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2. Global patient perspective on top challenges in lupus care and research participation.

Author

Werth V., Bloch L., Bruce I.N., Costenbader K., Dickerson B., Dorner T., Getz K., Kao A., Manzi S., Morand E.F., Raymond S., Rovin B.H., Schanberg L., Von Feldt J., Hanrahan L., Zook D., Tse K., Pena Y., Arntsen K., Bae S.C., Werth V., Bloch L., Bruce I.N., Costenbader K., Dickerson B., Dorner T., Getz K., Kao A., Manzi S., Morand E.F., Raymond S., Rovin B.H., Schanberg L., Von Feldt J., Hanrahan L., Zook D., Tse K., Pena Y., Arntsen K., and Bae S.C.

Abstract

Background: The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus initiative to identify, prioritize and address top barriers in lupus drug development, clinical care and access to care. The Lupus Foundation of America convenes ALPHA with Tufts Center for the Study of Drug Development and a Global Advisory Committee of lupus experts representing clinician-scientists, industry and patients. Objective(s): Collect global patient input to determine alignment with the lupus clinician-scientist community on prior published consensus of top lupus barriers. Method(s): A 23-question online Qualtrics survey was developed to identify challenges across lupus diagnosis, clinical care and research participation. The survey, available in English, Spanish, Korean and simplified Chinese, was fielded in November 2019 to people with lupus and caregivers of children <18 with lupus. SPSS 26 and SAS 9.4 were used for descriptive statistics and sub-analysis. Result(s): Analysis included only consented responses with >= 68% survey completion (n=3,447) received across 83 countries. 95% were female with a mean age of 45. Respondents reported being White (57%), Black or of African descent (14%), Hispanic or Latino (18%) and Asian (10%). 65% resided in the US while 35% resided in countries outside of the US. 97% were people with lupus while 3% were caregivers to children <18 with lupus. Highest ranked challenges were similar globally and across children and adults: medication side effects, lack of treatment options and high out-of-pocket costs. Managing side effects ranked significantly higher (p<.05) outside of the US (48%) compared to US (40%). 50% of caregivers reported managing side effects as the top challenge for children compared to 43% of adults (p<.05). Research participation was low (24%) and lower among children (16%). The top reason for not participating in a clinical trial was not being asked by their doctor. Conclusion(s): This global survey re

Published
2020

3. AB1338-HPR GLOBAL PATIENT PERSPECTIVE ON TOP CHALLENGES IN LUPUS CARE AND RESEARCH PARTICIPATION

Author

Tse, K., primary, Peña, Y., additional, Arntsen, K., additional, Bae, S. C., additional, Bloch, L., additional, Bruce, I. N., additional, Costenbader, K., additional, Dickerson, B., additional, Dörner, T., additional, Getz, K., additional, Kao, A., additional, Manzi, S., additional, Morand, E. F., additional, Raymond, S., additional, Rovin, B. H., additional, Schanberg, L., additional, Werth, V., additional, Von Feldt, J., additional, Zook, D., additional, and Hanrahan, L., additional

Published
2020
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5. THU0253 FATIGUE AND PAIN REMAIN PROMINENT AND IMPACTFUL IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE): A CROSS-SECTIONAL SURVEY OF SLE PATIENTS IN THE UNITED STATES

Author

Birt, J., primary, Hadi, M., additional, Sargalo, N., additional, Brookes, E., additional, Swinburn, P., additional, Hanrahan, L., additional, Tse, K., additional, Bello Vega, N., additional, Griffing, K., additional, Silk, M., additional, Delbecque, L., additional, and Kamen, D. L., additional

Published
2020
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6. Global consensus building and prioritization of major challenges in lupus diagnosis, care, treatment and research.

Author

Dorner T., Kao A.H., Manzi S., Morand E., Raymond S., Rovin B.H., Schanberg L.E., Werth V.P., Getz K., Von Feldt J., Tse K., Daly R.P., Hanrahan L., Anderson A., Arntsen K., Bae S.-C., Bruce I.N., Costenbader K., Dorner T., Kao A.H., Manzi S., Morand E., Raymond S., Rovin B.H., Schanberg L.E., Werth V.P., Getz K., Von Feldt J., Tse K., Daly R.P., Hanrahan L., Anderson A., Arntsen K., Bae S.-C., Bruce I.N., and Costenbader K.

Abstract

Background/Purpose: The Addressing Lupus Pillars for Health Advancement (ALPHA) Project is a global consensus initiative seeking to identify and prioritize top barriers in lupus impacting diagnosis, care, treatment and research, with the goal of improving rates of accurate and timely diagnosis, increasing access to care, and improving short and long-term patient outcomes. This abstract presents Phase I consensus building and prioritization process methodology, and findings of initial project activities. Method(s): The Lupus Foundation of America and its research partner, Tufts Center for the Study of Drug Development, assembled a Global Advisory Committee (GAC) of 13 lupus experts across 5 countries to provide input and support throughout the effort. A mixed methods approach is being used to elicit concepts seen as major barriers in lupus diagnosis, care, treatment and research, then consolidate and confirm those selected as most urgent. First, a brief web survey was distributed to each GAC member to begin concept elicitation. Identified items were then ranked during a GAC meeting, and will be presented through an in-depth semi-structured interview among 22 stakeholders representing industry, academia, regulatory bodies, patient/advocacy groups, clinicians, and researchers. Finally, an online survey among 200-500 individuals will further validate and demonstrate consensus around top barriers in a broader audience for this Phase I initiative. Result(s): GAC member response rate was 85% for the concept elicitation exercise. Findings are shown in Figure 1. 15 main concepts were identified, with substantial discussion on lupus heterogeneity, lupus as a spectrum of diseases, and the importance of biomarkers in trial design and understanding of the disease. Categorization and prioritization of these concepts is seen in Figure 2. Notably, all GAC members cited issues surrounding disease definition and diagnosis as the most significant burden in lupus. Half also cited clini

Published
2019

7. Global consensus building and prioritisation of fundamental lupus challenges: The ALPHA project.

Author

Schanberg L.E., Rovin B., Von Feldt J.M., Costenbader K., Werth V.P., Manzi S., Raymond S., Tse K., Pena Y., Anderson A., Arntsen K., Bae S.-C., Bruce I., Dorner T., Getz K., Hanrahan L., Kao A., Morand E., Schanberg L.E., Rovin B., Von Feldt J.M., Costenbader K., Werth V.P., Manzi S., Raymond S., Tse K., Pena Y., Anderson A., Arntsen K., Bae S.-C., Bruce I., Dorner T., Getz K., Hanrahan L., Kao A., and Morand E.

Abstract

Objective Lupus is a complex, heterogeneous autoimmune disease that has yet to see significant progress towards more timely diagnosis, improved treatment options for short-Term and long-Term outcomes, and appropriate access to care. The Addressing Lupus Pillars for Health Advancement (ALPHA) project is the first step in establishing global consensus and developing concrete strategies to address the challenges limiting progress. Methods A Global Advisory Committee of 13 individuals guided the project and began barrier identification. Seventeen expert interviews were conducted to further characterise key barriers. Transcripts were analysed using Nvivo and a codebook was created containing a list of thematic a nodes' (topics) and their descriptions. Findings were used to develop a final survey instrument that was fielded to a diverse, international stakeholder audience to achieve broad consensus. Results Expert interviews identified lupus heterogeneity as the primary barrier hindering advancement. Subsequent barriers were categorised into three areas: (1) Drug development. (2) Clinical care. (3) Access and value. The global survey received 127 completed responses from experts across 20 countries. Respondents identified barriers as high priority including the lack of biomarkers for clinical and drug development use, flawed clinical trial design, lack of access to clinicians familiar with lupus, and obstacles to effective management of lupus due to social determinants of care. Respondents also identified 30 autoimmune conditions that may be lupus-related based on overlapping features, shared autoantibodies and pathophysiology. Conclusions ALPHA is a comprehensive initiative to identify and prioritise the continuum of challenges facing people with lupus by engaging a global audience of lupus experts. It also explored views on lupus as a spectrum of related diseases. Conclusions from this effort provide a framework to generate actionable approaches to the identified high-p

Published
2019

8. Sixteenth sir peter freyer memorial lecture and surgical symposium September 13th & 14th, 1991 Session I

Author

Coulter, J., Molloy, R. G., Moran, K. T., Waldron, R., Kirwan, W. O., O’Suilleabhain, C., Horgan, A., Mealy, K., Burke, P., Hyland, J., Horgan, A. F., Sheehan, M., Browne, R. M., Austin, O., Clery, A. P., Deasy, J. M., Sulaiman-Shoaib S., Soeda, J., O’Briain, D. S., Puri, P., Coveney, E. C., McAllister, V., McDermott, E. W. M., O’Higgins, N. J., Maher, M., Caldwell, M. T. P., Murchan, P., Beesley, W., Feeley, T. M., Tanner, W. A., Keane, F. B. V., Abbasakoor, F., Attwood, S. E. A., McGrath, L P., Stephens, R. B., O’Broin, E., Davies, M. G., McGinley, J., Mannion, C., Gupta, S., Shine, M. F., Lennon, F., Ninan, G., Fitzgerald, R. J., Guiney, E. J., O’Donnell, B., O’Donnell, A. F., Luke, D., Wood, A. E., Murphy, P. G., Walsh, T. N., Hill, A. D. K., Li, H., Hennessy, T. P. J., Noonan, N., Breslin, B., Keeling, P. W. N., Curran, A. J., Gough, D. B., Davidson, I. R., Keeling, P., O’Leary, D. P., Smythe, A., Bird, N. C., Johnson, A. G., Nicholson, P., Traynor, O., Dawson, K., Aitken, J., Cooke, B. A., Parbhoo, S. P., N.Williams, N., Daly, J. M., Herlyn, M., Bouchier-Hayes, D., Stuart, R. C., Allen, M. J., Thompson, W. D., Peel, A. L. G., Hehir, D. T., Cronin, K., McCann, A., Dervan, P. A., Heffernan, S. J., Hederman, W. P., Galea, M. H., Dilks, B., Gilmour, A., Ellis, L. O., Elston, C. W., Blarney, R. W., O’Rourke, S., Mookens, A., Carter, R., Parkin, D., Couse, N. F., Delaney, C. P., Horgan, P. G., Fitzpatrick, J. M., Gorey, T. F., O’Byrne, J. M., McCabe, J. P., Stephens, M., McManus, F., L.Mangan, J., Barr, D. A., Mulvenna, G. J., Maginn, P., Kernohan, W. G., Mollan, R. A. B., O’Flanagan, S. J., Stack, J. P., Dervan, P., Hurson, B., Tierney, S., Fitzgerald, P., O’Sullivan, T., Grace, P., Wyatt, J. P., Evans, R. J., Cusack, S. P., McGowan, S., McGovem, E., Schwaitzberg, S. D., Connolly, R. J., Sullivan, R. P., Mortimer, G., Geraghty, J. G., O’Dwyer, P. J., McGlone, B. S., O’Brien, D. P., Younis, H. A., Given, H. F., Phelan, C., Byrne, J., Barry, K., Gough, D., Hanrahan, L., Given, F., Sweeney, J. P., Korebrits, A. M., Reynolds, J. V, Gorey, T. F, O’Hanlon, D. M., Stokes, M. A., Redmond, H. P., McCarthy, J., Daly, J. M., Losty, P., Murphy, M., Butler, P. E. M., Grace, P. G., Novell, J. R., Hobbs, S. K., Smith, O., Hazlehurst, G., Brozovic, B., Rolles, K., Burroughs, A., Mallett, S., Mehta, A., Buckley, D., Waldron, D., O’Brien, D., Curran, C., Given, F., Grey, L., Leahy, A., Darzi, A., Leader, D., Broe, P., Geoghegan, J. G., Cheng, C. A., Lawson, D. C., Pappas, T. N., O’Sullivan, D., Lieber, M. M., Colby, T. V, Barrett, D. M., Rogers, E., Greally, J., Bredin, H. C., Corcoran, M. O., Kenny, M., Horgan, P., Headon, D., Grace, A., Grace, P. A., Bouchier-Hayes, D., Cross, S., Hehir, D., O’Briain, S., Hartigan, P., Colgan, M. P., Moore, D., Shanik, G., Zaidi, S. Z., Hehir, D. J., Cross, K. S., Colgan, M. P., Moore, D. J., Shanik, D. G., Lacy, P., Cross, S., Hehir, D., Moore, D., Shanik, G., Coleman, J. E., McEnroe, C. S., Gelfand, J. A., O’Donnell, T. F., Callow, A. D., Buckley, D. J., O’Riordain, D. S., O’Donnell, J. A., Meagher, P., Boos, K., Gillen, P., Corrigan, T., Vashisht, R., Sian, M., Sharp, E. J, O’Malley, M. K., Kerin, M. J., Wilkinson, D., Parkin, A., Kester, R. C., Maher, M. M., Waldron, R. P., Waldron, D. J., Brady, M. P., Allen, M., Lyncy, T. H, Waymont, B., Emtage, L., Blackledge, G. R., Hughes, M. A., Wallace, D. M. A., O’Sullivan, D., Mynderse, L., Barrett, D. M., Rogers, E., Grimes, H., Chambers, F., Lowe, D., Bredin, H. C., Corcoran, M. O., Waldron, D. J., Prasad, B., O’Sullivan, D. C., Gillen, M. Barry P., McNicholas, M., Traynor, O., Bredin, H., O’Dowd, T. H., Corcoran, M., O’Donoghue, J. M., Corcoran, M., McGuire, M., McNamara, A., Creagh, T., Grainger, R., McDermott, T. B. D., Butler, M. R., Gleeson, M., Creagh, T., Grainger, R., McDermott, T. E. D., Hurley, J. P., Hone, R., Neligan, M., Hurley, J., White, M., McDonagh, P., Phelan, D., McGovern, E., Quinn, F., Breatnach, F., O’Meara, A., McGrath, J. P., McCann, S. R., Gaffney, E. F., Hennessy, A, Leader, M., Taleb, F. S., McKiernan, M. V., Leyden, P. J., McCann, J. J., Coleman, J., Quereshi, A., Ajayi, N., McEntee, G., Osborne, H., Bouchier-Hayes, D. J., Johnston, S., O’Malley, K., Smyth, E., Bouchier-Hayes, D. L, Darzi, A., Quereshi, A., McEntee, G., O’Connell, P. R., Gorey, T., McAnena, O. J., Reed, M. W., Duncan, J. L., Reilly, C. S., McGibney, C., Lawlor, P., Lawless, B., McGuinness, E., and Leahy, S.

Published
1992
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9. Fifteenth Sir Peter Freyer Memorial Lecture and Surgical Symposium Proceedings of meeting held 14th & 15th September, 1990 at University College, Galway

Author

Bolger, C., Fry, G., Coakley, D., Philips, J., Sheahan, N., Malone, J., Gray, W. P., O’Sullivan, M., Buckley, T. F., O’Dwyer, T. P., Gullane, P. J., Kneafsey, B. P., Moran, K. T., O’Sullivan, S. T., Brady, M. P., Coveney, E. C., Geraghty, J. G., O’Higgins, N. J., O’Beirne, J., Seighe, P., McElwain, J. P., McCabe, J. P., Waldron, B., Byme, J., Waldron, B., Hickey, N., McCabe, J., McMahon, J., Colville, J., Moran, B. J., Frost, R. A., Kerin, M. J., Jaeger, J. J., Mitchell, C. J., MacFie, J., O’Hanrahan, T., Scott, N. A., Leinhardt, D., Irving, M. H., Gough, D., White, M., Morrin, M., Joyce, W., Phelan, D., Fitzpatrick, J., Gorey, T., Kerin, M. J., Wilkinson, D., Parkin, A., Kester, R. C., Gibney, E. J., McGrath, K., Cunningham, A. J., Bouchier-Hayes, D., Barry, M., Farrell, M., Monkhouse, W., Bouchier-Hayes, D., Dawson, K. J., Hehir, D., Hamilton, G., Grace, P. A., Quereschi, A., Keane, R., Broe, P., Bouchier-Hayes, D., Stansby, G., Hehir, D., Fuller, B., Hamilton, G., Connolly, A., O’Donnell, J., Little, D., Keane, R. M., Regan, M., Bouchier-Hayes, D., Horgan, P. G., Curran, C., O’Brien, D., Waldron, D., Mooney, E., Greally, J., Given, H. F., Duffy, M. J., Reilly, D., Coveney, E., Geraghty, J., Fennelly, J. J., O’Higgins, N., O’Hare, C. M., Jones, P. L., Zoma, T. A., Hemstreet, G. P., Postier, R. G., Coleman, J. E., Chaikof, E. L., Merrill, E. W., Callow, A. D., Williams, N. N., Daly, J. M., Herlyn, M., Bouchier-Hayes, D., Gaffney, R., Walsh, M., McShane, D., Timon, C., Hamilton, D., Connolly, J., Byrne, P. J., Stuart, R. B., Kay, E., Gorey, T., Hennessy, T. P. J., O’Leary, D. P., Booker, M., Scott, T. E., LaMorte, W. W., Geraty, J. G., Angerson, W. A., Carter, D. C., Lyons, J., Gough, D., Stack, A., Joyce, W., Gorey, T., Fitzpatrick, J. M., Kelly, C., Augustine, C., Kennedy, J., Creagh, T., Bouchier-Hayes, D., Mannion, D., Seigne, P., Fitzpatrick, G., Feeley, M., Butler, P., Grace, P., Leader, M., Curren, B., Barry-Walsh, C., Bouchier-Hayes, D., O’Brien, D., Horgan, P. G., Waldron, R., Shearer, M., Given, H. F., O’Rourke, S., Galea, M., Gilmour, A., Carter, R., Parkin, D., Blarney, R. W., Hehir, D. J., Parbhoo, S. P., Rothnie, N., Crowe, J., Wells, C., Dawson, K. J., Geraghty, J. G., Coveney, E. C., Duffy, M. J., Sherry, F., O’Higgins, N. J., Duffy, M. J., O’Grady, P., Coveney, E., Geraghty, J., Fennelly, J. J., O’Higgins, N. J., Byrne, J., Horgan, P. G., England, S., O’Callaghan, J., Given, H. F., Horgan, P. G., Waldron, D., O’Brien, D., Mooney, E., Grimes, H., Given, H. F., O’Brien, D., Horgan, P. G., Mooney, E., Waldron, D., Grimes, H., Given, H. F., Mulcahy, Ursula, Coveney, E. C., Smyth, P. P. A., McAlister, V., Geraghty, J. G., Murray, M. J., O’Higgins, M. J., Laoide, R. O., Coveney, E. C., Geraghty, J. G., Hourihane, J. B., O’Higgins, N. J., Mooney, E. F., Horgan, P. G., Brougham, C., Headon, D. R., Given, H. F., Coleman, C., Coveny, E. C., Laoide, R. O., Geraghty, J. G., Hourihane, J. B., O’Higgins, N. J., Jazawi, S., Walsh, T. N., Byrne, P. J., Lawlor, P., Li, H., Bolger, C., Sanfey, H., Hennessy, T. P. J., Joyce, W. P., Gough, D. B., Delaney, P. V., Gorey, T. F., Fitzpatrick, J. M., Attwood, S. E. A., Watson, A., Rogers, E., Waldron, R. P., Glynn, G., El-Bouri, K. U., Flynn, J., Keeling, P., Davies, M. G., Lavelle, J., Connolly, J., Shine, M. F., Lennon, F., Byrne, P. J., Stewart, R. C., Lawlor, P., Walsh, T. N., Hennessy, T. P., McKiernan, M. V., Johnston, J. G., Rogers, E., Greally, J., Hanrahan, L., Bredin, H. C., Corcoran, M. O., Norton, M., Rogers, E., Bredin, H. C., Corcoran, M. O., Flynn, R., Gleeson, M., Grainger, R., McDermott, T. E. D., Lanigan, D., McLean, P., Curran, B., Leader, M., Gleeson, M. J., Griffin, D. P., Gallagher, H. J., Creagh, T. A., Mulvin, D. M., Donovan, M. G., Murphy, D. M., McLean, P. A., Mulvin, D. W., Creagh, T. A., O’Brien, A., Murphy, D. M., O’Flynn, K. L., McDonagh, R., Thomas, D. G., Lynch, T. H., Anderson, P., Vaughan, A. T. M., Beaney, R. P., Wallace, D. M. A., Connolly, J., Solomon, L., Lavelle, J., Lennon, F., Shine, M. F., O’Riordain, D. S., O’Connell, P. R., Kirwan, W. O., Li, Hui, Byrne, P. J., Lawlor, P., Stuart, R. C., Jazrawi, S., Walsh, T. N., Hennessy, T. P. J., Koh, T. N., Sheehan, S. J., McKeever, J., Donohoe, J., Carmody, M., Osborne, D. H., Waldron, D. E., Rodgers, E., Patel, F., Horgan, P., Corcoran, M., Given, H. F., Walsh, K., Joyce, W. P., Gough, D. B., Gorey, T. F., Fitzpatrick, J. M., O’Donoghue, J. M., Waldron, R., Kerin, M. J., McCabe, J. P., McAnena, O. J., McGuire, M., Given, H. F., Smyth, J., Keye, G., Bahadursingh, A., Delaney, C., Joyce, W. P., Gough, D., Fitzpatrick, J. M., Gorey, T. F., Richie, A. J., Gibbons, J. R. P., O’Hanrahan, T., Marples, M., Banacewicz, J., Coleman, J. E., Troidl, H., Cassidy, L., Grace, P., Bouchier-Hayes, D., Prenderville, E. J., Burke, P. E., Colgan, M. -.P, Wee, B. L., Moore, D. J., Shanik, G. D., Cross, K. S., El-Sanadiki, M., Murray, J. J., Mikat, E., McCann, R., Hagen, P. -O., Cheatle, T. R., Steibe, E., Smith, P. D. Colebridge, Scurr, J. H., Barry, K., Waldron, D., Bresnihan, E., Courtney, D. F., Quill, D. S., Buckley, D., O’Riordan, D. S., O’Donncll, J. A., Gray, W. P., O’Donnell, J. A., Hill, A. D. K., O’Dwycr, P. J., MacErlean, D. P., Kerin, M. J., Couse, N. F., MacFie, J., Campbell, D., McBride, K., Geraghty, J. G., MacErlean, D., Murphy, J. J., Kirwan, W. O., Kaar, K., Docrat, H., Malik, S., Egan, J., Davidson, I. R., Hurley, J., Keeling, P., Rowley, H., Kaar, K., O’Sullivan, S. T., and Brady, M. P.

Published
1991
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13. Evolution of Carotid Surgical Practice in the last Decade

Author

Hanrahan L, Canning C, Abdulrahim O, Fitzgerald L, O'Neill S, Madhavan P, Joseph Harbison, Mp, Colgan, and Martin Z

Subjects
Aged, 80 and over, Male, Stroke, Endarterectomy, Carotid, Humans, Female, Middle Aged, Hospital Units, Ireland, Aged
Abstract

Stroke units provide immediate care and appropriate intervention in the evolving stroke. The aims of this study were to review the practice of carotid endarterectomy (CEA) before and after the establishment of a Stroke Unit in St. James's Hospital. Prior to the introduction of the Stroke Unit, 263 CEA's were performed over a five-year period. 139/263 (53%) of these were for symptomatic disease. 229 were performed in the five years since. 179/229 (78%) of these were for symptomatic disease. The 30-day stroke and death rates were2% before the introduction of the Stroke Unit, and have remained unchanged. Since the introduction of the Stroke Unit, there has been a slight decrease in the overall number of CEA's performed with a 25% increase in the proportion of endarterectomies performed for symptomatic disease. Despite the reduction in surgery for asymptomatic disease the overall 30-day stroke and death rate remains excellent at 2/229 (2%).

Published
2015

32. International consensus for a definition of disease flare in lupus.

Author

Ruperto, N.., Hanrahan, L. M., Alarcón, G. S., Belmont, H. M., Brey, R. L., Brunetta, P., Buyon, J. P., Costner, M. I., Cronin, M. E., Dooley, M. A., Filocamo, G., Fiorentino, D., Fortin, P. R., Franks, A. G., Gilkeson, G., Ginzler, E., Gordon, C., Grossman, J., Hahn, B., and Isenberg, D. A.

Subjects
*SYSTEMIC lupus erythematosus, *CONSENSUS (Social sciences), *AUTOIMMUNE diseases, *DELPHI method, *HEALTH surveys, *ETIOLOGY of diseases
Abstract

The Lupus Foundation of America (LFA) convened an international working group to obtain a consensus definition of disease flare in lupus. With help from the Paediatric Rheumatology International Trials Organization (PRINTO), two web-based Delphi surveys of physicians were conducted. Subsequently, the LFA held a second consensus conference followed by a third Delphi survey to reach a community-wide agreement for flare definition. Sixty-nine of the 120 (57.5%) polled physicians responded to the first survey. Fifty-nine of the responses were available to draft 12 preliminary statements, which were circulated in the second survey. Eighty-seven of 118 (74%) physicians completed the second survey, with an agreement of 70% for 9/12 (75%) statements. During the second conference, three alternative flare definitions were consolidated and sent back to the international community. One hundred and sixteen of 146 (79.5%) responded, with agreement by 71/116 (61%) for the following definition: “A flare is a measurable increase in disease activity in one or more organ systems involving new or worse clinical signs and symptoms and/or laboratory measurements. It must be considered clinically significant by the assessor and usually there would be at least consideration of a change or an increase in treatment.” The LFA proposes this definition for lupus flare on the basis of its high face validity. [ABSTRACT FROM AUTHOR]

Published
2011
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35. School nurses: a resource for young worker safety.

Author

Higgins DN, Tierney J, Lins M, and Hanrahan L

Abstract

On average, 67 youths under age 18 die at work in the United States each year, and many more suffer work-related injuries. In 1998, an estimated 77,000 young workers suffered work injuries that required treatment in hospital emergency rooms. It is estimated that only one third of work-related injuries are seen in emergency departments; therefore, the National Institute for Occupational Safety and Health (NIOSH) estimates that nearly 230,000 youths suffer work-related injuries each year. Through NIOSH's Fatality Assessment and Control Evaluation (FACE) program, NIOSH investigators identified poor knowledge of child labor laws, lack of safety training and supervision, inappropriate job assignment, and lack of employer compliance with labor laws as factors contributing to young worker deaths. School nurses serve as a resource to other professionals, parents, employers, and students and can help foster safer working conditions for youth by providing these groups with young worker safety information. [ABSTRACT FROM AUTHOR]

Published
2004
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42. Monensin Toxicosis in Broiler Chickens

Author

Hanrahan, L. A., Corrier, D. E., and Naqi, S. A.

Abstract

Chickens treated at seven weeks of age with 150, 200, or 250 mg of crystalline monensin sodium/kg body weight had signs of toxicosis, including extreme weakness, anorexia, paralysis and death. Gross lesions included emaciation, generalized congestion, myocardial enlargement and pallor, and hydropericardium. Samples of ventricular myocardium, superficial pectoralis (white fibers), anterior latissimus dorsi (intermediate fibers), and sartorius muscles (mixed red, intermediate, and white fibers) were examined by light microscope. Intermyofibrillar vacuolation, histochemically positive for neutral fat, was severe in the myocardium and red muscle fibers and moderate in the intermediate muscle fibers. Myofiber necrosis was limited to the red muscle fibers. Mitochondrial degeneration was apparent in myocardial sections from several chickens. Interstitial infiltration by macrophages and heterophils was common in the myocardium and aerobic skeletal muscle.

Published
1981
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43. SMRFIT: a Statistical Analysis System (SAS) program for standardized mortality ratio analyses and Poisson regression model fits in community disease cluster investigations.

Author

Hanrahan, L P, Mirkin, I, Olson, J, Anderson, H A, and Fiore, B J

Abstract

Increasingly, health departments are being pressed by the public to respond to disease risk with cluster investigations in communities and neighborhoods. This is a direct result of growing concern about the role that the environment may play in disease risk. While extensive analyses directly inputing exposures or numbers at risk are often necessary to thoroughly investigate clusters, it is quite useful to perform an exploratory analysis with existing morbidity and mortality data as a first level of response. To meet this need for timely evaluation, the authors describe a user-friendly Statistical Analysis System (SAS) program called SMRFIT to automate community disease cluster evaluations. The program creates frequency tables for number at risk and number of disease outcomes for the community, balance of parent county, and balance of state. SMRFIT then constructs standardized mortality ratios, with the community compared with balance of county and balance of state referents. Poisson regression is offered as an option for the modeling of community disease rates.

Published
1990
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44. A monitoring system to detect increased rates of cancer incidence.

Author

Sitter, R R, Hanrahan, L P, Demets, D, and Anderson, H A

Abstract

A new method for monitoring occurrences of rare health events is proposed. This proposed method is similar in principle to the sets technique but is shown to have much better expected time to alarm properties. This is illustrated for a number of hypothetical situations, and then both methods are applied to cancer mortality data. The proposed method will allow the use of large monitoring systems consisting of implementations of the method in a number of subregions (i.e., counties) of a larger region (i.e., state) independently, and still maintain reasonable expected times between false alarms.

Published
1990
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45. State health department response to disease cluster reports: a protocol for investigation.

Author

Fiore, B J, Hanrahan, L P, and Anderson, H A

Abstract

State health departments are increasingly faced with the task of responding to reports of apparent cancer and other disease clusters. Since 1979, 141 requests for investigation have been received by the Wisconsin Division of Health, with over 60% of these requests occurring since 1985. Mounting public concern and limited resources have resulted in the development of a "disease cluster investigation and analysis protocol." Protocol steps include: 1) circumscribing the cluster; 2) ascertaining cases; 3) assessing risk of the exposed versus a referent population; 4) statistically analyzing disease rates; 5) examining potential exposure; 6) assessing biologic plausibility; 7) determining cluster significance and need for further investigation; and 8) reporting results. To demonstrate the protocol, the authors present a case example of an investigation of an apparent cancer cluster. Since 1979, 62 reports were resolved with initial contact with informant education (step 1), 61 reports required descriptive analysis (steps 1-8) with no site visit, and 18 reports required site visits. None of the reports required further in-depth epidemiologic investigation. This protocol provides a systematic approach to investigation and analysis, prioritizes the need for more in-depth study, and, when necessary, assuages community concerns when a disease cluster is reported.

Published
1990
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