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Genomewide Association Study of Platelet Reactivity and Cardiovascular Response in Patients Treated With Clopidogrel: A Study by the International Clopidogrel Pharmacogenomics ConsortiumAntiplatelet response to clopidogrel shows wide variation, and poor response is correlated with adverse clinical outcomes. CYP2C19 loss-of-function alleles play an important role in this response, but account for only a small proportion of variability in response to clopidogrel. An aim of the International Clopidogrel Pharmacogenomics Consortium (ICPC) is to identify other genetic determinants of clopidogrel pharmacodynamics and clinical response. A genomewide association study (GWAS) was performed using DNA from 2,750 European ancestry individuals, using adenosine diphosphate-induced platelet reactivity and major cardiovascular and cerebrovascular events as outcome parameters. GWAS for platelet reactivity revealed a strong signal for CYP2C19*2 (P value = 1.67e−33). After correction for CYP2C19*2 no other single-nucleotide polymorphism reached genomewide significance. GWAS for a combined clinical end point of cardiovascular death, myocardial infarction, or stroke (5.0% event rate), or a combined end point of cardiovascular death or myocardial infarction (4.7% event rate) showed no significant results, although in coronary artery disease, percutaneous coronary intervention, and acute coronary syndrome subgroups, mutations in SCOS5P1, CDC42BPA, and CTRAC1 showed genomewide significance (lowest P values: 1.07e−09, 4.53e−08, and 2.60e−10, respectively). CYP2C19*2 is the strongest genetic determinant of on-clopidogrel platelet reactivity. We identified three novel associations in clinical outcome subgroups, suggestive for each of these outcomes. Copyright 2020 The Authors.
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The National Behavioral Consortium Benchmarking Study: Industry Profile of 82 External EAP ProvidersIt is common practice in many professions, fields and industries to disseminate benchmarking information. Absent this vital resource an individual company cannot accurately evaluate their performance against a similar cohort and therefore must rely upon anecdotal information. The findings of this study address this deficiency in the external Employee Assistance Program (EAP) field by reporting publicly available empirically derived benchmarking data for external providers of EAP services. During 2012 the National Behavioral Consortium conducted a survey that collected data from 82 external EAP vendors primarily located in the United States and Canada. The survey included a total of 44 items organized into eight categories: (1) Company Profile; (2) Staffing; (3) Customer Profile; (4) Utilization Metrics; (5) Survey Tools and Outcomes; (6) Business Management; (7) Business Development; and (8) Forecasting the Future of EAP. The survey respondents included companies that ranged in size from local providers to global business enterprises. The combined customer base represented by these vendors included over 35,000 client companies and over 164 million total covered lives. Results reveal a wide range between vendors on almost all of these factors. Primary findings for utilization include an average case level utilization rate of 4.5% of the covered employee population using the EAP for counseling in the past year (median of 3.6%), with an average of 2.5 counseling sessions delivered per each case. Counseling services were also the most common type of service provided by EAPs, accounting for over 90% of all EAP-related services provided when also considering the use levels for organizational services. In addition to EAP services, 75% of vendors also offered work/life and 49% also offered workplace wellness as “primary” services. Comparisons between smaller and larger market vendors revealed some differences whereas comparisons between countries had few differences. Select benchmarks were also explored between vendors with different pricing models. The role of the Human Resources department at client organizations and product pricing were important themes for business management. Implications for operational practices are discussed along with considerations for future research.
