652 results on '"Margaret, Johnson"'
Search Results
2. Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT)Research in context
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Nicholas I. Paton, Wolfgang Stöhr, Alejandro Arenas-Pinto, Amanda Clarke, Ian Williams, Margaret Johnson, Chloe Orkin, Fabian Chen, Vincent Lee, Alan Winston, Mark Gompels, Julie Fox, Karen Sanders, David T. Dunn, Martin Fisher, Wendy Hadley, David Stacey, Pat Byrne, Nahum De Esteban, Pierre Pellegrino, Lewis Haddow, James Hand, Carl De Souza, Lisa Murthen, Andrew Crawford-Jones, Ruth Wilson, Elizabeth Green, John Masterson, Kamlesh Patel, Rebecca Howe, Scott Mullaney, Louise Jennings, Nicholas Beeching, Rebecca Tamaklo, Alistair Teague, Isabelle Jendrulek, Juan Manuel Tiraboschi, Ed Wilkins, Yvonne Clowes, Andrew Thompson, Gary Brook, Manoj Trivedi, Kazeem Aderogba, Martin Jones, Andrew DeBurgh-Thomas, Liz Jones, Iain Reeves, Sifiso Mguni, David Chadwick, Pauline Spence, Nellie Nkhoma, Zoe Warwick, Suzanne Price, Sally Read, Elbushra Herieka, James Walker, Ruth Woodward, John Day, Laura Hilton, Veerakathy Harinda, Helen Blackman, Phillip Hay, Wendy Mejewska, Olanike Okolo, Edmund Ong, Karen Martin, Lee Munro, David Dockrell, Lynne Smart, Jonathan Ainsworth, Anele Waters, Stephen Kegg, Sara McNamara, Steve Taylor, Gerry Gilleran, Brian Gazzard, Jane Rowlands, Sris Allan, Rumun Sandhu, Nigel O'Farrell, Sheena Quaid, Fabiola Martin, Caroline Bennett, Moses Kapembwa, Jane Minton, James Calderwood, Frank Post, Lucy Campbell, Emily Wandolo, Adrian Palfreeman, Linda Mashonganyika, Thambiah Balachandran, Memory Kakowa, Rebecca O'Connell, Cheryl Tanawa, Sinna Jebakumar, Lesley Hagger, Say Quah, Sinead McKernan, Charles Lacey, Sarah Douglas, Sarah Russell-Sharpe, Christine Brewer, Clifford Leen, Sheila Morris, Sharmin Obeyesekera, Shirley Williams, Nelson David, Mark Roberts, Julie Wollaston, Nicholas Paton, Karen Scott, David Dunn, Emma Beaumont, Sue Fleck, Mark Hall, Susie Hennings, Ischa Kummeling, Sara Martins, Ellen Owen-Powell, Fionna van Hooff, Livia Vivas, Ellen White, Brian Angus, Andrew Freedman, Ben Cromerty, Danielle Mercey, Sarah Fidler, Estee Torok, Abdel Babiker, Tim Peto, David Lalloo, Andrew Phillips, and Robert James
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HIV ,Randomised ,Protease inhibitor monotherapy ,Simplification ,Darunavir ,Medicine (General) ,R5-920 - Abstract
Summary: Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings: We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference −0.6%, 95% CI −3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation: A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding: The National Institute for Health Research Health Technology Assessment programme.
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- 2024
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3. Definition and Assessment of Paediatric Breakthrough Pain: A Qualitative Interview Study
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Eleanor Dawson, Katie Greenfield, Bernie Carter, Simon Bailey, Anna-Karenia Anderson, Dilini Rajapakse, Kate Renton, Christine Mott, Richard Hain, Emily Harrop, Margaret Johnson, and Christina Liossi
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breakthrough pain ,pediatrics ,palliative care ,pain measurement ,interview ,delivery of healthcare ,Pediatrics ,RJ1-570 - Abstract
Infants, children and young people with life-limiting or life-threatening conditions often experience acute, transient pain episodes known as breakthrough pain. There is currently no established way to assess breakthrough pain in paediatric palliative care. Anecdotal evidence suggests that it is frequently underdiagnosed and undertreated, resulting in reduced quality of life. The development of a standardised paediatric breakthrough pain assessment, based on healthcare professionals’ insights, could improve patient outcomes. This study aimed to explore how healthcare professionals define and assess breakthrough pain in paediatric palliative care and their attitudes towards a validated paediatric breakthrough pain assessment. This was a descriptive qualitative interview study. Semi-structured interviews were conducted with 29 healthcare professionals working in paediatric palliative care across the UK. An inductive thematic analysis was conducted on the data. Five themes were generated: ‘the elusive nature of breakthrough pain’, ‘breakthrough pain assessment’, ‘positive attitudes towards’, ‘reservations towards’ and ‘features to include in’ a paediatric breakthrough pain assessment. The definition and assessment of breakthrough pain is inconsistent in paediatric palliative care. There is a clear need for a validated assessment questionnaire to improve assessment, diagnosis and management of breakthrough pain followed by increased healthcare professional education on the concept.
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- 2024
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4. Carer preferences of route of administration of transmucosal diamorphine and willingness to take part in a randomised controlled trial: an interview study (DIPPER)
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Liz Jamieson, Emily Harrop, Christina Liossi, Katherine Boyce, Lorraine Mitchell, Margaret Johnson, Yogini Jani, Victoria Akinyooye, Simon S. Skene, Ian C. K. Wong, Richard F. Howard, and Kate Oulton
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Paediatrics ,Palliative care ,Terminal care ,Opioids ,Diamorphine ,Breakthrough pain ,Special situations and conditions ,RC952-1245 - Abstract
Abstract Background Children and young people are usually given liquid morphine by mouth for breakthrough pain, which can take thirty minutes to work. A faster-acting, quickly absorbed, needle-free pain medicine, that is easy to administer is needed such as transmucosal (sublingual, buccal, intranasal) diamorphine. Research evidence relating to the administration of medication for breakthrough pain in children and young people is limited. This study aims to describe the experiences and preferences of parents and/or children and young people regarding the route of administration of diamorphine, barriers and facilitators comparative to oral morphine, and participation in a randomised controlled trial. Methods In-depth, semi-structured interviews with parents and/or children and young people at home or hospital/hospice. Results Thirteen interviews with: nine mothers, one father, and three sets of parents jointly. No interviews took place with a child/young person. Most families had experience of the buccal route which was effective in ease of administration and time to control pain. The intranasal route was preferred by parents irrespective of experience. Parents’ willingness for their child to take part in a trial depended on the time commitment, their child’s pain trajectory and the stability of analgesic requirements. Conclusion A randomised controlled trial of oral morphine versus transmucosal diamorphine would need to consider trial logistics, especially time commitment. Parents felt that the trial should be introduced initially by the clinical team, with written information from the research team, and sufficient time to ask questions. Patients who had discontinued oral morphine because of side effects, or those with gastrointestinal failure, should be excluded. Maintaining stability in pain management was essential to families, so the timing of the trial is a potential issue.
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- 2022
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5. Modelling wildland fire burn severity in California using a spatial Super Learner approach.
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Nicholas Simafranca, Bryant Willoughby, Erin O'Neil, Sophie Farr, Brian J. Reich, Naomi Giertych, Margaret Johnson, and Madeleine Pascolini-Campbell
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- 2023
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6. Perceived Levels of Trust of Christian University Presidents and Their Perceptions of Advancement Effectiveness
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Linda Margaret Johnson Cunning
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Christian higher education is important in the academic field since integration of faith and vocation are a fundamental part of Christian responsibility (Ostrander, 2015). Presidents of Christian colleges and universities play an important role in leading their institutions. Presidents are also responsible for creating an organizational culture that helps to achieve goals and outcomes. Challenges are threatening higher education in such a way that yearly Christian colleges and universities are facing the reality of budget reductions or even closure (Belz, 2019; Gehrz, 2013; Zylstra, 2019). This study explored perceptions of university presidents in biblical higher education, specifically, perceptions of trust within the institution and perceptions of university advancement effectiveness. Advancement effectiveness is characterized by the efforts that affect fundraising and result in financial gains. Effective advancement efforts support the institution's mission and work, which is critical in the competitive higher education field. In previous studies, trust is seen as foundational for attainment of organizational goals and operational effectiveness (Dirks & Ferrin, 2001). This study explored the Christian university president's role, trust definitions and attributes, and university advancement that led to the question, is there a difference in perceived levels of trust of Christian university presidents and their perceptions of advancement effectiveness? A quantitative approach was used to gather data. The t-test of independent means was used to examine if there is a difference in perceived levels of trust of Christian university presidents and their perceptions of advancement effectiveness. The results of this study may help in furthering efforts that contribute to successful trust cultures and advancement efforts of Christian higher education institutions. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]
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- 2020
7. Attenuated humoral responses in HIV after SARS-CoV-2 vaccination linked to B cell defects and altered immune profiles
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Emma Touizer, Aljawharah Alrubayyi, Rosemarie Ford, Noshin Hussain, Pehuén Pereyra Gerber, Hiu-Long Shum, Chloe Rees-Spear, Luke Muir, Ester Gea-Mallorquí, Jakub Kopycinski, Dylan Jankovic, Anna Jeffery-Smith, Christopher L. Pinder, Thomas A. Fox, Ian Williams, Claire Mullender, Irfaan Maan, Laura Waters, Margaret Johnson, Sara Madge, Michael Youle, Tristan J. Barber, Fiona Burns, Sabine Kinloch, Sarah Rowland-Jones, Richard Gilson, Nicholas J. Matheson, Emma Morris, Dimitra Peppa, and Laura E. McCoy
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Immunology ,Virology ,Science - Abstract
Summary: We assessed a cohort of people living with human immunodeficiency virus (PLWH) (n = 110) and HIV negative controls (n = 64) after 1, 2 or 3 SARS-CoV-2 vaccine doses. At all timepoints, PLWH had significantly lower neutralizing antibody (nAb) titers than HIV-negative controls. We also observed a delayed development of neutralization in PLWH that was underpinned by a reduced frequency of spike-specific memory B cells (MBCs). Improved neutralization breadth was seen against the Omicron variant (BA.1) after the third vaccine dose in PLWH but lower nAb responses persisted and were associated with global MBC dysfunction. In contrast, SARS-CoV-2 vaccination induced robust T cell responses that cross-recognized variants in PLWH. Strikingly, individuals with low or absent neutralization had detectable functional T cell responses. These PLWH had reduced numbers of circulating T follicular helper cells and an enriched population of CXCR3+CD127+CD8+T cells after two doses of SARS-CoV-2 vaccination.
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- 2023
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8. Hypersensitivity reactions, hepatotoxicity, and other discontinuations in persons receiving integrase strand transfer inhibitors: results from the EuroSIDA study
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Annegret Pelchen-Matthews, Jakob Friis Larsen, Leah Shepherd, Josip Begovac, Karen Pedersen, Stéphane De Wit, Andrzej Horban, Elzbieta Jablonowska, Margaret Johnson, Irina Khromova, Marcelo H. Losso, Lars N. Nielsen, Anna Lisa Ridolfo, Brigitte Schmied, Christoph Stephan, Israel Yust, Lloyd Curtis, Vani Vannappagari, Leigh Ragone, Ashley Roen, Dorthe Raben, Ole Kirk, Lars Peters, Amanda Mocroft, and for the EuroSIDA Study Group
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human immunodeficiency virus ,antiretroviral therapy ,integrase strand transfer inhibitors ,dolutegravir ,serious adverse events ,hypersensitivity reaction ,hepatotoxicity ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background: Hypersensitivity reaction (HSR) and hepatotoxicity are rare, but potentially serious side-effects of antiretroviral use. Objective: To investigate discontinuations due to HSR, hepatotoxicity or other reasons among users of dolutegravir (DTG) vs. raltegravir (RAL) or elvitegravir (EVG) in the EuroSIDA cohort. Methods: We compared individuals ≥18 years and starting combination antiretroviral therapy (ART, ≥3 drugs) with DTG vs. RAL or EVG, with or without abacavir (ABC), between January 16, 2014 and January 23, 2019. Discontinuations due to serious adverse events (SAEs) were independently reviewed. Results: Altogether 4366 individuals started 5116 ART regimens including DTG, RAL, or EVG, contributing 9180 person-years of follow-up (PYFU), with median follow-up 1.6 (interquartile range 0.7–2.8) years per treatment episode. Of these, 3074 (60.1%) used DTG (1738 with ABC, 1336 without) and 2042 (39.9%) RAL or EVG (286 with ABC, 1756 without). 1261 (24.6%) INSTI episodes were discontinued, 649 of the DTG-containing regimens (discontinuation rate 115, 95% CI 106–124/1000 PYFU) and 612 RAL or EVG-containing regimens (173, CI 160–188/1000 PYFU). After independent review, there were five HSR discontinuations, two for DTG (one with and one without ABC, discontinuation rate 0.35, CI 0.04–1.28/1000 PYFU), and three for RAL or EVG without ABC (0.85, CI 0.18–2.48/1000 PYFU). There was one hepatotoxicity discontinuation on DTG with ABC (discontinuation rate 0.18, CI 0.00–0.99/1000 PYFU). Conclusion: During 5 years of observations in the EuroSIDA cohort independently reviewed discontinuations due to HSR or hepatotoxicity were very rare, indicating a low rate of SAEs.
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- 2021
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9. Impact of the COVID-19 pandemic on cancer assessment in primary care: a qualitative study of GP views
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Stephanie Archer, Natalia Calanzani, Stephanie Honey, Margaret Johnson, Richard Neal, Suzanne E Scott, and Fiona M Walter
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general practice ,neoplasms ,early diagnosis ,coronavirus ,Medicine (General) ,R5-920 - Abstract
Background: Early diagnosis is key to improve cancer outcomes, and most cancers are diagnosed in primary care after initial symptomatic presentation. Emerging evidence suggests an increase in avoidable cancer deaths owing to the COVID-19 pandemic. Aim: To understand GPs’ views on the impact of the COVID-19 pandemic on the clinical assessment of possible cancer. Design & setting: A qualitative semi-structured interview study with GPs from the East of England. Method: GPs were purposively sampled based on age, sex, and years of experience. Interviews were conducted via Zoom or Microsoft Teams in August and September 2020. Transcribed recordings were analysed inductively using thematic analysis. The Model of Pathways to Treatment guided the analysis. Results: Three themes were identified across 23 interviews on GP views on the impact of: (1) changes in patient help-seeking behaviour on symptoms at presentation; (2) remote consultations on managing patients with possible cancer symptoms; and (3) the COVID-19 pandemic on triaging and referring patients with possible cancer. There were positive changes to practice, but concerns were raised about the adequacy of remote consultations for assessing symptoms. Some GPs reported delayed cancer diagnoses, and uncertainty about how backlog in referrals would be managed. Conclusion: This study provides new evidence on the impact of the COVID-19 pandemic on assessing symptomatic patients. Recommendations are made to inform safe and effective primary care clinical practice. Urgent action is needed to mitigate the impact of the COVID-19 pandemic, and ensure appropriate symptomatic assessment now and in the future.
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- 2021
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10. Associations between baseline characteristics, CD4 cell count response and virological failure on first-line efavirenz + tenofovir + emtricitabine for HIV
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Oliver T. Stirrup, Caroline A. Sabin, Andrew N. Phillips, Ian Williams, Duncan Churchill, Anna Tostevin, Teresa Hill, David T. Dunn, David Asboe, Anton Pozniak, Patricia Cane, David Chadwick, Duncan Clark, Simon Collins, Valerie Delpech, Samuel Douthwaite, David Dunn, Esther Fearnhill, Kholoud Porter, Oliver Stirrup, Christophe Fraser, Anna Maria Geretti, Rory Gunson, Antony Hale, Stéphane Hué, Linda Lazarus, Andrew Leigh-Brown, Tamyo Mbisa, Nicola Mackie, Chloe Orkin, Eleni Nastouli, Deenan Pillay, Andrew Phillips, Caroline Sabin, Erasmus Smit, Kate Templeton, Peter Tilston, Erik Volz, Hongyi Zhang, Keith Fairbrother, Justine Dawkins, Siobhan O’Shea, Jane Mullen, Alison Cox, Richard Tandy, Tracy Fawcett, Mark Hopkins, Clare Booth, Lynne Renwick, Matthias L. Schmid, Brendan Payne, Jonathan Hubb, Simon Dustan, Stuart Kirk, Amanda Bradley-Stewart, Sophie Jose, Alicia Thornton, Susie Huntington, Adam Glabay, Shaadi Shidfar, Janet Lynch, James Hand, Carl de Souza, Nicky Perry, Stuart Tilbury, Elaney Youssef, Brian Gazzard, Mark Nelson, Tracey Mabika, Sundhiya Mandalia, Jane Anderson, Sajid Munshi, Frank Post, Ade Adefisan, Chris Taylor, Zachary Gleisner, Fowzia Ibrahim, Lucy Campbell, Kirsty Baillie, Richard Gilson, Nataliya Brima, Jonathan Ainsworth, Achim Schwenk, Sheila Miller, Chris Wood, Margaret Johnson, Mike Youle, Fiona Lampe, Colette Smith, Rob Tsintas, Clinton Chaloner, Samantha Hutchinson, John Walsh, Nicky Mackie, Alan Winston, Jonathan Weber, Farhan Ramzan, Mark Carder, Clifford Leen, Alan Wilson, Sheila Morris, Mark Gompels, Sue Allan, Adrian Palfreeman, Adam Lewszuk, Stephen Kegg, Akin Faleye, Victoria Ogunbiyi, Sue Mitchell, Phillip Hay, Christian Kemble, Fabiola Martin, Sarah Russell-Sharpe, Janet Gravely, Sris Allan, Andrew Harte, Anjum Tariq, Hazel Spencer, Ron Jones, Jillian Pritchard, Shirley Cumming, Claire Atkinson, Dushyant Mital, Veronica Edgell, Juli Allen, Andy Ustianowski, Cynthia Murphy, Ilise Gunder, Roy Trevelion, and Abdel Babiker
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antiretroviral therapy ,ART ,drug resistance ,HIV ,NNRTI ,NRTI ,Microbiology ,QR1-502 ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: The aim of this study was to investigate associations between baseline characteristics and CD4 cell count response on first-line antiretroviral therapy and risk of virological failure (VF) with or without drug resistance. Methods: We conducted an analysis of UK Collaborative HIV Cohort data linked to the UK HIV Drug Resistance Database. Inclusion criteria were viral sequence showing no resistance prior to initiation of first-line efavirenz + tenofovir disoproxil fumarate + emtricitabine and virological suppression within 6 months. Outcomes of VF (≥200 copies/mL) with or without drug resistance were assessed using a competing risks approach fitted jointly with a model for CD4 cell count recovery. Hazard ratios for each VF outcome were estimated for baseline CD4 cell count and viral load and characteristics of CD4 cell count response using latent variables on a standard normal scale. Results: A total of 3640 people were included with 338 VF events; corresponding viral sequences were available in 134 with ≥1 resistance mutation in 36. VF with resistance was associated with lower baseline CD4 (0.30, 0.09–0.62), lower CD4 recovery (0.04, 0.00–0.17) and higher CD4 variability (4.40, 1.22–12.68). A different pattern of associations was observed for VF without resistance, but the strength of these results was less consistent across sensitivity analyses. Cumulative incidence of VF with resistance was estimated to be >2% at 3 years for baseline CD4 ≥350 cells/μL. Conclusion: Lower baseline CD4 cell count and suboptimal CD4 recovery are associated with VF with drug resistance. People with low CD4 cell count before ART or with suboptimal CD4 recovery on treatment should be a priority for regimens with high genetic barrier to resistance.
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- 2019
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11. Evaluating diagnostic strategies for early detection of cancer: the CanTest framework
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Fiona M. Walter, Matthew J. Thompson, Ian Wellwood, Gary A. Abel, William Hamilton, Margaret Johnson, Georgios Lyratzopoulos, Michael P. Messenger, Richard D. Neal, Greg Rubin, Hardeep Singh, Anne Spencer, Stephen Sutton, Peter Vedsted, and Jon D. Emery
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Cancer ,Diagnostic strategies ,Early detection ,Diagnosis ,Conceptual framework ,Primary care ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and quality of care, while minimising over-investigation and over-diagnosis. Methods We performed a systematic scoping review of frameworks for the evaluation of tests and diagnostic approaches. Results We identified 16 frameworks: none addressed the entire continuum from test development to impact on diagnosis and patient outcomes in the intended population, nor the way in which tests may be used for triage purposes as part of a wider diagnostic strategy. Informed by these findings, we developed a new framework, the ‘CanTest Framework’, which proposes five iterative research phases forming a clear translational pathway from new test development to health system implementation and evaluation. Conclusion This framework is suitable for testing in low prevalence populations, where tests are often applied for triage testing and incorporated into a wider diagnostic strategy. It has relevance for a wide range of stakeholders including patients, policymakers, purchasers, healthcare providers and industry.
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- 2019
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12. The Enduring Effects of COVID for Cancer Care: Learning from Real-Life Clinical Practice
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Alex Broom, Leah Williams Veazey, Katherine Kenny, Imogen Harper, Michelle Peterie, Alexander Page, Nicole Cort, Jennifer Durling, Eric S. Lipp, Aaron C. Tan, Kyle M. Walsh, Brent A. Hanks, Margaret Johnson, Amanda E.D. Van Swearingen, Carey K. Anders, David M. Ashley, and Mustafa Khasraw
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Cancer Research ,Oncology - Abstract
For three years, COVID-19 has circulated among our communities and around the world, fundamentally changing social interactions, health care systems, and service delivery. For people living with (and receiving treatment for) cancer, pandemic conditions presented significant additional hurdles in an already unstable and shifting environment, including disrupted personal contact with care providers, interrupted access to clinical trials, distanced therapeutic encounters, multiple immune vulnerabilities, and new forms of financial precarity. In a 2020 perspective in this journal, we examined how COVID-19 was reshaping cancer care in the early stages of the pandemic and how these changes might endure into the future. Three years later, and in light of a series of interviews with patients and their caregivers from the United States and Australia conducted during the pandemic, we return to consider the potential legacy effects of the pandemic on cancer care. While some challenges to care provision and survivorship were unforeseen, others accentuated and amplified existing problems experienced by patients, caregivers, and health care providers. Both are likely to have enduring effects in the “post-pandemic” world, raising the importance of focusing on lessons that can be learned for the future.
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- 2023
13. Editorial 6.4
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Sabine Kinloch, Christina Psomas, and Margaret Johnson
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Microbiology ,QR1-502 ,Public aspects of medicine ,RA1-1270 - Published
- 2020
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14. Promoting Chronic Obstructive Pulmonary Disease Wellness through Remote Monitoring and Health Coaching: A Clinical Trial
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Roberto, Benzo, Johanna, Hoult, Charlene, McEvoy, Matthew, Clark, Maria, Benzo, Margaret, Johnson, and Paul, Novotny
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Pulmonary Disease, Chronic Obstructive ,Dyspnea ,Forced Expiratory Volume ,Quality of Life ,Humans ,Mentoring ,Female ,Middle Aged ,Aged - Published
- 2022
15. Editorial
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Margaret Johnson, Sabine Kinloch-de Loës, and Christina K. Psomas
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Microbiology ,QR1-502 ,Public aspects of medicine ,RA1-1270 - Published
- 2020
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16. Sensitivity and uncertainty quantification for the ECOSTRESS evapotranspiration algorithm – DisALEXI
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Kerry Cawse-Nicholson, Amy Braverman, Emily L. Kang, Miaoqi Li, Margaret Johnson, Gregory Halverson, Martha Anderson, Christopher Hain, Michael Gunson, and Simon Hook
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Uncertainty ,Spatial statistics ,disALEXI ,Evapotranspiration ,Physical geography ,GB3-5030 ,Environmental sciences ,GE1-350 - Abstract
Evapotranspiration (ET) is a measure of plant water use that is utilized regionally for drought detection and monitoring, and locally for agricultural water resource management. Understanding the uncertainty associated with this measurement is vital for science predictions and analysis and for water resource management decision making. In this manuscript, the uncertainty in disaggregated Atmosphere-Land Exchange (disALEXI) is quantified; disALEXI is an ET algorithm that utilizes land surface temperature (LST) derived from the ECOsystem Spaceborne Thermal Radiometer Experiment on Space Station (ECOSTRESS), as well ancillary inputs for landcover, elevation, vegetation parameters, and meteorological inputs. Since each of these inputs has an associated, and potentially unknown, uncertainty, in this study a Monte Carlo simulation based on a spatial statistical model is used to determine the algorithm's sensitivity to each of its inputs, and to quantify the probability distribution of algorithm outputs. Analysis shows that algorithm is most sensitive to LST (the input derived from ECOSTRESS). Significantly, the output uncertainty distribution is non-Gaussian, due to the non-linear nature of the algorithm. This means that ET uncertainty cannot be prescribed by accuracy and precision alone. Here, uncertainty was represented using five quantiles of the output distribution. The distribution was consistent across five different datasets (mean offset is 0.01 mm/day, and 95% of the data is contained within 0.3 mm/day). An additional two datasets with low ET, showed higher uncertainty (95% of the data is within 1 mm/day), and a positive bias (i.e., ET was overestimated by an average of 0.12 mm/day when ET was low).
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- 2020
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17. Enrichment of the airway microbiome in people living with HIV with potential pathogenic bacteria despite antiretroviral therapy
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Sylvia A.D. Rofael, James Brown, Elisha Pickett, Margaret Johnson, John R. Hurst, David Spratt, Marc Lipman, and Timothy D. McHugh
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Microbiota ,Bacteria/Classification ,16S rRNA sequencing ,HIV ,Infection ,Respiratory ,Medicine (General) ,R5-920 - Abstract
Background: Long-term antiretroviral therapy (ART) enables people living with HIV (PLW-HIV) to be healthier and live longer; though they remain at greater risk of pneumonia and chronic lung disease than the general population. Lung microbial dysbiosis has been shown to contribute to respiratory disease. Methods: 16S-rRNA gene sequencing on the Miseq-platform and qPCR for typical respiratory pathogens were performed on sputum samples collected from 64 PLW-HIV (median blood CD4 count 676 cells/μL) and 38 HIV-negative participants. Finding: Richness and α-diversity as well as the relative-abundance (RA) of the major taxa (RA>1%) were similar between both groups. In unweighted-Unifrac ß-diversity, the samples from PLW-HIV showed greater diversity, in contrast to the HIV negative samples which clustered together. Gut bacterial taxa such as Bilophila and members of Enterobacteriaceae as well as pathogenic respiratory taxa (Staphylococcus, Pseudomonas and Klebsiella) were significantly more frequent in PLW-HIV and almost absent in the HIV-negative group. Carriage of these taxa was correlated with the length of time between HIV diagnosis and initiation of ART (Spearman-rho=0·279, p=0·028). Interpretation: Although the core airway microbiome was indistinguishable between PLW-HIV on effective ART and HIV-negative participants, PLW-HIV's respiratory microbiome was enriched with potential respiratory pathogens and gut bacteria. The observed differences in PLW-HIV may be due to HIV infection altering the local lung microenvironment to be more permissive to harbour pathogenic bacteria that could contribute to respiratory comorbidities. Prompt start of ART for PLW-HIV may reduce this risk.
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- 2020
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18. A protocol for a systematic review and meta-analysis to identify measures of breakthrough pain and evaluate their psychometric properties
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Emily Harrop, Margaret Johnson, Katie Greenfield, Simone Holley, Daniel Eric Schoth, Richard Howard, Julie Bayliss, Satbir Jassal, Ian Wong, Christina Liossi, Anna-Karenia Anderson, Lorna Katharine Fraser, Dilini Rajapakse, and Christine Mott
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Medicine - Abstract
IntroductionBreakthrough pain is common in children and adults with cancer and other conditions, including those approaching end-of-life, although it is often poorly managed, possibly partly due to a lack of validated assessment tools. This review aims to (1) identify all available instruments measuring breakthrough pain in infants, children, adolescents or adults and (2) critically appraise, compare and summarise the quality of the psychometric properties of the identified instruments using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria.Methods and analysisTwo searches will be carried out between October 2019 and January 2020, one for each aim of the review. The Cochrane Library, International Prospective Register of Systematic Reviews, Embase, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Web of Science Core Collection, Google Scholar, the ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey databases will be searched from database inception until the date the search is conducted. Reference lists of eligible articles will be screened and authors in the field contacted. For search 1, articles will be screened by two reviewers by abstract, and full-text where necessary, to identify if a breakthrough pain assessment was used. Search 2 will then be conducted to identify studies evaluating measurement properties of these assessments. Two reviewers will screen articles from search 2 by title and abstract. All potentially relevant studies will be screened by full text by both reviewers. For search 2, data will be extracted in parallel with the quality assessment process, as recommended by COSMIN. Two reviewers will assess methodological quality using the COSMIN Risk of Bias checklist and the COSMIN updated criteria for good measurement properties. Findings will be summarised and, if possible, data will be pooled using meta-analysis. The quality of the evidence will be graded and summarised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines.Ethics and disseminationResults of this review will be submitted for publication in a peer review journal and presented at conferences.PROSPERO registration numberCRD42019155583.
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- 2020
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19. The effect of HIV status on the frequency and severity of acute respiratory illness.
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James Brown, Elisha Pickett, Colette Smith, Memory Sachikonye, Lucy Brooks, Tabitha Mahungu, David M Lowe, Sara Madge, Mike Youle, Margaret Johnson, John R Hurst, Timothy D McHugh, Ibrahim Abubakar, and Marc Lipman
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Medicine ,Science - Abstract
IntroductionAntiretroviral therapy has improved the health of people living with HIV (PLW-HIV), though less is known about how this impacts on acute respiratory illness. These illnesses are a common cause of ill health in the general population and any increase in their frequency or severity in PLW-HIV might have significant implications for health-related quality of life and the development of chronic respiratory disease.MethodsIn a prospective observational cohort study following PLW-HIV and HIV negative participants for 12 months with weekly documentation of any acute respiratory illness, we compared the frequency, severity and healthcare use associated with acute respiratory illnesses to determine whether PLW-HIV continue to have a greater frequency or severity of such illnesses despite antiretroviral therapy.ResultsWe followed-up 136 HIV positive and 73 HIV negative participants for 12 months with weekly documentation of any new respiratory symptoms. We found that HIV status did not affect the frequency of acute respiratory illness: unadjusted incidence rates per person year of follow-up were 2.08 illnesses (95% CI 1.81-2.38) and 2.30 illnesses (1.94-2.70) in HIV positive and negative participants respectively, IRR 0.87 (0.70-1.07) p = 0.18. However, when acute respiratory illnesses occurred, PLW-HIV reported more severe symptoms (relative fold-change in symptom score 1.61 (1.28-2.02), p ConclusionsHIV suppression with antiretroviral therapy reduces the frequency of acute respiratory illness to background levels, however when these occur, they are associated with more severe self-reported symptoms and greater healthcare utilisation. Exploration of the reasons for this greater severity of acute respiratory illness may allow targeted interventions to improve the health of people living with HIV.Trial registrationISRCTN registry (ISRCTN38386321).
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- 2020
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20. Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study
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Elka Humphrys, Fiona M Walter, Greg Rubin, Jon D Emery, Margaret Johnson, Anthony Richards, Rebecca C Fitzgerald, Yirupaiahgari KS Viswanath, and Jenni Burt
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primary health care ,gastrointestinal neoplasms ,early diagnosis ,interviews ,surveys and questionnaires ,esophageal neoplasms ,general practice ,Medicine (General) ,R5-920 - Abstract
Background: Late stage diagnosis of oesophageal and gastric cancer is common, which limits treatment options and contributes to poor survival. Aim: To explore patients' understanding, experience and presentation of symptoms before a diagnosis of oesophageal or gastric cancer. Design & setting: Between May 2016 and October 2017, all patients newly diagnosed with oesophageal or gastric cancer were identified at weekly multidisciplinary team meetings at two large hospitals in England. A total of 321 patients were invited to participate in a survey and secondary care medical record review; 127 (40%) participants responded (102 patients had oesophageal cancer and 25 had gastric cancer). Of these, 26 participated in an additional face-to-face interview. Method: Survey and medical record data were analysed descriptively. Interviews were analysed using thematic analysis, informed by the Model of Pathways to Treatment. Results: Participants experienced multiple symptoms before diagnosis. The most common symptom associated with oesophageal cancer was dysphagia (n = 66, 65%); for gastric cancer, fatigue or tiredness (n = 20, 80%) was the most common symptom. Understanding of heartburn, reflux and indigestion, and associated symptoms differed between participants and often contrasted with clinical perspectives. Bodily changes attributed to personal and/or lifestyle factors were self-managed, with presentation to primary care prompted when symptoms persisted, worsened, or impacted daily life, or were notably severe or unusual. Participants rarely presented all symptoms at the initial consultation. Conclusion: The patient interval may be lengthened by misinterpretation of key terms, such as heartburn, or misattribution or non-recognition of important bodily changes. Clearly defined symptom awareness messages may encourage earlier help-seeking, while eliciting symptom experience and meanings in primary care consultations could prompt earlier referral and diagnosis.
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- 2020
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21. Making the Case for Addressing Health Disparities: What Drives Providers and Payers?
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Margaret Johnson, Heather McPheron, Rachel Dolin, Julia Doherty, and Lisa Green
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business case ,case studies ,disparities ,economic case ,health disparities ,Public aspects of medicine ,RA1-1270 - Abstract
Purpose: The creation of the Centers for Medicare & Medicaid Services Office of Minority Health placed increased emphasis on federal efforts to address health disparities. Although the literature establishes a social justice case for addressing health disparities, there is limited evidence of this case being sufficient for businesses to invest in such initiatives. The purpose of this study was to better understand the ?business case? behind an organization's investment in health disparity reduction work. Methods: We conducted six case studies (44 on-site interviews) with diverse private-sector provider and payer organizations. Results: While providers and payers cited business rationales for initiating disparity-focused efforts, their motivations differed. Conclusion: As federal entities address health disparities, and payment models shift from volume to value, engaging private stakeholders with the leverage to move the health disparities needle is of principal importance.
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- 2018
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22. Therapeutic time window of multipotent adult progenitor therapy after traumatic brain injury
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Supinder S. Bedi, Benjamin M. Aertker, George P. Liao, Henry W. Caplan, Deepa Bhattarai, Fanni Mandy, Franciska Mandy, Luis G. Fernandez, Pamela Zelnick, Matthew B. Mitchell, Walter Schiffer, Margaret Johnson, Emma Denson, Karthik Prabhakara, Hasen Xue, Philippa Smith, Karen Uray, Scott D. Olson, Robert W. Mays, and Charles S. Cox
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Microglia ,Neuroinflammation ,Spatial learning and blood-brain barrier ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Background Traumatic brain injury (TBI) is a major cause of death and disability. TBI results in a prolonged secondary central neuro-inflammatory response. Previously, we have demonstrated that multiple doses (2 and 24 h after TBI) of multipotent adult progenitor cells (MAPC) delivered intravenously preserve the blood-brain barrier (BBB), improve spatial learning, and decrease activated microglia/macrophages in the dentate gyrus of the hippocampus. In order to determine if there is an optimum treatment window to preserve the BBB, improve cognitive behavior, and attenuate the activated microglia/macrophages, we administered MAPC at various clinically relevant intervals. Methods We administered two injections intravenously of MAPC treatment at hours 2 and 24 (2/24), 6 and 24 (6/24), 12 and 36 (12/36), or 36 and 72 (36/72) post cortical contusion injury (CCI) at a concentration of 10 million/kg. For BBB experiments, animals that received MAPC at 2/24, 6/24, and 12/36 were euthanized 72 h post injury. The 36/72 treated group was harvested at 96 h post injury. Results Administration of MAPC resulted in a significant decrease in BBB permeability when administered at 2/24 h after TBI only. For behavior experiments, animals were harvested post behavior paradigm. There was a significant improvement in spatial learning (120 days post injury) when compared to cortical contusion injury (CCI) in groups when MAPC was administered at or before 24 h. In addition, there was a significant decrease in activated microglia/macrophages in the dentate gyrus of hippocampus of the treated group (2/24) only when compared to CCI. Conclusions Intravenous injections of MAPC at or before 24 h after CCI resulted in improvement of the BBB, improved cognitive behavior, and attenuated activated microglia/macrophages in the dentate gyrus.
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- 2018
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23. Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation
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Merel M Pannebakker, Katie Mills, Margaret Johnson, Jon D Emery, and Fiona M Walter
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melanoma ,skin cancer ,qualitative ,electronic clinical decision support (eCDS) ,patients ,general practice ,Medicine (General) ,R5-920 - Abstract
Background: Timely diagnosis of the serious skin cancer melanoma can improve patient outcomes. Clinical guidelines suggest that GPs use checklists, such as the 7-point checklist (7PCL), to assess pigmented lesions. In 2016, the 7PCL was disseminated by EMIS as an electronic clinical decision support (eCDS) tool. Aim: To understand GP and patient perspectives on the implementation and usefulness of the eCDS. Design & setting: Semi-structured interviews with GPs and patients were undertaken. The interviews took place in four general practices in the south east of England following consultations using the eCDS for suspicious pigmented lesions. Method: Data were collected from semi-structured face-to-face interviews with GPs and from telephone interviews with patients. They were recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) underpinned the analysis using thematic approaches. Results: A total of 14 interviews with GPs and 14 interviews with patients were undertaken. Most GPs reported that, as the eCDS was embedded in the medical record, it was useful, easy to use, time-efficient, and could facilitate patient–GP communication. They were less clear that it could meet policy or patient needs to improve early diagnosis, and some felt that it could lead to unnecessary referrals. Few felt that it had been sufficiently implemented at practice level. More felt confident with their own management of moles, and that the eCDS could be most useful for borderline decision-making. No patients were aware that the eCDS had been used during their consultation. Conclusion: Successful implementation of a new tool, such as eCDS for melanoma, requires GPs to perceive its value and understand how it can best be integrated into clinical practice. Disseminating a tool without such explanations is unlikely to promote its adoption into routine practice.
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- 2019
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24. A systems approach identifies Enhancer of Zeste Homolog 2 (EZH2) as a protective factor in epilepsy.
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Nadia Khan, Barry Schoenike, Trina Basu, Heidi Grabenstatter, Genesis Rodriguez, Caleb Sindic, Margaret Johnson, Eli Wallace, Rama Maganti, Raymond Dingledine, and Avtar Roopra
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Medicine ,Science - Abstract
Complex neurological conditions can give rise to large scale transcriptomic changes that drive disease progression. It is likely that alterations in one or a few transcription factors or cofactors underlie these transcriptomic alterations. Identifying the driving transcription factors/cofactors is a non-trivial problem and a limiting step in the understanding of neurological disorders. Epilepsy has a prevalence of 1% and is the fourth most common neurological disorder. While a number of anti-seizure drugs exist to treat seizures symptomatically, none is curative or preventive. This reflects a lack of understanding of disease progression. We used a novel systems approach to mine transcriptome profiles of rodent and human epileptic brain samples to identify regulators of transcriptional networks in the epileptic brain. We find that Enhancer of Zeste Homolog 2 (EZH2) regulates differentially expressed genes in epilepsy across multiple rodent models of acquired epilepsy. EZH2 undergoes a prolonged upregulation in the epileptic brain. A transient inhibition of EZH2 immediately after status epilepticus (SE) robustly increases spontaneous seizure burden weeks later. This suggests that EZH2 upregulation is a protective. These findings are the first to characterize a role for EZH2 in opposing epileptogenesis and debut a bioinformatic approach to identify nuclear drivers of complex transcriptional changes in disease.
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- 2019
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25. Dynamin1 long- and short-tail isoforms exploit distinct recruitment and spatial patterns to form endocytic nanoclusters
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Anmin Jiang, Rachel Gormal, Tristan Wallis, Phillip Robinson, Margaret Johnson, Merja Joensuu, and Frederic Meunier
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Endocytosis requires a coordinated framework of molecular interactions that ultimately lead to the fission of nascent endosomes. How cytosolic proteins, such as dynamin, timely concentrate at discrete sites that are sparsely distributed across the plasma membrane remains poorly understood. Two dynamin 1 (Dyn1) major splice variants differ by the length of their C-terminal proline-rich region (short-tail and long-tail). Using sptPALM in PC12 cells, neurons and MEF cells, we demonstrate that short-tail Dyn1 isoforms Dyn1ab and Dyn1bb display an activity-dependent recruitment to the membrane, promptly followed by concentration into nanoclusters. These nanoclusters were sensitive to both Calcineurin and Dyn1 GTPase inhibitors, and were larger, denser, and more numerous than that of long-tail isoform Dyn1aa. Spatiotemporal modelling confirmed that Dyn1 isoforms perform distinct search patterns and undergo dimensional reduction to generate endocytic nanoclusters, with short-tail isoforms more robustly exploiting lateral trapping in the generation of nanoclusters compared to long-tail isoform Dyn1aa.
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- 2023
26. Contextual Factors Affecting Implementation of Pediatric Quality Improvement Programs
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Elizabeth L. Cope, Margaret Johnson, Marya Khan, Heather C. Kaplan, Anne Sales, and Kamila B. Mistry
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Pediatrics, Perinatology and Child Health ,Humans ,Child ,Quality Improvement ,Organizational Innovation - Abstract
Context is a critical determinant of the effectiveness of quality improvement programs. We assessed the role of contextual factors in influencing the efforts of 5 diverse quality improvement projects as part of the Pediatric Quality Measure Program (PQMP) directed by the Agency for Health Care Research and Quality.We conducted a mixed methods study of 5 PQMP grantees involving semistructured interviews followed by structured worksheets to identify influential contextual factors. Semistructured interviews and worksheets were completed between August and October 2020. Participants were comprised of PQMP grantee teams (2-4 team members per team for a total of 15 participants). Coding and analysis was based on the Tailored Implementation for Chronic Diseases (TICD) framework.Despite heterogeneity in the process and outcome targets of the PQMP initiatives, professional interactions, incentives and resources, and capacity for organizational change were the domains most commonly identified as influential across the grantees. While social, political, and legal factors was not commonly referenced as an important domain, payer or funder policies (a factor within this domain) was highlighted as one of the most influential factors. Overall, the incentives and resources domain was identified as the most influential.We found that using a determinant framework, such as the TICD, is valuable in facilitating comparisons across heterogeneous projects, allowing us to identify key contextual factors influencing the implementation of pediatric quality measures across a diverse range of clinical topics and settings. Future quality improvement work should account for this and include resources to support infrastructure development in addition to program implementation.
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- 2022
27. Real-World Considerations for Implementing Pediatric Quality Measures: Insights From Key Stakeholders
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Claudia, Schur, Margaret, Johnson, Julia, Doherty, and Kamila B, Mistry
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Medicaid ,Child Health Services ,Pediatrics, Perinatology and Child Health ,Child Welfare ,Humans ,Child ,Quality Improvement ,Problem Solving ,United States - Abstract
Since its inception, the Pediatric Quality Measures Program has focused on the development and implementation of new and innovative pediatric quality measures (PQM) for both public and private use. Building the evidence base related to measure usability and feasibility is central to increasing measure uptake and, thereby, to increased performance monitoring and quality improvement (QI) for children in Medicaid or the Children's Health Insurance Program. This paper describes key stakeholder insights focused on measure implementation and increasing the uptake of PQM.The PQMP Learning Collaborative conducted semistructured interviews with 9 key informants (KIs) representing states, health plans, and other potential end users of the measures. The interviews focused on gaining KIs' perspectives on 6 research questions focused on assessing the feasibility and usability of PQM and strengthening the connection between measurement and improvement.Our synthesis identified insights that highlight facilitators and barriers from the KIs' experience and the strategies they employ when using measures to drive improvement "on-the-ground." Importantly, while the KIs agreed on how essential the research questions are to measure implementation and uptake, they uniformly acknowledged the complexity of the issues raised and pinpointed multiple unresolved issues.The views expressed by these stakeholders point to several key issues - including incorporation of socio-economic status into quality measures and performance comparisons, use of benchmark data, and criteria for QI versus accountability - for developing a real-world research agenda to guide the future direction of quality measurement and implementation to improve children's health care.
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- 2022
28. Palliative Care Use for Critically Ill Patients With Brain Metastases
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Margaret Johnson, Tara Dalton, Peter E. Fecci, Arif H. Kamal, Katherine B. Peters, Luis Ramirez, Meghan Price, Courtney Rory Goodwin, and Jennifer H. Kang
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medicine.medical_specialty ,Palliative care ,Critical Illness ,Population ,Context (language use) ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,education ,Prospective cohort study ,General Nursing ,Retrospective Studies ,education.field_of_study ,Brain Neoplasms ,business.industry ,Mortality rate ,Palliative Care ,Retrospective cohort study ,Intensive care unit ,Intensive Care Units ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Emergency medicine ,Cohort ,Neurology (clinical) ,business - Abstract
Context Critically ill patients with brain metastases (BM) face significant uncertainty regarding prognosis and survival and can benefit from Palliative care (PC). However, research regarding the role of PC in this population is lacking. Objectives We sought to compare BM patients admitted to an intensive care unit who received an inpatient PC consult (PC cohort) to those who did not (Usual Care, UC cohort). Methods We performed a single-institution retrospective cohort analysis. Our outcome variables were mortality, time from intensive care unit admission to death, disposition, and change in code status. We also evaluated PC's role in complex medical decision making, symptom management and hospice education. Results PC consult was placed in 31 of 118 (28%) of patients. The overall mortality rates were not statistically different (78.8% vs. 90.3%, P= 0.15, UC vs. PC cohort). Patients in the PC cohort had a shorter time to death, higher rate of death within 30 days of admission, increased rate of discharge to hospice, and increase percentage of code status change to “do not attempt resuscitation” during the admission. The primary services provided by PC were symptom management (n = 21, 67.7%) and assistance in complex medical decision making (n = 20, 64.5%). Conclusion In our patient cohort, PC is an underutilized service that can assist in complex medical decision making and symptom management of critically ill BM patients. Further prospective studies surveying patient, family and provider experiences could better inform the qualitative impact of PC in this unique patient population.
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- 2021
29. Attenuated humoral responses in HIV infection after SARS-CoV-2 vaccination are linked to global B cell defects and cellular immune profiles
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Emma Touizer, Aljawharah Alrubbayi, Rosemarie Ford, Noshin Hussain, Pehuén Pereyra Gerber, Hiu-Long Shum, Chloe Rees-Spear, Luke Muir, Ester Gea-Mallorquí, Jakub Kopycinski, Dylan Jankovic, Christopher Pinder, Thomas A Fox, Ian Williams, Claire Mullender, Irfaan Maan, Laura Waters, Margaret Johnson, Sara Madge, Michael Youle, Tristan Barber, Fiona Burns, Sabine Kinloch, Sarah Rowland-Jones, Richard Gilson, Nicholas J Matheson, Emma Morris, Dimitra Peppa, and Laura E McCoy
- Abstract
People living with HIV (PLWH) on suppressive antiretroviral therapy (ART) can have residual immune dysfunction and often display poorer responses to vaccination. We assessed in a cohort of PLWH (n=110) and HIV negative controls (n=64) the humoral and spike-specific B-cell responses following 1, 2 or 3 SARS-CoV-2 vaccine doses. PLWH had significantly lower neutralizing antibody (nAb) titers than HIV-negative controls at all studied timepoints. Moreover, their neutralization breadth was reduced with fewer individuals developing a neutralizing response against the Omicron variant (BA.1) relative to controls. We also observed a delayed development of neutralization in PLWH that was underpinned by a reduced frequency of spike-specific memory B cells (MBCs) and pronounced B cell dysfunction. Improved neutralization breadth was seen after the third vaccine dose in PLWH but lower nAb responses persisted and were associated with global, but not spike-specific, MBC dysfunction. In contrast to the inferior antibody responses, SARS-CoV-2 vaccination induced robust T cell responses that cross-recognized variants in PLWH. Strikingly, a subset of PLWH with low or absent neutralization had detectable functional T cell responses. These individuals had reduced numbers of circulating T follicular helper cells and an enriched population of CXCR3+CD127+CD8+T cells after two doses of SARS-CoV-2 vaccination, which may compensate for sub-optimal serological responses in the event of infection. Therefore, normalisation of B cell homeostasis could improve serological responses to vaccines in PLWH and evaluating T cell immunity could provide a more comprehensive immune status profile in these individuals and others with B cell imbalances.
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- 2022
30. Attenuated humoral responses in HIV after SARS-CoV-2 vaccination linked to B cell defects and altered immune profiles
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Emma Touizer, Aljawharah Alrubayyi, Rosemarie Ford, Noshin Hussain, Pehuén Pereyra Gerber, Hiu-Long Shum, Chloe Rees-Spear, Luke Muir, Ester Gea-Mallorquí, Jakub Kopycinski, Dylan Jankovic, Anna Jeffery-Smith, Christopher L. Pinder, Thomas A. Fox, Ian Williams, Claire Mullender, Irfaan Maan, Laura Waters, Margaret Johnson, Sara Madge, Michael Youle, Tristan J. Barber, Fiona Burns, Sabine Kinloch, Sarah Rowland-Jones, Richard Gilson, Nicholas J. Matheson, Emma Morris, Dimitra Peppa, Laura E. McCoy, Muir, Luke [0000-0002-7834-6066], Morris, Emma [0000-0003-4834-1130], and Apollo - University of Cambridge Repository
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Multidisciplinary ,FOS: Clinical medicine ,Virology ,Immunology - Abstract
We assessed a cohort of people living with human immunodeficiency virus (PLWH) (n = 110) and HIV negative controls (n = 64) after 1, 2 or 3 SARS-CoV-2 vaccine doses. At all timepoints, PLWH had significantly lower neutralizing antibody (nAb) titers than HIV-negative controls. We also observed a delayed development of neutralization in PLWH that was underpinned by a reduced frequency of spike-specific memory B cells (MBCs). Improved neutralization breadth was seen against the Omicron variant (BA.1) after the third vaccine dose in PLWH but lower nAb responses persisted and were associated with global MBC dysfunction. In contrast, SARS-CoV-2 vaccination induced robust T cell responses that cross-recognized variants in PLWH. Strikingly, individuals with low or absent neutralization had detectable functional T cell responses. These PLWH had reduced numbers of circulating T follicular helper cells and an enriched population of CXCR3+CD127+CD8+T cells after two doses of SARS-CoV-2 vaccination.
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- 2022
31. Rate of HIV rebound and CD4 T cell kinetics in an ageing population on successful antiretroviral therapy
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Abhishek Katiyar, Esther Gathogo, Sabine Kinloch, Margaret Johnson, Fiona Lampe, and Colette Smith
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Microbiology ,QR1-502 ,Public aspects of medicine ,RA1-1270 - Published
- 2018
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32. Alcohol, smoking, recreational drug use and association with virological outcomes among people living with HIV: cross‐sectional and longitudinal analyses
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Alison Rodger, Lewis J. Haddow, Margaret Johnson, Fiona C Lampe, Anna Maria Geretti, Lorraine Sherr, Simon Collins, Alejandro Arenas-Pinto, Colette Smith, Monica Lascar, Andrew N. Phillips, Timothy Willem Jones, Jeffrey McDonnell, and Elaney Yousef
- Subjects
Male ,medicine.medical_specialty ,Sexual transmission ,Anti-HIV Agents ,HIV Infections ,Medication Adherence ,Unit of alcohol ,Men who have sex with men ,Sexual and Gender Minorities ,Recreational Drug Use ,Internal medicine ,medicine ,Humans ,Outpatient clinic ,Pharmacology (medical) ,Homosexuality, Male ,business.industry ,Health Policy ,Smoking ,Alcohol dependence ,Hazard ratio ,Odds ratio ,Viral Load ,Cross-Sectional Studies ,Infectious Diseases ,Female ,business ,Viral load - Abstract
Objectives There is increasing evidence to suggest that people living with HIV (PLWH) have significant morbidity from alcohol, recreational drug use and cigarette smoking. Our aim was to report associations of these factors with antiretroviral therapy (ART) non-adherence, viral non-suppression and subsequent viral rebound in PLWH. Methods The Antiretroviral Sexual Transmission Risk and Attitudes (ASTRA) study recruited PLWH attending eight outpatient clinics in England between February 2011 and December 2012. Data included self-reported excessive drinking (estimated consumption of > 20 units of alcohol/week), alcohol dependency (CAGE score ≥ 2 with current alcohol consumption), recreational drug use (including injection drug use in the past 3 months), and smoking status. Among participants established on ART, cross-sectional associations with ART non-adherence [missing ≥2 consecutive days of ART on ≥2 occasions in the past three months] and viral-non suppression [viral load (VL) > 50 copies/mL] were assessed using logistic regression. In participants from one centre, longitudinal associations with subsequent viral rebound (first VL > 200 copies/mL) in those on ART with VL ≤ 50 copies/mL at baseline were assessed using Cox regression during a 7-year follow-up. Results Among 3258 PLWH, 2248 (69.0%) were men who have sex with men, 373 (11.4%) were heterosexual men, and 637 (19.6%) were women. A CAGE score ≥ 2 was found in 568 (17.6%) participants, 325 (10.1%) drank > 20 units/week, 1011 (31.5%) currently smoked, 1242 (38.1%) used recreational drugs and 74 (2.3%) reported injection drug use. In each case, prevalence was much more common among men than among women. Among 2459 people on ART who started at least 6 months previously, a CAGE score ≥ 2, drinking > 20 units per week, current smoking, injection and non-injection drug use were all associated with ART non-adherence. After adjusting for demographic and socioeconomic factors, CAGE score ≥ 2 [adjusted odds ratio (aOR) = 1.52, 95% confidence interval (CI): 1.09-2.13], current smoking (aOR = 1.58, 95% CI: 1.10-2.17) and injection drug use (aOR = 2.11, 95% CI: 1.00-4.47) were associated with viral non-suppression. During follow-up of a subset of 592 people virally suppressed at recruitment, a CAGE score ≥ 2 [adjusted hazard ratio (aHR) = 1.66, 95% CI: 1.03-2.74], use of 3 or more non-injection drugs (aHR = 1.82, 95% CI: 1.12-3.57) and injection drug use (aHR = 2.73, 95% CI: 1.08-6.89) were associated with viral rebound. Conclusions Screening and treatment for alcohol, cigarette and drug use should be integrated into HIV outpatient clinics, while clinicians should be alert to the potential for poorer virological outcomes.
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- 2021
33. Advancing health equity through organizational change: Perspectives from health care leaders
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Margaret Johnson, Julia A Doherty, and Heather McPheron
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Strategic planning ,Quality management ,Health Equity ,Leadership and Management ,business.industry ,Strategy and Management ,Health Policy ,Health Promotion ,Public relations ,Organizational Innovation ,Health equity ,Health administration ,Leadership ,Patient safety ,Health care ,Humans ,Organizational structure ,Thematic analysis ,business ,Delivery of Health Care - Abstract
Background Published literature on health care administration, management, and leadership and its impacts on health systems' programs to address health care inequities is limited, as is information about how organizations integrate health equity in their cultures, missions, and strategic plans. Purpose The aims of this study were to identify the key components necessary for health systems to implement systematic organizational change to promote health equity and to describe approaches organizations have implemented. Methodology/approach We conducted an environmental scan to identify central principles for implementing lasting change in health systems and experts working to advance health equity through organizational change. We interviewed 19 experts in health equity and hospital executives in 2020. Using iterative thematic analysis, we identified common themes. Results Consistent with the literature on organizational change, interviewees described a variety of systematic approaches to change, all of which involve the following core components: (a) committed and engaged leadership; (b) integrated organizational structure; (c) commitment to quality improvement and patient safety; (d) ongoing training and education; (e) effective data collection and analytics; and (f) stakeholder communication, engagement, and collaboration. Conclusion and practice implications There is no "one-size-fits-all" approach to advancing health equity. Decisions about which components require the most attention vary depending on an organization's internal and external environment. Understanding those environments and identifying which levers will be most effective are essential. As provider organizations strive to develop more strategic and systematic approaches to addressing disparities, long-term vision and commitment are necessary to achieve sustainable organizational change.
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- 2021
34. Quantitation of Methamphetamine and Amphetamine in Postmortem Canine Tissues and Fluids
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Birgit Puschner, Margaret Wixson, Margaret Johnson, and John P. Buchweitz
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Chemical Health and Safety ,Recreational Drug ,business.industry ,Health, Toxicology and Mutagenesis ,medicine.medical_treatment ,010401 analytical chemistry ,Physiology ,Methamphetamine ,Toxicology ,01 natural sciences ,0104 chemical sciences ,Analytical Chemistry ,Stimulant ,03 medical and health sciences ,0302 clinical medicine ,Diagnostic specimens ,Lc ms ms ,medicine ,Source material ,Environmental Chemistry ,030216 legal & forensic medicine ,Intentional poisoning ,Amphetamine ,business ,medicine.drug - Abstract
The production and use of the highly addictive stimulant methamphetamine are a serious public health problem in the USA and globally. Because of its increased popularity with recreational drug users, accidental or intentional poisoning incidents in companion animals have become an unavoidable scenario in veterinary medicine. We describe a case of methamphetamine poisoning in a 4-year-old female German Shepherd, with postmortem analytical quantitation of methamphetamine and its metabolite, amphetamine, in bodily tissues and fluids. Many tissues and bodily fluids can be tested to confirm methamphetamine exposure. More importantly, the higher concentrations found in stomach contents and liver, kidney and heart tissues suggest these are the most useful diagnostic specimens for postmortem confirmation of toxicosis in pets, especially in cases in which the source material is not available for testing or in cases with no postmortem evaluation.
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- 2021
35. BIOM-43. THE GENOMIC, TRANSCRIPTOMIC, AND EPIGENOMIC LANDSCAPE OF ISOCITRATE DEHYDROGENASE WILD TYPE GLIOBLASTOMA ACROSS THE AGE CONTINUUM
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Margaret Johnson, April Bell, Yajas Shah, Kayla Viets-Layng, Elizabeth Mauer, Joanne Xiu, Olivier Elemento, Michael Glantz, Phillip Walker, Clark Chen, Erin Dunbar, Ekokobe Fonkem, Santosh Kesari, Andrew Brenner, Herbert Newton, Justin Low, Ashley Sumrall, Wolfgang Korn, David Ashley, and Derek Wainwright
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Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND Older age is a poor prognostic factor for glioblastoma (GBM) patients. We tested whether the intrinsic molecular landscape of the tumor may contribute to this poor prognosis. METHODS In accordance with the 2021 WHO classification scheme, we included only isocitrate dehydrogenase (IDH) wild type GBM. Based on published literature, we defined older as age > 65. RNA expression, gene amplification, tumor mutational burden (TMB) and mutational profiles were analyzed in three unique datasets: Tempus (n = 1,410), Caris (n = 1,432), and TCGA (n = 557). Comparison were made between < 65 and ³ 65 year olds using Pearson’s Chi-squared tests, Fisher’s exact tests, or Wilcoxon rank-sum where appropriate. RESULTS From our evaluable gene sets, TERT promoter mutations were more prevalent in patients ³ 65 years old (Caris 82.64 vs 77.27%, p = 0.016; Tempus 58.0 vs 49.0%, p = 0.002). There were no significant differences in PDCD1, CD274, CD3E, TNFRSF18, CD40, CD8A, TNFRSF4, CTLA4, HAVCR2, TNFSF9, CD274, or CDKN2A; PDL-1 (by IHC); dMMR/MSI-H, TMB; CDK6 amplification, EGFR amplification, EGFR, EGFRvIII, EGFR fusions, MET fusions, PTEN, TP53, or NF-1. MGMT promoter methylation (Caris data) was more common in the older group (49.73 v 34.14%, p < 0.001). TGCA data demonstrated that gene expression, TMB, and methylation did not change significantly with age. Additionally, PCOLCE2 and SLC10A4 were differentially methylated, and missense mutations, of any type, were more common in the older group (p=0.006). CONCLUSION Despite worse survival outcomes for older patients with IDHwt GBM as compared to younger counterparts, the molecular landscape is similar at the genomic, transcriptomic and epigenomic levels. The key exception is TERT promoter mutations that are more common in older GBM patients. Poorer survival is therefore not likely to be attributable solely to intratumoral factors.
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- 2022
36. NCOG-43. A RETROSPECTIVE ANALYSIS OF THE IMPACT OF THE COVID-19 INFECTION ON NEURO-ONCOLOGY CARE AND PATIENT OUTCOMES: A TWO-SITE STUDY
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Margaret Johnson, Jennifer Durling, Casey B Brown, Mustafa Khasraw, Zoey Petitt, Nicole Cort, Eric S Lipp, Evan D Buckley, James E Herndon, Waynekid Kam, Karen Gao, Milan G Chheda, and Omar H Butt
- Subjects
Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND COVID-19 radically changed neuro-oncology care. In this retrospective study, we examine the impact of COVID-19 infection on neuro-oncological care and clinical outcomes in two geographically separate populations. METHODS Descriptive statistics compared demographic and clinical history extracted from the medical records of COVID-19 positive patients with primary brain tumors treated between 3/1/2020 and 3/31/2021. All subjects were unvaccinated given our cohort pre-dates the ubiquitous availability of vaccines. Patients were treated at Washington University (WashU) in St. Louis, MO and Duke University in Durham, NC. Each site’s respective institutional review board approved the study, with a data transfer agreement in place. RESULTS We identified 62 total (WashU=13; Duke=49) subjects with positive COVID-19 infection. Patients were predominantly white (85.5%), male (56.5%), with KPS >=70 (82.3%) and never smoked (69.4%). WashU patients tended to be older with grade 4 tumors, but this was not significant. At the time of COVID infection 35.5% of patients were receiving cancer-directed therapy. Notably, 37.1% experienced delayed care due to a COVID-19 diagnosis, most often for scheduled systemic treatment or radiation treatment. A further 37.1% had an ER visit, hospitalization, or ICU stay attributed to COVID-19. Of the 17 patients who died during the study period, 4 deaths were attributed directly to COVID-19 and not to their underlying brain tumor or other cause. Finally, telehealth use differed between sites (84.6% at WashU vs 14.3% at Duke). However, this difference could not be attributed to patient age, performance status, or distance from treating institution. CONCLUSION COVID-19 infection led to treatment delays and death for a subset, but not the majority of neuro-oncology patients. Telehealth use varied between sites and was not associated with commonly held assumptions about patient distance or performance status, suggesting evolving practice norms following telehealth’s introduction. Study limitations include a small sample size
- Published
- 2022
37. All-cause hospitalization according to demographic group in people living with HIV in the current antiretroviral therapy era
- Author
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Margaret Johnson, Clinton Chaloner, Colette J. Smith, Sanjay Bhagani, Sophia M. Rein, Fiona C Lampe, Robert F. Miller, Andrew N. Phillips, and Fiona Burns
- Subjects
Male ,0301 basic medicine ,Immunology ,Human immunodeficiency virus (HIV) ,Ethnic group ,HIV Infections ,medicine.disease_cause ,ethnic groups ,Men who have sex with men ,Cohort Studies ,Sexual and Gender Minorities ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,sexual orientation ,Antiretroviral Therapy, Highly Active ,Health care ,medicine ,Humans ,Immunology and Allergy ,030212 general & internal medicine ,Poisson regression ,Homosexuality, Male ,business.industry ,Proportional hazards model ,HIV ,acquired immunodeficiency syndrome ,Clinical Science ,Hospitalization ,030104 developmental biology ,Infectious Diseases ,symbols ,ethnicity ,Female ,sex identity ,business ,All cause mortality ,Demography ,Cohort study - Abstract
Objective: We investigated differences in all-cause hospitalization between key demographic groups among people with HIV in the UK in the current antiretroviral therapy (ART) era. Design/Methods: We used data from the Royal Free HIV Cohort study between 2007 and 2018. Individuals were classified into five groups: MSM, Black African men who have sex with women (MSW), MSW of other ethnicity, Black African women and women of other ethnicity. We studied hospitalizations during the first year after HIV diagnosis (Analysis-A) separately from those more than one year after diagnosis (Analysis-B). In Analysis-A, time to first hospitalization was assessed using Cox regression adjusted for age and diagnosis date. In Analysis-B, subsequent hospitalization rate was assessed using Poisson regression, accounting for repeated hospitalization within individuals, adjusted for age, calendar year, time since diagnosis. Results: The hospitalization rate was 30.7/100 person-years in the first year after diagnosis and 2.7/100 person-years subsequently; 52% and 13% hospitalizations, respectively, were AIDS-related. Compared with MSM, MSW and women were at much higher risk of hospitalization during the first year [aHR (95% confidence interval, 95% CI): 2.7 (1.7–4.3), 3.0 (2.0–4.4), 2.0 (1.3–2.9), 3.0 (2.0–4.5) for Black African MSW; other ethnicity MSW; Black African women; other ethnicity women respectively, Analysis-A] and remained at increased risk subsequently [corresponding aIRR (95% CI): 1.7 (1.2–2.4), 2.1 (1.5–2.8), 1.5 (1.1–1.9), 1.7 (1.2–2.3), Analysis-B]. Conclusion: In this setting with universal healthcare, substantial variation exists in hospitalization risk across demographic groups, both in early and subsequent periods after HIV diagnosis, highlighting the need for targeted interventions.
- Published
- 2021
38. Shape from spectra
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Nimrod Carmon, Alexander Berk, Niklas Bohn, Phillip G. Brodrick, Jeff Dozier, Margaret Johnson, Charles E. Miller, David R. Thompson, Michael Turmon, Charles M. Bachmann, Robert O. Green, Regina Eckert, Elliott Liggett, Hai Nguyen, Francisco Ochoa, Gregory S. Okin, Rory Samuels, David Schimel, Joon Jin Song, and Jouni Susiluoto
- Subjects
Soil Science ,Geology ,Computers in Earth Sciences - Published
- 2023
39. Factors associated with obesity in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) cohort: an observational cross‐sectional analysis
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Margaret Johnson, Patrick W. G. Mallon, Memory Sachikonye, Daphne Babalis, Alan Winston, Davide De Francesco, Frank A. Post, Emmanouil Bagkeris, S Savinelli, Jaime H. Vera, Jane Anderson, Eoin R. Feeney, Caroline A. Sabin, Marta Boffito, and I Williams
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Cross-sectional study ,HIV Infections ,Comorbidity ,Disease ,Type 2 diabetes ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Recreational Drug Use ,Internal medicine ,Prevalence ,Humans ,Medicine ,Pharmacology (medical) ,Obesity ,030212 general & internal medicine ,Aged ,Sex Characteristics ,business.industry ,Health Policy ,Age Factors ,Middle Aged ,Recreational drug use ,medicine.disease ,030112 virology ,United Kingdom ,CD4 Lymphocyte Count ,Osteopenia ,Cross-Sectional Studies ,Infectious Diseases ,Cohort ,Quality of Life ,Female ,business - Abstract
The aims of the study were to describe the prevalence of obesity in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) cohort, to identify demographic, clinical and HIV-specific factors associated with obesity, and to characterize the association between obesity and sociodemographic, clinical and HIV-specific factors and quality of life (QoL).A cross-sectional analysis was carried out of baseline data from the three groups ["older" people with HIV infection (PWH) aged ≥ 50 years, "younger" PWH aged50 years and HIV-negative controls aged ≥ 50 years] within the POPPY cohort. Obesity was defined as a body mass index (BMI) 30 kg/mA total of 1361 subjects were included in the study, of whom 335 (24.6%) were obese. The prevalence of obesity was higher in controls (22.3%) than in older (16.8%) and younger (14.2%) PWH, with no differences between the two groups of PWH. Factors associated with obesity were older age, female gender, black African ethnicity and alcohol consumption. Recreational drug use and a higher current CD4 T-cell count (in PWH) were associated with lower and higher odds of being obese, respectively. The presence of obesity was associated with worse physical health QoL scores, higher odds of having cardiovascular disease, type 2 diabetes and hypertension, but lower odds of having osteopenia/osteoporosis, irrespective of HIV status.Despite a lower prevalence of obesity in PWH, specific subgroups (women, people of black African origin and older people) were more likely to be obese, and negative health consequences of obesity were evident, regardless of HIV status. Whether targeted preventive strategies can reduce the burden of obesity and its complications in PWH remains to be determined.
- Published
- 2020
40. Patterns of relapse after successful completion of initial therapy in primary central nervous system lymphoma: a case series
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Henry S. Friedman, Katherine B. Peters, Annick Desjardins, James E. Herndon, Mallika P Patel, Patrick Healy, David M. Ashley, Margaret Johnson, John P. Kirkpatrick, Dina Randazzo, Elizabeth S Miller, and Eric S. Lipp
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Cancer Research ,Systemic disease ,medicine.medical_specialty ,Neurology ,business.industry ,Primary central nervous system lymphoma ,medicine.disease ,Lymphoma ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Methotrexate ,Rituximab ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,medicine.drug ,Rare disease - Abstract
Primary central nervous system lymphoma (PCNSL) is a subtype of non-Hodgkin’s lymphoma that involves the brain, spinal cord, or leptomeninges, without evidence of systemic disease. This rare disease accounts for ~ 3% of all primary central nervous system (CNS) tumors. Methotrexate-based regimens are the standard of care for this disease with overall survival rates ranging from 14 to 55 months. Relapse after apparent complete remission can occur. We sought to understand the outcomes of patients who relapsed. This is an IRB-approved investigation of patients treated at our institution between 12/31/2004 and 10/12/2016. We retrospectively identified all cases of PCNSL as part of a database registry and evaluated these cases for demographic information, absence or presence of relapse, location of relapse, treatment regimens, and median relapse-free survival. This analysis identified 44 patients with a pathologically confirmed diagnosis of PCNSL. Mean age at diagnosis was 63.1 years (range 20–86, SD = 13.2 years). Of the 44 patients, 28 patients successfully completed an initial treatment regimen without recurrence or toxicity that required a change in therapy. Relapse occurred in 11 patients with the location of relapse being in the CNS only (n = 5), vitreous fluid only (n = 1), outside CNS only (n = 3), or a combination of CNS and outside of the CNS (n = 2). Sites of relapse outside of the CNS included testes (n = 1), lung (n = 1), adrenal gland (n = 1), kidney/adrenal gland (n = 1), and retroperitoneum (n = 1). Median relapse-free survival after successful completion of therapy was 6.7 years (95% CI 1.1, 12.6). After successful initial treatment, PCNSL has a propensity to relapse, and this relapse can occur both inside and outside of the CNS. Vigilant monitoring of off-treatment patients with a history of PCNSL is necessary to guide early diagnosis of relapse and to initiate aggressive treatment.
- Published
- 2020
41. Limited weight impact after switching from boosted protease inhibitors to dolutegravir in persons with HIV with high cardiovascular risk: a post hoc analysis of the 96-week NEAT-022 randomized trial
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Laura, Waters, Lambert, Assoumou, Ana, González-Cordón, Stefano, Rusconi, Pere, Domingo, Mark, Gompels, Stephane, de Wit, François, Raffi, Christoph, Stephan, Mar, Masiá, Jürgen, Rockstroh, Christine, Katlama, Georg M N, Behrens, Graeme, Moyle, Margaret, Johnson, Julie, Fox, Hans-Jürgen, Stellbrink, Giovanni, Guaraldi, Eric, Florence, Stefan, Esser, José M, Gatell, Anton, Pozniak, and Esteban, Martínez
- Subjects
Settore MED/17 - Malattie Infettive ,Weight ,dolutegravir ,switch - Abstract
In the NEAT022 trial, virologically suppressed persons with HIV at high cardiovascular risk switching from protease inhibitors to dolutegravir either immediately (DTG-I) or after 48 weeks (DTG-D) showed non-inferior virological suppression and significant lipid and CVD risk reductions on switching to dolutegravir relative to continuing protease inhibitors.Post-hoc analysis. Major endpoints were 48-week and 96-week weight and body mass index (BMI) changes. Factors associated with weight/BMI changes within the first 48 weeks of DTG exposure, proportion of participants by category of percent weight change, proportions of BMI categories over time, and impact on metabolic outcomes were also assessed.Between May/2014 and November/2015, 204 (DTG-I) and 208 (DTG-D) participants were included. Weight significantly increased (mean +0.810 kg DTG-I arm, and +0.979 kg DTG-D arm) in the first 48 weeks post-switch, but remained stable from 48 to 96 weeks in DTG-I arm. Switching from darunavir, white race, total-to-HDL cholesterol ratio3.7, and normal/underweight BMI were independently associated with higher weight/BMI gains. The proportion of participants with ≥5% weight change increased similarly in both arms over time. The proportions of BMI categories, use of lipid-lowering drugs, diabetes and/or use of antidiabetic agents, and hypertension and/or use of antihypertensive agents did not change within or between arms at 48 and 96 weeks.Switching from protease inhibitors to dolutegravir in persons with HIV with high cardiovascular risk led to modest weight gain limited to the first 48 weeks which involved preferentially normal-weight or underweight persons and was not associated with negative metabolic outcomes.
- Published
- 2022
42. Racial, Ethnic and Socioeconomic Disparities in Treatment and Outcome of Patients with Bronchiectasis and Nontuberculous Mycobacteria
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Pamela McShane, Radmilla Choate, Margaret Johnson, Diego Maselli, Kevin Winthrop, and Mark Metersky
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History ,Polymers and Plastics ,Business and International Management ,Industrial and Manufacturing Engineering - Published
- 2022
43. CTIM-24. NUTMEG: A RANDOMIZED PHASE II STUDY OF NIVOLUMAB AND TEMOZOLOMIDE VERSUS TEMOZOLOMIDE ALONE IN NEWLY DIAGNOSED ELDERLY PATIENTS WITH GLIOBLASTOMA
- Author
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Hao-Wen Sim, Zarnie Lwin, Elizabeth Barnes, Kerrie McDonald, Sonia Yip, Roel Verhaak, Amy Heimberger, Merryn Hall, Matthew Wong, Ross Jennens, David Ashley, Mark Rosenthal, Elizabeth Hovey, Benjamin Ellingson, Annette Tognela, Hui Gan, Michael Back, Eng-Siew Koh, Anne Long, Katharine Cuff, Stephen Begbie, Craig Gedye, Anna Mislang, Hien Le, Margaret Johnson, Benjamin Kong, John Simes, and Mustafa Khasraw
- Subjects
Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND Nivolumab is a PD-1 inhibitor with known safety profile. An increase in mutations as we age is well documented in glioblastoma and other cancers. Higher mutational load is associated with increased response to nivolumab in extracranial malignancies. NUTMEG examined the activity of nivolumab added to temozolomide in glioblastoma patients aged ≥ 65 years. METHODS NUTMEG was an international multicenter phase II trial for newly diagnosed glioblastoma patients aged ≥ 65 years, randomized 2:1 to experimental (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide 150-200mg/m2 D1-5 Q28D + nivolumab 240mg D1,15 Q28D C1-4 and 480mg D1 Q28D C5-6) versus standard arm (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide alone 150-200mg/m2 D1-5 Q28D), stratified by age, ECOG status, MGMT status and resection extent. RESULTS 103 patients were enrolled (69 in experimental arm, 34 in standard arm). Median age was 73 years, 36% ECOG 0, 57% MGMT-unmethylated and 51% gross macroscopic resection. Median follow-up is 31 months to date, with 77 deaths (surviving patients to continue follow-up and final results will be presented). Median overall survival was 11.8 months in the experimental arm versus 12.0 months in the standard arm (HR 0.95 95%CI 0.59-1.53 for experimental relative to control). Six-month progression-free survival rate using mRANO was 64% in the experimental arm versus 49% in the standard arm (HR 0.81 95%CI 0.51-1.26). Grade 3/4 adverse events were reported in 46% of experimental arm (7% lung infection, 7% thromboembolic events, 6% fatigue, 6% muscle weakness) and in 29% of control arm (9% fatigue, 6% seizure, 6% thromboembolic events). CONCLUSIONS There was insufficient evidence of clinical benefit with nivolumab in this population. No new safety signals were identified. Central imaging review is underway and correlative studies will characterize the immune landscape, including mutational load, neoantigen and other immune markers. NCT04195139.
- Published
- 2022
44. CTIM-23. DOSE ESCALATION TRIAL OF FC-ENGINEERED ANTI-CD40 MONOCLONAL ANTIBODY (2141-V11) ADMINISTERED INTRATUMORALLY WITH D2C7-IT VIA CONVECTION-ENHANCED DELIVERY (CED) FOR RECURRENT MALIGNANT GLIOMAS (RMGS)
- Author
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Annick Desjardins, Vidya Chandramohan, Daniel Landi, Katherine B Peters, Margaret Johnson, Mustafa Khasraw, Justin Low, Stevie Threatt, Chevelle Bullock, James E Herndon II, Eric S Lipp, John Sampson, Allan Friedman, Henry S Friedman, David Ashley, David Knorr, Jeffrey Ravetch, and Darell Bigner
- Subjects
Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND D2C7-IT, a novel immunotoxin-based cytotoxic therapy, targets epidermal growth factor receptor (EGFR) and mutant EGFR variant III. In preclinical studies, D2C7-IT kills tumor cells and prolongs survival, but is unable to generate cures in all animals. We hypothesized that immunosuppression in glioblastoma limits D2C7-IT efficacy. Eliminating glioblastoma immunosuppression via CD40 co-stimulation is anticipated to enhance D2C7-IT-induced antitumor responses. In murine glioma models, CED of D2C7-IT+αCD40 generated cures and long-term tumor-specific adaptive immunity. Hence, we are conducting a phase 1 trial of D2C7-IT+2141-V11 (αhuman-CD40) administered via CED in rMG patients. METHODS Eligibility includes adult patients with solitary supratentorial rMG (WHO grade 3/4); ≥ 4 weeks after chemotherapy, bevacizumab, or study drug; adequate organ function; and KPS ≥ 70%. Cohorts of 3 patients are treated with increasing doses of 2141-V11 to determine the maximum tolerated dose when administered sequentially following D2C7-IT (166,075 ng) via CED at 0.5 mL/hr. Five dose levels (DLs) are evaluated (2141-V11 at: #1: 0.70 mg; #2: 2.0 mg; #2**: 3.0 mg #2*: 4.0 mg; #3: 7.0 mg). RESULTS As of May 29, 2022, 13 patients were treated (3 patients on DL1, DL2, and DL2**; 2 patients on DL3 and DL2*). No dose-limiting toxicities were observed; however, lower DLs were added due to higher frequency of adverse events (AEs) expected with D2C7-IT+2141-V11 with DL3 and DL2* (fever, neurologic symptoms). All patients remain alive 0.7-10.6 months after therapy. Grade ≥ 2 AEs due to D2C7-IT+2141-V11 include: headache (grade 3, n = 1; grade 2, n = 4); pyramidal tract disorder (grade 3, n = 1; grade 2, n = 2); paresthesia (grade 3, n = 1); dysphasia (grade 3, n = 1); seizures (grade 2; n = 2); fever (grade 2; n = 2); and one each of grade 2 depressed level of consciousness, fatigue, and concentration impairment. Enrollment is ongoing. CONCLUSIONS Intratumoral administration of D2C7-IT+2141-V11 via CED is safe, encouraging efficacy results are observed.
- Published
- 2022
45. TMIC-15. AGE-RELATED MARKERS FOR SENESCENCE INCREASE IN THE OLDER ADULT EXTRATUMORAL MOUSE BRAIN DUE TO GLIOBLASTOMA
- Author
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April Bell, Margaret Johnson, Erik Ladomersky, Miri Kim, Junfei Zhao, Jason Miska, Lijie Zhai, Kristen Lauing, Evridiki Asimakidou, Prashant Bommi, James Chandler, Xinlei Mi, Masha Kocherginski, Rimas Lukas, and Derek Wainwright
- Subjects
Cancer Research ,Oncology ,Neurology (clinical) - Abstract
OBJECTIVE The median age of onset for glioblastoma (GBM; IDHwt) is 68-70 years. Age is a strong prognostic factor for GBM patient outcomes such that overall survival in older adults is less than their younger counterparts – even after adjustment for MGMT promoter methylation status. Aging is associated with increased levels of senescence in the brain. Several age-related neurological disorders have been shown to improve with senolytic treatments. Here, we explored the effects and therapeutic neutralization of syngeneic brain tumors on increasing senescence levels in the extratumoral brain (ie. outside of the brain tumor) of young and old mice. METHODS General RNA-sequencing, as well as single-cell (sc) RNA-sequencing was performed on extratumoral tissue from young (8-12 weeks) and older adult (80-90 weeks) C57BL/6 mice with or without GL261 and key markers were validated with RT-PCR. The combined effects of the senolytics, dasatinib and quercetin, with radiation, anti-PD-1 mAb, and IDO enzyme inhibitor treatment, was also investigated. RESULTS General- and sc-RNA sequencing revealed a distinct gene expression profile in the extratumoral brain of older mice with syngeneic GL261 as compared to all other groups. RT-PCR results confirmed that the brain tumor increased gene expression for senescence levels, p53, and NFkB signaling in the older adult extratumoral brain. Expression of the senescence marker p16INK4A was primarily localized to oligodendrocyte progenitor cells in the older adult brain. The combinatorial treatment of senolytics with RT, anti-PD-1 mAb, and IDO enzyme inhibitor led to a synergistic survival benefit in older adult mice with GL261 as compared to the treatment with senolytics, or immunotherapy, alone. CONCLUSIONS The data suggest that the extratumoral brain may be responsible in-part for the poorer outcomes of older adults with GBM and that treatment approaches that target senescent cells may provide clinical benefit.
- Published
- 2022
46. QOL-08. PHASE II RANDOMIZED STUDY TO EVALUATE EFFICACY AND SATISFACTION OF ROLAPITANT PLUS ONDANSETRON VS. ONDANSETRON MONOTHERAPY IN PREVENTING NAUSEA/VOMITING FOR GLIOMAS RECEIVING RADIATION/TEMOZOLOMIDE
- Author
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Mary Lou Affronti, Mallika Patel, Erin Severance, Charles Loughlin, Claire Bradbury, James E Herndon, Kendra Boyd, Eric S Lipp, Henry S Friedman, Annick Desjardins, Margaret Johnson, and Katherine B Peters
- Subjects
Cancer Research ,Oncology ,Neurology (clinical) - Abstract
BACKGROUND Nausea and vomiting remain the most feared cancer treatment-related side effects. Trials establishing antiemetic guidelines exclude malignant glioma (MG) patients. In MG patients receiving radiation with concurrent temozolomide, chemoradiation-induced nausea and vomiting (cRINV) rates are 35 and 26%, respectively, which reduce quality of life, treatment adherence, and potentially cancer control.OBJECTIVES: In a randomized phase II open label trial, we compared patient satisfaction and efficacy of ondansetron monotherapy (short-acting 5HT3-RA; 3h half-life) vs. rolapitant (long-acting NK1-RA; 180h half-life) plus ondansetron in preventing cRINV during 6-weeks of daily temozolomide (75 mg/m2/dX42d) with radiation. METHODS Fifty-three eligible patients receiving chemoradiation were randomized to Arm-A (ondansetron 8mg Days 1-42, rolapitant 180mg on Day 21) or Arm-B (rolapitant on Day 1 plus daily ondansetron). Primary endpoint included the percentage achieving cRINV-complete response (CR; no vomiting or antiemetic rescue) during the first 2-weeks of radiation. Secondary endpoints included cRIN/cRIV rates, preference for rolapitant plus ondansetron, and toxicity. RESULTS Forty-eight initiated protocol treatment. Mean age=53, 58% male, median KPS 90%, 71% low alcohol N/V risk factor, 73% glioblastoma. During the first 2-weeks of radiation, cRINV-CR was 60% for 25 evaluable patients receiving ondansetron monotherapy and 65% for 23 receiving rolapitant/ondansetron (p< 0.71). Patient-reported cRINV-CR was 61% and 74%, respectively (p< 0.41); cRIN rates (44% Arm-A; 53% Arm-B) were more than cRIV rates (28% Arm-A; 11% Arm-B). More patients receiving ondansetron alone vomited the first 2-weeks (22%) than with rolapitant/ondansetron (0%); p< 0.05. Among 32 patients who completed the study, patients preferred ondansetron (63%) over rolapitant/ondansetron (19%); p< 0.0039; 19% had no preference. Adverse events attributable to antiemetic treatment (fatigue/constipation) were all grade 1-2. CONCLUSIONS While patients prefer ondansetron monotherapy, there was no difference in cRINV-CR between the first 2-week treatments and some had less vomiting with rolapitant plus ondansetron. We will present overall N/V results.
- Published
- 2022
47. A systematic review of measures of breakthrough pain and their psychometric properties
- Author
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Emily Harrop, Margaret Johnson, Christine Mott, Satbir Jassal, Christina Liossi, Anna-Karenia Anderson, Katherine Greenfield, Daniel E. Schoth, Lorna K Fraser, Richard F. Howard, and Dilini Rajapakse
- Subjects
Adult ,medicine.medical_specialty ,Databases, Factual ,Psychometrics ,MEDLINE ,Context (language use) ,PsycINFO ,CINAHL ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Pain assessment ,Surveys and Questionnaires ,Content validity ,Medicine ,Humans ,030212 general & internal medicine ,Medical diagnosis ,Child ,General Nursing ,business.industry ,Breakthrough Pain ,Reproducibility of Results ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Physical therapy ,Neurology (clinical) ,Self Report ,business - Abstract
Context Breakthrough pain (BTP) is common in cancer and other conditions yet there is a lack of validated BTP measurement tools. Objectives We aimed to identify all tools assessing or characterising BTP in patients of any age with any condition, and to critically appraise their psychometric properties. Methods The Cochrane Library, PROSPERO, Embase, CINAHL, Medline, PsycINFO, Web of Science, Google Scholar, ProQuest, Evidence Search and OpenGrey were searched to identify all available tools used to assess BTP. A second search identified studies that had evaluated psychometric properties of tools identified in Search 1. Databases were searched from inception to November 2020. Studies were assessed using COSMIN criteria and GRADE guidelines. Results Search 1 found 51 tools used to assess BTP. Search 2 found six tools that had a development study and/or a study evaluating a tool psychometric property. No tool had more than one study evaluating psychometric properties so a meta-analysis could not be conducted. Studies were of inadequate to very good quality. Only the Breakthrough Pain Assessment Tool (BAT) had sufficient content validity and at least low-quality evidence for sufficient internal consistency. Conclusion The BAT is recommended to characterise BTP in adults with cancer; its applicability to other conditions is unknown. The remaining tools need further evaluation. Only the Breakthrough Pain Questionnaire for Children was designed for children with cancer, but no psychometric properties were evaluated. There is a need for a tool to assess and characterise BTP in children with non-cancer diagnoses and those who cannot self-report.
- Published
- 2021
48. Large self-assembled clathrin lattices spontaneously disassemble without sufficient adaptor proteins
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Margaret Johnson, Alexander Sodt, and Sikao Guo
- Subjects
Cellular and Molecular Neuroscience ,Computational Theory and Mathematics ,Ecology ,Modeling and Simulation ,Cell Membrane ,Genetics ,Molecular Biology ,Ecology, Evolution, Behavior and Systematics ,Clathrin ,Endocytosis ,Adaptor Proteins, Signal Transducing - Abstract
Clathrin-coated structures must assemble on cell membranes to internalize receptors, with the clathrin protein only linked to the membrane via adaptor proteins. These structures can grow surprisingly large, containing over 20 clathrin, yet they often fail to form productive vesicles, instead aborting and disassembling. We show that clathrin structures of this size can both form and disassemble spontaneously when adaptor protein availability is low, despite high abundance of clathrin. Here, we combine recent in vitro kinetic measurements with microscopic reaction-diffusion simulations and theory to differentiate mechanisms of stable vs unstable clathrin assembly on membranes. While in vitro conditions drive assembly of robust, stable lattices, we show that concentrations, geometry, and dimensional reduction in physiologic-like conditions do not support nucleation if only the key adaptor AP-2 is included, due to its insufficient abundance. Nucleation requires a stoichiometry of adaptor to clathrin that exceeds 1:1, meaning additional adaptor types are necessary to form lattices successfully and efficiently. We show that the critical nucleus contains ~25 clathrin, remarkably similar to sizes of the transient and abortive structures observed in vivo. Lastly, we quantify the cost of bending the membrane under our curved clathrin lattices using a continuum membrane model. We find that the cost of bending the membrane could be largely offset by the energetic benefit of forming curved rather than flat structures, with numbers comparable to experiments. Our model predicts how adaptor density can tune clathrin-coated structures from the transient to the stable, showing that active energy consumption is therefore not required for lattice disassembly or remodeling during growth, which is a critical advance towards predicting productive vesicle formation.
- Published
- 2021
49. No evidence of neuronal damage as measured by neurofilament light chain in a HIV cure study utilising a kick-and-kill approach
- Author
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Lucy Dorrell, Nneka Nwokolo, Magnus Gisslén, Jonathan Underwood, Mark T. Nelson, Amanda Clarke, Sabine Kinloch, Maryam Khan, M Pace, Tomáš Hanke, Margaret Johnson, Wolfgang Stöhr, Alan Winston, Julie Fox, Sarah Fidler, John Frater, Amanda Heslegrave, Jasmini Alagaratnam, Sarah Pett, Henrik Zetterberg, Jamie Toombs, and Jakub Kopycinski
- Subjects
Epidemiology ,Neurofilament light ,Immunology ,Human immunodeficiency virus (HIV) ,medicine.disease_cause ,Microbiology ,Kick and kill ,Andrology ,Lower body ,Neuronal damage ,Virology ,HIV-1 remission approach ,Medicine ,HIV-1 therapeutic vaccination ,Vorinostat ,business.industry ,Original research ,Significant difference ,Public Health, Environmental and Occupational Health ,Neuro-axonal injury ,QR1-502 ,Peripheral ,Neurofilament light chain protein ,Infectious Diseases ,Real-time polymerase chain reaction ,Biomarker (medicine) ,Public aspects of medicine ,RA1-1270 ,business - Abstract
Objective\udHIV-remission strategies including kick-and-kill could induce viral transcription and immune-activation in the central nervous system, potentially causing neuronal injury. We investigated the impact of kick-and-kill on plasma neurofilament light (NfL), a marker of neuro-axonal injury, in RIVER trial participants commencing antiretroviral treatment (ART) during primary infection and randomly allocated to ART-alone or kick-and-kill (ART + vaccination + vorinostat (ART + V + V)).\ud\udDesign\udSub-study measuring serial plasma NfL concentrations.\ud\udMethods\udPlasma NfL (using Simoa digital immunoassay), plasma HIV-1 RNA (using single-copy assay) and total HIV-1 DNA (using quantitative polymerase chain reaction in peripheral CD4+ T-cells) were measured at randomisation (following ≥22 weeks ART), week 12 (on final intervention day in ART + V + V) and week 18 post-randomisation. HIV-specific T-cells were quantified by intracellular cytokine staining at randomisation and week 12. Differences in plasma NfL longitudinally and by study arm were analysed using mixed models and Student's t-test. Associations with plasma NfL were assessed using linear regression and rank statistics.\ud\udResults\udAt randomisation, 58 male participants had median age 32 years and CD4+ count 696 cells/μL. No significant difference in plasma NfL was seen longitudinally and by study arm, with median plasma NfL (pg/mL) in ART-only vs ART + V + V: 7.4 vs 6.4, p = 0.16 (randomisation), 8.0 vs 6.9, p = 0.22 (week 12) and 7.1 vs 6.8, p = 0.74 (week 18). Plasma NfL did not significantly correlate with plasma HIV-1 RNA and total HIV-1 DNA concentration in peripheral CD4+ T-cells at any timepoint. While higher HIV-specific T-cell responses were seen at week 12 in ART + V + V, there were no significant correlations with plasma NfL. In multivariate analysis, higher plasma NfL was associated with older age, higher CD8+ count and lower body mass index.\ud\udConclusions\udDespite evidence of vaccine-induced HIV-specific T-cell responses, we observed no evidence of increased neuro-axonal injury using plasma NfL as a biomarker up to 18 weeks following kick-and-kill, compared with ART-only.
- Published
- 2021
50. 784 Healthcare professionals’ experiences of the barriers and facilitators to community paediatric pain management at end-of-life
- Author
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Christina Liossi, Emily Harrop, Julie Bayliss, Katie Greenfield, Ian C. K. Wong, Kate Renton, Richard F. Howard, Margaret Johnson, Bernie Carter, Satbir Jassal, and Simone Holley
- Subjects
Nursing ,Health professionals ,business.industry ,Medicine ,Pain management ,business - Published
- 2021
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