Digital Commons Network^™

Perceptions On Diversity In Cardiology: A Survey Of Cardiology Fellowship Training Program Directors, Anna Lisa Crowley, Julie Damp, Melanie S Sulistio, Kathryn Berlacher, Donna M Polk, Robert A Hong, Gaby Weissman, Dorothy Jackson, Chittur A Sivaram, James A Arrighi, Andrew M Kates, Claire S Duvernoy, Sandra J Lewis, Quinn Capers Iv

Open Access Publications

Background The lack of diversity in the cardiovascular physician workforce is thought to be an important driver of racial and sex disparities in cardiac care. Cardiology fellowship program directors play a critical role in shaping the cardiology workforce. Methods and Results To assess program directors' perceptions about diversity and barriers to enhancing diversity, the authors conducted a survey of 513 fellowship program directors or associate directors from 193 unique adult cardiology fellowship training programs. The response rate was 21% of all individuals (110/513) representing 57% of US general adult cardiology training programs (110/193). While 69% of respondents endorsed the belief …

Un-Linqed: Spontaneous Extrusion Of Newer Generation Implantable Loop Recorders, Joseph Zakhar, Thomas J Blount, Anil K Gehi, Sunita J Ferns

Open Access Publications

BACKGROUND: Insertable cardiac monitors (ICMs) are often used for long-term monitoring of cardiac rhythm. The Medtronic's LINQ Reveal ™ is a new generation wireless, automated, and patient responsive subcutaneous ECG monitoring device. Despite several advantages to its small size we have noted an unusually high incidence of extrusion at our center.

METHODS: & Results: We conducted a retrospective case analysis to review Reveal LINQs implanted at our center. All devices were inserted using the provided insertion tools. Patients with extruded devices were identified and details regarding the site and technique of insertion, incision closure, use of peri-operative antibiotics, and follow-up …

Reducing Antibiotic Prescribing And Addressing The Global Problem Of Antibiotic Resistance By Targeted Hygiene In The Home And Everyday Life Settings: A Position Paper, Jean-Yves Maillard, Sally F Bloomfield, Patrice Courvalin, Sabiha Y Essack, Sumanth Gandra, Charles P Gerba, Joseph R Rubino, Elizabeth A Scott

Open Access Publications

Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of health care facilities with home and everyday life settings barely addressed. As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms. This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It …

Malignant Cell-Specific Cxcl14 Promotes Tumor Lymphocyte Infiltration In Oral Cavity Squamous Cell Carcinoma, Anuraag Parikh, Juneho Shin, William Faquin, Derrick T Lin, Itay Tirosh, John B Sunwoo, Sidharth V Puram

Open Access Publications

OBJECTIVES: To explore lymphocyte infiltration as a potential mechanism behind CXCL14-mediated tumor growth suppression in oral cavity squamous cell carcinoma (OSCC).

METHODS: We analyzed single cell RNA-sequencing (scRNA-seq) data from OSCC to identify expression changes among malignant cells in lymph nodes (LN) versus primary tumors. CXCL14 expression in murine OSCC cell lines was quantified using qRT-PCR. Short hairpin RNA knockdown of CXCL14 was performed in mouse oral cavity (MOC)1 cells, and CXCL14 overexpression was performed in MOC2 cells. Cells in each condition were injected into C57BL/6 mice with and without T cell depletion, and tumor volume was measured. At 30 …

Association Of Guideline Publication And Delays To Treatment In Pediatric Status Epilepticus, Iván Sánchez Fernández, Réjean M Guerriero, Et Al

Open Access Publications

OBJECTIVE: To determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011-2014) and after (2015-2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.

METHODS: We performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month-21 years of age) with rSE.

RESULTS: We studied 328 patients (56% male) with median (25th-75th percentile [p

CONCLUSION: Publication …

Imaging Features Of Neonatal Systemic Juvenile Xanthogranuloma: A Case Report And Review Of The Literature, Siping He, Ke Jin, Xicheng Deng, Zhengzhen Zhou, Robert C Mckinstry, Yong Wang

Open Access Publications

Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytic disorder in children. This report describes the case of a 28-day-old boy that presented with multiple subcutaneous nodular lesions on the trunk and extremities, and multiple red nodular lesions on the scrotum. Magnetic resonance imaging (MRI) of the brain showed a well-demarcated extra-axial dura-based mass that appeared isointense or slightly hyperintense on T1-weighted images, hypointense on T2-weighted images and had intense enhancement on gadolinium-enhanced T1-weighted images. Computed tomography (CT) or MRI scans of the chest and abdomen revealed multiple scattered nodular or patchy lesions of varying sizes in the lungs, …

Antibiotic Overuse In The Primary Health Care Setting: A Secondary Data Analysis Of Standardised Patient Studies From India, China And Kenya, Giorgia Sulis, Benjamin Daniels, Ada Kwan, Sumanth Gandra, Amrita Daftary, Jishnu Das, Madhukar Pai

Open Access Publications

INTRODUCTION: Determining whether antibiotic prescriptions are inappropriate requires knowledge of patients' underlying conditions. In low-income and middle-income countries (LMICs), where misdiagnoses are frequent, this is challenging. Additionally, such details are often unavailable for prescription audits. Recent studies using standardised patients (SPs) offer a unique opportunity to generate unbiased prevalence estimates of antibiotic overuse, as the research design involves patients with predefined conditions.

METHODS: Secondary analyses of data from nine SP studies were performed to estimate the proportion of SP-provider interactions resulting in inappropriate antibiotic prescribing across primary care settings in three LMICs (China, India and Kenya). In all studies, SPs …

Impact Of Annual And Semi-Annual Mass Drug Administration For Lymphatic Filariasis And Onchocerciasis On Hookworm Infection In Côte D'Ivoire, Agodio Loukouri, Aboulaye Méité, Benjamin G. Koudou, Charles W. Goss, Daphne Lew, Gary J. Weil, Eliezer K. N'Goran, Peter U. Fischer

Open Access Publications

Mass Drug Administration (MDA) programs to eliminate Lymphatic Filariasis (LF) in western Africa use the anthelminthics ivermectin plus albendazole. These drugs have the potential to impact also Soil-Transmitted Helminth (STH) infections, since the drugs have a broad range of anthelminthic activity. Integration of preventive chemotherapy efforts for LF, onchocerciasis and STH is recommended by the World Health Organization (WHO) in order to avoid duplication of MDA and to reduce costs. The objective of the current study was to determine whether five semi-annual rounds of community-wide MDA to eliminate LF and onchocerciasis have a greater impact on STH than three annual …

Counseling On Access To Lethal Means-Emergency Department (Calm-Ed): A Quality Improvement Program For Firearm Injury Prevention, Kristen L Mueller, Sonya Naganathan, Richard T Griffey

Open Access Publications

INTRODUCTION: Suicide is the 10

METHODS: We conducted this single-center, prospective, quality improvement study (QI) in an urban, academic ED with over 90,000 annual patient visits. The study looked at adult patients who were discharged after presenting to the ED with suicidal crisis. Assessment of access to lethal means was conducted at the bedside, followed by a counseling session regarding safe storage of lethal means and follow-up via telephone call 48-72 hours after ED discharge. We collected data on patient's sociodemographics, psychiatric history, access to lethal means, lethal means storage methods, the patient's specific plans for lethal means storage after …

Cd300lf Polymorphisms Of Inbred Mouse Strains Confer Resistance To Murine Norovirus Infection In A Cell Type-Dependent Manner, Kevin Furlong, Scott B. Biering, Jayoung Choi, Craig B. Wilen, Robert C. Orchard, Christiane E. Wobus, Christopher A. Nelson, Daved H. Fremont, Megan T. Baldridge, Glenn Randall, Seungmin Hwang

Open Access Publications

Human norovirus is the leading cause of gastroenteritis worldwide, yet basic questions about its life cycle remain unanswered due to an historical lack of robust experimental systems. Recent studies on the closely related murine norovirus (MNV) have identified CD300LF as an indispensable entry factor for MNV. We compared the MNV susceptibilities of cells from different mouse strains and identified polymorphisms in murine CD300LF which are critical for its function as an MNV receptor. Bone marrow-derived macrophages (BMDMs) from I/LnJ mice were resistant to infection from multiple MNV strains which readily infect BMDMs from C57BL/6J mice. The resistance of I/LnJ BMDMs …

Youth Participatory Research Evidence To Inform Health Policy: A Systematic Review Protocol, Janet Njelesani, Jean Hunleth

Open Access Publications

INTRODUCTION: Young people's participation in health research produces knowledge that is indispensable for creating appropriate and effective policies. However, how best to disseminate youth participatory research evidence to impact health policy is not known. Therefore, the objectives of this systematic review are to describe the evidence produced through youth participatory research, including the strategies used to disseminate youth participatory research evidence to health policymakers. These are necessary to improve policymakers' use of youth participatory research evidence and, thereby, make programmes more impactful for young people.

METHODS AND ANALYSIS: The meta-narrative methodology will guide the systematic review to highlight the contrasting …

Thalidomide For Refractory Gastrointestinal Bleeding From Vascular Malformations In Patients With Significant Comorbidities, Alexis Mae Bayudan, Chien-Huan Chen

Open Access Publications

BACKGROUND: Refractory gastrointestinal bleeding (GIB) secondary to gastrointestinal vascular malformations (GIVM) such as gastrointestinal angiodysplasia (GIAD) and gastric antral vascular ectasia (GAVE) remains challenging to treat when endoscopic therapy fails. Recently thalidomide has been suggested as a treatment option for refractory GIB.

AIM: To determine the outcome of patients treated with thalidomide for refractory GIB due to GIVM.

METHODS: IRB approved, single center, retrospective review of electronic medical records from January 2012 to November 2018. Patients age > 18 years old, who had > 3 episodes of GIB refractory to medical or endoscopic therapy, and who had been treated with thalidomide for …

Osterix-Cre Marks Distinct Subsets Of Cd45- And Cd45+ Stromal Populations In Extra-Skeletal Tumors With Pro-Tumorigenic Characteristics, Biancamaria Ricci, Eric Tycksen, Hamza Celik, Jad I. Belle, Francesca Fontana, Roberto Civitelli, Roberta Faccio

Open Access Publications

Cancer-associated fibroblasts (CAFs) are a heterogeneous population of mesenchymal cells supporting tumor progression, whose origin remains to be fully elucidated. Osterix (Osx) is a marker of osteogenic differentiation, expressed in skeletal progenitor stem cells and bone-forming osteoblasts. We report

Protocol For Economic Evaluation Alongside The Shine (Supporting Healthy Image, Nutrition And Exercise) Cluster Randomised Controlled Trial, Victoria Brown, Joanne Williams, Lisa Mcgivern, Susan Sawyer, Liliana Orellana, Wei Luo, Kylie D Hesketh, Denise E Wilfley, Marj Moodie

Open Access Publications

INTRODUCTION: Limited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adolescents, as well as targeted advice to young people with body image concerns who are at risk of developing disordered eating behaviours. This paper describes the methods for the economic evaluation of the SHINE cRCT, to determine whether the intervention is cost-effective as an obesity prevention measure.

METHODS AND ANALYSIS: A public payer …

Effectiveness Of A Digital Cognitive Behavior Therapy-Guided Self-Help Intervention For Eating Disorders In College Women: A Cluster Randomized Clinical Trial, Ellen E. Fitzsimmons-Craft, C. Barr Taylor, Andrea K. Graham, Shiri Sadeh-Sharvit, Katherine N. Balantekin, Dawn M. Eichen, Grace E. Monterubio, Neha J. Goel, Rachael E. Flatt, Anna M. Karam, Marie-Laure Firebaugh, Corinna Jacobi, Booil Jo, Mickey T. Trockel, Denise E. Wilfley

Open Access Publications

Importance: Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap.

Objective: To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care.

Design, Setting, and Participants: This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the …

Sarm1 Acts Downstream Of Neuroinflammatory And Necroptotic Signaling To Induce Axon Degeneration, Kwang Woo Ko, Jeffrey Milbrandt, Aaron Diantonio

Open Access Publications

Neuroinflammation and necroptosis are major contributors to neurodegenerative disease, and axon dysfunction and degeneration is often an initiating event. SARM1 is the central executioner of pathological axon degeneration. Here, we demonstrate functional and mechanistic links among these three pro-degenerative processes. In a neuroinflammatory model of glaucoma, TNF-α induces SARM1-dependent axon degeneration, oligodendrocyte loss, and subsequent retinal ganglion cell death. TNF-α also triggers SARM1-dependent axon degeneration in sensory neurons via a noncanonical necroptotic signaling mechanism. MLKL is the final executioner of canonical necroptosis; however, in axonal necroptosis, MLKL does not directly trigger degeneration. Instead, MLKL induces loss of the axon survival …

Deconvolving The Contributions Of Cell-Type Heterogeneity On Cortical Gene Expression, Ellis Patrick, Mariko Taga, Ayla Ergun, Bernard Ng, William Casazza, Maria Cimpean, Christina Yung, Julie A. Schneider, David A. Bennett, Chris Gaiteri, Philip L. De Jager, Elizabeth M. Bradshaw, Sara Mostafavi

Open Access Publications

Complexity of cell-type composition has created much skepticism surrounding the interpretation of bulk tissue transcriptomic studies. Recent studies have shown that deconvolution algorithms can be applied to computationally estimate cell-type proportions from gene expression data of bulk blood samples, but their performance when applied to brain tissue is unclear. Here, we have generated an immunohistochemistry (IHC) dataset for five major cell-types from brain tissue of 70 individuals, who also have bulk cortical gene expression data. With the IHC data as the benchmark, this resource enables quantitative assessment of deconvolution algorithms for brain tissue. We apply existing deconvolution algorithms to brain …

Radiation Causes Tissue Damage By Dysregulating Inflammasome-Gasdermin D Signaling In Both Host And Transplanted Cells, Jianqiu Xiao, Chun Wang, Juo-Chin Yao, Yael Alippe, Tong Yang, Dustin Kress, Kai Sun, Kourtney L. Kostecki, Joseph B. Monahan, Deborah J. Veis, Yousef Abu-Amer, Daniel C. Link, Gabriel Mbalaviele

Open Access Publications

Radiotherapy is a commonly used conditioning regimen for bone marrow transplantation (BMT). Cytotoxicity limits the use of this life-saving therapy, but the underlying mechanisms remain poorly defined. Here, we use the syngeneic mouse BMT model to test the hypothesis that lethal radiation damages tissues, thereby unleashing signals that indiscriminately activate the inflammasome pathways in host and transplanted cells. We find that a clinically relevant high dose of radiation causes severe damage to bones and the spleen through mechanisms involving the NLRP3 and AIM2 inflammasomes but not the NLRC4 inflammasome. Downstream, we demonstrate that gasdermin D (GSDMD), the common effector of …

Which Metrics Are Being Used To Evaluate Children And Adolescents After Acl Reconstruction? A Systematic Review, Peter D Fabricant, Christopher M Brusalis, Jonathan M Schachne, Pluto Study Group, Matthew J Matava

Open Access Publications

PURPOSE: To identify a comprehensive list of outcome measures previously used in the literature to evaluate clinical outcomes after reconstruction of the anterior cruciate ligament (ACL) in patients 18 years of age or younger.

METHODS: A literature search was performed by querying MEDLINE, Embase and Cochrane computerized databases for relevant articles that reported clinical outcomes in pediatric patients undergoing ACL reconstruction. Studies that were nonclinical, that reported on patients older than 19 years, that were not available in English, or that included fewer than 10 patients were excluded. Outcome measures of all eligible studies were recorded.

RESULTS: We identified 77 …

The Personality Profile Of Chronic Alcohol Dependent Patients With Comorbid Gambling Disorder Symptoms, Ildikó Kovács, Ildikó Katalin Pribék, Ildikó Demeter, Sándor Rózsa, Zoltán Janka, Zsolt Demetrovics, Bálint Andó

Open Access Publications

BACKGROUND AND AIMS: The importance of personality characteristics in the diagnosis and treatment of gambling disorder (GD) and alcohol use disorder (AUD) is often highlighted in scientific literature. This study aimed to test predictions about the associations of temperament and character in chronic AUD patients with comorbid GD symptoms and without them.

METHODS: Chronic AUD patients enrolled from an inpatient clinic were divided in two groups based on cluster analysis, AUD patients with (AUD + GD group: n = 30) and without (AUD group: n = 68) GD symptoms. Severity of GD symptoms and personality dimensions (Cloninger's Temperament and Character …

A Cross-Reactive Antibody Protects Against Ross River Virus Musculoskeletal Disease Despite Rapid Neutralization Escape In Mice, Julie M. Fox, Ling Huang, Stephen Tahan, Laura A. Powell, James E. Crowe, David Wang, Michael S. Diamond

Open Access Publications

Arthritogenic alphaviruses cause debilitating musculoskeletal disease and historically have circulated in distinct regions. With the global spread of chikungunya virus (CHIKV), there now is more geographic overlap, which could result in heterologous immunity affecting natural infection or vaccination. Here, we evaluated the capacity of a cross-reactive anti-CHIKV monoclonal antibody (CHK-265) to protect against disease caused by the distantly related alphavirus, Ross River virus (RRV). Although CHK-265 only moderately neutralizes RRV infection in cell culture, it limited clinical disease in mice independently of Fc effector function activity. Despite this protective phenotype, RRV escaped from CHK-265 neutralization in vivo, with resistant variants …

Virus Infection Is Controlled By Hematopoietic And Stromal Cell Sensing Of Murine Cytomegalovirus Through Sting, Sytse J. Piersma, Jennifer Poursine-Laurent, Liping Yang, Glen N. Barber, Bijal A. Parikh, Wayne M. Yokoyama

Open Access Publications

Recognition of DNA viruses, such as cytomegaloviruses (CMVs), through pattern-recognition receptor (PRR) pathways involving MyD88 or STING constitute a first-line defense against infections mainly through production of type I interferon (IFN-I). However, the role of these pathways in different tissues is incompletely understood, an issue particularly relevant to the CMVs which have broad tissue tropisms. Herein, we contrasted anti-viral effects of MyD88 versus STING in distinct cell types that are infected with murine CMV (MCMV). Bone marrow chimeras revealed STING-mediated MCMV control in hematological cells, similar to MyD88. However, unlike MyD88, STING also contributed to viral control in non-hematological, stromal …

The Brief Case: "Not Positive" Or "Not Sure"-Covid-19-Negative Results In A Symptomatic Patient, Bijal A Parikh, Thomas C Bailey, Patrick G Lyons, Neil W Anderson

Open Access Publications

No abstract provided.

Expert Consensus On The Management Of Adverse Events And Prescribing Practices Associated With The Treatment Of Patients Taking Pirfenidone For Idiopathic Pulmonary Fibrosis: A Delphi Consensus Study, Franck F Rahaghi, Zeenat Safdar, Anne Whitney Brown, Joao A De Andrade, Kevin R Flaherty, Robert J Kaner, Christopher S King, Maria L Padilla, Imre Noth, Mary Beth Scholand, Adrian Shifren, Steven D Nathan

Open Access Publications

BACKGROUND: In patients with idiopathic pulmonary fibrosis (IPF) treated with pirfenidone (Esbriet®, Genentech USA, Inc. South San Francisco, CA.), effectively managing treatment-related adverse events (AEs) may improve adherence. Due to a lack of clinical evidence and expertise, managing these AEs can be challenging for patients and physicians alike. In the absence of evidence, consensus recommendations from physicians experienced in using pirfenidone to treat IPF are beneficial.

METHODS: Using a modified Delphi process, expert recommendations were developed by a panel of physicians experienced with using pirfenidone for IPF. Over three iterations, panelists developed and refined a series of statements on the …

Analysis Of Single-Cell Rnaseq Identifies Transitional States Of T Cells Associated With Hepatocellular Carcinoma, Yanying Yang, Fangming Liu, Weiren Liu, Mingyue Ma, Jie Gao, Yan Lu, Li-Hao Huang, Xiaoying Li, Yinghong Shi, Xiangdong Wang, Duojiao Wu

Open Access Publications

BACKGROUND: Exhausted T cells and regulatory T cells (Tregs) comprise diverse subsets of tumor immunosuppressive microenvironment that play key roles in tumor progress. Understanding subset diversity in T cells is a critical question for developing cancer immunotherapy.

METHODS: A total of 235 specimens from surgical resections of hepatocellular carcinoma (HCC) patients were examined for infiltration of exhausted T cell (Tex) in tumor and adjacent tissue. We conducted deep single-cell targeted immune profiling on CD3

RESULTS: We observed transitional differentiation of exhausted CD8

CONCLUSIONS: T cell exhaustion is a progressive process, and the gene-expression profiling displayed T cell exhaustion and anergy …

Taf15 Contributes To The Radiation-Inducible Stress Response In Cancer, Abhay Kumar Singh, Vaishali Kapoor, Dinesh Thotala, Dennis E. Hallahan

Open Access Publications

Resistance to radiation therapy is a significant problem in the treatment of non-small cell lung cancer (NSCLC). There is an unmet need to discover new molecular targets for drug development in combination with standard of care cancer therapy. We found that TAF15 was radiation-inducible using phage-displayed peptide libraries. In this study, we report that overexpression of TAF15 is correlated with worsened survival in NSCLC patients. Radiation treatment led to surface induction of TAF15

Clinical Teaching: An Evidence-Based Guide To Best Practices From The Council Of Emergency Medicine Residency Directors, Sreeja Natesan, John Bailitz, Andrew King, Sara M Krzyzaniak, Sarah K Kennedy, Albert J Kim, Richard Byyny, Michael Gottlieb

Open Access Publications

Clinical teaching is the primary educational tool use to train learners from day one of medical school all the way to the completion of fellowship. However, concerns over time constraints and patient census have led to a decline in bedside teaching. This paper provides a critical review of the literature on clinical teaching with a focus on instructor teaching strategies, clinical teaching models, and suggestions for incorporating technology. Recommendations for instructor-related teaching factors include adequate preparation, awareness of effective teacher attributes, using evidence-based-knowledge dissemination strategies, ensuring good communication, and consideration of environmental factors. Proposed recommendations for potential teaching strategies include …

Associations Among Discharge Opioid Prescribing And Inpatient Postpartum Opioid Usage After Delivery, Ashley Veade, Tyler Mckinnish, Ebony Carter, Adam Lewkowitz

Open Access Publications

No abstract provided.

Clinical Outcomes Of Patients With Advanced Synovial Sarcoma Or Myxoid/Round Cell Liposarcoma Treated At Major Cancer Centers In The United States, Seth M Pollack, Neeta Somaiah, Dejka M Araujo, Mihaela Druta, Brian A Van Tine, Melissa A Burgess, Sant P Chawla, Mahesh Seetharam, Scott H Okuno, Chet Bohac, Michael Chen, Sergey Yurasov, Steven Attia

Open Access Publications

BACKGROUND: Outcomes data regarding advanced synovial sarcoma (SS) and myxoid/round cell liposarcoma (MRCL) are limited, consisting primarily of retrospective series and post hoc analyses of clinical trials.

METHODS: In this multi-center retrospective study, data were abstracted from the medical records of 350 patients from nine sarcoma centers throughout the United States and combined into a registry. Patients with advanced/unresectable or metastatic SS (n = 249) or MRCL (n = 101) who received first-line systemic anticancer therapy and had records of tumor imaging were included. Overall survival (OS), time to next treatment, time to distant metastasis, and progression-free survival (PFS) were …

A Simplified, Combined Protocol Versus Standard Treatment For Acute Malnutrition In Children 6-59 Months (Compas Trial): A Cluster-Randomized Controlled Non-Inferiority Trial In Kenya And South Sudan, Jeanette Bailey, Charles Opondo, Natasha Lelijveld, Bethany Marron, Pamela Onyo, Eunice N. Musyoki, Susan W. Adongo, Mark Manary, André Briend, Marko Kerac

Open Access Publications

BACKGROUND: Malnutrition underlies 3 million child deaths worldwide. Current treatments differentiate severe acute malnutrition (SAM) from moderate acute malnutrition (MAM) with different products and programs. This differentiation is complex and costly. The Combined Protocol for Acute Malnutrition Study (ComPAS) assessed the effectiveness of a simplified, unified SAM/MAM protocol for children aged 6-59 months. Eliminating the need for separate products and protocols could improve the impact of programs by treating children more easily and cost-effectively, reaching more children globally.

METHODS AND FINDINGS: A cluster-randomized non-inferiority trial compared a combined protocol against standard care in Kenya and South Sudan. Randomization was stratified …