Catala Bauset J. C., Diaz Del Gobbo R., Farre Font R., Flores Clotet R., Gomez Diaz C. J., Guariglia C. A., Sanchez Jimenez R., Soto Montesinos C., Albi Martin B., Garcia Villayzan J. E., Baeza Pintado N., Jimenez Miramon J., Jover J. M., Landeo Aguero S. A., Perez Simon V., Rodriguez J. L., Valle Rubio A., Aldecoa Ansorregui I., Bravo Infante R., De Lacy F. B., Di Somma A., Ensenat Nora J., Gil Ibanez B., Gonzalez Sanchez J. J., Hoyos Castro J. A., Lacy A. M., Poblete Carrizo J., Reyes Figueroa L. A., Roldan Ramos P., Tercero-Uribe A. I., Topczewski T. E., Del Campo Martin M., Garcia Alonso M., Garcia Romero E., Gomez Latorre L., Muguerza J. M., Pizarro M. J., Saez Carlin P., Sanchez del Pueblo C., Sanz Ortega G., Beltran de Heredia J., De Andres Asenjo B., Gomez Sanz T., Nunez Del Barrio H., Ortiz de Solorzano Aurusa F. J., Romero de Diego A., Ruiz Soriano M., Trujillo Diaz J., Sosa M. V., Minaya Bravo A. M., Cazador Labat M., Espinosa C. A., Jimenez Toscano M., Lopez Campillo A., Grau-Talens E. J., Benavides Buleje J. A., Carrasco Prats M., Fernandez P. V., Garcia Escudero D., Garcia Porcel V. J., Garcia Soria V., Gimenez Frances C., Gonzalez Valverde F. M., Marco Garrido A., Martinez Alonso J. A., Munoz Camarena J. M., Parra Banos P. A., Pena Ros E., Ramirez Faraco M., Sanchez Rodriguez C., Valero Soriano M., Estaire Gomez M., Fernandez Camunas A., Garcia Santos E. P., Jimenez Higuera E., Picon Rodriguez R., Redondo Calvo F. J., Colombari R. C., Lozano Lominchar P., Rey Valcarcel C., Zorrilla Ortuzar J., Alcaide Matas F., Garcia Perez J. M., Troncoso Pereira P., Achalandabaso Boira M., Memba Ikuga R., Sales Mallafre R., Cavalle Busquets P., Mgp G. P., Salinas Pena J., Aragon Achig E. J., Caja Vivancos P., Garcia Gutierrez J. J., Mallabiabarrena Ormaechea G., Martin Playa P., Melchor Corcostegui I., Prieto Calvo M., Rodriguez Fraga A., Villalabeitia Ateca I., De Andres Olabarria U., Duran Ballesteros M., Fernandez Pablos F. J., Ibanez-Aguirre F. J., Sanz Larrainzar A., De la Hoz Rodriguez A., Di Martino M., Garcia Septiem J., Munoz de Nova J. L., Calvo Espino P., Guillamot Ruano P., Colao Garcia L., Diaz Perez D., Esteban Agusti E., Galindo Jara P., Gutierrez Samaniego M., Serrano Gonzalez J., Alonso Poza A., Chiesa-Estomba C. M., Gonzalez Garcia J. A., Sistiaga-Suarez J. A., Garcia Pineda V., Gegundez Simon A., Hernandez Gutierrez A., Maria Dolores D. T., Prieto Nieto M. I., Sanchez-Mendez J. I., Siegrist Ridruejo J., Gascon Ferrer I., Gonzalez-Nicolas Trebol M. T., Herrero Lopez M., Jariod Ferrer U. M., Martinez German A., Sanchez Fuentes N., Simon Sanz M. V., Blazquez Martin A., Diez Alonso M., Garcia Rico E., Garcia-Loarte Gomez E., Garcia-Moreno Nisa F., Gutierrez Calvo A., Morales Palacios N., Ovejero Merino E., Vera Mansilla C., Acebes Garcia F., Bueno Canones A. D., Choolani Bhojwani E., Pacheco Sanchez D., Sanchez Gonzalez J., Gil Martinez J., Gutierrez Fernandez A. I., Lopez Abad A., Ramirez Romero P., Roca Calvo M. J., Ruiz Manzanera J. J., Soriano A. I., Cintas Catena J., Oliva Mompean F., Rio Lafuente F. D., Torres Arcos C., Marina Martin T., Martinez Chicote C., Landaluce-olavarria A., Abad Gurumeta A., Ruiz Escobar A., Garcia-Sancho Tellez L., Heras Aznar J., Ortega Vazquez I., Picardo A. L., Rojo Lopez J. A., Sanchez Cabezudo Noguera F., Serralta de Colsa D., Anchuelo Latorre J., Cagigas Fernandez C., Caina Ruiz R., Gomez Ruiz M., Jimeno Fraile J., Santarrufina Martinez S., Valbuena Jabares V., Ruiz Martin I., Blas Laina J. L., Garcia Egea J., Talal El-Abur I., Cagigal Ortega E. P., Diaz Pena P., Gdcr E., Fernandez Bernabe P., Garces Garcia R., Marqueta De Salas M., Martinez Pascual P., Perez Gonzalez M., Ramos Bonilla A., Rodriguez Gomez L., De Pablo Garcia-Cuenca A., Giralt Lopez de Sagredo J., Pujol Pina R., Gbk B., Rodrigo V. S., Lindqvist E. K., Di Giuseppe M., La Regina D., Crugnale A. S., Ozmen B. B., Arikan A. E., Bilgin I. A., Ceyhan G. O., Dincer H. A., Salman M. C., OZcelik M. F., Sanli A. N., Uludag S. S., Zengin A. K., Azamat I. F., Kulle C. B., Guler S. A., Tatar O. C., Utkan N. Z., Kucuk I. F., Kucuk G. O., Avci E. K., Demirli Atici S., Cheung L. K., Davies R. J., Khan D. Z., Mitrofan C. G., Pushpa-rajah J., Tan X. S., Mfi D. L. C. M., Roy Mahapatra S., Serevina O. L., Labib P. L., Kyk K., Ng H. J., De Gea Rico A., Vaz O. P., Sundaram Venkatesan G., Chowdhry M. F., Aboelkassem Ibrahim A., Akw C., Ssa Q., Thulasiraman S. V., Ccl L., Di Chiara F., Obf R., Tebala G. D., Bhatti M. I., Harky A., Shackcloth M., Divya G. S., Mahmoud Ali F., Rxn L., Jkc M., Pathanki A. M., Khan A. H., Tan K. L., Malcolm F. L., Hidalgo Salinas C., Machairas N., Pollok J. M., Raptis D. A., Xyda S. E., Macdonald M., Tan J. R., Leal Silva I., Ledesma F. S., Barrett-Brown Z. M., Durio Yates H., Pradeep I. S., Madhuri T. K., Bodla A. S., Hasan M. T., Al-mukhtar A., Sureshkumar Shah N., Sekhon G. K., Lin D. J., Rajgor A. D., Watson L. J., Aneke I. A., Mccluney S., Smb I., Sef J., Maccabe T., Al-omishy H., Di Taranto G., Sarma D. R., Stewart K. E., Aguilar Gonzalez M., Kolli V. S., Lala A. K., Osterberg E. C., Hwang E. S., Jenny H. E., Oh J. S., Abel M. K., El-sayed I., Bcs H., Kornblith L. Z., Kratz J. R., Miller P. N., Xu M. J., Roland C. L., Zafar S. N., Ban V. S., Batjer H. H., Apollo - University of Cambridge Repository, and Collaborative, COVIDSurg
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Lung Diseases ,Male ,AcademicSubjects/MED00910 ,COVID-19/diagnosis ,Settore MED/18 - CHIRURGIA GENERALE ,neoplasms ,030230 surgery ,minorsurgical procedures ,Medical and Health Sciences ,Lung Disease ,0302 clinical medicine ,Postoperative Complications ,030202 anesthesiology ,aged ,aged, 80 and over ,COVID-19 ,elective surgical procedures ,female ,humans ,lung diseases ,male ,middle aged ,Nasopharynx ,pandemics ,postoperative complications ,risk assessment ,SARS-CoV-2 ,COVID-19 nucleic acid testing ,Neoplasms ,80 and over ,030212 general & internal medicine ,610 Medicine & health ,Lung ,Cancer ,Aged, 80 and over ,Incidence (epidemiology) ,Confounding ,Pulmonary Complication ,Lung Diseases/*etiology ,Neoplasms/surgery ,General Medicine ,Middle Aged ,Elective Surgical Procedures/adverse effects ,Oncology ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,COVID-19 Nucleic Acid Testing ,Original Article ,Female ,Patient Safety ,AcademicSubjects/MED00010 ,Elective Surgical Procedure ,6.4 Surgery ,Human ,Cohort study ,medicine.medical_specialty ,preoperative caresurgical procedures ,Preoperative care ,Risk Assessment ,Article ,COVIDSurg Collaborative ,NO ,Vaccine Related ,03 medical and health sciences ,Clinical Research ,Biodefense ,medicine ,Nasopharynx/*virology ,Humans ,Nasopharynx/virology ,Elective surgery ,Adverse effect ,Pandemics ,LS7_4 ,Aged ,Pandemic ,business.industry ,Surgery, Sars Cov2 ,Prevention ,No key words available ,electivesurgical procedures ,Lung Diseases/etiology ,Evaluation of treatments and therapeutic interventions ,Postoperative complication ,operativenasopharynxsurgery specialtypulmonary complicationscancer surgerysars-cov-2covid-19coronavirus pandemic ,Odds ratio ,medicine.disease ,Confidence interval ,Surgery ,COVID-19/*diagnosis ,Emerging Infectious Diseases ,Good Health and Well Being ,Neoplasm ,Postoperative Complication ,preoperative caresurgical procedures, electivesurgical procedures, minorsurgical procedures, operativenasopharynxsurgery specialtypulmonary complicationscancer surgerysars-cov-2covid-19coronavirus pandemic ,Elective Surgical Procedures/*adverse effects ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. Results Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. Conclusion Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas., This was an international cohort study of 8784 patients undergoing elective cancer surgery during the COVID-19 pandemic. Preoperative nasopharyngeal swab testing for SARS-CoV-2 was associated with a reduction in postoperative pulmonary complications. This was consistent for major surgery and in high-incidence areas, but with no proven benefit before minor surgery in low-incidence areas.
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- 2021
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5. Maternal Blood Pressure in Relation to Prenatal Lipid-Based Nutrient Supplementation and Adverse Birth Outcomes in a Ghanaian Cohort: A Randomized Controlled Trial and Cohort Analysis
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Kathryn G. Dewey, Ashley L. Buchanan, Alyssa M Abreu, Ingrid E. Lofgren, Harriet Okronipa, Anna Lartey, Brietta M Oaks, Rebecca R Young, Per Ashorn, Seth Adu-Afarwuah, Tampere University, and Clinical Medicine
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Medicine (miscellaneous) ,Blood Pressure ,Ghana ,Cohort Studies ,Pregnancy ,Maternal hypertension ,Birth Weight ,Micronutrients ,Nutrition and Dietetics ,Obstetrics ,Vitamins ,Lipids ,3142 Public health care science, environmental and occupational health ,maternal blood pressure ,Premature birth ,Hypertension ,Gestation ,Premature Birth ,Female ,prenatal supplements ,medicine.symptom ,Cohort study ,circulatory and respiratory physiology ,medicine.medical_specialty ,Birth weight ,Iron ,Prenatal care ,AcademicSubjects/MED00060 ,Food Sciences ,Folic Acid ,Animal Production ,medicine ,Humans ,low birth weight ,Nutrition & Dietetics ,business.industry ,birth outcomes ,Infant, Newborn ,preterm birth ,Maternal Nutritional Physiological Phenomena ,medicine.disease ,maternal hypertension ,Pregnancy Complications ,Low birth weight ,Community and International Nutrition ,Dietary Supplements ,AcademicSubjects/SCI00960 ,business - Abstract
Author(s): Abreu, Alyssa M; Young, Rebecca R; Buchanan, Ashley; Lofgren, Ingrid E; Okronipa, Harriet ET; Lartey, Anna; Ashorn, Per; Adu-Afarwuah, Seth; Dewey, Kathryn G; Oaks, Brietta M | Abstract: BackgroundIt is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined.ObjectivesWe aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes.MethodsPregnant Ghanaian women at ≤20 weeks of gestation (nn=n1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130nmmnHg or diastolic BP (DBP) ≥80nmmnHg] and birth outcomes by linear and logistic regressions.ResultsMeann±nSD SBP and DBP were 110n±n11 and 63n±n8nmmnHg at 36 weeks of gestation and did not differ by supplementation group (SBP, P gn0.05; DBP, P gn0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point.ConclusionsDaily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes.This trial was registered at clinicaltrials.gov as NCT00970866.
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- 2021
6. Impact of biological sex on cryptococcal meningitis mortality in Uganda and South Africa
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Lillian Tugume, Kenneth Ssebambulidde, Katherine Huppler Hullsiek, Anna M Stadelman, Darlisha A. Williams, Katelyn A Pastick, Edwin Nuwagira, David B. Meya, Emily E Evans, Sarah M Lofgren, David R. Boulware, Radha Rajasingham, Joshua Rhein, and Conrad Muzoora
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Adult ,Male ,medicine.medical_specialty ,Anemia ,030231 tropical medicine ,Clinical Trials, Phase IV as Topic ,Meningitis, Cryptococcal ,Cohort Studies ,Pathogenesis ,Hemoglobins ,South Africa ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Immune system ,Altered Mental Status ,CSF pleocytosis ,Risk Factors ,Internal medicine ,medicine ,Humans ,Uganda ,030212 general & internal medicine ,Risk factor ,Proportional Hazards Models ,AIDS-Related Opportunistic Infections ,Proportional hazards model ,business.industry ,Hazard ratio ,General Medicine ,medicine.disease ,Infectious Diseases ,Cytokines ,Original Article ,Female ,business - Abstract
The role of biological sex on clinical outcomes and the pathogenesis of AIDS-related opportunistic infections is unknown. We assessed baseline biomarkers and outcomes between 577 men and 400 women in HIV-related cryptococcal meningitis cohorts in Uganda and South Africa from 2010 to 2017. We compared 10-week mortality by sex via Cox proportional hazards models. The 10-week mortality for women was 50% (198/400) and 43% (247/577) for men. Women had higher risk of death in an unadjusted model (Hazard Ratio (HR) = 1.20; 95%CI, 1.00–1.45; P = .05). Women maintained a higher risk when adjusting for quantitative CSF culture, altered mental status, CSF pleocytosis, age, and antiretroviral status (HR = 1.31; 95%CI, 1.07–1.59; P Lay Summary We examined the role of biological sex in cryptococcal meningitis mortality in a large cohort. Our findings reveal significant differences in inflammatory markers by biological sex. Women have significantly higher mortality due to cryptococcal meningitis that is attributable to anemia at baseline.
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- 2021
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7. Hydroxychloroquine in Nonhospitalized Adults With Early COVID-19
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Ananta S Bangdiwala, Ilan S. Schwartz, Matthew F Pullen, Melanie R. Nicol, Alanna A Nascene, Sarah M Lofgren, Matthew P. Cheng, Sylvain A. Lother, David R. Boulware, Darlisha A. Williams, Katelyn A Pastick, Darlette Luke, Caleb P Skipper, Mahsa Abassi, Radha Rajasingham, Lauren E. Kelly, Glen Drobot, Katherine Huppler Hullsiek, Elizabeth C Okafor, Nicole S Engen, Lauren J. MacKenzie, Todd C. Lee, Emily G. McDonald, and Ryan Zarychanski
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Visual analogue scale ,business.industry ,010102 general mathematics ,Hydroxychloroquine ,Retrospective cohort study ,General Medicine ,Placebo ,medicine.disease ,01 natural sciences ,law.invention ,03 medical and health sciences ,Pneumonia ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Internal Medicine ,medicine ,Clinical endpoint ,030212 general & internal medicine ,0101 mathematics ,business ,medicine.drug - Abstract
BACKGROUND: No effective oral therapy exists for early coronavirus disease 2019 (COVID-19). OBJECTIVE: To investigate whether hydroxychloroquine could reduce COVID-19 severity in adult outpatients. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from 22 March through 20 May 2020. (ClinicalTrials.gov: NCT04308668). SETTING: Internet-based trial across the United States and Canada (40 states and 3 provinces). PARTICIPANTS: Symptomatic, nonhospitalized adults with laboratory-confirmed COVID-19 or probable COVID-19 and high-risk exposure within 4 days of symptom onset. INTERVENTION: Oral hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 more days) or masked placebo. MEASUREMENTS: Symptoms and severity at baseline and then at days 3, 5, 10, and 14 using a 10-point visual analogue scale. The primary end point was change in overall symptom severity over 14 days. RESULTS: Of 491 patients randomly assigned to a group, 423 contributed primary end point data. Of these, 341 (81%) had laboratory-confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or epidemiologically linked exposure to a person with laboratory-confirmed infection; 56% (236 of 423) were enrolled within 1 day of symptoms starting. Change in symptom severity over 14 days did not differ between the hydroxychloroquine and placebo groups (difference in symptom severity: relative, 12%; absolute, -0.27 point [95% CI, -0.61 to 0.07 point]; P = 0.117). At 14 days, 24% (49 of 201) of participants receiving hydroxychloroquine had ongoing symptoms compared with 30% (59 of 194) receiving placebo (P = 0.21). Medication adverse effects occurred in 43% (92 of 212) of participants receiving hydroxychloroquine versus 22% (46 of 211) receiving placebo (P < 0.001). With placebo, 10 hospitalizations occurred (2 non-COVID-19-related), including 1 hospitalized death. With hydroxychloroquine, 4 hospitalizations occurred plus 1 nonhospitalized death (P = 0.29). LIMITATION: Only 58% of participants received SARS-CoV-2 testing because of severe U.S. testing shortages. CONCLUSION: Hydroxychloroquine did not substantially reduce symptom severity in outpatients with early, mild COVID-19. PRIMARY FUNDING SOURCE: Private donors.
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- 2020
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8. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19
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Sarah M Lofgren, Ryan Zarychanski, David R. Boulware, Kathy H. Hullsiek, Derek LaBar, Emily G. McDonald, Matthew P. Cheng, Sylvain A. Lother, Katelyn A Pastick, Matthew F Pullen, Alanna A Nascene, Nicole Marten, Elizabeth C Okafor, Caleb P Skipper, Todd C. Lee, Lauren J. MacKenzie, Mahsa Abassi, Glen Drobot, Radha Rajasingham, Melanie R. Nicol, Lauren E. Kelly, Nicole W. Engen, Ilan S. Schwartz, and Ananta S. Bangdiwala
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Adult ,Male ,Canada ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,viruses ,medicine.medical_treatment ,Pneumonia, Viral ,030204 cardiovascular system & hematology ,law.invention ,Betacoronavirus ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Double-Blind Method ,Randomized controlled trial ,law ,Occupational Exposure ,Internal medicine ,Epidemiology ,medicine ,Humans ,Treatment Failure ,030212 general & internal medicine ,Post-exposure prophylaxis ,Pandemics ,Inhalation exposure ,Inhalation Exposure ,SARS-CoV-2 ,business.industry ,COVID-19 ,virus diseases ,Hydroxychloroquine ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Pneumonia ,Female ,Coronavirus Infections ,Post-Exposure Prophylaxis ,business ,medicine.drug - Abstract
Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown.We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days.We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was -2.4 percentage points (95% confidence interval, -7.0 to 2.2; P = 0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported.After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. (Funded by David Baszucki and Jan Ellison Baszucki and others; ClinicalTrials.gov number, NCT04308668.).
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- 2020
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9. Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada
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Susanne Lofgren, Joelle Helou, Christine A. Koch, Zhihui A. Liu, Fei-Fei Liu, Kathy Han, Ezra Hahn, Grace Lee, Anthony Fyles, Danielle Rodin, Jane DeRocchis, Aisling Barry, Naghmeh Isfahanian, Thomas G. Purdie, and Jennifer Croke
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.medical_treatment ,MEDLINE ,Cancer ,medicine.disease ,Lower risk ,Article ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,Radiology Nuclear Medicine and imaging ,030220 oncology & carcinogenesis ,Pandemic ,Health care ,Emergency medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
Purpose Mitigation strategies to balance the risk of coronavirus disease 2019 (COVID-19) infection against oncologic risk in patients with breast cancer undergoing radiation therapy have been deployed. To this end, shorter hypofractionated regimens have been recommended where appropriate, with prioritization of radiation therapy by oncologic risk and omission or deferral of radiation therapy for lower risk cases. Timely adoption of these measures reduces COVID-19 risk to both patients and health care workers and preserves resources. Herein, we present our early response and adaptation of breast radiation therapy utilization during the COVID-19 pandemic at a large academic cancer center in Canada. Methods and Materials A state of emergency was announced in Ontario on March 17, 2020, owing to the COVID-19 pandemic. Emergency guidelines were instituted. To examine our response, the number of weekly breast radiation therapy starts, type of breast radiation therapy, and patient age were compared from March 1 to April 30, 2020 to the same period in 2019. Results After the declaration of emergency in Ontario, there was a decrease of 39% in radiation therapy starts in 2020 compared with 2019 (79 vs 129, P < .001). There was a relative increase in the proportion of patients receiving regional nodal irradiation (RNI) in 2020 compared with 2019 (46% vs 29%, respectively), with the introduction of hypofractionated RNI in 2020 (27 of 54 cases, 50%). A smaller proportion of patients starting radiation therapy were aged >50 years in 2020, 66% (78 of 118) versus 83% (132 of 160) in 2019, P = .0027. Conclusions A significant reduction in breast radiation therapy starts was noted during the early response to the COVID-19 pandemic, with prioritization of radiation therapy to patients associated with higher oncologic risk requiring RNI. A quick response to a health care crisis is critical and is of particular importance for higher volume cancer sites where the potential effect on resources is greater.
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- 2020
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10. High-throughput quantitative histology in systemic sclerosis skin disease using computer vision
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Monique Hinchcliff, Rana Saber, Kathleen Aren, Roberta Goncalves Marangoni, Purvesh Khatri, Shane Lofgren, Aileen Hoffmann, J. Matthew Mahoney, Isaac Goldberg, Shannon Teaw, Jungwha Lee, Michelle Cheng, Seamus Mawe, Chase Correia, and Shawn E. Cowper
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Male ,0301 basic medicine ,lcsh:Diseases of the musculoskeletal system ,Biopsy ,Deep neural network ,Logistic regression ,Severity of Illness Index ,Outcome measures ,AlexNet ,Scleroderma ,Cohort Studies ,Correlation ,Scleroderma, Localized ,0302 clinical medicine ,Fibrosis ,Computer vision ,skin and connective tissue diseases ,Skin ,Principal Component Analysis ,Quantitative image features ,medicine.diagnostic_test ,integumentary system ,Middle Aged ,3. Good health ,Cohort ,Eosine Yellowish-(YS) ,Systemic sclerosis ,Female ,Algorithms ,Research Article ,Adult ,medicine.medical_specialty ,Histology ,Outcomes ,03 medical and health sciences ,Deep Learning ,Methyl Green ,Internal medicine ,Linear regression ,medicine ,Humans ,030203 arthritis & rheumatology ,Scleroderma, Systemic ,business.industry ,Modified Rodnan skin score ,medicine.disease ,Rheumatology ,Clinical trial ,030104 developmental biology ,Neural Networks, Computer ,Artificial intelligence ,lcsh:RC925-935 ,business ,Azo Compounds - Abstract
Background Skin fibrosis is the clinical hallmark of systemic sclerosis (SSc), where collagen deposition and remodeling of the dermis occur over time. The most widely used outcome measure in SSc clinical trials is the modified Rodnan skin score (mRSS), which is a semi-quantitative assessment of skin stiffness at seventeen body sites. However, the mRSS is confounded by obesity, edema, and high inter-rater variability. In order to develop a new histopathological outcome measure for SSc, we applied a computer vision technology called a deep neural network (DNN) to stained sections of SSc skin. We tested the hypotheses that DNN analysis could reliably assess mRSS and discriminate SSc from normal skin. Methods We analyzed biopsies from two independent (primary and secondary) cohorts. One investigator performed mRSS assessments and forearm biopsies, and trichrome-stained biopsy sections were photomicrographed. We used the AlexNet DNN to generate a numerical signature of 4096 quantitative image features (QIFs) for 100 randomly selected dermal image patches/biopsy. In the primary cohort, we used principal components analysis (PCA) to summarize the QIFs into a Biopsy Score for comparison with mRSS. In the secondary cohort, using QIF signatures as the input, we fit a logistic regression model to discriminate between SSc vs. control biopsy, and a linear regression model to estimate mRSS, yielding Diagnostic Scores and Fibrosis Scores, respectively. We determined the correlation between Fibrosis Scores and the published Scleroderma Skin Severity Score (4S) and between Fibrosis Scores and longitudinal changes in mRSS on a per patient basis. Results In the primary cohort (n = 6, 26 SSc biopsies), Biopsy Scores significantly correlated with mRSS (R = 0.55, p = 0.01). In the secondary cohort (n = 60 SSc and 16 controls, 164 biopsies; divided into 70% training and 30% test sets), the Diagnostic Score was significantly associated with SSc-status (misclassification rate = 1.9% [training], 6.6% [test]), and the Fibrosis Score significantly correlated with mRSS (R = 0.70 [training], 0.55 [test]). The DNN-derived Fibrosis Score significantly correlated with 4S (R = 0.69, p = 3 × 10− 17). Conclusions DNN analysis of SSc biopsies is an unbiased, quantitative, and reproducible outcome that is associated with validated SSc outcomes.
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- 2020
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11. 455: Aspergillus fumigatus persistence and infection in cystic fibrosis: Adaptation to hypoxia and in vivo HOG pathway mutation
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B. Ross, Alix Ashare, L. Lofgren, J. Stajich, and R. Cramer
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Pulmonary and Respiratory Medicine ,biology ,business.industry ,Clinical Sciences ,Respiratory System ,Hypoxia (medical) ,biology.organism_classification ,medicine.disease ,Cystic fibrosis ,Aspergillus fumigatus ,Microbiology ,Persistence (computer science) ,In vivo ,Pediatrics, Perinatology and Child Health ,Mutation (genetic algorithm) ,Medicine ,Adaptation ,medicine.symptom ,business - Published
- 2021
12. Internal Jugular Venous Extension of a Mandibular Osteosarcoma With Literature Review
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Daniel B Hilton, Carlos Ramirez, Jens C Brown, and Daniel H Lofgren
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musculoskeletal diseases ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General Engineering ,Mandible ,medicine.disease ,Submandibular gland ,Metastasis ,Modified Radical Neck Dissection ,Otolaryngology ,head and neck neoplasms ,medicine.anatomical_structure ,Oncology ,intravenous metastasis ,head and neck reconstruction ,Chondroblastic Osteosarcoma ,osteosarcoma ,Biopsy ,medicine ,Osteosarcoma ,chondroblastic ,Radiology ,business ,Internal jugular vein - Abstract
Head and neck osteosarcomas (HNOS) account for less than 1% of all head and neck cancers and makeup 6-10% of all primary osteosarcomas. Mandibular osteosarcomas are the second most common subtype of HNOS. They demonstrate higher recurrence rates; however, are amenable to surgery. An 18-year-old male presented with a 2 cm x 3 cm x 2 cm intraoral mass for two months. Biopsy revealed chondroblastic osteosarcoma. Computed tomography revealed extension into the left internal jugular vein. Composite resection of the left mandible, floor of the mouth, ventral tongue, submandibular gland, and modified radical neck dissection with fibular flap repair was performed. Adjuvant chemotherapy and palliative radiotherapy were added. Unfortunately, progressive metastasis to the contralateral mandible and entire spinal cord ensued. We report the first case of head and neck osteosarcoma with intravascular invasion into the internal jugular vein.
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- 2021
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13. Aspergillus fumigatus In-Host HOG Pathway Mutation for Cystic Fibrosis Lung Microenvironment Persistence
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Alix Ashare, Robert A. Cramer, Lotus A. Lofgren, Jason E. Stajich, Brandon S. Ross, and Alspaugh, J Andrew
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Glycerol ,Cystic fibrosis ,Aspergillus fumigatus ,cystic fibrosis ,Congenital ,Genotype ,2.1 Biological and endogenous factors ,2.2 Factors relating to the physical environment ,oxidative stress ,Longitudinal Studies ,Aetiology ,skin and connective tissue diseases ,Lung ,biology ,pathogenesis ,Genomics ,QR1-502 ,Infectious Diseases ,MAP kinases ,Host-Pathogen Interactions ,Allergic bronchopulmonary aspergillosis ,Infection ,Metabolic Networks and Pathways ,Biotechnology ,Research Article ,Signal Transduction ,Virulence ,Microbiology ,Rare Diseases ,Clinical Research ,Virology ,medicine ,genomics ,Aspergillosis ,Humans ,Allele ,Aspergillus ,hypoxia ,Aspergillosis, Allergic Bronchopulmonary ,Osmolar Concentration ,Allergic Bronchopulmonary ,biology.organism_classification ,medicine.disease ,chronic infection ,Chronic infection ,Mutation ,osmotic stress - Abstract
The prevalence of Aspergillus fumigatus colonization in individuals with cystic fibrosis (CF) and subsequent fungal persistence in the lung is increasingly recognized. However, there is no consensus for clinical management of A. fumigatus in CF individuals, due largely to uncertainty surrounding A. fumigatus CF pathogenesis and virulence mechanisms. To address this gap in knowledge, a longitudinal series of A. fumigatus isolates from an individual with CF were collected over 4.5 years. Isolate genotypes were defined with whole-genome sequencing that revealed both transitory and persistent A. fumigatus in the lung. Persistent lineage isolates grew most readily in a low-oxygen culture environment, and conidia were more sensitive to oxidative stress-inducing conditions than those from nonpersistent isolates. Closely related persistent isolates harbored a unique allele of the high-osmolarity glycerol (HOG) pathway mitogen-activated protein kinase kinase, Pbs2 (pbs2C2). Data suggest this novel pbs2C2 allele arose in vivo and is necessary for the fungal response to osmotic stress in a low-oxygen environment through hyperactivation of the HOG (SakA) signaling pathway. Hyperactivation of the HOG pathway through pbs2C2 comes at the cost of decreased conidial stress resistance in the presence of atmospheric oxygen levels. These novel findings shed light on pathoadaptive mechanisms of A. fumigatus in CF, lay the foundation for identifying persistent A. fumigatus isolates that may require antifungal therapy, and highlight considerations for successful culture of persistent Aspergillus CF isolates. IMPORTANCE Aspergillus fumigatus infection causes a spectrum of clinical manifestations. For individuals with cystic fibrosis (CF), allergic bronchopulmonary aspergillosis (ABPA) is an established complication, but there is a growing appreciation for A. fumigatus airway persistence in CF disease progression. There currently is little consensus for clinical management of A. fumigatus long-term culture positivity in CF. A better understanding of A. fumigatus pathogenesis mechanisms in CF is expected to yield insights into when antifungal therapies are warranted. Here, a 4.5-year longitudinal collection of A. fumigatus isolates from a patient with CF identified a persistent lineage that harbors a unique allele of the Pbs2 mitogen-activated protein kinase kinase (MAPKK) necessary for unique CF-relevant stress phenotypes. Importantly for A. fumigatus CF patient diagnostics, this allele provides increased fitness under CF lung-like conditions at a cost of reduced in vitro growth under standard laboratory conditions. These data illustrate a molecular mechanism for A. fumigatus CF lung persistence with implications for diagnostics and antifungal therapy.
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- 2021
14. Mycoplasma Pneumoniae-Induced Rash and Mucositis: A Systematic Review of the Literature
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Daniel H Lofgren and Christopher Lenkeit
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medicine.medical_specialty ,Mycoplasma pneumoniae ,General Computer Science ,business.industry ,mirm ,Mycoplasma ,rash ,medicine.disease ,medicine.disease_cause ,Dermatology ,Rash ,mim ,mycoplasma pneumoniae ,Toxic epidermal necrolysis ,Pneumonia ,mucositis ,Mycoplasma pneumonia ,Mucositis ,mycoplasma pneumoniae-induced rash and mucositis ,Medicine ,Erythema multiforme ,Systematic Review ,medicine.symptom ,business - Abstract
INTRODUCTION Mycoplasma pneumoniae (MP) is a common respiratory pathogen that can result in community-acquired pneumonia (CAP). Approximately 25% of patients diagnosed with MP experience extrapulmonary manifestations. Mycoplasma-induced rash and mucositis (MIRM) was coined as a unique disease process in 2014. MIRM has prominent mucositis with or without a characteristic vesiculobullous and/or atypical targetoid eruption. Appropriate identification of this disease is important because it has a milder disease course with low rates of sequelae, and lower mortality compared to Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis. The objective of this systematic review was to examine the English literature on Mycoplasma Pneumonia-induced rash and mucositis since the establishment of its diagnosis in 2014. METHODS The following online databases were used to identify appropriate studies that met the established inclusion and exclusion criteria: Pubmed, Cochrane, MedLine, Health Evidence, EPPI center, Allied Health Evidence. The following MesH search terms were used to further identify articles; “Mycoplasma pneumoniae induced rash and mucositis,” “Mycoplasma pneumoniae rash and mucositis,” “Mycoplasma pneumoniae rash,” “Mycoplasma pneumoniae mucositis,” “MIRM,” “Mycoplasma induced rash and mucositis,” “Mycoplasma rash and mucositis,” “Mycoplasma rash,” and “Mycoplasma mucositis.” Data was extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS One hundred and seventy-five records were initially screened, and nineteen studies were included in the review, leading to a total of 27 patients. Patients had a mean age of 16 years old (Range 4 - 46 years old), with the majority being males (74%). Pulmonary symptoms tended to precede extrapulmonary symptoms on an average of 7.8 days. Extrapulmonary symptoms consisted of oral lesions (96.3%) followed by ocular lesions (92.6%) and genital lesions (59.3%). Female patients were more likely to have genital lesions (71.4%) when compared with male patients (55%). Cutaneous rashes occurred in approximately one-half of the patients, which supports the theory that MIRM is a separate clinical entity from SJS and other related skin disorders. Confirmatory testing for MIRM was performed using IgM/IgG Mycoplasma antibody testing or PCR in 19 (66.7%) and 6 (22.2%) patients respectively, although four cases reported the use of both serology and PCR, while five did not report confirmatory testing. Systemic antibiotics were used frequently in treatment 22 patients (77.8%) and 27 (100%) of the patients received various supportive care. Approximately 11 (37%) patients of reported cases used systemic steroids to reduce systemic inflammation. Other systemic treatments were used in six (21.4%) cases, and included intravenous immunoglobulins and cyclosporine A. Only eight patients (22.2%) reported having any lasting sequelae. CONCLUSION Mycoplasma-induced rash and mucositis is a recently described extra-pulmonary manifestation of Mycoplasma pneumoniae infections. To the best of the authors’ knowledge, this is the first systematic review of the MIRM literature since the introduction of the diagnosis in 2014. The authors hope that this review can serve to better our current understanding and lead to improved identification, work-up, and treatment of this disease. One notable limitation of this study is the relatively small sample size, which is due to the recent introduction of the term.
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- 2021
15. Amphiregulin deletion strongly attenuates the development of estrogen receptor-positive tumors in p53 mutant mice
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Kristopher A. Lofgren, David R. Meier, Megan A. Girtman, and Paraic A. Kenny
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0301 basic medicine ,Cancer Research ,animal structures ,medicine.drug_class ,Estrogen receptor ,Breast Neoplasms ,medicine.disease_cause ,Amphiregulin ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Mediator ,Breast cancer ,Cell Line, Tumor ,Biomarkers, Tumor ,medicine ,Animals ,Epidermal growth factor receptor ,skin and connective tissue diseases ,Alleles ,Mutation ,biology ,Prognosis ,medicine.disease ,Immunohistochemistry ,Xenograft Model Antitumor Assays ,carbohydrates (lipids) ,Disease Models, Animal ,Cell Transformation, Neoplastic ,030104 developmental biology ,Receptors, Estrogen ,Oncology ,Estrogen ,030220 oncology & carcinogenesis ,Cancer research ,biology.protein ,Female ,Tumor Suppressor Protein p53 ,Estrogen receptor alpha ,Gene Deletion - Abstract
The epidermal growth factor receptor ligand, Amphiregulin, is a transcriptional target of estrogen receptor alpha and is required for pubertal mammary gland development. Previous studies using immortalized human breast cancer cell line xenografts have suggested that Amphiregulin may be an important effector of estrogen receptor alpha during breast cancer development, at least in immune-compromised animals. Here, we evaluate the requirement for Amphiregulin in an immune-competent mouse model which is prone to developing estrogen receptor-positive tumors. We have intercrossed mice with mammary-specific mutation of p53 with mice deficient in Amphiregulin in order to assess the requirement for Amphiregulin in the initiation and progression of both estrogen receptor-positive and estrogen receptor-negative mammary tumors. Deletion of Amphiregulin significantly delayed the onset of palpable mammary tumors and also strongly reduced the proportion of estrogen receptor alpha-positive tumors formed. Upon necropsy, no substantial differences in the prevalence of non-palpable lesions were observed between cohorts, suggesting that the importance of Amphiregulin in mammary tumorigenesis is limited to the post-initiation phase. This study underlines the importance of the EGFR ligand, Amphiregulin, as a key mediator of estrogen receptor action in breast cancer.
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- 2019
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16. Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa
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Kabanda Taseera, Sarah M Lofgren, Henry W. Nabeta, Caleb P Skipper, Conrad Muzoora, David B. Meya, Abdu K Musubire, Radha Rajasingham, Charlotte Schutz, Joshua Rhein, Nelmary Hernandez-Alvarado, Mark R. Schleiss, David R. Boulware, Graeme Meintjes, Ananta S Bangdiwala, and Darin L. Wiesner
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0301 basic medicine ,Microbiology (medical) ,Tuberculosis ,Congenital cytomegalovirus infection ,Cytomegalovirus ,HIV Infections ,Viremia ,Meningitis, Cryptococcal ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Interquartile range ,medicine ,Humans ,030212 general & internal medicine ,Articles and Commentaries ,Africa South of the Sahara ,business.industry ,Mortality rate ,Hazard ratio ,virus diseases ,medicine.disease ,CD4 Lymphocyte Count ,030104 developmental biology ,Infectious Diseases ,Cytomegalovirus Infections ,Immunology ,business - Abstract
Background Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. Methods We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. Results Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. Conclusions Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). Clinical Trials Registration NCT01075152.
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- 2019
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17. Adjunctive sertraline for HIV-associated cryptococcal meningitis: a randomised, placebo-controlled, double-blind phase 3 trial
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Joshua Rhein, Kathy Huppler Hullsiek, Lillian Tugume, Edwin Nuwagira, Edward Mpoza, Emily E Evans, Reuben Kiggundu, Katelyn A Pastick, Kenneth Ssebambulidde, Andrew Akampurira, Darlisha A Williams, Ananta S Bangdiwala, Mahsa Abassi, Abdu K Musubire, Melanie R Nicol, Conrad Muzoora, David B Meya, David R Boulware, Jane Francis Ndyetukira, Cynthia Ahimbisibwe, Florence Kugonza, Carolyne Namuju, Alisat Sadiq, Alice Namudde, James Mwesigye, Kiiza K Tadeo, Paul Kirumira, Michael Okirwoth, Tonny Luggya, Julian Kaboggoza, Eva Laker, Leo Atwine, Davis Muganzi, Stewart Walukaga, Bilal Jawed, Matthew Merry, Anna Stadelman, Nicole Stephens, Andrew G Flynn, Ayako W Fujita, Richard Kwizera, Liliane Mukaremera, Sarah M Lofgren, Fiona V Cresswell, Bozena M Morawski, Nathan C Bahr, and Kirsten Nielsen
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Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Antifungal Agents ,Cost-Benefit Analysis ,030106 microbiology ,HIV Infections ,Meningitis, Cryptococcal ,Placebo ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Amphotericin B ,Sertraline ,Internal medicine ,Clinical endpoint ,medicine ,Humans ,Uganda ,030212 general & internal medicine ,Adverse effect ,Fluconazole ,Adjuvants, Pharmaceutic ,AIDS-Related Opportunistic Infections ,business.industry ,medicine.disease ,Clinical trial ,Cryptococcus ,Treatment Outcome ,Infectious Diseases ,Female ,business ,Meningitis ,medicine.drug - Abstract
Summary Background Identifying new antifungals for cryptococcal meningitis is a priority given the inadequacy of current therapy. Sertraline has previously shown in vitro and in vivo activity against cryptococcus. We aimed to assess the efficacy and cost-effectiveness of adjunctive sertraline in adults with HIV-associated cryptococcal meningitis compared with placebo. Methods In this double-blind, randomised, placebo-controlled trial, we recruited HIV-positive adults with cryptococcal meningitis from two hospitals in Uganda. Participants were randomly assigned (1:1) to receive standard therapy with 7–14 days of intravenous amphotericin B (0·7–1·0 mg/kg per day) and oral fluconazole (starting at 800 mg/day) with either adjunctive sertraline or placebo. Sertraline was administered orally or via nasogastric tube at a dose of 400 mg/day for 2 weeks, followed by 200 mg/day for 12 weeks, then tapered off over 3 weeks. The primary endpoint was 18-week survival, analysed by intention-to-treat. This study is registered with ClinicalTrials.gov , number NCT01802385 . Findings Between March 9, 2015, and May 29, 2017, we screened 842 patients with suspected meningitis and enrolled 460 of a planned 550 participants, at which point the trial was stopped for futility. Three patients in the sertraline group and three patients in the placebo group were lost to follow-up and therefore discontinued before study end. At 18 weeks, 120 (52%) of 229 patients in the sertraline group and 106 (46%) of 231 patients in the placebo group had died (hazard ratio 1·21, 95% CI 0·93–1·57; p=0·15). The fungal clearance rate from cerebrospinal fluid was similar between groups (0·43 –log10 CFU/mL per day [95% CI 0·37–0·50] in the sertraline group vs 0·47 –log10 CFU/mL per day [0·40–0·54] in the placebo group; p=0·59), as was occurrence of grade 4 or 5 adverse events (72 [31%] of 229 vs 75 [32%] of 231; p=0·98), most of which were associated with amphotericin B toxicity. Interpretation Sertraline did not reduce mortality and should not be used to treat patients with HIV-associated cryptococcal meningitis. The reasons for sertraline inactivity appear to be multifactorial and might be associated with insufficient duration of therapeutic sertraline concentrations. Funding National Institutes of Health and Medical Research Council, Wellcome Trust.
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- 2019
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18. Abstract P5-10-04: Exome sequencing in high breast and ovarian cancer incidence families which lack detectable mutations in established cancer susceptibility genes
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Kristopher A. Lofgren, CR Vos, Paraic A. Kenny, Craig S. Richmond, Jake A Deviley, Meier, and Megan A. Girtman
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Oncology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Cancer susceptibility ,medicine.disease ,Internal medicine ,Medicine ,business ,Ovarian cancer ,Gene ,Exome sequencing - Abstract
At our center, a standard 25 gene panel has proved useful for the identification of pathogenic germline mutations in many families with a high penetrance of breast and ovarian cancer, yet there remain several families with very high cancer incidence but from whom these assays have not identified pathogenic alleles. To attempt to define the genetic mechanism of susceptibility in such cases, are conducting germline whole exome sequencing in affected individuals. Here we describe the identification of strong candidate susceptibility variants in two such families. Both variants cause loss-of-function of DNA repair genes not previously implicated in breast cancer, but which share properties with genes with known roles in maintenance of genome integrity. In one individual, with a personal history of ovarian cancer and two independent breast tumors, we identified a novel point mutation in POLD2 which introduces a mutation at a residue which is biochemically conserved in all animal species thus far sequenced. In the second individual, a frameshift mutation was detected in ERCC4. In both cases, the variants found have not been observed in large exome datasets (e.g. ExAC) or reported in ClinVar. Our study highlights the potential utility of whole exome sequencing as a discovery tool in those families with high cancer incidence yet which lack mutations in known hereditary cancer predisposition genes. Citation Format: Kenny PA, Girtman MA, Deviley JA, Meier DR, Vos CR, Richmond CS, Lofgren KA. Exome sequencing in high breast and ovarian cancer incidence families which lack detectable mutations in established cancer susceptibility genes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-10-04.
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- 2019
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19. Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic
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Marty M. Lofgren, Ben Freedman, Zain Ul Abideen Asad, Stavros Stavrakis, Lancer D. Stephens, and Khaled Elkholey
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Male ,medicine.medical_specialty ,Time Factors ,digital health ,030204 cardiovascular system & hematology ,Electrocardiography ,03 medical and health sciences ,0302 clinical medicine ,Atrial Fibrillation ,Prevalence ,Humans ,Mass Screening ,Medicine ,Arrhythmia and Electrophysiology ,Prospective Studies ,030212 general & internal medicine ,Opportunistic screening ,American Indian or Alaska Native ,Original Research ,Aged ,Primary Health Care ,business.industry ,screening ,Incidence ,American Indian adults ,Oklahoma ,Atrial fibrillation ,Racial group ,Middle Aged ,medicine.disease ,Digital health ,Primary care clinic ,Family medicine ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single‐lead ECG device. Methods and Results American Indian patients aged ≥50 years followed in a tribal primary care clinic with no history of AF underwent a 30‐second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5±8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%–2.2%, P =0.002). Eight of 15 with new screen‐detected AF were aged 2 DS 2 ‐VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA 2 DS 2 ‐VASc score ≥1 and initiated anticoagulation. Conclusions Opportunistic, mobile single‐lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03740477.
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- 2021
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20. A Descriptive Analysis of Dried Blood Spot Adherence Testing Among Ugandans with HIV Presenting with Cryptococcal Meningitis
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Edward Mpoza, Ananta S Bangdiwala, Melanie R. Nicol, Kenneth Ssebambulidde, Jose R Castillo-Mancilla, Peter L. Anderson, David R. Boulware, Joshua Rhein, Tadeo Kiiza Kandole, Sarah M Lofgren, David B. Meya, Lillian Tugume, and Katherine Huppler Hullsiek
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0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,business.industry ,Immunology ,Human immunodeficiency virus (HIV) ,medicine.disease_cause ,medicine.disease ,Antiretroviral therapy ,Dried blood spot ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Infectious Diseases ,Virology ,Cryptococcosis ,medicine ,030212 general & internal medicine ,Cryptococcal meningitis ,business - Abstract
Early antiretroviral therapy (ART) initiation after cryptococcal meningitis increases mortality, and those unmasking cryptococcosis after
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- 2021
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21. Aspergillus fumigatusIn-Host HOG pathway mutation for Cystic Fibrosis Lung Microenvironment Persistence
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Jason E. Stajich, Brandon S. Ross, Lotus A. Lofgren, Robert A. Cramer, and Alix Ashare
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Pathogenesis ,biology ,Genotype ,medicine ,Virulence ,Allergic bronchopulmonary aspergillosis ,Allele ,biology.organism_classification ,medicine.disease ,Phenotype ,Cystic fibrosis ,Microbiology ,Aspergillus fumigatus - Abstract
The prevalence ofAspergillus fumigatuscolonization in individuals with Cystic Fibrosis (CF) and subsequent fungal persistence in the lung is increasingly recognized. However, there is no consensus for clinical management ofA. fumigatusin CF individuals, due largely to uncertainty surroundingA. fumigatusCF pathogenesis and virulence mechanisms. To address this gap in knowledge, a longitudinal series ofA. fumigatusisolates from an individual with CF were collected over 4.5 years. Isolate genotypes were defined with whole genome sequencing that revealed both transitory and persistentA. fumigatusin the lung. Persistent lineage isolates grew most readily in a low oxygen culture environment and conidia were more sensitive to oxidative stress inducing conditions compared to non-persistent isolates. Closely related persistent isolates harbor a unique allele of the high osmolarity glycerol (HOG) pathway mitogen activated protein kinase kinase, Pbs2 (pbs2C2). Data suggest this novelpbs2C2allele arosein vivoand is necessary for the fungal response to osmotic stress in a low oxygen environment through hyperactivation of the HOG (SakA) signaling pathway. Hyperactivation of the HOG pathway throughpbs2C2comes at the cost of decreased conidia stress resistance in the presence of atmospheric oxygen levels. These novel findings shed light on pathoadaptive mechanisms ofA. fumigatusin CF, lay the foundation for identifying persistentA. fumigatusisolates that may require antifungal therapy, and highlight considerations for successful culture of persistent fungal CF isolates.ImportanceAspergillus fumigatusinfection causes a spectrum of clinical manifestations. For individuals with Cystic Fibrosis (CF), Allergic Bronchopulmonary Aspergillosis (ABPA) is an established complication, but there is a growing appreciation forA. fumigatusairway persistence in CF disease progression. There currently is little consensus for clinical management ofA. fumigatuslong-term culture positivity in CF. A better understanding ofA. fumigatuspathogenesis mechanisms in CF is expected to yield insights into when antifungal therapies are warranted. Here, a 4.5-year longitudinal collection ofA. fumigatusisolates identified a persistent lineage that harbors a unique allele of the Pbs2 MAPKK necessary for unique CF-relevant stress phenotypes. Importantly forA. fumigatusCF patient diagnostics, this allele provides increased CF lung fitness at a cost of reducedin vitrogrowth in standard laboratory conditions. These data illustrate a molecular mechanism forA. fumigatusCF lung persistence with implications for diagnostics and antifungal therapy.
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- 2021
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22. Aspergillus fumigatus Strain-Specific Conidia Lung Persistence Causes an Allergic Broncho-Pulmonary Aspergillosis-Like Disease Phenotype
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Xi Wang, Brandon S. Ross, Ko-Wei Liu, Tobias M. Hohl, Joshua J. Obar, Jane T. Jones, Caitlin H. Kowalski, Jason E. Stajich, Robert A. Cramer, Joshua D. Kerkaert, Lotus A. Lofgren, Kathleen A. M. Mills, and Mitchell, Aaron P
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0301 basic medicine ,Hyphal growth ,Spores ,Aspergillosis ,medicine.disease_cause ,Inbred C57BL ,Cystic fibrosis ,Aspergillus fumigatus ,Pathogenesis ,Mice ,oxidative stress ,2.1 Biological and endogenous factors ,2.2 Factors relating to the physical environment ,Aetiology ,Lung ,Spores, Fungal ,ABPA ,QR1-502 ,medicine.anatomical_structure ,Fungal ,Phenotype ,Infectious Diseases ,Allergic response ,Respiratory ,Cytokines ,Female ,medicine.symptom ,Infection ,Research Article ,030106 microbiology ,Biology ,Microbiology ,03 medical and health sciences ,Rare Diseases ,medicine ,genomics ,Animals ,Humans ,Molecular Biology ,Inflammation ,strain heterogeneity ,Inflammatory and immune system ,Aspergillosis, Allergic Bronchopulmonary ,Allergic Bronchopulmonary ,Allergens ,medicine.disease ,biology.organism_classification ,chronic infection ,Asthma ,respiratory tract diseases ,Mice, Inbred C57BL ,030104 developmental biology ,Emerging Infectious Diseases ,Sputum ,allergic broncho-pulmonary aspergillosis - Abstract
Aspergillus fumigatus is a filamentous fungus which can cause multiple diseases in humans. Allergic broncho-pulmonary aspergillosis (ABPA) is a disease diagnosed primarily in cystic fibrosis patients caused by a severe allergic response often to long-term A. fumigatus colonization in the lungs. Mice develop an allergic response to repeated inhalation of A. fumigatus spores; however, no strains have been identified that can survive long-term in the mouse lung and cause ABPA-like disease. We characterized A. fumigatus strain W72310, which was isolated from the expectorated sputum of an ABPA patient, by whole-genome sequencing and in vitro and in vivo viability assays in comparison to a common reference strain, CEA10. W72310 was resistant to leukocyte-mediated killing and persisted in the mouse lung longer than CEA10, a phenotype that correlated with greater resistance to oxidative stressors, hydrogen peroxide, and menadione, in vitro. In animals both sensitized and challenged with W72310, conidia, but not hyphae, were viable in the lungs for up to 21 days in association with eosinophilic airway inflammation, airway leakage, serum IgE, and mucus production. W72310-sensitized mice that were recall challenged with conidia had increased inflammation, Th1 and Th2 cytokines, and airway leakage compared to controls. Collectively, our studies demonstrate that a unique strain of A. fumigatus resistant to leukocyte killing can persist in the mouse lung in conidial form and elicit features of ABPA-like disease. IMPORTANCE Allergic broncho-pulmonary aspergillosis (ABPA) patients often present with long-term colonization of Aspergillus fumigatus. Current understanding of ABPA pathogenesis has been complicated by a lack of long-term in vivo fungal persistence models. We have identified a clinical isolate of A. fumigatus, W72310, which persists in the murine lung and causes an ABPA-like disease phenotype. Surprisingly, while viable, W72310 showed little to no growth beyond the conidial stage in the lung. This indicates that it is possible that A. fumigatus can cause allergic disease in the lung without any significant hyphal growth. The identification of this strain of A. fumigatus can be used not only to better understand disease pathogenesis of ABPA and potential antifungal treatments but also to identify features of fungal strains that drive long-term fungal persistence in the lung. Consequently, these observations are a step toward helping resolve the long-standing question of when to utilize antifungal therapies in patients with ABPA and fungal allergic-type diseases.
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- 2021
23. PastoralScape: An Environment-Driven Model of Vaccination Decision Making Within Pastoralist Groups in East Africa
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Ofer Amram, Eric Lofgren, Craig S. McConnel, Richard A. Iles, and Matthew J. Sottile
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Vaccination ,Random field ising model ,Economic decision making ,Contagious bovine pleuropneumonia ,Geography ,Pastoralism ,Computer Science (miscellaneous) ,medicine ,East africa ,General Social Sciences ,Rift Valley fever ,Socioeconomics ,medicine.disease - Published
- 2021
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24. Lessons Learned From Conducting Internet-Based Randomized Clinical Trials During a Global Pandemic
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Radha Rajasingham, David R. Boulware, Sarah M Lofgren, Caleb P Skipper, Ananta S Bangdiwala, Alanna A Nascene, Katherine Huppler Hullsiek, Elizabeth C Okafor, Nicole Engen, Matthew F Pullen, Emily G. McDonald, Todd C. Lee, Mahsa Abassi, Darlisha A. Williams, and Katelyn A Pastick
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coronavirus ,030204 cardiovascular system & hematology ,Occupational safety and health ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Pandemic ,Medicine ,Social media ,030212 general & internal medicine ,Review Articles ,business.industry ,SARS-CoV-2 ,Clinical study design ,COVID-19 ,internet-based clinical trial ,methodology ,medicine.disease ,Clinical trial ,Outreach ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,The Internet ,Medical emergency ,business - Abstract
As the severe acute respiratory syndrome coronavirus 2 pandemic evolved, it was apparent that well designed and rapidly conducted randomized clinical trials were urgently needed. However, traditional clinical trial design presented several challenges. Notably, disease prevalence initially varied by time and region, and the pockets of outbreaks evolved geographically over time. Coupled with an occupational hazard from in-person study visits, timely recruitment would prove difficult in a traditional in-person clinical trial. Thus, our team opted to launch nationwide internet-based clinical trials using patient-reported outcome measures. In total, 2795 participants were recruited using traditional and social media, with screening and enrollment performed via an online data capture system. Follow-up surveys and survey reminders were similarly managed through this online system with manual participant outreach in the event of missing data. In this report, we present a narrative of our experience running internet-based clinical trials and provide recommendations for the design of future clinical trials during a world pandemic., The global SARS-CoV-2 pandemic presents novel challenges to conducting high quality randomized clinical trials. Internet-based clinical trials are a possible avenue for surmounting some of these challenges. Here, we offer some of the lessons learned from conducting such a trial.
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- 2020
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25. Strain specific persistence in the murine lung of Aspergillus fumigatus conidia causes an Allergic Broncho-Pulmonary Aspergillosis-like disease phenotype
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Tobias M. Hohl, Brandon S. Ross, Joshua D. Kerkaert, Joshua J. Obar, Jane T. Jones, Xi Wang, Caitlin H. Kowalski, Ko-Wei Liu, Lotus A. Lofgren, Robert A. Cramer, Jason E. Stajich, and Kathleen A. M. Mills
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biology ,Inhalation ,Inflammation ,Aspergillosis ,medicine.disease ,biology.organism_classification ,medicine.disease_cause ,Cystic fibrosis ,In vitro ,Microbiology ,Aspergillus fumigatus ,In vivo ,Allergic response ,medicine ,medicine.symptom - Abstract
Aspergillus fumigatus is a filamentous fungus which can cause multiple diseases in humans. Allergic Broncho-pulmonary Aspergillosis (ABPA) is a disease diagnosed primarily in Cystic Fibrosis patients caused by a severe allergic response often to long-term A. fumigatus colonization in the lungs. Mice develop an allergic response to repeated inhalation of A. fumigatus spores; however, no strains have been identified that can survive long-term in the mouse lung and cause ABPA-like disease. We characterized A. fumigatus strain W72310 by whole genome sequencing and in vitro and in vivo viability assays in comparison to a common reference strain, CEA10. W72310 was resistant to leukocyte-mediated killing and persisted in the mouse lung longer than CEA10, a phenotype that correlated with greater resistance to oxidative stressors, hydrogen peroxide and menadione, in vitro. In animals both sensitized and challenged with W72310, conidia, but not hyphae, were viable in the lungs for up to 21 days in association with eosinophilic airway inflammation, airway leakage, serum IgE, and mucus production. W72310-sensitized mice that were recall-challenged with conidia had increased inflammation, Th1 and Th2 cytokines, and airway leakage compared to controls. Collectively, our studies demonstrate that a unique strain of A. fumigatus resistant to leukocyte killing can persist in the mouse lung in conidial form and elicit features of ABPA-like disease.IMPORTANCEAllergic Broncho-pulmonary Aspergillosis (ABPA) patients often present with long-term colonization of Aspergillus fumigatus. Current understanding of ABPA pathogenesis has been complicated by a lack of long-term in vivo fungal persistence models. We have identified a clinical isolate of A. fumigatus, W72310, which persists in the murine lung and causes an ABPA-like disease phenotype. Surprisingly, while viable, W72310 showed little to no growth beyond the conidial stage in the lung. This indicates that it is possible that A. fumigatus can cause allergic disease in the lung without any significant hyphal growth. The identification of this strain of A. fumigatus can not only be used to better understand disease pathogenesis of ABPA and potential anti-fungal treatments, but also to identify features of fungal strains that drive long-term fungal persistence in the lung. Consequently, these observations are a step toward helping resolve the long-standing question when to utilize antifungal therapies in patients with ABPA and fungal allergic type diseases.
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- 2020
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26. Intraoperative Urinary Biomarkers and Acute Kidney Injury After Cardiac Surgery
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Lars R. Lofgren, Gregory J. Stoddard, Isaac E. Hall, Guillaume L. Hoareau, Brad Harris, Jackson S. Harley, Natalie A. Silverton, Natalia P. Melendez, Samuel R. Parry, and Kai Kuck
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medicine.medical_specialty ,Urinary system ,030204 cardiovascular system & hematology ,law.invention ,Excretion ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Postoperative Complications ,030202 anesthesiology ,law ,Intensive care ,Cardiopulmonary bypass ,Medicine ,Humans ,Prospective Studies ,Cardiac Surgical Procedures ,Creatinine ,Cardiopulmonary Bypass ,business.industry ,Acute kidney injury ,Acute Kidney Injury ,medicine.disease ,Cardiac surgery ,Anesthesiology and Pain Medicine ,chemistry ,Quartile ,Anesthesia ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Objectives To evaluate the association of intraoperative urinary biomarker excretion during cardiac surgery and the subsequent development of acute kidney injury (AKI). Design Prospective, nonrandomized, observational study. Setting Single tertiary-level, university-affiliated hospital. Participants Ninety patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Interventions None. Measurements and Main Results Urinary samples were collected every 30 minutes intraoperatively and then at four, 12, and 24 hours after CPB. Samples were measured for interleukin 18 (IL-18), kidney injury molecule-1 (KIM1), and creatinine concentrations. Urinary biomarker excretion (raw and indexed to creatinine) for four intraoperative and three postoperative points were compared between patients with and those without subsequent AKI defined by increased serum creatinine concentration ≥0.3 mg/dL within the first 48 hours or ≥1.5 times baseline within seven days. Raw and indexed median IL-18 values were similar between AKI groups at all intraoperative points, but became significantly different at 12 hours after CPB. Raw and indexed median KIM1 values were significantly different between AKI groups at multiple intraoperative points and at four and 12 hours after CPB. During intraoperative and postoperative points, patients in the fourth quartile of KIM1 excretion had greater AKI incidence and longer intensive care and hospital lengths of stay than those in the first quartile. Only postoperatively did the differences in these outcomes between the fourth and first quartile of IL-18 excretion occur. Conclusions Intraoperative KIM1 but not IL-18 excretion was associated with postoperative development of AKI.
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- 2020
27. Preferential observation of large infectious disease outbreaks leads to consistent overestimation of intervention efficacy
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Kelly Broen, Eric Lofgren, Jon Zelner, and Nina B. Masters
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2019-20 coronavirus outbreak ,Tuberculosis ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Human immunodeficiency virus (HIV) ,Psychological intervention ,Outbreak ,medicine.disease_cause ,medicine.disease ,Infectious disease (medical specialty) ,Environmental health ,medicine ,business ,Overconfidence effect - Abstract
Data from infectious disease outbreaks in congregate settings are often used to elicit clues about which types of interventions may be useful in other facilities. This is commonly done using before-and-after comparisons in which the infectiousness of pre-intervention cases is compared to that of post-intervention cases and the difference is attributed to intervention impact. In this manuscript, we show how a tendency to preferentially observe large outbreaks can lead to consistent overconfidence in how effective these interventions actually are. We show, in particular, that these inferences are highly susceptible to bias when the pathogen under consideration exhibits moderate-to-high amounts of heterogeneity in infectiousness. This includes important pathogens such as SARS-CoV-2, influenza, Noroviruses, HIV, Tuberculosis, and many others
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- 2020
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28. Testing early warning and response systems through a full-scale exercise in Vietnam
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Lynne Clemens, Frances Veasey, Tasha Stehling-Ariza, Anh T. P. Dao, Hannah Lofgren, Huong Thien Nguyen, Karen Talbert, Peter Rzeszotarski, S. Arunmozhi Balajee, Tan Q. Dang, Trang T. Do, Anthony W. Mounts, Quang D. Tran, Alexey Clara, Quy M. Tran, and Phu D. Tran
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medicine.medical_specialty ,030231 tropical medicine ,Pneumonia, Viral ,World Health Organization ,International Health Regulations ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Health facility ,Medicine ,Humans ,Public Health Surveillance ,030212 general & internal medicine ,Early warning and response ,Full scale exercise ,Warning system ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Public Health, Environmental and Occupational Health ,COVID-19 ,lcsh:RA1-1270 ,medicine.disease ,Triage ,Vietnam ,Middle East Respiratory Syndrome Coronavirus ,Medical emergency ,Biostatistics ,business ,Risk assessment ,Coronavirus Infections ,Research Article - Abstract
Background Simulation exercises can functionally validate World Health Organization (WHO) International Health Regulations (IHR 2005) core capacities. In 2018, the Vietnam Ministry of Health (MOH) conducted a full-scale exercise (FSX) in response to cases of severe viral pneumonia with subsequent laboratory confirmation for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to evaluate the country’s early warning and response capabilities for high-risk events. Methods An exercise planning team designed a complex fictitious scenario beginning with one case of severe viral pneumonia presenting at the hospital level and developed all the materials required for the exercise. Actors, controllers and evaluators were trained. In August 2018, a 3-day exercise was conducted in Quang Ninh province and Hanoi city, with participation of public health partners at the community, district, province, regional and national levels. Immediate debriefings and an after-action review were conducted after all exercise activities. Participants assessed overall exercise design, conduction and usefulness. Results FSX findings demonstrated that the event-based surveillance component of the MOH surveillance system worked optimally at different administrative levels. Detection and reporting of signals at the community and health facility levels were appropriate. Triage, verification and risk assessment were successfully implemented to identify a high-risk event and trigger timely response. The FSX identified infection control, coordination with internal and external response partners and process documentation as response challenges. Participants positively evaluated the exercise training and design. Conclusions This exercise documents the value of exercising surveillance capabilities as part of a real-time operational scenario before facing a true emergency. The timing of this exercise and choice of disease scenario was particularly fortuitous given the subsequent appearance of COVID-19. As a result of this exercise and subsequent improvements made by the MOH, the country may have been better able to deal with the emergence of SARS-CoV-2 and contain it.
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- 2020
29. Variable Cognition in ABM Decision-Making: An Application to Livestock Vaccine Choice
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Richard A. Iles, Matthew J. Sottile, Ofer Amram, Eric Lofgren, and Craig S. McConnel
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cognition ,lcsh:Veterinary medicine ,General Veterinary ,Computer science ,pastoralist ,Context (language use) ,Rationality ,Cognition ,Rational agent ,decision-making ,medicine.disease ,Kenya ,Data-driven ,Environmental data ,Variable (computer science) ,Contagious bovine pleuropneumonia ,agent-base model ,Risk analysis (engineering) ,vaccine ,medicine ,lcsh:SF600-1100 ,Veterinary Science ,Original Research - Abstract
Modeling realistic human decision-making is an important feature of good policy design processes. The use of an agent-based modelling framework allows for quantitative human decision-models that assume fully rational agents. This research introduces a dynamic human decision-making sub-model. The parameterisation of human memory and ‘rationality’ in a decision-making model represents an important extension of decision-making in ABMs. A data driven model of herd movement within a dynamic natural environment is the context for evaluating the cognitive decision-making model. The natural and human environments are linked via memory and rationality that affect herdsmen decision-making to vaccinate cattle using a once-for-life vaccine (Rift Valley fever) and an annual booster vaccine (Contagious Bovine Pleuropneumonia). The simulation model uses environmental data from Samburu county, Kenya from 2004 to 2015. The cognitive parameters of memory and ‘rationality’ are shown to successfully differentiate between vaccination decisions that are characterised by annual and once-for-life choices. The preliminary specifications and findings from the dynamic cognition - pastoralist agent-based model (PastoralScape) indicate that the model offers much to livestock vaccination modelling among small-scale herders.
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- 2020
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30. Diet Quality, Swallow Function, and Health-Related Quality of Life Among People with Parkinson's Disease
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Sarah Dobiszewski, Matthew J. Delmonico, Furong Xu, Leslie Mahler, Dara L. LoBuono, Alison Tovar, Ingrid E. Lofgren, and Skye N. Leedahl
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Health related quality of life ,Gerontology ,Nutrition and Dietetics ,Parkinson's disease ,business.industry ,Disease progression ,Medicine (miscellaneous) ,medicine.disease ,Healthy diet ,Outcome variable ,Diet quality ,Neuroscience, Nutrition and the Brain ,Cost of illness ,Medicine ,business ,Self report ,Food Science - Abstract
OBJECTIVES: To describe the diet quality, swallow function, and disease burden of people with Parkinson's disease (PwPD) and explore the relationship between diet quality, swallow function, and health related quality of life (HRQOL). METHODS: A convenience sample of twenty PwPD participated in this study. They completed various measures including: height and weight, two 24-h recalls, a time swallow test and a self-reported HRQOL questionnaire. Body mass index (BMI, kg/m(2)) were calculated from height and weight. Healthy Eating Index (HEI)-2015, a mean to assess dietary quality, was calculated from two 24-h dietary recalls. Total and component HEI-2015 scores were examined and interpreted using the graded approach (grades A-F). Radar graphs were constructed to provide visual representation of overall HEI-sores and component scores. A time swallow test assessed swallow function. The 39-item Parkinson's Disease Questionnaire (PDQ-39) assessed PD-specific HRQOL across 8 dimensions; the higher the score the lower the HRQOL. Descriptives were reported as mean ± standard deviation, frequencies, and percentages. Correlations were used to examine associations between outcome variables. RESULTS: The majority of PwPD were male (65%). The mean age was 69.7 ± 9.2 years and average time since diagnosis was 7.6 ± 5.4 years. The average BMI score was 27.1 ± 5.4 kg/m(2). Mean HEI scores were 58.3 ± 12.4, translating to an F, consistent with average HEI scores for Americans. The majority (75%) had a letter grade of F or D. Mean timed swallow speed was 14.4 ± 8.4 total mL/second. However, 8 (40%) had time swallow speeds of
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- 2020
31. SETD5-Coordinated Chromatin Reprogramming Regulates Adaptive Resistance to Targeted Pancreatic Cancer Therapy
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Marcello Caporicci, Pawel K. Mazur, Zhentian Wang, Julien Sage, Mary Esmeralda Fuentes, Joshua E. Elias, Matthew J. Meiners, Sarah A. Howard, Lichao Zhang, Michael C. Bassik, Or Gozani, Ze Yang, Tie-Mei Li, Shane Lofgren, Michael P. Kim, Anirban Maitra, Natasha M. Flores, Simone Hausmann, Huamin Wang, Ruitu Lyu, Michael-Christopher Keogh, and Marcus A. Cheek
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0301 basic medicine ,Cancer Research ,Histone methyltransferase activity ,endocrine system diseases ,Pyridones ,medicine.medical_treatment ,MAP Kinase Kinase 2 ,MAP Kinase Kinase 1 ,Context (language use) ,Apoptosis ,Mice, SCID ,Pyrimidinones ,Biology ,Article ,Histone Deacetylases ,Targeted therapy ,Small Molecule Libraries ,03 medical and health sciences ,Mice ,0302 clinical medicine ,Mice, Inbred NOD ,Pancreatic cancer ,Histocompatibility Antigens ,medicine ,Tumor Cells, Cultured ,Gene silencing ,Animals ,Humans ,Molecular Targeted Therapy ,Protein Kinase Inhibitors ,Cell Proliferation ,Histone-Lysine N-Methyltransferase ,Methyltransferases ,medicine.disease ,HDAC3 ,Xenograft Model Antitumor Assays ,digestive system diseases ,Chromatin ,Mice, Inbred C57BL ,Pancreatic Neoplasms ,030104 developmental biology ,Oncology ,Drug Resistance, Neoplasm ,030220 oncology & carcinogenesis ,Cancer research ,Female ,Reprogramming ,Carcinoma, Pancreatic Ductal - Abstract
Summary Molecular mechanisms underlying adaptive targeted therapy resistance in pancreatic ductal adenocarcinoma (PDAC) are poorly understood. Here, we identify SETD5 as a major driver of PDAC resistance to MEK1/2 inhibition (MEKi). SETD5 is induced by MEKi resistance and its deletion restores refractory PDAC vulnerability to MEKi therapy in mouse models and patient-derived xenografts. SETD5 lacks histone methyltransferase activity but scaffolds a co-repressor complex, including HDAC3 and G9a. Gene silencing by the SETD5 complex regulates known drug resistance pathways to reprogram cellular responses to MEKi. Pharmacological co-targeting of MEK1/2, HDAC3, and G9a sustains PDAC tumor growth inhibition in vivo. Our work uncovers SETD5 as a key mediator of acquired MEKi therapy resistance in PDAC and suggests a context for advancing MEKi use in the clinic.
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- 2020
32. Contrasting serum biomarker profiles in two Colombian populations with different risks for progression of premalignant gastric lesions during chronic Helicobacter pylori infection
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Jennifer L Lofgren, Kvin Lertpiriyapong, Richard M. Peek, Luis Eduardo Bravo, Jose M. Restrepo Avenia, James G. Fox, Robertino Mera-Giler, Keith T. Wilson, M. Blanca Piazuelo, Pelayo Correa, and Mark T. Whary
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Epidemiology ,Helminthiasis ,Chronic gastritis ,Colombia ,Gastroenterology ,Article ,Serology ,Helicobacter Infections ,03 medical and health sciences ,0302 clinical medicine ,Stomach Neoplasms ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Helicobacter ,biology ,Helicobacter pylori ,business.industry ,Incidence ,Cancer ,Odds ratio ,Middle Aged ,biology.organism_classification ,medicine.disease ,Toxoplasmosis ,Oncology ,030220 oncology & carcinogenesis ,Case-Control Studies ,Female ,Interleukin-5 ,Trefoil Factor-3 ,business ,Precancerous Conditions ,Biomarkers - Abstract
Background Colombians in coastal Tumaco have a lower incidence of Helicobacter pylori-associated gastric cancer compared to individuals from Tuquerres in the high Andes. This is despite nearly universal prevalence of H. pylori infection and chronic gastritis. Methods H. pylori infection was confirmed by Steiner stain and serology using African and European-origin strains. Gastric histology and serum inflammatory biomarkers in dyspeptic Tumaco or Tuquerres patients were evaluated to predict progression of gastric lesions. Results H. pylori infection was nearly universal by Steiner stain and serology. IgG response to European-origin H. pylori strains were greater than African-origin. High gastric cancer-risk Tuquerres patients, compared to low-risk Tumaco, had significant odds ratios for lesion progression associated with serum IL-5, trefoil factor 3 (TFF3), and low pepsinogen I/II ratio. Sensitivity and specificity for these parameters was 63.8% and 67.9%, respectively, with correctly classifying patients at 66.7%. Most odds ratios for 26 other biomarkers were significant for the town of residency, indicating an environmental impact on Tumaco patients associated with decreased lesion progression. Conclusion An IL-5 association with progression of gastric lesions is novel and could be evaluated in addition to TFF3 and pepsinogen I/II ratio as a non-invasive prognostic screen. Results suggest Tumaco patients were exposed to infectious diseases beyond H. pylori such as the documented high incidence of helminthiasis and toxoplasmosis. Impact Results support a prior recommendation to evaluate TFF3 and pepsinogen I/II together to predict aggressive gastric histology. Our data indicate IL-5 should be further evaluated as prognostic parameter.
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- 2020
33. Mycoplasma Pneumoniae Induced Rash and Mucositis with Bilateral Otitis Media and Sinusitis
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Jaishree Palanisamy, Jens C Brown, Christopher Lenkeit, and Daniel H Lofgren
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Mycoplasma pneumoniae ,medicine.medical_specialty ,Ethmoid Sinusitis ,sinusitis ,Dermatology ,rash ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Otolaryngology ,03 medical and health sciences ,0302 clinical medicine ,Mucositis ,Medicine ,mycoplasma ,Sinusitis ,mycoplasma pneumoniae induced rash and mucositis ,business.industry ,mirm ,General Engineering ,otitis media ,medicine.disease ,mycoplasma pneumoniae ,Rash ,mucositis ,Otitis ,Medical Education ,Atypical pneumonia ,Mycoplasma pneumonia ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a recently identified clinical entity, which describes a subset of extrapulmonary manifestations resulting from Mycoplasma pneumonia infection. Patients present with a wide variety of symptoms including cough, dyspnea, mucositis, conjunctivitis, with or without a variable cutaneous rash. A 24-year-old male presented to the emergency department with worsening dyspnea and new-onset oral, ocular, and genital mucosal lesions. The patient was also found to have bilateral otitis media with tympanic membrane rupture and ethmoid sinusitis upon further evaluation. The patient was originally diagnosed with atypical pneumonia leading to acute hypoxic respiratory failure and was admitted to inpatient care. Work-up revealed positive Mycoplasma pneumoniae immunoglobulin M, and the patient was subsequently diagnosed with MIRM. The patient was provided with supportive care as well as systemic antibiotics, and he fully recovered by day 12 without complication. No standardized treatment guidelines exist for MIRM, and it is universally accepted that supportive management is the mainstay of treatment, consisting of pain management, intravenous hydration, and mucosal care. Although the majority of MIRM patients are generally known to have a full recovery (81%), a variety of ocular, oral, and genital complications have been noted in the literature. Here we present a unique case of MIRM in a 24-year-old male who also had ethmoid sinusitis and bilateral otitis media with unilateral tympanic membrane perforation - two head and neck symptoms not described in previous literature.
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- 2020
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34. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013
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Meghan D. Mooney, Ken Takahashi, Andrea Stewart, Jonathan C Brown, Shireen Sindi, Amany H Refaat, Ruben Castro, Sara Sheikhbahaei, Kyle R. Heuton, Gillian M. Hansen, Chante Karimkhani, Bryan K. Phillips, Ibrahim Abubakar, Yohannes Kinfu, Victoria F Bachman, Konstantinos Stroumpoulis, Megan Coggeshall, Lucía Cuevas-Nasu, Yichong Li, Vineet K. Chadha, Andrew G. M. Bulloch, Takayoshi Ohkubo, Don C. Des Jarlais, Giancarlo Logroscino, Francis Apolinary Mhimbira, Jefferson G Fernandes, Cheng Huang, Ejaz Ahmad Khan, Fortuné Gbètoho Gankpé, Roderick J Hay, Itamar S. Santos, Zanfina Ademi, Fiona J Charlson, Norlinah Mohamed Ibrahim, Anwar Rafay, Andrew L. Thorne-Lyman, Juanita A. Haagsma, Emmanuel A. Ameh, John J. McGrath, Massimo Cirillo, Wubegzier Mekonnen, Holly Hagan, Naohiro Yonemoto, Frida Namnyak Ngalesoni, Dietrich Plass, Matias Trillini, David Phillips, Braden Te Ao, Wanqing Chen, Yun Jin Kim, David Rojas-Rueda, Christina Papachristou, Andrew E. Moran, Richard A. Gosselin, Maziar Moradi-Lakeh, Soraya Seedat, Janet L Leasher, Belinda K Lloyd, Lorenzo Monasta, Bruno F. Sunguya, Eun-Kee Park, Eduardo A. Undurraga, Mohammad A. AlMazroa, Mohammad H. Forouzanfar, Young-Ho Khang, Vasiliki Stathopoulou, Dima M. Qato, James Scott, Ileana Heredia-Pi, Luca Ronfani, Haidong Kan, Tasara T. Mazorodze, Murugesan Raju, Saeid Shahraz, Taavi Tillmann, Wang Wenzhi, Neil Pearce, Eric Y. Tenkorang, Aliya Naheed, Ferrán Catalá-López, Sudan Prasad Neupane, Emily Dansereau, Michael McKee, Derrick A Bennett, Mazeda Hossain, Paul S. F. Yip, Grant Nguyen, Norberto Perico, Miguel Angel Alegretti, Babak Eshrati, Boris Bikbov, Palwasha Anwari, Guoqing Hu, Amelia Bertozzi-Villa, Peter A. Meaney, Farshad Farzadfar, Svetlana Popova, Tara Templin, Hmwe H Kyu, Uche S. Uchendu, Kebede Deribe, Sergey Soshnikov, Nobhojit Roy, Daniel Kim, Ilana N. Ackerman, Homie Razavi, Leslie T. Cooper, Sandra Nolte, David T. Felson, John J Huang, Yang Liu, Fiorella Cavalleri, Adrian Davis, Héctor Gómez Dantés, Klara Dokova, Yuantao Hao, Catalina Medina, Austin E Schumacher, Stan Biryukov, Jane Rowley, Arindam Basu, Jose C. Adsuar, Rosana E. Norman, Yousef Khader, Rafael Alfonso-Cristancho, Sukanta Saha, Simón Barquera, Diego Gonzalez-Medina, Philip B. Mitchell, Lars Barregard, Haidong Wang, Yongmei Li, Ami R. Moore, Marie Ng, Raghib Ali, Peter T. Serina, Lijing L Yan, Ayse Abbasoglu Ozgoren, Ricky Leung, Michelle L. Bell, Tim Driscoll, Azmeraw T. Amare, Farshad Pourmalek, Tea Lallukka, Benjamin O Anderson, Raimundas Lunevicius, Corine Karema, Robert G. Weintraub, Erin C Mullany, Anders Larsson, Glen Mola, Paulo A. Lotufo, Luke Nyakarahuka, Sayed Saidul Alam, Louisa Degenhardt, Hugh R. Taylor, E. Ray Dorsey, Suzanne Polinder, Hilton Lam, Urbano Fra Paleo, David Zonies, Rahman Shiri, Marco A Avila, Alicia Elena Beatriz Lawrynowicz, Katya Anne Shackelford, Lynne Gaffikin, Konstantin Kazanjan, Mark T Mackay, Jasvinder A. Singh, Bryan L. Sykes, Sadaf G. Sepanlou, Chantal Huynh, Rakhi Dandona, Logan Sandar, Lavanya Singh, Dietrich Rothenbacher, Theo Vos, Steven E. Lipshultz, Coen H. Van Gool, Peggy P. Chiang, Mark G. Shrime, Christopher J L Murray, Scott Weichenthal, Jae-Hyun Park, Samia Alhabib, Philimon Gona, Christian Kieling, Yuichiro Yano, Ronny Westerman, Thomas Truelsen, Rajeev Gupta, Megan Bohensky, Abdullatif Husseini, Qing Lan, Luke D. Knibbs, Yousef M. Elshrek, H. Ross Anderson, Guohong Jiang, Madeline L. Moyer, Vinod K. Paul, Wim H. van Brakel, Emin Murat Tuzcu, Kara Estep, Lalit Dandona, Uchechukwu K.A. Sampson, Mohammad Tavakkoli, Ying Jiang, Joseph A Wagner, Mitsuru Mukaigawara, In-Hwan Oh, Siyi Shangguan, Noela M. Prasad, Charles D.A. Wolfe, Borja del Pozo-Cruz, Gokalp Kadri Yentur, Hilda L Harb, Elena Alvarez, Carlos A Castañeda-Orjuela, Mustafa Z. Younis, Herbert C. Duber, Erica Leigh Slepak, George A. Mensah, Knud Juel, Graeme J. Hankey, Natan M. Bornstein, Martha Híjar, Johan Ärnlöv, Mohamed Hsairi, Katherine T. Lofgren, Murray B. Stein, Renata Micha, Luigi Naldi, Margreet ten Have, Bolajoko O. Olusanya, Kyle J Foreman, Kenji Shibuya, F. Gerry R. Fowkes, Abdullah Sulieman Terkawi, Rana J. Asghar, Karen M. Tabb, Kovin Naidoo, Rogelio Pérez-Padilla, Honglei Chen, Antônio Luiz Pinho Ribeiro, Rasmus Havmoeller, Yukito Shinohara, Bongani M. Mayosi, Ernst J Kuipers, Konrad Pesudovs, Mouhanad Hammami, Lee Richardson, Rintaro Mori, Thomas D. Fleming, Pouria Heydarpour, Stephen G. Waller, Nicholas Graetz, Chanda Kulkarni, Peter Brooks, Gulfaraz Khan, Marcel Tanner, Van C. Lansingh, François Alla, Jamie Hancock, Yohannes Adama Melaku, Neeraj Bedi, Anthony D. Woolf, Tariku Jibat Beyene, Amanda W Pain, Eric L. Ding, Narayanaswamy Venketasubramanian, Semaw Ferede Abera, Devina Nand, Odgerel Chimed-Ochir, George D Thurston, Victor Aboyans, Alanur Çavlin, Jefferson Traebert, Michael R. Phillips, Yingfeng Zheng, Baffour Awuah, Carlo Irwin A. Panelo, Selen Begüm Uzun, Muhammad Imran Nisar, Samir Soneji, Veena S. Kulkarni, Mukesh Dherani, Stephen S Lim, Andre Keren, Kingsley N. Ukwaja, Sajjad Ur Rahman, Giuseppe Remuzzi, Kjetil Søreide, Blake Thomson, Samath D Dharmaratne, Christopher D. Blosser, David H. Rothstein, Amanda G. Thrift, Fabrizio Tediosi, Andrew H. Kemp, H. Dean Hosgood, Yoshihiro Kokubo, Miia Kivipelto, Amitava Banerjee, Edgar P. Simard, Reza Malekzadeh, Maggie Lind, Robert P. Dellavalle, Emerito Jose A. Faraon, Lydia S. Atkins, Tom Achoki, Aslam Pervaiz, Peter Scarborough, Hans W. Hoek, Ettore Beghi, Emilie Agardh, Abraham D. Flaxman, Dariush Mozaffarian, Juan R. Sanabria, Muluken Dessalegn, David C. Schwebel, Caitlyn Steiner, Ubai Alsharif, Richard C. Franklin, Gail Davey, Gelin Xu, Reyna A Gutiérrez, Joannie Lortet-Tieulent, Ashish Bhalla, Jost B. Jonas, Paul N. Jensen, Simon I. Hay, Xiaonong Zou, Andre Pascal Kengne, Tolesa Bekele, Brittany Wurtz, Jung-Chen Chang, Joseph Murray, Luciano A. Sposato, Stefan Ma, Summer Lockett Ohno, Charles R. Newton, Bradford D. Gessner, JianLi Wang, Scott B. Patten, Thomas Fürst, Carol Brayne, Christina Fitzmaurice, Peilin Shi, Ted R. Miller, Kinnari S. Murthy, Habib Benzian, Peter W. Gething, Cesar Diaz-Torne, Burcu Kucuk Bicer, Bo Norrving, Carly E Levitz, Adam D M Briggs, Sungroul Kim, Isabela M. Benseñor, John A. Crump, Sergey Petrovich Ermakov, Kalpana Balakrishnan, Awoke Misganaw Temesgen, Marcella Montico, Sanjay Krishnaswami, Kim Moesgaard Iburg, Ann Kristin Knudsen, Sun Ha Jee, Valery L. Feigin, Christine M. Budke, Anne Bulchis, Anand Dayama, Jonathan R. Carapetis, Cyrus Cooper, Teresa Shamah Levy, Ismael R. Campos-Nonato, Nataliya A. Foigt, Beth E. Ebel, Max Petzold, Heresh Amini, Ole Frithjof Norheim, Zulfiqar A Bhutta, Dan Poenaru, Jim van Os, Michele E. Murdoch, Samantha M. Colquhoun, Michael H. Criqui, Giorgia Giussani, Man Mohan Mehndiratta, Thomas N. Williams, Chandrashekhar T Sreeramareddy, Chuanhua Yu, Luis M. Coppola, Thomas J. Montine, Alaa Badawi, Eduardo Bernabé, Melvin Barrientos Marzan, James Leigh, Frédéric B. Piel, Ratilal Lalloo, Panniyammakal Jeemon, Maheswar Satpathy, Hélène Carabin, Corina Benjet, Seyed-Mohammad Fereshtehnejad, Ryan M Barber, Fotis Topouzis, Bin Li, Serge Resnikoff, Taavi Lai, Rachelle Buchbinder, Randah R. Hamadeh, Valeria Caso, Holly E. Erskine, Dragos Virgil Davitoiu, Miltiadis K. Tsilimbaris, Rachel L. Pullan, Ben Schöttker, Rafael Lozano, Damian G Hoy, Fiona M. Blyth, Belinda J. Gabbe, Hebe N. Gouda, Farhad Islami, Atte Meretoja, Christopher Margono, Marissa Iannarone, Ronan A Lyons, Wilkister N. Moturi, Donald H. Silberberg, Alexandra Brazinova, Monica Cortinovis, Deena Alasfoor, Richard Matzopoulos, Jerry Abraham, Francesco Saverio Violante, Monika Sawhney, Dorairaj Prabhakaran, Valentina Colistro, Derek F J Fay, Mamta Swaroop, Nima Hafezi-Nejad, John Nelson Opio, Hanne Christensen, Jun She, Soewarta Kosen, Atsushi Goto, Costas A. Christophi, Jeyaraj D. Pandian, Peter J. Hotez, K. Srinath Reddy, Al Artaman, Peter Allebeck, Jonas Minet Kinge, Graham S Cooke, Dan J. Stein, Kawkab Shishani, Laith J. Abu-Raddad, Katrina F Ortblad, Deborah Jarvis, Arsène Kouablan Adou, Barthelemy Kuate Defo, Alan D. Lopez, G Anil Kumar, K.M. Venkat Narayan, Yong Zhao, Rajiv Chowdhury, Hadi Danawi, George C Patton, Vasiliy Victorovich Vlassov, André Karch, Tommi J. Vasankari, Matthias Endres, Ione Jayce Ceola Schneider, Nelson Alvis-Guzman, Charles N Mock, Katharine J Looker, Bach Xuan Tran, Fernando Perez-Ruiz, Harish Chander Gugnani, Reza Assadi, Hannah Hamavid, Rosario Cárdenas, Mohammed I. Albittar, Sarah Derrett, Mohammad Yahya Saeedi, Traolach S. Brugha, Jan Hendrik Richardus, Alireza Esteghamati, Seok Jun Yoon, Josep Maria Haro, Michael Brainin, Ziad A. Memish, Rupert R A Bourne, Katherine B Gibney, David M. Pereira, Kathryn H. Jacobsen, Luc E. Coffeng, Joshua A. Salomon, Xia Wan, Ian Bolliger, Boris I. Pavlin, Karen Sliwa, Tati S. Warouw, Geoffrey Buckle, Chakib Nejjari, Diego De Leo, Ashkan Afshin, Vinay Nangia, Daniel Pope, Johanna M. Geleijnse, Nikhil Tandon, Kelly Bienhoff, Jed D. Blore, Walid Ammar, D. Allen Roberts, Elisabete Weiderpass, Gregory A. Roth, Manami Inoue, James D. Wilkinson, Hideaki Toyoshima, Soufiane Boufous, Ivy Shiue, Edward J Mills, Leilei Duan, Matthew M Coates, Ganesan Karthikeyan, Alberto Ortiz, Steven van de Vijver, David Carpenter, Suzanne Lyn Barker-Collo, Antony Stevens, Sanjay Basu, Maria Cecilia Bahit, Kaire Innos, Lindsay N. Boyers, Nicholas J K Breitborde, Alize J. Ferrari, Timothy M. Wolock, Simerjot K. Jassal, Mohammad Ali Sahraian, Joanna Moschandreas, Howard J. Hoffman, Hideki Higashi, George M. Ruhago, Karzan Abdulmuhsin Mohammad, Mohammed Basulaiman, D. Alex Quistberg, Justin Beardsley, Marcello Tonelli, Maurice Giroud, Karen Edmond, Norito Kawakami, Mohammad T Mashal, Neeraj Bhala, Carl Abelardo T. Antonio, David Tanne, Abhishek Singh, Kazem Rahimi, Vivekanand Jha, Wagner Marcenes, David J. Margolis, Yara A. Halasa, Zewdie Aderaw Alemu, Carrie Beth Peterson, Edson Serván-Mori, Anil Kaul, Foad Abd-Allah, Marek Majdan, Rahul Gupta, Robyn M. Lucas, Sarah Wulf, Lars Jacob Stovner, Mohsen Naghavi, Vegard Skirbekk, Ulrich Otto Mueller, Pengpeng Ye, Ali H. Mokdad, Dipan Bose, Saleem M Rana, Jeffrey D Stanaway, Abigail Mclain, Timothy J. Steiner, Amira Shaheen, Stein Emil Vollset, Andrea Werdecker, Michele Meltzer, Richie G Poulton, Joseph R. Masci, Inga Dora Sigfusdottir, Daniel Dicker, Maysaa El Sayed Zaki, Shiwei Liu, Julio C. Montañez Hernandez, Valentina Arsić Arsenijević, William Msemburi, Lope H Barrero, Linhong Wang, Soumya Swaminathan, Harvey Whiteford, Michael F. Macintyre, Berrak Bora Basara, Gregory R. Wagner, Paul I. Dargan, Hermann Brenner, Carolyn C. Gotay, Niveen M E Abu-Rmeileh, Nicholas J Kassebaum, Shams Eldin Ali Hassan Khalifa, Neil McGill, Murray, Christopher J. L, Barber, Ryan M., Foreman, Kyle J., Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw F., Aboyans, Victor, Abraham, Jerry P., Abubakar, Ibrahim, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M., Achoki, Tom, Ackerman, Ilana N., Ademi, Zanfina, Adou, Arsène K., Adsuar, José C., Afshin, Ashkan, Agardh, Emilie E., Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I., Alegretti, Miguel A., Alemu, Zewdie A., Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Françoi, Allebeck, Peter, Almazroa, Mohammad A., Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Amare, Azmeraw T., Ameh, Emmanuel A., Amini, Heresh, Ammar, Walid, Anderson, H. Ro, Anderson, Benjamin O., Antonio, Carl Abelardo T., Anwari, Palwasha, Arnlöv, Johan, Arsenijevic, Valentina S. Arsic, Artaman, Al, Asghar, Rana J., Assadi, Reza, Atkins, Lydia S., Avila, Marco A., Awuah, Baffour, Bachman, Victoria F., Badawi, Alaa, Bahit, Maria C., Balakrishnan, Kalpana, Banerjee, Amitava, Barker-Collo, Suzanne L., Barquera, Simon, Barregard, Lar, Barrero, Lope H., Basu, Arindam, Basu, Sanjay, Basulaiman, Mohammed O., Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L., Benjet, Corina, Bennett, Derrick A., Bensenor, Isabela M., Benzian, Habib, Bernabé, Eduardo, Bertozzi-Villa, Amelia, Beyene, Tariku J., Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar A., Bienhoff, Kelly, Bikbov, Bori, Biryukov, Stan, Blore, Jed D., Blosser, Christopher D., Blyth, Fiona M., Bohensky, Megan A., Bolliger, Ian W., Başara, Berrak Bora, Bornstein, Natan M., Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R. A., Boyers, Lindsay N., Brainin, Michael, Brayne, Carol E., Brazinova, Alexandra, Breitborde, Nicholas J. K., Brenner, Hermann, Briggs, Adam D., Brooks, Peter M., Brown, Jonathan C., Brugha, Traolach S., Buchbinder, Rachelle, Buckle, Geoffrey C., Budke, Christine M., Bulchis, Anne, Bulloch, Andrew G., Campos-Nonato, Ismael R., Carabin, Hélène, Carapetis, Jonathan R., Cárdenas, Rosario, Carpenter, David O., Caso, Valeria, Castañeda-Orjuela, Carlos A., Castro, Ruben E., Catalá-López, Ferrán, Cavalleri, Fiorella, Çavlin, Alanur, Chadha, Vineet K., Chang, Jung-Chen, Charlson, Fiona J., Chen, Honglei, Chen, Wanqing, Chiang, Peggy P., Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A., Cirillo, Massimo, Coates, Matthew M., Coffeng, Luc E., Coggeshall, Megan S., Colistro, Valentina, Colquhoun, Samantha M., Cooke, Graham S., Cooper, Cyru, Cooper, Leslie T., Coppola, Luis M., Cortinovis, Monica, Criqui, Michael H., Crump, John A., Cuevas-Nasu, Lucia, Danawi, Hadi, Dandona, Lalit, Dandona, Rakhi, Dansereau, Emily, Dargan, Paul I., Davey, Gail, Davis, Adrian, Davitoiu, Dragos V., Dayama, Anand, De Leo, Diego, Degenhardt, Louisa, Del Pozo-Cruz, Borja, Dellavalle, Robert P., Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C., Dessalegn, Muluken, Dharmaratne, Samath D., Dherani, Mukesh K., Diaz-Torné, Cesar, Dicker, Daniel, Ding, Eric L., Dokova, Klara, Dorsey, E Ray, Driscoll, Tim R., Duan, Leilei, Duber, Herbert C., Ebel, Beth E., Edmond, Karen M., Elshrek, Yousef M., Endres, Matthia, Ermakov, Sergey P., Erskine, Holly E., Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Faraon, Emerito Jose A., Farzadfar, Farshad, Fay, Derek F., Feigin, Valery L., Felson, David T., Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G., Ferrari, Alize J., Fitzmaurice, Christina, Flaxman, Abraham D., Fleming, Thomas D., Foigt, Nataliya, Forouzanfar, Mohammad H., Fowkes, F Gerry R., Paleo, Urbano Fra., Franklin, Richard C., Fürst, Thoma, Gabbe, Belinda, Gaffikin, Lynne, Gankpé, Fortuné G., Geleijnse, Johanna M., Gessner, Bradford D., Gething, Peter, Gibney, Katherine B., Giroud, Maurice, Giussani, Giorgia, Dantes, Hector Gomez, Gona, Philimon, González-Medina, Diego, Gosselin, Richard A., Gotay, Carolyn C., Goto, Atsushi, Gouda, Hebe N., Graetz, Nichola, Gugnani, Harish C., Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A., Haagsma, Juanita, Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara A., Hamadeh, Randah R., Hamavid, Hannah, Hammami, Mouhanad, Hancock, Jamie, Hankey, Graeme J., Hansen, Gillian M., Hao, Yuantao, Harb, Hilda L., Haro, Josep Maria, Havmoeller, Rasmu, Hay, Simon I., Hay, Roderick J., Heredia-Pi, Ileana B., Heuton, Kyle R., Heydarpour, Pouria, Higashi, Hideki, Hijar, Martha, Hoek, Hans W., Hoffman, Howard J., Hosgood, H Dean, Hossain, Mazeda, Hotez, Peter J., Hoy, Damian G., Hsairi, Mohamed, Hu, Guoqing, Huang, Cheng, Huang, John J., Husseini, Abdullatif, Huynh, Chantal, Iannarone, Marissa L., Iburg, Kim M., Innos, Kaire, Inoue, Manami, Islami, Farhad, Jacobsen, Kathryn H., Jarvis, Deborah L., Jassal, Simerjot K., Jee, Sun Ha, Jeemon, Panniyammakal, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B., Juel, Knud, Kan, Haidong, Karch, André, Karema, Corine K., Karimkhani, Chante, Karthikeyan, Ganesan, Kassebaum, Nicholas J., Kaul, Anil, Kawakami, Norito, Kazanjan, Konstantin, Kemp, Andrew H., Kengne, Andre P., Keren, Andre, Khader, Yousef S., Khalifa, Shams Eldin A., Khan, Ejaz A., Khan, Gulfaraz, Khang, Young-Ho, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kim, Yunjin, Kinfu, Yohanne, Kinge, Jonas M., Kivipelto, Miia, Knibbs, Luke D., Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J., Kulkarni, Chanda, Kulkarni, Veena S., Kumar, G Anil, Kyu, Hmwe H., Lai, Taavi, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lan, Qing, Lansingh, Van C., Larsson, Ander, Lawrynowicz, Alicia E. B., Leasher, Janet L., Leigh, Jame, Leung, Ricky, Levitz, Carly E., Li, Bin, Li, Yichong, Li, Yongmei, Lim, Stephen S., Lind, Maggie, Lipshultz, Steven E., Liu, Shiwei, Liu, Yang, Lloyd, Belinda K., Lofgren, Katherine T., Logroscino, Giancarlo, Looker, Katharine J., Lortet-Tieulent, Joannie, Lotufo, Paulo A., Lozano, Rafael, Lucas, Robyn M., Lunevicius, Raimunda, Lyons, Ronan A., Ma, Stefan, Macintyre, Michael F., Mackay, Mark T., Majdan, Marek, Malekzadeh, Reza, Marcenes, Wagner, Margolis, David J., Margono, Christopher, Marzan, Melvin B., Masci, Joseph R., Mashal, Mohammad T., Matzopoulos, Richard, Mayosi, Bongani M., Mazorodze, Tasara T., Mcgill, Neil W., Mcgrath, John J., Mckee, Martin, Mclain, Abigail, Meaney, Peter A., Medina, Catalina, Mehndiratta, Man Mohan, Mekonnen, Wubegzier, Melaku, Yohannes A., Meltzer, Michele, Memish, Ziad A., Mensah, George A., Meretoja, Atte, Mhimbira, Francis A., Micha, Renata, Miller, Ted R., Mills, Edward J., Mitchell, Philip B., Mock, Charles N., Ibrahim, Norlinah Mohamed, Mohammad, Karzan A., Mokdad, Ali H., Mola, Glen L. D., Monasta, Lorenzo, Hernandez, Julio C. Montañez, Montico, Marcella, Montine, Thomas J., Mooney, Meghan D., Moore, Ami R., Moradi-Lakeh, Maziar, Moran, Andrew E., Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N., Moyer, Madeline L., Mozaffarian, Dariush, Msemburi, William T., Mueller, Ulrich O., Mukaigawara, Mitsuru, Mullany, Erin C., Murdoch, Michele E., Murray, Joseph, Murthy, Kinnari S., Naghavi, Mohsen, Naheed, Aliya, Naidoo, Kovin S., Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K M. Venkat, Nejjari, Chakib, Neupane, Sudan P., Newton, Charles R., Ng, Marie, Ngalesoni, Frida N., Nguyen, Grant, Nisar, Muhammad I., Nolte, Sandra, Norheim, Ole F., Norman, Rosana E., Norrving, Bo, Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Ohno, Summer L., Olusanya, Bolajoko O., Opio, John Nelson, Ortblad, Katrina, Ortiz, Alberto, Pain, Amanda W., Pandian, Jeyaraj D., Panelo, Carlo Irwin A., Papachristou, Christina, Park, Eun-Kee, Park, Jae-Hyun, Patten, Scott B., Patton, George C., Paul, Vinod K., Pavlin, Boris I., Pearce, Neil, Pereira, David M., Perez-Padilla, Rogelio, Perez-Ruiz, Fernando, Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B., Petzold, Max, Phillips, Michael R., Phillips, Bryan K., Phillips, David E., Piel, Frédéric B., Plass, Dietrich, Poenaru, Dan, Polinder, Suzanne, Pope, Daniel, Popova, Svetlana, Poulton, Richie G., Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M., Pullan, Rachel L., Qato, Dima M., Quistberg, D Alex, Rafay, Anwar, Rahimi, Kazem, Rahman, Sajjad U., Raju, Murugesan, Rana, Saleem M., Razavi, Homie, Reddy, K Srinath, Refaat, Amany, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L., Richardson, Lee, Richardus, Jan Hendrik, Roberts, D Allen, Rojas-Rueda, David, Ronfani, Luca, Roth, Gregory A., Rothenbacher, Dietrich, Rothstein, David H., Rowley, Jane T., Roy, Nobhojit, Ruhago, George M., Saeedi, Mohammad Y., Saha, Sukanta, Sahraian, Mohammad Ali, Sampson, Uchechukwu K. A., Sanabria, Juan R., Sandar, Logan, Santos, Itamar S., Satpathy, Maheswar, Sawhney, Monika, Scarborough, Peter, Schneider, Ione J., Schöttker, Ben, Schumacher, Austin E., Schwebel, David C., Scott, James G., Seedat, Soraya, Sepanlou, Sadaf G., Serina, Peter T., Servan-Mori, Edson E., Shackelford, Katya A., Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G., Sigfusdottir, Inga D., Silberberg, Donald H., Simard, Edgar P., Sindi, Shireen, Singh, Abhishek, Singh, Jasvinder A., Singh, Lavanya, Skirbekk, Vegard, Slepak, Erica Leigh, Sliwa, Karen, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stanaway, Jeffrey D., Stathopoulou, Vasiliki, Stein, Dan J., Stein, Murray B., Steiner, Caitlyn, Steiner, Timothy J., Stevens, Antony, Stewart, Andrea, Stovner, Lars J., Stroumpoulis, Konstantino, Sunguya, Bruno F., Swaminathan, Soumya, Swaroop, Mamta, Sykes, Bryan L., Tabb, Karen M., Takahashi, Ken, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R., Te Ao, Braden J., Tediosi, Fabrizio, Temesgen, Awoke M., Templin, Tara, Ten Have, Margreet, Tenkorang, Eric Y., Terkawi, Abdullah S., Thomson, Blake, Thorne-Lyman, Andrew L., Thrift, Amanda G., Thurston, George D., Tillmann, Taavi, Tonelli, Marcello, Topouzis, Foti, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X., Trillini, Matia, Truelsen, Thoma, Tsilimbaris, Miltiadi, Tuzcu, Emin M., Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen B., Van Brakel, Wim H., Van De Vijver, Steven, Van Gool, Coen H., Van Os, Jim, Vasankari, Tommi J., Venketasubramanian, N, Violante, Francesco S., Vlassov, Vasiliy V., Vollset, Stein Emil, Wagner, Gregory R., Wagner, Joseph, Waller, Stephen G., Wan, Xia, Wang, Haidong, Wang, Jianli, Wang, Linhong, Warouw, Tati S., Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Wenzhi, Wang, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wilkinson, James D., Williams, Thomas N., Wolfe, Charles D., Wolock, Timothy M., Woolf, Anthony D., Wulf, Sarah, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L., Yano, Yuichiro, Ye, Pengpeng, Yentür, Gökalp K., Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Zaki, Maysaa E., Zhao, Yong, Zheng, Yingfeng, Zonies, David, Zou, Xiaonong, Salomon, Joshua A., Lopez, Alan D., Vos, Theo, Medische Sociologie, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Psychiatrie (3), Psychiatrie & Neuropsychologie, Barber, Ryan M, Foreman, Kyle J, Abd Allah, Foad, Abera, Semaw F, Abraham, Jerry P, Abu Raddad, Laith J, Abu Rmeileh, Niveen M, Ackerman, Ilana N, Adou, Arsène K, Adsuar, José C, Agardh, Emilie E, Albittar, Mohammed I, Alegretti, Miguel A, Alemu, Zewdie A, Alfonso Cristancho, Rafael, Almazroa, Mohammad A, Alvis Guzman, Nelson, Amare, Azmeraw T, Ameh, Emmanuel A, Anderson, Benjamin O, Antonio, Carl Abelardo T, Asghar, Rana J, Atkins, Lydia S, Avila, Marco A, Bachman, Victoria F, Bahit, Maria C, Barker Collo, Suzanne L, Barrero, Lope H, Basulaiman, Mohammed O, Bell, Michelle L, Bennett, Derrick A, Bensenor, Isabela M, Bertozzi Villa, Amelia, Beyene, Tariku J, Bhutta, Zulfiqar A, Blore, Jed D, Blosser, Christopher D, Blyth, Fiona M, Bohensky, Megan A, Bolliger, Ian W, Bornstein, Natan M, Bourne, Rupert R. A, Boyers, Lindsay N, Brayne, Carol E, Breitborde, Nicholas J. K, Briggs, Adam D, Brooks, Peter M, Brown, Jonathan C, Brugha, Traolach S, Buckle, Geoffrey C, Budke, Christine M, Bulloch, Andrew G, Campos Nonato, Ismael R, Carapetis, Jonathan R, Carpenter, David O, Castañeda Orjuela, Carlos A, Castro, Ruben E, Catalá López, Ferrán, Chadha, Vineet K, Chang, Jung Chen, Charlson, Fiona J, Chiang, Peggy P, Chimed Ochir, Odgerel, Christophi, Costas A, Coates, Matthew M, Coffeng, Luc E, Coggeshall, Megan S, Colquhoun, Samantha M, Cooke, Graham S, Cooper, Leslie T, Coppola, Luis M, Criqui, Michael H, Crump, John A, Cuevas Nasu, Lucia, Dargan, Paul I, Davitoiu, Dragos V, Del Pozo Cruz, Borja, Dellavalle, Robert P, Jarlais, Don C. De, Dharmaratne, Samath D, Dherani, Mukesh K, Diaz Torné, Cesar, Ding, Eric L, Dorsey, E. 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Dean, Hotez, Peter J, Hoy, Damian G, Huang, John J, Iannarone, Marissa L, Iburg, Kim M, Jacobsen, Kathryn H, Jarvis, Deborah L, Jassal, Simerjot K, Jensen, Paul N, Jonas, Jost B, Karema, Corine K, Kassebaum, Nicholas J, Kemp, Andrew H, Kengne, Andre P, Khader, Yousef S, Khalifa, Shams Eldin A, Khan, Ejaz A, Khang, Young Ho, Kinge, Jonas M, Knibbs, Luke D, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G. Anil, Kyu, Hmwe H, Lansingh, Van C, Lawrynowicz, Alicia E. B, Leasher, Janet L, Levitz, Carly E, Lim, Stephen S, Lipshultz, Steven E, Lloyd, Belinda K, Lofgren, Katherine T, Looker, Katharine J, Lortet Tieulent, Joannie, Lotufo, Paulo A, Lucas, Robyn M, Lyons, Ronan A, Macintyre, Michael F, Mackay, Mark T, Margolis, David J, Marzan, Melvin B, Masci, Joseph R, Mashal, Mohammad T, Mayosi, Bongani M, Mazorodze, Tasara T, Mcgill, Neil W, Mcgrath, John J, Meaney, Peter A, Melaku, Yohannes A, Memish, Ziad A, Mensah, George A, Mhimbira, Francis A, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L. D, Montine, Thomas J, Mooney, Meghan D, Moore, Ami R, Moradi Lakeh, Maziar, Moran, Andrew E, Moturi, Wilkister N, Moyer, Madeline L, Msemburi, William T, Mueller, Ulrich O, Mullany, Erin C, Murdoch, Michele E, Murthy, Kinnari S, Naidoo, Kovin S, Narayan, K. M. Venkat, Neupane, Sudan P, Newton, Charles R, Ngalesoni, Frida N, Nisar, Muhammad I, Norheim, Ole F, Norman, Rosana E, Oh, In Hwan, Ohno, Summer L, Olusanya, Bolajoko O, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Park, Eun Kee, Park, Jae Hyun, Patten, Scott B, Patton, George C, Paul, Vinod K, Pavlin, Boris I, Pereira, David M, Perez Padilla, Rogelio, Perez Ruiz, Fernando, Peterson, Carrie B, Phillips, Michael R, Phillips, Bryan K, Phillips, David E, Piel, Frédéric B, Poulton, Richie G, Prasad, Noela M, Pullan, Rachel L, Qato, Dima M, Quistberg, D. Alex, Rahman, Sajjad U, Rana, Saleem M, Reddy, K. Srinath, Ribeiro, Antonio L, Roberts, D. Allen, Rojas Rueda, David, Roth, Gregory A, Rothstein, David H, Rowley, Jane T, Ruhago, George M, Saeedi, Mohammad Y, Sampson, Uchechukwu K. A, Sanabria, Juan R, Santos, Itamar S, Schneider, Ione J, Schumacher, Austin E, Schwebel, David C, Scott, James G, Sepanlou, Sadaf G, Serina, Peter T, Servan Mori, Edson E, Shackelford, Katya A, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Singh, Jasvinder A, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stanaway, Jeffrey D, Stein, Dan J, Stein, Murray B, Steiner, Timothy J, Stovner, Lars J, Sunguya, Bruno F, Sykes, Bryan L, Tabb, Karen M, Taylor, Hugh R, Ao, Braden J. Te, Temesgen, Awoke M, Tenkorang, Eric Y, Terkawi, Abdullah S, Thorne Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tran, Bach X, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, van Gool, Coen H, Vasankari, Tommi J, Violante, Francesco S, Vlassov, Vasiliy V, Wagner, Gregory R, Waller, Stephen G, Warouw, Tati S, Weintraub, Robert G, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Yan, Lijing L, Yentür, Gökalp K, Yoon, Seok Jun, Younis, Mustafa Z, Zaki, Maysaa E, Salomon, Joshua A, Lopez, Alan D, Computational Science and Engineering Department [Daresbury] ( STFC ), Science & Technologie Facilities Council, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Weill Cornell Medical College - Qatar, Qatar Foundation - Education City, Doha, Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Karolinska Institute, karolinska institute, Centro de Estudios Avanzados en Zonas Aridas ( CEAZA ), Ecole Polytechnique Fédérale de Lausanne ( EPFL ), Wisconsin Division of Public Health, Regional Genetic Service, St Mary's Hospital, Manchester, Laboratoire d'Ingénierie des Matériaux ( LIM ), Centre National de la Recherche Scientifique ( CNRS ), Computer Science Department [Bristol], University of Bristol [Bristol], Lawrence Berkeley National Laboratory [Berkeley] ( LBNL ), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) ( SRI-B ), Multimedia Research Center ( MRC ), University of Alberta [Edmonton], Division of Biostatistics ( Biostat - MINNEAPOLIS ), University of Minnesota [Minneapolis], Laboratory of Neurologic Diseases, Mario Negri Institute, Milan, University of Southampton [Southampton], Imperial College London, Neurology Department, Ichilov Medical Center, Department of Public Health and Primary Care, Cambridge University, Interactions, transferts, ruptures artistiques et culturels - EA 6301 ( InTRu ), Université de Tours, Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Institute of Parasitology, STAR laboratory, Stanford University [Stanford], Unité de recherche Virologie et Immunologie Moléculaires ( VIM ), Institut National de la Recherche Agronomique ( INRA ), Tennent Institute of Ophthalmology, National University of Singapore ( NUS ), Multidisciplinary Nanotechnology Centre, Swansea University, Department of Computer Sciences [Scheffield], University of Sheffield [Sheffield], Cyprus International Institute for the Environment and Public Health, Harvard School of Public Health, Glasgow Centre for Physical Organic Chemistry, University of Glasgow, King‘s College London, Université Panthéon-Sorbonne - UFR Science Politique ( UP1 UFR11 ), Université Panthéon-Sorbonne ( UP1 ), National Diagnostics Centre ( NDC ), National University of Ireland [Galway] ( NUI Galway ), Arthritis Research UK Epidemiology Unit ( MANCHESTER - Arthritis Research ), University of Manchester [Manchester], CEGOT - Porto, Universidade do Porto [Porto], Advanced Laboratories on Embedded Systems [Roma] ( ALES ), Department of Biology [Miami], University of Miami [Coral Gables], Division of Human Nutrition, Wageningen University and Research Centre [Wageningen] ( WUR ), Spatial Ecology and Epidemiology Group, University of Oxford [Oxford], Department of Civil Engineering [Hamirpur], National Institute of Technology [Hamirpur], GEMMA — Environmental Engineering and Microbiology Research Group, Department of Hydraulic, Maritime and Environmental Engineering, Universitat Politècnica de Catalunya [Barcelona] ( UPC ), Institut National de Recherche et d'Analyse Physico-Chimique ( INRAP ), Institut National de Recherche et d'Analyse Physico-chimique (INRAP-Tunisie), University of Connecticut ( UCONN ), Norwegian Institute for Air Research ( NILU ), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) ( FEMTO-ST ), Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Ecole Nationale Supérieure de Mécanique et des Microtechniques ( ENSMM ) -Université de Technologie de Belfort-Montbeliard ( UTBM ), Tehran University, Friedrich-Alexander Universität Erlangen-Nürnberg ( FAU ), Secretariat of the Pacific Community, Public Health Division, Sociétés, Acteurs, Gouvernement en Europe ( SAGE ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Physics and Astronomy, Washington State University ( WSU ), Laboratoire de Physique de l'ENS Lyon ( Phys-ENS ), École normale supérieure - Lyon ( ENS Lyon ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en informatique de Toulouse ( IRIT ), Institut National Polytechnique [Toulouse] ( INP ) -Université Toulouse 1 Capitole ( UT1 ) -Université Toulouse - Jean Jaurès ( UT2J ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique ( CNRS ), School of Computer Science - China University of Geosciences (China University of Geosciences (East Area)), Université Catholique de Louvain ( UCL ), Div Cyclotron & Radiopharmaceut Sci ( DRDO, INMAS ), Univ New Delhi, University of St Andrews [Scotland], University of Cape Town, Department of Neuroscience, Karolinska Institutet [Stockholm], Institut de Physique Nucléaire d'Orsay ( IPNO ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Department of Computer Science and Engineering [Daejeon] (Chungnam National University), Lawrence University, Gastroenterology & Hepatology, Tata Research Development and Design Center ( TRDDC ), TCS Innovation Labs, Laboratoire MOLTECH-Anjou [Angers] ( MOLTECH ANJOU ), Université d'Angers ( UA ) -Centre National de la Recherche Scientifique ( CNRS ), University of Helsinki [Helsinki], Google Inc [Mountain View], Research at Google, Swedish Defense Research Agency ( FOI ), Centre de Recherche en Information Biomédicale sino-français ( CRIBS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratory of Image Science and Technology [Nanjing] ( LIST ), Southeast University [Jiangsu]-School of Computer Science and Engineering, Laboratoire de glaciologie et géophysique de l'environnement ( LGGE ), Observatoire des Sciences de l'Univers de Grenoble ( OSUG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Business and Informatics, University of Boras, Department of Mechanical and Automation Engineering ( CAD Laboratory ), The Chinese University of Hong Kong [Hong Kong], Università degli studi di Bari, Heuristique et Diagnostic des Systèmes Complexes [Compiègne] ( Heudiasyc ), Université de Technologie de Compiègne ( UTC ) -Centre National de la Recherche Scientifique ( CNRS ), Department of plant pathology and microbiology - centre for sustainable pest and disease management, Rothamsted Research, RGU, Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Barts and The London School of Medicine and Dentistry, Queen Mary University of London ( QMUL ), Centre d'économie de la Sorbonne ( CES ), Université Panthéon-Sorbonne ( UP1 ) -Centre National de la Recherche Scientifique ( CNRS ), Paris School of Economics ( PSE ), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale ( IDSIA ), Università della Svizzera italiana ( USI ) -Scuola universitaria professionale della Svizzera italiana [Manno] ( SUPSI ), Anaesthetics, Southampton University Hospital, Department of Mathematics, University of Iowa [Iowa City], College of Medicine, Alfaisal University, Saudi Ministry of Health, Institut national des recherches agricoles du Bénin, Centre de Recherches agricoles du Sud, Departments of Epidemiology and Nutrition, Unit of Human Nutrition, Agricultural University of Athens, Department of Animal Science, PennState University [Pennsylvania] ( PSU ), University of Virginia, University of Virginia [Charlottesville], Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS ‘‘Burlo Garofolo', Jet Propulsion Laboratory ( JPL ), NASA-California Institute of Technology ( CALTECH ), Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital [Boston], Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Department of Chemistry, Scientific Computing Research Unit, Department of dermatology, Milano University-Azienda Ospedaleria Ospedali Riuniti di Bergamo, Department of epidemiology and Public Health, Faculty of Medicine, Hong Kong Baptist University ( HKBU ), Département Optique ( OPT ), Université européenne de Bretagne ( UEB ) -Télécom Bretagne-Institut Mines-Télécom [Paris], Department of Neurology Lunds University Hospital Lund, Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux ( SAMOVAR ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ) -Centre National de la Recherche Scientifique ( CNRS ), Département Réseaux et Services Multimédia Mobiles ( RS2M ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ), Electrical Engineering and Computer Science Department - Case Western Reserve University, Case Western Reserve University [Cleveland], Institut Lumière Matière [Villeurbanne] ( ILM ), Université Claude Bernard Lyon 1 ( UCBL ), World Health Organization, Nordic School of Public Health, The James Hutton Institute, Sero, Sero consulting, Evolutionary Ecology of Infectious Disease Group, Department of Zoology, Horia Hulubei National Institute for Physics and Nuclear Engineering, Dunedin School of Medicine, University of Otago, Department of Physics, Clarendon Laboratory, Center for TeleInFrastruktur ( CTIF ), Aalborg University [Denmark] ( AAU ), Physikalisches Institut [Freiburg], Albert-Ludwigs-Universität Freiburg, Savoirs, Textes, Langage (STL) - UMR 8163 ( STL ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Dept.of Computer Science, Indian Institute of Technology Madras ( IIT Madras ), Istituto Mario Negri Bergamo, Centro Ricerche e Trapianti Villa Camozzi, Universidade Estadual Paulista Júlio de Mesquita ( UNESP ), Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Clinical Epidemiology and Aging Research, German Cancer Research Center, Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Symantec, European Microsoft Innovation Center ( EMIC ), Microsoft Corporation [Redmond, Wash.], Laboratoire de Mécanique, Physique et Géosciences ( LMPG ), Université Le Havre Normandie ( ULH ), Normandie Université ( NU ) -Normandie Université ( NU ), Novartis institute for tropical diseases, Institut de Génétique et de Biologie Moléculaire et Cellulaire ( IGBMC ), Université de Strasbourg ( UNISTRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Departments of Anatomy and Cell Biology, Wayne State University School of Medicine, Departments of Ophthalmology, Departments of Applied Physics [New Haven], Yale University [New Haven], Center for Mathematical Modeling ( CMM ), Universidad de Santiago de Chile [Santiago] ( USACH ), Laboratory for Atmospheric and Space Physics [Boulder] ( LASP ), University of Colorado Boulder [Boulder], University of Occupational and Environmental Health [Kitakyushu] ( UEOH ), Department of Computer Science and Engineering [New Delhi], Indian Institute of Technology Delhi ( IIT Delhi ), Institut de Recherche sur les Phénomènes Hors Equilibre ( IRPHE ), Aix Marseille Université ( AMU ) -Ecole Centrale de Marseille ( ECM ) -Centre National de la Recherche Scientifique ( CNRS ), GlaxoSmithKline, Imperial College London-Clinical Imaging Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale School of Medicine-Yale School of Medicine-Yale Stem Cell Center, Maclean Building, Benson Lane, Crowmarsh Gifford, Centre for Ecology and Hydrology, Nanoscience Institute ( NEST ), Dipartimento di Fisica, Università di Pisa, Aristotle University of Thessaloniki, Laboratory Of Immune Cell Biology ( LICB ), National Institutes of Health ( NIH ), Institute of Human Genetics, Bonn Universität [Bonn], Occupational Health Unit, Bologna University Hospital-Sant'Orsola-Malpighi Polyclinic, Royal Institute of Technology [Stockholm] ( KTH ), Institut für Informatik [München/Munich] ( LMU ), Ludwig-Maximilians-Universität München, NICTA [Eveleigh], National ICT Australia [Sydney] ( NICTA ), Manchester Academic Health Sciences Centre, Institut d'Histoire et de Philosophie des Sciences et des Techniques ( IHPST ), Université Panthéon-Sorbonne ( UP1 ) -Département d'Etudes Cognitives - ENS Paris ( DEC ), École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ), Ghent University [Belgium] ( UGENT ), German Research Centre for Geosciences - Helmholtz-Centre Potsdam ( GFZ ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique ( LHEEA ), École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Génie Civil et Mécanique ( GeM ), Université de Nantes ( UN ) -École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Neurorestoration Group, King‘s College London-Wolfson Centre for Age-related Diseases, Department of Computer Science [KAIST] ( CS ), Korea Advanced Institute of Science and Technology ( KAIST ), Laboratoire de l'Accélérateur Linéaire ( LAL ), Natl Engn Res Ctr Vegetables, Key Lab Biol & Genet Improvement Hort Crops N Chi, Beijing Acad Agr & Forestry Sci, University Hospital Puerta de Hierro, Madrid, Computational Science and Engineering Department [Daresbury] (STFC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Weill Cornell Medicine [Qatar], Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centro de Estudios Avanzados en Zonas Aridas (CEAZA), Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratoire d'Ingénierie des Matériaux (LIM), Centre National de la Recherche Scientifique (CNRS), Lawrence Berkeley National Laboratory [Berkeley] (LBNL), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) (SRI-B), Multimedia Research Center (MRC), University of Alberta, Division of Biostatistics (Biostat - MINNEAPOLIS), University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System, University of Southampton, University of Cambridge [UK] (CAM), Interactions, transferts, ruptures artistiques et culturels - EA 6301 (InTRu), Université de Tours (UT), Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Stanford University, Unité de recherche Virologie et Immunologie Moléculaires (VIM (UR 0892)), Institut National de la Recherche Agronomique (INRA), National University of Singapore (NUS), Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Paris 1 Panthéon-Sorbonne (UP1), National Diagnostics Centre (NDC), National University of Ireland [Galway] (NUI Galway), Arthritis Research UK Epidemiology Unit (MANCHESTER - Arthritis Research), Universidade do Porto = University of Porto, Advanced Laboratories on Embedded Systems [Roma] (ALES), Wageningen University and Research [Wageningen] (WUR), University of Oxford, Universitat Politècnica de Catalunya [Barcelona] (UPC), Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), University of Connecticut (UCONN), Norwegian Institute for Air Research (NILU), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Tehran, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Sociétés, Acteurs, Gouvernement en Europe (SAGE), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), The George Washington University (GW), Washington State University (WSU), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université Catholique de Louvain = Catholic University of Louvain (UCL), Div Cyclotron & Radiopharmaceut Sci (DRDO, INMAS), School of Physics and Astronomy [St Andrews], Tata Research Development and Design Center (TRDDC), MOLTECH-Anjou, Université d'Angers (UA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Swedish Defense Research Agency (FOI), Centre de Recherche en Information Biomédicale sino-français (CRIBS), Université de Rennes (UR)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Image Science and Technology [Nanjing] (LIST), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Department of Mechanical and Automation Engineering (CAD Laboratory), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] (Heudiasyc), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), Biotechnology and Biological Sciences Research Council (BBSRC)-Biotechnology and Biological Sciences Research Council (BBSRC), Queen Mary University of London (QMUL), Centre d'économie de la Sorbonne (CES), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana = University of Applied Sciences and Arts of Southern Switzerland [Manno] (SUPSI), Pennsylvania State University (Penn State), Penn State System-Penn State System, Jet Propulsion Laboratory (JPL), NASA-California Institute of Technology (CALTECH), Hong Kong Baptist University (HKBU), Département Optique (OPT), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT), Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux (SAMOVAR), Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP), Département Réseaux et Services Multimédia Mobiles (TSP - RS2M), University of Melbourne, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Otago [Dunedin, Nouvelle-Zélande], Center for TeleInFrastruktur (CTIF), Aalborg University [Denmark] (AAU), Savoirs, Textes, Langage (STL) - UMR 8163 (STL), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Indian Institute of Technology Madras (IIT Madras), Universidade Estadual Paulista Júlio de Mesquita Filho = São Paulo State University (UNESP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), European Microsoft Innovation Center (EMIC), Laboratoire de Mécanique, Physique et Géosciences (LMPG), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU), Novartis Institute for Tropical Diseases (NITD), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Center for Mathematical Modeling (CMM), Universidad de Chile = University of Chile [Santiago] (UCHILE), Laboratory for Atmospheric and Space Physics [Boulder] (LASP), University of Colorado [Boulder], University of Occupational and Environmental Health [Kitakyushu] (UEOH), Indian Institute of Technology Delhi (IIT Delhi), Institut de Recherche sur les Phénomènes Hors Equilibre (IRPHE), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Yale University [New Haven]-Yale School of Medicine [New Haven, Connecticut] (YSM), Nanoscience Institute (NEST), University of Pisa - Università di Pisa, Laboratory Of Immune Cell Biology (LICB), National Institutes of Health [Bethesda] (NIH), Rheinische Friedrich-Wilhelms-Universität Bonn, Royal Institute of Technology [Stockholm] (KTH ), Institut für Informatik [München/Munich] (LMU), Ludwig-Maximilians-Universität München (LMU), National ICT Australia [Sydney] (NICTA), Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Paris 1 Panthéon-Sorbonne (UP1)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Universiteit Gent = Ghent University (UGENT), German Research Centre for Geosciences - Helmholtz-Centre Potsdam (GFZ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Génie Civil et Mécanique (GeM), Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Department of Computer Science [KAIST] (CS), Korea Advanced Institute of Science and Technology (KAIST), Kardiyoloji, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Minnesota [Twin Cities], Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Unité de recherche Virologie et Immunologie Moléculaires (VIM), Université Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Panthéon-Sorbonne (UP1), Wageningen University and Research Centre [Wageningen] (WUR), Institut National de Recherche et d'Analyse Physico-chimique (Ariana, Tunisie) (INRAP), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), George Washington University (GW), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université Toulouse 1 Capitole (UT1)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Université Catholique de Louvain (UCL), MOLTECH-ANJOU (MOLTECH-ANJOU), Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Università della Svizzera italiana (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), California Institute of Technology (CALTECH)-NASA, Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP)-Centre National de la Recherche Scientifique (CNRS), Département Réseaux et Services Multimédia Mobiles (RS2M), Universidade Estadual Paulista Júlio de Mesquita Filho [São José do Rio Preto] (UNESP), Université Grenoble Alpes (UGA), Universidad de Santiago de Chile [Santiago] (USACH), Yale University [New Haven]-Yale University School of Medicine, Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), Ghent University [Belgium] (UGENT), Université de Nantes - Faculté des Sciences et des Techniques, Grelier, Elisabeth, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Universidade do Porto, Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université Toulouse 1 Capitole (UT1), Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire des Sciences de l'Univers de Grenoble (OSUG), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Università degli studi di Bari Aldo Moro (UNIBA), École des Ponts ParisTech (ENPC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), Institut Mines-Télécom [Paris] (IMT)-Télécom Bretagne-Université européenne de Bretagne - European University of Brittany (UEB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Universiteit Gent = Ghent University [Belgium] (UGENT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-CHU Limoges-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Technologie de Belfort-Montbeliard (UTBM), Institut de Chimie du CNRS (INC)-Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Nantes (ECN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Wolfson Centre for Age-related Diseases-King‘s College London, Cell biology, Public Health, Epidemiology, Health Technology Assessment (HTA), Erasmus MC other, Pathology, and Cardiothoracic Surgery
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Gerontology ,Male ,CHANGING RELATION ,Nutrition and Disease ,MESH : Life Expectancy ,MESH : Aged ,ECONOMIC-DEVELOPMENT ,Poison control ,MESH: Global Health ,Global Health ,Socioeconomic Factor ,Communicable Disease ,MESH : Chronic Disease ,Health Transition ,Voeding en Ziekte ,Quality-Adjusted Life Year ,SELF-RATED HEALTH ,MESH : Socioeconomic Factors ,Medicine ,MESH : Female ,MESH: Mortality, Premature ,2. Zero hunger ,MESH: Aged ,education.field_of_study ,MESH: Middle Aged ,Mortality rate ,Medicine (all) ,GBD2013 diseases ,[ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie ,General Medicine ,Middle Aged ,3. Good health ,MESH : Wounds and Injuries ,Epidemiological transition ,MESH: Quality-Adjusted Life Years ,MESH: Communicable Diseases ,NONCOMMUNICABLE DISEASES ,Female ,Quality-Adjusted Life Years ,MESH: Life Expectancy ,MESH: Health Transition ,Human ,MESH: Socioeconomic Factors ,ACUTE MYOCARDIAL-INFARCTION ,MESH : Male ,MORTALITY TRENDS ,Population ,MESH : Health Transition ,Communicable Diseases ,Article ,Life Expectancy ,EUROPEAN-UNION ,SDG 3 - Good Health and Well-being ,General & Internal Medicine ,SYSTEMATIC ANALYSIS ,Disability-adjusted life year ,Humans ,Life Science ,MESH : Middle Aged ,Mortality ,education ,Premature ,MESH : Mortality, Premature ,VLAG ,Aged ,MESH: Humans ,business.industry ,Mortality, Premature ,MESH: Chronic Disease ,MESH : Communicable Diseases ,Wounds and Injurie ,MESH : Humans ,MESH : Quality-Adjusted Life Years ,Non-communicable disease ,Chronic Disease ,Socioeconomic Factors ,Wounds and Injuries ,medicine.disease ,MESH: Male ,LOW SOCIOECONOMIC-STATUS ,Years of potential life lost ,[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie ,MESH: Wounds and Injuries ,Life expectancy ,RISK-FACTORS ,MESH : Global Health ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business ,MESH: Female ,Demography - Abstract
Summary Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Funding Bill & Melinda Gates Foundation. BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
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- 2015
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35. Symptomatic Cryptococcal Antigenemia Presenting as Early Cryptococcal Meningitis With Negative Cerebral Spinal Fluid Analysis
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Richard Kwizera, Mahsa Abassi, Edward Mpoza, Tadeo Kiiza Kandole, Kenneth Ssebambulidde, Sarah M Lofgren, Abdu K Musubire, Conrad Muzoora, Lillian Tugume, David B. Meya, Reuben Kiggundu, Darlisha A. Williams, Fiona V Cresswell, Joshua Rhein, Ananta S Bangdiwala, David R. Boulware, Edwin Nuwagira, and Katherine Huppler Hullsiek
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Antigens, Fungal ,030106 microbiology ,Cryptococcus ,HIV Infections ,Meningitis, Cryptococcal ,Gastroenterology ,Tuberculous meningitis ,03 medical and health sciences ,0302 clinical medicine ,CSF pleocytosis ,Internal medicine ,medicine ,Viral meningitis ,Humans ,030212 general & internal medicine ,Articles and Commentaries ,biology ,Diagnostic Tests, Routine ,business.industry ,HIV ,Aseptic meningitis ,Meningoencephalitis ,biology.organism_classification ,medicine.disease ,Fungal antigen ,3. Good health ,Infectious Diseases ,Cryptococcus neoformans ,Female ,Symptom Assessment ,business ,Meningitis ,Biomarkers - Abstract
Background Individuals with cryptococcal antigenemia are at high risk of developing cryptococcal meningitis if untreated. The progression and timing from asymptomatic infection to cryptococcal meningitis is unclear. We describe a subpopulation of individuals with neurologic symptomatic cryptococcal antigenemia but negative cerebral spinal fluid (CSF) studies. Methods We evaluated 1201 human immunodeficiency virus-seropositive individuals hospitalized with suspected meningitis in Kampala and Mbarara, Uganda. Baseline characteristics and clinical outcomes of participants with neurologic-symptomatic cryptococcal antigenemia and negative CSF cryptococcal antigen (CrAg) were compared to participants with confirmed CSF CrAg+ cryptococcal meningitis. Additional CSF testing included microscopy, fungal culture, bacterial culture, tuberculosis culture, multiplex FilmArray polymerase chain reaction (PCR; Biofire), and Xpert MTB/Rif. Results We found 56% (671/1201) of participants had confirmed CSF CrAg+ cryptococcal meningitis and 4% (54/1201) had neurologic symptomatic cryptococcal antigenemia with negative CSF CrAg. Of those with negative CSF CrAg, 9% (5/54) had Cryptococcus isolated on CSF culture (n = 3) or PCR (n = 2) and 11% (6/54) had confirmed tuberculous meningitis. CSF CrAg-negative patients had lower proportions with CSF pleocytosis (16% vs 26% with ≥5 white cells/μL) and CSF opening pressure >200 mmH2O (16% vs 71%) compared with CSF CrAg-positive patients. No cases of bacterial or viral meningitis were detected by CSF PCR or culture. In-hospital mortality was similar between symptomatic cryptococcal antigenemia (32%) and cryptococcal meningitis (31%; P = .91). Conclusions Cryptococcal antigenemia with meningitis symptoms was the third most common meningitis etiology. We postulate this is early cryptococcal meningoencephalitis. Fluconazole monotherapy was suboptimal despite Cryptococcus-negative CSF. Further studies are warranted to understand the clinical course and optimal management of this distinct entity. Clinical trials registration NCT01802385.
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- 2018
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36. Mutant GATA3 Actively Promotes the Growth of Normal and Malignant Mammary Cells
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David R. Meier, Esther A. Peterson, Kristopher A. Lofgren, Eric H. Jung, Paraic A. Kenny, and Natasha Emmanuel
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0301 basic medicine ,Genetically modified mouse ,Cancer Research ,Cell ,Mice, Nude ,Estrogen receptor ,Breast Neoplasms ,Mice, Transgenic ,GATA3 Transcription Factor ,Biology ,Epithelium ,Article ,Mice ,03 medical and health sciences ,Breast cancer ,Cell Line, Tumor ,medicine ,Animals ,Humans ,Breast ,Transcription factor ,Cell Proliferation ,GATA3 ,Epithelial Cells ,General Medicine ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Receptors, Estrogen ,Oncology ,Mammary Epithelium ,Mutation ,Cancer research ,Female ,Haploinsufficiency ,Transcription Factors - Abstract
Background/aim GATA3, a transcription factor expressed in luminal breast epithelial cells, is required for mammary gland development. Heterozygous GATA3 mutations occur in up to 15% of estrogen receptor (ER)-positive breast tumors and have been proposed to be null alleles resulting in haploinsufficiency; however, the mutation spectrum of GATA3 in breast cancer is in sharp contrast to that found in HDR syndrome, a true GATA3 haploinsufficiency disease. Materials and methods Transgenic mice, 3D cultures and xenografts were used to examine the effect of mutant GATA3 expression on mammary cell proliferation. Results Mutant GATA3 accelerated tumor growth of ZR751 cell xenografts and promoted precocious lobuloalveolar development in transgenic mouse mammary glands. Conclusion GATA3 mutations, recently observed in breast cancer, encode active transcription factors, which elicit proliferative phenotypes in normal mammary epithelium and promote the growth of ER-positive breast cancer cell lines.
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- 2018
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37. Neurocognitive outcomes of HIV-associated tuberculous meningitis
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Sarah M Lofgren, David R. Boulware, Noeline Nakasujja, Ananta S Bangdiwala, Alice Namudde, Alison M. Elliott, Carson M Quinn, Mable Kabahubya, Fiona V Cresswell, David B. Meya, and John Kasibante
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education.field_of_study ,Pediatrics ,medicine.medical_specialty ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Population ,Medicine (miscellaneous) ,medicine.disease ,Verbal learning ,General Biochemistry, Genetics and Molecular Biology ,Tuberculous meningitis ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Cohort ,medicine ,030212 general & internal medicine ,education ,business ,Neurocognitive ,030217 neurology & neurosurgery ,Depression (differential diagnoses) ,Management of depression - Abstract
Background: The toll of tuberculous meningitis (TBM) in both mortality and disability is considerable, but advancements in rehabilitation have the potential to improve the functional abilities and the quality of survivors’ lives. However, the typical phenotype of neurocognitive impairment in TBM survivors remains unstudied in HIV-predominant populations in sub-Saharan Africa. Methods: We tested 36 survivors of TBM in Uganda with a comprehensive battery of neurocognitive assessments at 8 and 24 weeks after diagnosis, and compared results to a representative cohort of HIV-uninfected Ugandans. Results: While participants had a broad range of impairments at eight weeks, there was marked improvement by 24 weeks, when a phenotype of impairment including deficits in motor functioning, verbal learning and memory, processing speed, and executive function emerged. These deficits were present despite good clinician-rated functional status. The majority (23/27, 85%) had evidence of moderate to severe depression at week 8, and at week 24 (18/24, 75%). Conclusion: These findings highlight the need for more comprehensive neurocognitive assessment in the survivors of TBM, and further investment in and study of rehabilitation, including management of depression, to improve long-term outcomes in this population.
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- 2021
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38. The cost-effectiveness of preimplantation genetic testing for aneuploidy in the United States: an analysis of cost and birth outcomes from 158,665 in vitro fertilization cycles
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Katherine T. Lofgren, Mark D. Hornstein, Andrea Lanes, Elizabeth S. Ginsburg, Ann M. Thomas, Malinda Lee, and Randi H. Goldman
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Adult ,Infertility ,medicine.medical_specialty ,Reproductive Techniques, Assisted ,Cost effectiveness ,Cost-Benefit Analysis ,medicine.medical_treatment ,Context (language use) ,Fertilization in Vitro ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Genetic Testing ,030212 general & internal medicine ,Preimplantation Diagnosis ,Genetic testing ,030219 obstetrics & reproductive medicine ,Assisted reproductive technology ,In vitro fertilisation ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Age Factors ,Pregnancy Outcome ,Obstetrics and Gynecology ,Aneuploidy ,Embryo Transfer ,medicine.disease ,United States ,Costs and Cost Analysis ,Female ,Live birth ,business ,Live Birth ,Incremental cost-effectiveness ratio - Abstract
A controversial and unresolved question in reproductive medicine is the utility of preimplantation genetic testing for aneuploidy as an adjunct to in vitro fertilization. Infertility is prevalent, but its treatment is notoriously expensive and typically not covered by insurance. Therefore, cost-effectiveness is critical to consider in this context.This study aimed to analyze the cost-effectiveness of preimplantation genetic testing for aneuploidy for the treatment of infertility in the United States.As reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System, a national data registry, in vitro fertilization cycles occurring between 2014 and 2016 in the United States were analyzed. A probabilistic decision tree was developed using empirical outputs to simulate the events and outcomes associated with in vitro fertilization with and without preimplantation genetic testing for aneuploidy. The treatment strategies were (1) in vitro fertilization with intended preimplantation genetic testing for aneuploidy and (2) in vitro fertilization with transfers of untested embryos. Patients progressed through the treatment model until they achieved a live birth or 12 months after ovarian stimulation. Clinical costs related to both treatment strategies were extracted from the literature and considered from both the patient and payer perspectives. Outcome metrics included incremental cost (measured in 2018 US dollars), live birth outcomes, incremental cost-effectiveness ratio, and incremental cost per live birth between treatment strategies.The study population included 114,157 first fresh in vitro fertilization stimulations and 44,508 linked frozen embryo transfer cycles. Of the fresh stimulations, 16.2% intended preimplantation genetic testing for aneuploidy and 83.8% did not. In patients younger than 35 years old, preimplantation genetic testing for aneuploidy was associated with worse clinical outcomes and higher costs. At age 35 years and older, preimplantation genetic testing for aneuploidy led to more cumulative births but was associated with higher costs from both perspectives. From a patient perspective, the incremental cost per live birth favored the no preimplantation genetic testing for aneuploidy strategy from the35 years age group to the 38 years age group and beginning at age 39 years favored preimplantation genetic testing for aneuploidy. From a payer perspective, the incremental cost per live birth favored preimplantation genetic testing for aneuploidy regardless of patient age.The cost-effectiveness of preimplantation genetic testing for aneuploidy is dependent on patient age and perspective. From an economic perspective, routine preimplantation genetic testing for aneuploidy should not be universally adopted; however, it may be cost-effective in certain scenarios.
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- 2021
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39. Analgesics promote welfare and sustain tumour growth in orthotopic 4T1 and B16 mouse cancer models
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Jennifer L Lofgren, Claudia Chui Shan Lee, Paul A. Flecknell, Carla Bradshaw, Amy L. Miller, and Johnny V Roughan
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0301 basic medicine ,Lung Neoplasms ,medicine.medical_treatment ,Melanoma, Experimental ,Thiazines ,Pain ,Breast Neoplasms ,Animal Welfare ,Meloxicam ,Mice ,03 medical and health sciences ,Cell Line, Tumor ,medicine ,cancer ,Animals ,refinement ,Neoplasm Metastasis ,Saline ,mouse ,Analgesics ,Mice, Inbred BALB C ,Lung ,General Veterinary ,business.industry ,Mammary Neoplasms, Experimental ,Cancer ,analgesia ,Original Articles ,buprenorphine ,medicine.disease ,Xenograft Model Antitumor Assays ,NSAID ,Mice, Inbred C57BL ,Disease Models, Animal ,Thiazoles ,030104 developmental biology ,Nociception ,medicine.anatomical_structure ,Tumour development ,Anesthesia ,Cohort ,Female ,Animal Science and Zoology ,business ,medicine.drug ,Buprenorphine - Abstract
Murine orthotopic cancer models often require surgery, potentially causing pain or distress. However, analgesics are often withheld because they may alter tumour development. Two orthotopically implanted cancers were investigated in mice pre-treated with meloxicam (10 mg/kg), buprenorphine (0.2 mg/kg) or saline (1 ml/kg). Tumours were imaged and welfare was assessed using body weight, behaviour and nociceptive responses. In study 1, BALB/c mice were inoculated with 4T1 mammary carcinoma or saline during surgery or anaesthesia. As pre-treatment with a single buprenorphine dose appeared beneficial to cancer growth consistency, a second cohort of mice additionally received saline or buprenorphine at 12 and 24 h. Surgery resulted in increased mammary tumour growth and lung metastases. These unwanted effects were lessened by buprenorphine pre-treatment, especially when given repeatedly. Mammary tumour-bearing mice became less active and nociceptive thresholds declined over time, indicating some discomfort as tumours grew. In study 2, C57BL/6 mice received B16 melanoma. This non-surgical model was used to determine whether meloxicam or buprenorphine affected cancer seeding of the lungs. While meloxicam reduced B16 lung seeding, buprenorphine did not. Mechanical thresholds decreased as cancer developed in mice bearing melanoma, but the magnitude of this was insufficient to conclude that there were any significant welfare concerns. This study highlights the scientific value in utilising non-surgical models, where possible. When surgery must be performed at the time of tumour inoculation, the effects of this should be controlled with appropriate analgesics to enhance the value and possibly translation of the research.
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- 2017
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40. Genomic analysis of melanoma evolution following a 30-year disease-free interval
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Jerry J. Miller, Steven E. Cash, Paraic A. Kenny, Sarah R. Hughes, and Kristopher A. Lofgren
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0301 basic medicine ,Pathology ,medicine.medical_specialty ,Histology ,Disease free interval ,Melanoma ,Dermatology ,Biology ,medicine.disease ,Bioinformatics ,Asymptomatic ,Germline ,Pathology and Forensic Medicine ,Lesion ,03 medical and health sciences ,Patient population ,030104 developmental biology ,medicine ,medicine.symptom ,Exome sequencing - Abstract
Ultra-late melanoma recurrence is infrequent, poorly understood and, in most cases, difficult to unambiguously distinguish from a new primary melanoma. We identified a patient with a second melanoma diagnosed after a 30 year disease-free interval, and sought to determine if this new lesion was a recurrence of the original melanoma. Here we report the genomic sequence analysis of the exomes of two melanoma lesions isolated from the same individual in 1985 and 2015, and their comparison to each other and to the germline DNA of the patient. Identification of many shared somatic mutations between these lesions prove a lineal relationship spanning 30 years. Unlike prior reports of ultra-late melanoma recurrence, the availability of the original tumor and the use of comprehensive genomic analysis allowed us to confirm that the second lesion is truly a recurrence. We demonstrate the acquisition of numerous additional mutations during the three decade asymptomatic period. These data highlight the low but very long-lasting risk of recurrence in this patient population.
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- 2017
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41. Proposed Features for a Digital Nutrition Intervention for Managing Parkinson’s Disease
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Matthew J. Delmonico, Dara L. LoBuono, Furong Xu, Leslie Mahler, Alison Tovar, Ingrid E. Lofgren, Sarah Dobiszewski, and Skye N. Leedahl
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medicine.medical_specialty ,Health (social science) ,Parkinson's disease ,business.industry ,Chronic Disease and Multimorbidity I ,medicine.disease ,Health Professions (miscellaneous) ,Abstracts ,Physical medicine and rehabilitation ,Intervention (counseling) ,Session 2916 (Paper) ,Medicine ,AcademicSubjects/SOC02600 ,Life-span and Life-course Studies ,business - Abstract
Digital health technologies can enhance quality of care for people with Parkinson’s disease (PwPD) and their informal caregivers (ICG), but research in this area is lacking. Developing digital health nutrition services incorporating end-user preferences is essential. This cross-sectional, mixed-method study assessed 20 PwPD and their ICG. Participants reported sources they first search for when seeking health information, the amount of effort it takes to find the information, their confidence level in finding reliable health information, and their level of trust of information obtained. Semi-structured dyadic interviews obtained information about technology, digital health, and nutrition. Transcripts were double coded by two researchers to identify nutrition service features and a >80% agreement was achieved. The mean age was 68.1±11.2 years and 65% of PwPD were male, while 80% of ICG were female. Most PwPD and ICG (82.5%) went to the internet the last time they looked up health information, and about 1/3 reported it took a lot of effort to get this information. Nearly half were concerned about the quality of the information, and approximately 70% had issues trusting health information from government agencies or diet programs. Six themes around key features for a digital nutrition intervention emerged: tailored and specific, inclusion of caregivers, promote self-efficacy, from a nutrition expert, contain a social element, and include a follow-up session. The results suggest that digital health interventions will need to be tailored to meet the needs of PwPD and their ICG.
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- 2020
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42. Acquisition of Cabozantinib-Sensitive MET D1228N Mutation During Progression on Crizotinib in MET-Amplified Triple-Negative Breast Cancer
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Craig S. Richmond, Paraic A. Kenny, Kristopher A. Lofgren, Grzegorz T. Gurda, Benjamin M. Parsons, David R. Meier, Dustin A. Deming, and Mark E. Burkard
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0301 basic medicine ,Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Cabozantinib ,medicine.drug_class ,Pyridines ,Biopsy ,DNA Mutational Analysis ,Primary Cell Culture ,Triple Negative Breast Neoplasms ,Drug resistance ,Tyrosine-kinase inhibitor ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Breast cancer ,Crizotinib ,Internal medicine ,Positron Emission Tomography Computed Tomography ,medicine ,Tumor Cells, Cultured ,Humans ,Anilides ,Breast ,Lung cancer ,Protein Kinase Inhibitors ,Triple-negative breast cancer ,business.industry ,Gene Amplification ,Cancer ,Proto-Oncogene Proteins c-met ,medicine.disease ,030104 developmental biology ,Treatment Outcome ,chemistry ,Amino Acid Substitution ,Drug Resistance, Neoplasm ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,business ,medicine.drug - Abstract
Background Targeting of somatic MET mutations using crizotinib has led to strong clinical responses, most frequently in patients with lung cancer, raising the possibility of adopting similar treatment strategies in patients with MET alterations in other cancer types. Patient and Methods We describe a patient with advanced triple-negative breast cancer with a 30-fold amplification of MET. Next-generation sequencing of pre- and postprogression biopsies was performed to identify the resistance mechanism emerging after an initial exceptional response to crizotinib. The response of the resistance mutant to type I and II MET inhibitors was assessed in cultured cells. Results After progressing on crizotinib, a MET-D1228N mutation was detected, which is located in the crizotinib-binding region of the MET kinase domain. Experimental studies demonstrated that this mutation confers complete resistance to crizotinib yet retains cabozantinib sensitivity. Treatment of the patient with cabozantinib led to a subjective improvement in clinical symptoms, but the patient progressed after 7 weeks. Conclusion Although MET mutations are rare in breast cancer, these patients may experience substantial clinical benefit from crizotinib treatment. Nevertheless, drug resistance owing to on-target MET mutations will likely be frequently encountered and comprehensive mechanistic studies to assess sensitivity of these mutants to a series of potential second-line therapies may help guide subsequent treatment for these patients.
- Published
- 2019
43. P6537Screening for Atrial Fibrillation in Native Americans using iPhone ECG
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Khaled Elkholey, M Lofgren, Stavros Stavrakis, and Ben Freedman
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medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,Cardiology ,Atrial fibrillation ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Abstract
Background Atrial fibrillation (AF) is a major risk factor for stroke. Screening for silent AF, with subsequent initiation of anticoagulation in at-risk individuals, may decrease the risk of stroke. Native Americans (NA) have a high prevalence of diabetes and higher incidence of stroke than whites and blacks. Indigenous Australians, and Maori in New Zealand develop AF on average 10–20 years earlier than Europeans and Asians living in the same country. We hypothesized that screening for AF using a single time point, 30-second iPhone-based ECG recording will result in identification of silent AF in a significant number of NA compared to routine care, and that the age profile of those detected may be younger than non-NA. Purpose To determine the prevalence of AF, and incidence of unknown AF in NA seen at a tribal clinic using opportunistic screening with a single-lead iPhone-based ECG device (Kardia Mobile). Methods A database study was carried out in NA patients aged ≥50 followed to determine the prevalence of AF. Consecutive patients aged ≥50 with no prior history of AF were approached when attending the AST clinic for a primary care visit for opportunistic screening. Following consent, a 30-second ECG was recorded. A cardiologist overread all tracings to confirm the diagnosis of AF. Those confirmed to have AF were referred to a cardiologist for further management. Results The AF prevalence in 2952 NA patients aged ≥50 (1256 male, 1696 female), was 2.2%. Prevalence increased significantly with age (age 50–59, 0.9%; age 60–69, 2.6%; age 70–79, 3.6%; age ≥80, 7.8%; p for trend Conclusions Opportunistic screening for AF using iPhone ECG in NA is feasible and well accepted by the patients when attending a tribal clinic. Our preliminary data suggest that NA, like other first nation peoples, may develop AF at a younger age compared to non-NA populations and would be likely to benefit from AF screening. In light of the high prevalence of risk factors for development of AF in NA, this novel approach for AF screening in tribal clinics has the potential to improve health outcomes among a large number of individuals.
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- 2019
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44. Long-term outcome of pT1a-b, cN0 breast cancer without axillary dissection or staging: a prospective observational study of 1543 women
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Stefan O. Emdin, L. Lofgren, M. Nordander, J. Ahlgren, Christian Ingvar, L-G Arnesson, and Emma Niméus
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Adult ,medicine.medical_specialty ,Antineoplastic Agents, Hormonal ,medicine.medical_treatment ,Breast Neoplasms ,030230 surgery ,Mastectomy, Segmental ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Survival rate ,Aged ,Aged, 80 and over ,Sweden ,business.industry ,Axillary Lymph Node Dissection ,Cancer ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,Tamoxifen ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,Neoplasm Recurrence, Local ,business ,Mastectomy ,Cohort study ,Follow-Up Studies - Abstract
The implementation of screening programmes in Sweden during the mid-1990s increased the number of small node-negative breast cancers. In this era before staging by sentinel node biopsy, routine axillary dissection for staging of early breast cancer was questioned owing to the increased morbidity and lack of perceived benefit. The long-term risk of axillary recurrence when axillary staging is omitted remains unclear.This prospective observational multicentre cohort study included Swedish women diagnosed with breast cancer between 1997 and 2002. The patients had clinically node-negative, pT1a-b, grade I-II tumours. No axillary staging or dissection was performed. The primary outcome was ipsilateral axillary recurrence and survival.A total of 1543 patients were included. Breast-conserving surgery (BCS) was performed in 94·0 per cent and the rest underwent mastectomy. After surgery, 58·1 per cent of the women received adjuvant radiotherapy, 11·9 per cent adjuvant endocrine therapy and 31·5 per cent did not receive any adjuvant treatment. After a median follow-up of 15·5 years, 6·4 per cent developed contralateral breast cancer and 16·5 per cent experienced a recurrence. The first recurrence was local in 116, regional in 47 and distant in 59 patients. The breast cancer-specific survival rate was 93·7 per cent after 15 years. There were no differences in overall or breast cancer-specific survival between patients who received adjuvant radiotherapy and those who did not. Only 3·0 per cent of patients had an axillary recurrence, which was isolated in only 1·0 per cent.Axillary surgery can safely be omitted in patients with low-grade, T1a-b, cN0 breast cancers. This large prospective cohort with 15-year follow-up had a very low incidence of axillary recurrences and high breast cancer-specific survival rate.La puesta en marcha en Suecia, a mediados de los años 90, de los programas de cribaje aumentó el número de cánceres de mama precoces con ganglios negativos. En esa era, antes de la estadificación mediante la biopsia del ganglio centinela, se cuestionó la disección axilar rutinaria para la estadificación del cáncer de mama precoz debido a su aumento de la morbilidad y la falta de percepción de beneficio. El riesgo de recidiva axilar a largo plazo cuando no se omite la estadificación axilar sigue sin estar claro. MÉTODOS: Estudio de cohortes prospectivo, observacional y multicéntrico de las mujeres suecas diagnosticadas de cáncer de mama entre 1997-2002. Se incluyeron las pacientes con ganglios clínicamente no detectables, pT1a-b, grados I-II y no se realizó disección/estadificación axilar en ninguna de ellas. El resultado principal fue la recidiva axilar ipsilateral y la supervivencia.Se incluyeron 1.543 pacientes. Se realizó cirugía conservadora de la mama (breast conserving surgery, BCS) en el 94% de las mujeres y en las restantes se practicó una mastectomía. Tras la BCS, el 58% de las mujeres recibió radioterapia adyuvante, el 12% tratamiento endocrino adyuvante y el 32% no recibió ningún tratamiento adyuvante. Tras una mediana de seguimiento de 15,5 años, el 6% desarrolló un cáncer de mama contralateral y un 14% una recidiva. La primera recidiva fue local en 116 pacientes, regional en 47 y a distancia en 59. La supervivencia específica para el cáncer de mama a los 15 años fue del 94%. No hubo diferencias en la supervivencia general o específica por cáncer de mama entre las pacientes que recibieron radioterapia adyuvante y las que no. Solo el 3% de las pacientes presentó una recidiva axilar, de las cuales tan solo el 1% padecieron exclusivamente una recidiva axilar. CONCLUSIÓN: La cirugía axilar se puede omitir con seguridad en los cánceres de mama de bajo grado, T1a-b, cN0. Esta gran cohorte prospectiva con un seguimiento de 15 años muestra que la incidencia de recidivas axilares es muy baja y la supervivencia específica por cáncer de mama muy alta.
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- 2019
45. Abdominal Wall Abscess Secondary to Cholecystocutaneous Fistula via Percutaneous Cholecystostomy Tract
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Victorico Singzon, Daniel H Lofgren, and Sugam Vasani
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cholecystocutaneous fistula ,non-compliance ,medicine.medical_specialty ,Abdominal pain ,Percutaneous ,medicine.medical_treatment ,Fistula ,abscess ,cholecystectomy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Incision and drainage ,medicine ,Abscess ,percutaneous cholecystostomy ,business.industry ,Gallbladder ,Gastroenterology ,abdominal pain ,General Engineering ,medicine.disease ,Surgery ,medicine.anatomical_structure ,General Surgery ,Cholecystostomy ,Cholecystectomy ,Anatomy ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Cholecystocutaneous fistulas (CCFs) are an increasingly rare consequence of chronic gallbladder inflammation and disease. Historically, they were commonly noted in the literature by Courvoisier, Naunyn, and Bonnet in the late 1800s. Due to improvements in diagnostic imaging and treatment options in the last century, there has been a marked decrease in the incidence of the CCF cases in the literature. From the late 1890s to 1949, there were only 37 cases presented in the literature; only 28 cases have been reported since 2007. This case is only the second noted CCF in the literature that followed percutaneous cholecystostomy drain placement and removal. General surgery was consulted on a 60-year-old morbidly obese female, who presented to the emergency department after one week of fever, right upper quadrant (RUQ) pain, nausea, emesis, and shortness of breath. She had a history of acute cholecystitis treated with a cholecystostomy tube the year prior, but after the removal of the tube, she was lost to follow up. She was found to have a 14cm x 5cm fluctuant abdominal wall abscess in her RUQ that was treated with incision and drainage (I&D) along with ertapenem. She continued to improve until day 7 post-I&D when yellowish-green discharge was noted draining from the wound. After a negative hepatobiliary iminodiacetic acid scan, a follow-up abdominal computed tomography (CT) showed a contracted gallbladder with fistula formation underlying the abscess location, near the site of her prior cholecystostomy tube. A robotic-assisted cholecystectomy was performed, which improved the wound drainage, and the patient was discharged home 5 days later. This case is the only noted CCF presenting as a RUQ abscess after cholecystostomy drain placement. The patient lacks follow up after the removal of her percutaneous drain and continued inflammation in the gallbladder provided perfect nidus for the fistula formation. As seen in other CCF patients, cholecystectomy is the treatment of choice, and this case was successfully treated via robotic-assisted cholecystectomy with adhesiolysis.
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- 2019
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46. SAT-331 Elucidating the Role of Breast Cancer Specific GATA3 Mutation in Estrogen Receptor Positive Breast Cancer
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Paraic A. Kenny, Natasha Emmanuel, Kristopher A. Lofgren, and David R. Meier
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business.industry ,Endocrinology, Diabetes and Metabolism ,GATA3 ,Estrogen receptor ,Tumor Biology of Breast and Prostate Cancers ,medicine.disease ,Breast cancer ,Text mining ,Mutation (genetic algorithm) ,medicine ,Cancer research ,Tumor Biology ,Breast cancer specific ,business - Abstract
Approximately 266,000 women will be newly diagnosed with invasive breast cancer in the US this year, making it the most prevalent cancer in females, resulting in a 1 in 8 lifetime risk. Many of these tumors are of the hormone receptor positive luminal subtype, with 60-80% expressing the estrogen and/or progesterone receptor (ER+/PR+). The transcription factor GATA3 is expressed in the luminal epithelial cells of the mammary gland and is required for mammary development and luminal cell differentiation. Its deletion from the gland results in defects affecting the tightly regulated processes of terminal end bud formation, ductal elongation, and lactation. GATA3 is involved in a positive cross-regulatory loop with ER-alpha expression, and as such, GATA3 is highly expressed in most ER+ breast cancers and is required for breast cancer cell line responses to estradiol. Mutations in GATA3 are observed in approximately 15% of ER+ breast tumors, behind only PIK3CA and TP53 mutation in frequency, and the median tumor onset is eight years earlier than in ER+ tumors without GATA3 mutation. Analysis of TCGA breast tumors illustrated that most mutations cluster to the C-terminal end of GATA3, suggesting a selective advantage for expressing a significant portion of the wild-type protein. Previous studies have relied on xenografts in immunocompromised mice to characterize the effects of GATA3 mutations on tumor biology. We developed a transgenic mouse expressing a hotspot frameshift mutation at GATA3 codon 335 (GATA3335fs) in the mammary gland. These mice did not develop spontaneous mammary tumors; however, they do exhibit hyperproliferative phenotypes in the mammary epithelium that are recapitulated in breast cancer cell lines and xenografts also expressing the GATA3335fs protein, findings consistent with an active role for mutant GATA3 proteins in regulating mammary cell proliferation. We have used integrated gene expression and ChIP-Seq profiling to demonstrate that these zinc-finger deleted proteins retain the ability to associate with the genome by tethering to complexes associated with FOXA1 and AP-2gamma recognition motifs, where they modulate the expression of adjacent genes. Continuous exposure to a medroxyprogesterone acetate (MPA) depot induces ER+/PR+ mammary tumors at an 80% incidence in wild-type mice with a median latency of one-year. This study follows a cohort of our recently described MMTV-GATA3335fs transgenic mouse in a long-term MPA driven mammary tumorigenesis protocol. Given the requirement for GATA3 in ER-alpha expression and the estradiol response, this experimental model will provide insight into the biology of ER driven tumorigenesis and whether and how GATA3 mutation plays a role in this process. This study was supported by the Gundersen Medical Foundation and a Peter T. Rowley Breast Cancer Research Grant from the New York State Dept. of Health.
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- 2019
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47. An Aggressive Diffuse Supraorbital Mass
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Michael R. Pascolini, Cang T. Nguyen, and Daniel H Lofgren
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Male ,Frontal sinus ,medicine.diagnostic_test ,business.industry ,Adenocarcinoma, Sebaceous ,Computed tomography ,Anatomy ,medicine.disease ,Diagnosis, Differential ,medicine.anatomical_structure ,Fatal Outcome ,Otorhinolaryngology ,medicine ,Humans ,Surgery ,Pott's puffy tumor ,Basal cell carcinoma ,Mucocele ,Eyelid ,Sebaceous Gland Neoplasms ,Orbit (control theory) ,Facial Neoplasms ,business ,Epithelioid cell ,Aged - Published
- 2019
48. Burn and thoracic trauma alters fracture healing, systemic inflammation, and leukocyte kinetics in a rat model of polytrauma
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Brady J. Hurtgen, Joshua J. Avila, Lauren H. Mangum, Joseph C. Wenke, and Alicia L. Lofgren
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Male ,lcsh:Diseases of the musculoskeletal system ,Thoracic Injuries ,medicine.medical_treatment ,Nonunion ,Inflammation ,Bone healing ,Wounds, Nonpenetrating ,Osteotomy ,Systemic inflammation ,Rats, Sprague-Dawley ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Leukocytes ,medicine ,Animals ,Orthopedics and Sports Medicine ,Fracture Healing ,030203 arthritis & rheumatology ,030222 orthopedics ,Extremity fracture ,Multiple Trauma ,business.industry ,Polytrauma ,Bone fracture ,medicine.disease ,Rats ,lcsh:RD701-811 ,Disease Models, Animal ,Kinetics ,Anesthesia ,Surgery ,lcsh:RC925-935 ,medicine.symptom ,Burns ,business ,Wound healing ,Research Article - Abstract
Background Singular traumatic insults, such as bone fracture, typically initiate an appropriate immune response necessary to restore the host to pre-insult homeostasis with limited damage to self. However, multiple concurrent insults, such as a combination of fracture, blunt force trauma, and burns (polytrauma), are clinically perceived to result in abnormal immune response leading to inadequate healing and resolution. To investigate this phenomenon, we created a model rat model of polytrauma. Methods To investigate relationship between polytrauma and delayed healing, we created a novel model of polytrauma in a rat which encompassed a 3-mm osteotomy, blunt chest trauma, and full-thickness scald burn. Healing outcomes were determined at 5 weeks where the degree of bone formation at the osteotomy site of polytrauma animals was compared to osteotomy only animals (OST). Results We observed significant differences in the bone volume fraction between polytrauma and OST animals indicating that polytrauma negatively effects wound healing. Polytrauma animals also displayed a significant decrease in their ability to return to pre-injury weight compared to osteotomy animals. Polytrauma animals also exhibited significantly altered gene expression in osteogenic pathways as well as the innate and adaptive immune response. Perturbed inflammation was observed in the polytrauma group compared to the osteotomy group as evidenced by significantly altered white blood cell (WBC) profiles and significantly elevated plasma high-mobility group box 1 protein (HMGB1) at 6 and 24 h post-trauma. Conversely, polytrauma animals exhibited significantly lower concentrations of plasma TNF-alpha (TNF-α) and interleukin 6 (IL-6) at 72 h post-injury compared to OST. Conclusions Following polytrauma with burn injury, the local and systemic immune response is divergent from the immune response following a less severe singular injury (osteotomy). This altered immune response that follows was associated with a reduced capacity for wound healing. Electronic supplementary material The online version of this article (10.1186/s13018-019-1082-4) contains supplementary material, which is available to authorized users.
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- 2019
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49. The Association between Physical Activity and Metabolic Syndrome in Older Adults with Obesity
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Steven A. Cohen, Mary L. Greaney, Michael J. Delmonico, Furong Xu, Geoffrey W. Greene, and Ingrid E. Lofgren
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medicine.medical_specialty ,National Health and Nutrition Examination Survey ,030204 cardiovascular system & hematology ,Logistic regression ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Environmental health ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Exercise ,Aged ,Metabolic Syndrome ,business.industry ,Confounding ,General Medicine ,Middle Aged ,medicine.disease ,Rheumatology ,Blood pressure ,Cross-Sectional Studies ,Metabolic syndrome ,business - Abstract
Background: Physical activity reduces the likelihood of developing metabolic syndrome (MetS). However, the association between different physical activity levels and MetS remains unclear in older adults with obesity. Methods: This cross-sectional study used four waves of data (2007-2008, 2009-2010, 2011-2012, 2013-2014) from two datasets: The National Health and Nutrition Examination Survey and United Sates Department of Agriculture’s Food Patterns Equivalents Database. The sample included adults 60+ years of age (n= 613) with obesity who had physical activity and MetS data. Physical activity was assessed using the Global Physical Activity Questionnaire and categorized into three physical activity levels (low, medium, and high); and medium or high physical activity levels are aligned with or exceed current physical activity recommendations. Participants were classified as having MetS using a commonly agreed upon definition. Multiple logistic regression models examined the association between the three physical activity levels and MetS risk factors and MetS. All analyses adjusted for potential confounding variables and accounted for complex sampling. Results: Of 613 respondents, 72.1% (n=431) were classified as having MetS, and 44.3% (n = 263) had not met physical activity recommendations. Participants with high levels of physical activity had a lower risk of MetS (OR = 0.31, 95%CI: 0.13, 0.72) and more healthful levels of high-density lipoprotein cholesterol (OR = 0.39, 95%CI: 0.18, 0.84), blood pressure (OR = 0.39, 95%CI: 0.20, 0.77), fasting glucose (OR = 0.34, 95%CI: 0.15, 0.78) than participants categorized as having low physical activity. Conclusions: Physical activity is associated with lower risk of MetS only for participants with the highest level of physical activity, which suggests that physical activity dosage is important to reduce MetS risk in older adults with obesity.
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- 2019
50. Diet Quality and Social Engagement of People With Parkinson’s Disease and Their Informal Caregivers
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Dara L. LoBuono, Matthew J. Delmonico, Skye N. Leedahl, Ingrid E. Lofgren, Furong Xu, and Angelique Szymanski
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Gerontology ,Nutrition and Dietetics ,Parkinson's disease ,Diet quality ,medicine ,Medicine (miscellaneous) ,medicine.disease ,Social engagement ,Psychology ,Neuroscience/Nutrition and the Brain ,Food Science - Abstract
OBJECTIVES: To describe and compare the diet quality and social engagement of people with Parkinson's disease (PwPD) and their informal caregivers (ICG). To explore relationships in diet quality and social engagement activities. METHODS: Forty participants (20PwPD, 20ICG) were assessed. They rated their participation in seven social activities (visiting friends, social groups, social events, group exercise, educational courses, paid and volunteer work) on a scale of 0–3 (never, rarely, sometimes, often). Diet quality was assessed using Healthy Eating Index (HEI) 2015 scores (ranged from 0–100). Descriptive statistics were reported. Pearson Chi-Square analysis compared social engagement activities between PwPD and ICG. Spearman correlations explored the association between diet quality and social engagement variables. RESULTS: Mean age of participants was 68.05 ± 11.2 yr, and 57.5% were female. Mean HEI-2015 score was 58.2 ± 11.4, with no difference in scores between ICG and PwPD. Half of participants (PwPD = 9, ICG = 11) reported participating in volunteer work at least once a month, and 72.5% (PwPD = 14, ICG = 15) attended social groups at least once a month. Only 30% (PwPD = 6, ICG = 6) reported taking education courses at least monthly. Eighty % of PwPD and 35% of ICG attended group exercise classes at least once a week. PwPD were more likely to participate in group exercise programs than ICG (P = 0.03). There was no association between diet quality and social engagement variables. There was a positive association between being involved in social groups and volunteering (r = 0.3, P = 0.03), taking courses (r = 0.4, P = 0.02), and visiting friends (r = 0.4, P = 0.01). A positive association was found between visiting friends and paid community work (r = 0.3, P = 0.04) and between volunteer work and taking educational courses (r = 0.5, P = 0.002). CONCLUSIONS: PwPD and ICG have low diet quality, but are engaged in a variety of social activities. Although no association between diet quality and social engagement, future research should explore if relationships exist in a larger, more diverse sample to understand how involvement in these activities can impact diet quality and quality of life. FUNDING SOURCES: There was no external funding for this study.
- Published
- 2021
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