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Rein DB, Hackney ME, Haddad YK, Sublett FA, Moreland B, Imhof L, Peterson C, Legha JK, Mark J, Vaughan CP, Johnson Ii TM, Bergen G. Telemedicine-Based Risk Program to Prevent Falls Among Older Adults: Protocol for a Randomized Quality Improvement Trial. JMIR Res Protoc 2024; 13:e54395. [PMID: 38346180 PMCID: PMC11005432 DOI: 10.2196/54395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND The Center for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers health care providers tools and resources to assist with fall risk screening and multifactorial fall risk assessment and interventions. Its effectiveness has never been evaluated in a randomized trial. OBJECTIVE This study aims to describe the protocol for the STEADI Options Randomized Quality Improvement Trial (RQIT), which was designed to evaluate the impact on falls and all-cause health expenditures of a telemedicine-based form of STEADI implemented among older adults aged 65 years and older, within a primary care setting. METHODS STEADI Options was a pragmatic RQIT implemented within a health system comparing a telemedicine version of the STEADI fall risk assessment to the standard of care (SOC). Before screening, we randomized all eligible patients in participating clinics into the STEADI arm or SOC arm based on their scheduled provider. All received the Stay Independent screener (SIS) to determine fall risk. Patients were considered at risk for falls if they scored 4 or more on the SIS or answered affirmatively to any 1 of the 3 key questions within the SIS. Patients screened at risk for falls and randomized to the STEADI arm were offered a registered nurse (RN)-led STEADI assessment through telemedicine; the RN provided assessment results and recommendations to the providers, who were advised to discuss fall-prevention strategies with their patients. Patients screened at risk for falls and randomized to the SOC arm were asked to participate in study data collection only. Data on recruitment, STEADI assessments, use of recommended prevention services, medications, and fall occurrences were collected using electronic health records and patient surveys. Using staff time diaries and administrative records, the study prospectively collected data on STEADI implementation costs and all-cause outpatient and inpatient charges incurred over the year following enrollment. RESULTS The study enrolled 720 patients (n=307, 42.6% STEADI arm; n=353, 49% SOC arm; and n=60, 8.3% discontinued arm) from September 2020 to December 2021. Follow-up data collection was completed in January 2023. As of February 2024, data analysis is complete, and results are expected to be published by the end of 2025. CONCLUSIONS The STEADI RQIT evaluates the impact of a telemedicine-based, STEADI-based fall risk assessment on falls and all-cause health expenditures and can provide information on the intervention's effectiveness and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT05390736, http://clinicaltrials.gov/ct2/show/NCT05390736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/54395.
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Affiliation(s)
- David B Rein
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Madeleine E Hackney
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Yara K Haddad
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Farah A Sublett
- Department of Public Health, NORC at the University of Chicago, Atlanta, GA, United States
| | - Briana Moreland
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Laurie Imhof
- Department of Health Sciences, NORC at the University of Chicago, Chicago, IL, United States
| | - Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jaswinder K Legha
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Janice Mark
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States
| | - Camille P Vaughan
- Department of Medicine, Division of Geriatrics and Gerontology, Emory University School of Medicine, Atlanta, GA, United States
- Atlanta Veterans Affairs Center for Visual & Neurocognitive Rehabilitation, Atlanta, GA, United States
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
| | - Theodore M Johnson Ii
- Birmingham/Atlanta VA Geriatric Research Education Clinical Center, Atlanta, GA, United States
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Gwen Bergen
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Moreland B, Shakya I, Idaikkadar N. Development and Evaluation of Syndromic Surveillance Definitions for Fall- and Hip Fracture-Related Emergency Department Visits Among Adults Aged 65 Years and Older, United States 2017-2018. J Public Health Manag Pract 2023; 29:297-305. [PMID: 36730978 PMCID: PMC10038877 DOI: 10.1097/phh.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To develop syndromic surveillance definitions for unintentional fall- and hip fracture-related emergency department (ED) visits among older adults (aged ≥65 years) for use in the Centers for Disease Control and Prevention's National Syndromic Surveillance Program (NSSP) data and compare the percentage of ED visits captured using these new syndromes with ED visits from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS), a nationally representative administrative data set. DESIGN/SETTING Syndromic definitions were developed using chief complaint terms and discharge diagnosis codes in NSSP data. The percentages of ED visits among older adults related to falls and hip fractures in NSSP were compared with the percentages in HCUP-NEDS in 2017 and 2018. MEASURES Prevalence ratios were calculated as the relative difference in the percentage of ED visits related to falls or hip fractures in NSSP compared with HCUP-NEDS. Counts and percentages calculated using HCUP-NEDS were weighted to produce nationally representative estimates. Data were analyzed overall and by sex and age group. RESULTS The percentage of ED visits among older adults related to falls in NSSP was 12% less in 2017 (10.81%) and 7% less in 2018 (11.42%) compared with HCUP-NEDS (2017: 12.30%; 2018: 12.26%). The percentage of ED visits among older adults related to hip fractures in NSSP was 41% less in 2017 (0.65%) and 30% less in 2018 (0.76%) compared with HCUP-NEDS (2017: 1.10%; 2018: 1.09%). In both 2017 and 2018, a higher percentage of ED visits among older women and adults aged 85 years or older were related to falls or hip fractures compared with older men and younger age groups across both data sets. CONCLUSION A smaller percentage of older adults' ED visits met the falls and hip fracture definitions in NSSP compared with HCUP-NEDS in 2017 and 2018. However, demographic trends remained similar across both data sets.
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Affiliation(s)
- Briana Moreland
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Mss Moreland and Shakya and Mr Idaikkadar); and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (Ms Shakya)
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Haddad Y, Bergen G, Shakya I, Yuan K, Law R, Moreland B, Haileyesus T. TRENDS IN FALL-RELATED EMERGENCY DEPARTMENT VISITS INVOLVING ALCOHOL AMONG OLDER ADULTS: 2011–2020. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Falls disproportionately affect older adults (≥65) resulting in three million emergency department (ED) visits annually. The relationship between alcohol and falls is unclear, but side effects of alcohol consumption include gait and balance impairments, which are risk factors for falls. This study examined trends of older adult fall-related ED visits involving alcohol from 2011-2020. Alcohol data are not routinely collected during ED visits. Alcohol involvement was identified from National Electronic Injury Surveillance System-All Injury Program free-text narratives using natural language processing and text analytic techniques. Joinpoint regression was used and cross-validated with SAS to determine significant older adult fall changes from 2011-2020 by sex and to compare older adult trends to adults < 65 (20-34, 35-54, 55-64). From 2011-2020, 2.2% of all ED visits for older adult falls involved alcohol. Alcohol-involved fall ED visit rates for older adults increased annually by 7.2% (95%CI:6.1%-8.4%). These older adult ED visit rates increased by 6.8% (95%CI:5.4%-8.2%) for males and 7.4% (95%CI:6.0%-8.9%) for females annually. For adults aged 20-34 and 35-54, alcohol-involved fall ED visit rates increased annually by 1.3% (95%CI:0.1%-2.6%) and 3.8% (95%CI:2.7%-5.0%), respectively, until 2017 and then decreased by 4.4% (95%CI:1.2%-7.5%) and 4.0% (95%CI:0.3%-7.5%). For adults aged 55-64, ED visit rates increased annually by 8.5% (95%CI:6.8%-10.2%) until 2018 and then stabilized. Documenting alcohol use when treating falls is important for monitoring trends. Assessing alcohol use in conjunction with assessments for other fall risk factors can inform healthcare providers on effective strategies to recommend to reduce fall risk.
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Affiliation(s)
- Yara Haddad
- Centers for Disease Control and Prevention , Atlanta, Georgia , United States
| | - Gwen Bergen
- Centers for Disease Control and Prevention , Atlanta, Georgia , United States
| | - Iju Shakya
- Oak Ridge Institute for Science and Education , Oak Ridge, Tennessee , United States
| | - Keming Yuan
- Centers for Disease Control and Prevention , Atlanta, Georgia , United States
| | - Royal Law
- Centers for Disease Control and Prevention , Atlanta, Georgia , United States
| | - Briana Moreland
- Cherokee Nation Operational Solutions , Atlanta, Georgia , United States
| | - Tadesse Haileyesus
- Centers for Disease Control and Prevention , Atlanta, Georgia , United States
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Moreland B, Ortmann N, Clemens T. Increased unintentional drowning deaths in 2020 by age, race/ethnicity, sex, and location, United States. J Safety Res 2022; 82:463-468. [PMID: 36031277 PMCID: PMC9418042 DOI: 10.1016/j.jsr.2022.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, one study in Australia showed an increase in drowning deaths in certain settings, while a study in China showed a decrease in drowning deaths. The impact of the COVID-19 pandemic on drowning deaths in the United States is unknown. OBJECTIVE To report on unintentional drowning deaths among U.S. persons aged ≤29 years by demographic characteristics and compare 2020 fatal drowning rates with rates from 2010 to 2019. METHODS Data from CDC WONDER were analyzed to calculate unintentional drowning death rates among persons aged ≤29 years by age group, sex, race/ethnicity, and location of drowning. These rates were compared to drowning death rates for the previous 10 years (2010-2019). RESULTS In 2020, 1.26 per 100,000 persons aged ≤29 years died from unintentional drowning, a 16.79% increase from 2019. Drowning death rates decreased 1.81% per year on average (95% CI: -3.02%, -0.59%) from 2010 to 2019. The largest increases in unintentional drowning deaths from 2019 to 2020 occurred among young adults aged 20 to 24 years (44.12%), Black or African American persons (23.73%), and males (19.55%). The location with the largest increase in drowning was natural water (26.44%). CONCLUSION Drowning death rates among persons aged ≤29 years significantly increased from 2019 to 2020. Further research is needed to understand the impacts of the COVID-19 pandemic on drowning and identify how drowning prevention strategies can be adapted and strengthened. PRACTICAL APPLICATIONS Drowning remains a leading cause of injury death among persons aged ≤29 years. However, drowning is preventable. Interventions such as learning basic swimming and water safety skills, and consistent use of lifejackets on boats and among weaker swimmers in natural water, have the potential to reduce drowning deaths. Developing strategies that ensure equitable access to these interventions may prevent future drowning.
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Affiliation(s)
- Briana Moreland
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States; Cherokee Nation Operational Solutions, United States.
| | - Neil Ortmann
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States; Oak Ridge Institute for Science and Education, United States
| | - Tessa Clemens
- Division of Injury Prevention, National Center of Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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Clemens T, Moreland B, Lee R. Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years - United States, 1999-2019. MMWR Morb Mortal Wkly Rep 2021; 70:869-874. [PMID: 34138831 PMCID: PMC8220955 DOI: 10.15585/mmwr.mm7024a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Moreland B, Lee R. Emergency Department Visits and Hospitalizations for Selected Nonfatal Injuries Among Adults Aged ≥65 Years - United States, 2018. MMWR Morb Mortal Wkly Rep 2021; 70:661-666. [PMID: 33956783 PMCID: PMC9368752 DOI: 10.15585/mmwr.mm7018a1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Approximately 60,000 older adults (aged ≥65 years) die from unintentional injuries each year; in 2019 these included 34,000 fall deaths, 8,000 traffic-related motor vehicle crash deaths, and 3,000 drug poisoning deaths (1). In addition, >9,000 suicide deaths occur among older adults each year (1). Deaths among older adults account for 33% of these unintentional injury deaths and 19% of suicide deaths among all age groups (1). Nonfatal injuries from these causes are more common in this age group and can lead to long-term health consequences, such as brain injury and loss of independence. This study included 2018 data from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) to determine the prevalence of selected nonfatal injuries among older adults treated in emergency departments (EDs) and hospitals. Injury mechanisms among the leading causes of injury death in older adults were studied, including unintentional falls, unintentional traffic-related motor vehicle crashes, unintentional opioid overdoses, and self-harm (suicidal and nonsuicidal by any mechanism). In 2018, an estimated 2.4 million ED visits and >700,000 hospitalizations from these injuries occurred among adults aged ≥65 years. Unintentional falls accounted for >90% of the selected ED visits and hospitalizations. Injuries among older adults can be prevented (2). Educational campaigns, such as CDC's Still Going Strong* awareness campaign, that use positive messages can encourage older adults to take steps to prevent injuries. Health care providers can help prevent injuries by recommending that older patients participate in effective interventions, including referrals to physical therapy and deprescribing certain medications.†.
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Gaspar N, Campbell-Hewson Q, Bielack S, Campbell M, Bautista F, Meazza C, Janeway K, Dela Cruz F, Whittle S, Morgenstern D, Dutta L, McKenzie J, O'Hara K, Huang J, Okpara C, Bidadi B, Koh KN, Moreland B. 443TiP A multicenter, open-label, randomized phase II study to compare the efficacy and safety of lenvatinib in combination with ifosfamide and etoposide versus ifosfamide and etoposide in children, adolescents, and young adults with relapsed or refractory osteosarcoma (OLIE; ITCC-082). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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West BA, Bergen G, Moreland B. Older Adults' Attitudes About Future Mobility Changes and the Usefulness of Mobility Assessment Materials. J Appl Gerontol 2020; 40:1356-1365. [PMID: 32783575 DOI: 10.1177/0733464820947927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To understand older adults' attitudes about future mobility and usefulness of mobility assessment materials. METHODS Data came from a telephone survey of 1,000 older adults aged 60-74 years. After answering baseline questions, respondents received mobility assessment materials, then completed follow-up interviews. Respondents were asked about future mobility challenges. During baseline and follow-up, subjects were asked four questions about their mobility as they aged which measured thinking about mobility, thinking about protecting mobility, confidence in protecting mobility, and motivation to protect mobility. Differences in percent of respondents' attitudes between baseline and follow-up and 95% confidence intervals were calculated. RESULTS Driving (42%) was the most commonly reported challenge. Significant increases from baseline to follow-up in thinking about mobility (25%), thinking about protecting mobility (39%), and confidence in protecting mobility (29%) were reported. DISCUSSION Brief mobility assessment materials can encourage older adults to consider future mobility. Planning for changes can prolong safe mobility.
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Affiliation(s)
- Bethany A West
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gwen Bergen
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018. MMWR Morb Mortal Wkly Rep 2020; 69:875-881. [PMID: 32644982 PMCID: PMC7732363 DOI: 10.15585/mmwr.mm6927a5] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mark J, Bergen G, Moreland B. UNDERSTANDING FACILITATORS AND BARRIERS TO PARTICIPATION IN EVIDENCE-BASED FALL-PREVENTION INTERVENTIONS. Innov Aging 2019. [PMCID: PMC6845763 DOI: 10.1093/geroni/igz038.2095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prescribing evidence-based interventions based on older adults’ modifiable risk factors is recommended to prevent falls. Older adults need to adhere to the prescribed intervention to successfully reduce risk. This study reports on a structured systematic review to understand patient attitudes to adherence to fall prevention interventions. A systematic search for publications from 2008-2018 identified 72 articles on patient attitudes toward exercise, physical therapy, medication management, podiatry, and vision care for fall prevention. Three reviewers coded facilitators and barriers based on a socio-ecological model of interpersonal, intrapersonal, community, and policy factors. Perceived susceptibility to falling and perceived effectiveness of the intervention were important factors across all fall prevention interventions. Physician prescribing and discussion facilitated exercise, medication changes, and physical therapy. For attitudes related to community and policy, the most reported barriers were transportation and cost. Information from this review can be used to improve the implementation of fall prevention interventions.
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Affiliation(s)
- Janice Mark
- American Association of Colleges in Nursing, Washington DC, United States
| | - Gwen Bergen
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Briana Moreland
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Abstract
INTRODUCTION In 2017, unintentional injuries were the seventh leading cause of death among older adults (age ≥ 65), resulting in over 55,000 deaths. Falls accounted for more than half of these deaths. Given that older adults are the fastest growing age group in the United States, we can anticipate that injuries will become an even greater health concern in the near future. METHODS Aging without injury is possible. There are evidence-based strategies that can reduce falls. However, older adults may not realize that falls can be prevented or they may be afraid to admit their fear of falling or difficulty with walking as these issues may signal their inability to live independently. RESULTS In this commentary, we will highlight what the Centers for Disease Control and Prevention is doing to prevent older adult falls. We also highlight the importance of broadening older adults' awareness about falls to successfully empower them to begin contemplating and preparing to adopt fall prevention strategies that can help them age in place. CONCLUSIONS Older adult falls are common and can result in severe injury and death but they can be prevented. Broadening older adults' awareness about falls can empower them to take the actions necessary to reduce their fall risk. Practical applications: Increasing awareness about falls can help older adults, healthcare providers, and local and state health departments take steps to reduce fall risk.
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Affiliation(s)
- Robin Lee
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States.
| | - Briana Moreland
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention, 4770 Buford Highway, Atlanta, GA 30341, United States; Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, United States
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Tvaskis V, Christy ME, Arrington J, Asaturyan R, Baker OK, Blok HP, Bosted P, Boswell M, Bruell A, Cochran A, Cole L, Crowder J, Dunne J, Ent R, Fenker HC, Filippone BW, Garrow K, Gasparian A, Gomez J, Jackson HE, Keppel CE, Kinney E, Lapikás L, Liang Y, Lorenzon W, Lung A, Mack DJ, Martin JW, McIlhany K, Meekins D, Milner RG, Mitchell JH, Mkrtchyan H, Moreland B, Nazaryan V, Niculescu I, Opper A, Piercey RB, Potterveld DH, Rose B, Sato Y, Seo W, Smith G, Spurlock K, van der Steenhoven G, Stepanyan S, Tadevosian V, Uzzle A, Vulcan WF, Wood SA, Zihlmann B, Ziskin V. Longitudinal-transverse separations of deep-inelastic structure functions at low Q2 for hydrogen and deuterium. Phys Rev Lett 2007; 98:142301. [PMID: 17501267 DOI: 10.1103/physrevlett.98.142301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Indexed: 05/15/2023]
Abstract
We report on a study of the longitudinal to transverse cross section ratio, R=sigmaL/sigmaT, at low values of x and Q2, as determined from inclusive inelastic electron-hydrogen and electron-deuterium scattering data from Jefferson Laboratory Hall C spanning the four-momentum transfer range 0.06<Q2<2.8 GeV2. Even at the lowest values of Q2, R remains nearly constant and does not disappear with decreasing Q2, as might be expected. We find a nearly identical behavior for hydrogen and deuterium.
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Affiliation(s)
- V Tvaskis
- Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
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Abstract
Most pediatric thoracic malignancy is pulmonary disease secondary to solid tumors of childhood. The management of isolated pulmonary metastases in adulthood is well documented. Little has been published to document the long-term outcome of pulmonary metastasectomy in childhood. A retrospective study was undertaken to assess the results of surgery for isolated pulmonary metastases. Twenty children underwent surgery over 12 years (mean follow-up 8 years). Five had Wilms' tumor (mean age 51 months), eight had osteogenic sarcoma (mean age 141 months), three had rhabdomyosarcoma (mean age 92 months), two had hepatoblastoma (mean age 30 months) and two had teratoma (mean age 72 months). Four had bilateral synchronous metastases and thoracotomies, and one had bilateral metachronous metastases and thoracotomies. Nineteen children were discharged well within 10 days of surgery. There was one early complication: a death due to pneumonia. Four children subsequently died postoperatively with cranial metastases (mean 29 months postoperatively). The remaining 16 children remain alive and well. As part of the combined therapy, these results would support an aggressive surgical approach to this disease. Preoperative assessment should include contrast enhanced computed tomogram of the head and chest as well as chest X-ray taken immediately preoperatively to exclude metastases. Bilateral synchronous and metachronous thoracotomy is well tolerated in childhood.
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Affiliation(s)
- R M Abel
- Department of Pediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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Lall A, Schulster D, Moreland B. A differential extraction procedure for studying changes in skeletal muscle proteins. Biochem Soc Trans 1993; 21 ( Pt 3):278S. [PMID: 8224428 DOI: 10.1042/bst021278s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A Lall
- Division of Biochemistry, U.M.D.S., Guy's Hospital, London
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Rubenstein EB, Rolston K, Benjamin RS, Loewy J, Escalante C, Manzullo E, Hughes P, Moreland B, Fender A, Kennedy K. Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer 1993. [PMID: 8490912 DOI: 10.1002/1097-0142(19930601)71:11<3640::aid-cncr2820711128>3.0.co;2-h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hospitalization and intravenous (IV) broad-spectrum antibiotics are the standard of care for all febrile neutropenic patients with cancer. Recent work suggests that a low-risk population exists who might benefit from an alternate approach. METHODS A prospective randomized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clindamycin 600 mg every 8 hours for the empiric outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. RESULTS The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than that of the IV regimen (P < 0.0001), it was associated with significant renal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superior (P = 0.03). CONCLUSIONS This prospective study suggested that outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.
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Affiliation(s)
- E B Rubenstein
- Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030
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Rubenstein EB, Rolston K, Benjamin RS, Loewy J, Escalante C, Manzullo E, Hughes P, Moreland B, Fender A, Kennedy K. Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer 1993; 71:3640-6. [PMID: 8490912 DOI: 10.1002/1097-0142(19930601)71:11<3640::aid-cncr2820711128>3.0.co;2-h] [Citation(s) in RCA: 205] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hospitalization and intravenous (IV) broad-spectrum antibiotics are the standard of care for all febrile neutropenic patients with cancer. Recent work suggests that a low-risk population exists who might benefit from an alternate approach. METHODS A prospective randomized clinical trial was performed comparing oral ciprofloxacin 750 mg plus clindamycin 600 mg every 8 hours with IV aztreonam 2 g plus clindamycin 600 mg every 8 hours for the empiric outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. RESULTS The oral regimen cured 35 of 40 episodes (88% response rate), whereas the IV regimen cured 41 of 43 episodes (95% response rate, P = 0.19). Although the cost of the oral regimen was significantly less than that of the IV regimen (P < 0.0001), it was associated with significant renal toxicity (P < 0.05), which led to early termination of the study. Overall, combining its safety and efficacy, the IV regimen was superior (P = 0.03). CONCLUSIONS This prospective study suggested that outpatient antibiotic therapy for febrile episodes in low-risk neutropenic patients with cancer is safe and effective. Better oral regimens are needed.
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Affiliation(s)
- E B Rubenstein
- Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston 77030
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Watts DC, Anosike EO, Moreland B, Pollitt RJ, Lee CR. The use of arginine analogues for investigating the functional organization of the arginine-binding site in lobster muscle arginine kinase. Role of the 'essential' thiol group. Biochem J 1980; 185:593-9. [PMID: 6248027 PMCID: PMC1161435 DOI: 10.1042/bj1850593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
1. The nature of arginine binding to lobster arginine kinase and the extent of its possible involvement with the ;essential' thiol group of the enzyme has been investigated with some inhibitory analogues of arginine. 2. Most of the analogues inhibit competitively, although mixed inhibition may occur if the alpha-carboxy group or alpha-amino group is absent. 3. The K(i) values indicate that strength of binding depends on the length of the carbon chain (l-isoleucine>l-valine>l- alpha-aminobutyrate>l-alanine) and the integrity of the substituents on the alpha-carbon atom (l-arginine>agmatine and l-ornithine>putrescine). The guanidino group probably contributes little to substrate binding, but a positive charge near the delta-nitrogen atom appears to be important (l-ornithine>l -citrulline>l-alpha-aminobutyrate). A cyclic analogue, 2-carboxymethyl-3-oxo-2,3,5,6,7,8-hexahydro-1H-imidazo [1,2-a][1,3]diazepine-8-carboxylic acid, has a low K(i) value similar to that of an equivalent straight-chain form, suggesting that arginine probably binds in a folded configuration. 4. The aliphatic l-amino acids give enzyme difference spectra similar to that with l-arginine and the integrity of the alpha-carboxy and alpha-amino groups appears to be a minimal but not sufficient requirement for this, as l-ornithine gives an atypical difference spectrum. A difference spectrum is interpreted as indicating an enzyme conformational change. No difference spectrum was observed with methylguanidine. 5. The ability of aliphatic alpha-l-amino acids to protect against inhibition by 5,5'-dithiobis-(2-nitrobenzoic acid) is proportional to the number of atoms in the carbon chain and inversely proportional to K(i). Ornithine gives greater protection than citrulline; analogues lacking the alpha-amino groups also protect. Agmatine, lacking the alpha-carboxy group, did not protect. 6. It is concluded that it is unlikely that the ;essential' thiol group in the enzyme interacts with any part of the arginine molecule during catalysis except, possibly, the alpha-carboxyl group.
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Watts DC, Moreland B, Tatchell EC, Bannister LH. A particulate ATP-arginine phosphotransferase in the protozoan Stentor coeruleus. Comp Biochem Physiol 1968; 25:553-8. [PMID: 4231670 DOI: 10.1016/0010-406x(68)90367-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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