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Phillips K, Callaghan B, Rajagopalan V, Akram F, Newburger JW, Kasparian NA. Neuroimaging and Neurodevelopmental Outcomes Among Individuals With Complex Congenital Heart Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:2225-2245. [PMID: 38030353 DOI: 10.1016/j.jacc.2023.09.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023]
Abstract
Although neuroimaging advances have deepened our understanding of brain health in individuals with congenital heart disease (CHD), it is less clear how neuroimaging findings relate to neurodevelopmental and mental health outcomes across the lifespan. We systematically synthesized and critically evaluated evidence on associations between neuroimaging and neurodevelopmental, neurocognitive, psychiatric, or behavioral outcomes among individuals with transposition of great arteries or single-ventricle CHD (Protocol CRD42021229617). Six databases were searched and 45 papers from 25 unique studies were identified. Structural brain injury was generally linked to poorer neurodevelopment in infancy. Brain volumes and microstructural and functional brain changes appear linked to neurocognitive outcomes, including deficits in attention, learning, memory, and executive function in children and adolescents. Fetal neuroimaging studies were limited. Four papers investigated psychiatric outcomes; none found associations with neuroimaging. Multicenter, longitudinal studies incorporating functional neuroimaging and mental health outcomes are much-needed to inform early neuroprotective and therapeutic strategies in CHD.
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Affiliation(s)
- Katelyn Phillips
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bridget Callaghan
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Vidya Rajagopalan
- Department of Radiology, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Farah Akram
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jane W Newburger
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
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Akram F, Wolf JL, Trandafir TE, Dingemans AMC, Stubbs AP, von der Thüsen JH. Artificial intelligence-based recurrence prediction outperforms classical histopathological methods in pulmonary adenocarcinoma biopsies. Lung Cancer 2023; 186:107413. [PMID: 37939498 DOI: 10.1016/j.lungcan.2023.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Between 10 and 50% of early-stage lung adenocarcinoma patients experience local or distant recurrence. Histological parameters such as a solid or micropapillary growth pattern are well-described risk factors for recurrence. However, not every patient presenting with such a pattern will develop recurrence. Designing a model which can more accurately predict recurrence on small biopsy samples can aid the stratification of patients for surgery, (neo-)adjuvant therapy, and follow-up. MATERIAL AND METHODS In this study, a statistical model on biopsies fed with histological data from early and advanced-stage lung adenocarcinomas was developed to predict recurrence after surgical resection. Additionally, a convolutional neural network (CNN)-based artificial intelligence (AI) classification model, named AI-based Lung Adenocarcinoma Recurrence Predictor (AILARP), was trained to predict recurrence, with an ImageNet pre-trained EfficientNet that was fine-tuned on lung adenocarcinoma biopsies using transfer learning. Both models were validated using the same biopsy dataset to ensure that an accurate comparison was demonstrated. RESULTS The statistical model had an accuracy of 0.49 for all patients when using histology data only. The AI classification model yielded a test accuracy of 0.70 and 0.82 and an area under the curve (AUC) of 0.74 and 0.87 on patch-wise and patient-wise hematoxylin and eosin (H&E) stained whole slide images (WSIs), respectively. CONCLUSION AI classification outperformed the traditional clinical approach for recurrence prediction on biopsies by a fair margin. The AI classifier may stratify patients according to their recurrence risk, based only on small biopsies. This model warrants validation in a larger lung biopsy cohort.
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Affiliation(s)
- F Akram
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J L Wolf
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - T E Trandafir
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Center, University Medical Center, Rotterdam, The Netherlands
| | - A P Stubbs
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J H von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Akram F, Pidcock M, Oake D, Sholler GF, Farrar MA, Kasparian NA. "The usual challenges of work are all magnified": Australian paediatric health professionals' experiences during the COVID-19 pandemic. Int J Cardiol Congenit Heart Dis 2023; 11:100434. [PMID: 36571073 PMCID: PMC9769021 DOI: 10.1016/j.ijcchd.2022.100434] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background The COVID-19 pandemic has significantly increased stress and strain on health professionals. With a focus on paediatric cardiac care, this study explored health professionals' concerns about COVID-19, perceptions of the impact of pandemic on healthcare, and experiences of psychological stress. Methods Paediatric health professionals working at a large quaternary hospital in Australia were invited to complete a survey between June 2020 and February 2021. Demographic factors, clinical role characteristics, and anxiety and depressive symptoms were assessed. Qualitative data on experiences and perceived effects of the pandemic on paediatric cardiac care were also collected. Results 228 health professionals (152 nurses, 37 medical doctors, 22 allied and mental health professionals, 17 medical research and administrative staff) participated in the survey (54.4% response rate, 85% women). Half the sample (52.2%) endorsed 'moderate' to 'extreme' worry about COVID-19 and 38% of participants perceived healthcare services as adversely impacted by the pandemic to a 'great' or 'very great' extent. Almost one in five health professionals reported anxiety (18%) and 11% reported depressive symptoms indicative of a need for clinical intervention. Six themes were identified in the qualitative data: (1) Concern about the consequences of visitor restrictions and disrupted patient services, (2) Intensified strain on healthcare workers, (3) Feelings of fear and loss, (4) Social isolation and disconnection, (5) Adapting to change, and (6) Gratitude. Conclusion Timely, tailored policies, supports, and interventions are needed to address health professionals' mental health needs during and beyond the pandemic, to minimize the far-reaching impact of situational stressors.
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Affiliation(s)
- Farah Akram
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, The University of New South Wales, Sydney, Australia
| | - Madeleine Pidcock
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, The University of New South Wales, Sydney, Australia
| | - Diane Oake
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, The University of New South Wales, Sydney, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, Australia
- Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Michelle A Farrar
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, The University of New South Wales, Sydney, Australia
- Department of Neurology, Randwick, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Nadine A Kasparian
- Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Wolf JL, Trandafir TE, Akram F, Andrinopoulou ER, Maat AWPM, Mustafa DAM, Kros JM, Stubbs AP, Dingemans AC, von der Thüsen JH. The value of prognostic and predictive parameters in early-stage lung adenocarcinomas: A comparison between biopsies and resections. Lung Cancer 2023; 176:112-120. [PMID: 36634572 DOI: 10.1016/j.lungcan.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/11/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Since lung adenocarcinoma (LUAD) biopsies are usually small, it is questionable if their prognostic and predictive information is comparable to what is offered by large resection specimens. This study compares LUAD biopsies and resection specimens for their ability to provide prognostic and predictive parameters. METHODS We selected 187 biopsy specimens with stage I and II LUAD. In 123 cases, subsequent resection specimens were also available. All specimens were evaluated for growth pattern, nuclear grade, fibrosis, inflammation, and genomic alterations. Findings were compared using non-parametric testing for categorical variables. Model performance was assessed using the area under the curve for both biopsies and resection specimens, and overall (OS) and disease-free survival (DFS) was calculated. RESULTS The overall growth pattern concordance between biopsies and resections was 73.9%. The dominant growth pattern correlated with OS and DFS in resected adenocarcinomas and for high-grade growth pattern in biopsies. Multivariate analysis of biopsy specimens revealed that T2-tumors, N1-status, KRAS mutations and a lack of other driver mutations were associated with poorer survival. Model performance using clinical, histological and genetic data from biopsy specimens for predicting OS and DSF demonstrated an AUC of 0.72 and 0.69, respectively. CONCLUSIONS Our data demonstrated the prognostic relevance of a high-grade growth pattern in biopsy specimens of LUAD. Combining clinical, histological and genetic information in one model demonstrated a suboptimal performance for DFS prediction and good performance for OS prediction. However, for daily practice, more robust (bio)markers are required to predict prognosis and stratify patients for therapy and follow-up.
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Affiliation(s)
- J L Wolf
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T E Trandafir
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - F Akram
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - E R Andrinopoulou
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A W P M Maat
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - D A M Mustafa
- Department of Laboratory of Tumor Immuno-Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J M Kros
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Laboratory of Tumor Immuno-Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A P Stubbs
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - A C Dingemans
- Department of Pulmonary Diseases, Erasmus MC Cancer Center, University Medical Center, Rotterdam, the Netherlands
| | - J H von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Laboratory of Tumor Immuno-Pathology, Erasmus Medical Center, Rotterdam, the Netherlands.
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Naureen U, Kayani A, Akram F, Rasheed A, Saleem M. Protease production and molecular characterization of a protease dipeptidyl-aminopeptidase gene from different strains of Sordaria fimicola. BRAZ J BIOL 2022; 84:e255692. [PMID: 35584457 DOI: 10.1590/1519-6984.255692] [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] [Received: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
The current research was designed to reach extracellular protease production potential in different strains of Sordaria fimicola which were previously obtained from Dr. Lamb (Imperial College, London) from North Facing Slope and South Facing Slope of Evolution Canyon. After initial and secondary screening, two hyper-producers strains S2 and N6 were selected for submerged fermentation and cultural conditions including temperature, pH, incubation period, inoculum size, substrate concentration, and different carbon and nitrogen sources were optimized for enzyme production. S2 strain showed maximum protease production of 3.291 U/mL after 14 days of incubation at 30 °C with 7 pH, 1% substrate concentration and 1 mL inoculum, While N6 strain showed maximum protease production of 1.929 U/mL under fermentation optimized conditions. Another aim of the present research was to underpin the biodiversity of genetics and post-translational modifications (PTMs) of protease DPAP (peptidyl-aminopeptidase) in Sordaria fimicola. Five polymorphic sites were observed in amino acid sequence of S. fimicola strains with reference to Neurospora crassa. PTMs prediction from bioinformatics tools predicted 38 phosphorylation sites on serine residues for protease peptidyl-aminopeptidase in S1 strain of S. fimicola while 45 phosphorylation sites on serine in N7 strain and 47 serine phosphorylation modifications were predicted in N. crassa. Current research gave an insight that change in genetic makeup effected PTMs which ultimately affected the production of protease enzyme in different strains of same organism (S. fimicola). The production and molecular data of the research revealed that environmental stress has strong effects on the specific genes through mutations which may cause genetic diversity. S. fimicola is non- pathogenic fungus and has a short life cycle. This fungus can be chosen to produce protease enzyme on a commercial scale.
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Affiliation(s)
- U Naureen
- University of the Punjab, Department of Botany, Molecular Genetics Research Laboratory, Lahore, Pakistan
| | - A Kayani
- Government Model Degree College for Women, Model Town, Lahore, Pakistan
| | - F Akram
- University of the Punjab, Department of Botany, Molecular Genetics Research Laboratory, Lahore, Pakistan
| | - A Rasheed
- University of the Punjab, Department of Botany, Molecular Genetics Research Laboratory, Lahore, Pakistan
| | - M Saleem
- University of the Punjab, Department of Botany, Molecular Genetics Research Laboratory, Lahore, Pakistan
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Akram F, Pidcock M, Oake D, Sholler G, Farrar M, Kasparian N. “The Usual Challenges of Work Are All Magnified”: Australian Paediatric Health Professionals’ Experiences During the COVID-19 Pandemic. Heart Lung Circ 2022. [PMCID: PMC9345548 DOI: 10.1016/j.hlc.2022.06.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Introduction Much has changed in healthcare during the coronavirus disease (COVID)-19 pandemic. Medicine, a profession of traditional principles and virtues, has faced unprecedented challenges in the light of scarce and unequal distribution of ventilators, testing, and personal protective equipment. Healthcare workers have been- and are increasingly likely to be- forced into situations that require difficult decision making under life-and-death conditions. Concepts of "medical necessity" and "maximum benefit" challenge healthcare systems that already struggle to manage unequal treatment and access to services, giving rise to moral distress and moral injury on the front lines. Methods This article focuses on moral injury in the context of coronavirus disease (COVID)-19 pandemic. I review recent literature to highlight the psychological impact of many morally-injurious events that have been reported during the COVID-19 pandemic. With the help of a clinical vignette, I point out how healthcare systems adopt many utilitarian policies in times of excessive healthcare burden. A viewpoint is offered that many morally injurious events happen when healthcare workers, traditionally practicing Kantian and virtue ethics, are forced to follow utilitarian policies of healthcare system. Conclusion One form of moral injury may arise from inherent conflicts between individual deontological moral judgments and organizational utilitarian moral judgments. More research is needed to validate the philosophical viewpoint as well as to explore whether increased awareness and education of key principles within moral philosophy can better equip healthcare workers in situations when public health takes precedence over individual health.
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Affiliation(s)
- F Akram
- Saint-Elizabeths Hospital/DC Department of Behavioral Health, Washington, DC, USA
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Akram F, Fuchs D, Daue M, Nijjar G, Ryan A, Benros ME, Okusaga O, Baca‐Garcia E, Brenner LA, Lowry CA, Ryan KA, Pavlovich M, Mitchell BD, Snitker S, Postolache TT. Association of plasma nitrite levels with obesity and metabolic syndrome in the Old Order Amish. Obes Sci Pract 2018; 4:468-476. [PMID: 30338117 PMCID: PMC6180710 DOI: 10.1002/osp4.290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Plasma nitrite is a metabolite of nitric oxide and reflects endogenous nitric oxide synthase (NOS) activity. Although plasma nitrites were previously linked with obesity and metabolic syndrome (MetS), the direction of association remains inconsistent, possibly due to sample heterogeneity. In a relatively homogeneous population, we hypothesized that nitrite levels will be positively associated with overweight/obesity and MetS. METHODS Fasting nitrite levels were measured in 116 Old Order Amish (78% women). We performed age-and-sex-adjusted ancovas to compare nitrite levels between three groups (a) overweight/obese(-)MetS(-), (b) overweight/obese(+)MetS(-) and (c) overweight/obese(+)MetS)(+). Multivariate linear regressions were conducted on nitrite associations with continuous metabolic variables, with successive adjustments for demographics, body mass index, C-reactive protein and neopterin. RESULTS Nitrite levels were higher in the obese/overweight(+)MetS(+) group than in the other two groups (p < 0.001). Nitrites were positively associated with levels of triglycerides (p < 0.0001), total cholesterol (p = 0.048), high-density lipoprotein/cholesterol ratio (p < 0.0001) and fasting glucose (p < 0.0001), and negatively correlated with high-density lipoprotein-cholesterol (p < 0.0001). These associations were robust to adjustments for body mass index and inflammatory markers. CONCLUSION Further investigation of the connection between obesity/MetS and plasma nitrite levels may lead to novel dietary and pharmacological approaches that ultimately may contribute to reducing the increasing burden of obesity, MetS and cardiovascular morbidity and mortality.
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Affiliation(s)
- F. Akram
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Psychiatry Residency Training ProgramSt. Elizabeth's HospitalWashingtonDCUSA
| | - D. Fuchs
- Division of Biological Chemistry, BiocenterInnsbruck Medical UniversityInnsbruckAustria
| | - M. Daue
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - G. Nijjar
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - A. Ryan
- Department of Veterans AffairsVISN 5 Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreMDUSA
| | - M. E. Benros
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - O. Okusaga
- Michael E DeBakey VA Medical CenterHoustonTXUSA
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTXUSA
| | - E. Baca‐Garcia
- Department of Psychiatry, Fundación Jimenez Diaz HospitalAutónoma University, Centro de Investigacion en Red Salud MentalMadridSpain
| | - L. A. Brenner
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
- Department of Integrative Physiology and Center for NeuroscienceUniversity of Colorado BoulderBoulderCO80309USA
| | - C. A. Lowry
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
- Department of Integrative Physiology and Center for NeuroscienceUniversity of Colorado BoulderBoulderCO80309USA
| | - K. A. Ryan
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - M. Pavlovich
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - B. D. Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Program for Personalized and Genomic Medicine, Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - S. Snitker
- Division of Endocrinology, Diabetes and Nutrition, Department of MedicineUniversity of Maryland, School of MedicineBaltimoreMDUSA
| | - T. T. Postolache
- Mood and Anxiety ProgramUniversity of Maryland, School of MedicineBaltimoreMDUSA
- Department of Veterans AffairsVISN 5 Mental Illness Research Education and Clinical Center (MIRECC)BaltimoreMDUSA
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC)Denver Veterans Affairs Medical Center (VAMC)DenverCOUSA
- Department of Physical Medicine & Rehabilitation and Center for NeuroscienceUniversity of Colorado Anschutz Medical CampusAuroraCO80045USA
- Military and Veteran Microbiome: Consortium for Research and Education (MVM‐CoRE)DenverCO80220USA
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Huggan PJ, Akram F, Er BHD, Christen LSJ, Weixian L, Lim V, Huang Y, Merchant RA. Measures of acute physiology, comorbidity and functional status to differentiate illness severity and length of stay among acute general medical admissions: a prospective cohort study. Intern Med J 2015; 45:732-40. [DOI: 10.1111/imj.12795] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. J. Huggan
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - F. Akram
- University Medicine Cluster; National University Health System; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - B. H. D. Er
- Saw Swee Hock School of Public Health Singapore; Singapore
| | - L. S. J. Christen
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - L. Weixian
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - V. Lim
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Y. Huang
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - R. A. Merchant
- University Medicine Cluster; National University Health System; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Murtaza G, Khan S, Murtaza (Junior) G, Javed K, Akram F, Hamid A, Hussain I. An assessment of Pakistani pharmacy and medical students knowledge of black box warnings. ACTA BIOETH 2014. [DOI: 10.4067/s1726-569x2014000100013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Akram F, Bashir A, Gutiérrez-Guerrero LX, Masud B, Rodríguez-Quintero J, Calcaneo-Roldan C, Tejeda-Yeomans ME. Vacuum polarization and dynamical chiral symmetry breaking: Phase diagram of QED with four-fermion contact interaction. Int J Clin Exp Med 2013. [DOI: 10.1103/physrevd.87.013011] [Citation(s) in RCA: 11] [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] [Indexed: 11/07/2022]
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