1
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Affiliation(s)
- Shakkaura Kemet
- Medical student, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Dereck W Paul
- Medical student, School of Medicine, University of California, San Francisco, San Francisco, California; ; Twitter: @dereckwpaul; ORCID: https://orcid.org/0000-0001-6099-5933
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Afolabi T, Borowsky HM, Cordero DM, Paul DW, Said JT, Sandoval RS, Davis D, Ölveczky D, Chatterjee A. Student-Led Efforts to Advance Anti-Racist Medical Education. Acad Med 2021; 96:802-807. [PMID: 33711839 DOI: 10.1097/acm.0000000000004043] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Over the past decade, medical schools across the United States have increasingly dedicated resources to advancing racial and social justice, such as by supporting diversity and inclusion efforts and by incorporating social medicine into the traditional medical curricula. While these changes are promising, the academic medicine community must apply an anti-racist lens to every aspect of medical education to equip trainees to recognize and address structural inequities. Notably, organizing and scholarly work led by medical students has been critical in advancing anti-racist curricula. In this article, the authors illustrate how student activism has reshaped medical education by highlighting examples of student-led efforts to advance anti-racist curricula at Harvard Medical School (HMS) and at the University of California, San Francisco (UCSF) School of Medicine. HMS students collaborated with faculty to address aspects of existing clinical practice that perpetuate racism, such as the racial correction factor in determining kidney function. They also responded to the existing curricula by noting missed opportunities to discuss structural racism, and they planned supplemental sessions to address these gaps. At UCSF, students identified specific avenues to improve the rigor of social medicine courses and developed new curricula to equip students with skills to confront and work to dismantle racism. The authors describe how HMS students, in an effort to improve the learning environment, developed a workshop to assist students in navigating microaggressions and discrimination in the clinical setting. At UCSF, students partnered with faculty and administration to advocate pass/fail grading for clerkships after university data revealed racial disparities in students' clerkship assessments. In reviewing these examples of students' advocacy to improve their own curricula and learning environments, the authors aim to provide support for students and faculty pursuing anti-racist curricular changes at their own institutions.
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Affiliation(s)
- Titilayo Afolabi
- T. Afolabi is a fourth-year student, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-1273-2183
| | - Hannah M Borowsky
- H.M. Borowsky is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0001-8779-7873
| | - Daniella M Cordero
- D.M. Cordero is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0003-4207-5708
| | - Dereck W Paul
- D.W. Paul Jr is a fourth-year student, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0001-6099-5933
| | - Jordan Taylor Said
- J.T. Said is a fourth-year student, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-0357-6916
| | - Raquel Sofia Sandoval
- R.S. Sandoval is a fourth-year student, Harvard Medical School and Harvard Kennedy School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-0770-4030
| | - Denise Davis
- D. Davis is a clinical professor of medicine, University of California, San Francisco, specialist for diversity, University of California, San Francisco, and vice president, Diversity, Equity, and Inclusion, Academy of Communication in Healthcare, San Francisco, California
| | - Daniele Ölveczky
- D. Ölveczky is a physician, Department of Medicine, Beth Israel Deaconess Medical Center (BIDMC), inclusion officer, Department of Medicine, BIDMC, and assistant professor, Department of Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8972-4483
| | - Avik Chatterjee
- A. Chatterjee is a physician, Boston Health Care for the Homeless Program, assistant professor, Boston University School of Medicine and Boston Medical Center, part-time lecturer, Harvard Medical School, associate epidemiologist, Division of Global Health Equity, Department of Internal Medicine, Brigham and Women's Hospital, and faculty supervisor, the Racial Justice Coalition, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8437-6774
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Choi IK, Wang Z, Ke Q, Hong M, Paul DW, Fernandes SM, Hu Z, Stevens J, Guleria I, Kim HJ, Cantor H, Wucherpfennig KW, Brown JR, Ritz J, Zhang B. Mechanism of EBV inducing anti-tumour immunity and its therapeutic use. Nature 2020; 590:157-162. [PMID: 33361812 PMCID: PMC7864874 DOI: 10.1038/s41586-020-03075-w] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
Tumour-associated antigens (TAAs) comprise a large set of non-mutated cellular antigens recognized by T cells in human and murine cancers. Their potential as targets for immunotherapy has been explored for more than two decades1, yet the origins of TAA-specific T cells remain unclear. While tumour cells may be an important source of TAAs for T cell priming2, several recent studies suggest that infection with some viruses, including Epstein-Barr virus and influenza virus can elicit T cell responses against abnormally expressed cellular antigens that function as TAAs3,4. However, the cellular and molecular basis of such responses remains undefined. Here we show that expression of the Epstein-Barr virus signalling protein LMP1 in B cells provokes T cell responses to multiple TAAs. LMP1 signalling leads to overexpression of many cellular antigens previously shown to be TAAs, their presentation on major histocompatibility complex classes I (MHC-I) and II (MHC-II) (mainly through the endogenous pathway) and the upregulation of costimulatory ligands CD70 and OX40L, thereby inducing potent cytotoxic CD4+ and CD8+ T cell responses. These findings delineate a mechanism of infection-induced anti-tumour immunity. Furthermore, by ectopically expressing LMP1 in tumour B cells from patients with cancer and thereby enabling them to prime T cells, we develop a general approach for rapid production of autologous cytotoxic CD4+ T cells against a wide range of endogenous tumour antigens, such as TAAs and neoantigens, for treating B cell malignancies. This work stresses the need to revisit classical concepts concerning viral and tumour immunity, which will be critical to fully understand the impact of common infections on human health and to improve the rational design of immune approaches to treatment of cancers.
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Affiliation(s)
- Il-Kyu Choi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zhe Wang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Qiang Ke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Diagnostics, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Min Hong
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dereck W Paul
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Stacey M Fernandes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Zhuting Hu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jonathan Stevens
- Clinical Laboratory Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Indira Guleria
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Clinical Laboratory Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Hye-Jung Kim
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Harvey Cantor
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Kai W Wucherpfennig
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Immunology, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jerome Ritz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Baochun Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.
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4
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Affiliation(s)
- Dereck W Paul
- From the University of California, San Francisco, San Francisco
| | - Kelly R Knight
- From the University of California, San Francisco, San Francisco
| | - Andre Campbell
- From the University of California, San Francisco, San Francisco
| | - Louise Aronson
- From the University of California, San Francisco, San Francisco
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5
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Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Dereck W Paul
- University of California, San Francisco School of Medicine, San Francisco
| | - Margot Kushel
- University of California, San Francisco School of Medicine, San Francisco.,University of California, San Francisco Center for Vulnerable Populations, San Francisco
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Paul DW, Knight KR, Olsen P, Weeks J, Yen IH, Kushel MB. Racial Discrimination in the Life Course of Older Adults Experiencing Homelessness: Results from the HOPE HOME Study. J Soc Distress Homeless 2019; 29:184-193. [PMID: 33727778 PMCID: PMC7958187 DOI: 10.1080/10530789.2019.1702248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 05/12/2023]
Abstract
Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons experiencing homelessness. We recruited participants who were enrolled in two sub-studies of the Health Outcomes of People Experiencing Homelessness in Older Middle AgE (HOPE HOME) Study in Oakland California. We identified two major themes within interviews with Black participants (n=52) related to race: (1) participants experienced overt racial discrimination in early life and (2) structural racism precipitated and perpetuated adult homelessness. Further, we identified sub-themes of structural racism that contributed to participants becoming or staying homeless: criminal justice discrimination, employment discrimination, exposure to violence, premature death, and limited family wealth. We developed a theoretical model of how these elements of structural racism may increase susceptibility to homelessness. These relationships between racial discrimination and homelessness may serve as targets for policies aimed at preventing homelessness.
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Affiliation(s)
- Dereck W. Paul
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Kelly R. Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - Pamela Olsen
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - John Weeks
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - Irene H. Yen
- Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA
| | - Margot B. Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
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Paul DW, Lagat DK, MacIntyre N, Egger JR, Murdoch DM, Que LG, Kussin PS. Validation of spirometry prediction equations in western Kenya. Int J Tuberc Lung Dis 2019; 22:112-118. [PMID: 29297435 DOI: 10.5588/ijtld.17.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Community of Eldoret, Kenya. OBJECTIVE To test the performance of three commonly used spirometry prediction equations in a healthy Kenyan population. DESIGN Cross-sectional assessment of healthy adults in Eldoret. RESULTS Of the 331 subjects enrolled in the study, 282 subjects aged 18-85 years (45% males, 55% females) produced high-quality spirograms. Lung function predictions were made using the Global Lung Initiative 2012 (GLI 2012) prediction equations for African Americans, the National Health and Nutrition Examination Survey III (NHANES III) prediction equations for African Americans, and the Crapo prediction equation. Bland-Altman analyses were performed to measure the agreement between observed and predicted spirometry parameters. Overall, the GLI 2012 and NHANES equations for African Americans performed similarly for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), significantly overestimating FVC while accurately predicting observed FEV1 values. CONCLUSION The study brings into question the utility of three major spirometry prediction equations in a Kenyan population. The significant overestimation of FVC by the best-performing equations despite accurate prediction of FEV1 suggests poor performance of these equations in our population.
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Affiliation(s)
- D W Paul
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke Global Health Institute, Duke University, Durham, North Carolina, USA, Academic Model Providing Access to Healthcare (AMPATH), Eldoret
| | - D K Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Department of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - N MacIntyre
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - J R Egger
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - D M Murdoch
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - L G Que
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - P S Kussin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Academic Model Providing Access to Healthcare (AMPATH), Eldoret
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Affiliation(s)
- Dereck W Paul
- From the University of California, San Francisco, School of Medicine, San Francisco
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9
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Abstract
In this Invited Commentary, the author probes current events overlapping with his early medical education for unwritten lessons. Today's generation of trainees studies the careful application of science to suffering in the roiling context of resurgent white supremacy, anti-immigrant hatred, climate disasters, contentious public health epidemics, and attacks on the structures undergirding access to health care for millions. The author reflects on the connections between sociopolitical events and his own experiences, as well as those of his classmates, friends, and family members. These experiences, he argues, have galvanized his and his fellow medical students' commitment to decency, truth, diversity, and equity. He concludes that, in the current climate, the practice of healing is inextricably tied to the social and political context, such that advocacy and activism have become essential to a career in medicine.
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Affiliation(s)
- Dereck W Paul
- D.W. Paul Jr is an MD candidate, Class of 2021, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0001-6099-5933
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Davarpanah NN, Lindenberg L, Paul DW, Steinberg SM, Francis DC, Berniger MA, Weaver J, McKinney Y, Parnes HL, Choyke PL, Apolo AB. 18F-FDG-PET/CT imaging to assess response to treatment with cabozantinib at 4 weeks versus 8 weeks of therapy in patients (pts) with metastatic urothelial carcinoma (mUC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
317 Background: This study investigates whether changes in 18F-FDG-PET/CT correlate with response to cabozantinib at an early time point (4 wks) versus the conventional time point of restaging (8 wks) in pts with mUC, using Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST). Methods: 68 pts with mUC in a single arm phase II clinical trial of cabozantinib underwent FDG-PET/CT scans at baseline, 4 and 8 wks. Up to 5 lesions with the highest Standard Uptake Value (SUV) were designated as target lesions. Response was determined using 2 versions of PERCIST (1 lesion vs top 5 lesions with highest FDG uptake) for FDG-PET/CT at 4 and 8 wks. PERCIST response classifications were compared to RECIST v1.1 at 8 wks. Results: 54 pts had evaluable disease. The single lesion 4 wk response by PERCIST showed 40% partial metabolic response (PMR), 33% stable metabolic disease (SMD), and 27% progressive metabolic disease (PMD). The single lesion 8 wk response by PERCIST showed 31% PMR, 31% SMD, and 38% PMD. The single lesion analysis coincided with multiple lesion PERCIST analysis in 86% of pts at 4 wks and 89% at 8 wks. The 4 wk PET/CT was predictive of the 8 wk PET/CT in 75% of single lesion and 76% of multiple lesion analyses. In lesion-based analysis, the 4 wk PET/CT was predictive of the 8 wk PET/CT in 74% of bone, 89% of lung, 77% of lymph node, 74% of soft tissue, and 58% of liver lesions. Only 42% of the 8 wk PERCIST and RECIST classifications coincided. At 8 wks, 40% showed response in FDG PET-CT restaging vs 7% complete/partial response by RECIST. Conclusions: The 4 wk PET/CT scan predicts the therapy response at the 8 wk PET/CT scan however the 4 wk scan overestimates the 8 wk response. The single lesion analysis by PERCIST correlates with the multiple lesion analysis and may have more clinical utility. In the lesion-based analysis, the 4 wk PET/CT scan is predictive of the 8 wk PET/CT for bone, lung, lymph node and soft tissue but not for liver lesions. Response classifications by PERCIST are not in agreement with response classifications by RECIST. Although the methods may be complementary, they are not interchangeable. Further studies are required to validate these findings. Clinical trial information: NCT01688999.
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Affiliation(s)
- Nicole N. Davarpanah
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | - Seth M. Steinberg
- Biostatistics and Data Management Section, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Deneise C Francis
- Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | - Juanita Weaver
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Yolanda McKinney
- Molecular Imaging Program, Center for Cancer Research, Bethesda, MD
| | - Howard L. Parnes
- Division of Cancer Prevention, National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Andrea B. Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Paul DW, Ghassemi P, Ramella-Roman JC, Prindeze NJ, Moffatt LT, Alkhalil A, Shupp JW. Noninvasive imaging technologies for cutaneous wound assessment: A review. Wound Repair Regen 2015; 23:149-62. [PMID: 25832563 DOI: 10.1111/wrr.12262] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [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] [Received: 12/02/2014] [Accepted: 01/22/2015] [Indexed: 02/02/2023]
Abstract
The ability to phenotype wounds for the purposes of assessing severity, healing potential and treatment is an important function of evidence-based medicine. A variety of optical technologies are currently in development for noninvasive wound assessment. To varying extents, these optical technologies have the potential to supplement traditional clinical wound evaluation and research, by providing detailed information regarding skin components imperceptible to visual inspection. These assessments are achieved through quantitative optical analysis of tissue characteristics including blood flow, collagen remodeling, hemoglobin content, inflammation, temperature, vascular structure, and water content. Technologies that have, to this date, been applied to wound assessment include: near infrared imaging, thermal imaging, optical coherence tomography, orthogonal polarization spectral imaging, fluorescence imaging, laser Doppler imaging, microscopy, spatial frequency domain imaging, photoacoustic detection, and spectral/hyperspectral imaging. We present a review of the technologies in use or development for these purposes with three aims: (1) providing basic explanations of imaging technology concepts, (2) reviewing the wound imaging literature, and (3) providing insight into areas for further application and exploration. Noninvasive imaging is a promising advancement in wound assessment and all technologies require further validation.
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Affiliation(s)
- Dereck W Paul
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Pejhman Ghassemi
- Department of Electrical Engineering and Computer Science, The Catholic University of America, Washington, DC
| | - Jessica C Ramella-Roman
- Department of Biomedical Engineering and Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Nicholas J Prindeze
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Lauren T Moffatt
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Abdulnaser Alkhalil
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
| | - Jeffrey W Shupp
- The Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC
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12
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Prindeze NJ, Amundsen BM, Pavlovich AR, Paul DW, Carney BC, Moffatt LT, Shupp JW. Staphylococcal superantigens and toxins are detectable in the serum of adult burn patients. Diagn Microbiol Infect Dis 2014; 79:303-7. [PMID: 24809857 DOI: 10.1016/j.diagmicrobio.2014.01.024] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 01/25/2023]
Abstract
Bacterial infection in burn patients is still a devastating contributor to morbidity and mortality. Little is known regarding the presence of staphylococcal toxins in the burn-injured patient. The aim of this study was to characterize the prevalence of several of these toxins and their relationship to clinical metrics and mortality in burn patients. Levels of exotoxins staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B, toxic shock syndrome toxin 1 (TSST-1), and α-hemolysin were assayed from the serum of 207 adult burn patients aged 16-92 years. Clinical, demographic, and microbiological data from these patients were then compared to toxin levels. Staphylococcal exotoxins α-hemolysin and SEA were present in 45% and 25% of the population, respectively. Bacterial cultures concomitantly showed a high prevalence of Staphylococcus aureus in 48% of patients, of which 59% were methicillin resistant. Several metrics may be predictive of high toxin concentrations of α-hemolysin and TSST-1 and SEA including burn size, length of stay, and bacteremia. Mortality associations indicated that burn size, bacteremia, age, and the presence of α-hemolysin and SEA may be predictors of mortality. A high prevalence of staphylococcal toxin α-hemolysin and superantigens TSST-1 and SEA can be found in the circulation of the adult burn population. The presence of these toxins may contribute to the morbidity and mortality of the burn patient.
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Affiliation(s)
- Nicholas J Prindeze
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Bethany M Amundsen
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Anna R Pavlovich
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Dereck W Paul
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Bonnie C Carney
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Lauren T Moffatt
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975
| | - Jeffrey W Shupp
- The Burn Center, Department of Surgery, MedStar Washington Hospital Center, MedStar Health Research Institute, 110 Irving Street NW, Washington, DC 20010-2975.
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13
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Parks S, Paul DW. Ozone exposure: a case report and discussion. J Okla State Med Assoc 2000; 93:48-51. [PMID: 10692811] [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: 02/15/2023]
Abstract
A 45-year-old man working with ozone presents with evidence of sinusitis, mucus membrane irritation, sleep disturbance and shortness of breath. Naturally occurring or manmade, ozone may damage pulmonary alveolar type I cells at significant exposure levels. EPA and OSHA regulate exposure concentrations. Studies show dose responses with exposures. Supporting epidemiological studies are reviewed briefly. Limiting potential for excess exposure is key to prevention. Recognition of ozone as a potential exposure in the Oklahoma workplace is key to symptom management.
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Affiliation(s)
- S Parks
- Occupational and Environmental Medicine Division, University of Oklahoma Health Sciences Center-Oklahoma City, USA
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14
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Abstract
In competitive speed skating healthy athletes complain of subjective variants of exercise-induced bronchoconstriction such as coughing, chest tightness and excessive mucus production. This is especially so after a 1500 m race which can be considered as extremely strenuous. We compared peak expiratory flow (PEF) measurements 3, 10, 20, 60, 90 and 120 min after such a race with baseline, just before the race, in 10 adults in a competitive situation in Calgary (Canada) and The Hague (NL) and in 8 children in Utrecht (NL). A gradual decline in PEF was found, the mean decrease reaching significance (p < 0.05) at 10, 90 and 120 min in Calgary, at 90 and 120 min in The Hague and at 90 min in Utrecht for the children. The mean decrease over the whole period was significantly greater (3.6%, SEM 0.6%) in Calgary when compared with The Hague. The decrease could not be explained by the daily PEF variation that we measured in both groups. We conclude that there is a slight bronchoconstrictory effect, even in healthy athletes, when partaking in this strenuous type of exercise at low temperatures. An explanation may be the strong drying and temperature stimulus to the airways, stimulating vagal nerve activity, causing not only the cough and mucus production but also a gradually increasing minor bronchoconstriction.
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Affiliation(s)
- D W Paul
- Department of Pulmonary Diseases, University Hospital Dijkzigt, The Netherlands
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15
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Paul LC, Davidoff A, Paul DW, Benediktsson H, Issekutz TB. Monoclonal antibodies against LFA-1 and VLA-4 inhibit graft vasculitis in rat cardiac allografts. Transplant Proc 1993; 25:813-4. [PMID: 8438494] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- L C Paul
- Department of Medicine, University of Calgary, Alberta, Canada
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Paul DW. Occupational medicine and worker's compensation in Oklahoma. J Okla State Med Assoc 1989; 82:112-7. [PMID: 2523479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The worker's compensation system in Oklahoma is the product of a long history of evolution involving influences from social, legal, political, cultural, and economic realms. This process of adaptation continues today. Most recently the system was amended effective November 1986. The basic principles of a worker's compensation program are important, as well as the new changes resulting from recent reforms.
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Paul DW. Stress and the workplace. J Okla State Med Assoc 1989; 82:59-61. [PMID: 2926537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Paul DW. Regional physician maldistribution. Tex Med 1978; 74:116-22. [PMID: 653611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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