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10. Advancing a machine learning-based decision support tool for pre-hospital assessment of dyspnoea by emergency medical service clinicians: a retrospective observational study

Author

Wivica Kauppi, Henrik Imberg, Johan Herlitz, Oskar Molin, Christer Axelsson, and Carl Magnusson

Subjects
Dyspnoea, Serious adverse event, Prehospital, Ambulance, Emergency medical services, Machine learning, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background In Sweden with about 10 million inhabitants, there are about one million primary ambulance missions every year. Among them, around 10% are assessed by Emergency Medical Service (EMS) clinicians with the primary symptom of dyspnoea. The risk of death among these patients has been reported to be remarkably high, at 11,1% and 13,2%. The aim was to develop a Machine Learning (ML) model to provide support in assessing patients in pre-hospital settings and to compare them with established triage tools. Methods This was a retrospective observational study including 6,354 patients who called the Swedish emergency telephone number (112) between January and December 2017. Patients presenting with the main symptom of dyspnoea were included which were recruited from two EMS organisations in Göteborg and Södra Älvsborg. Serious Adverse Event (SAE) was used as outcome, defined as any of the following:1) death within 30 days after call for an ambulance, 2) a final diagnosis defined as time-sensitive, 3) admitted to intensive care unit, or 4) readmission within 72 h and admitted to hospital receiving a final time-sensitive diagnosis. Logistic regression, LASSO logistic regression and gradient boosting were compared to the Rapid Emergency Triage and Treatment System for Adults (RETTS-A) and National Early Warning Score2 (NEWS2) with respect to discrimination and calibration of predictions. Eighty percent (80%) of the data was used for model development and 20% for model validation. Results All ML models showed better performance than RETTS-A and NEWS2 with respect to all evaluated performance metrics. The gradient boosting algorithm had the overall best performance, with excellent calibration of the predictions, and consistently showed higher sensitivity to detect SAE than the other methods. The ROC AUC on test data increased from 0.73 (95% CI 0.70–0.76) with RETTS-A to 0.81 (95% CI 0.78–0.84) using gradient boosting. Conclusions Among 6,354 ambulance missions caused by patients suffering from dyspnoea, an ML method using gradient boosting demonstrated excellent performance for predicting SAE, with substantial improvement over the more established methods RETTS-A and NEWS2.

Published
2025
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11. The development of a decision support tool in the prehospital setting for acute chest pain – a study protocol for an observational study (BRIAN2)

Author

Elin Lökholm, Carl Magnusson, Johan Herlitz, Annica Ravn-Fischer, Ola Hammarsten, Magnus Johansson, Kristoffer Hallin, and Kristoffer Wibring

Subjects
Chest pain, EMS, Troponin, Prehospital, AMI, Emergency medical services, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Introduction Chest pain is one of the most common reasons for contacting the emergency medical services (EMS). It is difficult for EMS personnel to distinguish between patients suffering from a high-risk condition in need of prompt hospital care and patients suitable for non-conveyance. A vast majority of patients with chest pain are therefore transported to the emergency department (ED) for further investigation even if hospital care is not necessary. Improved prehospital assessment and risk stratification, thus accurately and safely identifying patients suitable for non-conveyance, could prevent unnecessary transport to the ED. This would reduce ED crowding and overburdening sparse EMS resources. It would thus also probably reduce healthcare costs. Little is known about the prehospital use of the 5th generation, i.e. high-sensitivity troponin analyses. The aim of this project is to develop an EMS decision support tool using high-sensitivity troponin I for risk assessment of chest pain patients. Methods and analysis This is a prospective, multicentre, cohort study including adult unselected EMS patients with chest pain. Data is being collected from 20 May 2023 to 31 December 2025, aiming to include at least 2,000 patients. High-sensitivity troponin I is being analysed bedside using Siemens Healthineers Atellica VTLi. In addition to prehospital troponin I, data is being collected on patient medical history, onset, vital signs, symptoms, ECG and diagnosis at hospital discharge. Several statistical analyses (random forest, logistic regression, gradient boosting) will be conducted to identify the best model for identifying patients with low-risk conditions suitable for non-conveyance. Ethics and dissemination The study has been approved by the Swedish Ethical Review Authority (Dnr 2022-01066-01 and 2022-06846-02). Patients are being informed about the study both orally and in writing. The results of the study will be published in a peer-reviewed journal and will be presented at national and/or international conferences. Registration details The study is registered at ClinicalTrials.gov (NCT05767619).

Published
2025
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13. Safety and Efficacy of Avacopan in Patients with Complement 3 Glomerulopathy: Randomized, Double-Blind Clinical Trial

Author

Bomback, Andrew S., Herlitz, Leal C., Kedia, Priyanka Punit, Petersen, Jeffrey, Yue, Huibin, Lafayette, Richard A., Bomback, Andrew, Parikh, Samir, Nester, Carla, Niles, John, Fervenza, Fernando, Lafayette, Richard, Ghossein, Cybele, Farias, Antony, Gohh, Reginald, Abraham, Josephine, Singh, Pooja, Hellemans, Rachel, Weekers, Laurent, Hougardy, Jean-Michel, Claes, Kathleen, Girard, Louis-Philippe, Barbour, Sean, Dieperink, Hans, Gregersen, Jon Waarst, Szpirt, Wladimir, Mesbah, Rafik, Zaoui, Philippe, Cartery, Claire, Servais, Aude, Nitschke, Martin, Schoenermarck, Ulf, Haller, Hermann, Hugo, Christian, Witzke, Oliver, Conlon, Peter, La Manna, Gaetano, Vivarelli, Marina, Rota, Stefano, Alberici, Federico, Maggiore, Umberto, de Vries, Aiko P.J., Wetzels, Jack, Bemelman, F.J., van de Kar, Nicole, Berger, Stefan, Cavero, Teresa, Cigarran, Secundino, Pamplona, Irene Agraz, Encarnacion, Montserrat Diaz, Kavanagh, David, and Booth, John

Published
2024
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14. Kidney Biopsy Findings Among Patients With Diabetes in the Cleveland Clinic Kidney Biopsy Epidemiology Project

Author

Alvin G. Kwon, Hanny Sawaf, Gilda Portalatin, Shruti Shettigar, Leal C. Herlitz, Tariq Shafi, Hong Liang, Adam Kabuka, Scott Cohen, Surafel K. Gebreselassie, and Shane A. Bobart

Subjects
Kidney biopsy, diabetic nephropathy, nondiabetic kidney disease, proteinuria, retinopathy, Diseases of the genitourinary system. Urology, RC870-923
Abstract

Rationale & Objectives: Diabetic kidney disease (DKD) is a significant complication of diabetes mellitus, often leading to kidney failure. The absence of well-defined factors prevents distinguishing DKD from non-diabetic kidney disease (non-DKD; alternative primary diagnosis identified on kidney biopsy). Study Design: Retrospective cohort study. Setting & Participants: This study assessed 1,242 patients with a history of diabetes from the Cleveland Clinic Kidney Biopsy Epidemiology Project between January 2015 and September 2021. Exposure: Proteinuria, retinopathy, A1c levels, and estimated glomerular filtration rate. Outcomes: Non-DKD, defined as an alternative primary diagnosis identified on kidney biopsy other than DKD. Analytical Approach: Multivariate logistic regression model with backward elimination method. Results: At the time of biopsy, the median (IQR) age was 63 (53-71 years) years, and 58.8% were men. The median hemoglobin A1c value was 6.7% (6.0%-8.1%), and the median serum creatinine level was 2.5 (1.6-3.9 mg/dL) mg/dL. Among 1,242 patients, 462 (37.2%) had DKD alone, and 780 (62.8%) had non-DKD. Among those with non-DKD, the most common diagnoses were focal segmental glomerulosclerosis (24%), global glomerulosclerosis otherwise not specified (13%), acute tubular necrosis (9%), IgA nephropathy (8%), antineutrophil cytoplasmic antibody vasculitis (7%), and membranous nephropathy (5%). Factors associated with having non-DKD on biopsy were having no retinopathy (vs retinopathy) (adjusted odds ratio [aOR], 3.98; 95% CI, 2.69-5.90), lower A1c levels (

Published
2024
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15. Cumulative incidence of chronic health conditions recorded in hospital admissions from birth to age 16 in England: a cohort study using linked hospital and education administrative data

Author

Matthew Jay, Lauren Herlitz, Jessica Deighton, Ruth Gilbert, and Ruth Blackburn

Subjects
Demography. Population. Vital events, HB848-3697
Abstract

Objective Monitoring the incidence of chronic health conditions (CHCs) in childhood in England using administrative data to derive numerators and denominators is challenged by unmeasured migration. We used a birth cohort design and different criteria for contact with health or education services to estimate the cumulative incidence of CHCs to age 16 years. Approach We identified all births in Hospital Episode Statistics (HES) from 2002/3 to 2011/12, with follow-up to 2018/19 (maximum age 8 to 16 years), censoring on death, first non-England residence record or 16th birthday. Children must have linked to later HES records and/or the National Pupil Database (NPD), which provides information on all state-school enrolments. The cumulative incidence of CHCs was estimated to age 16 using diagnostic codes in hospital admission records. We also explored temporal variation. Sensitivity analyses varied denominator criteria. Results Between 423,456 children (79.4%, of all HES-recorded births in 2002/3) and 618,054 (97.5% in 2011/12) linked to later HES or NPD records. The cumulative incidence of ever having a recorded CHC before age 16 among children born in 2002/3 or 2003/4 was 24.6%, ranging from 21% to 32% in sensitivity analyses. There was little temporal variation. At least 28% of children with any CHC had more than one body system affected by age 16. Multimorbidity rates rose with later cohorts. Conclusions Approximately one quarter of children are affected by CHCs, but varies depending on how the denominator is defined. More accurate estimation of the incidence of CHCs requires a dynamic population estimate.

Published
2024
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16. Patient Characteristics Associated With Disparities in Engagement With and Experience of COVID‐19 Remote Home Monitoring Services: A Mixed‐Methods Evaluation

Author

Nadia E. Crellin, Lauren Herlitz, Manbinder S. Sidhu, Jo Ellins, Theo Georghiou, Ian Litchfield, Efthalia Massou, Pei Li Ng, Chris Sherlaw‐Johnson, Sonila M. Tomini, Cecilia Vindrola‐Padros, Holly Walton, and Naomi J. Fulop

Subjects
COVID‐19, disparities, health inequalities, home monitoring, patient engagement, remote monitoring, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Introduction The adoption of remote healthcare methods has been accelerated by the COVID‐19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID‐19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. Methods This was a mixed‐methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. Findings Survey responses were received from 292 staff and 1069 patients and carers. Twenty‐three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p

Published
2024
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20. Patient and caregiver characteristics associated with differential use of primary care for children and young people in the UK: a scoping review

Author

Stephen Morris, Jenny Woodman, Claire Powell, Lauren Herlitz, and Kevin Herbert

Subjects
Medicine
Abstract

Objective To systematically map evidence to answer the research question: What is the relationship between the characteristics of children and young people (CYP) or their caregivers and primary care service use in the UK, taking into account underlying healthcare needs?Design Scoping review.Setting Primary care.Eligibility criteria English-language quantitative or mixed-methods studies published between 2012 and 2022.Data sources Medline, Embase, Scopus and Web of Science Social Sciences Citation Index, and grey literature.Results 22 eligible studies were identified, covering general practice (n=14), dental health (n=4), child mental health (MN) services (n=3) and immunisation (n=1). Only eight studies (36%) controlled for variables associated with healthcare need (eg, age, birth weight and long-term conditions). In these, evidence of horizontal inequity in primary care use was reported for CYP living in deprived areas in England, with and without complex needs. Horizontal inequity was also identified in primary care MN referrals for CYP in England identifying as mixed-race, Asian or black ethnicity, compared with their white British peers. No evidence of horizontal inequity was observed, however, in primary care use for CYP in England exposed to parental depression, or for CYP children from low-income households in Scotland. Increasing CYP’s age was associated with decreasing primary care use across included studies. No studies were found regarding CYP from Gypsy or Traveller communities, children in care, or those with disabilities or special educational needs.Conclusions There is evidence that socioeconomic factors impact on CYP’s primary care use, in particular age, ethnicity and deprivation. However, better quality evidence is required to evaluate horizontal inequity in use and address knowledge gaps regarding primary care use for vulnerable CYP populations and the impact of policy and practice related ‘supply side’ of primary care.

Published
2024
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21. Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP’s, caregivers’ and healthcare professionals’ views and experiences of facilitators and barriers

Author

Stephen Morris, Jenny Woodman, Claire Powell, Lauren Herlitz, Kevin Herbert, and Emily Ashford

Subjects
Medicine
Abstract

Objectives To examine children and young people’s (CYP), caregivers’ and healthcare professionals’ (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems.Design Scoping review.Eligibility criteria Included studies were in English, published 2012–2022 and reported: the views/experiences of CYP (0–25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods.Data sources PubMed, CINAHL, Web of Science, PsycINFO and Scopus.Results We included 47 reports (46 studies). CYP/caregivers’ decision to access care was facilitated by CYP/caregivers’ or their family/friends’ ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP’s knowledge and a lack of connectedness between primary and secondary care.Conclusions Connecting general practices and community health workers/services, improving CYP/caregivers’ understanding of common childhood conditions, addressing HCP’s knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.

Published
2024
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22. A Cross-Sectional Investigation of the Impact of Stuttering on Swedish Females and Males in Childhood, Adolescence, and Young Adulthood

Author

Samson, Ineke, Schalling, Ellika, Herlitz, Agneta, Lindström, Elisabeth, and Sand, Anders

Abstract

Purpose: We aimed to cross-sectionally describe the impact of stuttering on persons who stutter (PWS): children, adolescents, and young adults. Based on previous research on PWS and psychosocial health in the general population, we hypothesized that (a) the adverse impact of stuttering in PWS would be larger among adolescents than children and young adults and that (b) females, especially adolescent females, would report being more adversely impacted by their stuttering than males. Method: We pooled samples of Swedish PWS, obtaining 162 individuals (75 females and 87 males), aged 7-30 years. We measured the impact of stuttering using age-relevant versions of the Overall Assessment of the Speaker's Experience of Stuttering (OASES). The relationship between OASES score, age, and sex was described using a polynomial model with an interaction term between age and sex to allow for potential differences between females and males' age-related curves. Results: The average trends were that (a) the impact of stuttering was greater for the adolescents than for the children and young adults, and (b) females, especially adolescent females, were on average more impacted by their stuttering than males. Taking self-reported speech fluency into account did not change this pattern. Conclusions: In line with findings on psychosocial health, communication attitude, and self-esteem in the general population, the impact of stuttering seems to be particularly adverse among adolescents, especially female adolescents. Thus, clinicians need to be aware of the risk that young girls who stutter may develop a negative attitude to speech and communication, and this should also be communicated to caregivers and teachers.

Published
2022
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23. Fast track to stroke unit for patients not eligible for acute intervention, a case–control register study on 1066 patients

Author

Ingela Wennman, Helle Wijk, Katarina Jood, Eric Carlström, Bengt Fridlund, Linda Alsholm, Johan Herlitz, and Per-Olof Hansson

Subjects
Medicine, Science
Abstract

Abstract Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case–control register study was to evaluate outcomes for such “low priority” stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.

Published
2023
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27. Precision Medicine in Nephrology: An Integrative Framework of Multidimensional Data in the Kidney Precision Medicine Project

Author

Lake, Blue, Zhang, Kun, Lecker, Stewart, Morales, Alexander, Bogen, Steve, Amodu, Afolarin A., Beck, Laurence, Henderson, Joel, Ilori, Titlayo, Maikhor, Shana, Onul, Ingrid, Schmidt, Insa, Verma, Ashish, Waikar, Sushrut, Yadati, Pranav, Yu, Guanghao, Colona, Mia R., McMahon, Gearoid, Hacohen, Nir, Greka, Anna, Hoover, Paul J., Marshall, Jamie L., Aulisio, Mark, Bush, William, Chen, Yijiang, Crawford, Dana, Madabhushi, Anant, Viswanathan, Vidya S., Bush, Lakeshia, Cooperman, Leslie, Gadegbeku, Crystal, Herlitz, Leal, Jolly, Stacey, Nguyen, Jane, O’Malley, Charles, O’Toole, John, Palmer, Ellen, Poggio, Emilio, Spates-Harden, Kassandra, Sedor, John, Sendrey, Dianna, Taliercio, Jonathan, Appelbaum, Paul, Balderes, Olivia, Barasch, Jonathan, Berroue, Cecilia, Bomback, Andrew, Canetta, Pietro A., D’Agati, Vivette, Kiryluk, Krzysztof, Kudose, Satoru, Mehl, Karla, Sabatello, Maya, Shang, Ning, de Pinho Gonçalves, Joana, Lardenoije, Roy, Migas, Lukasz, Van de Plas, Raf, Rennke, Helmut, Azeloglu, Evren, Campbell, Kirk, Coca, Steven, He, Cijang, He, John, Iyengar, Srinivas Ravi, Lefferts, Seanee, Nadkarni, Girish, Patel, Marissa, Tokita, Joji, Ward, Stephen, Xiong, Yuguang, Verdoes, Abraham, Sabo, Angela, Barwinska, Daria, Gisch, Debora Lidia, Williams, James, Kelly, Katherine, Dunn, Kenneth, Asghari, Mahla, Eadon, Michael, Ferkowicz, Michael, Dagher, Pierre, Ferreira, Ricardo Melo, Winfree, Seth, Bledsoe, Sharon, Wofford, Stephanie, El-Achkar, Tarek, Sutton, Timothy, Bowen, William, Cheng, Ying-Hua, Slade, Austen, Record, Elizabeth, Cheng, Yinghua, Borner, Katy, Herr, Bruce, Jain, Yashvardhan, Quardokus, Ellen, Atta, Mohamed, Bernard, Lauren, Menez, Steven, Parikh, Chirag, Corona Villalobos, Celia Pamela, Wang, Ashley, Wen, Yumeng, Xu, Alan, Chen, Sarah, Donohoe, Isabel, Johansen, Camille, Rosas, Sylvia, Sun, Jennifer, Ardayfio, Joseph, Bebiak, Jack, Campbell, Taneisha, Fox, Monica, Knight, Richard, Koewler, Robert, Pinkeney, Roy, Saul, John, Shpigel, Anna, Prasad, Pottumarthi, Madhavan, Sethu M., Parikh, Samir, Rovin, Brad, Shapiro, John P., Anderton, Christopher, Lukowski, Jessica, Pasa-Tolic, Ljiljana, Velickovic, Dusan, Oliver, George, Mao, Weiguang, Sealfon, Rachel, Troyanskaya, Olga, Pollack, Ari, Goltsev, Yury, Ginley, Brandon, Anjani, Kavya, Laszik, Zoltan G., Mukatash, Tariq, Nolan, Garry, Beyda, David, Bracamonte, Erika, Brosius, Frank, Campos, Baltazar, Marquez, Nicole, Mendoza, Katherine, Scott, Raymond, Thajudeen, Bijin, Tsosie, Rebecca, Woodhead, Gregory, Saunders, Milda, Alloway, Rita R., Lee, Paul J., Rike, Adele, Shi, Tiffany, Woodle, E. Steve, Bjornstad, Petter, Hsieh, Elena, Kendrick, Jessica, Pyle, Laura, Thurman, Joshua, Vinovskis, Carissa, Wrobel, Julia, Lucarelli, Nicholas, Sarder, Pinaki, Bui, James, Carmona-Powell; Ron Gaba, Eunice, Kelly, Tanika, Lash, James, Meza, Natalie, Redmond, Devona, Renteria, Amada, Ricardo, Ana, Setty, Suman, Srivastava, Anand, Alakwaa, Fadhl, Ascani, Heather, Balis, Ul, Bitzer, Markus, Blanc, Victoria, Bonevich, Nikki, Conser, Ninive, Demeke, Dawit, Dull, Rachel, Eddy, Sean, Frey, Renee, Hartman, John, He, Yongqun Oliver, Hodgin, Jeffrey, Kretzler, Matthias, Lienczewski, Chrysta, Luo, Jinghui, Mariani, Laura, McCown, Phillip, Menon, Rajasree, Nair, Viji, Otto, Edgar, Reamy, Rebecca, Rose, Michael, Schaub, Jennifer, Steck, Becky, Wright, Zachary, Coleman, Alyson, Henderson-Brown; Jerica Berge, Dorisann, Caramori, Maria Luiza, Adeyi, Oyedele, Nachman, Patrick, Safadi, Sami, Flanagan, Siobhan, Ma, Sisi, Klett, Susan, Wolf, Susan, Harindhanavudhi, Tasma, Rao, Via, Bream, Peter, Froment, Anne, Kelley, Sara, Mottl, Amy, Chaudhury; Evan Zeitler, Prabir Roy, Bender, Filitsa, Elder, Michele, Gilliam, Matthew, Hall, Daniel E., Kellum, John A., Murugan, Raghavan, Palevsky, Paul, Rosengart, Matthew, Tan, Roderick, Tublin, Mitchell, Winters, James, Bansal, Shweta, Montellano, Richard, Pamreddy, Annapurna, Sharma, Kumar, Venkatachalam, Manjeri, Ye, Hongping, Zhang, Guanshi, Basit, Mujeeb, Cai, Qi, Hendricks, Allen, Hedayati, Susan, Kermani, Asra, Lee, Simon C., Ma, Shihong, Miller, Richard Tyler, Moe, Orson W., Park, Harold, Patel, Jiten, Pillai, Anil, Sambandam, Kamalanathan, Torrealba, Jose, Toto, Robert D., Vazquez, Miguel, Wang, Nancy, Wen, Natasha, Zhang, Dianbo, Alpers, Charles, Berglund, Ashley, Berry, Brooke, Blank, Kristina, Brown, Keith, Carson, Jonas, Daniel, Stephen, de Boer, Ian H., Dighe, Ashveena L., Dowd, Frederick, Grewenow, Stephanie M., Himmelfarb, Jonathan, Hoofnagle, Andrew, Jefferson, Nichole, Larson, Brandon, Limonte, Christine, McClelland, Robyn, Mooney, Sean, Nam, Yunbi, Park, Christopher, Phuong, Jimmy, Rezaei, Kasra, Roberts, Glenda, Sarkisova, Natalya, Shankland, Stuart, Snyder, Jaime, Stutzke, Christy, Tuttle, Katherine, Wangperawong, Artit, Wilcox, Adam, Williams, Kayleen, Young, Bessie, Allen, Jamie, Caprioli, Richard M., de Caestecker, Mark, Djambazova, Katerina, Dufresne, Martin, Farrow, Melissa, Fogo, Agnes, Sharman, Kavya, Spraggins, Jeffrey, Basta, Jeannine, Conlon, Kristine, Diettman, Sabine M., Gaut, Joseph, Kaushal, Madhurima, Jain, Sanjay, Knoten, Amanda, Minor, Brittany, Nwanne, Gerald, Vijayan, Anitha, Zhang, Bo, Arora, Tanima, Cantley, Lloyd, Victoria Castro, Angela M., Kakade, Vijayakumar, Moeckel, Gilbert, Moledina, Dennis, Shaw, Melissa, Wilson, Francis P., El-Achkar, Tarek M., and Eadon, Michael T.

Published
2024
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29. Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study

Author

Ellen Dejby, Deepak L. Bhatt, Kristofer Skoglund, Aidin Rawshani, Elmir Omerovic, Björn Redfors, Anna Myredal, Petur Petursson, Oskar Angerås, Arvid Gustafsson, Daniella Isaksén, Johan Herlitz, and Araz Rawshani

Subjects
Medicine, Science
Abstract

Abstract Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7 years in AS, 4.5 years in AR and 4.1 years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30 days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46–0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.

Published
2023
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31. Early ICD implantation following out-of-hospital cardiac arrest: a retrospective cohort study from the Swedish Registry for Cardiopulmonary Resuscitation

Author

Johan Herlitz, Araz Rawshani, Andreas Martinsson, Cecilia Rorsman, Aidin Rawshani, Pedram Sultanian, Peter Lundgren, Annica Ravn-Fischer, Amar Taha, Anna Myredal, Sebastian Möller, Arash Hadi Jafari, Laura David, and Shavan Yassinson

Subjects
Medicine
Abstract

Background It is unclear whether an implantable cardioverter-defibrillator (ICD) is generally beneficial in survivors of out-of-hospital cardiac arrest (OHCA).Objective We studied the association between ICD implantation prior to discharge and survival in patients with cardiac aetiology or initial shockable rhythm in OHCA.Design We conducted a retrospective cohort study in the Swedish Registry for Cardiopulmonary Resuscitation. Treatment associations were estimated using propensity scores. We used gradient boosting, Bayesian additive regression trees, neural networks, extreme gradient boosting and logistic regression to generate multiple propensity scores. We selected the model yielding maximum covariate balance to obtain weights, which were used in a Cox regression to calculate HRs for death or recurrent cardiac arrest.Participants All cases discharged alive during 2010 to 2020 with a cardiac aetiology or initial shockable rhythm were included. A total of 959 individuals were discharged with an ICD, and 2046 were discharged without one.Results Among those experiencing events, 25% did so within 90 days in the ICD group, compared with 52% in the other group. All HRs favoured ICD implantation. The overall HR (95% CI) for ICD versus no ICD was 0.38 (0.26 to 0.56). The HR was 0.42 (0.28 to 0.63) in cases with initial shockable rhythm; 0.18 (0.06 to 0.58) in non-shockable rhythm; 0.32 (0.20 to 0.53) in cases with a history of coronary artery disease; 0.36 (0.22 to 0.61) in heart failure and 0.30 (0.13 to 0.69) in those with diabetes. Similar associations were noted in all subgroups.Conclusion Among survivors of OHCA, those discharged with an ICD had approximately 60% lower risk of death or recurrent cardiac arrest. A randomised trial is warranted to study this further.

Published
2024
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32. Combining distributive ethics and causal Inference to make trade-offs between austerity and population health

Author

Daoud, Adel, Herlitz, Anders, and Subramanian, SV

Subjects
Economics - General Economics, Computer Science - Computers and Society
Abstract

The International Monetary Fund (IMF) provides financial assistance to its member-countries in economic turmoil, but requires at the same time that these countries reform their public policies. In several contexts, these reforms are at odds with population health. While researchers have empirically analyzed the consequences of these reforms on health, no analysis exist on identifying fair tradeoffs between consequences on population health and economic outcomes. Our article analyzes and identifies the principles governing these tradeoffs. First, this article reviews existing policy-evaluation studies, which show, on balance, that IMF policies frequently cause adverse effects on child health and material standards in the pursuit of macroeconmic improvement. Second, this article discusses four theories in distributive ethics (maximization, egalitarianianism, prioritarianiasm, and sufficientarianism) to identify which is the most compatible with the core mission of the IMF, that is, improved macroeconomics (Articles of Agreement) while at the same time balancing consequences on health. Using a distributive-ethics analyses of IMF polices, we argue that sufficientarianism is the most compatible theory. Third, this article offer a qualitative rearticulation of the Articles of Agreement, and formalize sufficientarian principles in the language of causal inference. We also offer a framework on how to empirically measure, from observational data, the extent that IMF policies trade off fairly between population health and economic outcomes. We conclude with policy recommendations and suggestions for future research., Comment: Working paper

Published
2020

35. Molecular Signatures of Glomerular Neovascularization in a Patient with Diabetic Kidney Disease

Author

Ferkowicz, Michael J., Verma, Ashish, Barwinska, Daria, Melo Ferreira, Ricardo, Henderson, Joel M., Kirkpatrick, Mary, Silva, Paolo S., Steenkamp, Devin W., Phillips, Carrie L., Waikar, Sushrut S., Sutton, Timothy A., Lake, Blue, Zhang, Kun, Lecker, Stewart, Morales, Alexander, Stillman, Isaac, Bogen, Steve, Amodu, Afolarin A., Beck, Laurence, Henderson, Joel, Ilori, Titlayo, Maikhor, Shana, Onul, Ingrid, Schmidt, Insa, Verma, Ashish, Waikar, Sushrut, Yadati, Pranav, Yu, Guanghao, Colona, Mia R., McMahon, Gearoid, Weins, Astrid, Hacohen, Nir, Greka, Anna, Hoover, Paul J., Marshall, Jamie L., Aulisio, Mark, Bush, William, Chen, Yijiang, Crawford, Dana, Madabhushi, Anant, Viswanathan, Vidya S., Bush, Lakeshia, Cooperman, Leslie, Gadegbeku, Crystal, Herlitz, Leal, Jolly, Stacey, Nguyen, Jane, O’Malley, Charles, O’Toole, John, Palmer, Ellen, Poggio, Emilio, Spates-Harden, Kassandra, Sedor, John, Sendrey, Dianna, Taliercio, Jonathan, Appelbaum, Paul, Balderes, Olivia, Barasch, Jonathan, Berroue, Cecilia, Bomback, Andrew, Canetta, Pietro A., D’Agati, Vivette, Kiryluk, Krzysztof, Kudose, Satoru, Mehl, Karla, Sabatello, Maya, Shang, Ning, Varela, German, de Pinho Gonçalves, Joana, Lardenoije, Roy, Migas, Lukasz, Van de Plas, Raf, Barisoni, Laura, Rennke, Helmut, Azeloglu, Evren, Campbell, Kirk, Coca, Steven, He, Cijang, He, John, Iyengar, Srinivas Ravi, Lefferts, Seanee, Nadkarni, Girish, Patel, Marissa, Tokita, Joji, Ward, Stephen, Xiong, Yuguang, Verdoes, Abraham, Sabo, Angela, Barwinska, Daria, Gisch, Debora Lidia, Williams, James, Kelly, Katherine, Dunn, Kenneth, Asghari, Mahla, Eadon, Michael, Ferkowicz, Michael, Dagher, Pierre, Ferreira, Ricardo Melo, Winfree, Seth, Bledsoe, Sharon, Wofford, Stephanie, El-Achkar, Tarek, Sutton, Timothy, Bowen, William, Cheng, Ying-Hua, Slade, Austen, Record, Elizabeth, Cheng, Yinghua, Borner, Katy, Herr, Bruce, Jain, Yashvardhan, Quardokus, Ellen, Atta, Mohamed, Bernard, Lauren, Menez, Steven, Parikh, Chirag, Corona Villalobos, Celia Pamela, Wang, Ashley, Wen, Yumeng, Xu, Alan, Chen, Sarah, Donohoe, Isabel, Johansen, Camille, Rosas, Sylvia, Sun, Jennifer, Ardayfio, Joseph, Bebiak, Jack, Brown, Keith, Campbell, Taneisha, Fox, Monica, Hayashi, Lynda, Jefferson, Nichole, Richard Knight, Jennifer Jones, Koewler, Robert, Pinkeney, Roy, Saul, John, Shpigel, Anna, Stutzke, Christy, Prasad, Pottumarthi, Madhavan, Sethu M., Parikh, Samir, Rovin, Brad, Shapiro, John P., Anderton, Christopher, Lukowski, Jessica, Pasa-Tolic, Ljiljana, Velickovic, Dusan, Oliver, George, Mao, Weiguang, Sealfon, Rachel, Troyanskaya, Olga, Wong, Aaron, Pollack, Ari, Goltsev, Yury, Ginley, Brandon, Lutnick, Brendon, Anjani, Kavya, Laszik, Zoltan G., Mukatash, Tariq, Nolan, Garry, Beyda, David, Bracamonte, Erika, Brosius, Frank, Campos, Baltazar, Marquez, Nicole, Mendoza, Katherine, Scott, Raymond, Thajudeen, Bijin, Tsosie, Rebecca, Woodhead, Gregory, Saunders, Milda, Alloway, Rita R., Lee, Paul J., Rike, Adele, Shi, Tiffany, Woodle, E. Steve, Bjornstad, Petter, Hsieh, Elena, Kendrick, Jessica, Pyle, Laura, Thurman, Joshua, Vinovskis, Carissa, Wrobel, Julia, Lucarelli, Nicholas, Sarder, Pinaki, Bui, James, Carmona-Powell, Eunice, Gaba, Ron, Kelly, Tanika, Lash, James, Meza, Natalie, Redmond, Devona, Renteria, Amada, Ricardo, Ana, Setty, Suman, Srivastava, Anand, Alakwaa, Fadhl, Ascani, Heather, Balis, Ul, Bitzer, Markus, Blanc, Victoria, Bonevich, Nikki, Conser, Ninive, Demeke, Dawit, Dull, Rachel, Eddy, Sean, Frey, Renee, Hartman, John, He, Yongqun Oliver, Hodgin, Jeffrey, Kretzler, Matthias, Lienczewski, Chrysta, Luo, Jinghui, Mariani, Laura, McCown, Phillip, Menon, Rajasree, Nair, Viji, Otto, Edgar, Reamy, Rebecca, Rose, Michael, Schaub, Jennifer, Steck, Becky, Wright, Zachary, Coleman, Alyson, Henderson-Brown, Dorisann, Berge, Jerica, Caramori, Maria Luiza, Adeyi, Oyedele, Nachman, Patrick, Safadi, Sami, Flanagan, Siobhan, Ma, Sisi, Klett, Susan, Wolf, Susan, Harindhanavudhi, Tasma, Rao, Via, Bream, Peter, Froment, Anne, Kelley, Sara, Mottl, Amy, Roy-Chaudhury, Prabir, Zeitler, Evan, Bender, Filitsa, Elder, Michele, Gilliam, Matthew, Hall, Daniel E., Kellum, John A., Murugan, Raghavan, Palevsky, Paul, Rosengart, Matthew, Tan, Roderick, Tublin, Mitchell, Winters, James, Bansal, Shweta, Montellano, Richard, Pamreddy, Annapurna, Sharma, Kumar, Venkatachalam, Manjeri, Ye, Hongping, Zhang, Guanshi, Basit, Mujeeb, Cai, Qi, Hendricks, Allen, Hedayati, Susan, and Asra

Published
2024
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36. Participant Experience with Protocol Research Kidney Biopsies in the Kidney Precision Medicine Project

Author

Victoria-Castro, Angela M., Corona-Villalobos, Celia P., Xu, Alan Y., Onul, Ingrid, Huynh, Courtney, Chen, Sarah W., Ugwuowo, Ugochukwu, Sarkisova, Natalya, Dighe, Ashveena L., Blank, Kristina N., Blanc, Victoria M., Rose, Michael P., Himmelfarb, Jonathan, de Boer, Ian H., Tuttle, Katherine R., Roberts, Glenda V., Alexandrov, Theodore, Alloway, Rita R., Alpers, Charles E., Amodu, Afolarin A., Anderton, Christopher R., Anjani, Kavya, Appelbaum, Paul, Ardayfio, Joseph, Arora, Tanima, Ascani, Heather, El-Achkar, Tarek M., Aulisio, Mark, Azeloglu, Evren U., Balderes, Olivia, Balis, Ulysses G.J., Bansal, Shweta, Barasch, Jonathan M., Bansal, Shweta, Barkell, Alex, Barwinska, Daria, Basit, Mujeeb, Basta, Jeanine, Bebiak, Jack, Beck, Laurence H., Bender, Filitsa, Berglund, Ashley, Bernard, Lauren, Berrouet, Cecilia, Berry, Brooke, Bjornstad, Petter M., Blanc, Victoria M., Blank, Kristina N., Bledsoe, Sharon, Boada, Patrick, Bogen, Steve, Bomback, Andrew S., Bonevich, Nikole, Borner, Katy, Brown, Keith, Bueckle, Andreas, Burg, Ashley R., Burgess, Adam, Bush, Lakeshia, Bush, William S., Campbell, Catherine E., Campbell, Taneisha, Canetta, Pietro A., Cantley, Lloyd G., Caprioli, Richard M., Carson, Jonas, Chen, Sarah, Chen, Yijiang M., Cheng, Yinghua, Cimino, Jim, Colona, Mia R., Conser, Ninive C., Cooperman, Leslie, Crawford, Dana C., DʼAgati, Vivette D., Dagher, Pierre C., Daniel, Stephen, Daratha, Kenn, de Boer, Ian H., Diettman, Sabine M., Dighe, Ashveena L., Donohoe, Isabel, Dowd, Frederick, Dunn, Kenneth W., Eadon, Michael T., Eddy, Sean, Elder, Michele M., Ferkowicz, Michael J., Frey, Renee, Gadegbeku, Crystal A., Gaut, Joseph P., Gilliam, Matthew, Ginley, Brandon, Gisch, Debora, Goltsev, Yury, Gonzalez-Vicente, Agustin, Greka, Anna, Grewenow, Stephanie M., Hacohen, Nir, Hall, Daniel E., Hansen, Jens, Hayashi, Lynda, He, Cijang, He, Yougqun, Hedayati, S. Susan, Henderson, Joel M., Hendricks, Allen H., Herlitz, Leal, Herr, Bruce W., Himmelfarb, Jonathan, Hodgin, Jeffrey B., Hoofnagle, Andrew N., Hoover, Paul J., Ilori, Titlayo, Iyengar, Ravi, Jain, Sanjay, Jain, Yashvardhan, Janowczyk, Andrew, Jefferson, Nichole, Johansen, Camille, Jolly, Stacey, Kakade, Vijaykumar R., Kellum, John A., Kelly, Katherine J., Kermani, Asra, Kiryluk, Krzysztof, Knight, Richard, Koewler, Robert, Kretzler, Matthias, Kudose, Satoru, Lake, Blue B., Larson, Brandon, Laszik, Zoltan G., Lecker, Stewart H., Lee, Paul J., Lee, Simon C., Lienczewski, Chrysta, Limonte, Christine, Lu, Christopher Y., Lucarelli, Nicholas, Lukowski, Jessica, Luo, Jinghui, Lutnick, Brendon, Ma, Shihong, Madabhushi, Anant, Madhavan, Sethu M., Maikhor, Shana, Mariani, Laura H., Marshall, Jamie L., McClelland, Robyn L., McMahon, Gearoid M., Mehl, Karla, Ferreira, Ricardo Melo, Menez, Steven, Menon, Rajasree, Miller, R. Tyler, Moe, Orson W., Moledina, Dennis, Montellano, Richard, Mooney, Sean D., Morales, Martha Catalina, Mukatash, Tariq, Murugan, Raghavan, Nam, Yunbi, Nguyen, Jane, Nolan, Garry, Oʼtoole, John, Oliver, George (Holt), Onul, Ingrid, Otto, Edgar, Palevsky, Paul M., Palmer, Ellen, Pamreddy, Annapurna, Parikh, Chirag R., Parikh, Samir, Park, Christopher, Park, Harold, Pasa-Tolic, Ljiljana, Patel, Jiten, Patterson, Nathan, Phuong, Jim, Pillai, Anil, Pinkeney, Roy, Poggio, Emilio, Pollack, Ari, Prasad, Pottumarthi, Pyle, Laura, Quardokus, Ellen M., Randhawa, Parmjeet, Rauchman, Michael I., Record, Elizabeth, Rennke, Helmut, Rezaei, Kasra, Rike, Adele, Rivera, Marcelino, Roberts, Glenda V., Rosas, Sylvia E., Rosenberg, Avi, Rosengart, Matthew, Rovin, Brad, Roy, Neil, Sabatello, Maya, Sambandam, Kamalanathan, Sarder, Pinaki, Sarkisova, Natalya, Sarwal, Minnie, Saul, John, Schaub, Jennifer, Schmidt, Insa, Sealfon, Rachel, Sedor, John, Sendrey, Dianna, Shang, Ning, Shankland, Stuart, Shapiro, John P., Sharma, Kumar, Sharman, Kavya, Shaw, Melissa M., Shi, Tiffany, Shpigel, Anna, Sigdel, Tara, Slade, Austen, Snyder, Jamie, Spates-Harden, Kassandra, Spraggins, Jeffrey M., Srivastava, Anand, Steck, Becky, Stillman, Isaac, Stutzke, Christy, Su, Jing, Sun, Jennifer, Sutton, Timothy A., Taliercio, Jonathan, Tan, Roderick, Torrealba, Jose, Toto, Robert D., Troyanskaya, Olga, Tublin, Mitchell, Tuttle, Katherine R., Ugwuowo, Ugochukwu, Valerius, M. Todd, Van de Plas, Raf, Varela, German, Vazquez, Miguel, Velickovic, Dusan, Venkatachalam, Manjeri, Verma, Ashish, Victoria-Castro, Angela M., Vijayan, Anitha, Corona-Villalobos, Celia P., Vinovskis, Carissa, Viswanathan, Vidya S., Vita, Tina, Waikar, Sushrut, Wang, Ashley, Wang, Ruikang, Wang, Nancy, Weins, Astrid, Wen, Natasha, Wen, Yumeng, Wilcox, Adam, Williams, James C., Jr., Kayleen Williams, Williams, Mark, Wilson, Francis P., Winfree, Seth, Winters, James, Wofford, Stephanie, Wong, Aaron, Woodle, E. Steve, Xiong, Yuguang, Xu, Alan, Yadati, Pranav, Ye, Hongping, Yu, Guanghao, Zhang, Dianbo, Zhang, Guanshi, and Zhang, Kun

Published
2024
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40. Understanding the sustainability of school interventions to improve students' health, wellbeing and behaviour

Author

Herlitz, L. and Bonell, C.

Subjects
362.1
Abstract

Background: The sustainability of school-based health interventions to improve students' health, wellbeing and behaviour after start-up funding/resources cease has been relatively unexplored compared to health-care. Discontinuing effective interventions prevents new practices from reaching wider student populations and wastes investment in implementation. This thesis examines evidence on whether/how schools sustain health interventions and explores sustainability processes. Method: Empirical studies were systematically reviewed to assess the sustainability of school health interventions. A case-study was conducted of the sustainability of 'Learning Together', a bullying-prevention intervention initiated in English secondary schools through an effectiveness trial. The intervention entailed: restorative practice (RP), a staff-student action group, and a curriculum. Qualitative, longitudinal data were collected from five schools: interviews with multiple staff/school, and with students and external facilitators the first-year post-trial; interviews with one staff member/school two years post-trial; and descriptive data from the trial's process evaluation. Results: Twenty-four studies of eighteen interventions were included in the systematic review. No interventions were sustained entirely; all interventions had some components sustained by some schools/staff, bar one that was discontinued. Key facilitators included commitment from senior leaders, staff observing an improvement in students' engagement/wellbeing, and confidently delivering valued intervention approaches. Important contextual barriers emerged: the norm of prioritising educational outcomes under time/resource constraints, insufficient funding/resources and ongoing training, and staff turnover. Learning Together was not sustainable two years post-trial. RP had been continued by some individuals in all schools and was sustained at school-level in one school; the curriculum and action groups were discontinued in all schools, though actions initiated by the groups were sustained in two schools. Staff's experiences of components' effectiveness compared to existing provision and views of their long-term value affected components' sustainability. Sustainability depended on staff's ability to mainstream desired components across the school, which they had little capacity to do. Conclusion: Intervention developers need to support schools to mainstream evidence-based interventions to sustain them at school-level. Methodologically stronger primary research on sustainability and sustainability strategies is needed.

Published
2021
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41. Rationale and design of the Kidney Precision Medicine Project

Author

de Boer, Ian H, Alpers, Charles E, Azeloglu, Evren U, Balis, Ulysses GJ, Barasch, Jonathan M, Barisoni, Laura, Blank, Kristina N, Bomback, Andrew S, Brown, Keith, Dagher, Pierre C, Dighe, Ashveena L, Eadon, Michael T, El-Achkar, Tarek M, Gaut, Joseph P, Hacohen, Nir, He, Yongqun, Hodgin, Jeffrey B, Jain, Sanjay, Kellum, John A, Kiryluk, Krzysztof, Knight, Richard, Laszik, Zoltan G, Lienczewski, Chrysta, Mariani, Laura H, McClelland, Robyn L, Menez, Steven, Moledina, Dennis G, Mooney, Sean D, O’Toole, John F, Palevsky, Paul M, Parikh, Chirag R, Poggio, Emilio D, Rosas, Sylvia E, Rosengart, Matthew R, Sarwal, Minnie M, Schaub, Jennifer A, Sedor, John R, Sharma, Kumar, Steck, Becky, Toto, Robert D, Troyanskaya, Olga G, Tuttle, Katherine R, Vazquez, Miguel A, Waikar, Sushrut S, Williams, Kayleen, Wilson, Francis Perry, Zhang, Kun, Iyengar, Ravi, Kretzler, Matthias, Himmelfarb, Jonathan, Project, Kidney Precision Medicine, Lecker, Stewart, Stillman, Isaac, Waikar, Sushrut, Mcmahon, Gearoid, Weins, Astrid, Short, Samuel, Hoover, Paul, Aulisio, Mark, Cooperman, Leslie, Herlitz, Leal, O’Toole, John, Poggio, Emilio, Sedor, John, Jolly, Stacey, Appelbaum, Paul, Balderes, Olivia, Barasch, Jonathan, Bomback, Andrew, Canetta, Pietro A, d’Agati, Vivette D, Kudose, Satoru, Mehl, Karla, Radhakrishnan, Jai, Weng, Chenhua, Alexandrov, Theodore, Ashkar, Tarek, Barwinska, Daria, Dagher, Pierre, Dunn, Kenneth, Eadon, Michael, Ferkowicz, Michael, Kelly, Katherine, Sutton, Timothy, Winfree, Seth, Parikh, Chirag, Rosenberg, Avi, Villalobos, Pam, Malik, Rubab, Fine, Derek, Atta, Mohammed, Trujillo, Jose Manuel Monroy, Slack, Alison, Rosas, Sylvia, and Williams, Mark

Subjects
Clinical Research, Transplantation, Kidney Disease, Prevention, Renal and urogenital, Good Health and Well Being, Acute Kidney Injury, Adult, Humans, Kidney, Precision Medicine, Prospective Studies, Proteomics, Renal Insufficiency, Chronic, acute kidney injury, chronic kidney disease, diabetes, hypertension, precision medicine, Kidney Precision Medicine Project, Clinical Sciences, Urology & Nephrology
Abstract

Chronic kidney disease (CKD) and acute kidney injury (AKI) are common, heterogeneous, and morbid diseases. Mechanistic characterization of CKD and AKI in patients may facilitate a precision-medicine approach to prevention, diagnosis, and treatment. The Kidney Precision Medicine Project aims to ethically and safely obtain kidney biopsies from participants with CKD or AKI, create a reference kidney atlas, and characterize disease subgroups to stratify patients based on molecular features of disease, clinical characteristics, and associated outcomes. An additional aim is to identify critical cells, pathways, and targets for novel therapies and preventive strategies. This project is a multicenter prospective cohort study of adults with CKD or AKI who undergo a protocol kidney biopsy for research purposes. This investigation focuses on kidney diseases that are most prevalent and therefore substantially burden the public health, including CKD attributed to diabetes or hypertension and AKI attributed to ischemic and toxic injuries. Reference kidney tissues (for example, living-donor kidney biopsies) will also be evaluated. Traditional and digital pathology will be combined with transcriptomic, proteomic, and metabolomic analysis of the kidney tissue as well as deep clinical phenotyping for supervised and unsupervised subgroup analysis and systems biology analysis. Participants will be followed prospectively for 10 years to ascertain clinical outcomes. Cell types, locations, and functions will be characterized in health and disease in an open, searchable, online kidney tissue atlas. All data from the Kidney Precision Medicine Project will be made readily available for broad use by scientists, clinicians, and patients.

Published
2021

43. The evidence supporting AHA guidelines on adult cardiopulmonary resuscitation (CPR).

Author

Emma Junedahl, Peter Lundgren, Erik Andersson, Vibha Gupta, Truls Råmunddal, Aidin Rawshani, Araz Rawshani, Gabriel Riva, Ida Arnetorp, Fredrik Hessulf, Johan Herlitz, and Therese Djärv

Subjects
Medicine, Science
Abstract

BackgroundGuidelines for the management of cardiac arrest play a crucial role in guiding clinical decisions and care. We examined the strength and quality of evidence underlying these recommendations in order to elucidate strengths and gaps in knowledge.MethodsUsing the 2020 American Heart Association (AHA) Guidelines for Adult CPR, we subdivided all recommendations into advanced life support (ALS), basic life support (BLS), and recovery after cardiac arrest, as well as a more granular categorization by topic (i.e. the intervention or evaluation recommended). The Class of Recommendation (COR) and Level of Evidence (LOE) for each were reviewed. Additionally, we reviewed the 2023 guidelines to ensure the inclusion of the most recent updates.ResultsWe noted 254 recommendations, of which 181 were ALS, 69 were BLS, and 4 were recovery after resuscitation. In total, only 2 (1%) had the most robust evidence (LOE A), while 23% were at LOE B-NR (Non-Randomized), 15% at LOE B-R (Randomized), 50% at LOE C-LD (Limited Data), and 12% relied on expert opinion LOE C-EO (Expert Opinion). Despite the strength of ALS recommendations (Class 1, 2a, or 2b), none had LOE A. In BLS, no recommendations were supported by LOE A. For BLS, 7% of recommendations had LOE C (C-LD or C-EO). The evidence for specific BLS topics, such as airway management, was notably low. Among ALS topics, neurological prognostication had relatively stronger evidence.ConclusionsOnly 26 out of the 81 COR 1 recommendations (32%) were supported by LOE A or B, indicating a strong discrepancy between the strength of recommendation and the underlying evidence in cardiac arrest guidelines. The findings underscore a pressing need for more rigorous research, particularly randomized trials.

Published
2024
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44. Consensus Parameter: Research Methodologies to Evaluate Neurodevelopmental Effects of Pubertal Suppression in Transgender Youth

Author

Chen, Diane, Strang, John F, Kolbuck, Victoria D, Rosenthal, Stephen M, Wallen, Kim, Waber, Deborah P, Steinberg, Laurence, Sisk, Cheryl L, Ross, Judith, Paus, Tomas, Mueller, Sven C, McCarthy, Margaret M, Micevych, Paul E, Martin, Carol L, Kreukels, Baudewijntje PC, Kenworthy, Lauren, Herting, Megan M, Herlitz, Agneta, Haraldsen, Ira RJ Hebold, Dahl, Ronald, Crone, Eveline A, Chelune, Gordon J, Burke, Sarah M, Berenbaum, Sheri A, Beltz, Adriene M, Bakker, Julie, Eliot, Lise, Vilain, Eric, Wallace, Gregory L, Nelson, Eric E, and Garofalo, Robert

Subjects
Neurosciences, Pediatric, Behavioral and Social Science, Clinical Research, Mental Health, Mental health, Good Health and Well Being, expert consensus, Delphi, puberty blockers, GnRHa, transgender, adolescents
Abstract

Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that occur during puberty, a critical question is whether this treatment impacts neurodevelopment. Methods: A Delphi consensus procedure engaged 24 international experts in neurodevelopment, gender development, puberty/adolescence, neuroendocrinology, and statistics/psychometrics to identify priority research methodologies to address the empirical question: is pubertal suppression treatment associated with real-world neurocognitive sequelae? Recommended study approaches reaching 80% consensus were included in the consensus parameter. Results: The Delphi procedure identified 160 initial expert recommendations, 44 of which ultimately achieved consensus. Consensus study design elements include the following: a minimum of three measurement time points, pubertal staging at baseline, statistical modeling of sex in analyses, use of analytic approaches that account for heterogeneity, and use of multiple comparison groups to minimize the limitations of any one group. Consensus study comparison groups include untreated transgender youth matched on pubertal stage, cisgender (i.e., gender congruent) youth matched on pubertal stage, and an independent sample from a large-scale youth development database. The consensus domains for assessment includes: mental health, executive function/cognitive control, and social awareness/functioning. Conclusion: An international interdisciplinary team of experts achieved consensus around primary methods and domains for assessing neurodevelopmental effects (i.e., benefits and/or difficulties) of pubertal suppression treatment in transgender youth.

Published
2020

46. The Significance of Hematuria in Podocytopathies

Author

Marchel, Dorota, Trachtman, Howard, Larkina, Maria, Helmuth, Margaret, Lai Yee, Jennifer Y., Fermin, Damian, Bomback, Andrew S., Canetta, Pietro A., Gipson, Debbie S., Mottl, Amy K., Parekh, Rulan S., Saha, Manish K., Sampson, Matthew G., Lafayette, Richard A., Mariani, Laura H., Massengill, S., Lo, L., Dell, K., Sedor, J., Martin, B., Lemley, K., Fajardo, C., Sharma, S., Srivastava, T., Markus, K., Sethna, C., Vento, S., Canetta, P., Pradhan, A., Gbadegesin, R., Olabisi, O., Smith, M., Greenbaum, L., Wang, C.S., Yun, E., Adler, S., LaPage, J., Amarah, A., Itteera, M., Atkinson, M., Williams, M., Fervenza, F., Hogan, M., Lieske, J., Selewski, D., Alston, C., Kaskel, F., Ross, M., Flynn, P., Kopp, J., Malaga-Dieguez, L., Zhdanova, O., Pehrson, L.J., Almaani, S., Roberts, L., Lafayette, R., Dave, S., Lee, I., Pfeffer, Z., Shah, S., Deslandes, A., Reich, H., Hladunewich, M., Ling, P., Romano, M., Brakeman, P, Podoll, A., Rogers, N., McCarthy, E., Landry, E., Fornoni, A., Bidot, C., Kretzler, M., Gipson, D., Williams, A., Stelzer, M., Nachman, P., Rheault, M., Rao, V., Derebail, V., Gibson, K., Froment, A., Ochoa-Toro, F., Holzman, L., Meyers, K., Kallem, K., Swenson, A., Sharma, K., Sambandam, K., Robles, E., Turk, M., Jefferson, A., Hingorani, S., Tuttle, K., Manahan, L., Pao, E., Kuykendall K, K., Lin, J.J., Cody, E., Kretzler, M., Barisoni, L., Gadegbeku, C., Gillespie, B., Gipson, D., Holzman, L., Mariani, L., Sampson, M.G., Sedor, J., Smith, A., Zee, J., Alter, G., Desmond, H., Eddy, S., Fermin, D., Ju, W., Larkina, M., Li, S., Lienczewski, C.C., Mainieri, T., Scherr, R., Troost, J., Williams, A., Wang, Y., Avila-Casado, Carmen, Bagnasco, Serena, Cassol, Clarissa, Bu, Lihong, Caltharp, Shelley, Demeke, Dawit, Gillespie, Brenda, Hassler, Jared, Herlitz, Leal, Hewitt, Stephen, Hodgin, Jeff, Holanda, Danni, Kambham, Neeraja, Lemley, Kevin, Mariani, Laura, Messias, Nidia, Mikhailov, Alexei, Najafian, Behzad, Palmer, Matthew, Rosenberg, Avi, Royal, Virginie, Stokes, Barry, Thomas, David, Yamashita, Michifumi, Yin, Hong, Zee, Jarcy, Zuo, Yiqin, Barisoni, Laura, Nast, Cynthia, Ahn, Wooin, Appel, Gerald, Appelbaum, Paul, Babayev, Revekka, Bomback, Andrew, Canetta, Pietro, Chan, Brenda, DʼAgati, Vivette Denise, Dogra, Samitri, Fernandez, Hilda, Gharavi, Ali, Hines, William, Husain, Syed Ali, Jain, Namrata, Kiryluk, Krzysztof, Lin, Fangming, Marasa, Maddalena, Markowitz, Glen, Rasouly, Hila Milo, Mohan, Sumit, Mongera, Nicola, Nestor, Jordan, Nickolas, Thomas, Radhakrishnan, Jai, Rao, Maya, Sanna-Cherchi, Simone, Shirazian, Shayan, Stokes, Michael Barry, Uy, Natalie, Valeri, Anthony, Vena, Natalie, Foroncewicz, Bartosz, Moszczuk, Barbara, Mucha, Krzysztof, Perkowska-Ptasińska, Agnieszka, Ghiggeri, Gian Marco, Lugani, Francesca, Ambruzs, Josephine, Liapis, Helen, Baracco, Rossana, Jain, Amrish, Ashoor, Isa, Aviles, Diego, Srivastava, Tarak, Ahn, Sun-Young, Devarajan, Prasad, Erkan, Elif, Claes, Donna, Stone, Hillarey, Mason, Sherene, Gbadegesin, Rasheed, Gomez-Mendez, Liliana, Greenbaum, Larry, Wang, Chia-shi, Yin, Hong (Julie), Cai, Yi, Jens, Goebel, Steinke, Julia, Weaver, Donald, Lane, Jerome, Cramer, Carl, Pan, Cindy, Paloian, Neil, Sreedharan, Rajasree, Selewski, David, Twombley, Katherine, Bowers, Corinna, Dreher, Mary, Kallash, Mahmoud, Mahan, John, Sharpe, Samantha, Smoyer, William, Al-Uzri, Amira, Iragorri, Sandra, Khalid, Myda, Belsha, Craig, Alge, Joseph, Braun, Michael, Gomez, AC, Wenderfer, Scott, Vasylyeva, Tetyana, Feig, Daniel, Fuentes, Gabriel Cara, Hannah, Melisha, Nester, Carla, Chishti, Aftab, Klein, Jon, Katsoufis, Chryso, Seeherunvong, Wacharee, Rheault, Michelle, Wong, Craig, Mathews, Nisha, Barcia, John, Swiatecka-Urban, Agnes, Bartosh, Sharon, Hunley, Tracy, Dharnidharka, Vikas, Gaut, Joseph, Laurin, Louis-Philippe, Royal, Virginie, Achanti, Anand, Budisavljevic, Milos, Self, Sally, Ghossein, Cybele, Peleg, Yonatan, Wadhwani, Shikha, Almaani, Salem, Ayoub, Isabelle, Nadasdy, Tibor, Samir, Parikh, Rovin, Brad, Chang, Anthony, Fatima, Huma, Julian, Bruce, Novak, Jan, Renfrow, Matthew, Rizk, Dana, Chen, Dhruti, Derebail, Vimal, Falk, Ronald, Gibson, Keisha, Glenn, Dorey, Hogan, Susan, Jain, Koyal, Jennette, J. Charles, Mottl, Amy, Poulton, Caroline, Saha, Manish Kanti, Fogo, Agnes, Sanghani, Neil, Kidd, Jason, Muthusamy, Selvaraj, Schelling, Jeffrey, Hou, Jean, Lemley, Kevin, Mika, Warren, Russo, Pierre, Denburg, Michelle, Kogon, Amy, Meyers, Kevin, Pradhan, Madhura, Matar, Raed Bou, OʼToole, John, Sedor, John, Sethna, Christine, Vento, Suzanne, Atta, Mohamed, Bagnasco, Serena, Neu, Alicia, Sperati, John, Adler, Sharon, Dai, Tiane, Dukkipati, Ram, Fervenza, Fernando, Sethi, Sanjeev, Kaskel, Frederick, Brathwaite, Kaye, Reidy, Kimberly, Weisstuch, Joseph, Wu, Ming, Zhdanova, Olga, Heymann, Jurgen, Kopp, Jeffrey, Waldman, Meryl, Winkler, Cheryl, Tuttle, Katherine, Krissberg, Jill, Lafayette, Richard, Fahmeedah, Kamal, Talley, Elizabeth, Hladunewich, Michelle, Parekh, Rulan, Avila-Casado, Carmen, Cattran, Daniel, Heather, Reich, Boll, Philip, Drexler, Yelena, Fornoni, Alessia, Gipson, Patrick, Hodgin, Jeffrey, Oliverio, Andrea, Hogan, Jon, Holzman, Lawrence, Palmer, Matthew, Coppock, Gaia, Abromovitz, Blaise, Mortiz, Michael, Alpers, Charles, Jefferson, J. Ashley, Brown, Elizabeth, Sambandam, Kamal, Roehm, Bethany, Smith, Abigail, Nast, Cynthia, Barisoni, Laura, Gillespie, Brenda, Robinson, Bruce, Kretzler, Matthias, Mariani, Laura, and Guay-Woodford, Lisa M.

Published
2024
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49. Prehospital monitoring of cerebral circulation during out of hospital cardiac arrest ? A feasibility study

Author

Anna Henningsson, Lukas Lannemyr, Oskar Angerås, Joakim Björås, Niklas Bergh, Johan Herlitz, Bengt Redfors, and Peter Lundgren

Subjects
Cerebral oximetry, Regional cerebral oxygen saturation, Cardiac arrest, EMS, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background About two-thirds of the in-hospital deaths after out-of-hospital cardiac arrests (OHCA) are a consequence of anoxic brain injuries, which are due to hypoperfusion of the brain during the cardiac arrests. Being able to monitor cerebral perfusion during cardiopulmonary resuscitation (CPR) is desirable to evaluate the effectiveness of the CPR and to guide further decision making and prognostication. Methods Two different devices were used to measure regional cerebral oxygen saturation (rSO2): INVOS™ 5100 (Medtronic, Minneapolis, MN, USA) and Root® O3 (Masimo Corporation, Irvine, CA, USA). At the scene of the OHCA, advanced life support (ALS) was immediately initiated by the Emergency Medical Services (EMS) personnel. Sensors for measuring rSO2 were applied at the scene or during transportation to the hospital. rSO2 values were documented manually together with ETCO2 (end tidal carbon dioxide) on a worksheet specially designed for this study. The study worksheet also included a questionnaire for the EMS personnel with one statement on usability regarding potential interference with ALS. Results Twenty-seven patients were included in the statistical analyses. In the INVOS™5100 group (n = 13), the mean rSO2 was 54% (95% CI 40.3–67.7) for patients achieving a return of spontaneous circulation (ROSC) and 28% (95% CI 12.3–43.7) for patients not achieving ROSC (p = 0.04). In the Root® O3 group (n = 14), the mean rSO2 was 50% (95% CI 46.5–53.5) and 41% (95% CI 36.3–45.7) (p = 0.02) for ROSC and no ROSC, respectively. ETCO2 values were not statistically different between the groups. The EMS personnel graded the statement of interference with ALS to a median of 2 (IQR 1–6) on a 10-point Numerical Rating Scale. Conclusion Our results suggest that both INVOS™5100 and ROOT® O3 can distinguish between ROSC and no ROSC in OHCA, and both could be used in the pre-hospital setting and during transport with minimal interference with ALS.

Published
2022
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50. Outcome prediction for patients assessed by the medical emergency team: a retrospective cohort study

Author

Anna Adielsson, Christian Danielsson, Pontus Forkman, Thomas Karlsson, Linda Pettersson, Johan Herlitz, and Stefan Lundin

Subjects
Medical emergency team, Rapid response team, Risk score, Outcome, Mortality, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Background Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days. Methods Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality. Results The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774–0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762–0.773). Conclusions Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.

Published
2022
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