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Cifra N, Pitts S, Mink R, Schwartz A, Herman B, Turner DA, Yussman S. Analysis of fellowship program director opinions of entrustable professional activities in adolescent medicine fellowship. Int J Adolesc Med Health 2024; 0:ijamh-2023-0154. [PMID: 38522004 DOI: 10.1515/ijamh-2023-0154] [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: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES This study aimed to explore the minimum entrustable professional activity (EPA) supervision levels at which pediatric fellowship program directors (FPDs) would be willing to graduate fellows and the levels deemed necessary for safe and effective practice for each of the common pediatric subspecialty and the four adolescent medicine-specific EPAs. METHODS This cross-sectional study utilized survey data from pediatric FPDs in 2017. FPDs indicated the minimum level of supervision (LOS) for fellows at graduation and for safe and effective practice. RESULTS 82 percent (23/28) of adolescent medicine FPDs completed the survey. For each EPA, there were differences (p<0.05) between LOS expected for graduation and for safe and effective practice. There was also variability in the level at which FPDs would graduate fellows. CONCLUSIONS This study summarizes pediatric FPD opinions regarding the minimum levels of supervision required for fellows at the time of graduation as well as the levels deemed necessary for safe and effective practice. The difference between the minimum LOS at which FPDs would graduate a fellow and that deemed appropriate for safe and effective practice, along with variability in minimum LOS for graduation, highlight the need for clearer standards for fellowship graduation as well as more structured early career support for ongoing learning. These data highlight variability in FPD opinion regarding such expectations and both the need to better define desired training outcomes and potential need for post-graduation supervision in clinical practice.
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Affiliation(s)
- Nicole Cifra
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Sarah Pitts
- Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | | | - Alan Schwartz
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | | | | | - Susan Yussman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, USA
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Pattani S, Herman B, Sritharan. Significance of Guide Catheter Disengagement During Fractional Flow Reserve (FFR) Measurements Following Intracoronary Adenosine. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.380] [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: 10/16/2022]
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Thompson EC, Andorko ND, Rouhakhtar PR, Millman ZB, Sagun K, Han SC, Chibani D, Reeves GM, Herman B, Schiffman J. Psychosis-Spectrum Screening and Assessment Within a College Counseling Center: A Pilot Study Exploring Feasibility and Clinical Need. J College Stud Psychother 2022; 36:201-222. [PMID: 35694629 PMCID: PMC9175646 DOI: 10.1080/87568225.2020.1797604] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence supports the use of brief psychosis-spectrum screening tools for identifying individuals at an increased risk of developing a psychotic disorder. Screening has not been well studied in general mental health settings that serve young adults in the age range associated with highest risk for psychosis. This study explored the feasibility of psychosis-risk screening and assessment among help-seeking students at a university counseling center. The PRIME Screen-Revised was administered to students at clinic intake. Participants who screened positively were offered a follow-up assessment using the Structured Interview for Psychosis-risk Syndromes (SIPS). At intake, 510 students completed the PRIME Screen-Revised, with 132 (25.9%) screening positive. Comprehensive psychosis-spectrum evaluations were completed with 38 participants, and 22 met criteria for a psychosis-spectrum disorder, representing 57.9% of this subsample. Findings suggest that psychosis-risk screening in a college clinic is a promising approach to identifying those at high risk for or in the early stages of psychosis.
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Affiliation(s)
- Elizabeth C. Thompson
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Nicole D. Andorko
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | | | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Kristin Sagun
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Susan C. Han
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Doha Chibani
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Gloria M. Reeves
- Child and Adolescent Psychiatry, University of Maryland Medical Center, Baltimore, MD, 21201
| | - Bruce Herman
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
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Turner DA, Schwartz A, Carraccio C, Herman B, Weiss P, Baffa JM, Chess P, Curran M, Dammann C, High P, Hsu D, Pitts S, Sauer C, Aye T, Fussell J, Kesselheim J, Mahan J, McGann K, Myers A, Mink R. Continued Supervision for the Common Pediatric Subspecialty Entrustable Professional Activities May Be Needed Following Fellowship Graduation. Acad Med 2021; 96:S22-S28. [PMID: 34183598 DOI: 10.1097/acm.0000000000004091] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Entrustable professional activities (EPAs) are one approach to competency-based medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate. METHOD In 2017, SPIN surveyed all FPDs of accredited fellowships for 14 subspecialties. For each EPA, the minimum supervision level for graduation (ranging from observation only to unsupervised practice) was set such that no more than 20% of FPDs would accept a lower level. RESULTS The survey response rate was 82% (660/802). The minimum supervision level for graduation varied across the 7 EPAs from 2 (direct) to 4 (indirect for complex cases), with significant differences between EPAs. The percentage of FPDs desiring a lower minimum supervision level ranged from 3% to 17%. Compared with the 4 nonclinical EPAs (quality improvement, management, lead within the profession, scholarship), the 3 clinical EPAs (consultation, handover, lead a team) had higher minimum supervision graduation levels (P < .001), with less likelihood that an FPD would graduate a learner below their minimum level (P < .001). CONCLUSIONS Consensus among FPDs across all pediatric subspecialties demonstrates the potential need for ongoing supervision for graduates in all 7 common pediatric subspecialty EPAs after fellowship. As CBME programs are implemented, processes and infrastructure to support new graduates are important considerations for leaders.
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Affiliation(s)
- David A Turner
- D.A. Turner is vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, and consulting professor, Duke University Medical Center, Durham, North Carolina. At the time this work was completed, he was associate professor, Duke University Medical Center, Durham, North Carolina
| | - Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education, interim head, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Carol Carraccio
- C. Carraccio was vice president of competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina at the time this work was completed
| | - Bruce Herman
- B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Pnina Weiss
- P. Weiss is vice chair of education and associate professor, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Jeanne M Baffa
- J.M. Baffa is emeritus associate professor of pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Patricia Chess
- P. Chess is professor, University of Rochester Medical Center, Rochester, New York
| | - Megan Curran
- M. Curran is associate professor, Department of Pediatrics, University of Colorado-Denver, Denver, Colorado
| | - Christiane Dammann
- C. Damman is professor, Department of Pediatrics, Tufts Children's Hospital, Boston, Massachusetts
| | - Pamela High
- P. High is professor, the Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Deborah Hsu
- D. Hsu is professor, Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Sarah Pitts
- S. Pitts is assistant professor, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Cary Sauer
- C. Sauer is associate professor, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Tandy Aye
- T. Aye is associate professor, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jill Fussell
- J. Fussell is professor, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jennifer Kesselheim
- J. Kesselheim is associate professor, Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - John Mahan
- J. Mahan is professor, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Kathleen McGann
- K. McGann is vice chair of education and professor, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Angie Myers
- A. Myers is professor of pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Richard Mink
- R. Mink is professor of pediatrics, The David Geffen School of Medicine at University of California Los Angeles (UCLA) and The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
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Schwartz A, Borman-Shoap E, Carraccio C, Herman B, Hobday PM, Kaul P, Long M, O'Connor M, Mink R, Schumacher DJ, Turner DA, West DC. Learner Levels of Supervision Across the Continuum of Pediatrics Training. Acad Med 2021; 96:S42-S49. [PMID: 34183601 DOI: 10.1097/acm.0000000000004095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To describe trajectories in level of supervision ratings for linked entrustable professional activities (EPAs) among pediatric learners in medical school, residency, fellowship. METHOD The authors performed secondary analyses of 3 linked datasets of level of supervision ratings for the Core EPAs for Entering Residency, the General Pediatrics EPAs, and the Subspecialty Pediatrics EPAs. After identifying 9 activities in common across training stages and aligning the level of entrustment-supervision scales across the datasets, piecewise ordinal and linear mixed effects models were fitted to characterize trajectories of supervision ratings. RESULTS Within each training period, learners were rated as needing less supervision over time in each activity. When transitioning from medical school to residency or during the first year of residency, learners were rated as needing greater supervision in activities related to patient management, teamwork, emergent care, and public health/QI than in earlier periods. When transitioning from residency to fellowship, learners were always rated as needing greater supervision than they had been accorded at the end of residency and sometimes even more than they had been accorded at the start of residency. CONCLUSIONS Although development over training is often imagined as continuous and monotonically increasing competence, this study provides empirical evidence supporting the idea that entrustment is a set of discrete decisions. The relaxation of supervision in training is not a linear process. Even with a seamless curriculum, supervision is tightly bound to the training setting. Several explanations for these findings are discussed.
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Affiliation(s)
- Alan Schwartz
- A. Schwartz is Michael Reese Endowed Professor of Medical Education and research professor, pediatrics, University of Illinois College of Medicine, Chicago, Illinois, and network director, Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN), McLean, Virginia; ORCID: http://orcid.org/0000-0003-3809-6637
| | - Emily Borman-Shoap
- E. Borman-Shoap is associate professor, residency program director, and vice chair of education, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-7514-7793
| | - Carol Carraccio
- C. Carraccio was vice president for competency-based medical education, American Board of Pediatrics, Chapel Hill, North Carolina, at the time the work was completed; ORCID: https://orcid.org/0000-0001-5473-8914
| | - Bruce Herman
- B. Herman is professor and vice chair of education, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Patricia M Hobday
- P.M. Hobday is assistant professor and director, Education in Pediatrics Across the Continuum (EPAC), Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Paritosh Kaul
- P. Kaul is professor and associate director, EPAC, Department of Pediatrics, University of Colorado, School of Medicine, Denver, Colorado; ORCID: https://orcid.org/0000-0003-4155-7406
| | - Michele Long
- M. Long is professor and director, EPAC, Department of Pediatrics, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-8399-5589
| | - Meghan O'Connor
- M. O'Connor is assistant professor and director, EPAC, Department of Pediatrics, University of Utah, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0002-5403-923X
| | - Richard Mink
- R. Mink is professor of pediatrics, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, pediatric critical care fellowship program director, Harbor-UCLA Medical Center, Torrance, California, and director, APPD Subspecialty Pediatrics Investigator Network, McLean, Virginia; ORCID: http://orcid.org/0000-0002-7998-4713
| | - Daniel J Schumacher
- D.J. Schumacher is associate professor, Department of Pediatrics, Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0001-5507-8452
| | - David A Turner
- D.A. Turner was associate professor, Division of Pediatric Critical Care, Department of Pediatrics, and associate director, Graduate Medical Education, Duke University Hospital and Health System, Durham, North Carolina, at the time the work was completed
| | - Daniel C West
- D.C. West is professor and senior director of medical education, Department of Pediatrics, Children's Hospital of Philadelphia and The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: https://orcid.org/0000-0002-0909-4213
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Thompson EC, Jay SY, Andorko ND, Millman ZB, Rouhakhtar PR, Sagun K, Han SC, Herman B, Schiffman J. Sleep quality moderates the association between psychotic-like experiences and suicidal ideation among help-seeking university students. Psychiatry Res 2021; 296:113668. [PMID: 33401091 PMCID: PMC8482876 DOI: 10.1016/j.psychres.2020.113668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023]
Abstract
Suicide is a leading cause of death for young adults, and college-enrolled students are at markedly high risk for suicide. Psychotic-like experiences (PLEs) and sleep difficulties are prevalent among college students and have been linked to increased suicidal ideation (SI). This cross-sectional study examined the relation between PLEs and SI, moderated by sleep quality, in a sample of 442 students at a university counseling center. The Behavioral Health Measure-43 (BHM-43) was used to evaluate mental health symptoms, including sleep quality and SI. The PRIME Screen-Revised was used to measure PLEs. Regression results indicated that higher PRIME scores statistically predicted greater SI. There was a significant interaction between PRIME and sleep quality in predicting SI. Among individuals with greater sleep difficulties, PLEs were positively, significantly associated with SI. The PRIME was not a significant predictor of SI at lower levels of sleep difficulties (i.e. better sleep quality). This interaction effect remained significant when controlling for age and the BHM-43 depression and bipolar subscales. Findings suggest that sleep difficulties may be linked to increased SI for individuals with PLEs, and better sleep may be protective. Further research is needed to explore treatment targeting PLEs and/or sleep to mitigate suicide risk among university students.
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Affiliation(s)
- Elizabeth C. Thompson
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Samantha Y. Jay
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Nicole D. Andorko
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | | | - Kristin Sagun
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Susan C. Han
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Bruce Herman
- Counseling Center, University of Maryland, Baltimore County, Catonsville, MD, 21250
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, 21250
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Herman B, Pongpanich S, Viwattanakulvanid P. National health insurance impact on malnutrition in under-five years old children in Indonesia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1392] [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: 11/12/2022] Open
Abstract
Abstract
Background
The premium-based National Health Insurance Program under Jaminan Kesehatan Nasional (JKN), has been launched in 2014, although it lacks evaluation of the benefits, particularly on clinical outcomes-based. This study aimed to assess the impact of JKN possession on nutrition status among under-five years old children.
Methods
A Cross-Sectional Study was conducted during January-September 2019 in Balikpapan, Indonesia to assess the impact of JKN in the nutrition status of this specific group. Primary data (socio-demographic, feeding pattern, basic knowledge of nutrition and Health Insurance ownership) has retrieved through validated questionnaires from the parents and/or the guardian, followed by anthropometry measurement (Weight per Age Z-Score) to determine the nutrition status. Bivariate analysis was conducted to identify the confounder. Binary Logistic Regression was performed to determine the impact of JKN health insurance on the nutrition status among the target population
Results
As 62 from 312 (19.87%) children fall <-2 Z-Score (Underweight) whereas 5 children were overweight (>2 Zscore) and 2 children were obese (>3 Z Score). Only 77 (24.68%) children have JKN. The education of both parents was associated with nutrition status but no difference in knowledge regarding nutrition and identifying nutritional disease. Various feeding patterns (Breastfeeding status, vitamin A status, and snack intake) were not potential confounders. Adjusted by birth weight and history of disease within 6 months, child who possess Health Insurance (JKN) tend to have a normal weight child up to 1.998 times (AOR = 1.998, 95% CI 1.056-3.780 p = 0.033) compared to underweight, but no significant finding was found between Health Insurance and children with normal and overweight/obese children, adjusted by birthweight (AOR = 3.091, 95% CI 0.639-14.692 p = 0.161)
Conclusions
This study illustrated the significant benefit of JKN to prevent undernourished event but not overnutrition.
Key messages
National Health Insurance Coverage provides benefit on malnutrition prevention in under-five years old children. Children covered with National Health Insurance will unlikely get undernourished but no significant finding in overnourished prevention.
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Affiliation(s)
- B Herman
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
- Family Medicine and Preventive Medicine, Hasanuddin University Faculty of Medicine, Makassar, Indonesia
- Disease Prevention and Control, Government Office of Public Health, Balikpapan, Indonesia
| | - S Pongpanich
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
| | - P Viwattanakulvanid
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
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Herman B, Herya Ulfah N, Fauzi R, Pongpanich S. 48 hours public response to Corona epidemic status in Indonesia. Perceived risk and panic buying. Eur J Public Health 2020. [PMCID: PMC7543503 DOI: 10.1093/eurpub/ckaa166.1250] [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: 11/26/2022] Open
Abstract
Background President of Indonesia, Joko Widodo has announced two confirmed CoVid-19 cases who live in Depok, West Java, on Monday, March 2nd, 2020. A rapid assessment of public response toward the new status was conducted, focusing on perceived risk and panic buying. Methodology A cross-sectional survey was conducted within 48 hours after the announcement through an online questionnaire. A demographic data including, sex, age, education, occupation (medical vs nonmedical), income, health insurance, island domicile (Java vs non-Java), mobility, history of contact with a foreigner, and history of overseas travel within a month. Knowledge regarding Covid 19 was determined by the average score of 38 5-Likert scale questions (5 indicates better knowledge). Perceived risk was measured with a 10-scale question, and panic buying was assessed through an average score of 6 5-Likert scale questions (5 indicates panic buying). Mann-Whitney and Linear regression were performed to identify the associated factors. Results As a total of 214 respondents, panic buying was lower (2.28 ± 0.79 on a 5-scale) except for perceived risk (5.91 ± 2.13 on a 10-scale). No difference between medical and nonmedical staff in panic buying (p = 0.619) and perceived risk (p = 0.477) and the domicile of respondents (Java VS nonjava) in panic buying (p = 0.810) and perceived risk (p = 0.101). Younger age, working in a medical field and living in Java are associated with higher perceived risk in the linear model whereas panic buying is solely affected by knowledge (β -1.459. p < 0.001). The respondents agreed that scarcity of single-use components (mean 4.32 out of 5) such as masker and goods inflation particularly groceries (mean 4.31 out of 5) will appear soon Conclusions It is important to disseminate the correct information to the public to reduce panic buying. Collaborative action between the government and medical staff should be done particularly in Java as the first locus of CoVid 19 in Indonesia. Key messages Knowledge regarding corona virus affects the Panic Buying. An intervention to disseminate the correct information should be done. To reduce the perceived risk, a rigorous action should be done in Java and a collaborative work between the government and medical staffs should be established.
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Affiliation(s)
- B Herman
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
| | - N Herya Ulfah
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
- Department of Public Health, Universitas Negeri Malang, Malang, Indonesia
| | - R Fauzi
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
- Faculty of Public Health, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia
| | - S Pongpanich
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
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Herman B, Sirichokchatcawan W, Pongpanich S, Nantasenamat C. Artificial Intelligence in Drug-Resistant Tuberculosis Diagnosis. Systematic Review & Meta Analysis. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.006] [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: 11/13/2022] Open
Abstract
Abstract
Background
Artificial Intelligence (AI) models possess potential screening or diagnosing Drug-Resistant Tuberculosis. This meta-analysis aimed to elaborate on the performance of AI models in predicting drug-resistant TB compared to the gold standard.
Methods
A systematic search of full-paper articles from Pubmed/MEDLINE and SCOPUS published between January 2005 and April 2020 was conducted. Studies involving whole-genome sequencing or human subject data that used drug-susceptibility test results as a reference standard were retrieved. Hierarchical summary receiver-operating characteristic (HSROC) and bivariate model were performed to calculate pooled sensitivity and specificity. Heterogeneity and publication bias were also assessed.
Results
25 Models form four genome-based studies, four radiology-based studies, and two clinical and demographic-based studies were included. The radiology-based models, mainly built with the Convolutional Neural Network (CNN), possessed pooled sensitivity of 58% (95%CI 50%-65%), and a pooled specificity of 75% (95% CI 47%-91%) for detecting MDR-TB. Genome-based models outperformed other models despite developed with simpler classifiers (CART/GBT/LR). The genome-based studies reached pooled sensitivity of 92% (95%CI 90-93%), pooled specificity of 98 (95% CI 96%-98%) in predicting isoniazid resistance. For predicting rifampicin resistance, the pooled sensitivity and specificity were 93% (95%CI 90%-94%) and 98% (95% CI 96%-98%) respectively. The Artificial Neural Network (ANN) demonstrated superiority rather than the Classification and Regression Tree (CART), and logistic regression (LR) on the clinical and demographic model in predicting drug-resistant TB.
Conclusions
Simple classifier performs better in genomic data whereas the CNN model works best in high-dimensional data, such as radiology images. The ANN model indicates a preferred model for data obtained from clinical and demographic parameters. (PROSPERO number CRD42020167439)
Key messages
Artificial Intelligence model through machine learning and deep learning possess a good diagnostic performance for drug-resistant tuberculosis. Artificial Neural Network model outperforms other technique. The model built from genomic data shows the best performance, followed by model from patient-based data and radiology/imaging data.
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Affiliation(s)
- B Herman
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
- Public Health, Family Medicine and Preventive Medicine, Hasanuddin University, Faculty of Medicine, Makassar, Indonesia
| | - W Sirichokchatcawan
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
| | - S Pongpanich
- Public Health, College of Public Health Science, Chulalongkorn University Thailand, Bangkok, Thailand
| | - C Nantasenamat
- Medical Technology, Mahidol University, Bangkok, Thailand
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Khalifian CE, Murphy CM, Barry RA, Herman B. Skills for Healthy Adult Relationships at the University of Maryland, Baltimore County: Program Development and Preliminary Data. J Interpers Violence 2019; 34:2551-2572. [PMID: 27506229 DOI: 10.1177/0886260516662303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The present study examines the development and preliminary pilot findings of Skills for Healthy Adult Relationships at the University of Maryland, Baltimore County (SHARe@UMBC)-an intimate partner violence prevention program for college students. SHARe@UMBC is based on an integrative cognitive-behavioral model of communication and emotion regulation in close interpersonal relationships. There were four aims of the present study: first, to describe program development; second, to examine program acceptability and participant satisfaction; third, to examine the extent to which participants acquired relationship skills and their level of confidence in using those skills; and fourth, to examine perpetration and victimization of physical, sexual, and psychological aggression. These aims utilized data collected before program initiation, immediately after program completion, and at a follow-up 9 to 15 months after program completion. Findings from two pilot groups (15 students in total; eight women and seven men) indicated high ratings of program acceptability and satisfaction, reductions in negative communication, improvements in confidence using conflict management strategies with romantic partners and peers, and confidence initiating new romantic relationships. In addition, large effect sizes were observed for confidence providing emotional support to a romantic partner and self-disclosure with peers. Participants reported no incidents of physical, sexual, or psychological aggression perpetration or victimization at follow-up. Pilot implementation and initial uncontrolled results are encouraging and provide support for initiating a more extensive controlled investigation of program efficacy.
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Affiliation(s)
| | | | | | - Bruce Herman
- 1 University of Maryland, Baltimore County, MD, USA
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Mink R, Schwartz A, Carraccio C, High P, Dammann C, McGann KA, Kesselheim J, Herman B, Baffa G, Herman B, Turner DA, Fussell J, High P, Hsu D, Stafford D, Aye T, Sauer C, Kesselheim J, Myers A, McGann K, Dammann C, Chess P, Mahan J, Weiss P, Curran M, Schwartz A, Carraccio C, Herman B, Mink R, Havalad V, Pinheiro J, Alderman E, Fuloria M, McCabe ME, Mehta J, Rivas Y, Rosenberg M, Doughty C, Hergenroeder A, Kale A, Lee-Kim Y, Rama JA, Steuber P, Voigt B, Hardy K, Johnston S, Boyer D, Mauras C, Schonwald A, Sharma T, Barron C, Dennehy P, Jacobs ES, Welch J, Kumar D, Mason K, Roizen N, Rose JA, Bokor B, Chapman JI, Frank L, Sami I, Schuette J, Lutes RE, Savelli S, Amirnovin R, Harb R, Kato R, Marzan K, Monzavi R, Vanderbilt D, Doughty L, McAneney C, Rice W, Widdice L, Erenberg F, Gonzalez BE, Adkins D, Green D, Narayan A, Rehder K, Clingenpeel J, Starling S, Karpen HE, Rouster-Stevens K, Bhatia J, Fuqua J, Anders J, Trent M, Ramanathan R, Nicolau Y, Dozor AJ, Kinane TB, Stanley T, Rao AN, Bone M, Camarda L, Heffner V, Kim O, Nocton J, Rabbitt AL, Tower R, Amaya M, Jaroscak J, Kiger J, Macias M, Titus O, Awonuga M, Vogt K, Warwick A, Coury D, Hall M, Letson M, Rose M, Glickstein J, Lusman S, Roskind C, Soren K, Katz J, Siqueira L, Atlas M, Blaufox A, Gottleib B, Meryash D, Vuguin P, Weinstein T, Armsby L, Madison L, Scottoline B, Shereck E, Henry M, Teaford PA, Long S, Varlotta L, Zubrow A, Barlow C, Feldman H, Ganz H, Grimm P, Lee T, Weiner LB, Molle-Rios Z, Slamon N, Guillen U, Miller K, Federman M, Cron R, Hoover W, Simpson T, Winkler M, Harik N, Ross A, Al-Ibrahim O, Carnevale FP, Waz W, Bany-Mohammed F, Kim JH, Printz B, Brook M, Hermiston M, Lawson E, van Schaik S, McQueen A, Booth KVP, Tesher M, Barker J, Friedman S, Mohon R, Sirotnak A, Brancato J, Sayej WN, Maraqa N, Haller M, Stryjewski B, Brophy P, Rahhal R, Reinking B, Volk P, Bryant K, Currie M, Potter K, Falck A, Weiner J, Carney MM, Felt B, Barnes A, Bendel CM, Binstadt B, Carlson K, Garrison C, Moffatt M, Rosen J, Sharma J, Tieves KS, Hsu H, Kugler J, Simonsen K, Fastle RK, Dannaway D, Krishnan S, McGuinn L, Lowe M, Witchel SF, Matheo L, Abell R, Caserta M, Nazarian E, Yussman S, Thomas AD, Hains DS, Talati AJ, Adderson E, Kellogg N, Vasquez M, Allen C, Brion LP, Green M, Journeycake J, Yen K, Quigley R, Blaschke A, Bratton SL, Yost CC, Etheridge SP, Laskey T, Pohl J, Soprano J, Fairchild K, Norwood V, Johnston TA, Klein E, Kronman M, Nanda K, Smith L, Allen D, Frohna JG, Patel N, Estrada C, Fleming GM, Gillam-Krakauer M, Moore P, El Khoury JC, Helderman J, Barretto G, Levasseur K, Johnston L. Creating the Subspecialty Pediatrics Investigator Network. J Pediatr 2018; 192:3-4.e2. [PMID: 29246355 DOI: 10.1016/j.jpeds.2017.09.079] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Richard Mink
- Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Torrance, CA
| | | | | | - Pamela High
- W Alpert Medical School of Brown University, Providence, RI
| | | | | | | | - Bruce Herman
- University of Utah/Primary Children's Hospital, Salt Lake City, UT
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Elford A, Vo T, Melville H, Herman B. Reperfusion Strategies in Patients Presenting to Launceston General Hospital. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.979] [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: 10/28/2022]
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Balakrishnan K, Koshy G, Thompson B, Herman B. Long-Term Outcome Following Patent Foramen Ovale (PFO) Closure. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.393] [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: 11/27/2022]
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Gupta V, Balakrishnan K, Gupta L, Hayat U, Koshy G, Herman B. LVOT Obstruction- Identifying the Real Perpetrators. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.186] [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: 11/15/2022]
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15
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Berger RP, Fromkin J, Herman B, Pierce MC, Saladino RA, Flom L, Tyler-Kabara EC, McGinn T, Richichi R, Kochanek PM. Validation of the Pittsburgh Infant Brain Injury Score for Abusive Head Trauma. Pediatrics 2016; 138:peds.2015-3756. [PMID: 27338699 PMCID: PMC4925074 DOI: 10.1542/peds.2015-3756] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Abusive head trauma is the leading cause of death from physical abuse. Misdiagnosis of abusive head trauma as well as other types of brain abnormalities in infants is common and contributes to increased morbidity and mortality. We previously derived the Pittsburgh Infant Brain Injury Score (PIBIS), a clinical prediction rule to assist physicians deciding which high-risk infants should undergo computed tomography of the head. METHODS Well-appearing infants 30 to 364 days of age with temperature <38.3°C, no history of trauma, and a symptom associated with an increased risk of having a brain abnormality were eligible for enrollment in this prospective, multicenter clinical prediction rule validation. By using a predefined neuroimaging paradigm, subjects were classified as cases or controls. The sensitivity, specificity, and negative and positive predictive values of the rule for prediction of brain injury were calculated. RESULTS A total of 1040 infants were enrolled: 214 cases and 826 controls. The 5-point PIBIS included abnormality on dermatologic examination (2 points), age ≥3.0 months (1 point), head circumference >85th percentile (1 point), and serum hemoglobin <11.2g/dL (1 point). At a score of 2, the sensitivity and specificity for abnormal neuroimaging was 93.3% (95% confidence interval 89.0%-96.3%) and 53% (95% confidence interval 49.3%-57.1%), respectively. CONCLUSIONS Our data suggest that the PIBIS accurately identifies infants who would benefit from neuroimaging to evaluate for brain injury. An implementation analysis is needed before the PIBIS can be integrated into clinical practice.
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Affiliation(s)
- Rachel Pardes Berger
- Departments of Pediatrics, Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
| | | | - Bruce Herman
- Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City, Utah
| | - Mary Clyde Pierce
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | | | | | | | - Tom McGinn
- Department of Medicine, Hofstra North Shore Long Island School of Medicine, Manhasset, New York; and
| | - Rudolph Richichi
- Statistical Analysis and Measurement Consultants, Inc, Lanexa, Virginia
| | - Patrick M. Kochanek
- Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL, Norlin C, Percelay J, Sapién RE, Shiffman RN, Smith MBH. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary. Pediatrics 2016; 137:peds.2016-0591. [PMID: 27244836 DOI: 10.1542/peds.2016-0591] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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17
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Tieder JS, Bonkowsky JL, Etzel RA, Franklin WH, Gremse DA, Herman B, Katz ES, Krilov LR, Merritt JL, Norlin C, Percelay J, Sapién RE, Shiffman RN, Smith MBH. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics 2016; 137:peds.2016-0590. [PMID: 27244835 DOI: 10.1542/peds.2016-0590] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is the first clinical practice guideline from the American Academy of Pediatrics that specifically applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defined as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper- or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this definition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefit-harm relationship, and the strength of recommendation.
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Vanthournhout L, Herman B, Duisit J, Château F, Szewczyk J, Lengelé B, Raucent B. Requirements analysis and preliminary design of a robotic assistant for reconstructive microsurgery. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2015:4926-4930. [PMID: 26737397 DOI: 10.1109/embc.2015.7319497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Microanastomosis is a microsurgical gesture that involves suturing two very small blood vessels together. This gesture is used in many operations such as avulsed member auto-grafting, pediatric surgery, reconstructive surgery - including breast reconstruction by free flap. When vessels have diameters smaller than one millimeter, hand tremors make movements difficult to control. This paper introduces our preliminary steps towards robotic assistance for helping surgeons to perform microanastomosis in optimal conditions, in order to increase gesture quality and reliability even on smaller diameters. A general needs assessment and an experimental motion analysis were performed to define the requirements of the robot. Geometric parameters of the kinematic structure were then optimized to fulfill specific objectives. A prototype of the robot is currently being designed and built in order to providing a sufficient increase in accuracy without prolonging the duration of the procedure.
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19
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Parameswaran R, Gupta V, David T, Herman B. Clinical Outcomes of Percutaneous Interventions in Bypass Grafts. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.367] [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: 10/23/2022]
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20
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Gupta V, Parameswaran R, Noor W, Ullah I, Herman B. Right heart catheterisation via antecubital venous access: a promising technique. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.438] [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]
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21
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Gupta V, Parameswaran R, Boo S, Koneru S, David T, Herman B. Temporal trends of coronary in-stent restenosis in an era of complex interventional cardiovascular therapy. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.133] [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: 11/30/2022]
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22
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Herman B, Packard S, Pollack C, Houseal G, Sinn S, Fant J, Lewis AD, Wagenius S, Gustafson D, Hufford K, Allison B, Shaw K, Haines S, Daniels C. Decisions . . . Decisions . . . How to Source Plant Material for Native Plant Restoration Projects. ECOL RESTOR 2014. [DOI: 10.3368/er.32.3.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Parameswaran R, Koneru S, Miller R, Koshy G, Herman B. Outcomes of structural interventions in a hospital without onsite cardiothoracic surgery. Heart Lung Circ 2014. [DOI: 10.1016/j.hlc.2014.04.218] [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: 10/25/2022]
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24
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Conte N, Varela I, Grove C, Manes N, Yusa K, Moreno T, Segonds-Pichon A, Bench A, Gudgin E, Herman B, Bolli N, Ellis P, Haddad D, Costeas P, Rad R, Scott M, Huntly B, Bradley A, Vassiliou GS. Detailed molecular characterisation of acute myeloid leukaemia with a normal karyotype using targeted DNA capture. Leukemia 2013; 27:1820-5. [PMID: 23702683 PMCID: PMC3768109 DOI: 10.1038/leu.2013.117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 03/17/2013] [Accepted: 04/10/2013] [Indexed: 12/13/2022]
Abstract
Advances in sequencing technologies are giving unprecedented insights into the spectrum of somatic mutations underlying acute myeloid leukaemia with a normal karyotype (AML-NK). It is clear that the prognosis of individual patients is strongly influenced by the combination of mutations in their leukaemia and that many leukaemias are composed of multiple subclones, with differential susceptibilities to treatment. Here, we describe a method, employing targeted capture coupled with next-generation sequencing and tailored bioinformatic analysis, for the simultaneous study of 24 genes recurrently mutated in AML-NK. Mutational analysis was performed using open source software and an in-house script (Mutation Identification and Analysis Software), which identified dominant clone mutations with 100% specificity. In each of seven cases of AML-NK studied, we identified and verified mutations in 2-4 genes in the main leukaemic clone. Additionally, high sequencing depth enabled us to identify putative subclonal mutations and detect leukaemia-specific mutations in DNA from remission marrow. Finally, we used normalised read depths to detect copy number changes and identified and subsequently verified a tandem duplication of exons 2-9 of MLL and at least one deletion involving PTEN. This methodology reliably detects sequence and copy number mutations, and can thus greatly facilitate the classification, clinical research, diagnosis and management of AML-NK.
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Affiliation(s)
- N Conte
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
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Koneru S, David T, Herman B. Cumulative Incidence of Coronary Stent Thrombosis in a Rural/Regional Hospital. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.317] [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: 10/26/2022]
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26
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Merrick P, Nieminen AL, Harper RA, Herman B, Lemasters JJ. Cytotoxicity screening of surfactant-based shampoos using a multiwell fluorescence scanner: Correlation with Draize eye scores. Toxicol In Vitro 2012; 6:543-7. [PMID: 20732156 DOI: 10.1016/0887-2333(92)90066-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/1991] [Revised: 04/01/1992] [Indexed: 10/27/2022]
Abstract
The irritancy potential of seven shampoos was evaluated by a rapid cytotoxicity assay in cultured human keratinocytes and rat hepatocytes. Loss of cell viability was estimated from increases in propidium iodide fluorescence measured using a multiwell fluorescence scanner. The concentration of shampoo causing a 50% loss of cell viability after 15 min of incubation (V(50)) was determined by probit analysis. Log V(50) measured in human keratinocytes showed a strong negative correlation (r = -0.95; P <0.001) with Draize eye scores in rabbits. Log V(50) measured in rat hepatocytes did not show a statistically significant correlation with Draize eye scores. The results indicate that cytotoxicity screening of human keratinocytes using propidium iodide and a multiwell fluorescence scanner is highly predictive of Draize eye scores for surfactant-containing shampoos.
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Affiliation(s)
- P Merrick
- Laboratories for Cell Biology, Department of Cell Biology and Anatomy, University of North Carolina, Chapel Hill, NC 27599-7090, USA
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27
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Koneru S, Herman B. Same Day PCI Discharge. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.431] [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: 10/28/2022]
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Menudet JF, Zarhaee A, Solano B, Szewczyk J, Herman B, Rotinat C, Vidal C, Gayet B. Projet ID2U : instrument dextre à usage unique. Ing Rech Biomed 2011. [DOI: 10.1016/j.irbm.2011.01.024] [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: 10/18/2022]
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Bigelow TA, Church CC, Sandstrom K, Abbott JG, Ziskin MC, Edmonds PD, Herman B, Thomenius KE, Teo TJ. The thermal index: its strengths, weaknesses, and proposed improvements. J Ultrasound Med 2011; 30:714-734. [PMID: 21527623 DOI: 10.7863/jum.2011.30.5.714] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The thermal index (TI) has been used as a relative indicator of thermal risk during diagnostic ultrasound examinations for many years. It is useful in providing feedback to the clinician or sonographer, allowing assessment of relative, potential risks to the patient of an adverse effect due to a thermal mechanism. Recently, several shortcomings of the TI formulations in quantifying the risk to the patient have been identified by members of the basic scientific community, and possible improvements to address these shortcomings have been proposed. For this reason, the Output Standards Subcommittee of the American Institute of Ultrasound in Medicine convened a subcommittee to review the strengths of the TI formulations as well as their weaknesses and proposed improvements. This article summarizes the findings of this subcommittee. After a careful review of the literature and an assessment of the cost of updating the TI formulations while maximizing the quality of patient care, the Output Standards Subcommittee makes the following recommendations: (1) some inconsistencies in the current TI formulations should be resolved, and the break point distance should be redefined to take focusing into consideration; (2) an entirely new indicator of thermal risk that incorporates the time dependence not be implemented at this time but be included in continuing efforts toward standards or consensus documents; (3) the exponential dependence of risk on temperature not be incorporated into a new definition of the TI formulations at this time but be included in continuing efforts toward standards or consensus documents; (4) the TI formulations not be altered to include nonlinear propagation at this time but be included in continuing efforts toward standards or consensus documents; and (5) a new indicator for risk from thermal mechanisms should be developed, distinct from the traditional TI formulations, for new imaging modalities such as acoustic radiation force impulse imaging, which have more complicated pulsing sequences than traditional imaging.
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Affiliation(s)
- Timothy A Bigelow
- Department of Electrical and Computer Engineering, Iowa State University, 2215 Coover Hall, Ames, IA 50011, USA.
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Barthwal R, David T, Herman B. Clinical Profile and Long Term Outcomes in Stress Cardiomyopathy. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.500] [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: 10/18/2022]
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32
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Ni M, Benson L, Camp J, Herman B. Autonomous tip/tilt alignment and phasing of a distributed aperture imaging testbed. Opt Express 2010; 18:13051-13056. [PMID: 20588434 DOI: 10.1364/oe.18.013051] [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] [Indexed: 05/29/2023]
Abstract
Star-9 is an experimental demonstration of distributed aperture imaging built at the Lockheed Martin Advanced Technology Center. White light from a scene generator enters an array of nine actively controlled telescopes, and is combined at a focused image plane. This paper describes the algorithms used to automatically bring each telescope's relative tip/tilt and phasing errors to within the operational range of the control system. The algorithms work with point-sources as well as with extended scenes. Experimental results and software algorithms are presented.
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Affiliation(s)
- Mel Ni
- Lockheed Martin Space Systems Company, Advanced Technology Center, 3251 Hanover St, Palo Alto, CA 94304, USA.
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Siewert B, Gareen I, Vanness D, Herman B, Johnson CD, Gatsonis C. ACRIN 6664: Patient acceptance and preferance of CT colonography compared to optical colonoscopy for colon cancer screening. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4034 Background: Colorectal cancer screening must be repeated on a regular basis. Understanding patient perceptions and willingness to be rescreened will help to determine future compliance rates. The purpose of this study was to compare National CT Colonography Trial (NCTCT) screening participant experiences with CT colonography (CTC) and optical colonoscopy (OC), willingness to return for each procedure, and procedure preference. Methods: NCTCT participants underwent a single bowel preparation (BP). Participants were scheduled to receive CTC, followed by sedation and OC. Participants were asked to complete a questionnaire two weeks post-exam on physical discomfort and embarrassment during BP, CTC and OC and willingness to repeat CTC and OC (with or without BP) at different time intervals. McNemar's Test and logistic regression were used for statistical analysis. Results: 2310 of 2600 patients (89%) responded (1224 women, 1086 men). Mean age was 58.39 years (range 50–86). The participant population was 85% Caucasian, 11% African American and 4% other. Severe discomfort was reported by 7.1% participants with BP, 6.3% with CTC, and 2.2% with OC. Severe embarrassment was reported by 1.6% participants with BP, 1.3% with CTC, and 0.7% with OC. Forty-six percent of participants preferred CTC, 27.4% reported no preference, and 24.9% preferred OC (p<0.001). Repeat screening with CTC is currently recommended every 5 years and with OC every 10 years. 80.5% of the participants were willing to be screened again with CTC in 5 years and 97.5 % were willing to be screened again with OC in 10 years (p<0.001). If the screening interval for CTC were extended to ten years, 93.7% of participants were willing to return for screening (p<0.001). If BP were unnecessary, 91.0% were willing to be rescreened with CTC in 5 years and 97.5% were willing to be rescreened with OC in 10 years (p<0.001). Conclusions: NCTCT participants preferred CTC to OC, but their willingness to undergo repeat CTC was limited by the shorter interval between screenings currently recommended for CTC as opposed to OC. Improvements in technology that would eliminate the need for bowel preparation or extend the recommended screening interval would likely improve adherence to recommended repeat screening. [Table: see text]
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Affiliation(s)
- B. Siewert
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - I. Gareen
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - D. Vanness
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - B. Herman
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - C. D. Johnson
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
| | - C. Gatsonis
- Beth Israel Deaconess Medical Center, Boston, MA; Brown University, Providence, RI; University of Wisconsin, Madison, WI; Mayo Clinic, Scottsdale, AZ
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Herman B, Nyugen C. Fractional flow reserve in day-to-day clinical practice. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.526] [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: 10/20/2022]
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Herman B, Mandel F. Is Speed of Onset of Anti-anxiety Efficacy with Pregabalin Influenced by Starting Dose? Eur Psychiatry 2009. [DOI: 10.1016/s0924-9338(09)70762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective:There appears to be no dose-response effect for pregabalin at doses of 300-600 mg, and a modest dose-response effect in the range of 150-300 mg. The goal of the current investigation was to determine the effect of the starting dose on the speed of onset of anxiolytic efficacy.Methods:Data were analyzed from 7 trials of outpatients with DSM-IV GAD and a HAM-A total score ≥18. Starting doses of pregabalin ranged from 100 mg (N=301) or 150 mg (N=104), to 200 mg (N=167) and 300 mg (N=388). Assessment of early improvement included the HAM-A total score and CGI-Severity and Improvement scores.Results:The mean Week 1 HAM-A change score was similar for a starting dose of 200 mg/d with no titration (-8.24) when compared to patients who started on 200 mg/d and then titrated up to 400 mg/d on Day 4 (-8.64). The mean Week 1 HAM-A change score was somewhat higher for patients started on 300 mg/d, and then titrated to 450 mg/d on Day 4/5 (-8.84) when compared to patients started on a lower (100/150 mg/d) dose and titrated on Day 5 to 400/450 mg/d (-7.32). Starting on a dose of 300 mg/d with no titration resulted in an intermediate Week 1 change score (-7.87). The interaction of starting dose and titration schedule with baseline anxiety severity will be summarized in detail.Conclusion:The initial dose of pregabalin appears to have only a weak effect on the speed of onset of anxiolytic improvement.
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Chadwick DL, Bertocci G, Castillo E, Frasier L, Guenther E, Hansen K, Herman B, Krous HF. Annual risk of death resulting from short falls among young children: less than 1 in 1 million. Pediatrics 2008; 121:1213-24. [PMID: 18519492 DOI: 10.1542/peds.2007-2281] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday. METHODS A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed. RESULTS The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers. CONCLUSIONS The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.
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Affiliation(s)
- David L Chadwick
- Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
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Abstract
This unit lists absorption and emission maximum wavelengths for common fluorophores used in cell biology. This information can be used in designing experiments and selecting appropriate filters for use with the fluorophores.
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Affiliation(s)
- B Herman
- University of North Carolina, Chapel Hill, North Carolina, USA
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Kendrick RL, Aubrun JN, Bell R, Benson R, Benson L, Brace D, Breakwell J, Burriesci L, Byler E, Camp J, Cross G, Cuneo P, Dean P, Digumerthi R, Duncan A, Farley J, Green A, Hamilton HH, Herman B, Lauraitis K, de Leon E, Lorell K, Martin R, Matosian K, Muench T, Ni M, Palmer A, Roseman D, Russell S, Schweiger P, Sigler R, Smith J, Stone R, Stubbs D, Swietek G, Thatcher J, Tischhauser C, Wong H, Zarifis V, Gleichman K, Paxman R. Wide-field Fizeau imaging telescope: experimental results. Appl Opt 2006; 45:4235-40. [PMID: 16778931 DOI: 10.1364/ao.45.004235] [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] [Indexed: 05/10/2023]
Abstract
A nine-aperture, wide-field Fizeau imaging telescope has been built at the Lockheed-Martin Advanced Technology Center. The telescope consists of nine, 125 mm diameter collector telescopes coherently phased and combined to form a diffraction-limited image with a resolution that is consistent with the 610 mm diameter of the telescope. The phased field of view of the array is 1 murad. The measured rms wavefront error is 0.08 waves rms at 635 nm. The telescope is actively controlled to correct for tilt and phasing errors. The control sensing technique is the method known as phase diversity, which extracts wavefront information from a pair of focused and defocused images. The optical design of the telescope and typical performance results are described.
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Affiliation(s)
- R L Kendrick
- Lockheedmartin Advanced Technology Center, Palo Alto, California 94304, USA.
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Herman B. Memory and its reorganization in temporal lobe epilepsy. Epilepsy Curr 2005; 4:139-40. [PMID: 16059477 PMCID: PMC1176349 DOI: 10.1111/j.1535-7597.2004.44006.x] [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: 12/01/2022] Open
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Krishnan RV, Masuda A, Centonze VE, Herman B. Quantitative imaging of protein-protein interactions by multiphoton fluorescence lifetime imaging microscopy using a streak camera. J Biomed Opt 2003; 8:362-367. [PMID: 12880340 DOI: 10.1117/1.1577574] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Fluorescence lifetime imaging microscopy (FLIM) using multiphoton excitation techniques is now finding an important place in quantitative imaging of protein-protein interactions and intracellular physiology. Recent developments in multiphoton FLIM methods are reviewed and a novel multiphoton FLIM system using a streak camera is described. An example of a typical application of the system is provided in which the fluorescence resonance energy transfer between a donor-acceptor pair of fluorescent proteins within a cellular specimen is measured.
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Affiliation(s)
- R V Krishnan
- University of Texas Health Science Center, Department of Cellular and Structural Biology, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA
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Peele R, Kline L, Herman B. Treating the mentally ill. Health Aff (Millwood) 2001; 20:313-4. [PMID: 11816684 DOI: 10.1377/hlthaff.20.6.313-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Telemedicine has previously been defined as "live two-way interactive video communication between a physician and a patient and/or another physician, where all participants are able to see and hear one another much like a face to face encounter." This concept has gained recent notoriety because of the great advances in telecommunications and the potential future increased cost-effectiveness associated with its utilization. We have developed a telementoring deployment protocol that can be effectively used to introduce a student to telementoring processes. The strict protocol uses military commands to facilitate smooth information transfer. The use of a concept called tactical information deployment provides the surgeon with rapid access to reference information in the operating suite. Multimedia interactive CD-ROMs, with digitized movie clips, illustrations, sound bits, and the latest academic review of the literature arm the surgeon with a database that establishes an unprecedented clinical adaptive capability (CAC). The availability of this information is invaluable to surgeons in their initial advanced laparoscopic procedural efforts. Telementoring simulator opportunities are included to acclimate the participant to the process. If the process seems comprehensive, it is meant to be. This is a high-risk situation, and a patient's welfare is on the line. If this concept is to reach its maximal healthcare delivery potential, responsible and academically credible training programs should be established with directional guidelines.
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Affiliation(s)
- J C Rosser
- Yale Endolaparoscopic Surgery Center, Yale University School of Medicine, New Haven 06510, USA.
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Rosser J, Herman B, Ehrenwerth C. An overview of videostreaming on the Internet and its application to surgical education. Surg Endosc 2001; 15:624-9. [PMID: 11591955 DOI: 10.1007/s004640000338] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2000] [Accepted: 05/15/2000] [Indexed: 11/24/2022]
Abstract
The Information Age has endowed mankind with a wealth of new technologies. Applications of these technologies are being developed to facilitate content exchange between individuals and institutions. Internet streaming is an exciting new technology that allows multimedia content to be stored and sent over the Internet, and medical educators are challenged to harness the potential of streaming for educational enhancement. This article helps to define streaming, examining its potential for surgical education.
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Affiliation(s)
- J Rosser
- Department of Surgery, Yale University, New Haven CT, USA.
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Abstract
In this article, we describe the advantages and disadvantages of procedures for monitoring mitochondrial pH in situ using optical microscopic techniques. The first method employs the combination of the fluorescent pH-sensitive indicator carboxy-SNARF and laser scanning confocal microscopy. Manipulation of the loading and post-loading conditions enables relatively specific accumulation of carboxy-SNARF into mitochondria. With the use of a mitochondrial-specific marker, mitochondrial pH can be accurately monitored. More recently, mitochondrial-targeted, pH-sensitive probes have been used to monitor mitochondrial pH. In particular, mitochondrial targeting of the yellow fluorescent protein (YFP) mutant of green fluorescent protein (GFP) combines the advantages of specific mitochondrial localization, high-fluorophore quantum yield, and extinction coefficient with an appropriate pKa for measuring mitochondrial pH. The use of dual-excitation ratiometry with mitochondrially targeted YFP increases the dynamic range of mitochondrial pH measurements and corrects for differences in the amount of expression of mitochondrially targeted YFP at the level of individual mitochondria.
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Affiliation(s)
- A Takahashi
- Department of Cellular & Structural Biology, University of Texas HSC at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Abstract
Younger and older adults read short expository passages across 2 times of measurement for subsequent comprehension or recall. Regression analysis was used to decompose word-by-word reading times into resources allocated to word- and textbase-level processes. Readers were more sensitive to these demands when reading for recall than when reading for comprehension. Patterns of resource allocation showed good test-retest reliabilities and were predictive of memory performance. Within age group, resource allocation parameters were not systematically correlated with other individual-difference measures, suggesting that strategies of on-line resource allocation may be a unique source of individual differences in determining comprehension of and memory for text. Age differences in allocation patterns appeared to reflect general slowing among the older adults. Because older adults showed equivalent memory performance to that of younger readers, the reading time data may represent the on-line resource allocation needed for comparable outcomes among older and younger readers.
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Affiliation(s)
- E A Stine-Morrow
- Department of Psychology, University of New Hampshire, Durham 03824, USA.
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Michard F, Wolff MA, Herman B, Wysocki M. Right ventricular response to high-dose almitrine infusion in patients with severe hypoxemia related to acute respiratory distress syndrome. Crit Care Med 2001; 29:32-6. [PMID: 11176154 DOI: 10.1097/00003246-200101000-00007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of high-dose almitrine infusion on gas exchange and right ventricular function in patients with severe hypoxemia related to acute respiratory distress syndrome (ARDS). DESIGN Prospective study. SETTING Medicosurgical intensive care department (ten beds). PATIENTS Nine patients with ARDS and severe hypoxemia (PaO2/FIO2 ratio, <150 torr [20 kPa]). INTERVENTION High-dose almitrine infusion (16 microg/kg/min for 30 mins). MEASUREMENTS AND MAIN RESULTS Gas exchange and hemodynamic parameters were recorded before and after almitrine infusion. Right ventricular function was evaluated by using a fast response thermistor pulmonary artery catheter that allowed measurement of right ventricular ejection fraction and calculation of right ventricular end-diastolic and end-systolic volumes. Almitrine did not significantly alter arterial oxygenation and intrapulmonary shunt. Almitrine increased mean pulmonary arterial pressure (MPAP) from 31 +/- 4 to 33 +/- 4 mm Hg (p < .05), pulmonary vascular resistance index from 353 +/- 63 to 397 +/- 100 dyne x sec/ cm5 x m2 (p < .05), and right ventricular end-systolic volume index from 71 +/- 22 to 77 +/- 21 mL/m2 (p < .05); almitrine decreased right ventricular ejection fraction from 36% +/- 7% to 34% +/- 8% (p < .05). Stroke volume index and cardiac index did not change. The almitrine-induced changes in right ventricular ejection fraction were closely correlated with the baseline MPAP (r2 = .71, p < .01). CONCLUSION In patients with severe hypoxemia related to ARDS, high-dose almitrine infusion did not improve arterial oxygenation and impaired the loading conditions of the right ventricle. The decrease in right ventricular ejection fraction induced by almitrine was correlated with the baseline MPAP. Thus, high-dose almitrine infusion may be harmful in ARDS patients with severe hypoxemia and pulmonary hypertension.
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Affiliation(s)
- F Michard
- Service de réanimation polyvalente, Institut Mutualiste Montsouris, Paris, France
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Herman B, Greiser E. Are acute myocardial infarctions becoming smaller? J Intern Med 2000; 248:352-4. [PMID: 11086648 DOI: 10.1046/j.1365-2796.2000.00744.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lemasters JJ, Qian T, Trost LC, Herman B, Cascio WE, Bradham CA, Brenner DA, Nieminen AL. Confocal microscopy of the mitochondrial permeability transition in necrotic and apoptotic cell death. Biochem Soc Symp 2000; 66:205-22. [PMID: 10989668 DOI: 10.1042/bss0660205] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opening of a high-conductance pore in the mitochondrial inner membrane induces onset of the mitochondrial permeability transition (mPT). Cyclosporin A and trifluoperazine inhibit this pore and block necrotic cell death in oxidative stress, Ca2+ ionophore toxicity, Reye-related drug toxicity, pH-dependent ischaemia/reperfusion injury and other models of cell injury. Confocal fluorescence microscopy directly visualizes the increased mitochondrial membrane permeability of the mPT from the movement of calcein from the cytosol into the matrix space. Pyridine nucleotide oxidation, increased mitochondrial Ca2+ and mitochondrial generation of reactive oxygen species (ROS) all contribute to the onset of the mPT in situ. Confocal microscopy also shows directly that the mPT is a critical link in apoptotic signalling by tumour necrosis factor-alpha at a point downstream of caspase 8 and upstream of caspase 3. Cyclosporin A blocks this mPT, preventing release of pro-apoptotic cytochrome c from mitochondria and subsequent apoptotic cell killing. Progression to necrosis or apoptosis after the mPT depends on the availability of ATP, which blocks necrosis but promotes the apoptotic programme. Given the pathophysiological importance of the mPT, development of agents to modulate the mPT represents an important new goal for pharmaceutical drug discovery.
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Affiliation(s)
- J J Lemasters
- Department of Cell Biology and Anatomy, University of North Carolina at Chapel Hill 27599-7090, USA
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Liu Y, McKalip A, Herman B. Human papillomavirus type 16 E6 and HPV-16 E6/E7 sensitize human keratinocytes to apoptosis induced by chemotherapeutic agents: roles of p53 and caspase activation. J Cell Biochem 2000. [PMID: 10842327 DOI: 10.1002/(sici)1097-4644(20000801)78:2<334::aid-jcb15>3.0.co;2-f] [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: 01/15/2023]
Abstract
We and others have previously reported that human papillomavirus (HPV)-16 E6 protein expression sensitizes certain cell types to apoptosis. To confirm that this sensitization occurred in HPV's natural host cells, and to explore the mechanism(s) of sensitization, we infected human keratinocytes (HKCs) with retroviruses containing HPV-6 E6, HPV-16 E6, HPV-16 E7, or HPV-16 E6/E7. Apoptosis was monitored by DNA fragmentation gel analysis and direct observation of nuclei in cells stained with DAPI. Exposure of HKCs to etoposide, cisplatin, mitomycin C (MMC), atractyloside, and sodium butyrate, resulted in a time and dose-dependent induction of apoptosis. Expression of HPV-16 E6 and HPV-16 E6/E7, but not HPV-6 E6 or HPV-16 E7, enhanced the sensitivity of HKCs to cisplatin-, etoposide- and MMC-, but not atractyloside- or sodium butyrate-induced apoptosis. Expression of both HPV-16 E6 and HPV-16 E6/E7 decreased, but did not abolish, p53 protein levels relative to normal HKCs, and resulted in cytoplasmic localization of wt p53. P53 induction occurred in HPV-16 E6 and HPV-16 E6/E7 expressing cells after exposure to cisplatin or MMC, though never to levels found in normal untreated HKCs. P21 levels were decreased in HPV-16 E6 and HPV-16 E6/E7 expressing HKCs, and no induction of p21 was seen in these cells following exposure to cisplatin or MMC. Caspase-3 activity was found to be elevated in HPV-16 E6-expressing HKCs following exposure to cisplatin and MMC as documented by fluorometric and Western Blot analysis. Expression of wt CrmA or treatment of HPV-16 E6 expressing HKCs with the caspase-3 inhibitor DEVD.fmk prevented HPV-16 E6-induced sensitization in HKCs. These results suggest that HPV-16 E6 and HPV-16 E6/E7 expression sensitizes HKCs to apoptosis caused by cisplatin, etoposide and MMC, but not atractyloside or sodium butyrate. The data also suggest that wt p53 and caspase-3 activity are required for HPV-16 E6 and HPV-16 E6/E7-induced sensitization of HKCs to DNA damaging agents.
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Affiliation(s)
- Y Liu
- Department of Cellular & Structural Biology, University of Texas Health Science Center, San Antonio, Texas 78284, USA
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Herman B, Einav S, Vered Z. Feasibility of mitral flow assessment by echo-contrast ultrasound, part I: determination of the properties of echo-contrast agents. Ultrasound Med Biol 2000; 26:787-795. [PMID: 10942826 DOI: 10.1016/s0301-5629(00)00202-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Data on the ultrasonic properties of commercially available contrast agents are limited by being instrument-dependent, especially with regard to their backscattering properties. The present work describes methods of measurements that provide instrument-independent estimations of a contrast agent's attenuation coefficient and integrated backscatter index and provide them as functions of its concentration. The two studied commercially available contrast agents were Albunex and Levovist SHU 508-A, both representative of agents in common use for echocardiography. The attenuation coefficients and integrated backscatter indices of both agents were found to be a linear function of their concentrations. Proportionality coefficients +/- their standard deviations are provided. Actually, square root values of the averaged backscatter indices normalized with respect to the rms of the reference signal were determined. The coefficients of proportionality were found to be: C(A) = 3.11+/-0.1813 dB/mm; C(L) = 0.07+/-0.005 dB/mm for attenuation coefficients of the Albunex and Levovist contrast agents, respectively, and the corresponding values for backscattering were: D(A) = 0.07+/-0.0054; D(L) = 0.02+/-0.0012. Being apparatus-independent, the findings of the study are important prerequisites for the use of these echo-contrast agents as an indicator in research for a quantitative assessment of blood flow.
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Affiliation(s)
- B Herman
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv, Israel
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