108 results on '"Canning M"'
Search Results
2. Hydrolases in the digestive tracts of some Echinoderms
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Johnson, D.B., primary, Rushe, B., additional, Glynn, B., additional, Canning, M., additional, and Smyth, T., additional
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- 2020
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3. Sugar and gender relations in Malawi.
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Canning, M., primary
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- 2017
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4. Selection of cytotoxicity markers for the screening of new chemical entities in a pharmaceutical context: A preliminary study using a multiplexing approach
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Gerets, H.H.J., Hanon, E., Cornet, M., Dhalluin, S., Depelchin, O., Canning, M., and Atienzar, F.A.
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- 2009
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5. UbcD4, a ubiquitin-conjugating enzyme in Drosophila melanogaster expressed in pole cells
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Canning, M., Kirby, R., and Finnegan, D.
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- 2002
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6. 444 Assessing Admission Medication Prescription Accuracy With the Addition of a Pharmacist to the Cardiac Investigations Unit Clinic
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Oldham, C., primary, Canning, M., additional, Hayward, E., additional, and Dunn, E., additional
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- 2020
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7. Maternal immune responses in murine pregnancy
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Canning, M. B.
- Subjects
610 ,Medicine - Published
- 1986
8. Stereoselective renal tubular secretion of levocetirizine and dextrocetirizine, the two enantiomers of the H1-antihistamine cetirizine
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Strolin Benedetti, M., Whomsley, R., Mathy, F.-X., Jacques, P., Espie, P., and Canning, M.
- Published
- 2008
9. Immunosuppressive drugs that inhibit calcineurin decrease DNA repair and reduce apoptosis after UVB exposure in human keratinocytes: 109
- Author
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Canning, M T, Nay, S L, Pena, A V, Damaghi, N, Brown, D A, and Yarosh, D B
- Published
- 2005
10. Anti-inflammatory activity in skin by indole quinazoline alkaloids from traditional Chinese medicine: 045
- Author
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Yarosh, D B, Canning, M T, Nay, S L, Pena, A V, and Brown, D A
- Published
- 2005
11. A bicyclic monoterpene diol mixture stimulates release of nitric oxide from skin cells, increases microcirculation and elevates skin temperature: 013
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Brown, D A, Canning, M T, and Yarosh, D B
- Published
- 2005
12. Medical implications of DNA repair
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Yarosh, D., Canning, M., Galvin, J., and Brown, D.
- Published
- 2003
13. An abnormal adherence of monocytes to fibronectin in thyroid autoimmunity has consequences for cell polarization and the development of veiled cells
- Author
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Canning, M. O., Grotenhuis, K., De Haan-Meulman, M., De Wit, H. J., Berghout, A., and Drexhage, H. A.
- Published
- 2001
14. Wastewater Collection System Optimization for Cost-Effective and Sustainable Capital Improvement Planning
- Author
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Wilson, J. I., primary, Smith, P. J., primary, Witt, A., primary, and Canning, M. E., primary
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- 2010
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15. ALD-Al2O3 as an Inter-Poly Dielectric for a Product Demonstrator in a Proven eFlash Technology
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Shum, D., primary, Jaschke, G., additional, Canning, M., additional, Kakoschke, R., additional, Duschl, R., additional, Sikorski, R., additional, Erler, F., additional, Stiftinger, M., additional, Duch, A., additional, Power, J. R., additional, Tempel, G., additional, Strenz, R., additional, and Allinger, R., additional
- Published
- 2009
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16. Drug metabolism in the paediatric population and in the elderly
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BENEDETTI, M, primary, WHOMSLEY, R, additional, and CANNING, M, additional
- Published
- 2007
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17. Determination of Phospholipidosis Potential Based on Gene Expression Analysis in HepG2 Cells
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Atienzar, F., primary, Gerets, H., additional, Dufrane, S., additional, Tilmant, K., additional, Cornet, M., additional, Dhalluin, S., additional, Ruty, B., additional, Rose, G., additional, and Canning, M., additional
- Published
- 2006
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18. A short method to obtain high yields of dendritic cells from human peripheral blood monocytes
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Canning, M, primary
- Published
- 1997
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19. Stereoselective renal tubular secretion of levocetirizine and dextrocetirizine, the two enantiomers of the H1-antihistamine cetirizine.
- Author
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Strolin Benedetti, M., Whomsley, R., Mathy, F.-X., Jacques, P., Espie, P., and Canning, M.
- Subjects
BIOLOGICAL transport ,SECRETION ,ENANTIOMERS ,DRUG interactions ,GLOMERULAR filtration rate ,LIQUID scintillation counting ,BLOOD proteins ,BLOOD plasma - Abstract
Competition for uptake and/or efflux transporters can be responsible for drug interactions. Cetirizine is mainly eliminated unchanged in urine through both glomerular filtration and tubular secretion. The aim of this study was to investigate whether the eutomer, levocetirizine, and the distomer, dextrocetirizine, have a similar tubular secretion. The renal clearance associated with tubular secretion was calculated from the renal clearance of levocetirizine and dextrocetirizine obtained in a study in healthy volunteers. The values of the unbound fraction in plasma were obtained in an in vitro study of the binding of
14 C-cetirizine and14 C-levocetirizine to human plasma proteins using equilibrium dialysis and chiral high-performance liquid chromatography (HPLC) with on-line liquid scintillation counting. The unbound fraction was 0.074 for levocetirizine and 0.141 for dextrocetirizine. The tubular secretion of dextrocetirizine (44.5 mL/min) is higher than that of levocetirizine (23.1 mL/min), which may have consequences for drug interactions at the renal level. The higher tubular secretion for dextrocetirizine may be due to the higher free fraction available for secretion or to a higher affinity for (a) renal transporter(s) mediating the secretion pathway. [ABSTRACT FROM AUTHOR]- Published
- 2008
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20. Opposing effects of dehydroepiandrosterone and dexamethasone on the generation of monocyte-derived dendritic cells.
- Author
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Canning, M. O., Grotenhuis, K., de Wit, H. J., and Drexhage, H. A.
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- 2000
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21. Inducibility of aryl hydrocarbon hydroxylase in cultured human lymphocytes: a study of repeatability.
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Fletcher, K A, Evans, D A, and Canning, M V
- Abstract
Modifications to the method for estimating aryl hydrocarbon hydroxylase (AHH) activity in cultured human lymphocytes are described. Despite the improvements to the technique it was not possible to show significant 'repeatability' of values for AHH induction over a period of 2 weeks or more. Significant repeatability could be seen when a blood sample from each subject was split into duplicates. However, this level of repeatability was low when considered for quantitative genetics purposes. Possible reasons for the poor repeatability have been discussed. [ABSTRACT FROM PUBLISHER]
- Published
- 1978
22. Hormonal regulation of immunoglobulins and plasma cells in the mouse uterus
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Canning, M. B. and Billington, W. D.
- Abstract
Immunoperoxidase staining techniques were used to identify secreted immunoglobulin G (IgG) and IgA and the distribution of IgG- and IgA-producing cells in the uteri of mice during the oestrous cycle or after ovariectomy followed by the administration of ovarian hormones.The most extensive staining for IgA and IgG in the myometrium and endometrium occurred during pro-oestrus and plasma cells of both isotype were concentrated around the uterine glands and lumen in high numbers at this time. Staining for IgA and IgG was least prominent during dioestrus, the stage of the oestrous cycle when plasma cells were present in the lowest numbers. After ovariectomy and hormone treatment, the highest numbers of uterine plasma cells were seen in mice injected with oestradiol alone and the lowest in those injected with progesterone alone. In mice treated with both hormones the number of plasma cells was comparable to that seen in mice treated with progesterone alone.These results indicate that oestradiol plays a significant role in regulating uterine IgA and IgG and suggest that the increase in the numbers of plasma cells during the oestrous cycle is due to the action of oestradiol at the uterine level.
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- 1983
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23. A survey of rural and urban family physicians: Analysis of spasticity health literacy and availability of appropriate spasticity care
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Canning, M., Chetan Phadke, Ismail, F., and Boulias, C.
24. Electrophoresis of glucose-6-phosphate and 6-phosphogluconate dehydrogenases in erythrocytes from malaria-infected animals
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Fletcher, K. A., primary, Canning, M. V., additional, and Theakston, R. D. G., additional
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- 1977
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25. Identification and characterization of a cDNA encoding ribosomal protein S12 from Xenopus laevis
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Seery, L. T., Schoenberg, D. R., Canning, M. E., and Whitehead, A. S.
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- 1994
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26. Peptide hydrolases in holothurian intestinal mucosa
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McGettigan, S., Canning, M., O'Cuinn, G., and Johnson, D.B.
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- 1981
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27. Women veterans' perceptions and decision-making about Veterans Affairs health care.
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Washington DL, Kleimann S, Michelini AN, Kleimann KM, Canning M, Washington, Donna L, Kleimann, Susan, Michelini, Ann N, Kleimann, Kristin M, and Canning, Mark
- Abstract
The increase in women in the military is reshaping the veteran population and Veterans Affairs (VA) health care delivery imperatives. To determine women veterans' perspectives and decision-making about VA health care use, we conducted six focus groups (four VA users and two nonusers) and identified key themes. Barriers to VA use for both VA users and nonusers included lack of information about eligibility and available services. Nonusers often assumed the VA did not provide women's health care. All groups emphasized they required a health care system focused on quality and sensitivity to women's health issues. However, users and nonusers differed in perceptions of VA quality. VA environment and quality concerns led many women to limit their VA use to women's clinics. These qualitative findings provide a context to highlight where interventions and policies suggested by quantitative findings should focus. Dissemination of accurate information about VA eligibility and services, and continued responsiveness to women's perceptions of care are indicated. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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28. Shaping corporate social responsibility management and reporting through engagement: The role of advocacy organisations
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Clune, C., O'Dwyer, Brendan, Canning, M., Accounting (ABS, FEB), and Faculteit Economie en Bedrijfskunde
- Abstract
Advocacy organisations have traditionally played a prominent role in shaping corporate social responsibility (CSR) management and reporting practices through organisational-level and institutional-level engagement. Recent years have seen advocacy organisations expand the nature and content of their engagement interactions by (1) endeavouring to influence the emergence of institutional-level CSR frameworks and (2) placing enhanced emphasis on challenging the nature of companies’ implementation of CSR frameworks through direct engagement processes. Together, these actions have sought to guide companies’ adoption of CSR management and reporting mechanisms in order to ensure greater accountability is discharged for the social and environmental impact of their economic activities. This thesis comprises three research papers and two case studies that examine how two influential advocacy organisations sought to shape the nature and content of the CSR management and reporting mechanisms implemented by companies in the United Kingdom and The Netherlands. The research papers are interpreted and theoretically framed using aspects of Bourdieu’s theory of practice, the concepts of strategic frames and frame resonance, and institutional work. The thesis provides several empirical contributions that deepen our understanding of the role advocacy organisations play during processes of organisational-level and institutional-level engagement and the role forms of accounting play therein. The thesis also offers a number of theoretical contributions by advancing the application of the three aforementioned theoretical framings within the accounting and organisational studies literature streams.
- Published
- 2017
29. Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments.
- Author
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Ablan M, Canning M, Koski L, Landsman L, Stapleton GS, Nichols M, and Robyn M
- Subjects
- Animals, Humans, United States epidemiology, Needs Assessment, State Government, Agriculture, Milk, Disease Outbreaks, Pasteurization, Foodborne Diseases epidemiology, Foodborne Diseases prevention & control
- Abstract
Aims: Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk., Methods and Results: We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state., Conclusions: The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA.)
- Published
- 2024
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30. Comparing Individual and Community-level Characteristics of People with Ground Beef-associated Salmonellosis and Other Ground Beef Eaters: A Case-control Analysis.
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Salah Z, Canning M, Rickless D, Devine C, Buckman R, Payne DC, and Marshall KE
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- Humans, Case-Control Studies, Male, Female, Adult, Middle Aged, Retrospective Studies, Adolescent, Young Adult, Salmonella Food Poisoning epidemiology, Cattle, Animals, Disease Outbreaks, Salmonella Infections epidemiology, Child, Aged, Child, Preschool, United States, Red Meat, Salmonella
- Abstract
Salmonella is estimated to be the leading bacterial cause of U.S. domestically acquired foodborne illness. Large outbreaks of Salmonella attributed to ground beef have been reported in recent years. The demographic and sociodemographic characteristics of infected individuals linked to these outbreaks are poorly understood. We employed a retrospective case-control design; case-patients were people with laboratory-confirmed Salmonella infections linked to ground beef-associated outbreaks between 2012 and 2019, and controls were respondents to the 2018-2019 FoodNet Population Survey who reported eating ground beef and denied recent gastrointestinal illness. We used county-level CDC/ATSDR Social Vulnerability Index (SVI) to compare case-patient and controls. Case-patient status was regressed on county-level social vulnerability and individual-level demographic characteristics. We identified 376 case-patients and 1,321 controls in the FoodNet sites. Being a case-patient was associated with increased overall county-level social vulnerability (OR: 1.21 [95% CI: 1.07-1.36]) and socioeconomic vulnerability (OR: 1.24 [1.05-1.47]) when adjusted for individual-level demographics. Case-patient status was not strongly associated with the other SVI themes of household composition and disability, minority status and language, and housing type and transportation. Data on individual-level factors such as income, poverty, unemployment, and education could facilitate further analyses to understand this relationship., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)
- Published
- 2024
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31. Effect of Ground Beef Irradiation on Annual Nontyphoidal Salmonella and Escherichia coli O157 Burden and Direct Healthcare Costs in the United States: A Simulation Study.
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Khan MA, Collier SA, Ablan M, Canning M, Robyn M, and Marshall KE
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- Animals, Cattle, United States, Food Microbiology, Salmonella radiation effects, Health Care Costs, Colony Count, Microbial, Escherichia coli O157, Meat Products
- Abstract
Over 20% of E. coli O157 illnesses and over 5% of Salmonella illnesses are estimated to be attributable to beef consumption in the United States. Irradiating ground beef is one possible method to reduce disease burden. We simulated the effect of ground beef irradiation on illnesses, hospitalizations, deaths, and direct healthcare costs from ground beef-associated E. coli O157 and Salmonella illnesses in the United States. To estimate the fraction of illnesses, hospitalizations, deaths, and direct healthcare costs preventable by ground beef irradiation, we multiplied the disease burden attributable to ground beef; the estimated percentage of ground beef sold that is not currently irradiated; the percentage of unirradiated ground beef that would be irradiated; and the percentage reduction in risk of illness after irradiation. We multiplied this fraction by estimates of burden and direct healthcare costs to calculate the numbers or amounts averted. Model inputs were obtained from the literature and expert opinion. We used Monte Carlo simulation to incorporate uncertainty in inputs into model estimates. Simulation outcomes were summarized with means and 95% uncertainty intervals (UI). Irradiating 50% of the currently unirradiated ground beef supply would avert 3,285 (95% UI: 624-9,977) E. coli O157 illnesses, 135 (95% UI: 24-397) hospitalizations, 197 (95% UI: 34-631) hemolytic uremic syndrome cases, 2 (95% UI: 0-16) deaths, and $2,972,656 (95% UI: $254,708-$14,496,916) in direct healthcare costs annually. For Salmonella, irradiation would avert 20,308 (95% UI: 9,858-38,903) illnesses, 400 (95% UI: 158-834) hospitalizations, 6 (95% UI: 0-18) deaths, and $7,318,632 (95% UI: $1,436,141-$26,439,493) in direct healthcare costs. Increasing ground beef irradiation could reduce E. coli O157 and Salmonella burden in the United States. Additional studies should assess whether targeted irradiation of higher-risk ground beef products could prevent similar numbers of illnesses with less total product irradiated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Inc.)
- Published
- 2024
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32. Examining Age and Food Irradiation Knowledge as Influential Factors on Purchase of Irradiated Foods - United States, August 2022.
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Crawford TN, Ablan M, Canning M, Marshall KE, and Robyn M
- Abstract
Foodborne illness affects approximately 48 million Americans annually. Food irradiation is a safe and effective way to kill bacteria and extend a product's shelf-life. However, challenges to wider implementation of this technology include consumer hesitancy stemming from misconceptions about safety and lack of knowledge of irradiation's benefits. Research has shown that consumers are more willing to accept irradiation if informed about its safety. Due to increases in multistate foodborne outbreaks and consumers' growing concern and expectation of food safety, it is an opportune time to reconsider irradiation as a food safety tool. Consumer attitudes toward food safety differ by demographic characteristics; however, research on the association of demographic factors with attitudes on food irradiation are limited. Data collected from a survey (N=1,009) conducted in August 2022 were analyzed to describe the relationship between age and food irradiation knowledge as influential factors to purchase irradiated foods. More than half (56%) of respondents reported that learning more about irradiation would likely influence purchasing decisions; older adults were more knowledgeable about food irradiation. These findings suggest that age could be an important factor to consider when tailoring messaging as a prevention strategy around the benefits of food irradiation.
- Published
- 2024
33. Monitoring of Triple Negative Breast Cancer After Neoadjuvant Chemotherapy.
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Aldrich J, Canning M, and Bhave M
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- Humans, Female, Neoadjuvant Therapy methods, Neoplasm Recurrence, Local prevention & control, Neoplasm Recurrence, Local drug therapy, Progression-Free Survival, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Triple Negative Breast Neoplasms drug therapy, Breast Neoplasms drug therapy
- Abstract
Triple negative breast cancer (TNBC) is an aggressive disease with a poor prognosis that disproportionately affects young women and African Americans, and represents a major unmet need in the field. TNBCs display a more aggressive growth pattern with an increased risk of advanced disease and high recurrence risk in patients with early stage TNBC. The addition of immunotherapy to chemotherapy for the treatment of patients with early stage TNBC in the (neo) adjuvant setting per the pivotal KEYNOTE 522 significantly improved pCR rates. Despite this advancement, however, approximately 35% of patients had residual disease at the time of surgery and reduced event free survival. Further techniques to assess for molecular residual disease after completion of neoadjuvant chemotherapy (NAC) may allow us to identify patients at high risk of relapse who may benefit from salvage adjuvant systemic therapy, while also potentially de-escalating treatment in those achieving a molecular complete response., (Copyright © 2023. Published by Elsevier Inc.)
- Published
- 2023
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34. CDK4/6 Inhibition in the Metastatic Setting: Where Are We Headed?
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Sakach E, Keskinkilic M, Wood S, Canning M, and Kalinsky K
- Subjects
- Humans, Female, Quality of Life, Oncogenes, Molecular Targeted Therapy, Receptor, ErbB-2, Cyclin-Dependent Kinase 4, Cyclin-Dependent Kinase 6, Antineoplastic Combined Chemotherapy Protocols adverse effects, Breast Neoplasms drug therapy, Neoplasms, Second Primary
- Abstract
Opinion Statement: Hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER-2-) metastatic breast cancer (MBC) is the most common subtype of breast cancer. Due to therapeutic advances with molecularly targeted therapies, the prognosis for patients with metastatic disease has improved significantly. The advent of CDK4/6 inhibitors (CDK4/6i) has changed the treatment paradigm for patients with HR+HER2-MBC. CDK4/6i allowed for marked improvement in overall survival, delaying the time to chemotherapy initiation, and improved quality of life for our patients. Efforts are now focused on the best approach(es) for patients after progression on CDK4/6i. Can we further harness the benefit of CDK4/6i in novel combinations at the time of progression? Should we continue CDK4/6i or proceed other novel agents or endocrine therapies? As we advance our treatment strategies for HR+HER2-MBC, there is no longer a one-size-fits-all model, but instead a multifaceted and personalized approach lending to improved outcomes for our patients., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
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35. The impact of transition to a digital hospital on medication errors (TIME study).
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Engstrom T, McCourt E, Canning M, Dekker K, Voussoughi P, Bennett O, North A, Pole JD, Donovan PJ, and Sullivan C
- Abstract
Digital transformation in healthcare improves the safety of health systems. Within our health service, a new digital hospital has been established and two wards from a neighbouring paper-based hospital transitioned into the new digital hospital. This created an opportunity to evaluate the impact of complete digital transformation on medication safety. Here we discuss the impact of transition from a paper-based to digital hospital on voluntarily reported medication incidents and prescribing errors. This study utilises an interrupted time-series design and takes place across two wards as they transition from a paper to a digital hospital. Two data sources are used to assess impacts on medication incidents and prescribing errors: (1) voluntarily reported medication incidents and 2) a chart audit of medications prescribed on the study wards. The chart audit collects data on procedural, dosing and therapeutic prescribing errors. There are 588 errors extracted from incident reporting software during the study period. The average monthly number of errors reduces from 12.5 pre- to 7.5 post-transition (p < 0.001). In the chart audit, 5072 medication orders are reviewed pre-transition and 3699 reviewed post-transition. The rates of orders with one or more error reduces significantly after transition (52.8% pre- vs. 15.7% post-, p < 0.001). There are significant reductions in procedural (32.1% pre- vs. 1.3% post-, p < 0.001), and dosing errors (32.3% pre- vs. 14% post-, p < 0.001), but not therapeutic errors (0.6% pre- vs. 0.7% post-, p = 0.478). Transition to a digital hospital is associated with reductions in voluntarily reported medication incidents and prescribing errors., (© 2023. The Author(s).)
- Published
- 2023
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36. Effectiveness of an educational intervention targeting homophobic language use by young male athletes: a cluster randomised controlled trial.
- Author
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Denison E, Faulkner N, O'Brien KS, Jeanes R, and Canning M
- Subjects
- Adolescent, Humans, Male, Young Adult, Adult, Australia, Educational Status, Athletes
- Abstract
Objective: Homophobic language is common in male sport and associated with negative physical and mental health outcomes for all sport participants, but particularly for gay or bisexual youth populations. Evidence-based interventions are needed to reduce such language and mitigate harm. This study evaluated the effectiveness of a short social-cognitive educational intervention delivered by professional rugby union players in youth sport., Methods: In a two-arm, cluster randomised controlled trial, 13 Australian youth rugby teams from 9 clubs (N=167, ages 16-20, mean 17.9) were randomised into intervention or control groups. Professional rugby players delivered the intervention in-person. Frequency of homophobic language use was measured 2 weeks before and 2 weeks after the intervention. Hypothesised factors underpinning homophobic language were also measured, including descriptive (other people use), prescriptive and proscriptive injunctive norms (approval/disapproval by others), and attitudes towards the acceptability of homophobic language., Results: At baseline, 49.1% of participants self-reported using homophobic language in the past 2 weeks and 72.7% reported teammates using homophobic language. Significant relationships were found between this behaviour and the hypothesised factors targeted by the intervention. However, generalised estimating equations found the intervention did not significantly reduce homophobic language, or alter the associated norms and attitudes, relative to controls., Conclusion: Use of professional rugby athletes to deliver education on homophobic language was not effective. Other approaches to reduce homophobic language (and other forms of discrimination) such as peer-to-peer education, and enforcement of policies prohibiting specific language by coaches, should be explored., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
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37. Salmonella Outbreaks Linked to Beef, United States, 2012-2019.
- Author
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Canning M, Birhane MG, Dewey-Mattia D, Lawinger H, Cote A, Gieraltowski L, Schwensohn C, Tagg KA, Francois Watkins LK, Park Robyn M, and Marshall KE
- Subjects
- Animals, United States epidemiology, Humans, Cattle, Salmonella, Food Contamination, Disease Outbreaks, Foodborne Diseases epidemiology, Anti-Infective Agents
- Abstract
The Centers for Disease Control and Prevention (CDC) has identified nontyphoidal Salmonella as one of the top five pathogens contributing to foodborne illnesses in the United States. Beef continues to be a common source of Salmonella outbreaks, despite the implementation of interventions at slaughter and processing facilities to reduce contamination of beef. We described Salmonella outbreaks linked to beef in the United States during 2012-2019, examined trends, and identified potential targets for intervention and prevention strategies. We queried CDC's Foodborne Disease Outbreak Surveillance System (FDOSS) for all foodborne nontyphoidal Salmonella outbreaks linked to beef as the single contaminated ingredient or implicated food, with the date of first illness onset from 2012 to 2019. Information on antimicrobial resistance (AR) for outbreak-related isolates was obtained from CDC's National Antimicrobial Resistance Monitoring System (NARMS). We calculated the number of outbreaks, outbreak-related illnesses, hospitalizations, and deaths overall, by beef processing category and Salmonella serotype. During 2012-2019, 27 Salmonella outbreaks were linked to beef consumption, resulting in 1103 illnesses, 254 hospitalizations, and two deaths. The most common category of beef implicated was nonintact raw, ground beef (12 outbreaks, 44%), followed by intact raw (six outbreaks, 22%). Ground beef was responsible for the most illnesses (800, 73%), both of the reported deaths, and was the source of the largest outbreak. AR data were available for 717 isolates from 25 (93%) outbreaks. Nine (36%) of these outbreaks had isolates resistant to one or more of the antibiotics tested by NARMS, of which eight (89%) contained multidrug-resistant isolates. Several outbreaks reported highlight challenges faced during investigations, areas where further research may be warranted, and opportunities to prevent future outbreaks along the farm-to-fork continuum., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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38. Analysis of the trend in Oral Anticoagulation Overdose.
- Author
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Ali O, O'Reilly A, Bacha S, Canning M, Stenson C, Williams D, and Duggan E
- Subjects
- Humans, Anticoagulants, Administration, Oral, Drug Overdose drug therapy, Atrial Fibrillation
- Abstract
Competing Interests: None declared
- Published
- 2023
39. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022.
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Farrar JL, Lewis NM, Houck K, Canning M, Fothergill A, Payne AB, Cohen AL, Vance J, Brassil B, Youngkin E, Glenn B, Mangla A, Kupferman N, Saunders K, Meza C, Nims D, Soliva S, Blouse B, Henderson T, Banerjee E, White B, Birn R, Stadelman AM, Abrego M, McLafferty M, Eberhart MG, Pietrowski M, De León SM, Creegan E, Diedhiou A, Wiedeman C, Murray-Thompson J, McCarty E, Marcinkevage J, Kocharian A, Torrone EA, Ray LC, and Payne DC
- Subjects
- Humans, Demography, Vaccination, Mpox (monkeypox) diagnosis, Mpox (monkeypox) prevention & control, Smallpox Vaccine administration & dosage
- Published
- 2023
- Full Text
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40. Demographic and Clinical Characteristics of Mpox in Persons Who Had Previously Received 1 Dose of JYNNEOS Vaccine and in Unvaccinated Persons - 29 U.S. Jurisdictions, May 22-September 3, 2022.
- Author
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Farrar JL, Lewis NM, Houck K, Canning M, Fothergill A, Payne AB, Cohen AL, Vance J, Brassil B, Youngkin E, Glenn B, Mangla A, Kupferman N, Saunders K, Meza C, Nims D, Soliva S, Blouse B, Henderson T, Banerjee E, White B, Birn R, Stadelman AM, Abrego M, McLafferty M, Eberhart MG, Pietrowski M, De León SM, Creegan E, Diedhiou A, Wiedeman C, Murray-Thompson J, McCarty E, Marcinkevage J, Kocharian A, Torrone EA, Ray LC, and Payne DC
- Subjects
- Humans, Male, Demography, United States epidemiology, Smallpox Vaccine, Mpox (monkeypox) epidemiology, Mpox (monkeypox) prevention & control
- Abstract
As of November 14, 2022, monkeypox (mpox) cases had been reported from more than 110 countries, including 29,133 cases in the United States.* Among U.S. cases to date, 95% have occurred among males (1). After the first confirmed U.S. mpox case on May 17, 2022, limited supplies of JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) were made available to jurisdictions for persons exposed to mpox. JYNNEOS vaccine was approved by the Food and Drug Administration (FDA) in 2019 as a 2-dose series (0.5 mL per dose, administered subcutaneously) to prevent smallpox and mpox disease.
† On August 9, 2022, FDA issued an emergency use authorization to allow administration of JYNNEOS vaccine by intradermal injection (0.1 mL per dose) (2). A previous report on U.S. mpox cases during July 31-September 3, 2022, suggested that 1 dose of vaccine offers some protection against mpox (3). This report describes demographic and clinical characteristics of cases occurring ≥14 days after receipt of 1 dose of JYNNEOS vaccine and compares them with characteristics of cases among unvaccinated persons with mpox and with the vaccine-eligible vaccinated population in participating jurisdictions. During May 22-September 3, 2022, among 14,504 mpox cases reported from 29 participating U.S. jurisdictions,§ 6,605 (45.5%) had available vaccination information and were included in the analysis. Among included cases, 276 (4.2%) were among persons who had received 1 dose of vaccine ≥14 days before illness onset. Mpox cases that occurred in these vaccinated persons were associated with lower percentage of hospitalization (2.1% versus 7.5%), fever, headache, malaise, myalgia, and chills, compared with cases in unvaccinated persons. Although 1 dose of JYNNEOS vaccine offers some protection from disease, mpox infection can occur after receipt of 1 dose, and the duration of protection conferred by 1 dose is unknown. Providers and public health officials should therefore encourage persons at risk for acquiring mpox to complete the 2-dose vaccination series and provide guidance and education regarding nonvaccine-related prevention strategies (4)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Emma Creegan reports receiving an honorarium for a fall 2021 speaking event at Brown University. No other potential conflicts of interest were disclosed.- Published
- 2022
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41. Reduced Risk for Mpox After Receipt of 1 or 2 Doses of JYNNEOS Vaccine Compared with Risk Among Unvaccinated Persons - 43 U.S. Jurisdictions, July 31-October 1, 2022.
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Payne AB, Ray LC, Cole MM, Canning M, Houck K, Shah HJ, Farrar JL, Lewis NM, Fothergill A, White EB, Feldstein LR, Roper LE, Lee F, Kriss JL, Sims E, Spicknall IH, Nakazawa Y, Gundlapalli AV, Shimabukuro T, Cohen AL, Honein MA, Mermin J, and Payne DC
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- Humans, Male, Homosexuality, Male, United States epidemiology, United States Food and Drug Administration, Smallpox Vaccine administration & dosage, Sexual and Gender Minorities, Mpox (monkeypox) prevention & control
- Abstract
As of October 28, 2022, a total of 28,244* monkeypox (mpox) cases have been reported in the United States during an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), administered subcutaneously as a 2-dose (0.5 mL per dose) series (with doses administered 4 weeks apart), was approved by the Food and Drug Administration (FDA) in 2019 to prevent smallpox and mpox disease (2); an FDA Emergency Use Authorization issued on August 9, 2022, authorized intradermal administration of 0.1 mL per dose, increasing the number of persons who could be vaccinated with the available vaccine supply
† (3). A previous comparison of mpox incidence during July 31-September 3, 2022, among unvaccinated, but vaccine-eligible men aged 18-49 years and those who had received ≥1 JYNNEOS vaccine dose in 32 U.S. jurisdictions, found that incidence among unvaccinated persons was 14 times that among vaccinated persons (95% CI = 5.0-41.0) (4). During September 4-October 1, 2022, a total of 205,504 persons received JYNNEOS vaccine dose 2 in the United States.§ To further examine mpox incidence among persons who were unvaccinated and those who had received either 1 or 2 JYNNEOS doses, investigators analyzed data on 9,544 reported mpox cases among men¶ aged 18-49 years during July 31-October 1, 2022, from 43 U.S. jurisdictions,** by vaccination status. During this study period, mpox incidence (cases per 100,000 population at risk) among unvaccinated persons was 7.4 (95% CI = 6.0-9.1) times that among persons who received only 1 dose of JYNNEOS vaccine ≥14 days earlier and 9.6 (95% CI = 6.9-13.2) times that among persons who received dose 2 ≥14 days earlier. The observed distribution of subcutaneous and intradermal routes of administration of dose 1 among vaccinated persons with mpox was not different from the expected distribution. This report provides additional data suggesting JYNNEOS vaccine provides protection against mpox, irrespective of whether the vaccine is administered intradermally or subcutaneously. The degree and durability of such protection remains unclear. Persons eligible for mpox vaccination should receive the complete 2-dose series to optimize strength of protection†† (5)., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.- Published
- 2022
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42. Appliances Used by Consumers to Prepare Frozen Stuffed Chicken Products - United States, May-July 2022.
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Marshall KE, Canning M, Ablan M, Crawford TN, and Robyn M
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- Humans, Animals, United States, Disease Outbreaks prevention & control, Industry, Chickens, Cooking
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Frozen stuffed breaded raw chicken products have repeatedly been implicated in Salmonella outbreaks (1). These products are partially cooked to set the breading, often making them appear cooked (2). Despite their appearance, these products need to be cooked to an internal temperature of 165°F (74°C) to ensure that they are safe to eat. Producers began implementing labeling changes in 2006 to more clearly identify these products as raw; many warn against using microwave ovens (microwaves) to prepare them and provide validated cooking instructions solely for conventional ovens (ovens) (3,4). However, outbreaks continued to occur after implementation of these labeling changes (4). To describe the demographic characteristics of persons who prepare frozen stuffed chicken products and which appliances they use to prepare them, data from a May-July 2022 representative panel survey were analyzed. Although most (82.7%) respondents used an oven as one of their cooking methods, more than one half (54.0%) of respondents also used another appliance, including 29.0% who used a microwave. Oven use was lower among respondents with household income <$25,000 (68.9%), and who lived in mobile homes or other portable types of homes (66.5%). Among respondents who reported using microwaves to cook these products, 8% reported using a microwave with ≤750 W of power, which might be insufficient to thoroughly cook such products (1,5,6). Economic and other factors might influence some groups' access to recommended cooking appliances. Companies could consider implementing additional interventions that rely less on labeling and consumer preparation practices and focus on controlling or reducing levels of Salmonella in these products, such as selling them fully cooked, or monitoring and testing Salmonella levels, to ensure safety. These findings highlight challenges consumers might face in preparing frozen stuffed chicken products safely and can guide strategies for regulatory authorities and industry to prevent outbreaks and illnesses associated with them., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
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- 2022
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43. Incidence of Monkeypox Among Unvaccinated Persons Compared with Persons Receiving ≥1 JYNNEOS Vaccine Dose - 32 U.S. Jurisdictions, July 31-September 3, 2022.
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Payne AB, Ray LC, Kugeler KJ, Fothergill A, White EB, Canning M, Farrar JL, Feldstein LR, Gundlapalli AV, Houck K, Kriss JL, Lewis NM, Sims E, Smith DK, Spicknall IH, Nakazawa Y, Damon IK, Cohn AC, and Payne DC
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- Homosexuality, Male, Humans, Incidence, Male, United States epidemiology, Mpox (monkeypox) epidemiology, Mpox (monkeypox) prevention & control, Sexual and Gender Minorities, Smallpox Vaccine
- Abstract
Human monkeypox is caused by Monkeypox virus (MPXV), an Orthopoxvirus, previously rare in the United States (1). The first U.S. case of monkeypox during the current outbreak was identified on May 17, 2022 (2). As of September 28, 2022, a total of 25,341 monkeypox cases have been reported in the United States.* The outbreak has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) (3). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic), administered subcutaneously as a 2-dose (0.5 mL per dose) series with doses administered 4 weeks apart, was approved by the Food and Drug Administration (FDA) in 2019 to prevent smallpox and monkeypox infection (4). U.S. distribution of JYNNEOS vaccine as postexposure prophylaxis (PEP) for persons with known exposures to MPXV began in May 2022. A U.S. national vaccination strategy
† for expanded PEP, announced on June 28, 2022, recommended subcutaneous vaccination of persons with known or presumed exposure to MPXV, broadening vaccination eligibility. FDA emergency use authorization (EUA) of intradermal administration of 0.1 mL of JYNNEOS on August 9, 2022, increased vaccine supply (5). As of September 28, 2022, most vaccine has been administered as PEP or expanded PEP. Because of the limited amount of time that has elapsed since administration of initial vaccine doses, as of September 28, 2022, relatively few persons in the current outbreak have completed the recommended 2-dose series.§ To examine the incidence of monkeypox among persons who were unvaccinated and those who had received ≥1 JYNNEOS vaccine dose, 5,402 reported monkeypox cases occurring among males¶ aged 18-49 years during July 31-September 3, 2022, were analyzed by vaccination status across 32 U.S. jurisdictions.** Average monkeypox incidence (cases per 100,000) among unvaccinated persons was 14.3 (95% CI = 5.0-41.0) times that among persons who received 1 dose of JYNNEOS vaccine ≥14 days earlier. Monitoring monkeypox incidence by vaccination status in timely surveillance data might provide early indications of vaccine-related protection that can be confirmed through other well-controlled vaccine effectiveness studies. This early finding suggests that a single dose of JYNNEOS vaccine provides some protection against monkeypox infection. The degree and durability of such protection is unknown, and it is recommended that people who are eligible for monkeypox vaccination receive the complete 2-dose series., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.- Published
- 2022
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44. Patient and Caregiver Prioritization of Palliative and End-of-Life Cancer Care Quality Measures.
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O'Hanlon CE, Giannitrapani KF, Lindvall C, Gamboa RC, Canning M, Asch SM, Garrido MM, Walling AM, and Lorenz KA
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- Caregivers, Death, Humans, Pain, Palliative Care methods, Quality Indicators, Health Care, Neoplasms therapy, Terminal Care
- Abstract
Background: Development and prioritization of quality measures typically relies on experts in clinical medicine, but patients and their caregivers may have different perspectives on quality measurement priorities., Objective: To inform priorities for health system implementation of palliative cancer and end-of-life care quality measures by eliciting perspectives of patients and caregivers., Design: Using modified RAND-UCLA Appropriateness Panel methods and materials tailored for knowledgeable lay participants, we convened a panel to rate cancer palliative care process quality measure concepts before and after a 1-day, in-person meeting., Participants: Nine patients and caregivers with experience living with or caring for patients with cancer., Main Measures: Panelists rated each concept on importance for providing patient- and family-centered care on a nine-point scale and each panelist nominated five highest priority measure concepts ("top 5")., Key Results: Cancer patient and caregiver panelists rated all measure concepts presented as highly important to patient- and family- centered care (median rating ≥ 7) in pre-panel (mean rating range, 6.9-8.8) and post-panel ratings (mean rating range, 7.2-8.9). Forced choice nominations of the "top 5" helped distinguish similarly rated measure concepts. Measure concepts nominated into the "top 5" by three or more panelists included two measure concepts of communication (goals of care discussions and discussion of prognosis), one measure concept on providing comprehensive assessments of patients, and three on symptoms including pain management plans, improvement in pain, and depression management plans. Patients and caregivers nominated one additional measure concept (pain screening) back into consideration, bringing the total number of measure concepts under consideration to 21., Conclusions: Input from cancer patients and caregivers helped identify quality measurement priorities for health system implementation. Forced choice nominations were useful to discriminate concepts with the highest perceived importance. Our approach serves as a model for incorporating patient and caregiver priorities in quality measure development and implementation., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)
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- 2022
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45. Correction to: Patient and Caregiver Prioritization of Palliative and End-of-Life Cancer Care Quality Measures.
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O'Hanlon CE, Giannitrapani KF, Lindvall C, Gamboa RC, Canning M, Asch SM, Garrido MM, Walling AM, and Lorenz KA
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- 2021
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46. Expert Stakeholder Prioritization of Process Quality Measures to Achieve Patient- and Family-Centered Palliative and End-of-Life Cancer Care.
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O'Hanlon CE, Lindvall C, Giannitrapani KF, Garrido M, Ritchie C, Asch S, Gamboa RC, Canning M, Lorenz KA, and Walling AM
- Subjects
- Death, Humans, Palliative Care, Quality Indicators, Health Care, Quality of Health Care, Neoplasms therapy, Terminal Care
- Abstract
Importance: Quality measures of palliative and end-of-life care relevant to patients with advanced cancer have been developed, but few are in routine use. It is unclear which of these measures are most important for providing patient- and family-centered care and have high potential for improving quality of care. Objective: To prioritize process quality measures for assessing delivery of patient- and family-centered palliative and end-of-life cancer care in US Veterans Affairs (VA) health care facilities. Design, Setting, Participants: A panel of 10 palliative and cancer care expert stakeholders (7 physicians, 2 nurses, 1 social worker) rated process quality measure concepts before and after a 1-day meeting. Measures: Panelists rated 64 measure concepts on a nine-point scale on: (1) importance to providing patient- and family-centered care, and (2) potential for quality improvement (QI). Panelists also nominated five highest priority measure concepts ("top 5") on each attribute. Results: Panelists rated most measure concepts (54 premeeting, 56 post-meeting) as highly important to patient- and family-centered care (median rating ≥7). Considerably fewer (17 premeeting, 22 post-meeting) were rated as having high potential for QI. Measure concepts having postpanel median ratings ≥7 and nominated by one or more panelists as "top 5" on either attribute comprised a shortlist of 20 measure concepts. Conclusions: A panel of expert stakeholders helped prioritize 64 measure concepts into a shortlist of 20. Half of the shortlisted measures were related to communication about patient preferences and decision making, and half were related to symptom assessment and treatment.
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- 2021
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47. Risk of stroke and myocardial infarction after influenza-like illness in New York State.
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Kulick ER, Alvord T, Canning M, Elkind MSV, Chang BP, and Boehme AK
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- Humans, Male, New York epidemiology, Risk Factors, Influenza, Human epidemiology, Myocardial Infarction epidemiology, Myocardial Infarction etiology, Stroke epidemiology, Stroke etiology
- Abstract
Background: Influenza may be associated with increased stroke and myocardial infarction (MI) risk. We hypothesized that risk of stroke and MI after influenza-like illness (ILI) would be higher in patients in New York State. We additionally assessed whether this relationship differed across a series of sociodemographic factors., Methods: A case-crossover analysis of the 2012-2014 New York Statewide Planning and Research Cooperative System (SPARCS) was used to estimate odds of ischemic stroke and MI after ILI. Each patient's case window (the time period preceding event) was compared to their control windows (same dates from the previous 2 years) in conditional logistic regression models used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). We varied the case windows from 15 to 365 days preceding event as compared to control windows constructed using the same dates from the previous 2 years. Analyses were stratified by sex, race, and urban-rural status based on residential zip code., Results: A total of 33,742 patients were identified as having ischemic stroke and 53,094 had MI. ILI events in the 15 days prior were associated with a 39% increase in odds of ischemic stroke (95% CI 1.09-1.77), increasing to an almost 70% increase in odds when looking at ILI events over the last year (95% CI 1.56, 1.83). In contrast, the effect of ILI hospitalization on MI was strongest in the 15 days prior (OR = 1.24, 95% CI 1.06-1.44). The risk of ischemic stroke after ILI was higher among individuals living in rural areas in the 90 days prior to stroke and among men in the year prior to event. In contrast, the association between ILI and MI varied only across race with whites having significantly higher ILI associated MI., Conclusion: This study highlights risk period differences for acute cardiovascular events after ILI, indicating possible differences in mechanism behind the risk of stroke after ILI compared to the risk of MI. High risk populations for stroke after ILI include men and people living in rural areas, while whites are at high risk for MI after ILI. Future studies are needed to identify ways to mitigate these risks.
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- 2021
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48. Case series of acute appendicitis association with SARS-CoV-2 infection.
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Prichard C, Canning M, McWilliam-Ross K, Birbari J, Parker W, Wasson L, and Hollingsworth JW
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- Acute Disease, Adult, COVID-19 epidemiology, Female, Humans, Male, Middle Aged, Prevalence, Retrospective Studies, SARS-CoV-2, Appendicitis complications, COVID-19 complications
- Abstract
Background: Describe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2. We are unaware of previous reports of an association between SARS-CoV-2 and acute appendicitis., Methods: We performed a single institution retrospective review of SARS-CoV-2 pre-procedure testing and indications for surgical intervention. Statistical comparisons were performed using Chi Square analysis or two-tailed Student T test., Results: We report a high prevalence of SARS-CoV-2 in both all testing and pre-procedure testing during the enrollment period. We observe a high prevalence of acute appendicitis among patients identified to be SARS-CoV-2 positive during pre-procedure testing and without recognized symptoms of COVID19., Conclusion: We report a previously unrecognized association between SARS-CoV-2 and acute appendicitis.
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- 2021
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49. Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer.
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O'Hanlon CE, Lindvall C, Lorenz KA, Giannitrapani KF, Garrido M, Asch SM, Wenger N, Malin J, Dy SM, Canning M, Gamboa RC, and Walling AM
- Subjects
- Death, Humans, Palliative Care, Quality Indicators, Health Care, United States, Advance Care Planning, Neoplasms therapy, Terminal Care
- Abstract
Purpose: Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer., Methods: We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups., Results: Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1)., Conclusion: Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
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- 2021
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50. Evaluation of the nature, severity, likelihood and preventability of medication-related hospital-acquired complications.
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Canning M, Lee CH, Bolitho R, and Dunn E
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- Australia, Humans, Probability, Retrospective Studies, Tertiary Care Centers, Quality Improvement
- Abstract
Objective Pricing for safety and quality was introduced into Australian hospitals using a defined list of hospital-acquired complications (HACs). Medication-related HACs include drug-related respiratory complications (DRRC), haemorrhagic disorder due to circulating anticoagulants (HDDCA) and hypoglycaemia. The aim of this study was to determine the probability, severity and preventability of medication-related HACs, common contributory medications and themes, and whether medication-related HACs are a suitable data source to inform risk associated with medicines use. Methods Medical notes were reviewed retrospectively for all patients discharged from a tertiary referral metropolitan hospital between 1 July and 31 December 2018 who were flagged as experiencing a medication-related HAC. Naranjo, Hartwig's and Schumock and Thornton tools were used to assess the probability, severity and preventability of medication-related HACs. Results Over the 6-month period, 88 patients experienced a medication-related HAC. An HAC was not identified in five (5.7%) patient charts. The most common HAC was hypoglycaemia (n=59; 67%), followed by HDDCA (n=23; 26%) and DRRC (n=6; 7%). Fifteen patients (17%) flagged with a hypoglycaemia HAC were not on a medicine associated with hypoglycaemia. Overall, 6% (n=4) of HACs were severe, 72% (n=49) were moderate and 22% (n=15) were mild. Where the HAC and causal medication(s) were identified (n=68), over half were probable (51.5%, n=35) and 44.1% (n=30) were possible causes of the adverse drug reaction; only two (2.9%) were definite causes. None of the DRRC HACs was preventable. Over half the HDDCA HACs (52.2%; n=12) and almost half the hypoglycaemia HACs (46.2%; n=18) were not preventable. Common themes included appropriate anticoagulant agent, dose and monitoring, as well as periprocedural hypoglycaemic management, which considers oral intake and comorbidities. Conclusion Not all patients who experience medication-related HACs were on causative medications. Of those who were, medications were probable causal agents in over 50% of cases. Only a small number of HACs were severe and under half of medication-related HACs were preventable. What is known about the topic? The relationship between pricing for safety and quality and improvements in patient outcomes has shown mixed results. Medication-related harm is a problem within Australia and system-wide changes should be considered to improve patient care. What does this paper add? This paper adds evidence to the use of medication-related HACs as a source of data to inform risk associated with medicines use and provides details on the preventability and severity of medication-related HACs and the likelihood that medicines contribute to these complications. What are the implications for practitioners? This paper provides clinicians and policy makers details on the utility of using medication-related HACs as a measure of risk associated with medicines use. It discusses merit in using HACs as a source for quality improvement, but recommends that definitions may need to be reviewed to enhance utility.
- Published
- 2020
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