1,474 results on '"Bottomley, A."'
Search Results
2. Developing a fit-for-purpose composite symptom score as a symptom burden endpoint for clinical trials in patients with malignant pleural mesothelioma
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Charles S. Cleeland, Karen N. Keating, Brian Cuffel, Cem Elbi, Jonathan M. Siegel, Christoph Gerlinger, Tara Symonds, Jeff A. Sloan, Amylou C. Dueck, Andrew Bottomley, Xin Shelley Wang, Loretta A. Williams, and Tito R. Mendoza
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Medicine ,Science - Abstract
Abstract We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal data were collected from an open-label Phase IIB study in which 239 patients completed the validated MD Anderson Symptom Inventory for MPM (MDASI-MPM). A blinded, independent review committee of external patient-reported outcomes experts advised on MDASI-MPM symptoms to include in the CSS. Through iterative analyses of potential symptom-item combinations, 5 MPM symptoms (pain, fatigue, shortness of breath, muscle weakness, coughing) were selected. The CSS correlated strongly with the full MDASI-MPM symptom set (0.92–0.94) and the Lung Cancer Symptom Scale-Mesothelioma (0.79–0.87) at each co-administration of the scales. The CSS also had good sensitivity to worsening disease and global quality-of-life ratings. The MDASI-MPM CSS can be used as an outcome in MPM clinical trials, including in responder analyses and at the individual patient level. It is brief enough to administer frequently, including electronically, to better capture symptom trajectories during and after a trial and in clinical practice. As a single score, the CSS addresses multiplicity issues that can arise when several symptoms increase due to worsening disease. Our process can be adapted to produce a CSS for other advanced-cancer trials.
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- 2024
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3. Alignment of Physician-Stated vs Clinically Derived Reference Fibrosis Score in Patients with Non-Alcoholic Steatohepatitis: A Real-World European Survey
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Anstee QM, Hallsworth K, Lynch N, Hauvespre A, Mansour E, Kozma S, Bottomley J, Milligan G, Piercy J, and Higgins V
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fibrosis staging ,non-alcoholic steatohepatitis ,clinically derived reference fibrosis score ,physician-stated fibrosis score ,real-world evidence ,Medicine - Abstract
Quentin M Anstee,1,2 Kate Hallsworth,1,2 Niall Lynch,3 Adrien Hauvespre,4 Eid Mansour,5 Sam Kozma,5 Juliana Bottomley,6 Gary Milligan,7 James Piercy,8 Victoria Higgins9 1Translational & Clinical Research Institute, Faculty of Medical Sciences, University of Newcastle, Newcastle Upon Tyne, UK; 2Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; 3Global Value and Access, Gilead Sciences, Hayes, Uxbridge, UK; 4Market Access and Reimbursement, Gilead Sciences, Hayes, Uxbridge, UK; 5Pricing and Market Access (Middle East), Gilead Sciences, Dubai, United Arab Emirates; 6Pricing and Market Access, Gilead Sciences, Hayes, Uxbridge, UK; 7Statistics Department, Adelphi Real World, Bollington, UK; 8Scientific Franchise, Adelphi Real World, Bollington, UK; 9Scientific and NASH Franchise, Adelphi Real World, Bollington, UKCorrespondence: Victoria Higgins, Adelphi Real World, Adelphi Mill, Grimshaw Lane, Bollington, SK10 5JB, UK, Tel +44 1625 577233, Email victoria.higgins@adelphigroup.comObjective: Stratifying disease severity in patients with non-alcoholic steatohepatitis (NASH) is essential for appropriate treatment and long-term management. Liver biopsy is the reference standard for fibrosis severity in NASH, but less invasive methods are used, eg, Fibrosis-4 Index (FIB-4) and vibration-controlled transient elastography (VCTE), for which reference thresholds for no/early fibrosis and advanced fibrosis are available. We compared subjective physician assessment of NASH fibrosis versus reference thresholds to understand classification in a real-world setting.Methods: Data were drawn from Adelphi Real World NASH Disease Specific ProgrammeTM conducted in France, Germany, Italy, Spain and UK in 2018. Physicians (diabetologists, gastroenterologists, hepatologists) completed questionnaires for five consecutive NASH patients presenting for routine care. Physician-stated fibrosis score (PSFS) based on available information was compared with clinically defined reference fibrosis stage (CRFS) determined retrospectively using VCTE and FIB-4 data and eight reference thresholds.Results: One thousand two hundred and eleven patients had VCTE (n = 1115) and/or FIB-4 (n = 524). Depending on thresholds, physicians underestimated severity in 16– 33% (FIB-4) and 27– 50% of patients (VCTE). Using VCTE ≥ 12.2, diabetologists, gastroenterologists and hepatologists underestimated disease severity in 35%, 32%, and 27% of patients, respectively, and overestimated fibrosis in 3%, 4%, and 9%, respectively (p = 0.0083 across specialties). Hepatologists and gastroenterologists had higher liver biopsy rates than diabetologists (52%, 56%, 47%, respectively).Conclusion: PSFS did not consistently align with CRFS in this NASH real-world setting. Underestimation was more common than overestimation, potentially leading to undertreatment of patients with advanced fibrosis. More guidance on interpreting test results when classifying fibrosis is needed, thereby improving management of NASH.Keywords: fibrosis staging, non-alcoholic steatohepatitis, clinically derived reference fibrosis score, physician-stated fibrosis score, real-world evidence
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- 2023
4. The control of malaria vectors in rice fields: a systematic review and meta-analysis
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Kallista Chan, Christian Bottomley, Kazuki Saito, Jo Lines, and Lucy S. Tusting
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Medicine ,Science - Abstract
Abstract The relatively stable aquatic conditions of irrigated lowland and rainfed rice, which is grown across 145 million hectares in more than 100 countries, are capable of generating large numbers of mosquito vectors of malaria, which causes more than 400,000 deaths per year worldwide. Many methods can control these vectors, but a systematic review has not previously been conducted. This study assesses whether larviciding, fish or intermittent irrigation can significantly reduce malaria vectors in rice fields whilst increasing rice yield. After a literature search for studies reporting the effect of larval control and rice cultivation practices on malaria vector densities in rice fields, 33 studies were eligible for meta-analysis. Larviciding was effective at reducing rice-field malaria vectors. Pooled analysis of five controlled time-series (CTS) studies with chemical insecticides showed an overall combined reduction of larval densities of 77% compared to no larviciding. Eight CTSs with biological larvicides showed a pooled reduction of 60% compared to no larviciding. Cultivating rice and fish together provided good control too: a pooled analysis of three CTSs showed an overall 82% reduction in anopheline larvae compared to no fish. Pooled analysis of four studies suggested that intermittent irrigation (using various timings and frequencies of drainage) is effective at reducing the abundance of late-stage anopheline larvae (pooled reduction = − 35%), but not overall immature abundance, compared to continuous flooding. We conclude that many interventions such as larvicides, fish and intermittent irrigation can provide riceland malaria vector control, but the critical obstacle to wider use is farmer acceptability. Future research should be led by the agricultural sector, with inputs from entomologists, to investigate malaria control co-benefits within high-yielding rice cultivation practices.
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- 2022
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5. Mortality in rural coastal Kenya measured using the Kilifi Health and Demographic Surveillance System: a 16-year descriptive analysis [version 2; peer review: 3 approved, 1 approved with reservations]
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Jennifer Moisi, Michael Kahindi, Christian Bottomley, Amek Nyaguara, Amare Deribew, Kevin Marsh, Christopher Nyundo, Ambrose Agweyu, David Walumbe, Mark Otiende, Michael Kinuthia, David Amadi, Benjamin Tsofa, Philip Bejon, J. Anthony G. Scott, Norbert Kihuha, Thomas N. Williams, Gideon Nyutu, Emmanuel Tsory, and Evasius Bauni
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Child mortality ,adult mortality ,all-cause mortality ,demography ,demographic surveillance system ,mortality trends ,eng ,Medicine ,Science - Abstract
Background: The Kilifi Health and Demographic Surveillance System (KHDSS) was established in 2000 to define the incidence and prevalence of local diseases and evaluate the impact of community-based interventions. KHDSS morbidity data have been reported comprehensively but mortality has not been described. This analysis describes mortality in the KHDSS over 16 years. Methods: We calculated mortality rates from 2003–2018 in four intervals of equal duration and assessed differences in mortality across these intervals by age and sex. We calculated the period survival function and median survival using the Kaplan–Meier method and mean life expectancies using abridged life tables. We estimated trend and seasonality by decomposing a time series of monthly mortality rates. We used choropleth maps and random-effects Poisson regression to investigate geographical heterogeneity. Results: Mortality declined by 36% overall between 2003–2018 and by 59% in children aged
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- 2023
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6. Research engagement by British early-career practitioners in nephrology: a multidisciplinary survey
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Hannah Beckwith, Michael Nation, Aisling McMahon, David C Wheeler, Matthew J Bottomley, Neil S Sheerin, Jeremy Hughes, and Sharlene Greenwood
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Medicine - Abstract
Objectives To establish barriers and motivators underlying research engagement among early-career practitioners in nephrology across the UK, in order to guide potential interventions to enhance research involvement in renal units.Design Cross-sectional online survey employing a range of free-text, Likert scale and binomial/multiple-choice responses, distributed via mailing lists and social media. Topics covered research experience, research involvement and barriers, impact of COVID-19 and strategies to improve research engagement. Thematic analysis was used to assess free-text responses.Setting Renal units throughout the UK.Participants Non-consultant healthcare staff self-identifying as working in nephrology were included (n=211), with responses from non-UK respondents or consultant nephrologists excluded (n=12).Results Responses were received from across the multidisciplinary team (physicians (n=83) and nurses (n=83)) and other allied health professionals (n=45). Most were aware of ongoing local research, but under half of them were actively involved. Multivariate analysis indicated employment as a physician, protected time for research activity and provision of appropriate training were associated with greater research experience and output. There was general enthusiasm to undertake research, but perceived barriers included insufficient staffing, lack of time, funding and encouragement. COVID-19 was felt to have further impacted negatively upon opportunities. Among the suggested strategies to promote engagement, mentorship and an online research resource were felt to be of most interest.Conclusions In the first survey of this type in nephrology, we demonstrate differences across the multidisciplinary spectrum in perceived research experience and accessibility, which have been worsened by COVID-19. Our findings will guide strategies to broaden engagement in early-career practitioners and serve as a baseline to assess the impact of these interventions.
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- 2022
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7. Intestinal inflammation and increased intestinal permeability in Plasmodium chabaudi AS infected mice [version 2; peer review: 2 approved]
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Jason P Mooney, Christian Bottomley, Rivka Lim, Sophia M DonVito, Lia Pickles, Marianne Keith, Tara Wagner-Gamble, Eleanor A Maguire, Ana Bermejo Pariente, Thomas Oldfield, Adrian A Philbey, Ajoke M Ehimiyien, Eleanor M Riley, and Joanne Thompson
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malaria ,plasmodium ,intestine ,permeability ,enteritis ,eng ,Medicine ,Science - Abstract
Background: Gastrointestinal symptoms are commonly associated with acute Plasmodium spp infection. Malaria-associated enteritis may provide an opportunity for enteric pathogens to breach the intestinal mucosa, resulting in life-threatening systemic infections. Methods: To investigate whether intestinal pathology also occurs during infection with a murine model of mild and resolving malaria, C57BL/6J mice were inoculated with recently mosquito-transmitted Plasmodium chabaudi AS. At schizogony, intestinal tissues were collected for quantification and localisation of immune mediators and malaria parasites, by PCR and immunohistochemistry. Inflammatory proteins were measured in plasma and faeces and intestinal permeability was assessed by FITC-dextran translocation after oral administration. Results: Parasitaemia peaked at approx. 1.5% at day 9 and resolved by day 14, with mice experiencing significant and transient anaemia but no weight loss. Plasma IFNγ, TNFα and IL10 were significantly elevated during peak infection and quantitative RT-PCR of the intestine revealed a significant increase in transcripts for ifng and cxcl10. Histological analysis revealed parasites within blood vessels of both the submucosa and intestinal villi and evidence of mild crypt hyperplasia. In faeces, concentrations of the inflammatory marker lactoferrin were significantly raised on days 9 and 11 and FITC-dextran was detected in plasma on days 7 to 14. At day 11, plasma FITC-dextran concentration was significantly positively correlated with peripheral parasitemia and faecal lactoferrin concentration. Conclusions: In summary, using a relevant, attenuated model of malaria, we have found that acute infection is associated with intestinal inflammation and increased intestinal permeability. This model can now be used to explore the mechanisms of parasite-induced intestinal inflammation and to assess the impact of increased intestinal permeability on translocation of enteropathogens.
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- 2022
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8. Myocardial ATP depletion detected noninvasively predicts sudden cardiac death risk in patients with heart failure
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T. Jake Samuel, Shenghan Lai, Michael Schär, Katherine C. Wu, Angela M. Steinberg, An-Chi Wei, Mark E. Anderson, Gordon F. Tomaselli, Gary Gerstenblith, Paul A. Bottomley, and Robert G. Weiss
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Cardiology ,Medicine - Abstract
BACKGROUND Sudden cardiac death (SCD) remains a worldwide public health problem in need of better noninvasive predictive tools. Current guidelines for primary preventive SCD therapies, such as implantable cardioverter defibrillators (ICDs), are based on left ventricular ejection fraction (LVEF), but these guidelines are imprecise: fewer than 5% of ICDs deliver lifesaving therapy per year. Impaired cardiac metabolism and ATP depletion cause arrhythmias in experimental models, but to our knowledge a link between arrhythmias and cardiac energetic abnormalities in people has not been explored, nor has the potential for metabolically predicting clinical SCD risk.METHODS We prospectively measured myocardial energy metabolism noninvasively with phosphorus magnetic resonance spectroscopy in patients with no history of significant arrhythmias prior to scheduled ICD implantation for primary prevention in the setting of reduced LVEF (≤35%).RESULTS By 2 different analyses, low myocardial ATP significantly predicted the composite of subsequent appropriate ICD firings for life-threatening arrhythmias and cardiac death over approximately 10 years. Life-threatening arrhythmia risk was approximately 3-fold higher in patients with low ATP and independent of established risk factors, including LVEF. In patients with normal ATP, rates of appropriate ICD firings were several-fold lower than reported rates of ICD complications and inappropriate firings.CONCLUSION To the best of our knowledge, these are the first data linking in vivo myocardial ATP depletion and subsequent significant arrhythmic events in people, suggesting an energetic component to clinical life-threatening ventricular arrhythmogenesis. The findings support investigation of metabolic strategies that limit ATP loss to treat or prevent life-threatening cardiac arrhythmias and herald noninvasive metabolic imaging as a complementary SCD risk stratification tool.TRIAL REGISTRATION ClinicalTrials.gov NCT00181233.FUNDING This work was supported by the DW Reynolds Foundation, the NIH (grants HL61912, HL056882, HL103812, HL132181, HL140034), and Russell H. Morgan and Clarence Doodeman endowments at Johns Hopkins.
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- 2022
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9. Transplantation Without Overimmunosuppression (TWO) study protocol: a phase 2b randomised controlled single-centre trial of regulatory T cell therapy to facilitate immunosuppression reduction in living donor kidney transplant recipients
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Susan Dutton, Ines Rombach, Joanna Black, Paul Harden, Giovanna Lombardi, William Petchey, Kathryn Wood, Fadi Issa, Matthew Oliver Brook, Joanna Hester, Matthew James Bottomley, Seetha Abdul-Wahab, Andrew Bushell, and Peter Friend
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Medicine - Published
- 2022
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10. Adaptor Template Oligo-Mediated Sequencing (ATOM-Seq) is a new ultra-sensitive UMI-based NGS library preparation technology for use with cfDNA and cfRNA
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Thomas L. Dunwell, Simon C. Dailey, Anine L. Ottestad, Jihang Yu, Philipp W. Becker, Sarah Scaife, Susan D. Richman, Henry M. Wood, Hayley Slaney, Daniel Bottomley, Xiangsheng Yang, Hui Xiao, Sissel G. F. Wahl, Bjørn H. Grønberg, Hongyan Dai, and Guoliang Fu
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Medicine ,Science - Abstract
Abstract Liquid biopsy testing utilising Next Generation Sequencing (NGS) is rapidly moving towards clinical adoption for personalised oncology. However, before NGS can fulfil its potential any novel testing approach must identify ways of reducing errors, allowing separation of true low-frequency mutations from procedural artefacts, and be designed to improve upon current technologies. Popular NGS technologies typically utilise two DNA capture approaches; PCR and ligation, which have known limitations and seem to have reached a development plateau with only small, stepwise improvements being made. To maximise the ultimate utility of liquid biopsy testing we have developed a highly versatile approach to NGS: Adaptor Template Oligo Mediated Sequencing (ATOM-Seq). ATOM-Seq's strengths and versatility avoid the major limitations of both PCR- and ligation-based approaches. This technology is ligation free, simple, efficient, flexible, and streamlined, and it offers novel advantages that make it perfectly suited for use on highly challenging clinical material. Using reference and clinical materials, we demonstrate detection of known SNVs down to allele frequencies of 0.1% using as little as 20–25 ng of cfDNA, as well as the ability to detect fusions from RNA. We illustrate ATOM-Seq’s suitability for clinical testing by showing high concordance rates between paired cfDNA and FFPE clinical samples.
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- 2021
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11. Ten-year longitudinal health-related quality of life following iodine-125 brachytherapy monotherapy for localized prostate cancer
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Finbar Slevin, Brinda Sethugavalar, Bashar Al-Qaisieh, Peter Bownes, Joshua Mason, Jonathan Smith, David Bottomley, and Ann Henry
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brachytherapy ,iodine-125 ,quality of life ,prostate cancer ,Medicine - Published
- 2020
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12. Sero-surveillance for IgG to SARS-CoV-2 at antenatal care clinics in three Kenyan referral hospitals: Repeated cross-sectional surveys 2020–21
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Ruth K. Lucinde, Daisy Mugo, Christian Bottomley, Angela Karani, Elizabeth Gardiner, Rabia Aziza, John N. Gitonga, Henry Karanja, James Nyagwange, James Tuju, Perpetual Wanjiku, Edward Nzomo, Evans Kamuri, Kaugiria Thuranira, Sarah Agunda, Gideon Nyutu, Anthony O. Etyang, Ifedayo M. O. Adetifa, Eunice Kagucia, Sophie Uyoga, Mark Otiende, Edward Otieno, Leonard Ndwiga, Charles N. Agoti, Rashid A. Aman, Mercy Mwangangi, Patrick Amoth, Kadondi Kasera, Amek Nyaguara, Wangari Ng’ang’a, Lucy B. Ochola, Emukule Namdala, Oscar Gaunya, Rosemary Okuku, Edwine Barasa, Philip Bejon, Benjamin Tsofa, L. Isabella Ochola-Oyier, George M. Warimwe, Ambrose Agweyu, J. Anthony G. Scott, and Katherine E. Gallagher
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Medicine ,Science - Abstract
Introduction The high proportion of SARS-CoV-2 infections that have remained undetected presents a challenge to tracking the progress of the pandemic and estimating the extent of population immunity. Methods We used residual blood samples from women attending antenatal care services at three hospitals in Kenya between August 2020 and October 2021and a validated IgG ELISA for SARS-Cov-2 spike protein and adjusted the results for assay sensitivity and specificity. We fitted a two-component mixture model as an alternative to the threshold analysis to estimate of the proportion of individuals with past SARS-CoV-2 infection. Results We estimated seroprevalence in 2,981 women; 706 in Nairobi, 567 in Busia and 1,708 in Kilifi. By October 2021, 13% of participants were vaccinated (at least one dose) in Nairobi, 2% in Busia. Adjusted seroprevalence rose in all sites; from 50% (95%CI 42–58) in August 2020, to 85% (95%CI 78–92) in October 2021 in Nairobi; from 31% (95%CI 25–37) in May 2021 to 71% (95%CI 64–77) in October 2021 in Busia; and from 1% (95% CI 0–3) in September 2020 to 63% (95% CI 56–69) in October 2021 in Kilifi. Mixture modelling, suggests adjusted cross-sectional prevalence estimates are underestimates; seroprevalence in October 2021 could be 74% in Busia and 72% in Kilifi. Conclusions There has been substantial, unobserved transmission of SARS-CoV-2 in Nairobi, Busia and Kilifi Counties. Due to the length of time since the beginning of the pandemic, repeated cross-sectional surveys are now difficult to interpret without the use of models to account for antibody waning.
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- 2022
13. Self-assembling protein nanoparticles and virus like particles correctly display β-barrel from meningococcal factor H-binding protein through genetic fusion.
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Luigia Cappelli, Paolo Cinelli, Fabiola Giusti, Ilaria Ferlenghi, Sabrina Utrio-Lanfaloni, Newton Wahome, Matthew James Bottomley, Domenico Maione, and Roberta Cozzi
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Medicine ,Science - Abstract
Recombinant protein-based vaccines are a valid and safer alternative to traditional vaccines based on live-attenuated or killed pathogens. However, the immune response of subunit vaccines is generally lower compared to that elicited by traditional vaccines and usually requires the use of adjuvants. The use of self-assembling protein nanoparticles, as a platform for vaccine antigen presentation, is emerging as a promising approach to enhance the production of protective and functional antibodies. In this work we demonstrated the successful repetitive antigen display of the C-terminal β-barrel domain of factor H binding protein, derived from serogroup B Meningococcus on the surface of different self-assembling nanoparticles using genetic fusion. Six nanoparticle scaffolds were tested, including virus-like particles with different sizes, geometries, and physicochemical properties. Combining computational and structure-based rational design we were able generate antigen-fused scaffolds that closely aligned with three-dimensional structure predictions. The chimeric nanoparticles were produced as recombinant proteins in Escherichia coli and evaluated for solubility, stability, self-assembly, and antigen accessibility using a variety of biophysical methods. Several scaffolds were identified as being suitable for genetic fusion with the β-barrel from fHbp, including ferritin, a de novo designed aldolase from Thermotoga maritima, encapsulin, CP3 phage coat protein, and the Hepatitis B core antigen. In conclusion, a systematic screening of self-assembling nanoparticles has been applied for the repetitive surface display of a vaccine antigen. This work demonstrates the capacity of rational structure-based design to develop new chimeric nanoparticles and describes a strategy that can be utilized to discover new nanoparticle-based approaches in the search for vaccines against bacterial pathogens.
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- 2022
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14. Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil.
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Enny S Paixao, Christian Bottomley, Julia M Pescarini, Kerry L M Wong, Luciana L Cardim, Rita de Cássia Ribeiro Silva, Elizabeth B Brickley, Laura C Rodrigues, Flavia Jôse Oliveira Alves, Maria do Carmo Leal, Maria da Conceicao N Costa, Maria Gloria Teixeira, Maria Yury Ichihara, Liam Smeeth, Mauricio L Barreto, and Oona M R Campbell
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Medicine - Abstract
BackgroundThere is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances.Methods and findingsWe conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available.ConclusionsIn this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.
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- 2021
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15. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials
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Kirstie Haywood, Ameeta Retzer, Anita Slade, Melanie Calvert, Jane Blazeby, Rebecca Mercieca-Bebber, Antonia Bennett, Carolyn Ells, Gary Price, Galina Velikova, Heather Draper, Dennis Revicki, Julia Brown, Lori Frank, Madeleine King, Jane Scott, Sandra Mitchell, Grace Turner, Michael Brundage, Andrew Bottomley, Michael Palmer, Richard Stephens, Ingolf Griebsch, Donald Patrick, Lari Wenzel, Daniel O'Connor, Robert M Golub, Olalekan Aiyegbusi, E Basch, Jill Bell, Vishal Bhatnagar, Lisa Campbell, Amylou C Dueck, Amanda Hunn, Bellinda King-Kallimanis, Thomas Morel, Linda Nelson, Josephine Norquist, Antoine Regnault, Antonia Valakas, Maria von Hildebrand, and Anita Walker
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Medicine - Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients’ symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item’s importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
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- 2021
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16. Staphylococcus aureus Bacteremia in Children of Rural Areas of The Gambia, 2008–2015
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Aderonke Odutola, Christian Bottomley, Syed A. Zaman, Jodi Lindsay, Muhammed Shah, Ilias Hossain, Malick Ndiaye, Chidebere D.I. Osuorah, Yekini Olatunji, Henry Badji, Usman N.A. Ikumapayi, Ahmad Manjang, Rasheed Salaudeen, Lamin Ceesay, Momodou Jasseh, Richard A. Adegbola, Tumani Corrah, Philip C. Hill, Brian M. Greenwood, and Grant A. Mackenzie
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Staphylococcus aureus ,bacteremia ,Gambia ,children ,fatality ,epidemiology ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Staphylococcus aureus bacteremia is a substantial cause of childhood disease and death, but few studies have described its epidemiology in developing countries. Using a population-based surveillance system for pneumonia, sepsis, and meningitis, we estimated S. aureus bacteremia incidence and the case-fatality ratio in children
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- 2019
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17. The COVID-19 Pandemic Is Associated with Reduced Survival after Pancreatic Ductal Adenocarcinoma Diagnosis: A Single-Centre Retrospective Analysis
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Oliver Madge, Alexandra Brodey, Jordan Bowen, George Nicholson, Shivan Sivakumar, and Matthew J. Bottomley
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pancreatic cancer ,COVID-19 ,outcomes ,treatment ,survival ,Medicine - Abstract
The COVID-19 pandemic has hugely disrupted healthcare provision, including oncology services. To evaluate the effects of the pandemic on referral routes leading to diagnosis, treatments, and prognosis in patients with pancreatic ductal adenocarcinoma, we performed a retrospective cohort study at a single tertiary centre in the UK. The patients were identified from the weekly hepatopancreatobiliary multidisciplinary team meetings between February 2018 and March 2021. The demographic, referral, and treatment data for each patient and date of death, where applicable, were extracted from the electronic patient record. The patients (n = 203) were divided into “pre-pandemic” and “pandemic” cohorts based on a referral date cut-off of 23rd March 2020. The median survival was 7.4 months [4.9–9.3] in the “pre-pandemic” cohort (n = 125), halving to 3.3 months [2.2–6.0], (p = 0.015) in the “pandemic” cohort (n = 78). There was no significant difference in patient characteristics between the two cohorts. There was a trend toward increased emergency presentations at diagnosis and reduced use of surgical resection in the “pandemic” cohort. This small-scale study suggested that the COVID-19 pandemic is associated with a halving of median survival in pancreatic ductal adenocarcinoma. Urgent further studies are required to confirm these findings and examine corresponding effects in other cancer types.
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- 2022
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18. Association between hyperemesis gravidarum and psychological symptoms, psychosocial outcomes and infant bonding: a two-point prospective case–control multicentre survey study in an inner city setting
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Nicola Mitchell-Jones, Kim Lawson, Shabnam Bobdiwala, Jessica Alice Farren, and Cecilia Bottomley
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Medicine - Abstract
Objectives To assess if there is any association between hyperemesis gravidarum (HG), psychological morbidity and infant bonding and to quantify any psychosocial consequences of HG.Design Two-point prospective case–control, multicentre survey study with antenatal and postnatal data collection.Setting Three London hospitals.Participants Pregnant women at ≤12 completed weeks gestation recruited consecutively over 2 years. Women with HG were recruited at the time of admission; controls recruited from a low risk antenatal clinic. 106 women were recruited to the case group and 108 to the control. Response rates at antenatal data collection were 87% and 85% in the case and control groups, respectively. Postnatally, the response rate was 90% in both groups.Primary and secondary outcome measures Primary outcomes were psychological morbidity in the antenatal and postnatal periods, infant bonding in the postnatal period and psychosocial implications of HG. Secondary outcomes were the effects of severity and longevity of HG and assessment of correlation between Edinburgh Postnatal Depression Scale scores and maternal-to-infant bonding scores.Results Antenatally, 49% of cases had probable depression compared with 6% of controls (OR 14.4 (5.29 to 39.44)). Postnatally, 29% of cases had probable depression versus 7% of controls (OR 5.2 (1.65 to 17.21)). There was no direct association between HG and infant bonding. 53% of women in the HG group reported needing four or more weeks of sick leave compared with 2% in the control group (OR 60.5 (95% CI 8.4 to 2535.6)).Conclusions Long-lasting psychological morbidity associated with HG was evident. Significantly more women in the case group sought help for mental health symptoms in the antenatal period, however very few were diagnosed with or treated for depression in pregnancy or referred to specialist perinatal mental health services. HG did not directly affect infant bonding. Women in the case group required long periods off work, highlighting the socioeconomic impact of HG.
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- 2020
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19. Exercise intolerance and rapid skeletal muscle energetic decline in human age-associated frailty
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Sabra C. Lewsey, Kilian Weiss, Michael Schär, Yi Zhang, Paul A. Bottomley, T. Jake Samuel, Qian-Li Xue, Angela Steinberg, Jeremy D. Walston, Gary Gerstenblith, and Robert G. Weiss
- Subjects
Aging ,Medicine - Abstract
BACKGROUND Physical frailty in older individuals is characterized by subjective symptoms of fatigue and exercise intolerance (EI). Objective abnormalities in skeletal muscle (SM) mitochondrial high-energy phosphate (HEP) metabolism contribute to EI in inherited myopathies; however, their presence or link to EI in the frail older adult is unknown.METHODS Here, we studied 3 groups of ambulatory, community-dwelling adults with no history of significant coronary disease: frail older (FO) individuals (81 ± 2.7 years, mean ± SEM), nonfrail older (NFO) individuals (79 ± 2.0 years), and healthy middle-aged individuals, who served as controls (CONT, 51 ± 2.1 years). Lower extremity SM HEP levels and mitochondrial function were measured with 31P magnetic resonance (MR) techniques during graded multistage plantar flexion exercise (PFE). EI was quantified by a 6-minute walk (6MW) and peak oxygen consumption during cardiopulmonary testing (peak VO2).RESULTS During graded exercise, FO, NFO, and CONT individuals all fatigued at similar SM HEP levels, as measured by 31P-MR. However, FO individuals fatigued fastest, with several-fold higher rates of PFE-induced HEP decline that correlated closely with shorter exercise duration in the MR scanner and with 6MW distance and lower peak oxygen consumption on cardiopulmonary testing (P < 0.001 for all). SM mitochondrial oxidative capacity was lower in older individuals and correlated with rapid HEP decline but less closely with EI.CONCLUSION Several-fold faster SM energetic decline during exercise occurs in FO individuals and correlates closely with multiple measures of EI. Rapid energetic decline represents an objective, functional measure of SM metabolic changes and a potential new target for mitigating frailty-associated physical limitations.FUNDING This work was supported by NIH R21 AG045634, R01 AG063661, R01 HL61912, the Johns Hopkins University Claude D. Pepper Older Americans Independence Center P30AG021334, and the Clarence Doodeman Endowment in Cardiology at Johns Hopkins.
- Published
- 2020
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20. Length of stay following an accelerated knee arthroplasty pathway is age dependent
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N. Bottomley, Cathy Jenkins, Andrew Price, Karen Barker, D W Murray, and William Jackson
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Age dependent ,business ,Arthroplasty ,Surgery - Published
- 2023
21. Challenges and opportunities in evaluating programmes incorporating human-centred design: lessons learnt from the evaluation of Adolescents 360 [version 2; peer review: 2 approved, 1 approved with reservations]
- Author
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Aoife M. Doyle, Emma Mulhern, James Rosen, Gabrielle Appleford, Christina Atchison, Christian Bottomley, James R. Hargreaves, and Michelle Weinberger
- Subjects
Medicine - Abstract
Adolescents 360 (A360) is a four-year initiative (2016–2020) to increase 15-19-year-old girls’ use of modern contraception in Nigeria, Ethiopia and Tanzania. The innovative A360 approach is led by human-centred design (HCD), combined with social marketing, developmental neuroscience, public health, sociocultural anthropology and youth engagement ‘lenses’, and aims to create context-specific, youth-driven solutions that respond to the needs of adolescent girls. The A360 external evaluation includes a process evaluation, quasi-experimental outcome evaluation, and a cost-effectiveness study. We reflect on evaluation opportunities and challenges associated with measuring the application and impact of this novel HCD-led design approach. For the process evaluation, participant observations were key to capturing the depth of the fast-paced, highly-iterative HCD process, and to understand decision-making within the design process. The evaluation team had to be flexible and align closely with the work plan of the implementers. The HCD process meant that key information such as intervention components, settings, and eligible populations were unclear and changed over outcome evaluation and cost-effectiveness protocol development. This resulted in a more time-consuming and resource-intensive study design process. As much time and resources went into the creation of a new design approach, separating one-off “creation” costs versus those costs associated with actually implementing the programme was challenging. Opportunities included the potential to inform programmatic decision-making in real-time to ensure that interventions adequately met the contextualized needs in targeted areas. Robust evaluation of interventions designed using HCD, a promising and increasingly popular approach, is warranted yet challenging. Future HCD-based initiatives should consider a phased evaluation, focusing initially on programme theory refinement and process evaluation, and then, when the intervention program details are clearer, following with outcome evaluation and cost-effectiveness analysis. A phased approach would delay the availability of evaluation findings but would allow for a more appropriate and tailored evaluation design.
- Published
- 2019
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- View/download PDF
22. Modern contraceptive use among sexually active women aged 15–19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey
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Mussa Kelvin Nsanya, Christina J Atchison, Christian Bottomley, Aoife Margaret Doyle, and Saidi H Kapiga
- Subjects
Medicine - Abstract
ObjectivesTo describe differences in modern contraceptive use among adolescent women aged 15–19 years according to their marital status and to determine factors associated with modern contraceptive use among sexually active women in this population.DesignCross-sectional analysis of Adolescent 360 evaluation baseline survey.SettingThe 15 urban and semiurban wards of Ilemela district, Mwanza region, North-Western Tanzania.ParticipantsAdolescent women aged 15–19 years who were living in the study site from August 2017 to February 2018 and who provided informed consent. Women were classified as married if they had a husband or were living as married. Unmarried women were classified as sexually active if they reported having sexual intercourse in the last 12 months.Outcome measurePrevalence of modern contraceptive among adolescent women aged 15–19 years.ResultsData were available for 3511 women aged 15–19 years, of which 201 (5.7%) were married and 744 (22.5%) were unmarried-sexually active. We found strong evidence of differences in use of modern contraceptive methods according to marital status of adolescent women. Determinants of modern contraception use among unmarried-sexually active women were increasing age, increasing level of education, being in education, hearing of modern contraception from interpersonal sources or in the media in the last 12 months, perceiving partner and/or friends support for contraceptive use, as well as higher knowledge and self efficacy for contraception.ConclusionsSexual and reproductive health programmes aiming to increase uptake of modern contraceptives in this population of adolescent women should consider the importance of girl’s education and social support for contraceptive use particularly among unmarried-sexually active women.
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- 2019
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23. Life and bladder cancer: protocol for a longitudinal and cross-sectional patient-reported outcomes study of Yorkshire (UK) patients
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Amy Downing, Adam W Glaser, Samantha J Mason, Penny Wright, Sarah E Bottomley, Andrew Winterbottom, and James W F Catto
- Subjects
Medicine - Abstract
IntroductionLittle is known about the impact of bladder cancer (BC) and its treatments on health-related quality of life (HRQL). To date, most work has been small in scale or restricted to subsets of patients. Life and bladder cancer is a cross-sectional and longitudinal study collecting patient-reported outcomes within two distinct cohorts.Methods and analysisA longitudinal study will collect patient-reported outcomes at 3-monthly intervals from newly diagnosed patients. Eligible cases will be identified by recruiting hospitals and surveyed at baseline, 6, 9 and 12 months postdiagnosis to explore changes in outcomes over time. A separate cross-sectional cohort of patients diagnosed within the last 10 years across Yorkshire will be identified through cancer registration systems and surveyed once to explore longer-term HRQL in BC survivors. A comprehensive patient-reported outcome measure (PROM) has been developed using generic, cancer-specific and BC-specific instruments. The study will provide evidence about how useful these PROMs are in measuring BC patient HRQL. The outcome data will be linked with administrative health data (eg, treatment information from hospital data).Ethics and disseminationThe study has received the following approvals: Yorkshire and the Humber—South Yorkshire Research Ethics Committee (17/YH/0095), Health Research Authority Confidentiality Advisory Group (17/CAG/0054). Results will be made available to patients, funders, NHS Trusts, Clinical Commissioning Groups, Strategic Clinical Networks and other researchers.
- Published
- 2019
- Full Text
- View/download PDF
24. Challenges and opportunities in evaluating programmes incorporating human-centred design: lessons learnt from the evaluation of Adolescents 360 [version 1; peer review: 2 approved, 1 approved with reservations]
- Author
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Aoife M. Doyle, Emma Mulhern, James Rosen, Gabrielle Appleford, Christina Atchison, Christian Bottomley, James R. Hargreaves, and Michelle Weinberger
- Subjects
Medicine - Abstract
Adolescents 360 (A360) is a four-year initiative (2016–2020) to increase 15-19-year-old girls’ use of modern contraception in Nigeria, Ethiopia and Tanzania. The innovative A360 approach is led by human-centred design (HCD), combined with social marketing, developmental neuroscience, public health, sociocultural anthropology and youth engagement ‘lenses’, and aims to create context-specific, youth-driven solutions that respond to the needs of adolescent girls. The A360 external evaluation includes a process evaluation, quasi-experimental outcome evaluation, and a cost-effectiveness study. We reflect on evaluation opportunities and challenges associated with measuring the application and impact of this novel HCD-led design approach. For the process evaluation, participant observations were key to capturing the depth of the fast-paced, highly-iterative HCD process, and to understand decision-making within the design process. The evaluation team had to be flexible and align closely with the work plan of the implementers. The HCD process meant that key information such as intervention components, settings, and eligible populations were unclear and changed over outcome evaluation and cost-effectiveness protocol development. This resulted in a more time-consuming and resource-intensive study design process. As much time and resources went into the creation of a new design approach, separating one-off “creation” costs versus those costs associated with actually implementing the programme was challenging. Opportunities included the potential to inform programmatic decision-making in real-time to ensure that interventions adequately met the contextualized needs in targeted areas. Robust evaluation of interventions designed using HCD, a promising and increasingly popular approach, is warranted yet challenging. Future HCD-based initiatives should consider a phased evaluation, focusing initially on programme theory refinement and process evaluation, and then, when the intervention program details are clearer, following with outcome evaluation and cost-effectiveness analysis. A phased approach would delay the availability of evaluation findings but would allow for a more appropriate and tailored evaluation design.
- Published
- 2019
- Full Text
- View/download PDF
25. The relative age effect in European elite soccer: A practical guide to Poisson regression modelling.
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John R Doyle and Paul A Bottomley
- Subjects
Medicine ,Science - Abstract
Many disciplines of scholarship are interested in the Relative Age Effect (RAE), whereby age-banding confers advantages on older members of the cohort over younger ones. Most research does not test this relationship in a manner consistent with theory (which requires a decline in frequency across the cohort year), instead resorting to non-parametric, non-directional approaches. In this article, the authors address this disconnect, provide an overview of the benefits associated with Poisson regression modelling, and two managerially useful measures for quantifying RAE bias, namely the Indices of Discrimination and Wastage. In a tutorial-like exposition, applications and extensions of this approach are illustrated using data on professional soccer players competing in the top two tiers of the "Big Five" European football leagues in the search to identify paragon clubs, leagues, and countries from which others may learn to mitigate this form of age-discrimination in the talent identification process. As with OLS regression, Poisson regression may include more than one independent variable. In this way we test competing explanations of RAE; control for unwanted sources of covariation; model interaction effects (that different clubs and countries may not all be subject to RAE to the same degree); and test for non-monotonic versions of RAE suggested in the literature.
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- 2019
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26. A mixed methods analysis of factors affecting antenatal care content: A Syrian case study.
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Rima Mourtada, Christian Bottomley, Fiona Houben, Hyam Bashour, and Oona M R Campbell
- Subjects
Medicine ,Science - Abstract
BackgroundMaternity care services provide critical interventions aimed at improving maternal and newborn health. In this study, we examined determinants of antenatal care (ANC) content in Syria, together with changes over time.MethodsWe analysed two national surveys conducted by the Central Bureau of Statistics in Damascus (PAPFAM 2001 and MICS 2006). Findings of this initial analysis led to a qualitative study on adequacy of antenatal care content in two Syrian governorates, Aleppo and Latakia in 2010, which in turn informed further quantitative analysis. The perspectives and practices of doctors, women, midwives and health officials were explored using in-depth interviews. A framework approach was used to analyse the data.ResultsThe quantitative analysis demonstrated that women's education level, the type of health facility they attended and whether they had experienced health complications were important determinants of adequacy of ANC content received. The qualitative study revealed that additional factors related to supply side and demand side factors (e.g. organization of health services, doctors' selective prescription of ANC tests and women's selective uptake of those tests), influenced the quality of ANC and explained some regional differences between Aleppo and Latakia.ConclusionsThe percentage of women who received adequate ANC content was probably higher in Latakia than in Aleppo because women in Latakia were more educated, and because services were more available, accessible, and acceptable to them.
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- 2019
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27. Towards regulatory cellular therapies in solid organ transplantation
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Matthew O. Brook, Sushma Shankar, Matthew J. Bottomley, Fadi Issa, and Joanna Hester
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Immunosuppression Therapy ,medicine.medical_specialty ,business.industry ,Donor specific antibodies ,medicine.medical_treatment ,Immunology ,Cell- and Tissue-Based Therapy ,Immunosuppression ,Organ Transplantation ,Organ transplantation ,Clinical trial ,Transplantation ,Immune Tolerance ,medicine ,Humans ,Immunology and Allergy ,Off the shelf ,Transplantation Tolerance ,Good manufacturing practice ,Intensive care medicine ,business ,Solid organ transplantation - Abstract
Organ transplantation is a modern medical success story. However, since its inception it has been limited by the need for pharmacological immunosuppression. Regulatory cellular therapies offer an attractive solution to these challenges by controlling transplant alloresponses through multiple parallel suppressive mechanisms. A number of cell types have seen an accelerated development into human trials and are now on the threshold of a long-awaited breakthrough in personalized transplant therapeutics. Here we assess recent developments with a focus on the most likely candidates, some of which have already facilitated successful immunosuppression withdrawal in early clinical trials. We propose that this may constitute a promising approach in clinical transplantation but also evaluate outstanding issues in the field, providing cause for cautious optimism.
- Published
- 2022
28. Minimally important differences for the EORTC QLQ-C30 in prostate cancer clinical trials
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Eva M. Gamper, Jammbe Z. Musoro, Corneel Coens, Jean-Jacques Stelmes, Claudette Falato, Mogens Groenvold, Galina Velikova, Kim Cocks, Hans-Henning Flechtner, Madeleine T. King, Andrew Bottomley, on behalf of the EORTC Genito-Urinary Tract Cancer Group and Quality of Life Groups, and University of Zurich
- Subjects
Male ,Cancer Research ,Time Factors ,Health-related quality of life ,Social Interaction ,Interpretation of scores ,Severity of Illness Index ,Prostate cancer ,Quality of life ,Medicine ,HRQL ,Fatigue ,RC254-282 ,MIDs ,Eortc qlq c30 ,European Organisation for Research and Treatment of Cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Cancer Pain ,Middle Aged ,Physical Functional Performance ,10044 Clinic for Radiation Oncology ,humanities ,Europe ,HRQOL ,Oncology ,Research Article ,Diarrhea ,medicine.medical_specialty ,610 Medicine & health ,Denture Liners ,Linear regression ,Genetics ,Humans ,Patient Reported Outcome Measures ,Aged ,Patient-reported outcomes ,Performance status ,Clinical Deterioration ,business.industry ,Cancer ,Prostatic Neoplasms ,medicine.disease ,Health Surveys ,Clinical trial ,Clinical Trials, Phase III as Topic ,Sample size determination ,Physical therapy ,Quality of Life ,PROs ,business - Abstract
Background The aim of the study was to estimate the minimally important difference (MID) for interpreting group-level change over time, both within a group and between groups, for the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) scores in patients with prostate cancer. Methods We used data from two published EORTC trials. Clinical anchors were selected by strength of correlations with QLQ-C30 scales. In addition, clinicians’ input was obtained with regard to plausibility of the selected anchors. The mean change method was applied for interpreting change over time within a group of patients and linear regression models were fitted to estimate MIDs for between-group differences in change over time. Distribution-based estimates were also evaluated. Results Two clinical anchors were eligible for MID estimation; performance status and the CTCAE diarrhoea domain. MIDs were developed for 7 scales (physical functioning, role functioning, social functioning, pain, fatigue, global quality of life, diarrhoea) and varied by scale and direction (improvement vs deterioration). Within-group MIDs ranged from 4 to 14 points for improvement and − 13 to − 5 points for deterioration and MIDs for between-group differences in change scores ranged from 3 to 13 for improvement and − 10 to − 5 for deterioration. Conclusions Our findings aid the meaningful interpretation of changes on a set of EORTC QLQ-C30 scale scores over time, both within and between groups, and for performing more accurate sample size calculations for clinical trials in prostate cancer.
- Published
- 2021
29. Long-lasting effect of oral azithromycin taken by women during labour on infant nutrition: Follow-up cohort of a randomized clinical trial in western Gambia.
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Anna Roca, Bully Camara, Claire Oluwalana, Kodou Lette, Christian Bottomley, and Umberto D'Alessandro
- Subjects
Medicine ,Science - Abstract
ObjectiveTo assess the effect of administering an oral dose of 2g of azithromycin in Gambian women during labour on infant growth.MethodsChildren whose mothers had been randomized to receive either an oral dose of 2g of azithromycin or placebo during labour were visited at home at the end of infancy by trained study nurses blind to the treatment allocation. The follow-up visit of these cohorts (exposed and non-exposed to azithromycin), which was not part of the original trial design, was conducted between November 2014 and May 2015 when the infants were 11 to 13 months of age. During visits, nurses recorded anthropometrical measurements and transcribed information from the infants' welfare cards.ResultsFour-hundred and sixty-five (79.6%) of the 584 infants aged 11-13 months at the time of the survey were recruited. The proportion of children with an age-adjusted Z-score ConclusionsOur results show that azithromycin in labour may have a beneficial effect in MUAC among children who are below the curve. Larger studies with closer follow-up are warranted.Trial registration (main trial)ClinicalTrials.gov Identifier NCT01800942.
- Published
- 2018
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30. Relative age effect in elite soccer: More early-born players, but no better valued, and no paragon clubs or countries.
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John R Doyle and Paul A Bottomley
- Subjects
Medicine ,Science - Abstract
The paper analyses two datasets of elite soccer players (top 1000 professionals and UEFA Under-19 Youth League). In both, we find a Relative Age Effect (RAE) for frequency, but not for value. That is, while there are more players born at the start of the competition year, their transfer values are no higher, nor are they given more game time. We use Poisson regression to derive a transparent index of the discrimination present in RAE. Also, because Poisson is valid for small frequency counts, it supports analysis at the disaggregated levels of country and club. From this, we conclude there are no paragon clubs or countries immune to RAE; that is clubs and countries do not differ systematically in the RAE they experience; also, that Poisson regression is a powerful and flexible method of analysing RAE data.
- Published
- 2018
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31. Reliability and validity of the World Health Organization reading standards for paediatric chest radiographs used in the field in an impact study of Pneumococcal Conjugate Vaccine in Kilifi, Kenya.
- Author
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M Ominde, J Sande, M Ooko, C Bottomley, R Benamore, K Park, J Ignas, K Maitland, T Bwanaali, F Gleeson, and A Scott
- Subjects
Medicine ,Science - Abstract
BACKGROUND:Radiologically-confirmed pneumonia (RCP) is a specific end-point used in trials of Pneumococcal Conjugate Vaccine (PCV) to estimate vaccine efficacy. However, chest radiograph (CXR) interpretation varies within and between readers. We measured the repeatability and reliability of paediatric CXR interpretation using percent agreement and Cohen's Kappa and the validity of field readings against expert review in a study of the impact of PCV on pneumonia. METHODS:CXRs were obtained from 2716 children admitted between 2006 and 2014 to Kilifi County Hospital, Kilifi, Kenya, with clinically-defined severe or very-severe pneumonia. Five clinicians and radiologists attended a three-day training course on CXR interpretation using a WHO standard. All CXRs were read once by two local primary readers. Discordant readings and 13% of concordant readings were arbitrated by a panel of three expert radiologists. To assess repeatability, a 5% median random sample was presented twice. Sensitivity and specificity of the primary readers' interpretations was estimated against the 'gold-standard' of the arbitrators' results. RESULTS:Of 2716 CXRs, 2 were uninterpretable and 159 were evaluated twice. The percent agreement and Kappa for RCP were 89% and 0.68 and ranged between 84-97% and 0.19-0.68, respectively, for all pathological findings. Intra-observer repeatability was similar to inter-observer reliability. Sensitivities of the primary readers to detect RCP were 69% and 73%; specificities were 96% and 95%. CONCLUSION:Intra- and inter-observer agreements on interpretations of radiologically-confirmed pneumonia are fair to good. Reasonable sensitivity and high specificity make radiologically-confirmed pneumonia, determined in the field, a suitable measure of relative vaccine effectiveness.
- Published
- 2018
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32. Structures of NHBA elucidate a broadly conserved epitope identified by a vaccine induced antibody.
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Martina Maritan, Daniele Veggi, Roberta Cozzi, Lucia Dello Iacono, Erika Bartolini, Paola Lo Surdo, Giulietta Maruggi, Glen Spraggon, Matthew J Bottomley, and Enrico Malito
- Subjects
Medicine ,Science - Abstract
Neisserial heparin binding antigen (NHBA) is one of three main recombinant protein antigens in 4CMenB, a vaccine for the prevention of invasive meningococcal disease caused by Neisseria meningitidis serogroup B. NHBA is a surface-exposed lipoprotein composed of a predicted disordered N-terminal region, an arginine-rich region that binds heparin, and a C-terminal domain that folds as an anti-parallel β-barrel and that upon release after cleavage by human proteases alters endothelial permeability. NHBA induces bactericidal antibodies in humans, and NHBA-specific antibodies elicited by the 4CMenB vaccine contribute to serum bactericidal activity, the correlate of protection. To better understand the structural bases of the human antibody response to 4CMenB vaccination and to inform antigen design, we used X-ray crystallography to elucidate the structures of two C-terminal fragments of NHBA, either alone or in complex with the Fab derived from the vaccine-elicited human monoclonal antibody 5H2, and the structure of the unbound Fab 5H2. The structures reveal details on the interaction between an N-terminal β-hairpin fragment and the β-barrel, and explain how NHBA is capable of generating cross-reactive antibodies through an extensive conserved conformational epitope that covers the entire C-terminal face of the β-barrel. By providing new structural information on a vaccine antigen and on the human immune response to vaccination, these results deepen our molecular understanding of 4CMenB, and might also aid future vaccine design projects.
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- 2018
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33. Regular RNA screening detects asymptomatic SARS-CoV-2 infection in haemodialysis patients
- Author
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Oliver O'Sullivan, Lucinda Barrett, Ben Storey, Matthew J. Bottomley, Salim Hammad, Katherine R. Bull, and Allie Thornley
- Subjects
Transplantation ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,RNA ,Asymptomatic ,Virology ,Nephrology ,Research Letter ,Medicine ,medicine.symptom ,business ,AcademicSubjects/MED00340 - Published
- 2022
34. Quality of Life After Bladder Cancer: A Cross-sectional Survey of Patient-reported Outcomes
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Adam Glaser, Sarah Bottomley, James W.F. Catto, Kate Absolom, Penny Wright, Syed A. Hussain, Phil Kelly, Amy Downing, Luke Hounsome, Samantha J Mason, Mohini Varughese, and Caroline Raw
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,Urology ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Cystectomy ,03 medical and health sciences ,Rare Diseases ,0302 clinical medicine ,Quality of life ,EQ-5D ,Surveys and Questionnaires ,Internal medicine ,medicine ,Humans ,Patient Reported Outcome Measures ,education ,Pelvic Neoplasms ,Response rate (survey) ,education.field_of_study ,Bladder cancer ,business.industry ,medicine.disease ,humanities ,Cross-Sectional Studies ,Urinary Bladder Neoplasms ,030220 oncology & carcinogenesis ,Quality of Life ,Sexual function ,business - Abstract
Little is known about health-related quality of life (HRQOL) following treatment for bladder cancer (BC).To determine this, we undertook a cross-sectional survey covering 10% of the English population.Participants 1-10 yr from diagnosis were identified through national cancer registration data.A postal survey was administered containing generic HRQOL and BC-specific outcome measures. Findings were compared with those of the general population and other pelvic cancer patients.Generic HRQOL was measured using five-level EQ-5D (EQ-5D-5L) and European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ)-C30. BC-specific outcomes were derived from EORTC QLQ-BLM30 and EORTC QLQ-NMIBC24.A total of 1796 surveys were completed (response rate 55%), including 868 (48%) patients with non-muscle-invasive BC, 893 (50%) patients who received radiotherapy or radical cystectomy, and 35 (1.9%) patients for whom treatment was unknown. Most (69%) of the participants reported at least one problem in any EQ-5D dimension. Age/sex-adjusted generic HRQOL outcomes were similar across all stages and treatment groups, whilst problems increased with age (problems in one or more EQ-5D dimensions:65 yr [67% {95% confidence interval or CI: 61-74}] vs 85+ yr [84% {95% CI: 81-89}], p = 0.016) and long-term conditions (no conditions [53% {95% CI: 48-58}] vs more than four conditions [94% {95% CI: 90-97}], p0.001). Sexual problems were reported commonly in men, increasing with younger age and radical treatment. Younger participants (under 65 yr) reported more financial difficulties (mean score 20 [95% CI: 16-25]) than those aged 85+ yr (6.8 [4.5-9.2], p 0.001). HRQOL for BC patients (for comparison, males with problems in one or more EQ-5D dimensions 69% [95% CI: 66-72]) was significantly worse than what has been found after colorectal and prostate cancers and in the general population (51% [95% CI: 48-53], all p 0.05).HRQOL following BC appears to be relatively independent of disease stage, treatment, and multimodal care. Issues are reported with sexual function and financial toxicity. HRQOL after BC is worse than that after other pelvic cancers.Patients living with bladder cancer often have reduced quality of life, which may be worse than that for other common pelvic cancer patients. Age and other illnesses appear to be more important in determining this quality of life than the treatments received. Many men complain of sexual problems. Younger patients have financial worries.
- Published
- 2021
35. Seroprevalence of Antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 Among Healthcare Workers in Kenya
- Author
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Leonard Ndwiga, Shirine Voller, Kadondi Kasera, Rosemary Okuku, Anthony Etyang, Wangari Ng’ang’a, Ifedayo M. O. Adetifa, Nelson Kilimo, Thuranira Kaugiria, Katherine E. Gallagher, Ruth Lucinde, Mercy Mwangangi, Wycliffe Moracha, Philip Bejon, Ambrose Agweyu, Lucy B. Ochola, George M. Warimwe, Perpetual Wanjiku, Hosea Maroko, Justus Weru, Sophie Uyoga, Shadrack Mutua, James Tuju, J. Anthony G. Scott, David Mukabi, Barrack Angujo, Eddy Nzomo, Benjamin Tsofa, Rashid Aman, Namdala Emukule, Patrick Amoth, John N. Gitonga, Charles N. Agoti, Henry K. Karanja, Amek Nyaguara, Eric Maitha, Sande Charo, Christian Bottomley, Lynette Isabella Ochola-Oyier, Daisy Mugo, Edward Otieno, Monicah Ogutu, E Wangeci Kagucia, Evanson Kamuri, Mark Otiende, Angela Karani, David James Nokes, Edwine Barasa, Catherine Kalu, and James Nyagwange
- Subjects
0301 basic medicine ,Microbiology (medical) ,2019-20 coronavirus outbreak ,Health Personnel ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Seroprevalence ,Antibodies, Viral ,Antibodies ,03 medical and health sciences ,0302 clinical medicine ,Seroepidemiologic Studies ,Health care ,Major Article ,Humans ,Medicine ,030212 general & internal medicine ,Multivariable model ,biology ,SARS-CoV-2 ,business.industry ,Health Care Workers ,COVID-19 ,virus diseases ,Spike Protein ,Bayes Theorem ,Assay sensitivity ,Kenya ,AcademicSubjects/MED00290 ,030104 developmental biology ,Infectious Diseases ,Spike Glycoprotein, Coronavirus ,biology.protein ,Antibody ,business ,Demography - Abstract
Background Few studies have assessed the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) in Africa. We report findings from a survey among HCWs in 3 counties in Kenya. Methods We recruited 684 HCWs from Kilifi (rural), Busia (rural), and Nairobi (urban) counties. The serosurvey was conducted between 30 July and 4 December 2020. We tested for immunoglobulin G antibodies to SARS-CoV-2 spike protein, using enzyme-linked immunosorbent assay. Assay sensitivity and specificity were 92.7 (95% CI, 87.9-96.1) and 99.0% (95% CI, 98.1-99.5), respectively. We adjusted prevalence estimates, using bayesian modeling to account for assay performance. Results The crude overall seroprevalence was 19.7% (135 of 684). After adjustment for assay performance, seroprevalence was 20.8% (95% credible interval, 17.5%–24.4%). Seroprevalence varied significantly (P < .001) by site: 43.8% (95% credible interval, 35.8%–52.2%) in Nairobi, 12.6% (8.8%–17.1%) in Busia and 11.5% (7.2%–17.6%) in Kilifi. In a multivariable model controlling for age, sex, and site, professional cadre was not associated with differences in seroprevalence. Conclusion These initial data demonstrate a high seroprevalence of antibodies to SARS-CoV-2 among HCWs in Kenya. There was significant variation in seroprevalence by region, but not by cadre.
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- 2021
36. Housing Improvements and Malaria Risk in Sub-Saharan Africa: A Multi-Country Analysis of Survey Data.
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Lucy S Tusting, Christian Bottomley, Harry Gibson, Immo Kleinschmidt, Andrew J Tatem, Steve W Lindsay, and Peter W Gething
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Medicine - Abstract
BackgroundImprovements to housing may contribute to malaria control and elimination by reducing house entry by malaria vectors and thus exposure to biting. We tested the hypothesis that the odds of malaria infection are lower in modern, improved housing compared to traditional housing in sub-Saharan Africa (SSA).Methods and findingsWe analysed 15 Demographic and Health Surveys (DHS) and 14 Malaria Indicator Surveys (MIS) conducted in 21 countries in SSA between 2008 and 2015 that measured malaria infection by microscopy or rapid diagnostic test (RDT). DHS/MIS surveys record whether houses are built with finished materials (e.g., metal) or rudimentary materials (e.g., thatch). This information was used to develop a binary housing quality variable where houses built using finished wall, roof, and floor materials were classified as "modern", and all other houses were classified as "traditional". Conditional logistic regression was used to determine the association between housing quality and prevalence of malaria infection in children aged 0-5 y, adjusting for age, gender, insecticide-treated net (ITN) use, indoor residual spraying, household wealth, and geographic cluster. Individual survey odds ratios (ORs) were combined to determine a summary OR using a random effects meta-analysis. Of 284,532 total children surveyed, 139,318 were tested for malaria infection using microscopy (n = 131,652) or RDT (n = 138,540). Within individual surveys, malaria prevalence measured by microscopy ranged from 0.4% (Madagascar 2011) to 45.5% (Burkina Faso 2010) among children living in modern houses and from 0.4% (The Gambia 2013) to 70.6% (Burkina Faso 2010) in traditional houses, and malaria prevalence measured by RDT ranged from 0.3% (Senegal 2013-2014) to 61.2% (Burkina Faso 2010) in modern houses and from 1.5% (The Gambia 2013) to 79.8% (Burkina Faso 2010) in traditional houses. Across all surveys, modern housing was associated with a 9% to 14% reduction in the odds of malaria infection (microscopy: adjusted OR 0.91, 95% CI 0.85-0.97, p = 0.003; RDT: adjusted OR 0.86, 95% CI 0.80-0.92, p < 0.001). This association was consistent regardless of ITN usage. As a comparison, the odds of malaria infection were 15% to 16% lower among ITN users versus non-users (microscopy: adjusted OR 0.84, 95% CI 0.79-0.90, p < 0.001; RDT: adjusted OR 0.85, 95% CI 0.80-0.90, p < 0.001). The main limitation of this study is that residual confounding by household wealth of the observed association between housing quality and malaria prevalence is possible, since the wealth index may not have fully captured differences in socioeconomic position; however, the use of multiple national surveys offers the advantage of a large sample size and the elimination of many biases typically associated with pooling observational data.ConclusionsHousing quality is an important risk factor for malaria infection across the spectrum of malaria endemicity in SSA, with a strength of association between housing quality and malaria similar to that observed between ITN use and malaria. Improved housing should be considered a promising intervention for malaria control and elimination and long-term prevention of reintroduction.
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- 2017
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37. The costs of providing antiretroviral therapy services to HIV-infected individuals presenting with advanced HIV disease at public health centres in Dar es Salaam, Tanzania: Findings from a randomised trial evaluating different health care strategies.
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Godfather Dickson Kimaro, Sayoki Mfinanga, Victoria Simms, Sokoine Kivuyo, Christian Bottomley, Neil Hawkins, Thomas S Harrison, Shabbar Jaffar, Lorna Guinness, and REMSTART trial team
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Medicine ,Science - Abstract
BACKGROUND:Understanding the costs associated with health care delivery strategies is essential for planning. There are few data on health service resources used by patients and their associated costs within antiretroviral (ART) programmes in Africa. MATERIAL AND METHODS:The study was nested within a large trial, which evaluated screening for cryptococcal meningitis and tuberculosis and a short initial period of home-based adherence support for patients initiating ART with advanced HIV disease in Tanzania and Zambia. The economic evaluation was done in Tanzania alone. We estimated costs of providing routine ART services from the health service provider's perspective using a micro-costing approach. Incremental costs for the different novel components of service delivery were also estimated. All costs were converted into US dollars (US$) and based on 2012 prices. RESULTS:Of 870 individuals enrolled in Tanzania, 434 were enrolled in the intervention arm and 436 in the standard care/control arm. Overall, the median (IQR) age and CD4 cell count at enrolment were 38 [31, 44] years and 52 [20, 89] cells/mm3, respectively. The mean per patient costs over the first three months and over a one year period of follow up following ART initiation in the standard care arm were US$ 107 (95%CI 101-112) and US$ 265 (95%CI 254-275) respectively. ART drugs, clinic visits and hospital admission constituted 50%, 19%, and 19% of the total cost per patient year, while diagnostic tests and non-ART drugs (co-trimoxazole) accounted for 10% and 2% of total per patient year costs. The incremental costs of the intervention to the health service over the first three months was US$ 59 (p
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- 2017
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38. Tails of the Travelling Gaussian model and the relative age effect: Tales of age discrimination and wasted talent.
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John R Doyle, Paul A Bottomley, and Rob Angell
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Medicine ,Science - Abstract
The Relative Age Effect (RAE) documents the inherent disadvantages of being younger rather than older in an age-banded cohort, typically a school- or competition-year, to the detriment of career-progression, earnings and wellbeing into adulthood. We develop the Tails of the Travelling Gaussian (TTG) to model the mechanisms behind RAE. TTG has notable advantages over existing approaches, which have been largely descriptive, potentially confounded, and non-comparable across contexts. In Study 1, using data from the UK's Millennium Cohort Study, we investigate the different levels of RAE bias across school-level academic subjects and "personality" traits. Study 2 concerns biased admissions to elite English Premier League soccer academies, and shows the model can still be used with minimal data. We also develop two practical metrics: the discrimination index (ID), to quantify the disadvantages facing cohort-younger children; and the wastage metric (W), to quantify the loss through untapped potential. TTG is sufficiently well-specified to simulate the consequences of ID and W for policy change.
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- 2017
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39. Microbiome Analysis of More Than 2,000 NHS Bowel Cancer Screening Programme Samples Shows the Potential to Improve Screening Accuracy
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Henry M. Wood, Martin Brealey, Caroline Young, Lyndsay Wilkinson, Niall Gallop, Cerin John, Alba Fuentes Balaguer, Sally C Benton, Kelsey N. Thompson, Curtis Huttenhower, Daniel Bottomley, Yan Yan, Jennifer H. Barrett, Eva Morris, Carole Burtonwood, and Philip Quirke
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0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Colorectal cancer ,Fecal occult blood ,Colonoscopy ,Amplicon ,medicine.disease ,3. Good health ,Screening programme ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Metagenomics ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Research studies ,Microbiome ,business - Abstract
Purpose: There is potential for fecal microbiome profiling to improve colorectal cancer screening. This has been demonstrated by research studies, but it has not been quantified at scale using samples collected and processed routinely by a national screening program. Experimental Design: Between 2016 and 2019, the largest of the NHS Bowel Cancer Screening Programme hubs prospectively collected processed guaiac fecal occult blood test (gFOBT) samples with subsequent colonoscopy outcomes: blood-negative [n = 491 (22%)]; colorectal cancer [n = 430 (19%)]; adenoma [n = 665 (30%)]; colonoscopy-normal [n = 300 (13%)]; nonneoplastic [n = 366 (16%)]. Samples were transported and stored at room temperature. DNA underwent 16S rRNA gene V4 amplicon sequencing. Taxonomic profiling was performed to provide features for classification via random forests (RF). Results: Samples provided 16S amplicon-based microbial profiles, which confirmed previously described colorectal cancer–microbiome associations. Microbiome-based RF models showed potential as a first-tier screen, distinguishing colorectal cancer or neoplasm (colorectal cancer or adenoma) from blood-negative with AUC 0.86 (0.82–0.89) and AUC 0.78 (0.74–0.82), respectively. Microbiome-based models also showed potential as a second-tier screen, distinguishing from among gFOBT blood-positive samples, colorectal cancer or neoplasm from colonoscopy-normal with AUC 0.79 (0.74–0.83) and AUC 0.73 (0.68–0.77), respectively. Models remained robust when restricted to 15 taxa, and performed similarly during external validation with metagenomic datasets. Conclusions: Microbiome features can be assessed using gFOBT samples collected and processed routinely by a national colorectal cancer screening program to improve accuracy as a first- or second-tier screen. The models required as few as 15 taxa, raising the potential of an inexpensive qPCR test. This could reduce the number of colonoscopies in countries that use fecal occult blood test screening.
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- 2021
40. Objective neurocognitive functioning and neurocognitive complaints in patients with high-grade glioma
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Martin J. van den Bent, Martin Klein, Andrew Bottomley, Wolfgang Wick, Jos W. R. Twisk, Jaap C. Reijneveld, A Josephine Drijver, Ahmed Idbaih, Madeline Pe, Ivan Caramanna, Neurology, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Vrije Universiteit Amsterdam [Amsterdam] (VU), European Organisation for Research and Treatment of Cancer [Bruxelles] (EORTC), European Cancer Organisation [Bruxelles] (ECCO), VU University Medical Center [Amsterdam], Erasmus University Medical Center [Rotterdam] (Erasmus MC), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Heidelberg University Hospital [Heidelberg], Clinical Neuropsychology, Medical psychology, Epidemiology and Data Science, APH - Health Behaviors & Chronic Diseases, APH - Methodology, CCA - Cancer Treatment and quality of life, Gestionnaire, HAL Sorbonne Université 5, Unité de recherche de l'institut du thorax (ITX-lab), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS)
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0301 basic medicine ,Male ,Health Knowledge, Attitudes, Practice ,Cancer Research ,Cognition Disorders/etiology ,Health-related quality of life ,Neuropsychological Tests ,Correlation ,High-grade glioma ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Medicine ,Practice ,Brain Neoplasms ,Health Knowledge ,Cognition ,Glioma ,Middle Aged ,Mental Status and Dementia Tests ,Prognosis ,humanities ,3. Good health ,Europe ,Oncology ,030220 oncology & carcinogenesis ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Female ,Clinical psychology ,Cognitive awareness ,Concordance ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Glioma/complications ,03 medical and health sciences ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,SDG 3 - Good Health and Well-being ,Humans ,[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Cognitive skill ,business.industry ,Cancer ,medicine.disease ,Clinical trial ,Neurocognitive functioning ,030104 developmental biology ,Cross-Sectional Studies ,Brain Neoplasms/complications ,Attitudes ,Quality of Life ,PROs ,Cognition Disorders ,business ,Neurocognitive ,Follow-Up Studies - Abstract
BACKGROUND: Neurocognitively impaired patients with brain tumour are presumed to have reduced cognitive awareness preventing them from adequately valuing and reporting their own functioning, for instance, when providing patient-reported outcomes (PROs) such as health-related quality of life instruments. In this cross-sectional study, we aimed at assessing the concordance of neurocognitive complaints (NCCs) and objective neurocognitive functioning (NCF) as a measure of cognitive awareness.METHODS: NCF was assessed using an internationally accepted clinical trial battery. NCC was assessed using the cognitive functioning questionnaire from the Medical Outcome Study (MOS) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire cognitive functioning subscale. Patients were divided in cognitively impaired and unimpaired groups, based on their NCF performance. Pearson's correlation coefficients between NCF and NCCs were calculated. The same procedure was used to evaluate the correlation of NCF and QLQ-C30 CF subscale.RESULTS: Data from EORTC trials 26091 and 26101 were pooled into a data set of 546 patients. Twenty percent of patients could be characterised as unimpaired (109) and 80% as impaired (437). Impaired patients reported more cognitive complaints on the MOS scale than unimpaired patients. Correlations between NCF and NCCs were weak but significant for impaired patients and non-significant for unimpaired ones. Similar results were found for the correlation between NCF test performance and the QLQ-C30 CF subscale.CONCLUSION: Correlations between NCF test scores and complaints were weak but suggesting that neurocognitive impairment in patients with HGG does not preclude cognitive awareness. However, considering the findings of this study, we would suggest not to use PROs as a surrogate of performance-based neurocognitive evaluation.
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- 2021
41. The impact of the COVID-19 lockdown on HIV care in 65 South African primary care clinics: an interrupted time series analysis
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Hope Ngobese, Kelly Gate, Jienchi Dorward, Kathy Baisley, Thokozani Khubone, Christopher C Butler, Christian Bottomley, Aslam Jeewa, Lara Lewis, Yukteshwar Sookrajh, Nomakhosi Gxagxisa, Siyabonga Mkhize, and Nigel Garrett
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0301 basic medicine ,Adult ,Male ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Epidemiology ,Anti-HIV Agents ,Immunology ,HIV Infections ,Primary care ,Rate ratio ,Ambulatory Care Facilities ,Interrupted Time Series Analysis ,03 medical and health sciences ,symbols.namesake ,South Africa ,Young Adult ,0302 clinical medicine ,Public health surveillance ,Virology ,Antiretroviral Therapy, Highly Active ,Pandemic ,Medicine ,Humans ,Mass Screening ,Public Health Surveillance ,030212 general & internal medicine ,Poisson regression ,Young adult ,Child ,Primary Health Care ,business.industry ,SARS-CoV-2 ,Infant, Newborn ,COVID-19 ,Infant ,Articles ,Middle Aged ,030112 virology ,Infectious Diseases ,Child, Preschool ,symbols ,Female ,business ,Demography - Abstract
Background The effect of the COVID-19 pandemic on HIV outcomes in low-income and middle-income countries is poorly described. We aimed to measure the impact of the 2020 national COVID-19 lockdown on HIV testing and treatment in KwaZulu-Natal, South Africa, where 1·7 million people are living with HIV. Methods In this interrupted time series analysis, we analysed anonymised programmatic data from 65 primary care clinics in KwaZulu-Natal province, South Africa. We included data from people testing for HIV, initiating antiretroviral therapy (ART), and collecting ART at participating clinics during the study period, with no age restrictions. We used descriptive statistics to summarise demographic and clinical data, and present crude summaries of the main outcomes of numbers of HIV tests per month, ART initiations per week, and ART collection visits per week, before and after the national lockdown that began on March 27, 2020. We used Poisson segmented regression models to estimate the immediate impact of the lockdown on these outcomes, as well as post-lockdown trends. Findings Between Jan 1, 2018, and July 31, 2020, we recorded 1 315 439 HIV tests. Between Jan 1, 2018, and June 15, 2020, we recorded 71 142 ART initiations and 2 319 992 ART collection visits. We recorded a median of 41 926 HIV tests per month before lockdown (January, 2018, to March, 2020; IQR 37 838–51 069) and a median of 38 911 HIV tests per month after lockdown (April, 2020, to July, 2020; IQR 32 699–42 756). In the Poisson regression model, taking into account long-term trends, lockdown was associated with an estimated 47·6% decrease in HIV testing in April, 2020 (incidence rate ratio [IRR] 0·524, 95% CI 0·446–0·615). ART initiations decreased from a median of 571 per week before lockdown (IQR 498–678), to 375 per week after lockdown (331–399), with an estimated 46·2% decrease in the Poisson regression model in the first week of lockdown (March 30, 2020, to April 5, 2020; IRR 0·538, 0·459–0·630). There was no marked change in the number of ART collection visits (median 18 519 visits per week before lockdown [IQR 17 074–19 922] vs 17 863 visits per week after lockdown [17 509–18 995]; estimated effect in the first week of lockdown IRR 0·932, 95% CI 0·794–1·093). As restrictions eased, HIV testing and ART initiations gradually improved towards pre-lockdown levels (slope change 1·183/month, 95% CI 1·113–1·256 for HIV testing; 1·156/month, 1·085–1·230 for ART initiations). Interpretation ART provision was generally maintained during the 2020 COVID-19 lockdown, but HIV testing and ART initiations were heavily impacted. Strategies to increase testing and treatment initiation should be implemented. Funding Wellcome Trust, Africa Oxford Initiative.
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- 2021
42. The erythema Q‐score, an imaging biomarker for redness in skin inflammation
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Lauren Penzi, Tim Lentini, John W. Frew, Judilyn Fuentes-Duculan, Inna Cueto, Valerie R. Yanofsky, Emma Guttman-Yassky, Daniel S. Gareau, Tali Czarnowicki, Jae Hwan Kim, James G. Krueger, Robert Finney, Patrick M. Brunner, Hanako Ohmatsu, Claire Bottomley, Sandra Garcet, and Mayte Suárez-Fariñas
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Imaging biomarker ,Erythema ,Correlation coefficient ,Color ,Dermatitis ,Skin Pigmentation ,Dermatology ,Severity of Illness Index ,Biochemistry ,Q Score ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Psoriasis ,Minimal erythema dose ,Image Processing, Computer-Assisted ,Photography ,Humans ,Medicine ,skin and connective tissue diseases ,Molecular Biology ,Skin ,Observer Variation ,integumentary system ,business.industry ,Reproducibility of Results ,biomarkers ,Patch test ,Patch Tests ,medicine.disease ,inflammatory skin diseases ,Clinical trial ,030104 developmental biology ,inflammation ,Original Article ,medicine.symptom ,business ,Algorithms ,Regular Articles - Abstract
Physician rating of cutaneous erythema is central to clinical dermatological assessment as well as quantification of outcome measures in clinical trials in a number of dermatologic conditions. However, issues with inter‐rater reliability and variability in the setting of higher Fitzpatrick skin types make visual erythema assessment unreliable. We developed and validated a computer‐assisted image‐processing algorithm (EQscore) to reliably quantify erythema (across a range of skin types) in the dermatology clinical setting. Our image processing algorithm evaluated erythema based upon green light suppression differentials between affected and unaffected skin. A group of four dermatologists used a 4‐point Likert scale as a human evaluation of similar erythematous patch tests. The algorithm and dermatologist scores were compared across 164 positive patch test reactions. The intra‐class correlation coefficient of groups and the correlation coefficient between groups were calculated. The EQscore was validated on and independent image set of psoriasis, minimal erythema dose testing and steroid‐induced blanching images. The reliability of the erythema quantification method produced an intra‐class correlation coefficient of 0.84 for the algorithm and 0.67 for dermatologists. The correlation coefficient between groups was 0.85. The EQscore demonstrated high agreement with clinical scoring and superior reliability compared with clinical scoring, avoiding the pitfalls of erythema underrating in the setting of pigmentation. The EQscore is easily accessible (http://lab.rockefeller.edu/krueger/EQscore), user‐friendly, and may allow dermatologists to more readily and accurately rate the severity of dermatological conditions and the response to therapeutic treatments.
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- 2020
43. Equivalence testing of a newly developed interviewer-led telephone script for the EORTC QLQ-C30
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Madeline Pe, Claire Piccinin, Sally Wheelwright, Andrew Bottomley, James W. Shaw, and Dagmara Kuliś
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Male ,medicine.medical_specialty ,Interview ,Nausea ,Intraclass correlation ,Health Status ,03 medical and health sciences ,Pharmacoeconomics ,0302 clinical medicine ,Quality of life ,Neoplasms ,Surveys and Questionnaires ,medicine ,Humans ,Equivalence (measure theory) ,business.industry ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,Middle Aged ,Telephone ,Sample size determination ,030220 oncology & carcinogenesis ,Physical therapy ,Quality of Life ,Female ,medicine.symptom ,Outcomes research ,0305 other medical science ,business - Abstract
Purpose The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life-Core Questionnaire (QLQ-C30) is a widely used generic self-report measure of health-related quality of life (HRQOL) for cancer patients. However, no validated voice script for interviewer-led telephone administration was previously available. The aim of this study was to develop a voice script for interviewer administration via telephone. Methods Following guidelines from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) PRO Mixed Modes Good Research Practices Task Force, a randomised cross-over equivalence study, including cognitive debriefing, was conducted to assess equivalence between paper and telephone administration modes. Assuming an expected intraclass correlation coefficient (ICC) of 0.70 and a minimally acceptable level of 0.50, a sample size of 63 was required. Results Cognitive interviews with five cancer patients found the voice script to be clear and understandable. Due to a protocol deviation in the first wave of testing, only 26 patients were available for analyses. A second wave of recruitment was conducted, adding 37 patients (n = 63; mean age 55.48; 65.1% female). Total ICCs for mode comparison ranged from 0.72 (nausea and vomiting, 95% CI 0.48–0.86) to 0.90 (global health status/QoL, 95% CI 0.80–0.95; pain, 95% CI 0.79–0.95; constipation, 95% CI 0.80–0.95). For paper first administration, all ICCs were above 0.70, except nausea and vomiting (ICC 0.55; 95% CI 0.24–0.76) and financial difficulties (ICC 0.60; 95% CI 0.31–0.79). For phone first administration, all ICCs were above 0.70. Conclusions The equivalence testing results support the voice script’s validity for administration of the QLQ-C30 via telephone.
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- 2022
44. Impact of 18F-fluciclovine PET/CT on salvage radiotherapy plans for men with recurrence of prostate cancer postradical prostatectomy
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Payne, Heather, Bomanji, Jamshed, Bottomley, David, Scarsbrook, Andrew F., Teoh, Eugene J., Gleeson, Fergus V., Bradley, Kevin M., Andrade, Gerard, Camilieri, Philip, Hyde, Katherine, Macpherson, Ruth, Patel, Neel, Sabharwal, Ami, Subesinghe, Manil, Chau, Albert, Miller, Matthew P., Afaq, Asim, van As, Nicholas, Chua, Sue, Hoskin, Peter, Chambers, Anthony, Cook, Gary J., Warbey, Victoria S., Han, Sai, and Leung, Hing Y.
- Subjects
Biochemical recurrence ,medicine.medical_specialty ,medicine.medical_treatment ,Subgroup analysis ,Prostate cancer ,symbols.namesake ,18F-Fluciclovine ,Positron Emission Tomography Computed Tomography ,medicine ,biochemical recurrence ,Radiology, Nuclear Medicine and imaging ,Radiation treatment planning ,Fisher's exact test ,PET-CT ,business.industry ,Prostatectomy ,General Medicine ,Original Articles ,salvage radiotherapy ,medicine.disease ,prostate cancer ,Radiation therapy ,Salvage radiotherapy ,PET ,F-Fluciclovine ,symbols ,Radiology ,business - Abstract
Objectives Imaging options to localize biochemical recurrence (BCR) of prostate cancer after radical prostatectomy (RP) are limited, especially at low prostate-specific antigen (PSA) levels. The FALCON study evaluated the impact of 18F-fluciclovine PET/CT on management plans for patients with BCR. Here, we evaluate salvage radiotherapy decisions in patients post-RP. Methods We conducted a subgroup analysis of post-RP patients enrolled in FALCON who had a prescan plan for salvage radiotherapy (± androgen-deprivation therapy). Patients’ treatment plans post-18F-fluciclovine PET/CT were compared with their prescan plans. Fisher exact test was used to determine the impact of PSA and Gleason sum on positivity and anatomical patterns of uptake. Results Sixty-five (63%) FALCON patients had undergone RP. Of these, 62 (median PSA, 0.32 ng/mL) had a prescan plan for salvage radiotherapy. Twenty-one (34%) had 18F-fluciclovine-avid lesions. Disease was confined to the prostate bed in 11 patients (52%) and to the pelvis in a further 5 (24%), while 5 (24%) had extrapelvic findings. Trends towards more disseminated disease with increasing PSA or Gleason sum were observed but did not reach statistical significance. Postscan, 25 (40%) patients had a management change; 17 (68%) were changed to the treatment modality (8 to systemic therapy, 8 to active surveillance, 1 other) and 8 (32%) were radiotherapy field modifications. Conclusions Incorporating 18F-fluciclovine PET/CT into treatment planning may help identify patients suitable for salvage radiotherapy, help augment planned radiotherapy to better target lesions and support the clinician to optimise patient management.
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- 2022
45. Mifepristone and misoprostol versus placebo and misoprostol for resolution of miscarriage in women diagnosed with missed miscarriage: the MifeMiso RCT
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Ismail Hassan, Pratima Gupta, Versha Cheed, Jane Brewin, A. Shahid, Tracy E Roberts, Cecilia Bottomley, Justin Chu, Jackie Ross, A. Ahmed, Abigail Oliver, J. Naftalin, Chidubem Okeke Ogwulu, Yadava B. Jeve, Pollyanna Hardy, Rachel Small, Andrew W Horne, Shilpa Deb, Martyn Underwood, Adam J. Devall, Kim Hinshaw, Ying Cheong, Laura Jones, Eleanor Williams, Jenny H La Fontaine Papadopoulos, Leanne Beeson, Linda Watkins, Natalie Nunes, Judith Hamilton, Siobhan Quenby, Yongzhong Sun, Frances Hodge, Meenakshi Choudhary, Chitra S Kumar, Arri Coomarasamy, Ioannis D. Gallos, Feras Izzat, Stewart Pringle, Ruth Bender-Atik, and Kalsang Bhatia
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medicine.medical_specialty ,Technology Assessment, Biomedical ,medical management ,Cost-Benefit Analysis ,Placebo ,law.invention ,Miscarriage ,Randomized controlled trial ,Pregnancy ,law ,Medical technology ,Humans ,Medicine ,R855-855.5 ,Misoprostol ,gestational sac ,missed miscarriage ,business.industry ,Obstetrics ,Health Policy ,Gestational age ,Mifepristone ,medicine.disease ,Abortion, Spontaneous ,Relative risk ,Female ,business ,randomised controlled trial ,medicine.drug - Abstract
Trial design A randomised, parallel-group, double-blind, placebo-controlled multicentre study with health economic and nested qualitative studies to determine if mifepristone (Mifegyne®, Exelgyn, Paris, France) plus misoprostol is superior to misoprostol alone for the resolution of missed miscarriage. Methods Women diagnosed with missed miscarriage in the first 14 weeks of pregnancy were randomly assigned (1 : 1 ratio) to receive 200 mg of oral mifepristone or matched placebo, followed by 800 μg of misoprostol 2 days later. A web-based randomisation system allocated the women to the two groups, with minimisation for age, body mass index, parity, gestational age, amount of bleeding and randomising centre. The primary outcome was failure to pass the gestational sac within 7 days after randomisation. The prespecified key secondary outcome was requirement for surgery to resolve the miscarriage. A within-trial cost-effectiveness study and a nested qualitative study were also conducted. Women who completed the trial protocol were purposively approached to take part in an interview to explore their satisfaction with and the acceptability of medical management of missed miscarriage. Results A total of 711 women, from 28 hospitals in the UK, were randomised to receive either mifepristone plus misoprostol (357 women) or placebo plus misoprostol (354 women). The follow-up rate for the primary outcome was 98% (696 out of 711 women). The risk of failure to pass the gestational sac within 7 days was 17% (59 out of 348 women) in the mifepristone plus misoprostol group, compared with 24% (82 out of 348 women) in the placebo plus misoprostol group (risk ratio 0.73, 95% confidence interval 0.54 to 0.98; p = 0.04). Surgical intervention to resolve the miscarriage was needed in 17% (62 out of 355 women) in the mifepristone plus misoprostol group, compared with 25% (87 out of 353 women) in the placebo plus misoprostol group (risk ratio 0.70, 95% confidence interval 0.52 to 0.94; p = 0.02). There was no evidence of a difference in the incidence of adverse events between the two groups. A total of 42 women, 19 in the mifepristone plus misoprostol group and 23 in the placebo plus misoprostol group, took part in an interview. Women appeared to have a preference for active management of their miscarriage. Overall, when women experienced care that supported their psychological well-being throughout the care pathway, and information was delivered in a skilled and sensitive manner such that women felt informed and in control, they were more likely to express satisfaction with medical management. The use of mifepristone and misoprostol showed an absolute effect difference of 6.6% (95% confidence interval 0.7% to 12.5%). The average cost per woman was lower in the mifepristone plus misoprostol group, with a cost saving of £182 (95% confidence interval £26 to £338). Therefore, the use of mifepristone and misoprostol for the medical management of a missed miscarriage dominated the use of misoprostol alone. Limitations The results from this trial are not generalisable to women diagnosed with incomplete miscarriage and the study does not allow for a comparison with expectant or surgical management of miscarriage. Future work Future work should use existing data to assess and rank the relative clinical effectiveness and safety profiles for all methods of management of miscarriage. Conclusions Our trial showed that pre-treatment with mifepristone followed by misoprostol resulted in a higher rate of resolution of missed miscarriage than misoprostol treatment alone. Women were largely satisfied with medical management of missed miscarriage and would choose it again. The mifepristone and misoprostol intervention was shown to be cost-effective in comparison to misoprostol alone. Trial registration Current Controlled Trials ISRCTN17405024. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 68. See the NIHR Journals Library website for further project information.
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- 2022
46. Results from a 1-day workshop on the assessment of quality of life in cancer patients: a joint initiative of the Japan Clinical Oncology Group and the European Organisation for Research and Treatment of Cancer
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Laureline Gatellier, Haruhiko Fukuda, Kenichi Nakamura, Yoshiyuki Majima, Francesca Martinelli, Junko Eba, Mitsumi Terada, Naomi Kiyota, Madeline Pe, Andrew Bottomley, Junki Mizusawa, and Galina Velikova
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Cancer Research ,medicine.medical_specialty ,Endpoint Determination ,Data management ,Meeting Report ,Outcome assessment ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Quality of life ,Neoplasms ,medicine ,AcademicSubjects/MED00300 ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Practice Patterns, Physicians' ,patient-reported outcome measures ,Randomized Controlled Trials as Topic ,Clinical Oncology ,business.industry ,international cooperation ,Global Leadership ,Cancer ,General Medicine ,Congresses as Topic ,medicine.disease ,Europe ,Alliance ,quality of life ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,surveys and questionnaires ,Female ,Outcome data ,business - Abstract
This report summarizes the presentations and discussion in the first Japan Clinical Oncology Group-European Organisation for Research and Treatment of Cancer Quality of Life/Patient-Reported Outcome workshop funded by the National Cancer Center Hospital that was held on Saturday, 1 September 2018 in Tokyo, Japan. The infrastructure and understanding regarding the Quality of Life/Patient-Reported Outcome assessment of cancer patients in Japan is still immature, in spite of the increased demand for oncological Patient-Reported Outcome research felt not only by researchers but also by patients or other stakeholders of cancer drug development. The workshop aimed to share each perspective, common issues to be considered and future perspectives regarding the strong alliance between the European Organisation for Research and Treatment of Cancer Quality of Life Group and the Japan Clinical Oncology Group for Quality of Life/Patient-Reported Outcome research as well as explore the possibility of conducting collaborative research. European Organisation for Research and Treatment of Cancer is a leading international cancer clinical trials organization, and its Quality of Life Group is a global leader in the implementation of Quality of Life research in cancer patients. The three invited speakers from the European Organisation for Research and Treatment of Cancer Quality of Life Group presented their perspective, latest methodology and ongoing projects. The three speakers from the Japan Clinical Oncology Group presented their current status, experience and some issues regarding data management or interpretation of the Patient-Reported Outcome data. The two patient advocates also shared their expectations in terms of advances in cancer research based on the Patient-Reported Outcome assessment. As the next steps after this workshop, the Japan Clinical Oncology Group and European Organisation for Research and Treatment of Cancer have decided to cooperate more closely to facilitate Patient-Reported Outcome research in both the groups, and the Japan Clinical Oncology Group has approved the establishment of a new committee for Quality of Life/Patient-Reported Outcome research in Japan., The JCOG-EORTC QOL/PRO workshop was held on Saturday, 1 September 2018 in Tokyo and aimed to share the current status of QOL research and facilitate cooperative ties between the JCOG and EORTC.
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- 2020
47. Minimally important differences for interpreting European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores in patients with head and neck cancer
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Kim Cocks, Madeleine King, Jammbe Z. Musoro, Vincent Grégoire, Jean-Pascal Machiels, Andrew Bottomley, Galina Velikova, Sjoukje F. Oosting, Mirjam A. G. Sprangers, Christian Simon, Mogens Groenvold, Corneel Coens, Silke Tribius, Susanne Singer, UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Unité d'oncologie médicale, Medical Psychology, APH - Mental Health, APH - Personalized Medicine, CCA - Cancer Treatment and Quality of Life, and APH - Aging & Later Life
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medicine.medical_specialty ,minimally important difference ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Linear regression ,Medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,Core (anatomy) ,business.industry ,REGRESSION-ANALYSIS ,Head and neck cancer ,Cancer ,Regression analysis ,EORTC QLQ-C30 ,medicine.disease ,humanities ,Clinical trial ,health-related quality of life ,Otorhinolaryngology ,Sample size determination ,Head and Neck Neoplasms ,Research Design ,030220 oncology & carcinogenesis ,Physical therapy ,Quality of Life ,head and neck cancer ,sense organs ,business - Abstract
Background We aimed to estimate minimally important difference (MID) for interpreting group-level change over time for European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 (EORTC QLQ-C30) scores in head and neck cancer. Methods Data were derived retrospectively from two published EORTC trials. Clinical anchors were selected using correlation strength and clinical plausibility of the given anchor/QLQ-C30 scale pair. MIDs for within-group and between-group change were estimated via the mean change method and linear regression, respectively. Distribution-based MIDs were also examined. MIDs for two of the scales, dyspnea and nausea/vomiting, are more uncertain considering their low correlations with the anchors. Results Anchor-based MIDs could be determined for deterioration in 7 of the 14 QLQ-C30 scales assessed, and in 3 scales for improvement. MIDs varied by scale, direction of change, and anchor. Absolute MID values ranged from 5 to 15 points for within-group change and 4 to 12 for between-group change. Most MIDs were within 4 to 10 points. Conclusions Our findings, if confirmed, will aid interpreting changes in selected QLQ-C30 scale scores over time and inform sample size calculations in future clinical trials in head and neck cancer.
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- 2020
48. Efficacy and toxicity outcomes for patients treated with focal salvage high dose rate brachytherapy for locally recurrent prostate cancer
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Samantha Hodgson, Joshua Mason, Bashar Al-Qaisieh, Emma Dugdale, F. Slevin, Ese Adiotomre, Jonathan Smith, Ann Henry, Sree Lakshmi Rodda, David Bottomley, Oliver Hulson, and Peter Bownes
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medicine.medical_specialty ,Focal salvage brachytherapy ,medicine.medical_treatment ,Brachytherapy ,R895-920 ,Urology ,macromolecular substances ,Article ,030218 nuclear medicine & medical imaging ,Androgen deprivation therapy ,High dose rate brachytherapy ,Medical physics. Medical radiology. Nuclear medicine ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Median follow-up ,Local recurrence ,medicine ,Radiology, Nuclear Medicine and imaging ,RC254-282 ,Proportional hazards model ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,High-Dose Rate Brachytherapy ,Radiation therapy ,Clinical trial ,Oncology ,030220 oncology & carcinogenesis ,business - Abstract
Highlights • Local recurrence of prostate cancer may be treated with salvage therapies. • Focal salvage high dose rate brachytherapy provides good biochemical control. • Severe genitourinary and gastrointestinal toxicities are low., Introduction Isolated local recurrence of prostate cancer following primary radiotherapy or brachytherapy may be treated with focal salvage high dose rate brachytherapy, although there remains an absence of high quality evidence to support this approach. Methods Men with prostate cancer treated consecutively between 2015 and 2018 using 19 Gy in a single fraction high dose rate brachytherapy (HDR) for locally recurrent prostate cancer were identified from an institutional database. Univariable analysis was performed to evaluate the relationship between patient, disease and treatment factors with biochemical progression free survival (bPFS). Results 43 patients were eligible for evaluation. Median follow up duration was 26 months (range 1–60). Median bPFS was 35 months (95% confidence interval 25.6–44.4). Kaplan-Meier estimates for bPFS at 1, 2 and 3 years post salvage were 95.2%, 70.6% and 41.8% respectively. On univariable Cox regression analysis, only nadir PSA was significantly associated with bPFS although the majority of patients were also treated with androgen deprivation therapy. Only one late grade 3 genitourinary toxicity was observed. Conclusion Focal salvage HDR brachytherapy may provide good biochemical control with a low risk of severe toxicity. Further evaluation within clinical trials are needed to establish its role in the management of locally recurrent prostate cancer.
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- 2020
49. Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT
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Natalie Nunes, A. Shahid, Hoda Harb, Meenakshi Choudhary, Cecilia Bottomley, Kalsang Bhatia, Davor Jurkovic, Versha Cheed, Lee J Middleton, A. Ahmed, Jane Brewin, Caroline Overton, Abey Eapen, Fiona Crosfill, Jane P Daniels, Tracy E Roberts, Ruth Bender-Atik, Chidubem B. Ogwulu, K. Kriedt, Ioannis D. Gallos, Martyn Underwood, Arri Coomarasamy, Shilpa Deb, Jemma Johns, C. Wykes, Siobhan Quenby, Thomas Holland, Ilias Goranitis, W. Colin Duncan, Feras Izzat, Jane E. Norman, Jackie Ross, Nirmala Vaithilingham, Andrew W Horne, Linda Watkins, Adam J. Devall, Andrew K Ewer, Helen Williams, P. Manda, Kim Hinshaw, Sandhya Rao, and Mary Ann Lumsden
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Adult ,medicine.medical_specialty ,lcsh:Medical technology ,Adolescent ,Cost-Benefit Analysis ,Placebo ,live birth ,law.invention ,Miscarriage ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Pregnancy ,law ,threatened miscarriage ,medicine ,Humans ,Vaginal bleeding ,030212 general & internal medicine ,Progesterone ,Obstetrics ,business.industry ,Suppositories ,Health Policy ,Parturition ,early pregnancy vaginal bleeding ,medicine.disease ,United Kingdom ,Confidence interval ,Abortion, Spontaneous ,Pregnancy Trimester, First ,lcsh:R855-855.5 ,Gestation ,Female ,Uterine Hemorrhage ,medicine.symptom ,Live birth ,business ,first trimester ,randomised controlled trial ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Progesterone is essential for a healthy pregnancy. Several small trials have suggested that progesterone therapy may rescue a pregnancy in women with early pregnancy bleeding, which is a symptom that is strongly associated with miscarriage. Objectives (1) To assess the effects of vaginal micronised progesterone in women with vaginal bleeding in the first 12 weeks of pregnancy. (2) To evaluate the cost-effectiveness of progesterone in women with early pregnancy bleeding. Design A multicentre, double-blind, placebo-controlled, randomised trial of progesterone in women with early pregnancy vaginal bleeding. Setting A total of 48 hospitals in the UK. Participants Women aged 16–39 years with early pregnancy bleeding. Interventions Women aged 16–39 years were randomly assigned to receive twice-daily vaginal suppositories containing either 400 mg of progesterone or a matched placebo from presentation to 16 weeks of gestation. Main outcome measures The primary outcome was live birth at ≥ 34 weeks. In addition, a within-trial cost-effectiveness analysis was conducted from an NHS and NHS/Personal Social Services perspective. Results A total of 4153 women from 48 hospitals in the UK received either progesterone (n = 2079) or placebo (n = 2074). The follow-up rate for the primary outcome was 97.2% (4038 out of 4153 participants). The live birth rate was 75% (1513 out of 2025 participants) in the progesterone group and 72% (1459 out of 2013 participants) in the placebo group (relative rate 1.03, 95% confidence interval 1.00 to 1.07; p = 0.08). A significant subgroup effect (interaction test p = 0.007) was identified for prespecified subgroups by the number of previous miscarriages: none (74% in the progesterone group vs. 75% in the placebo group; relative rate 0.99, 95% confidence interval 0.95 to 1.04; p = 0.72); one or two (76% in the progesterone group vs. 72% in the placebo group; relative rate 1.05, 95% confidence interval 1.00 to 1.12; p = 0.07); and three or more (72% in the progesterone group vs. 57% in the placebo group; relative rate 1.28, 95% confidence interval 1.08 to 1.51; p = 0.004). A significant post hoc subgroup effect (interaction test p = 0.01) was identified in the subgroup of participants with early pregnancy bleeding and any number of previous miscarriage(s) (75% in the progesterone group vs. 70% in the placebo group; relative rate 1.09, 95% confidence interval 1.03 to 1.15; p = 0.003). There were no significant differences in the rate of adverse events between the groups. The results of the health economics analysis show that progesterone was more costly than placebo (£7655 vs. £7572), with a mean cost difference of £83 (adjusted mean difference £76, 95% confidence interval –£559 to £711) between the two arms. Thus, the incremental cost-effectiveness ratio of progesterone compared with placebo was estimated as £3305 per additional live birth at ≥ 34 weeks of gestation. Conclusions Progesterone therapy in the first trimester of pregnancy did not result in a significantly higher rate of live births among women with threatened miscarriage overall, but an important subgroup effect was identified. A conclusion on the cost-effectiveness of the PRISM trial would depend on the amount that society is willing to pay to increase the chances of an additional live birth at ≥ 34 weeks. For future work, we plan to conduct an individual participant data meta-analysis using all existing data sets. Trial registration Current Controlled Trials ISRCTN14163439, EudraCT 2014-002348-42 and Integrated Research Application System (IRAS) 158326. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 33. See the NIHR Journals Library website for further project information.
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- 2020
50. Effect of 18F-Fluciclovine Positron Emission Tomography on the Management of Patients With Recurrence of Prostate Cancer: Results From the FALCON Trial
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Andrew F. Scarsbrook, David Bottomley, Eugene J. Teoh, Kevin M. Bradley, Heather Payne, Asim Afaq, Jamshed Bomanji, Nicholas van As, Sue Chua, Peter Hoskin, Anthony Chambers, Gary J. Cook, Victoria S. Warbey, Sai Han, Hing Y. Leung, Albert Chau, Matthew P. Miller, Fergus V. Gleeson, Gerard Andrade, Philip Camilieri, Katherine Hyde, Ruth Macpherson, Neel Patel, Ami Sabharwal, Manil Subesinghe, and Maria Tsakok
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First episode ,Biochemical recurrence ,Cancer Research ,medicine.medical_specialty ,Radiation ,business.industry ,medicine.medical_treatment ,Brachytherapy ,Salvage therapy ,medicine.disease ,030218 nuclear medicine & medical imaging ,Radiation therapy ,03 medical and health sciences ,Prostate-specific antigen ,Prostate cancer ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Radiation treatment planning ,business - Abstract
Purpose\ud\udEarly and accurate localization of lesions in patients with biochemical recurrence (BCR) of prostate cancer may guide salvage therapy decisions. The present study, 18F-Fluciclovine PET/CT in biochemicAL reCurrence Of Prostate caNcer (FALCON; NCT02578940), aimed to evaluate the effect of 18F-fluciclovine on management of men with BCR of prostate cancer.\udMethods and Materials\ud\udMen with a first episode of BCR after curative-intent primary therapy were enrolled at 6 UK sites. Patients underwent 18F-fluciclovine positron emission tomography/computed tomography (PET/CT) according to standardized procedures. Clinicians documented management plans before and after scanning, recording changes to treatment modality as major and changes within a modality as other. The primary outcome measure was record of a revised management plan postscan. Secondary endpoints were evaluation of optimal prostate specific antigen (PSA) threshold for detection, salvage treatment outcome assessment based on 18F-fluciclovine-involvement, and safety.\udResults\ud\ud18F-Fluciclovine was well tolerated in the 104 scanned patients (median PSA = 0.79 ng/mL). Lesions were detected in 58 out of 104 (56%) patients. Detection was broadly proportional to PSA level; ≤1 ng/mL, 1 out of 3 of scans were positive, and 93% scans were positive at PSA >2.0 ng/mL. Sixty-six (64%) patients had a postscan management change (80% after a positive result). Major changes (43 out of 66; 65%) were salvage or systemic therapy to watchful waiting (16 out of 66; 24%); salvage therapy to systemic therapy (16 out of 66; 24%); and alternative changes to treatment modality (11 out of 66, 17%). The remaining 23 out of 66 (35%) management changes were modifications of the prescan plan: most (22 out of 66; 33%) were adjustments to planned brachytherapy/radiation therapy to include a 18F-fluciclovine-guided boost. Where 18F-fluciclovine guided salvage therapy, the PSA response rate was higher than when 18F-fluciclovine was not involved (15 out of 17 [88%] vs 28 out of 39 [72%]).\udConclusions\ud\ud18F-Fluciclovine PET/CT located recurrence in the majority of men with BCR, frequently resulting in major management plan changes. Incorporating 18F-fluciclovine PET/CT into treatment planning may optimize targeting of recurrence sites and avoid futile salvage therapy.
- Published
- 2020
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