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Wang Q, Seethapathy R, Ouyang T, Strohbehn IA, Katz-Agranov N, Hanna P, Madken M, Seethapathy H, Gupta S, Heller HM, Wszolek M, Steele D, Klepeis VE, Rennke H, Sise ME. Pyelonephritis is an Underrecognized Cause of CKD in Patients With Orthotopic Ileal Neobladder Substitution. Kidney Int Rep 2023; 8:2833-2837. [PMID: 38106586 PMCID: PMC10719585 DOI: 10.1016/j.ekir.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Qiyu Wang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rituvanthikaa Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tianqi Ouyang
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ian A. Strohbehn
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nurit Katz-Agranov
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Hanna
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohit Madken
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shruti Gupta
- Division of Renal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Adult Survivorship Program, Department of Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Howard M. Heller
- Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matthew Wszolek
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Veronica E. Klepeis
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helmut Rennke
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Steele D, Walker A. 'Vancowax' for haemostasis and topical antibiotic post sternotomy. Ann R Coll Surg Engl 2023; 105:385. [PMID: 36239947 PMCID: PMC10066641 DOI: 10.1308/rcsann.2022.0105] [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] [Accepted: 04/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- D Steele
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
| | - A Walker
- Blackpool Teaching Hospitals NHS Foundation Trust, UK
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Gevaert P, Bachert C, Maspero JF, Cuevas M, Steele D, Acharya S, Altman P. Phase 3b randomized controlled trial of fevipiprant in patients with nasal polyposis with asthma (THUNDER). J Allergy Clin Immunol 2022; 149:1675-1682.e3. [DOI: 10.1016/j.jaci.2021.12.759] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
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Bateman KM, Steele D, Sexton CM. Sustainability science education: our animalistic response-ability. Cult Stud Sci Educ 2021; 16:841-855. [PMID: 34257736 PMCID: PMC8265713 DOI: 10.1007/s11422-021-10039-7] [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] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/21/2021] [Indexed: 06/13/2023]
Abstract
In this paper, we craft a dialogue between "The Anthropocene as we know it: posthumanism, science education and scientific literacy as a path to sustainability," by Sophia Jeong, Brandon Sherman, and Deborah Tippins and, "The quest for sustainable futures: designing transformative spaces for youth through critical response-ability," by Shakhnoza Kayumova and Deborah Tippins. We argue for an optimistic approach to post-Anthropocene science education that acknowledges humans as the animals we are, albeit with a more sophisticated understanding of our place in the world. It is this understanding that gives us both responsibility and a response-ability to our human and non-human actors within our earthly entanglement. To do this requires reimagining science classrooms as locations of opportunity where students develop agential literacy. These classrooms provide an environment that allow students to develop their skills as sustainability engineers. We advocate for embracing indigenous ways of knowing, opening locations of possibilities through policy reform, fostering an integrated model of STEM education, and re-imagining teacher education to promote and move toward equitable science education.
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Affiliation(s)
- Kathryn M. Bateman
- Department of Psychology, Temple University, 1701 N. 13th Street, 333 Weiss Hall, Philadelphia, PA USA
| | - David Steele
- Alder Graduate School of Education, Redwood City, CA USA
| | - Chelsea M. Sexton
- Department of Mathematics and Science Education, University of Georgia, Athens, GA USA
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5
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Affiliation(s)
- Renajd Rrapi
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sidharth Chand
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen Gabel
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren Ko
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin J Moore
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - David Steele
- Department of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
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6
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Jing M, Mclaughlin D, Mcnamee SE, Raj S, Namee BM, Steele D, Finlay D, Mclaughlin J. A Novel Method for Quantitative Analysis of C-Reactive Protein Lateral Flow Immunoassays Images via CMOS Sensor and Recurrent Neural Networks. IEEE J Transl Eng Health Med 2021; 9:1900415. [PMID: 34873497 PMCID: PMC8641912 DOI: 10.1109/jtehm.2021.3130494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 11/16/2021] [Indexed: 12/28/2022]
Abstract
Objective: To design and implement an easy-to-use, Point-of-Care (PoC) lateral flow immunoassays (LFA) reader and data analysis system, which provides a more in-depth quantitative analysis for LFA images than conventional approaches thereby supporting efficient decision making for potential early risk assessment of cardiovascular disease (CVD). Methods and procedures: A novel end-to-end system was developed including a portable device with CMOS camera integrated with optimized illumination and optics to capture the LFA images produced using high-sensitivity C-Reactive Protein (hsCRP) (concentration level < 5 mg/L). The images were transmitted via WiFi to a back-end server system for image analysis and classification. Unlike common image classification approaches which are based on averaging image intensity from a region-of-interest (ROI), a novel approach was developed which considered the signal along the sample’s flow direction as a time series and, consequently, no need for ROI detection. Long Short-Term Memory (LSTM) networks were deployed for multilevel classification. The features based on Dynamic Time Warping (DTW) and histogram bin counts (HBC) were explored for classification. Results: For the classification of hsCRP, the LSTM outperformed the traditional machine learning classifiers with or without DTW and HBC features performed the best (with mean accuracy of 94%) compared to other features. Application of the proposed method to human plasma also suggests that HBC features from LFA time series performed better than the mean from ROI and raw LFA data. Conclusion: As a proof of concept, the results demonstrate the capability of the proposed framework for quantitative analysis of LFA images and suggest the potential for early risk assessment of CVD. Clinical impact: The hsCRP levels < 5 mg/L were aligned with clinically actionable categories for early risk assessment of CVD. The outcomes demonstrated the real-world applicability of the proposed system for quantitative analysis of LFA images, which is potentially useful for more LFA applications beyond presented in this study.
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Affiliation(s)
- Min Jing
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Donal Mclaughlin
- Department of Physics and AstronomyUniversity College London London WC1E 6BT U.K
| | - Sara E Mcnamee
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Shasidran Raj
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
| | - Brian Mac Namee
- School of Computer ScienceUniversity College Dublin Dublin 4 D04 V1W8 Ireland
| | | | - Dewar Finlay
- School of EngineeringUlster University Jordanstown BT37 0QB U.K
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7
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Puttaswamy SV, Shi Q, Steele D, Fishlock SJ, Lee C, McLaughlin J. High density nanowire electrodes for intracortical microstimulation. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5657-5660. [PMID: 31947136 DOI: 10.1109/embc.2019.8857305] [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: 11/05/2022]
Abstract
High-density electrodes with the nano feature size greatly enhance resolution and specificity during intracortical microstimulation. In this viewpoint, we fabricated and developed high-density nanowire (NW) electrodes, ~ 2.45×109 / cm2 that could directly stimulate specific region of the cortex with low current amplitude in the range of 120-180 μA. The proposed nanowire electrodes will help expand the capabilities of microstimulation and extend the range of dysfunctions that can be treated using microstimulation technique.
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Puttaswamy SV, Fishlock SJ, Steele D, Shi Q, Lee C, McLaughlin J. Versatile microfluidic platform embedded with sidewall three-dimensional electrodes for cell manipulation. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab268e] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Steele D, Baig KKK, Peter S. Evolving screening and surveillance techniques for Barrett's esophagus. World J Gastroenterol 2019; 25:2045-2057. [PMID: 31114132 PMCID: PMC6506582 DOI: 10.3748/wjg.v25.i17.2045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Barrett’s esophagus (BE) is a change in the esophageal lining and is known to be the major precursor lesion for most cases of esophageal adenocarcinoma (EAC). Despite an understanding of its association with BE for many years and the falling incidence rates of squamous cell carcinoma of the esophagus, the incidence for EAC continues to rise exponentially. In association with this rising incidence, if the delay in diagnosis of EAC occurs after the onset of symptoms, then the mortality at 5 years is greater than 80%. Appropriate diagnosis and surveillance strategies are therefore vital for BE. Multiple novel optical technologies and other advanced approaches are being utilized to assist in making screening and surveillance more cost effective. We review the current guidelines and evolving techniques that are currently being evaluated.
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Affiliation(s)
- David Steele
- Basil Hirschowitz Endoscopic Centre of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United Sates
| | - Kondal Kyanam Kabir Baig
- Basil Hirschowitz Endoscopic Centre of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United Sates
| | - Shajan Peter
- Basil Hirschowitz Endoscopic Centre of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, United Sates
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Soppa G, Theodoropoulos P, Bilkhu R, Harrison DA, Alam R, Beattie R, Bleetman D, Hussain A, Jones S, Kenny L, Khorsandi M, Lea A, Mensah K, Hici TN, Pinho-Gomes AC, Rogers L, Sepehripour A, Singh S, Steele D, Weaver H, Klein A, Fletcher N, Jahangiri M. Variation between hospitals in outcomes following cardiac surgery in the UK. Ann R Coll Surg Engl 2019; 101:333-341. [PMID: 30854865 PMCID: PMC6513373 DOI: 10.1308/rcsann.2019.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We examine the influence of variations in provision of cardiac surgery in the UK at hospital level on patient outcomes and also to assess whether there is an inequality of access and delivery of healthcare. Cardiothoracic surgery has pioneered the reporting of surgeon-specific outcomes, which other specialties have followed. We set out to identify factors other than the individual surgeon, which can affect outcomes and enable other surgical specialties to adopt a similar model. MATERIALS AND METHODS A retrospective analysis of prospectively collected data of patient and hospital level factors between 2013 and 2016 from 16 cardiac surgical units in the UK were analysed through the Society for Cardiothoracic Surgery of Great Britain and Ireland and the Royal College of Surgeons Research Collaborative. Patient demographic data, risks factors, postoperative complications and in-hospital mortality, as well as hospital-level factors such as number of beds and operating theatres, were collected. Correlation between outcome measures was assessed using Pearson's correlation coefficient. Associations between hospital-level factors and outcomes were assessed using univariable and multivariable regression models. RESULTS Of 50,871 patients (60.5% of UK caseload), 25% were older than 75 years and 29% were female. There was considerable variation between units in patient comorbidities, bed distribution and staffing. All hospitals had dedicated cardiothoracic intensive care beds and consultants. Median survival was 97.9% (range 96.3-98.6%). Postoperative complications included re-sternotomy for bleeding (median 4.8%; range 3.5-6.9%) and mediastinitis (0.4%; 0.1-1.0%), transient ischaemic attack/cerebrovascular accident (1.7%; range 0.3-3.0%), haemofiltration (3.7%; range 0.8-6.8%), intra-aortic balloon pump use (3.3%; range 0.4-7.4%), tracheostomy (1.6%; range 1.3-2.6%) and laparotomy (0.3%; range 0.2-0.6%). There was variation in outcomes between hospitals. Univariable analysis showed a small number of positive associations between hospital-level factors and outcomes but none remained significant in multivariable models. CONCLUSIONS Variations among hospital level factors exists in both delivery of, and outcomes, following cardiac surgery in the UK. However, there was no clear association between these factors and patient outcomes. This negative finding could be explained by differences in outcome definition, differences in risk factors between centres that are not captured by standard risk stratification scores or individual surgeon/team performance.
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Affiliation(s)
- G Soppa
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - P Theodoropoulos
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Bilkhu
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - DA Harrison
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Alam
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - R Beattie
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - D Bleetman
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Hussain
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - S Jones
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - L Kenny
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - M Khorsandi
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Lea
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - Ka Mensah
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - TN Hici
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - AC Pinho-Gomes
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - L Rogers
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Sepehripour
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - S Singh
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - D Steele
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - H Weaver
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - A Klein
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - N Fletcher
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
| | - M Jahangiri
- Department of Cardiothoracic Surgery, St. George’s Hospital, London, UK
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11
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Fan YC, Steele D, Kochar B, Arsene D, Long MD, Dellon ES. Increased Prevalence of Esophageal Eosinophilia in Patients with Inflammatory Bowel Disease. Inflamm Intest Dis 2019; 3:180-186. [PMID: 31111034 DOI: 10.1159/000497236] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/19/2019] [Indexed: 12/14/2022] Open
Abstract
Background The overlap between eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) has not been extensively examined. We aimed to assess the prevalence of esophageal eosinophilia in patients with IBD. Methods We conducted a retrospective cohort study using diagnostic codes to identify adults with EoE and IBD between 2008 and 2016 at a tertiary care center. Electronic medical records were reviewed to extract clinical, endoscopic, and treatment data. Patients with esophageal eosinophilia and IBD were compared to EoE cases without IBD. Results Of 621 EoE patients and 4,814 IBD patients identified, 35 had a code for both diseases and 12 were confirmed to have overlapping IBD and esophageal eosinophilia. The prevalence of esophageal eosinophilia in IBD was 12/4814 (0.25%), and the prevalence of confirmed EoE in IBD was 5/4,814 (0.10%). There were no substantial clinical, endoscopic, or histologic differences between EoE patients with and without IBD. IBD was diagnosed before esophageal eosinophilia 92% of the time, with an average time between diagnoses of 9.6 years. Of the IBD patients, 71% were started on biologic anti-tumor necrosis factor-α therapy an average of 7.6 years prior to developing esophageal eosinophilia. Conclusions The prevalence of esophageal eosinophilia in IBD is 5 times higher than expected in the general population (0.25 vs. 0.05%) and EoE in IBD is 2 times higher than expected (0.10 vs. 0.05%). Upper gastrointestinal (GI) symptoms in patients with IBD should merit evaluation not only for upper GI Crohn's disease, but also for esophageal eosinophilia.
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Affiliation(s)
- Y Claire Fan
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - David Steele
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Bharati Kochar
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Diana Arsene
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Millie D Long
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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12
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Catherwood PA, Steele D, Little M, Mccomb S, Mclaughlin J. A Community-Based IoT Personalized Wireless Healthcare Solution Trial. IEEE J Transl Eng Health Med 2018; 6:2800313. [PMID: 29888145 PMCID: PMC5991865 DOI: 10.1109/jtehm.2018.2822302] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/13/2018] [Accepted: 03/24/2018] [Indexed: 01/26/2023]
Abstract
This paper presents an advanced Internet of Things point-of-care bio-fluid analyzer; a LoRa/Bluetooth-enabled electronic reader for biomedical strip-based diagnostics system for personalized monitoring. We undertake test simulations (technology trial without patient subjects) to demonstrate potential of long-range analysis, using a disposable test ‘key’ and companion Android app to form a diagnostic platform suitable for remote point-of-care screening for urinary tract infection (UTI). The 868 MHz LoRaWAN-enabled personalized monitor demonstrated sound potential with UTI test results being correctly diagnosed and transmitted to a remote secure cloud server in every case. Tests ranged over distances of 1.1–6.0 Km with radio path losses from 119–141 dB. All tests conducted were correctly and robustly received at the base station and relayed to the secure server for inspection. The UTI test strips were visually inspected for correct diagnosis based on color change and verified as 100% accurate. Results from testing across a number of regions indicate that such an Internet of Things medical solution is a robust and simple way to deliver next generation community-based smart diagnostics and disease management to best benefit patients and clinical staff alike. This significant step can be applied to any type of home or region, particularly those lacking suitable mobile signals, broadband connections, or even landlines. It brings subscription-free long-range bio-telemetry to healthcare providers and offers savings on regular clinician home visits or frequent clinic visits by the chronically ill. This paper highlights practical hurdles in establishing an Internet of Medical Things network, assisting informed deployment of similar future systems.
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13
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Aalseth CE, Abgrall N, Aguayo E, Alvis SI, Amman M, Arnquist IJ, Avignone FT, Back HO, Barabash AS, Barbeau PS, Barton CJ, Barton PJ, Bertrand FE, Bode T, Bos B, Boswell M, Bradley AW, Brodzinski RL, Brudanin V, Busch M, Buuck M, Caldwell AS, Caldwell TS, Chan YD, Christofferson CD, Chu PH, Collar JI, Combs DC, Cooper RJ, Cuesta C, Detwiler JA, Doe PJ, Dunmore JA, Efremenko Y, Ejiri H, Elliott SR, Fast JE, Finnerty P, Fraenkle FM, Fu Z, Fujikawa BK, Fuller E, Galindo-Uribarri A, Gehman VM, Gilliss T, Giovanetti GK, Goett J, Green MP, Gruszko J, Guinn IS, Guiseppe VE, Hallin AL, Haufe CR, Hehn L, Henning R, Hoppe EW, Hossbach TW, Howe MA, Jasinski BR, Johnson RA, Keeter KJ, Kephart JD, Kidd MF, Knecht A, Konovalov SI, Kouzes RT, LaFerriere BD, Leon J, Lesko KT, Leviner LE, Loach JC, Lopez AM, Luke PN, MacMullin J, MacMullin S, Marino MG, Martin RD, Massarczyk R, McDonald AB, Mei DM, Meijer SJ, Merriman JH, Mertens S, Miley HS, Miller ML, Myslik J, Orrell JL, O'Shaughnessy C, Othman G, Overman NR, Perumpilly G, Pettus W, Phillips DG, Poon AWP, Pushkin K, Radford DC, Rager J, Reeves JH, Reine AL, Rielage K, Robertson RGH, Ronquest MC, Ruof NW, Schubert AG, Shanks B, Shirchenko M, Snavely KJ, Snyder N, Steele D, Suriano AM, Tedeschi D, Tornow W, Trimble JE, Varner RL, Vasilyev S, Vetter K, Vorren K, White BR, Wilkerson JF, Wiseman C, Xu W, Yakushev E, Yaver H, Young AR, Yu CH, Yumatov V, Zhitnikov I, Zhu BX, Zimmermann S. Search for Neutrinoless Double-β Decay in ^{76}Ge with the Majorana Demonstrator. Phys Rev Lett 2018; 120:132502. [PMID: 29694188 DOI: 10.1103/physrevlett.120.132502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/09/2018] [Indexed: 06/08/2023]
Abstract
The Majorana Collaboration is operating an array of high purity Ge detectors to search for neutrinoless double-β decay in ^{76}Ge. The Majorana Demonstrator comprises 44.1 kg of Ge detectors (29.7 kg enriched in ^{76}Ge) split between two modules contained in a low background shield at the Sanford Underground Research Facility in Lead, South Dakota. Here we present results from data taken during construction, commissioning, and the start of full operations. We achieve unprecedented energy resolution of 2.5 keV FWHM at Q_{ββ} and a very low background with no observed candidate events in 9.95 kg yr of enriched Ge exposure, resulting in a lower limit on the half-life of 1.9×10^{25} yr (90% C.L.). This result constrains the effective Majorana neutrino mass to below 240-520 meV, depending on the matrix elements used. In our experimental configuration with the lowest background, the background is 4.0_{-2.5}^{+3.1} counts/(FWHM t yr).
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Affiliation(s)
- C E Aalseth
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - N Abgrall
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - E Aguayo
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - S I Alvis
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - M Amman
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - I J Arnquist
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - F T Avignone
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - H O Back
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - A S Barabash
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow, 117218 Russia
| | - P S Barbeau
- Department of Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - C J Barton
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - P J Barton
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - F E Bertrand
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - T Bode
- Max-Planck-Institut für Physik, München, 80805 Germany
| | - B Bos
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - M Boswell
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - A W Bradley
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - R L Brodzinski
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - V Brudanin
- Joint Institute for Nuclear Research, Dubna, 141980 Russia
| | - M Busch
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - M Buuck
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - A S Caldwell
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - T S Caldwell
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - Y-D Chan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C D Christofferson
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - P-H Chu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J I Collar
- Department of Physics, University of Chicago, Chicago, Illinois 60637, USA
| | - D C Combs
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - R J Cooper
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - C Cuesta
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J A Detwiler
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - P J Doe
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J A Dunmore
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - Yu Efremenko
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37916, USA
| | - H Ejiri
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - S R Elliott
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J E Fast
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - P Finnerty
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - F M Fraenkle
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - Z Fu
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - B K Fujikawa
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - E Fuller
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | | | - V M Gehman
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T Gilliss
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - G K Giovanetti
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
- Department of Physics, Princeton University, Princeton, New Jersey 08544, USA
| | - J Goett
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M P Green
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - J Gruszko
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - I S Guinn
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - V E Guiseppe
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A L Hallin
- Centre for Particle Physics, University of Alberta, Edmonton, Alberta T6G 2E1, Canada
| | - C R Haufe
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - L Hehn
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - R Henning
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - E W Hoppe
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - T W Hossbach
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - M A Howe
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - B R Jasinski
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - R A Johnson
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K J Keeter
- Department of Physics, Black Hills State University, Spearfish, South Dakota 57799, USA
| | - J D Kephart
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - M F Kidd
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Tennessee Tech University, Cookeville, Tennessee 38505, USA
| | - A Knecht
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - S I Konovalov
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow, 117218 Russia
| | - R T Kouzes
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - B D LaFerriere
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - J Leon
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - K T Lesko
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - L E Leviner
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - J C Loach
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Shanghai Jiao Tong University, Shanghai 200240, China
| | - A M Lopez
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37916, USA
| | - P N Luke
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J MacMullin
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - S MacMullin
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - M G Marino
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - R D Martin
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R Massarczyk
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A B McDonald
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - D-M Mei
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S J Meijer
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - J H Merriman
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - S Mertens
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Max-Planck-Institut für Physik, München, 80805 Germany
- Physik Department and Excellence Cluster Universe, Technische Universität, München, 85748 Germany
| | - H S Miley
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - M L Miller
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J Myslik
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J L Orrell
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - C O'Shaughnessy
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - G Othman
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - N R Overman
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - G Perumpilly
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - W Pettus
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - D G Phillips
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - A W P Poon
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - K Pushkin
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - D C Radford
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - J Rager
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - J H Reeves
- Pacific Northwest National Laboratory, Richland, Washington 99354, USA
| | - A L Reine
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - K Rielage
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R G H Robertson
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - M C Ronquest
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N W Ruof
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - A G Schubert
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - B Shanks
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - M Shirchenko
- Joint Institute for Nuclear Research, Dubna, 141980 Russia
| | - K J Snavely
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - N Snyder
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - D Steele
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A M Suriano
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - D Tedeschi
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
| | - W Tornow
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
| | - J E Trimble
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - R L Varner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - S Vasilyev
- Joint Institute for Nuclear Research, Dubna, 141980 Russia
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37916, USA
| | - K Vetter
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Department of Nuclear Engineering, University of California, Berkeley, California 94720, USA
| | - K Vorren
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - B R White
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J F Wilkerson
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - C Wiseman
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
| | - W Xu
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27514, USA
| | - E Yakushev
- Joint Institute for Nuclear Research, Dubna, 141980 Russia
| | - H Yaver
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A R Young
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - C-H Yu
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - V Yumatov
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow, 117218 Russia
| | - I Zhitnikov
- Joint Institute for Nuclear Research, Dubna, 141980 Russia
| | - B X Zhu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Zimmermann
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
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14
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Lim K, Heher E, Steele D, Fenves AZ, Tucker JK, Thadhani R, Christopher K, Tolkoff-Rubin N. Hemodialysis failure secondary to hydroxocobalamin exposure. Proc (Bayl Univ Med Cent) 2017; 30:167-168. [PMID: 28405068 DOI: 10.1080/08998280.2017.11929569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Hydroxocobalamin is a recently approved antidote for the treatment of cyanide poisoning. The case presented involves a young patient administered empiric hydroxocobalamin due to suspected cyanide overdose. Due to the development of acute kidney injury and severe metabolic derangement, emergent hemodialysis was initiated. Unfortunately, hemodialysis was confounded by a recurrent "blood leak" alarm. This unforeseen effect was secondary to interference from hydroxocobalamin. Hydroxocobalamin causes orange/red discoloration of bodily fluids and permeates the dialysate. This leads to defraction of light in the effluent path of the blood leak detector from discolored dialysate, which can result in activation of the blood leak alarm and an inability to continue hemodialysis treatment. This case highlights several new and emerging critical concerns with this medication, including the potential consequence of delayed initiation of emergent renal replacement therapy with empiric administration, the need for increased awareness among clinicians of various disciplines, and the need for multidisciplinary communication.
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Affiliation(s)
- Kenneth Lim
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - Eliot Heher
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - David Steele
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - Andrew Z Fenves
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - John Kevin Tucker
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - Ravi Thadhani
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - Kenneth Christopher
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
| | - Nina Tolkoff-Rubin
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Heher, Steele, Fenves, Tucker, Thadhani, Tolkoff-Rubin); and the Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Lim, Tucker, Christopher)
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15
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Louridas M, Grantcharov T, Seeman N, Iancu AM, Steele D, Ahmed N, Shore E. Modelling the Learning Curves of Incoming Surgical Trainees. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.618] [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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16
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Affiliation(s)
- D. Steele
- Providence Care Mental Health Services, Brockville, Ontario, Canada,
- Lanark Leeds Grenville, Brockville, Ontario, Canada
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17
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Langer K, Steele D, Schnepper L, Fritzlar S. Applying the Evidence in Treatment of Acute Uncomplicated Bronchitis in Emergency Medicine. West J Nurs Res 2016; 38:1381-2. [DOI: 10.1177/0193945916658192] [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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18
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Abstract
This case report presents an unusual complication of upper endoscopy, resulting in jaw dislocation. Temporomandibular joint dislocation is commonly reported in association with anesthesia and intubation, but it is not widely recognized as a complication of gastrointestinal endoscopy. This report also reviews the current literature regarding this complication and discusses the potential causes of dislocation, differential diagnoses for jaw pain following endoscopy, and recommendations for prevention.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Disease and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, N.C., USA
| | - David Steele
- Center for Esophageal Disease and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, N.C., USA
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19
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Sise ME, Bloom AK, Wisocky J, Lin MV, Gustafson JL, Lundquist AL, Steele D, Thiim M, Williams WW, Hashemi N, Kim AY, Thadhani R, Chung RT. Treatment of hepatitis C virus-associated mixed cryoglobulinemia with direct-acting antiviral agents. Hepatology 2016; 63:408-17. [PMID: 26474537 PMCID: PMC4718772 DOI: 10.1002/hep.28297] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [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: 03/24/2015] [Accepted: 10/12/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) is the most common cause of mixed cryoglobulinemia syndrome (MCS). The efficacy and safety of all-oral direct-acting antiviral (DAA) therapy in HCV-associated MCS (HCV-MCS) is largely unknown. The authors studied case series of patients with HCV-MCS who were treated with sofosbuvir-based regimens and historical controls treated with pegylated interferon and ribavirin in a single health care network. HCV-MCS was defined by circulating cryoglobulin associated with systemic vasculitis symptoms. Renal involvement (n = 7) was established by kidney biopsy (n = 5) or by two or more of the following clinical findings: reduced kidney function, proteinuria, or hematuria with other causes excluded (n = 2). Twelve patients received DAA therapy between December 2013 and September 2014. Median age was 61 years, 58% were male, and 50% had cirrhosis. Median baseline serum creatinine was 0.97 mg/dL (range 0.7-2.47). Four patients received rituximab concurrent with DAA therapy. Sustained virological response rate at 12 weeks (SVR12) was 83% overall. Patients with glomerulonephritis who achieved SVR12 experienced an improvement in serum creatinine and a reduction in proteinuria. Cryoglobulin levels decreased in 89% of patients, with median percent decreasing from 1.5% to 0.5% and completely disappearing in four of nine cases who had cryoglobulins measured after treatment. Serious adverse events were infrequent (17%). In contrast, the historical cohort treated with pegylated interferon and ribavirin experienced only 10% SVR12, with 100% experiencing at least one adverse event and 50% experiencing premature discontinuation due to adverse events. CONCLUSION SVR12 rates for sofosbuvir-based DAA regimens in HCV-MCS were 83%, significantly higher than historical controls treated with pegylated interferon and ribavirin; patients with glomerulonephritis experienced improvement in renal function, including those not concomitantly treated with immunosuppression.
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Affiliation(s)
- Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Allyson K. Bloom
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Jessica Wisocky
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Ming V. Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Jenna L. Gustafson
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Andrew L. Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - David Steele
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Michael Thiim
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
| | - Winfred W. Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Nikroo Hashemi
- Division of Gastroenterology and Hepatology, Department of Medicine, Brigham and Women’s Hospital
| | - Arthur Y. Kim
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital
| | - Ravi Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital
| | - Raymond T. Chung
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital
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20
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Rella CW, Tsai TR, Botkin CG, Crosson ER, Steele D. Measuring emissions from oil and natural gas well pads using the mobile flux plane technique. Environ Sci Technol 2015; 49:4742-8. [PMID: 25806837 DOI: 10.1021/acs.est.5b00099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We present a study of methane emissions from oil and gas producing well pad facilities in the Barnett Shale region of Texas, measured using an innovative ground-based mobile flux plane (MFP) measurement system, as part of the Barnett Coordinated Campaign.1 Using only public roads, we measured the emissions from nearly 200 well pads over 2 weeks in October 2013. The population of measured well pads is split into well pads with detectable emissions (N = 115) and those with emissions below the detection limit of the MFP instrument (N = 67). For those well pads with nonzero emissions, the distribution was highly skewed, with a geometric mean of 0.63 kg/h, a geometric standard deviation of 4.2, and an arithmetic mean of 1.72 kg/h. Including the population of nonemitting well pads, we find that the arithmetic mean of the well pads sampled in this study is 1.1 kg/h. This distribution implies that 50% of the emissions is due to the 6.6% highest emitting well pads, and 80% of the emissions is from the 22% highest emitting well pads.
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Affiliation(s)
- Chris W Rella
- Picarro, Inc., 3105 Patrick Henry Drive, Santa Clara, California 95054, United States
| | - Tracy R Tsai
- Picarro, Inc., 3105 Patrick Henry Drive, Santa Clara, California 95054, United States
| | - Connor G Botkin
- Picarro, Inc., 3105 Patrick Henry Drive, Santa Clara, California 95054, United States
| | - Eric R Crosson
- Picarro, Inc., 3105 Patrick Henry Drive, Santa Clara, California 95054, United States
| | - David Steele
- Picarro, Inc., 3105 Patrick Henry Drive, Santa Clara, California 95054, United States
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21
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Zhang H, Brown KD, Lowe SP, Liu GS, Steele D, Abberton K, Daniell M. Acrylic Acid Surface-Modified Contact Lens for the Culture of Limbal Stem Cells. Tissue Eng Part A 2014; 20:1593-602. [DOI: 10.1089/ten.tea.2013.0320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Hong Zhang
- Eye Hospital, Harbin Medical University, Nangang District, Harbin, Heilongjiang Province, China
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne VIC, Australia
| | - Karl David Brown
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne VIC, Australia
- O'Brien Institute, Fitzroy, VIC, Australia
| | - Sue Peng Lowe
- Mawson Institute, SA, University Parade, Mawson Lakes, Adelaide, Australia
| | - Guei-Sheung Liu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne VIC, Australia
- O'Brien Institute, Fitzroy, VIC, Australia
| | - David Steele
- Mawson Institute, SA, University Parade, Mawson Lakes, Adelaide, Australia
| | | | - Mark Daniell
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne VIC, Australia
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Brown KD, Low S, Mariappan I, Abberton KM, Short R, Zhang H, Maddileti S, Sangwan V, Steele D, Daniell M. Plasma polymer-coated contact lenses for the culture and transfer of corneal epithelial cells in the treatment of limbal stem cell deficiency. Tissue Eng Part A 2014; 20:646-55. [PMID: 24328453 DOI: 10.1089/ten.tea.2013.0089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Extensive damage to the limbal region of the cornea leads to a severe form of corneal blindness termed as limbal stem cell deficiency (LSCD). Whereas most cases of corneal opacity can be treated with full thickness corneal transplants, LSCD requires stem cell transplantation for successful ocular surface reconstruction. Current treatments for LSCD using limbal stem cell transplantation involve the use of murine NIH 3T3 cells and human amniotic membranes as culture substrates, which pose the threat of transmission of animal-derived pathogens and donor tissue-derived cryptic infections. In this study, we aimed to produce surface modified therapeutic contact lenses for the culture and delivery of corneal epithelial cells for the treatment of LSCD. This approach avoids the possibility of suture-related complications and is completely synthetic. We used plasma polymerization to deposit acid functional groups onto the lenses at various concentrations. Each surface was tested for its suitability to promote corneal epithelial cell adhesion, proliferation, retention of stem cells, and differentiation and found that acid-based chemistries promoted better cell adhesion and proliferation. We also found that the lenses coated with a higher percentage of acid functional groups resulted in a higher number of cells transferred onto the corneal wound bed in rabbit models of LSCD. Immunohistochemistry of the recipient cornea confirmed the presence of autologous, transplanted 5-bromo-2'-deoxyuridine (BrdU)-labeled cells. Hematoxylin staining has also revealed the presence of a stratified epithelium at 26 days post-transplantation. This study provides the first evidence for in vivo transfer and survival of cells transplanted from a contact lens to the wounded corneal surface. It also proposes the possibility of using plasma polymer-coated contact lenses with high acid functional groups as substrates for the culture and transfer of limbal cells in the treatment of LSCD.
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Affiliation(s)
- Karl David Brown
- 1 Surgical Research Unit, Centre for Eye Research Australia , Melbourne, Australia
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Strazzula L, Nigwekar SU, Steele D, Tsiaras W, Sise M, Bis S, Smith GP, Kroshinsky D. Intralesional Sodium Thiosulfate for the Treatment of Calciphylaxis. JAMA Dermatol 2013; 149:946-9. [DOI: 10.1001/jamadermatol.2013.4565] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Nigwekar SU, Bhan I, Turchin A, Skentzos SC, Hajhosseiny R, Steele D, Nazarian RM, Wenger J, Parikh S, Karumanchi A, Thadhani R. Statin use and calcific uremic arteriolopathy: a matched case-control study. Am J Nephrol 2013; 37:325-32. [PMID: 23548843 PMCID: PMC4110510 DOI: 10.1159/000348806] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [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] [Received: 12/05/2012] [Accepted: 02/08/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is characterized by vascular calcification, thrombosis and intense inflammation. Prior research has shown that statins have anticalcification, antithrombotic and antiinflammatory properties; however, the association between statin use and CUA has not been investigated. METHODS This matched case-control study included 62 adult maintenance hemodialysis (HD) patients with biopsy-confirmed CUA diagnosed between the years 2002 and 2011 (cases). All cases were hospitalized at the time of diagnosis. Controls (n = 124) were hospitalized maintenance HD patients without CUA (matched to cases by gender and timing of hospitalization). Univariate and multivariable logistic regression models were applied to compute odds ratio (OR) and 95% confidence intervals (CI) for CUA in statin users, and also to examine previously described associations. RESULTS The mean age of cases was 58 years. Most were females (68%), and of white race (64%). Statin use was more common in controls than in cases (39 vs. 19%, p < 0.01). Statin use was associated with lower odds of CUA in unadjusted (OR 0.38, 95% CI 0.18-0.79) and adjusted (OR 0.20, 95% CI 0.05-0.88) analyses. Hypercalcemia (OR 2.25, 95% CI 1.14-4.43), hypoalbuminemia (OR 5.73, 95% CI 2.79-11.77), calcitriol use (OR 5.69, 95% CI 1.02-31.77) and warfarin use (OR 4.30, 95% CI 1.57-11.74) were positively associated with CUA in adjusted analyses whereas paricalcitol and doxercalciferol were not (OR 1.33, 95% CI 0.54-3.27). CONCLUSION Statin use may be negatively associated with odds of CUA. Further large prospective studies with attention to potential confounders are needed to confirm these findings.
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Affiliation(s)
- Sagar U Nigwekar
- Division of Nephrology, Dermatopathology Unit, Massachusetts General Hospital, Boston, MA 02114, USA.
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Kahn G, Fitzwater S, Tate J, Kang G, Ganguly N, Nair G, Steele D, Arora R, Chawlasarkar M, Parashar U, Santosham M. Epidemiology and prospects for prevention of rotavirus disease in India. Indian Pediatr 2012; 49:467-74. [DOI: 10.1007/s13312-012-0076-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zou L, Vidalis I, Steele D, Michelmore A, Low S, Verberk J. Surface hydrophilic modification of RO membranes by plasma polymerization for low organic fouling. J Memb Sci 2011. [DOI: 10.1016/j.memsci.2010.12.023] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Malls T, Steele D. Thickness Variations and Surface Layers in Ultramicrotomed Sections and Their Effects on Elemental Mapping. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-254-257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AbstractWhile the thickness of ultramicrotomed sections is much more uniform than that of wedge-shaped foils, its variation is seen to be dependent on such factors as the type of material, use of embedding media, water bath interaction (anodic dissolution) and quality of the diamond knife edge. The latter also affects the thickness of surface oxides formed during sectioning. More deleterious surface layers are produced by partial breakdown and redeposition of embedding media under the electron beam. These artefacts indicate that ultramicrotomy is not the panacea for elemental X-ray mapping that might, at first thought, appear to be the case. For the example of a metal matrix composite, useable maps are obtainable, but even the best microtomed sections are limited in terms of mapping by factors such as the lengthy times for map acquisition caused by the low X-ray count rates resulting from thin specimens, particularly where low mass fractions are involved.
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Abstract
ABSTRACTDiamond knife sectioning, or ultramicrotomy, is being used increasingly as an attractive alternative or complimentary means of producing quality TEM specimens. This paper represents a first attempt to provide a basic methodology for this technique for materials scientists, point out its drawbacks, provide a comprehensive listing of more than three decades of widely-scattered and ingeneous applications, and illustrate the diversity of these applications with clear examples. Suggestions will be made for further improvements in ultramicrotomy so that it can be applied in a more routine fashion to modern advanced materials or TEM applications involving demanding chemical microanalysis.
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Robbins J, Dalla Rosa L, Allen JM, Mattila DK, Secchi ER, Friedlaender AS, Stevick PT, Nowacek DP, Steele D. Return movement of a humpback whale between the Antarctic Peninsula and American Samoa: a seasonal migration record. ENDANGER SPECIES RES 2011. [DOI: 10.3354/esr00328] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chumley H, Carney P, Cochella S, Garrett E, Leroy G, Margo K, Matson C, Steele D, Steiner B. Family medicine clerkship curriculum--next steps. Ann Fam Med 2011; 9:88-9. [PMID: 21242568 PMCID: PMC3022055 DOI: 10.1370/afm.1220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/09/2022] Open
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Robinson RL, Carpenter D, Halsall PJ, Iles DE, Booms P, Steele D, Hopkins PM, Shaw MA. Epigenetic allele silencing and variable penetrance of malignant hyperthermia susceptibility. Br J Anaesth 2009; 103:220-5. [PMID: 19454545 DOI: 10.1093/bja/aep108] [Citation(s) in RCA: 15] [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: 11/12/2022] Open
Abstract
BACKGROUND Tissue-specific monoallelic silencing of the RYR1 gene has been proposed as an explanation for variable penetrance of dominant RYR1 mutations in malignant hyperthermia (MH). We examined the hypothesis that monoallelic silencing could explain the inheritance of an MH discordant phenotype in some instances. METHODS We analysed parent-offspring transmission data from MH kindreds to assess whether there was any deviation from the expected autosomal dominant Mendelian inheritance pattern. We also evaluated informative single-nucleotide polymorphism (SNP) genotypes in a cohort of unrelated MH patients using genomic DNA (gDNA, prepared from leucocytes) and coding DNA (cDNA, prepared from skeletal muscle). Finally, we examined the segregation of specific mutations at the gDNA and cDNA level within MH families where positive RYR1 gDNA genotype/normal MH phenotype discordance had been observed. RESULTS In 2113 transmissions from affected parents, there was a consistent parent-of-origin effect (P<0.001) with affected fathers having fewer affected daughters (20%, 95% CI 17-22%) than affected sons (25%, 95% CI 23-26%) or unaffected daughters (27%, 95% CI 25-30%). No discrepancies were observed between the RYR1 SNP genotypes recorded at the gDNA and cDNA levels. In 14 MH negative individuals from 11 discordant families, the familial mutation was detected in skeletal muscle cDNA in all cases. CONCLUSIONS Epigenetic allele silencing may play a role in the inheritance of MH susceptibility, but this is unlikely to involve silencing of RYR1.
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Affiliation(s)
- R L Robinson
- MH Investigation Unit, Academic Unit of Anaesthesia, St James's University Hospital, Leeds LS9 7TF, UK
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Bhattacharya S, Black R, Bourgeois L, Clemens J, Cravioto A, Deen JL, Dougan G, Glass R, Grais RF, Greco M, Gust I, Holmgren J, Kariuki S, Lambert PH, Liu MA, Longini I, Nair GB, Norrby R, Nossal GJV, Ogra P, Sansonetti P, von Seidlein L, Songane F, Svennerholm AM, Steele D, Walker R. The Cholera Crisis in Africa. Science 2009; 324:885. [DOI: 10.1126/science.1173890] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Carpenter D, Morris A, Robinson RL, Booms P, Iles D, Halsall PJ, Steele D, Hopkins PM, Shaw MA. Analysis ofRYR1Haplotype Profile in Patients with Malignant Hyperthermia. Ann Hum Genet 2009; 73:10-8. [DOI: 10.1111/j.1469-1809.2008.00482.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Capp R, Murray A, Noble V, Steele D, Liteplo A. 62: The Dynamics of B-lines: A Useful Tool in the Evaluation of Pulmonary Fluid Status as Fluid Shifts Occur in the Body. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.06.128] [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: 10/21/2022]
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Simpson PT, Reis-Filho JS, Lambros MBK, Jones C, Steele D, Mackay A, Iravani M, Fenwick K, Dexter T, Jones A, Reid L, Da Silva L, Shin SJ, Hardisson D, Ashworth A, Schmitt FC, Palacios J, Lakhani SR. Molecular profiling pleomorphic lobular carcinomas of the breast: evidence for a common molecular genetic pathway with classic lobular carcinomas. J Pathol 2008; 215:231-44. [DOI: 10.1002/path.2358] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hatem DS, Barrett SV, Hewson M, Steele D, Purwono U, Smith R. Teaching the medical interview: methods and key learning issues in a faculty development course. J Gen Intern Med 2007; 22:1718-24. [PMID: 17952511 PMCID: PMC2219821 DOI: 10.1007/s11606-007-0408-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 02/28/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the American Academy on Communication in Healthcare's (AACH) Faculty Development Course on Teaching the Medical Interview and report a single year's outcomes. DESIGN We delivered a Faculty Development course on Teaching the Medical Interview whose theme was relationship-centered care to a national and international audience in 1999. Participants completed a retrospective pre-post assessment of their perceived confidence in performing interview, clinical, teaching, and self-awareness skills. PARTICIPANTS AND SETTING A total of 79 participants in the 17th annual AACH national faculty development course at the University of Massachusetts Medical School in June 1999. INTERVENTION A 5-day course utilized the principles of learner-centered learning to teach a national and international cohort of medical school faculty about teaching the medical interview. MEASUREMENTS AND MAIN RESULTS The course fostered individualized, self-directed learning for participants, under the guidance of AACH faculty. Teaching methods included a plenary session, small groups, workshops, and project groups all designed to aid in the achievement of individual learning goals. Course outcomes of retrospective self-assessed confidence in interview, clinical, teaching, self-awareness, and control variables were measured using a 7-point Likert scale. Participants reported improved confidence in interview, clinical, teaching, and self-awareness variables. After controlling for desirability bias as measured by control variables, only teaching and self-awareness mean change scores were statistically significant (p < .001). CONCLUSIONS The AACH Faculty Development course on Teaching the Medical Interview utilized learner-centered teaching methods important to insure learning with experienced course participants. Perceived teaching and self-awareness skills changed the most when compared to other skills.
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Affiliation(s)
- David S Hatem
- American Academy on Communication in Healthcare, Chesterfield, MO, USA.
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Westbury CB, Pearson A, Nerurkar A, Reis-Filho JS, Steele D, Peckitt C, Sharp G, Yarnold JR. Hypoxia can be detected in irradiated normal human tissue: a study using the hypoxic marker pimonidazole hydrochloride. Br J Radiol 2007; 80:934-8. [PMID: 17908818 DOI: 10.1259/bjr/25046649] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Chronic tissue hypoxia may play a role in the pathogenesis of late radiation fibrosis. In order to investigate this hypothesis, the immunohistochemical distribution of pimonidazole hydrochloride (n = 14 patients) and carbonic anhydrase IX (CAIX) (n = 38 patients) was studied in samples of previously irradiated normal human tissue. One sample of irradiated breast tissue, which also showed marked histological features of radiation injury, stained positive for pimonidazole hydrochloride. No CAIX staining was seen in irradiated tissue other than some evidence of physiological hypoxia in the epidermis of two samples of irradiated skin; both were positive for pimonidazole and one was focally positive for CAIX. Pimonidazole hydrochloride staining of tissue with morphological changes of radiation injury could support a role for hypoxia in the pathogenesis of late normal tissue fibrosis in humans.
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Affiliation(s)
- C B Westbury
- Department of Radiotherapy, The Royal Marsden Hospital, Sutton, Surrey, UK
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Wolf M, Shah A, Gutierrez O, Ankers E, Monroy M, Tamez H, Steele D, Chang Y, Camargo CA, Tonelli M, Thadhani R. Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 2007; 72:1004-13. [PMID: 17687259 DOI: 10.1038/sj.ki.5002451] [Citation(s) in RCA: 627] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Vitamin D deficiency is associated with cardiovascular disease, the most common cause of mortality in hemodialysis patients. To investigate the relation between blood levels of 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) with hemodialysis outcomes, we measured baseline vitamin D levels in a cross-sectional analysis of 825 consecutive patients from within a prospective cohort of incident US hemodialysis patients. Of these patients, 78% were considered vitamin D deficient with 18% considered severely deficient. Calcium, phosphorus, and parathyroid hormone levels correlated poorly with 25D and 1,25D concentrations. To test the association between baseline vitamin D levels and 90-day mortality, we selected the next 175 consecutive participants who died within 90 days and compared them to the 750 patients who survived in a nested case-control analysis. While low vitamin D levels were associated with increased mortality, significant interaction was noted between vitamin D levels, subsequent active vitamin D therapy, and survival. Compared to patients with the highest 25D or 1,25D levels who received therapy, untreated deficient patients were at significantly increased risk for early mortality. Our study shows that among incident hemodialysis patients, vitamin D deficiency is common, correlates poorly with other components of mineral metabolism and is associated with increased early mortality.
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Affiliation(s)
- M Wolf
- Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zhang LJ, Fang ZY, Zeng G, Steele D, Jiang BM, Kilgore P. [Relationship between severity of rotavirus diarrhea and serotype G and genotype]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2007; 21:144-6. [PMID: 17653318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To learn the relationship between severity of rotavirus diarrhea and serotype G and genotype P. METHOD The clinical information and fecal specimens of hospitalized children less than 5 years of age with acute diarrhea in four sentinel hospitals were collected from Aug 2001 to July 2003. Specimens were tested and typed for rotavirus. Each child with rotavirus infection was assessed for severity of diarrhea according to the 20-points scoring system of Vesikari. RESULTS When combined with P[8], the severity scores for rotavirus diarrhea of P[8]G1 and P[8]G3 were 13 and 12 points, respectively, and the durations of diarrhea were 6 days and 5 days, respectively. The percentage of fever in patients with diarrhea caused by P[8]G1 was higher than that in those with diarrheas caused by P[8]G3 (97 percent vs. 73 percent). And the highest temperature in the cases with diarrheas caused by G1 and G3 was 39 degrees C and 38.6 degrees C, respectively. When combined with G3, the difference of diarrhea severity scores between P[4]G3 and P[8]G3 was not significant. But duration of diarrhea caused by P[4] was longer than that of diarrheas caused by P[8] (6.5 days vs. 5 days) and the maximum times of vomiting in P[8] cases was higher than in p[4] cases (4 times vs. 3 times per day). There was no significant difference in other clinical features between P[8] and P[4] infected cases. CONCLUSION When combined with P[8], RV diarrhea caused by G1 was associated with higher severity scores than diarrhea caused by G3. When combined with G3, there was no significant difference in severity scores between P[4] and P[8] infected cases.
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Affiliation(s)
- Li-jie Zhang
- Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China
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Abstract
Cognitive impairment in depression may be one of the more practically important aspects of the illness, responsible for much of its morbidity. It also is at the heart of its psychopathology, may contribute to strategies of treatment, and may give us a more easily quantifiable measure of impaired function to correlate with brain activity. Functional magnetic resonance imaging (fMRI) is ideally suited to examine brain function in depression. It has the correct time window to repeatedly sample cognitive task performance; it does not require exposure to radioactive tracers and can therefore be repeated many times; it also can be linked with high resolution structural images acquired in the same imaging session that help identify the regions of activation and support the spatial transformation necessary to compare the scans of different subjects. fMRI has already produced a series of consistent results in depression, identifying increased activity of rostral anterior cingulate and other medial prefrontal structures during effortful tasks and on occasion also increased dorsolateral prefrontal activity, suggesting increased possibly compensatory activity to maintain task performance. Investigating the interplay between limbic (orbitomedial) and 'cognitive' dorsolateral structures clearly has the potential to clarify important illness mechanisms of depressive illness.
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Affiliation(s)
- K Ebmeier
- Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh EH10 5HF, UK.
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Turner NC, Reis-Filho JS, Russell AM, Springall RJ, Ryder K, Steele D, Savage K, Gillett CE, Schmitt FC, Ashworth A, Tutt AN. BRCA1 dysfunction in sporadic basal-like breast cancer. Oncogene 2006; 26:2126-32. [PMID: 17016441 DOI: 10.1038/sj.onc.1210014] [Citation(s) in RCA: 461] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Basal-like breast cancers form a distinct subtype of breast cancer characterized by the expression of markers expressed in normal basal/myoepithelial cells. Breast cancers arising in carriers of germline BRCA1 mutations are predominately of basal-like type, suggesting that BRCA1 dysfunction may play a role in the pathogenesis of sporadic basal-like cancers. We analysed 37 sporadic breast cancers expressing the basal marker cytokeratin 5/6, and age- and grade-matched controls, for downregulation of BRCA1. Although BRCA1 promoter methylation was no more common in basal-like cancers (basal 14% vs controls 11%, P=0.72), BRCA1 messenger RNA expression was twofold lower in basal-like breast cancers compared to matched controls (P=0.008). ID4, a negative regulator of BRCA1, was expressed at 9.1-fold higher levels in basal-like breast cancer (P<0.0001), suggesting a potential mechanism of BRCA1 downregulation. BRCA1 downregulation correlated with the presence of multiple basal markers, revealing heterogeneity in the basal-like phenotype. Finally, we found that 63% of metaplastic breast cancers, a rare type of basal-like cancers, had BRCA1 methylation, in comparison to 12% of controls (P<0.0001). The high prevalence of BRCA1 dysfunction identified in this study could be exploited in the development of novel approaches to targeted treatment of basal-like breast cancer.
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Affiliation(s)
- N C Turner
- Chester Beatty Laboratories, The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London, UK
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Borg M, Sutherland P, Stapleton A, Bolt J, Steele D, Landers B, Porter A, Buxton S, Heilbornn C, Wong HZ. Outcome of post-prostatectomy radiotherapy in one institution. Australas Radiol 2006; 50:475-80. [PMID: 16981946 DOI: 10.1111/j.1440-1673.2006.01629.x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We present a retrospective study to evaluate the outcome of postoperative radiotherapy for biochemical or clinical recurrent prostate cancer. Twenty-six patients (median age 60 years) underwent radiotherapy after radical prostatectomy between January 1997 and January 2004. Seven patients received adjuvant radiotherapy and 19 received salvage radiotherapy. The median prostate-specific antigen at diagnosis was 8.6 (0.9-89) and most (23 patients) presented with T(3)N(0) disease. The median follow up was 19.5 months (5-84 months). All patients received a dose of 61.2 Gy at 1.8 Gy per fraction, 20 initially receiving 45 Gy to the lesser pelvis. The median dose to the bladder, rectum and left femoral head were 55.6, 57.5 and 33.8 Gy, respectively. All patients were managed radiotherapeutically by the first author. Twenty-four patients are alive. Two patients have died, one from oesophageal cancer and the second from metastatic prostate cancer. Two other patients also developed metastatic disease. Four asymptomatic patients with a rising prostate-specific antigen are under observation. None of the 26 patients has developed a local recurrence. Seven patients have developed grade 1 late bowel effects and three a grade 2 late effect. Eight patients suffer from grade 1 late genitourinary effects and two from grade 2 effects. One patient developed impotence, whereas 23 patients were rendered impotent postoperatively. There were no grade 3/4 late effects. Postoperative radiotherapy is well tolerated and provides effective local control.
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Affiliation(s)
- M Borg
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia.
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Reis-Filho JS, Milanezi F, Steele D, Savage K, Simpson PT, Nesland JM, Pereira EM, Lakhani SR, Schmitt FC. Metaplastic breast carcinomas are basal-like tumours. Histopathology 2006; 49:10-21. [PMID: 16842242 DOI: 10.1111/j.1365-2559.2006.02467.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Recently, an immunohistochemical panel comprising antibodies against HER2, oestrogen receptor (ER), epidermal growth factor receptor (EGFR) and cytokeratin (CK) 5/6 was reported to identify basal-like breast carcinomas, as defined by cDNA microarrays. Our aim was to analyse a series of metaplastic breast carcinomas (MBCs) using this panel plus two other basal markers (CK14 and p63) and progesterone receptor (PR), to define how frequently MBCs show a basal-like immunophenotype. METHODS AND RESULTS Sixty-five cases were retrieved from the pathology archives of the authors' institutions and reviewed by three of the authors. Immunohistochemistry with antibodies for HER2, ER, EGFR, CK5/6, CK14 and p63 was performed according to standard methods. All but six cases (91%) showed the typical immunoprofile of basal-like tumours (ER- and HER2-, EGFR+ and/or CK5/6+). When CK14 and p63 were added to the panel, two additional cases could be classified as basal-like. The majority of MBCs lacked PR, except 4/19 (21%) carcinomas with squamous metaplasia. CONCLUSIONS Our results demonstrate that MBCs show a basal-like phenotype, regardless of the type of metaplastic elements. Moreover, as these neoplasms frequently overexpress EGFR (57%), patients with MBC may benefit from treatment with anti-EGFR drugs.
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Affiliation(s)
- J S Reis-Filho
- The Breakthrough Toby Robins Breast Cancer Research Centre, Institute of Cancer Research, London, UK.
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Fodha I, Chouikha A, Peenze I, De Beer M, Dewar J, Geyer A, Messaadi F, Trabelsi A, Boujaafar N, Taylor M, Steele D. Identification of viral agents causing diarrhea among children in the Eastern Center of Tunisia. J Med Virol 2006; 78:1198-203. [PMID: 16847966 PMCID: PMC7166705 DOI: 10.1002/jmv.20681] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2006] [Indexed: 12/17/2022]
Abstract
Viral diarrhea remains a major cause of childhood morbidity and mortality worldwide. In Tunisia, no comprehensive studies of all viral agents related to diarrhea in children have yet been conducted. The present study was performed to investigate the role of enteric viruses in acute diarrhea in the country. Six hundred thirty-eight stool samples were collected from children under 5 years of age seeking medical care for acute diarrhea between October 2003 and September 2005 in hospitals from the Eastern-Center Tunisia. All samples were tested for rotavirus, astrovirus, and adenovirus using commercial antigen enzyme immunoassays (EIAs). Positive samples for rotavirus and astrovirus were confirmed by an "in-house" reverse transcriptase-polymerase chain reaction (RT-PCR). Samples positive for adenovirus antigen were subjected to further EIA screening for species F enteric adenovirus types 40 and 41. At least one viral agent was found in 30% of the specimens. The frequency of rotavirus, astrovirus, and adenovirus was 20%, 7%, and 6%, respectively. Of the stool samples containing adenovirus, 57% (20/35) were found to be positive for species F adenovirus types 40/41. Dual infections were found in 9% (17/191) of the positive samples. Enteric viruses appear to play an important role in pediatric diarrhea in Tunisia. The introduction of affordable viral diagnosis in pediatric hospitals will improve patient care by reducing the unnecessary use of antibiotics.
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Affiliation(s)
- I. Fodha
- Laboratory of Bacteriology‐Virology, University Hospital Sahloul, Sousse, Tunisia
- Laboratory MDT‐01, Faculty of Pharmacy, Monastir, Tunisia
| | - A. Chouikha
- Laboratory MDT‐01, Faculty of Pharmacy, Monastir, Tunisia
| | - I. Peenze
- MRC/Medunsa Diarrhoeal Pathogens Research Unit, University of Limpopo, South Africa
| | - M. De Beer
- MRC/Medunsa Diarrhoeal Pathogens Research Unit, University of Limpopo, South Africa
| | - J. Dewar
- MRC/Medunsa Diarrhoeal Pathogens Research Unit, University of Limpopo, South Africa
| | - A. Geyer
- MRC/Medunsa Diarrhoeal Pathogens Research Unit, University of Limpopo, South Africa
| | - F. Messaadi
- Laboratory of Hygiene, University Hospital Hedi Chaker, Sfax, Tunisia
| | - A. Trabelsi
- Laboratory of Bacteriology‐Virology, University Hospital Sahloul, Sousse, Tunisia
- Laboratory MDT‐01, Faculty of Pharmacy, Monastir, Tunisia
| | - N. Boujaafar
- Laboratory of Bacteriology‐Virology, University Hospital Sahloul, Sousse, Tunisia
| | - M.B. Taylor
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - D. Steele
- MRC/Medunsa Diarrhoeal Pathogens Research Unit, University of Limpopo, South Africa
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Affiliation(s)
- E.B. Gill
- a Department of Chemistry , Royal Holloway College (University of London) , Egham , Surrey , TW20 0EX
- b Department of Chemistry , University of Alberta , Edmonton , Alberta , T6G 2G2
| | - D. Steele
- a Department of Chemistry , Royal Holloway College (University of London) , Egham , Surrey , TW20 0EX
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Jarrar M, Gaynon PS, Periclou AP, Fu C, Harris RE, Stram D, Altman A, Bostrom B, Breneman J, Steele D, Trigg M, Zipf T, Avramis VI. Asparagine depletion after pegylated E. coli asparaginase treatment and induction outcome in children with acute lymphoblastic leukemia in first bone marrow relapse: a Children's Oncology Group study (CCG-1941). Pediatr Blood Cancer 2006; 47:141-6. [PMID: 16425271 DOI: 10.1002/pbc.20713] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Re-induction outcomes vary for children with acute lymphoblastic leukemia (ALL) and marrow relapse. We explored possible relationships among asparaginase (ASNase) activity levels, asparagine (ASN) depletion, anti-ASNase antibody titers, and response to re-induction therapy in children and adolescents with ALL and an 'early' first marrow relapse. PATIENTS AND METHODS After appropriate informed consent, we enrolled children and adolescents 1-21 years old with ALL and first marrow relapse within 12 months of completion of primary therapy. Induction therapy included intramuscular pegylated ASNase on Days 2 and 16. We assessed ASNase activity, anti-ASNase antibody titers against native and pegylated (E. coli) ASNase, and amino acid levels of asparagine (ASN) and glutamine (GLN) on Days 0, 14, and 35 of re-induction. RESULTS Ninety-three patients were at least partially assessable. Among 21 patients with M1 marrow status at Day 35, the median Day 14 ASN level was <1 microM. This is significantly lower than the median Day 14 ASN level of 4 microM in the group of patients with M3 marrow at Day 35. Neither Day 0 nor Day 35 antibody titers predicted ASNase enzymatic activity level on Day 14. Surprisingly, Day 14 ASNase activity did not predict serum ASN level on Day 14. However, Day 0 and Day 35 anti-native ASNase antibody titers, and Day 0 anti-PEG ASNase antibody titers correlated positively with Day 14 serum ASN levels as one might expect from neutralizing antibody. Day 35 anti-PEG ASNase antibody titers did not. CONCLUSIONS Patients with greater ASN depletion were more likely to achieve second remission in the context of six-drug therapy.
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Affiliation(s)
- Mohammad Jarrar
- Department of Pediatrics, Division of Hematology/Oncology, USC Keck School of Medicine, Childrens Hospital Los Angeles, Los Angeles, California, USA
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Gaynon PS, Harris RE, Altman AJ, Bostrom BC, Breneman JC, Hawks R, Steele D, Zipf T, Stram DO, Villaluna D, Trigg ME. Bone Marrow Transplantation Versus Prolonged Intensive Chemotherapy for Children With Acute Lymphoblastic Leukemia and an Initial Bone Marrow Relapse Within 12 Months of the Completion of Primary Therapy: Children's Oncology Group Study CCG-1941. J Clin Oncol 2006; 24:3150-6. [PMID: 16717292 DOI: 10.1200/jco.2005.04.5856] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [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: 11/20/2022] Open
Abstract
Purpose To compare conventional sibling bone marrow transplantation (CBMT), BMT with alternative donor (ABMT), and chemotherapy (CT) for children with acute lymphoblastic leukemia (ALL) and an early first marrow relapse. Patients and Methods After informed consent, 214 patients with ALL and early marrow relapse began multiagent induction therapy. One hundred sixty-three patients with fewer than 25% marrow blasts and count recovery at the end of induction (second remission [CR2]) were allocated by donor availability. Fifty patients with sibling donors were allocated to CBMT. Seventy-two patients were randomly allocated between ABMT and CT while 41 patients refused allocation. Results Overall, 3-year event free survival from entry is 19% ± 3%. Thirty-two of 50 CBMT patients (64%) and 19 of 37 ABMT patients (51%) underwent transplantation in CR2 with 3-year disease-free survival of 42% ± 7% and 29% ± 7%. The 3-year DFS is 29% ± 7%, 21% ± 7%, and 27% ± 8% for patients allocated to CBMT, ABMT, and CT, respectively. Contrary to protocol, 12 of 35 patients allocated to CT underwent BMT in CR2. Of these, five patients died after BMT and 5 patients relapsed. Conclusion More than one half of patients died, failed reinduction, or relapsed again before 3 months after CR2 (median time to BMT). Intent-to-treat pair-wise comparison of ABMT with CT, CT with CBMT, and CBMT with ABMT yields hazards of 1.2, 1.1, 0.8 with P values of .56, .80, and .36, respectively. Outcomes remain similar and poor for children with ALL and early marrow relapse. BMT is not a complete answer to the challenge of ALL and early marrow relapse.
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Affiliation(s)
- Paul S Gaynon
- Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Banerjee S, Reis-Filho JS, Ashley S, Steele D, Ashworth A, Lakhani SR, Smith IE. Basal-like breast carcinomas: clinical outcome and response to chemotherapy. J Clin Pathol 2006; 59:729-35. [PMID: 16556664 PMCID: PMC1860434 DOI: 10.1136/jcp.2005.033043] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Grade-III invasive ductal carcinomas of no special type (IDCs-NST) constitute a heterogeneous group of tumours with different clinical behaviour and response to chemotherapy. As many as 25% of all grade-III IDCs-NST are known to harbour a basal-like phenotype, as defined by gene expression profiling or immunohistochemistry for basal cytokeratins. Patients with basal-like breast carcinomas (BLBC) are reported to have a shorter disease-free and overall survival. MATERIAL AND METHODS A retrospective analysis of 49 patients with BLBC (as defined by basal cytokeratin expression) and 49 controls matched for age, nodal status and grade was carried out. Histological features, immunohistochemical findings for oestrogen receptor (ER), progesterone receptor (PgR) and HER2, and clinical outcome and survival after adjuvant chemotherapy were compared between the two groups. RESULTS It was more likely for patients with BLBCs to be found negative for ER (p<0.0001), PgR (p<0.0001) and HER2 (p<0.01) than controls. Patients with BLBCs were found to have a significantly higher recurrence rate (p<0.05) and were associated with significantly shorter disease-free and overall survival (both p<0.05). In the group of patients who received anthracycline-based adjuvant chemotherapy (BLBC group, n = 47; controls, n = 49), both disease-free and overall survival were found to be significantly shorter in the BLBC group (p<0.05). CONCLUSIONS BLBCs are a distinct clinical and pathological entity, characterised by high nuclear grade, lack of hormone receptors and HER2 expression and a more aggressive clinical course. Standard adjuvant chemotherapy seems to be less effective in these tumours and new therapeutic approaches are indicated.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Breast Neoplasms/drug therapy
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Chemotherapy, Adjuvant
- Female
- Humans
- Keratins/metabolism
- Middle Aged
- Neoplasm Proteins/metabolism
- Prognosis
- Receptor, ErbB-2/metabolism
- Receptors, Estrogen/metabolism
- Receptors, Progesterone/metabolism
- Retrospective Studies
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- S Banerjee
- Breast Unit, Royal Marsden Hospital, London, UK
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Ackermann M, Ahrens J, Bai X, Bartelt M, Barwick SW, Bay RC, Becka T, Becker JK, Becker KH, Berghaus P, Bernardini E, Bertrand D, Boersma DJ, Böser S, Botner O, Bouchta A, Bouhali O, Burgess C, Burgess T, Castermans T, Chirkin D, Collin B, Conrad J, Cooley J, Cowen DF, Davour A, De Clercq C, de los Heros CP, Desiati P, DeYoung T, Ekström P, Feser T, Gaisser TK, Ganugapati R, Geenen H, Gerhardt L, Goldschmidt A, Groß A, Hallgren A, Halzen F, Hanson K, Hardtke DH, Harenberg T, Hauschildt T, Helbing K, Hellwig M, Herquet P, Hill GC, Hodges J, Hubert D, Hughey B, Hulth PO, Hultqvist K, Hundertmark S, Jacobsen J, Kampert KH, Karle A, Kestel M, Kohnen G, Köpke L, Kowalski M, Kuehn K, Lang R, Leich H, Leuthold M, Liubarsky I, Lundberg J, Madsen J, Marciniewski P, Matis HS, McParland CP, Messarius T, Minaeva Y, Miočinović P, Morse R, Münich K, Nahnhauer R, Nam JW, Neunhöffer T, Niessen P, Nygren DR, Olbrechts P, Pohl AC, Porrata R, Price PB, Przybylski GT, Rawlins K, Resconi E, Rhode W, Ribordy M, Richter S, Rodríguez Martino J, Sander HG, Schlenstedt S, Schneider D, Schwarz R, Silvestri A, Solarz M, Spiczak GM, Spiering C, Stamatikos M, Steele D, Steffen P, Stokstad RG, Sulanke KH, Taboada I, Tarasova O, Thollander L, Tilav S, Wagner W, Walck C, Walter M, Wang YR, Wiebusch CH, Wischnewski R, Wissing H, Woschnagg K. Optical properties of deep glacial ice at the South Pole. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006687] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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