Publications by authors named "Amanda Adler"

124 Publications

REPRINT OF: CLASSIFICATION OF DIABETES MELLITUS.

Diabetes Res Clin Pract 2021 Jul 31:108972. Epub 2021 Jul 31.

Boden Institute, University of Sydney, Australia.

Executive Summary This document updates the 1999 World Health Organization (WHO) classification of diabetes. It prioritizes clinical care and guides health professionals in choosing appropriate treatments at the time of diabetes diagnosis, and provides practical guidance to clinicians in assigning a type of diabetes to individuals at the time of diagnosis. It is a compromise between clinical and aetiological classification because there remain gaps in knowledge of the aetiology and pathophysiology of diabetes. While acknowledging the progress that is being made towards a more precise categorization of diabetes subtypes, the aim of this document is to recommend a classification that is feasible to implement in different settings throughout the world. The revised classification is presented in Table 1. Unlike the previous classification, this classification does not recognize subtypes of type 1 diabetes and type 2 diabetes and includes new types of diabetes ("hybrid types of diabetes" and "unclassified diabetes").
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http://dx.doi.org/10.1016/j.diabres.2021.108972DOI Listing
July 2021

Increased Risk of Incident Heart Failure and Death Is Associated With Insulin Resistance in People With Newly Diagnosed Type 2 Diabetes: UKPDS 89.

Diabetes Care 2021 Aug 23;44(8):1877-1884. Epub 2021 Jun 23.

Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K.

Objective: Insulin resistance (IR) may mediate heart failure (HF) development. We examined whether IR in people with newly diagnosed type 2 diabetes (T2D) increased their risk of a composite outcome of HF or death or of HF alone.

Research Design And Methods: Insulin resistance (HOMA2-IR) values for UKPDS participants were derived from paired fasting plasma glucose (FPG) and insulin measures. Kaplan-Meier survival curves and multivariable survival models were used to evaluate associations between HOMA2-IR and HF/death or HF alone. We adjusted for potential confounders by including variables with univariate associations ( < 0.1) and by requiring a multivariable < 0.05.

Results: Of 5,102 UKPDS participants with newly diagnosed T2D, 4,344 had HOMA2-IR measurements. At enrollment, mean (SD) age was 52.5 (8.7) years, with HbA 7.2% (1.8%), and BMI 28.8 (5.5) kg/m, and median (interquartile range) HOMA2-IR was 1.6 (1.1-2.2). HF/death occurred in 1,974 (45.4%) participants (235 first HF events, 1,739 deaths) over a median follow-up of 16.4 years. Multivariable independent associations with HF/death were older age and higher BMI, HOMA2-IR, FPG, waist-to-hip ratio, systolic blood pressure, LDL cholesterol, and heart rate as well as sex, race, smoking status, prior atrial fibrillation, and prior microalbuminuria. A doubling of HOMA2-IR was associated with a 5% greater risk of HF/death (relative risk [RR] 1.05 [95% CI 1.01-1.12], = 0.0029) and a 14% greater risk of HF (RR 1.14, [95% CI 1.02-1.27], = 0.017).

Conclusions: Patients with newly diagnosed T2D and insulin resistance were more likely to develop HF or die than those more sensitive to insulin.
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http://dx.doi.org/10.2337/dc21-0429DOI Listing
August 2021

Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting.

JAMA Pediatr 2021 Jun 11. Epub 2021 Jun 11.

Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle.

Importance: The association between COVID-19 symptoms and SARS-CoV-2 viral levels in children living in the community is not well understood.

Objective: To characterize symptoms of pediatric COVID-19 in the community and analyze the association between symptoms and SARS-CoV-2 RNA levels, as approximated by cycle threshold (Ct) values, in children and adults.

Design, Setting, And Participants: This cross-sectional study used a respiratory virus surveillance platform in persons of all ages to detect community COVID-19 cases from March 23 to November 9, 2020. A population-based convenience sample of children younger than 18 years and adults in King County, Washington, who enrolled online for home self-collection of upper respiratory samples for SARS-CoV-2 testing were included.

Exposures: Detection of SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) from participant-collected samples.

Main Outcomes And Measures: RT-PCR-confirmed SARS-CoV-2 infection, with Ct values stratified by age and symptoms.

Results: Among 555 SARS-CoV-2-positive participants (mean [SD] age, 33.7 [20.1] years; 320 were female [57.7%]), 47 of 123 children (38.2%) were asymptomatic compared with 31 of 432 adults (7.2%). When symptomatic, fewer symptoms were reported in children compared with adults (mean [SD], 1.6 [2.0] vs 4.5 [3.1]). Symptomatic individuals had lower Ct values (which corresponded to higher viral RNA levels) than asymptomatic individuals (adjusted estimate for children, -3.0; 95% CI, -5.5 to -0.6; P = .02; adjusted estimate for adults, -2.9; 95% CI, -5.2 to -0.6; P = .01). The difference in mean Ct values was neither statistically significant between symptomatic children and symptomatic adults (adjusted estimate, -0.7; 95% CI, -2.2 to 0.9; P = .41) nor between asymptomatic children and asymptomatic adults (adjusted estimate, -0.6; 95% CI, -4.0 to 2.8; P = .74).

Conclusions And Relevance: In this community-based cross-sectional study, SARS-CoV-2 RNA levels, as determined by Ct values, were significantly higher in symptomatic individuals than in asymptomatic individuals and no significant age-related differences were found. Further research is needed to understand the role of SARS-CoV-2 RNA levels and viral transmission.
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http://dx.doi.org/10.1001/jamapediatrics.2021.2025DOI Listing
June 2021

Adjusting for Nonadherence or Stopping Treatments in Randomized Clinical Trials.

JAMA 2021 May;325(20):2110-2111

School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.

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http://dx.doi.org/10.1001/jama.2021.2433DOI Listing
May 2021

Viral genomes reveal patterns of the SARS-CoV-2 outbreak in Washington State.

Sci Transl Med 2021 05 3;13(595). Epub 2021 May 3.

Seattle Children's Research Institute, Seattle, WA 98101, USA.

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has gravely affected societies around the world. Outbreaks in different parts of the globe have been shaped by repeated introductions of new viral lineages and subsequent local transmission of those lineages. Here, we sequenced 3940 SARS-CoV-2 viral genomes from Washington State (USA) to characterize how the spread of SARS-CoV-2 in Washington State in early 2020 was shaped by differences in timing of mitigation strategies across counties and by repeated introductions of viral lineages into the state. In addition, we show that the increase in frequency of a potentially more transmissible viral variant (614G) over time can potentially be explained by regional mobility differences and multiple introductions of 614G but not the other variant (614D) into the state. At an individual level, we observed evidence of higher viral loads in patients infected with the 614G variant. However, using clinical records data, we did not find any evidence that the 614G variant affects clinical severity or patient outcomes. Overall, this suggests that with regard to D614G, the behavior of individuals has been more important in shaping the course of the pandemic in Washington State than this variant of the virus.
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http://dx.doi.org/10.1126/scitranslmed.abf0202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158963PMC
May 2021

Accurate accounting of caplacizumab cost effectiveness - Authors' reply.

Lancet Haematol 2021 05;8(5):e316

Centre for Health Technology Evaluation, National Institute for Health and Care Excellence, Manchester M1 4BT, UK; Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK. Electronic address:

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http://dx.doi.org/10.1016/S2352-3026(21)00074-0DOI Listing
May 2021

The STEP 1 trial for weight loss: a step change in treating obesity?

Authors:
Amanda I Adler

Nat Med 2021 04;27(4):589-590

Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1038/s41591-021-01319-4DOI Listing
April 2021

Effects of weather-related social distancing on city-scale transmission of respiratory viruses: a retrospective cohort study.

BMC Infect Dis 2021 Apr 9;21(1):335. Epub 2021 Apr 9.

Institute for Disease Modeling, Bellevue, WA, USA.

Background: Unusually high snowfall in western Washington State in February 2019 led to widespread school and workplace closures. We assessed the impact of social distancing caused by this extreme weather event on the transmission of respiratory viruses.

Methods: Residual specimens from patients evaluated for acute respiratory illness at hospitals in the Seattle metropolitan area were screened for a panel of respiratory viruses. Transmission models were fit to each virus to estimate the magnitude reduction in transmission due to weather-related disruptions. Changes in contact rates and care-seeking were informed by data on local traffic volumes and hospital visits.

Results: Disruption in contact patterns reduced effective contact rates during the intervention period by 16 to 95%, and cumulative disease incidence through the remainder of the season by 3 to 9%. Incidence reductions were greatest for viruses that were peaking when the disruption occurred and least for viruses in an early epidemic phase.

Conclusion: High-intensity, short-duration social distancing measures may substantially reduce total incidence in a respiratory virus epidemic if implemented near the epidemic peak. For SARS-CoV-2, this suggests that, even when SARS-CoV-2 spread is out of control, implementing short-term disruptions can prevent COVID-19 deaths.
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http://dx.doi.org/10.1186/s12879-021-06028-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8033554PMC
April 2021

Inactivation of genes in oxidative respiration and iron acquisition pathways in pediatric clinical isolates of Small colony variant Enterobacteriaceae.

Sci Rep 2021 Apr 2;11(1):7457. Epub 2021 Apr 2.

Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA.

Isolation of bacterial small colony variants (SCVs) from clinical specimens is not uncommon and can fundamentally change the outcome of the associated infections. Bacterial SCVs often emerge with their normal colony phenotype (NCV) co-isolates in the same sample. The basis of SCV emergence in vivo is not well understood in Gram-negative bacteria. In this study, we interrogated the causal genetic lesions of SCV growth in three pairs of NCV and SCV co-isolates of Escherichia coli, Citrobacter freundii, and Enterobacter hormaechei. We confirmed SCV emergence was attributed to limited genomic mutations: 4 single nucleotide variants in the E. coli SCV, 5 in C. freundii, and 8 in E. hormaechei. In addition, a 10.2 kb chromosomal segment containing 11 genes was deleted in the E. hormaechei SCV isolate. Each SCV had at least one coding change in a gene associated with bacterial oxidative respiration and another involved in iron capture. Chemical and genetic rescue confirmed defects in heme biosynthesis for E. coli and C. freundii and lipoic acid biosynthesis in E. hormaachei were responsible for the SCV phenotype. Prototrophic growth in all 3 SCV Enterobacteriaceae species was unaffected under anaerobic culture conditions in vitro, illustrating how SCVs may persist in vivo.
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http://dx.doi.org/10.1038/s41598-021-86764-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018945PMC
April 2021

NICE guidance on dapagliflozin for chronic heart failure with reduced ejection fraction.

Lancet Diabetes Endocrinol 2021 05 10;9(5):261-263. Epub 2021 Mar 10.

National Institute for Health and Care Excellence, Level 1A, City Tower, Piccadilly Plaza, Manchester, M1 4BT, UK.

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http://dx.doi.org/10.1016/S2213-8587(21)00072-3DOI Listing
May 2021

NICE guidance on caplacizumab for treating acute acquired thrombotic thrombocytopenia purpura.

Lancet Haematol 2021 01;8(1):e14-e15

Centre for Health Technology Evaluation, National Institute for Health and Care Excellence (NICE), Manchester M1 4BT, UK; Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford OX3 7LE, UK. Electronic address:

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http://dx.doi.org/10.1016/S2352-3026(20)30406-3DOI Listing
January 2021

USA stockpiling of remdesivir: How should the world respond?

J Comp Eff Res 2020 12 4;9(18):1243-1246. Epub 2020 Dec 4.

NICE Technology Appraisal Committee B, University of Oxford, Oxford, UK.

The race to find an effective treatment for coronavirus disease 2019 (COVID-19) is still on, with only two treatment options currently authorized for emergency use and/or recommended for patients hospitalized with severe respiratory symptoms: low-dose dexamethasone and remdesivir. The USA decision to stockpile the latter has resulted in widespread condemnation and in similar action being taken by some other countries. In this commentary we discuss whether stockpiling remdesivir is justified in light of the currently available evidence.
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http://dx.doi.org/10.2217/cer-2020-0174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717394PMC
December 2020

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children's Oncology Group.

Cancer 2020 01 20;127(1):56-66. Epub 2020 Oct 20.

Division of Haematology/Oncology, Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.

Background: To the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line-associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited.

Methods: In the current multicenter, randomized, double-blind, placebo-controlled trial, patients aged ≥2 months and <22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once-daily bathing with 2% CHG-impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration.

Results: The study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05-4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, -0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032).

Conclusions: The data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT.
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http://dx.doi.org/10.1002/cncr.33271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820990PMC
January 2020

The Seattle Flu Study: a multiarm community-based prospective study protocol for assessing influenza prevalence, transmission and genomic epidemiology.

BMJ Open 2020 10 7;10(10):e037295. Epub 2020 Oct 7.

Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

Introduction: Influenza epidemics and pandemics cause significant morbidity and mortality. An effective response to a potential pandemic requires the infrastructure to rapidly detect, characterise, and potentially contain new and emerging influenza strains at both an individual and population level. The objective of this study is to use data gathered simultaneously from community and hospital sites to develop a model of how influenza enters and spreads in a population.

Methods And Analysis: Starting in the 2018-2019 season, we have been enrolling individuals with acute respiratory illness from community sites throughout the Seattle metropolitan area, including clinics, childcare facilities, Seattle-Tacoma International Airport, workplaces, college campuses and homeless shelters. At these sites, we collect clinical data and mid-nasal swabs from individuals with at least two acute respiratory symptoms. Additionally, we collect residual nasal swabs and data from individuals who seek care for respiratory symptoms at four regional hospitals. Samples are tested using a multiplex molecular assay, and influenza whole genome sequencing is performed for samples with influenza detected. Geospatial mapping and computational modelling platforms are in development to characterise the regional spread of influenza and other respiratory pathogens.

Ethics And Dissemination: The study was approved by the University of Washington's Institutional Review Board (STUDY00006181). Results will be disseminated through talks at conferences, peer-reviewed publications and on the study website (www.seattleflu.org).
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http://dx.doi.org/10.1136/bmjopen-2020-037295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542952PMC
October 2020

Viral genomes reveal patterns of the SARS-CoV-2 outbreak in Washington State.

medRxiv 2020 Sep 30. Epub 2020 Sep 30.

University of Washington, Seattle, WA, USA.

The rapid spread of SARS-CoV-2 has gravely impacted societies around the world. Outbreaks in different parts of the globe are shaped by repeated introductions of new lineages and subsequent local transmission of those lineages. Here, we sequenced 3940 SARS-CoV-2 viral genomes from Washington State to characterize how the spread of SARS-CoV-2 in Washington State (USA) was shaped by differences in timing of mitigation strategies across counties, as well as by repeated introductions of viral lineages into the state. Additionally, we show that the increase in frequency of a potentially more transmissible viral variant (614G) over time can potentially be explained by regional mobility differences and multiple introductions of 614G, but not the other variant (614D) into the state. At an individual level, we see evidence of higher viral loads in patients infected with the 614G variant. However, using clinical records data, we do not find any evidence that the 614G variant impacts clinical severity or patient outcomes. Overall, this suggests that at least to date, the behavior of individuals has been more important in shaping the course of the pandemic than changes in the virus.
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http://dx.doi.org/10.1101/2020.09.30.20204230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536883PMC
September 2020

Real-world data for health technology assessment for reimbursement decisions in Asia: current landscape and a way forward.

Int J Technol Assess Health Care 2020 Oct 15;36(5):474-480. Epub 2020 Sep 15.

Saw Swee Hock School of Public Health, National University of Singapore (NUS), Singapore, Singapore.

There is growing interest globally in using real-world data (RWD) and real-world evidence (RWE) for health technology assessment (HTA). Optimal collection, analysis, and use of RWD/RWE to inform HTA requires a conceptual framework to standardize processes and ensure consistency. However, such framework is currently lacking in Asia, a region that is likely to benefit from RWD/RWE for at least two reasons. First, there is often limited Asian representation in clinical trials unless specifically conducted in Asian populations, and RWD may help to fill the evidence gap. Second, in a few Asian health systems, reimbursement decisions are not made at market entry; thus, allowing RWD/RWE to be collected to give more certainty about the effectiveness of technologies in the local setting and inform their appropriate use. Furthermore, an alignment of RWD/RWE policies across Asia would equip decision makers with context-relevant evidence, and improve timely patient access to new technologies. Using data collected from eleven health systems in Asia, this paper provides a review of the current landscape of RWD/RWE in Asia to inform HTA and explores a way forward to align policies within the region. This paper concludes with a proposal to establish an international collaboration among academics and HTA agencies in the region: the REAL World Data In ASia for HEalth Technology Assessment in Reimbursement (REALISE) working group, which seeks to develop a non-binding guidance document on the use of RWD/RWE to inform HTA for decision making in Asia.
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http://dx.doi.org/10.1017/S0266462320000628DOI Listing
October 2020

Cryptic transmission of SARS-CoV-2 in Washington state.

Science 2020 10 10;370(6516):571-575. Epub 2020 Sep 10.

Brotman Baty Institute for Precision Medicine, Seattle, WA, USA.

After its emergence in Wuhan, China, in late November or early December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus rapidly spread globally. Genome sequencing of SARS-CoV-2 allows the reconstruction of its transmission history, although this is contingent on sampling. We analyzed 453 SARS-CoV-2 genomes collected between 20 February and 15 March 2020 from infected patients in Washington state in the United States. We find that most SARS-CoV-2 infections sampled during this time derive from a single introduction in late January or early February 2020, which subsequently spread locally before active community surveillance was implemented.
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http://dx.doi.org/10.1126/science.abc0523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810035PMC
October 2020

Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak.

Nat Commun 2020 09 1;11(1):4378. Epub 2020 Sep 1.

Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.

Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases as of April 2, 2020. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. Here, to better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screen 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children have neutralizing activity, including one that neutralized at a dilution > 1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.
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http://dx.doi.org/10.1038/s41467-020-18178-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463158PMC
September 2020

Cryptic transmission of SARS-CoV-2 in Washington State.

medRxiv 2020 Apr 6. Epub 2020 Apr 6.

University of Washington, Seattle, WA USA.

Following its emergence in Wuhan, China, in late November or early December 2019, the SARS-CoV-2 virus has rapidly spread throughout the world. On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Genome sequencing of SARS-CoV-2 strains allows for the reconstruction of transmission history connecting these infections. Here, we analyze 346 SARS-CoV-2 genomes from samples collected between 20 February and 15 March 2020 from infected patients in Washington State, USA. We found that the large majority of SARS-CoV-2 infections sampled during this time frame appeared to have derived from a single introduction event into the state in late January or early February 2020 and subsequent local spread, strongly suggesting cryptic spread of COVID-19 during the months of January and February 2020, before active community surveillance was implemented. We estimate a common ancestor of this outbreak clade as occurring between 18 January and 9 February 2020. From genomic data, we estimate an exponential doubling between 2.4 and 5.1 days. These results highlight the need for large-scale community surveillance for SARS-CoV-2 introductions and spread and the power of pathogen genomics to inform epidemiological understanding.
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http://dx.doi.org/10.1101/2020.04.02.20051417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276023PMC
April 2020

Serological identification of SARS-CoV-2 infections among children visiting a hospital during the initial Seattle outbreak.

medRxiv 2020 Jun 30. Epub 2020 Jun 30.

Basic Sciences and Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.

Children are strikingly underrepresented in COVID-19 case counts. In the United States, children represent 22% of the population but only 1.7% of confirmed SARS-CoV-2 cases. One possibility is that symptom-based viral testing is less likely to identify infected children, since they often experience milder disease than adults. To better assess the frequency of pediatric SARS-CoV-2 infection, we serologically screened 1,775 residual samples from Seattle Children's Hospital collected from 1,076 children seeking medical care during March and April of 2020. Only one child was seropositive in March, but seven were seropositive in April for a period seroprevalence of ≈ 1%. Most seropositive children (6/8) were not suspected of having had COVID-19. The sera of seropositive children had neutralizing activity, including one that neutralized at a dilution >1:18,000. Therefore, an increasing number of children seeking medical care were infected by SARS-CoV-2 during the early Seattle outbreak despite few positive viral tests.
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http://dx.doi.org/10.1101/2020.05.26.20114124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273251PMC
June 2020

Impact of a Global Pandemic on Health Technology Assessment.

Appl Health Econ Health Policy 2020 06;18(3):339-343

Diabetes Trial Unit, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1007/s40258-020-00590-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202921PMC
June 2020

Cannabidiol with clobazam for seizures associated with Dravet and Lennox-Gastaut syndromes.

Lancet Neurol 2020 04 18;19(4):290-291. Epub 2020 Mar 18.

Centre for Health Technology Evaluation, National Institute for Health and Care Excellence (NICE), Manchester, UK, M1 4BT; Addenbrooke's Hospital, Cambridge, UK.

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http://dx.doi.org/10.1016/S1474-4422(20)30060-0DOI Listing
April 2020

Whole Genome Sequencing Detects Minimal Clustering Among Escherichia coli Sequence Type 131-H30 Isolates Collected From United States Children's Hospitals.

J Pediatric Infect Dis Soc 2021 Mar;10(2):183-187

Seattle Children's Research Institute, Seattle, Washington, USA.

We applied whole genome sequencing to identify putative transmission clusters among clinical multidrug-resistant Escherichia coli sequence type 131-H30 isolates from 4 United States children's hospitals. Of 126 isolates, 17 were involved in 8 putative transmission clusters; 4 clusters showed evidence of healthcare-associated epidemiologic linkages. Geographic clustering analyses showed weak geographic clustering.
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http://dx.doi.org/10.1093/jpids/piaa023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996643PMC
March 2021

NICE guidance on sotagliflozin for type 1 diabetes.

Lancet Diabetes Endocrinol 2020 04 24;8(4):274-275. Epub 2020 Feb 24.

National Institute for Health and Care Excellence, Manchester, UK.

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http://dx.doi.org/10.1016/S2213-8587(20)30066-8DOI Listing
April 2020

NICE guidance on dapagliflozin with insulin for type 1 diabetes.

Lancet Diabetes Endocrinol 2019 10 2;7(10):750-751. Epub 2019 Sep 2.

School of Health and Related Research, University of Sheffield, Sheffield, UK.

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http://dx.doi.org/10.1016/S2213-8587(19)30265-7DOI Listing
October 2019

In primary care, is measuring free-thyroxine plus thyroid-stimulating hormone to detect hypopituitarism cost-effective? A cost utility analysis using Markov chain models.

BMJ Open 2019 07 29;9(7):e029369. Epub 2019 Jul 29.

Institute of Metabolic Sciences, Addenbrooke's Hospital, Cambridge, UK.

Objective: We examined whether it is cost-effective to measure free thyroxine (FT4) in addition to thyrotropin (thyroid-stimulating hormone (TSH)) on all requests for thyroid function tests from primary care on adult patients.

Background: Hypopituitarism occurs in about 4 people per 100 000 per year. Loss of thyrotropin (TSH) secretion may lead to secondary hypothyroidism with a low TSH and low FT4, and this pattern may help to diagnose hypopituitarism that might otherwise be missed.

Design: Markov model simulation.

Primary Outcome Measure: Incremental cost-effectiveness ratio (ICER), the ratio of cost in pounds to benefit in quality-adjusted life years of this strategy.

Results: The ICER for this strategy was £71 437. Factors with a large influence on the ICER were the utilities of the treated hypopituitary state, the likelihood of going to the general practitioner (GP) and of the GP recognising a hypopituitary patient. The ICER would be below £20 000 at a cost to the user of an FT4 measurement of £0.61.

Conclusion: With FT4 measurements at their present cost to the user, routine inclusion of FT4 in a thyroid hormone profile is not cost-effective.
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http://dx.doi.org/10.1136/bmjopen-2019-029369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677967PMC
July 2019

Ocrelizumab for primary progressive multiple sclerosis.

Lancet Neurol 2019 Sep 3;18(9):816-817. Epub 2019 Jul 3.

National Institute of Health and Care Excellence, London SW1A 2BU, UK.

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http://dx.doi.org/10.1016/S1474-4422(19)30245-5DOI Listing
September 2019

NICE guidance on nivolumab with ipilimumab for untreated advanced renal cell carcinoma.

Lancet Oncol 2019 07 15;20(7):904-905. Epub 2019 May 15.

NICE, London SW1A 2BU, UK.

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http://dx.doi.org/10.1016/S1470-2045(19)30351-1DOI Listing
July 2019
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