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MacEwan SR, Rahurkar S, Tarver WL, Gaughan AA, Rush LJ, Schamess A, McAlearney AS. COVID-19 vaccination perspectives among patients with Long COVID: A qualitative study. Hum Vaccin Immunother 2024; 20:2327663. [PMID: 38532547 PMCID: PMC10978020 DOI: 10.1080/21645515.2024.2327663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
Individuals who have Long COVID may have unique perspectives about COVID-19 vaccination due to the significant impact that COVID-19 has had on their lives. However, little is known about the specific vaccination perspectives among this patient population. The goal of our study was to improve our understanding of perspectives about COVID-19 vaccines among individuals with Long COVID. Interviews were conducted with patients receiving care at a post-COVID recovery clinic. Deductive thematic analysis was used to characterize participant perspectives according to the vaccine acceptance continuum framework, which recognizes a spectrum from vaccine acceptance to refusal. From interviews with 21 patients, we identified perspectives across the continuum of vaccine acceptance. These perspectives included acceptance of vaccines to prevent future illness, concerns about vaccine side effects on Long COVID symptoms, and refusal of vaccines due to perceived natural immunity. A limitation of our study is that these perspectives are specific to individuals receiving care at one post-COVID recovery clinic. In conclusion, our study demonstrates that some patients with Long COVID are uncertain about COVID-19 vaccines and boosters but may also be amenable to conversations that impact future vaccination acceptance. Patient perspectives should be considered when communicating recommendations for COVID-19 vaccinations to this population.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L. Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Alice A. Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Kale SS, Tosto GD, Rush LJ, Kullgren J, Russell D, Fried M, Igboeli B, Teater J, Jones KF, Check DK, Merlin J, McAlearney AS. Creating a Palliative Care Clinic for Patients with Cancer Pain and Substance Use Disorder. J Pain Symptom Manage 2024:S0885-3924(24)00720-6. [PMID: 38670295 DOI: 10.1016/j.jpainsymman.2024.04.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use. MEASURES Patient volume, 60-day retention rate, and use of sublingual buprenorphine to treat opioid use disorder. INTERVENTION We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry. OUTCOMES During the first 18 months, patient volume increased steadily; 70% of patients had at least one subsequent visit within 60 days of the initial appointment; and buprenorphine was prescribed for 55% of patients with opioid use disorder. CONCLUSIONS/LESSONS LEARNED The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.
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Affiliation(s)
- Sachin S Kale
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Justin Kullgren
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Deborah Russell
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Martin Fried
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Blessing Igboeli
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Julie Teater
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Katie Fitzgerald Jones
- New England Geriatrics Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Jamaica Plain, MA
| | - Devon K Check
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina USA
| | - Jessica Merlin
- CHAllenges in Managing and Preventing Pain (CHAMPP) clinical research center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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3
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Quinn PL, Saiyed S, Hannon C, Sarna A, Waterman BL, Cloyd JM, Spriggs R, Rush LJ, McAlearney AS, Ejaz A. Reporting time toxicity in prospective cancer clinical trials: A scoping review. Support Care Cancer 2024; 32:275. [PMID: 38589750 DOI: 10.1007/s00520-024-08487-2] [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: 02/15/2024] [Accepted: 04/05/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE This review aimed to assess the measurement and reporting of time toxicity (i.e., time spent receiving care) within prospective oncologic studies. METHODS On July 23, 2023, PubMed, Scopus, and Embase were queried for prospective or randomized controlled trials (RCT) from 1984 to 2023 that reported time toxicity as a primary or secondary outcome for oncologic treatments or interventions. Secondary analyses of RCTs were included if they reported time toxicity. The included studies were then evaluated for how they reported and defined time toxicity. RESULTS The initial query identified 883 records, with 10 studies (3 RCTs, 2 prospective cohort studies, and 5 secondary analyses of RCTs) meeting the final inclusion criteria. Treatment interventions included surgery (n = 5), systemic therapies (n = 4), and specialized palliative care (n = 1). The metric "days alive and out of the hospital" was used by 80% (n = 4) of the surgical studies. Three of the surgical studies did not include time spent receiving ambulatory care within the calculation of time toxicity. "Time spent at home" was assessed by three studies (30%), each using different definitions. The five secondary analyses from RCTs used more comprehensive metrics that included time spent receiving both inpatient and ambulatory care. CONCLUSIONS Time toxicity is infrequently reported within oncologic clinical trials, with no standardized definition, metric, or methodology. Further research is needed to identify best practices in the measurement and reporting of time toxicity to develop strategies that can be implemented to reduce its burden on patients seeking cancer care.
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Affiliation(s)
- Patrick L Quinn
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Connor Hannon
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Angela Sarna
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Laura J Rush
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, University of Illinois Chicago, Chicago, IL, USA.
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Palmer Kelly E, Rush LJ, Eramo JL, Melnyk HL, Tarver WL, Waterman BL, Gustin J, Pawlik TM. Gaps in Patient-Centered Decision-Making Related to Complex Surgery: A Mixed-Methods Study. J Surg Res 2024; 295:740-745. [PMID: 38142577 DOI: 10.1016/j.jss.2023.11.070] [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: 07/10/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION We sought to understand the perceptions of surgeons around patient preferred roles in decision-making and their approaches to patient-centered decision-making (PCDM). METHODS A concurrent embedded mixed-methods design was utilized among a cohort of surgeons performing complex surgical procedures. Data were collected through online surveys. Associations between perceptions and PCDM approaches were examined. RESULTS Among 241 participants, most respondents were male (67.2%) with an average age of 47.6 y (standard deviation = 10.3); roughly half (52.4%) had practiced medicine for 10 or more years. Surgeons most frequently agreed (94.2%) with the statement, "Patients prefer to make health decisions on their own after seriously considering their physician's opinion." Conversely, surgeons most frequently disagreed (73.0%) with the statement, "Patients prefer that their physician make health decisions for them." Nearly one-third (30.4%) of surgeon qualitative responses (n = 115) indicated that clinical/biological information would help them tailor their approach to PCDM. Only 12.2% of respondents indicated that they assess patient preferences regarding both decision-making and information needs. CONCLUSIONS Surgeons most frequently agree that patients want to make their own health decisions after seriously considering their physicians opinion. A greater focus on what information surgeons should know before treatment decision-making may help optimize patient experience and outcomes related to complex surgical procedures.
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Affiliation(s)
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Jennifer L Eramo
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Halia L Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio; Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brittany L Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jillian Gustin
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Palmer Kelly E, Rush LJ, Melnyk HL, Eramo JL, McAlearney AS, Pawlik TM. Which factors influence the approach to shared decision-making among surgeons performing complex operations? J Commun Healthc 2024; 17:77-83. [PMID: 37818750 DOI: 10.1080/17538068.2023.2267827] [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] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Shared decision-making (SDM) aims to create a context in which patients and surgeons work together to explore treatment options and goals of care. The objective of the current study was to characterize demographic factors, behaviors, and perceptions of patient involvement among surgeons relative to SDM. METHODS Using a cross-sectional survey methodology, surgeon demographics, behaviors, and perceptions of patient involvement were assessed. Surgeon approaches to SDM were measured using a 100-point scale ranging from 'patient-led' (0) to 'surgeon-led' (100). RESULTS Among 241 respondents, most were male (n = 123, 67.2%) and White (n = 124, 69.3%); roughly one-half of surgeons had been in practice ≥10 years (n = 120, 52.4%). Surgeon approaches to SDM ranged from 0 to 81.0, with a median rating of 50.0 (IQR: 35.5, 62.0). Reported approaches to SDM were associated with years in practice, sharing information, and perceptions of patient involvement. Surgeons in practice 10 + years most frequently utilized a 'Shared, Patient-led' approach to SDM (27.5%), while individuals with less experience more often employed a 'Shared, Surgeon-led' approach (33.3%, p = 0.031). Surgeons with a 'Patient-led' approach perceived patient involvement as most important (M = 3.82, SD = 0.16), while respondents who had a 'Surgeon-led' approach considered this less important (M = 3.57, SD = 0.38; p < 0.001). CONCLUSION Surgeon factors including demographics, behaviors, and perceptions of patient involvement influenced SDM approaches. SDM between patients and surgeons should strive to be more dynamic and tailored to each specific patient's needs to promote optimal patient-centered care.
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Affiliation(s)
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Halia L Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Eramo
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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MacEwan SR, Rahurkar S, Tarver WL, Forward C, Eramo JL, Teuschler L, Gaughan AA, Rush LJ, Stanwick S, McConnell E, Schamess A, McAlearney AS. Patient Experiences Navigating Care Coordination For Long COVID: A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08622-z. [PMID: 38308155 DOI: 10.1007/s11606-024-08622-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care. OBJECTIVE Understand experiences of patients as they navigate care for long COVID. DESIGN Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID. PARTICIPANTS Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection. APPROACH Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. KEY RESULTS Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy. CONCLUSIONS Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Cortney Forward
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Eramo
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lauren Teuschler
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alice A Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stacy Stanwick
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Erin McConnell
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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MacEwan SR, Kenah E, Dixon GN, Stevens J, Eiterman LP, Powell JR, Gage CB, Rush LJ, Panchal AR, McAlearney AS. Identifying beliefs driving COVID-19 vaccination: Lessons for effective messaging. Hum Vaccin Immunother 2023; 19:2266929. [PMID: 37947193 PMCID: PMC10653659 DOI: 10.1080/21645515.2023.2266929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023] Open
Abstract
Increasing vaccination acceptance has been essential during the COVID-19 pandemic and in preparation for future public health emergencies. This study aimed to identify messaging strategies to encourage vaccine uptake by measuring the drivers of COVID-19 vaccination among the general public. A survey to assess COVID-19 vaccination acceptance and hesitancy was advertised on Facebook in February-April 2022. The survey included items asking about COVID-19 vaccination status and participant demographics, and three scales assessing medical mistrust, perceived COVID-19 risk, and COVID-19 vaccine confidence (adapted from the Oxford COVID-19 vaccine confidence and complacency scale). The main outcome was vaccination, predicted by patient demographics and survey scale scores. Of 1,915 survey responses, 1,450 (75.7%) were included, with 1,048 (72.3%) respondents reporting they had been vaccinated. In a multivariable regression model, the COVID-19 vaccine confidence scale was the strongest predictor of vaccination, along with education level and perceived COVID-19 risk. Among the items on this scale, not all were equally important in predicting COVID-19 vaccination. The items that best predicted vaccination, at a given score on the COVID-19 vaccine confidence scale, included confidence that vaccine side effects are minimal, that the vaccine will work, that the vaccine will help the community, and that the vaccine provides freedom to move on with life. This study improved our understanding of perceptions most strongly associated with vaccine acceptance, allowing us to consider how to develop messages that may be particularly effective in encouraging vaccination among the general public for both the COVID-19 pandemic and future public health emergencies.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Eben Kenah
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Graham N. Dixon
- School of Communication, College of Arts and Sciences, The Ohio State University, Columbus, OH, USA
| | - Jack Stevens
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Leanna Perez Eiterman
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jonathan R. Powell
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Christopher B. Gage
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ashish R. Panchal
- National Registry of Emergency Medical Technicians, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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8
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Lee S, Olvera RG, Shiu-Yee K, Rush LJ, Tarver WL, Blevins T, McAlearney AS, Andersen BL, Paskett ED, Carson WE, Chen JC, Obeng-Gyasi S. Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study. Support Care Cancer 2023; 32:24. [PMID: 38095729 DOI: 10.1007/s00520-023-08199-z] [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: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The rising cost of breast cancer treatment has increased patients' financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients' perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization. METHODS We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches. RESULTS Two overarching themes captured patients' experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients' focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients' lifestyles and outlooks for the future. CONCLUSION Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization.
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Affiliation(s)
- Sandy Lee
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Ramona G Olvera
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Karen Shiu-Yee
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Tessa Blevins
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
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Barrett TA, MacEwan SR, Melnyk H, Di Tosto G, Rush LJ, Shiu-Yee K, Volney J, Singer J, Benza R, McAlearney AS. The Role of Palliative Care in Heart Failure, Part 3: Facilitators and Barriers to Cardiac Palliative Care Clinic Development. J Palliat Med 2023; 26:1685-1690. [PMID: 37878332 DOI: 10.1089/jpm.2022.0597] [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] [Indexed: 10/26/2023] Open
Abstract
Background: Patients with heart failure frequently have significant disease burden and complex psychosocial needs. The integration of palliative care into the management of these patients can decrease symptom burden throughout their course of illness. Therefore, in 2009, we established a cardiac palliative care clinic colocated with heart failure providers in a large academic heart hospital. Objective: To better understand the facilitators and barriers to integrating palliative care into our heart failure management service. Design: Qualitative study using a semistructured interview guide. Setting, Subjects: Between October 2020 and January 2021, we invited all 25 primary cardiac providers at our academic medical center in the midwestern United States to participate in semistructured qualitative interviews to discuss their experiences with the cardiac palliative care clinic. Measurements: Interview transcripts were analyzed using a deductive-dominant thematic analysis approach to reveal emerging themes. Results: Providers noted that the integration of palliative care into the treatment of patients with heart failure was helped and hindered primarily by issues related to operations and communications. Operational themes about clinic proximity and the use of telehealth as well as communication themes around provider-provider communication and the understanding of palliative care were particularly salient. Conclusions: The facilitators and barriers identified have broad applicability that are independent of the etiological nature (e.g., cancer, pulmonary, neurological) of any specialty or palliative care clinic. Moreover, the strategies we used to implement improvements in our clinic may be of benefit to other practice models such as independent and embedded clinics.
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Affiliation(s)
- Todd A Barrett
- Division of Palliative Medicine, Department of Internal Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of General Internal Medicine, Department of Internal Medicine, and College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Halia Melnyk
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Karen Shiu-Yee
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jaclyn Volney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Singer
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Raymond Benza
- Division of Cardiology, Heart, and Vascular Institute/Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Barrett TA, MacEwan SR, Volney J, Singer J, Di Tosto G, Melnyk HL, Shiu-Yee K, Rush LJ, Benza R, McAlearney AS. The Role of Palliative Care in Heart Failure, Part 4: A Framework for Collaboration in Advance Care Planning. J Palliat Med 2023; 26:1691-1697. [PMID: 37878340 DOI: 10.1089/jpm.2022.0599] [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] [Indexed: 10/26/2023] Open
Abstract
Background: Palliative care integration into cardiology is growing, allowing primary cardiology care teams increasing opportunities to utilize palliative care to support processes such as advance care planning (ACP). Objective: The aim of the study is to understand perspectives of cardiac care team members about the involvement and impact of palliative care on ACP in heart failure. Design: A qualitative study using a semistructured interview guide was performed. Settings/Subjects: Interviews were conducted with cardiac care team members, including cardiologists, cardiac surgeons, and nurse practitioners, at a large academic medical center in the United States with an integrated cardiac palliative care team. Measurements: Deductive and inductive thematic analysis of interview transcripts enabled characterization of themes around the role of palliative care in ACP. Results: Two themes were identified with regard to providers' perspectives about ACP: (1) different levels of comfort with initiating and conducting ACP conversations and (2) different opinions about the desired role of palliative care in the ACP process. In exploring these themes, we characterized four distinct approaches to ACP with palliative care as a novel framework for planning consultation. Conclusions: The different approaches to ACP and the implications for how cardiac providers interact with the palliative care team present an important opportunity to guide ACP consultation in practice. Adoption of this framework may help cardiac providers enhance the process of care delivery and ACP in important ways that improve care for their patients.
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Affiliation(s)
- Todd A Barrett
- Division of Palliative Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jaclyn Volney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Singer
- Department of Psychological Science, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Halia L Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Karen Shiu-Yee
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Raymond Benza
- Division of Cardiology, Heart and Vascular Institute/Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Barrett TA, Di Tosto G, MacEwan SR, Rush LJ, Melnyk HL, Westerheide K, Waterman B, McAlearney AS. The Role of Palliative Care in Heart Failure, Part 2: Characteristics of Patients Undergoing Outpatient Palliative Care Evaluation for Advanced Cardiac Therapies. J Palliat Med 2023; 26:1678-1684. [PMID: 37878322 DOI: 10.1089/jpm.2022.0596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 10/26/2023] Open
Abstract
Background: Characteristics of patients undergoing outpatient evaluation for advanced cardiac therapies are largely unknown. Objective: To describe demographics, baseline quality of life, and frailty of patients undergoing evaluation for advanced therapies at the time of presentation for evaluation in an outpatient cardiac palliative care clinic and examine key quality of life differences across patients. Design: Retrospective chart review to report baseline demographics and quality of life. Settings/Subjects: Patients at a large academic medical center in the United States referred for advanced cardiac therapies in 2021. Measurements: Depression and anxiety were measured using the Hospital Anxiety and Depression Scale; quality of life was measured using the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) tool; and frailty was measured using the Fried Frailty Phenotype. Differences in quality of life by disease etiology, demographic characteristics, and frailty were assessed. Results: Fifty-four patients were seen in the outpatient cardiac palliative care clinic for advanced therapy evaluation. Most were Caucasian (80%) and male (74%). Patients traveled an average of 61 minutes to the clinic. All but five lived in a rural, medically underserved, or health professional shortage area. Forty percent scored abnormal or borderline abnormal for anxiety; 22% scored abnormal or borderline abnormal for depression. The FACIT-Pal mean score was 129 (standard deviation 23), with emotional and functional well-being domains contributing most to poor quality of life. Seventy-one percent were frail. Patients with a nonischemic etiology had a 3.32 times higher rate of anxiety than nonischemic patients (95% confidence interval = 1.05-10.54, p = 0.041). Conclusion: As patients undergoing transplant evaluation have high levels of depression, anxiety, and frailty, interdisciplinary care teams will be needed to properly manage the needs of this complex population. These results can inform efforts to integrate palliative care into advanced cardiac therapy and improve patients' experiences.
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Affiliation(s)
- Todd A Barrett
- Division of Palliative Medicine, Department of Internal Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Halia L Melnyk
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Krista Westerheide
- Heart and Vascular Institute/Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany Waterman
- Division of Palliative Medicine, Department of Internal Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Barrett TA, MacEwan SR, Melnyk HL, Volney J, Singer J, Di Tosto G, Rush LJ, Shiu-Yee K, Benza R, McAlearney AS. The Role of Palliative Care in Heart Failure, Part 1: Referring Provider Perspectives About Opportunities in Advanced Cardiac Therapies. J Palliat Med 2023; 26:1671-1677. [PMID: 37878337 DOI: 10.1089/jpm.2022.0595] [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] [Indexed: 10/26/2023] Open
Abstract
Background: There are many ways that palliative care can support patients with heart failure, but the role of palliative care in supporting patients who are considering or are already using advanced cardiac therapies is less clear. Objective: To understand referring providers' perspectives about the role of palliative care in the treatment of patients with heart failure considering or using advanced cardiac therapies. Design: Qualitative study using a semistructured interview guide. Setting/Subjects: This study was conducted at an academic medical center in the United States with an integrated cardiac palliative care program. Interviews were conducted with cardiology providers, including cardiologists, cardiac surgeons, and nurse practitioners who care for patients with heart failure and who are considering or receiving advanced cardiac therapies. Measurements: Interview transcripts were analyzed deductively and inductively to reveal themes in providers' perspectives. Results: Five themes were identified about the role of palliative care when advanced therapies were considered or being used: (1) educating patients; (2) supporting goal-concordant care; (3) managing symptoms; (4) addressing psychosocial needs; and (5) managing end-of-life care. Providers suggested palliative care could be a facilitator of advanced therapies, rather than merely something to add to end-of-life care. Conclusions: Cardiology providers recognize the value of integrating palliative care across the heart failure disease trajectory to provide therapy options, support decision-making processes, and provide goal-concordant care for patients considering or receiving advanced therapies. Increasing awareness of opportunities to integrate palliative care throughout the treatment of these patients may help cardiology providers better coordinate with palliative care specialists to improve patient care.
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Affiliation(s)
- Todd A Barrett
- Division of Palliative Medicine, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah R MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of General Internal Medicine, and College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Halia L Melnyk
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jaclyn Volney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Singer
- Department of Psychological Science, The Ohio State University, Columbus, Ohio, USA
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Karen Shiu-Yee
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Raymond Benza
- Division of Cardiology, Heart and Vascular Institute/Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Gonzalez R, Srinivas S, Waterman BL, Chawla M, Cloyd JM, Di Tosto G, Pawlik TM, Sarna A, Rush LJ, McAlearney AS, Ejaz A. Impact of early vs late palliative care referrals on healthcare utilization in patients with pancreatic cancer. J Cancer Res Clin Oncol 2023; 149:14997-15002. [PMID: 37610676 DOI: 10.1007/s00432-023-05113-2] [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: 05/15/2023] [Accepted: 07/04/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of early versus late palliative care referral (PCR) following pancreatic cancer diagnosis. METHODS Patients diagnosed with PDAC who received a PCR between 2014 and 2020 at a major academic institution were identified. PCR was classified as early (< 30 days) or late (≥ 30 days) based on time from definitive diagnosis. Data were obtained on number of emergency department (ED) visits, intensive care unit (ICU) admissions, and hospital admissions. RESULTS Among 1458 patients with PDAC, 419 (28.7%) received PCR, among which 67.3% (n = 282) received a late PCR. Of those who received PCR, the majority were White (85%) and male (54.8%), with a median age of 62 years at time of diagnosis. Patients who received an early PCR more commonly presented with stage 4 disease at diagnosis (early: n = 91, 69% vs. late: n = 132, 47%), whereas patients who received a late PCR more commonly presented with stage 1, 2, or 3 disease (early: n = 40, 30.5% vs. late: n = 150, 53.2%) (p < 0.001). Patients who received early PCR had fewer median ED visits (1 vs. 2, p < 0.001) and hospital admissions (1 vs. 2, p < 0.001) compared with patients who received late PCR. However, after performing recurrent-event Cox-proportional hazards models, the timing of PCR did not impact hospital admission (HR 0.88, 95% CI 0.68, 1.14; p = 0.3). CONCLUSION Timing of PCR for patients with PDAC was not associated with healthcare utilization. Further prospective trials are needed to study the patient-centered impact of early integration of palliative care services into multidisciplinary pancreatic cancer teams.
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Affiliation(s)
- Roberto Gonzalez
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shruthi Srinivas
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 320 W. 10th Ave., M-260 Starling-Loving Hall, Columbus, OH, USA
| | - Brittany L Waterman
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mehak Chawla
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 320 W. 10th Ave., M-260 Starling-Loving Hall, Columbus, OH, USA
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 320 W. 10th Ave., M-260 Starling-Loving Hall, Columbus, OH, USA
| | - Angela Sarna
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Aslam Ejaz
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 320 W. 10th Ave., M-260 Starling-Loving Hall, Columbus, OH, USA.
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14
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Gaughan AA, MacEwan SR, Rush LJ, Gatti‐Mays ME, Pariser AC, McAlearney AS. Perspectives of patients undergoing neoadjuvant chemotherapy for breast cancer during the COVID-19 pandemic. Cancer Rep (Hoboken) 2023; 6:e1882. [PMID: 37584345 PMCID: PMC10598258 DOI: 10.1002/cnr2.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in a lapse in routine health care and cancer screenings for many individuals. This study sought to improve our understanding of the impact of the COVID-19 pandemic on women being treated for breast cancer, both in general, and specifically related to their diagnosis. METHODS Semi-structured interviews were conducted between August 2021 and February 2022 with women who were receiving neoadjuvant chemotherapy for early-stage breast cancer at the Stefanie Spielman Comprehensive Breast Center in Columbus, Ohio. Interviews were recorded and transcribed verbatim. Transcripts were coded using deductive dominant thematic analysis and inductive coding that allowed for categorization of data as well as identification of emergent themes. RESULTS Data collected from our 19 interviews revealed that the COVID-19 pandemic posed important challenges for breast cancer patients including fear of COVID-19 infection and feelings of isolation. Most interviewees noted they had been vaccinated against COVID-19 because of a desire to protect themselves and others from getting sick. Some women also expressed concerns about having delayed their screening mammograms due to the pandemic. Several patients described unexpected positive aspects of the pandemic such as being able to spend more time with family and having the ability to continue working because of the option to work from home during their cancer treatment. CONCLUSIONS Our findings provide important insight about the impact of COVID-19 on breast cancer patients. We highlight the positives that have been reported because of the pandemic, as well as the need to address delayed breast cancer screening.
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Affiliation(s)
- Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Sarah R. MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
- Division of General Internal MedicineCollege of Medicine, The Ohio State UniversityColumbusOHUSA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Margaret E. Gatti‐Mays
- Pelotonia Institute for Immuno‐Oncology, Division of Medical OncologyThe Ohio State University Comprehensive Cancer Center – The JamesColumbusOhioUSA
| | - Ashley C. Pariser
- Pelotonia Institute for Immuno‐Oncology, Division of Medical OncologyThe Ohio State University Comprehensive Cancer Center – The JamesColumbusOhioUSA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of MedicineThe Ohio State UniversityColumbusOHUSA
- Department of Family and Community MedicineCollege of Medicine, The Ohio State UniversityColumbusOHUSA
- Department of Biomedical InformaticsCollege of Medicine, The Ohio State UniversityColumbusOHUSA
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15
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MacEwan SR, Gaughan AA, Dixon GN, Olvera RG, Tarver WL, Rahurkar S, Rush LJ, Schenk AD, Stevens J, McAlearney AS. Understanding Concerns about COVID-19 and Vaccination: Perspectives from Kidney Transplant Recipients. Vaccines (Basel) 2023; 11:1134. [PMID: 37514950 PMCID: PMC10386736 DOI: 10.3390/vaccines11071134] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic poses a significant risk for immunosuppressed groups such as transplant patients. The purpose of this study was to improve our understanding of the impact of the COVID-19 pandemic on kidney transplant recipients, including their views on COVID-19 vaccination. Semi-structured interviews were conducted from December 2021 to August 2022 with 38 kidney transplant recipients who had an appointment with their transplant care team within the previous 6 months. We used qualitative thematic analysis to characterize the perspectives of interviewees. Regardless of COVID-19 vaccination status, most interviewees reported utilizing public health measures such as masking, hand washing, and avoiding crowds to protect themselves against COVID-19. Vaccinated interviewees (n = 31) noted that they chose to receive a COVID-19 vaccine because of their increased risk due to their immunocompromised state. For unvaccinated interviewees (n = 7), reasons for not receiving a COVID-19 vaccine included concerns about the safety and efficacy of the vaccine. Both vaccinated and unvaccinated interviewees expressed concerns about the lack of adequate testing of the vaccine in transplant patients and questioned if the vaccine might have unknown side effects for transplant recipients. Regardless of the vaccination status, most interviewees noted having trust in their healthcare team. Interviewees also described interpersonal tensions that arose during the pandemic, many of which surrounded vaccination and other preventive measures that were important to participants to protect their health. Together, these data demonstrate differing concerns and experiences related to the COVID-19 pandemic for vaccinated and unvaccinated transplant recipients. These findings highlight the unique needs of transplant recipients and reveal opportunities to support this vulnerable patient population in efforts to protect their health as the COVID-19 pandemic evolves.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Graham N Dixon
- School of Communications, College of Arts and Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Ramona G Olvera
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Austin D Schenk
- Division of Transplantation, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Jack Stevens
- Department of Pediatrics, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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16
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Chawla M, Villarreal ME, Waterman BL, Di Tosto G, Gonzalez R, Sarna A, Patel R, Cloyd J, Pawlik TM, Rush LJ, McAlearney A, Ejaz A. Utilization of Palliative and Hospice Care Among Pancreatic Cancer Patients at an Academic Center. J Surg Res 2023; 289:22-26. [PMID: 37075607 DOI: 10.1016/j.jss.2023.03.014] [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: 12/02/2022] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma has the lowest 5-y relative survival of all solid tumor malignancies. Palliative care can improve the quality of life of both patients and their caregivers. However, the utilization patterns of palliative care in patients with pancreatic cancer are unclear. METHODS Pancreatic cancer patients who were diagnosed between October 2014 and December 2020 at the Ohio State University were identified. Palliative care and hospice utilization and referral patterns were assessed. RESULTS Of the 1458 pancreatic cancer patients, 55% (n = 799) were male, median age at diagnosis was 65 y (interquartile range [IQR]: 58, 73), and most were Caucasian (n = 1302, 89%). Palliative care was utilized by 29% (n = 424) of the cohort, with the initial consultation obtained after an average of 6 ± 9 mo from diagnosis. Patients who received palliative care were younger (62 y, IQR: 55, 70 versus 67 y, IQR: 59, 73; P < 0.001) and more frequently members of racial and ethnic minorities (15% versus 9%; P < 0.001) versus those who did not receive palliative care. Among the 344 (24%) patients who received hospice care, 153 (44%) had no prior palliative care consultation. Patients referred to hospice care survived a median of 14 d (95% CI, 12-16) after hospice referral. CONCLUSIONS Only 3 out of 10 patients with pancreatic cancer received palliative care at an average of 6 mo from initial diagnosis. More than two out of every five patients referred to hospice had no previous palliative care consultation. Efforts to understand the impact of improved integration of palliative care into pancreatic cancer programs are needed.
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Affiliation(s)
- Mehak Chawla
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael E Villarreal
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brittany L Waterman
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Roberto Gonzalez
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Angela Sarna
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Romal Patel
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura J Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ann McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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17
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Stevens E, Lampert BC, Whitson BA, Rush LJ, Mokadam NA, Barrett TA. Total artificial heart implantation: supportive care preparedness planning framework. BMJ Support Palliat Care 2023:spcare-2023-004210. [PMID: 36990682 DOI: 10.1136/spcare-2023-004210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The total artificial heart (TAH) is an implanted device approved as a modality to stabilize patients with severe biventricular heart failure or persistent ventricular arrhythmias for evaluation and bridge to transplantation. According to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), about 450 patients received a TAH between 2006 and 2018. Patients being evaluated for a TAH are often critically ill and a TAH offers the best chance at survival. Given the prognostic uncertainty of these patients, there is a crucial need for preparedness planning to help patients and their caregivers plan for living and supporting a loved one with a TAH. AIM To describe an approach to preparedness planning and highlight the importance of palliative care. METHODS We reviewed the current needs and approaches to preparedness planning for a TAH. We categorized our findings and suggest a guide to maximize conversations with patients and their decision makers. RESULTS We identified four critical areas to address: the decision maker, minimal acceptable outcome/maximal acceptable burden, living with the device, and dying with the device. We suggest using a framework of mental and physical outcomes and locations of care as a way to identify minimal acceptable outcome and maximal acceptable burden. CONCLUSION Decision making for a TAH is complex. There is an urgency and patients do not always have capacity. Identifying legal decision makers and social support is critical. The surrogate decision makers should be included in preparedness planning including discussions about end-of-life care and treatment discontinuation. Having palliative care as members of the interdisciplinary mechanical circulatory support team can assist in these preparedness conversations.
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Affiliation(s)
- Erin Stevens
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brent C Lampert
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Laura J Rush
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
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18
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Barrett TA, Di Tosto G, Shiu-Yee K, Melnyk HL, Rush LJ, Sova LN, Lampert BC, Ganapathi AM, Whitson BA, Waterman BL, McAlearney AS. Prevalence of Violence against Providers in Heart and Lung Transplant Programs. Int J Environ Res Public Health 2023; 20:4805. [PMID: 36981714 PMCID: PMC10049342 DOI: 10.3390/ijerph20064805] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Workplace violence in healthcare institutions is becoming more frequent. The objective of this study was to better understand the nature of threat and physical acts of violence from heart and lung transplant patients and families toward healthcare providers and suggest programmatic mitigation strategies. We administered a brief survey to attendees at the 2022 International Society of Heart and Lung Transplantation Conference in Boston, Massachusetts. A total of 108 participants responded. Threats of physical violence were reported by forty-five participants (42%), were more frequently reported by nurses and advanced practice providers than physicians (67% and 75% vs. 34%; p < 0.001) and were more prevalent in the United States than abroad (49% vs. 21%; p = 0.026). Acts of physical violence were reported by one out of every eight providers. Violence against providers in transplant programs warrants closer review by health systems in order to ensure the safety of team members.
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Affiliation(s)
- Todd A. Barrett
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Karen Shiu-Yee
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Halia L. Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Lindsey N. Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Asvin M. Ganapathi
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bryan A. Whitson
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brittany L. Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Gaughan AA, Rush LJ, MacEwan SR, Panchal AR, McAlearney AS. Perspectives of Volunteer Firefighters during the COVID-19 Pandemic: Stumbling Blocks and Silver Linings. Challenges (Basel) 2022; 13:46. [PMID: 36213181 PMCID: PMC9540602 DOI: 10.3390/challe13020046] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has profoundly affected the lives of almost every individual in every nation, with numbers of infections continuing to grow. Across these nations, first responders are essential in their roles addressing emergencies, despite their risk of exposure to COVID-19 in the course of their work. We sought to understand the impacts of the COVID-19 pandemic on the lives of volunteer firefighters in the United States, an understudied group of these first responders. Interviews were conducted with volunteer firefighters between September and November 2021. Interviews were analyzed using deductive dominant thematic analysis. Thirty-three firefighters were interviewed who had an average of 22 years of service and a mean age of 52 years. Interviewees described pandemic-related challenges including the fear of COVID exposure and frustrations with work and personal relationships. They also identified unexpected work-related benefits including a deepened commitment to serve and improvements to training and safety. Further, some volunteers noted personal benefits such as developing stronger connections with others, having a new outlook on life, and observing goodwill. Our findings provide insight into the multifaceted and complex impact of the COVID-19 pandemic on volunteer firefighters.
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Affiliation(s)
- Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Sarah R. MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ashish R. Panchal
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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20
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McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
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21
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MacEwan SR, Gaughan AA, Gregory ME, Rush LJ, Powell JR, Kurth JD, Panchal AR, McAlearney AS. An Opportunity to Understand Concerns about COVID-19 Vaccination: Perspectives from EMS Professionals. Vaccines (Basel) 2022; 10:vaccines10030380. [PMID: 35335012 PMCID: PMC8950335 DOI: 10.3390/vaccines10030380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 12/28/2022] Open
Abstract
Some healthcare professionals, including emergency medical service (EMS) professionals, remain hesitant about receiving COVID-19 vaccines. This study sought to understand EMS professionals’ perspectives regarding COVID-19 vaccination. Using open-ended comments from a national survey deployed electronically to over 19,000 EMS professionals in April of 2021, we examined perspectives about acceptance of and hesitancy toward COVID-19 vaccines. Survey comments revealed differences in perspectives between vaccinated and unvaccinated EMS professionals regarding their personal role in improving public health through COVID-19 vaccination as well as vaccine benefits and the protection conferred by vaccination. Unvaccinated individuals also expressed concerns over the research and development of the COVID-19 vaccines that led to their decision not to get vaccinated. Individuals who were vaccinated suggested ways to increase uptake of the vaccine including having healthcare professionals serve as leaders for vaccination and educating individuals about COVID-19 vaccination through credible resources. Vaccine hesitancy remains a challenge to achieving herd immunity to COVID-19 through vaccination, even among healthcare professionals. Understanding the perspectives of those who have chosen not to be vaccinated can help direct strategies to reduce confusion and concerns. The perspectives of vaccinated individuals may also be valuable in identifying opportunities to promote vaccination in the professional setting.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.A.G.); (M.E.G.); (L.J.R.); (A.S.M.)
- Correspondence:
| | - Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.A.G.); (M.E.G.); (L.J.R.); (A.S.M.)
| | - Megan E. Gregory
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.A.G.); (M.E.G.); (L.J.R.); (A.S.M.)
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.A.G.); (M.E.G.); (L.J.R.); (A.S.M.)
| | - Jonathan R. Powell
- National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA; (J.R.P.); (J.D.K.); (A.R.P.)
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
| | - Jordan D. Kurth
- National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA; (J.R.P.); (J.D.K.); (A.R.P.)
| | - Ashish R. Panchal
- National Registry of Emergency Medical Technicians, Columbus, OH 43229, USA; (J.R.P.); (J.D.K.); (A.R.P.)
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (A.A.G.); (M.E.G.); (L.J.R.); (A.S.M.)
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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22
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Gregory ME, MacEwan SR, Gaughan AA, Rush LJ, Powell JR, Kurth JD, Kenah E, Panchal AR, Scheck McAlearney A. Closing the Gap on COVID-19 Vaccinations in First Responders and Beyond: Increasing Trust. Int J Environ Res Public Health 2022; 19:644. [PMID: 35055463 PMCID: PMC8776085 DOI: 10.3390/ijerph19020644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 12/24/2022]
Abstract
Although COVID-19 vaccines are widely available in the U.S. and much of the world, many have chosen to forgo this vaccination. Emergency medical services (EMS) professionals, despite their role on the frontlines and interactions with COVID-positive patients, are not immune to vaccine hesitancy. Via a survey conducted in April 2021, we investigated the extent to which first responders in the U.S. trusted various information sources to provide reliable information about COVID-19 vaccines. Those vaccinated generally trusted healthcare providers as a source of information, but unvaccinated first responders had fairly low trust in this information source-a group to which they, themselves, belong. Additionally, regardless of vaccination status, trust in all levels of government, employers, and their community as sources of information was low. Free-response explanations provided some context to these findings, such as preference for other COVID-19 management options, including drugs proven ineffective. A trusted source of COVID-19 vaccination information is not readily apparent. Individuals expressed a strong desire for the autonomy to make vaccination decisions for themselves, as opposed to mandates. Potential reasons for low trust, possible solutions to address them, generalizability to the broader public, and implications of low trust in official institutions are discussed.
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Affiliation(s)
- Megan E. Gregory
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.R.M.); (A.A.G.); (L.J.R.)
| | - Sarah R. MacEwan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.R.M.); (A.A.G.); (L.J.R.)
| | - Alice A. Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.R.M.); (A.A.G.); (L.J.R.)
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.R.M.); (A.A.G.); (L.J.R.)
| | - Jonathan R. Powell
- National Registry of Emergency Medical Technicians, Columbus, OH 43210, USA; (J.R.P.); (J.D.K.); (A.R.P.)
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH 43210, USA
| | - Jordan D. Kurth
- National Registry of Emergency Medical Technicians, Columbus, OH 43210, USA; (J.R.P.); (J.D.K.); (A.R.P.)
| | - Eben Kenah
- Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH 43210, USA;
| | - Ashish R. Panchal
- National Registry of Emergency Medical Technicians, Columbus, OH 43210, USA; (J.R.P.); (J.D.K.); (A.R.P.)
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH 43210, USA
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (S.R.M.); (A.A.G.); (L.J.R.)
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Abstract
BACKGROUND Expanded insurance coverage will likely increase the demand for primary care physicians in the United States. Despite this demand, the number of medical students planning to specialize in primary care is decreasing. OBJECTIVE To explore premedical students' attitudes toward the primary care specialty. METHODS Students enrolled in premedicine at a large Midwestern university were invited to complete the Primary Care Attitudes Survey (Cronbach α=.76). This 25-item survey measures attitudes about primary care on a 5-point Likert scale, ranging from 1, "strongly disagree" to 5, "strongly agree." Basic sociodemographic characteristics were assessed using descriptive statistics, and frequencies of individual survey responses were calculated using SPSS statistical software version 21.0. RESULTS A total of 100 premedical students (mean [SD] age, 19.8 [1.5] years; 59 female, 82 white non-Hispanic, and 33 freshman) completed the survey. Of 100 students, 33 planned to pursue primary care; 66 thought that primary care physicians would always have a job; 25 thought that primary care may become obsolete as medicine becomes more specialized; 48 thought that physician assistants and nurse practitioners would take over many primary care duties in the future; 91 thought that primary care physicians make important contributions to medicine; and 84 agreed that primary care focuses on the whole patient. CONCLUSIONS Premedical students held positive views about the importance of primary care; however, many expressed uncertainty about the stability of primary care careers in the future. Further, a substantial number of students believed common misconceptions about the scope and practice of primary care, such as primary care doctors are gatekeepers and mostly diagnose colds and ear infections.
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Abstract
Intracellular crystalline deposits of immunoglobulin are occasionally seen in human B-cell lymphoproliferative disorders such as multiple myeloma, chronic lymphocytic leukemia, and various forms of lymphoma. Even more uncommon is the occurrence of immunoglobulin crystals in benign plasma cells or reactive lymphocytes. Here we describe the histologic, immunohistochemical, and ultrastructural features of intracellular immunoglobulin crystals in nonneoplastic plasma cells in a chronic inflammatory lesion in a dog. Microscopically, the intracellular, nonbirefringent eosinophilic crystals were square to rectangular, 2–20 μgm long, and caused nuclear displacement to the periphery. The crystal-containing cells, as well as some of the crystals themselves, were positive for lambda light chain. Ultrastructural findings were consistent with a lattice network of protein-molecule alignment. The cause and significance of the crystals is unknown.
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Affiliation(s)
- B Zimmerman
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA
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25
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26
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Amano S, Ludin AFM, Clift R, Nakazawa M, Law TD, Rush LJ, Manini TM, Thomas JS, Russ DW, Clark BC. Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials 2016; 17:81. [PMID: 26867541 PMCID: PMC4751635 DOI: 10.1186/s13063-016-1214-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is a highly prevalent condition in the United States and has a staggeringly negative impact on society in terms of expenses and disability. It has previously been suggested that rehabilitation strategies for persons with recurrent low back pain should be directed to the medial back muscles as these muscles provide functional support of the lumbar region. However, many individuals with low back pain cannot safely and effectively induce trunk muscle adaptation using traditional high-load resistance exercise, and no viable low-load protocols to induce trunk extensor muscle adaptation exist. Herein, we present the study protocol for a randomized controlled trial that will investigate the "cross-transfer" of effects of a novel exercise modality, blood flow restricted exercise, on cross-sectional area (primary outcome), strength and endurance (secondary outcomes) of trunk extensor muscles, as well as the pain, disability, and rate of recurrence of low back pain (tertiary outcomes). METHODS AND STUDY DESIGN This is a single-blinded, single-site, randomized controlled trial. A minimum of 32 (and up to 40) subjects aged 18 to 50 years with recurrent low back pain and poor trunk extensor muscle endurance will be recruited, enrolled and randomized. After completion of baseline assessments, participants will be randomized in a 1:1 ratio to receive a 10-week resistance exercise training program with blood flow restriction (BFR exercise group) or without blood flow restriction (control exercise group). Repeat assessments will be taken immediately post intervention and at 12 weeks after the completion of the exercise program. Furthermore, once every 4 weeks during a 36-week follow-up period, participants will be asked to rate their perceived disability and back pain over the past 14 days. DISCUSSION This study will examine the potential for blood flow restricted exercise applied to appendicular muscles to result in a "cross-transfer" of therapeutic effect to the lumbar musculature in individuals with low back pain. The results of this study will provide important insights into the effectiveness of this novel exercise modality, which could potentially provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (registration number: NCT02308189, date of registration: 2 December 2014).
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Affiliation(s)
- Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Arimi Fitri Mat Ludin
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA.,Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rachel Clift
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Masato Nakazawa
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Office of Research and Grants, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Timothy D Law
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Family Medicine, Ohio University, Athens, OH, 45701, USA.
| | - Laura J Rush
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Todd M Manini
- Department of Geriatric Medicine, University of Florida, 2004 Mowry Road, PO Box 100107, Gainesville, FL, 32611, USA.
| | - James S Thomas
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - David W Russ
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Geriatric Medicine, Ohio University, Institute on Aging, Athens, OH, USA.
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27
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Mishra A, Liu S, Sams GH, Curphey DP, Santhanam R, Rush LJ, Schaefer D, Falkenberg LG, Sullivan L, Jaroncyk L, Yang X, Fisk H, Wu LC, Chandler JC, Wu YZ, Heerema NA, Chan KK, Perrotti D, Zhang J, Porcu P, Racke FK, Garzon R, Lee RJ, Marcucci G, Caligiuri MA. Aberrant overexpression of IL-15 initiates large granular lymphocyte leukemia through chromosomal instability and DNA hypermethylation. Cancer Cell 2012; 22:645-55. [PMID: 23153537 PMCID: PMC3627362 DOI: 10.1016/j.ccr.2012.09.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 07/02/2012] [Accepted: 09/14/2012] [Indexed: 12/12/2022]
Abstract
How inflammation causes cancer is unclear. Interleukin-15 (IL-15) is a pro-inflammatory cytokine elevated in human large granular lymphocyte (LGL) leukemia. Mice overexpressing IL-15 develop LGL leukemia. Here, we show that prolonged in vitro exposure of wild-type (WT) LGL to IL-15 results in Myc-mediated upregulation of aurora kinases, centrosome aberrancies, and aneuploidy. Simultaneously, IL-15 represses miR-29b via induction of Myc/NF-κBp65/Hdac-1, resulting in Dnmt3b overexpression and DNA hypermethylation. All this is validated in human LGL leukemia. Adoptive transfer of WT LGL cultured with IL-15 led to malignant transformation in vivo. Drug targeting that reverses miR-29b repression cures otherwise fatal LGL leukemia. We show how excessive IL-15 initiates cancer and demonstrate effective drug targeting for potential therapy of human LGL leukemia.
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Affiliation(s)
- Anjali Mishra
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Shujun Liu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Gregory H. Sams
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Douglas P. Curphey
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Ramasamy Santhanam
- Department of Molecular & Cellular Biochemistry, The Ohio State University, Columbus OH, 43210 USA
| | - Laura J. Rush
- College of Veterinary Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Deanna Schaefer
- College of Veterinary Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Lauren G. Falkenberg
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Laura Sullivan
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Laura Jaroncyk
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Xiaojuan Yang
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Harold Fisk
- Department of Molecular Genetics, The Ohio State University, Columbus OH, 43210 USA
| | - Lai-Chu Wu
- Department of Molecular & Cellular Biochemistry, The Ohio State University, Columbus OH, 43210 USA
| | - Jason C. Chandler
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Yue-Zhong Wu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
| | - Nyla A. Heerema
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Department of Pathology, The Ohio State University, Columbus OH, 43210 USA
| | - Kenneth K. Chan
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Danilo Perrotti
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Jianying Zhang
- Center for Biostatistics, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Pierluigi Porcu
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Frederick K. Racke
- Department of Pathology, The Ohio State University, Columbus OH, 43210 USA
| | - Ramiro Garzon
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Robert J. Lee
- College of Pharmacy, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Guido Marcucci
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
| | - Michael A. Caligiuri
- Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus OH, 43210 USA
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus OH, 43210 USA
- The Comprehensive Cancer Center and The James Cancer Hospital and Solove Research Institute; The Ohio State University, Columbus OH, 43210 USA
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28
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Abstract
Malignant pilomatricoma, also known as pilomatrix carcinoma and calcifying epitheliocarcinoma (in the human literature), has been considered a rare neoplasm of dogs. The authors present 3 canine cases of malignant pilomatricoma (2 with distant metastasis) and compare its behavior with reported behavior. Cases include an 8-year-old spayed female Airedale Terrier, a 7-year-old male Bassett Hound, and a 12-year-old intact male Giant Schnauzer. In all cases, the histologic features included trabeculae of basaloid cells, abrupt keratinization, "ghost" or "shadow" cells, and various features of malignancy consistent with a diagnosis of malignant pilomatricoma. Metastasis, including that to bone, was confirmed in 2 cases. Four cases of the 13 canine pilomatricomas diagnosed within a 24-month period (2006-2008) at the Ohio State University (2 of which are discussed in this report) were classified as malignant, which suggests that malignant pilomatricoma is more common than previously reported.
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Affiliation(s)
- E E Carroll
- Armed Forces Institute of Pathology, Washington, DC, USA.
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29
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Schaefer DMW, Forman MA, Kisseberth WC, Lehman AM, Kelbick NT, Harper P, Rush LJ. Quantification of plasma DNA as a prognostic indicator in canine lymphoid neoplasia. Vet Comp Oncol 2009; 5:145-55. [PMID: 19754786 DOI: 10.1111/j.1476-5829.2007.00122.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Dogs have a similar incidence of spontaneous cancers as people, and a noninvasive test to monitor disease status in dogs would be of great value. Humans with cancer often have increased levels of cell-free circulating DNA in their plasma, which has shown promise for diagnosis, prognosis and detection of residual disease. We hypothesized that dogs with cancer have increased circulating DNA compared with healthy dogs or dogs with non-neoplastic diseases. Plasma DNA was measured in 40 healthy dogs, 20 dogs with non-neoplastic diseases and 80 dogs with cancer. The reference interval for plasma DNA in healthy dogs was 1-15 ng mL(-1). Dogs with lymphoma and lymphoid leukaemia had significantly higher concentrations (range: 0-91 ng mL(-1), P < 0.0001). Antigen receptor rearrangement assays suggest that plasma DNA had the same clonality as the primary lymphoid tumours. Dogs with lymphoid neoplasia and plasma DNA >25 ng mL(-1) had shorter remission times than those with < 25 ng mL(-1) (P = 0.0116). In contrast to humans, where increased plasma DNA is seen in many diseases, dogs with nonlymphoid malignancies and non-neoplastic diseases had plasma DNA concentrations similar to healthy dogs. This study shows that a portion of dogs with lymphoid neoplasia have increased tumour-derived plasma DNA, which serves as a negative prognostic indicator.
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Affiliation(s)
- D M W Schaefer
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA
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30
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Garzon R, Liu S, Fabbri M, Liu Z, Heaphy CEA, Callegari E, Schwind S, Pang J, Yu J, Muthusamy N, Havelange V, Volinia S, Blum W, Rush LJ, Perrotti D, Andreeff M, Bloomfield CD, Byrd JC, Chan K, Wu LC, Croce CM, Marcucci G. MicroRNA-29b induces global DNA hypomethylation and tumor suppressor gene reexpression in acute myeloid leukemia by targeting directly DNMT3A and 3B and indirectly DNMT1. Blood 2009; 113:6411-8. [PMID: 19211935 PMCID: PMC2710934 DOI: 10.1182/blood-2008-07-170589] [Citation(s) in RCA: 600] [Impact Index Per Article: 40.0] [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: 07/22/2008] [Accepted: 02/08/2009] [Indexed: 12/31/2022] Open
Abstract
Aberrant DNA hypermethylation contributes to myeloid leukemogenesis by silencing structurally normal genes involved in hematopoiesis. MicroRNAs (miRNAs) are noncoding RNAs that regulate gene expression by targeting protein-coding mRNAs. Recently, miRNAs have been shown to play a role as both targets and effectors in gene hypermethylation and silencing in malignant cells. In the current study, we showed that enforced expression of miR-29b in acute myeloid leukemia cells resulted in marked reduction of the expression of DNA methyltransferases DNMT1, DNMT3A, and DNMT3B at both RNA and protein levels. This in turn led to decrease in global DNA methylation and reexpression of p15(INK4b) and ESR1 via promoter DNA hypomethylation. Although down-regulation of DNMT3A and DNMT3B was the result of a direct interaction of miR-29b with the 3' untranslated regions of these genes, no predicted miR-29b interaction sites were found in the DNMT1 3' untranslated regions. Further experiments revealed that miR-29b down-regulates DNMT1 indirectly by targeting Sp1, a transactivator of the DNMT1 gene. Altogether, these data provide novel functional links between miRNAs and aberrant DNA hypermethylation in acute myeloid leukemia and suggest a potentially therapeutic use of synthetic miR-29b oligonucleotides as effective hypomethylating compounds.
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Affiliation(s)
- Ramiro Garzon
- Department of Medicine, Ohio State University, Columbus, 43210, USA
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31
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Cantor GH, Caswell JL, Crissman JW, Gillette DM, Gunson DE, Hogenesch H, Kiupel M, Mense MG, Miller MA, Rush LJ, Leger JAS, Schoeb TR, Sellers RS, Sills RC, Swayne DE, Thomas HC, Ward JM, Alden CL. Veterinary pathology and peer review. Vet Pathol 2009; 46:173-5. [PMID: 19261628 DOI: 10.1354/vp.46-2-173] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Abstract
The number of veterinarians in the United States is inadequate to meet societal needs in biomedical research and public health. Areas of greatest need include translational medical research, veterinary pathology, laboratory-animal medicine, emerging infectious diseases, public health, academic medicine, and production-animal medicine. Veterinarians have unique skill sets that enable them to serve as leaders or members of interdisciplinary research teams involved in basic science and biomedical research with applications to animal or human health. There are too few graduate veterinarians to serve broad national needs in private practice; academia; local, state, and federal government agencies; and private industry. There are no easy solutions to the problem of increasing the number of veterinarians in biomedical research. Progress will require creativity, modification of priorities, broad-based communication, support from faculty and professional organizations, effective mentoring, education in research and alternative careers as part of the veterinary professional curriculum, and recognition of the value of research experience among professional schools' admissions committees. New resources should be identified to improve communication and education, professional and graduate student programs in biomedical research, and support to junior faculty. These actions are necessary for the profession to sustain its viability as an integral part of biomedical research.
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Affiliation(s)
- Thomas J Rosol
- College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
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33
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Brena RM, Morrison C, Liyanarachchi S, Jarjoura D, Davuluri RV, Otterson GA, Reisman D, Glaros S, Rush LJ, Plass C. Aberrant DNA methylation of OLIG1, a novel prognostic factor in non-small cell lung cancer. PLoS Med 2007; 4:e108. [PMID: 17388669 PMCID: PMC1831740 DOI: 10.1371/journal.pmed.0040108] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 01/31/2007] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death worldwide. Currently, tumor, node, metastasis (TNM) staging provides the most accurate prognostic parameter for patients with non-small cell lung cancer (NSCLC). However, the overall survival of patients with resectable tumors varies significantly, indicating the need for additional prognostic factors to better predict the outcome of the disease, particularly within a given TNM subset. METHODS AND FINDINGS In this study, we investigated whether adenocarcinomas and squamous cell carcinomas could be differentiated based on their global aberrant DNA methylation patterns. We performed restriction landmark genomic scanning on 40 patient samples and identified 47 DNA methylation targets that together could distinguish the two lung cancer subgroups. The protein expression of one of those targets, oligodendrocyte transcription factor 1 (OLIG1), significantly correlated with survival in NSCLC patients, as shown by univariate and multivariate analyses. Furthermore, the hazard ratio for patients negative for OLIG1 protein was significantly higher than the one for those patients expressing the protein, even at low levels. CONCLUSIONS Multivariate analyses of our data confirmed that OLIG1 protein expression significantly correlates with overall survival in NSCLC patients, with a relative risk of 0.84 (95% confidence interval 0.77-0.91, p < 0.001) along with T and N stages, as indicated by a Cox proportional hazard model. Taken together, our results suggests that OLIG1 protein expression could be utilized as a novel prognostic factor, which could aid in deciding which NSCLC patients might benefit from more aggressive therapy. This is potentially of great significance, as the addition of postoperative adjuvant chemotherapy in T2N0 NSCLC patients is still controversial.
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Affiliation(s)
- Romulo M Brena
- Department of Molecular Genetics, The Ohio State University, Columbus, Ohio, United States of America
- Department of Molecular Virology, Immunology and Medical Genetics, Division of Human Cancer Genetics, The Ohio State University, Columbus, Ohio, United States of America
| | - Carl Morrison
- Department of Pathology, The Ohio State University, Columbus, Ohio, United States of America
| | - Sandya Liyanarachchi
- Department of Molecular Virology, Immunology and Medical Genetics, Division of Human Cancer Genetics, The Ohio State University, Columbus, Ohio, United States of America
| | - David Jarjoura
- Division of Biostatistics, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Ramana V Davuluri
- Department of Molecular Virology, Immunology and Medical Genetics, Division of Human Cancer Genetics, The Ohio State University, Columbus, Ohio, United States of America
| | - Gregory A Otterson
- Department of Internal Medicine, Division of Hematology and Oncology, College of Medicine and Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - David Reisman
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Selina Glaros
- Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Laura J Rush
- Department of Veterinary Biosciences and the Comprehensive Cancer Center, The Ohio State University Columbus, Ohio, United States of America
| | - Christoph Plass
- Department of Molecular Virology, Immunology and Medical Genetics, Division of Human Cancer Genetics, The Ohio State University, Columbus, Ohio, United States of America
- * To whom correspondence should be addressed. E-mail:
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34
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Dorrance AM, Liu S, Yuan W, Becknell B, Arnoczky KJ, Guimond M, Strout MP, Feng L, Nakamura T, Yu L, Rush LJ, Weinstein M, Leone G, Wu L, Ferketich A, Whitman SP, Marcucci G, Caligiuri MA. Mll partial tandem duplication induces aberrant Hox expression in vivo via specific epigenetic alterations. J Clin Invest 2006; 116:2707-16. [PMID: 16981007 PMCID: PMC1564428 DOI: 10.1172/jci25546] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 07/25/2006] [Indexed: 01/14/2023] Open
Abstract
We previously identified a rearrangement of mixed-lineage leukemia (MLL) gene (also known as ALL-1, HRX, and HTRX1), consisting of an in-frame partial tandem duplication (PTD) of exons 5 through 11 in the absence of a partner gene, occurring in approximately 4%-7% of patients with acute myeloid leukemia (AML) and normal cytogenetics, and associated with a poor prognosis. The mechanism by which the MLL PTD contributes to aberrant hematopoiesis and/or leukemia is unknown. To examine this, we generated a mouse knockin model in which exons 5 through 11 of the murine Mll gene were targeted to intron 4 of the endogenous Mll locus. Mll(PTD/WT) mice exhibit an alteration in the boundaries of normal homeobox (Hox) gene expression during embryogenesis, resulting in axial skeletal defects and increased numbers of hematopoietic progenitor cells. Mll(PTD/WT) mice overexpress Hoxa7, Hoxa9, and Hoxa10 in spleen, BM, and blood. An increase in histone H3/H4 acetylation and histone H3 lysine 4 (Lys4) methylation within the Hoxa7 and Hoxa9 promoters provides an epigenetic mechanism by which this overexpression occurs in vivo and an etiologic role for MLL PTD gain of function in the genesis of AML.
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Affiliation(s)
- Adrienne M. Dorrance
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Shujun Liu
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Weifeng Yuan
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Brian Becknell
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Kristy J. Arnoczky
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Martin Guimond
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Matthew P. Strout
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Lan Feng
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Tatsuya Nakamura
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Li Yu
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Laura J. Rush
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Michael Weinstein
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Gustavo Leone
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Lizhao Wu
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Amy Ferketich
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Susan P. Whitman
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Guido Marcucci
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
| | - Michael A. Caligiuri
- Department of Internal Medicine, Division of Hematology and Oncology,
Department of Veterinary Biosciences,
Integrated Biomedical Science Graduate Program,
Department of Molecular Virology, Immunology and Medical Genetics,
Comprehensive Cancer Center,
Department of Molecular Genetics, and
Division of Biometrics, The Ohio State University, Columbus, Ohio, USA
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35
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Lin TY, Rush LJ, London CA. Generation and characterization of bone marrow-derived cultured canine mast cells. Vet Immunol Immunopathol 2006; 113:37-52. [PMID: 16780961 DOI: 10.1016/j.vetimm.2006.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 03/23/2006] [Accepted: 03/23/2006] [Indexed: 10/24/2022]
Abstract
Disorders of mast cells, particularly mast cell tumors (MCTs), are common in dogs. There now is evidence that many of these disorders exhibit breed predilections, suggesting an underlying heritable component. In comparison to humans and mice, little is known regarding the biology of canine mast cells. To facilitate the study of mast cell biology in other species, bone marrow-derived cultured mast cells (BMCMCs) often are used because these represent a ready source of large numbers of cells. We have developed a protocol to successfully generate canine BMCMCs from purified CD34(+) cells. After 5-7 weeks of culture with recombinant canine stem cell factor (rcSCF), greater than 90% of the cell population consisted of mast cells as evidenced by staining with Wright's-Giemsa, as well as production of chymase, tryptase, IL-8 and MCP-1. These cells expressed cell surface markers typical of mast cells including Kit, Fc epsilonRI, CD44, CD45 and CD18/CD11b. The canine BMCMCs were dependent on rcSCF for survival and proliferation, and migrated in response to rcSCF gradients. Cross-linking of cell surface-bound IgE induced the release of histamine and TNFalpha. Histamine release could also be stimulated by ConA, compound 48/80, and calcium ionophore. In summary, canine BMCMCs possess phenotypic and functional properties similar to mast cells found in vivo. These cells represent a novel, valuable resource for investigating normal canine mast cell biology as well as for identifying factors that lead to mast cell dysregulation in the dog.
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Affiliation(s)
- Tzu-yin Lin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA
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36
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Whitman SP, Liu S, Vukosavljevic T, Rush LJ, Yu L, Liu C, Klisovic MI, Maharry K, Guimond M, Strout MP, Becknell B, Dorrance A, Klisovic RB, Plass C, Bloomfield CD, Marcucci G, Caligiuri MA. The MLL partial tandem duplication: evidence for recessive gain-of-function in acute myeloid leukemia identifies a novel patient subgroup for molecular-targeted therapy. Blood 2005; 106:345-52. [PMID: 15774615 PMCID: PMC1895129 DOI: 10.1182/blood-2005-01-0204] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [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] [Received: 01/18/2005] [Accepted: 03/10/2005] [Indexed: 01/11/2023] Open
Abstract
MLL (ALL-1) chimeric fusions and MLL partial tandem duplications (PTD) may have mechanistically distinct contributions to leukemogenesis. Acute myeloid leukemia (AML) blasts with the t(9;11)(p22; q23) express MLL-AF9 and MLL wild-type (WT) transcripts, while normal karyotype AML blasts with the MLL(PTD/WT) genotype express MLL PTD but not the MLL WT. Silencing of MLL WT in MLL(PTD/WT) blasts was reversed by DNA methyltransferase (DNMT) and histone deacetylase (HDAC) inhibitors, and MLL WT induction was associated with selective sensitivity to cell death. Reduction of MLL PTD expression induced MLL WT and reduced blast colony-forming units, supporting opposing functions for MLL PTD and MLL WT whereby the MLL PTD contributes to the leukemic phenotype via a recessive gain-of-function. The coincident suppression of the MLL WT allele with the expression of the MLL PTD allele, along with the functional data presented here, supports the hypothesis that loss of WT MLL function via monoallelic repression contributes to the leukemic phenotype by the remaining mutant allele. These data from primary AML and the pharmacologic reversal of MLL WT silencing associated with a favorable alteration in the threshold for apoptosis suggest that these patients with poor prognosis may benefit from demethylating or histone deacetylase inhibitor therapy, or both.
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Affiliation(s)
- Susan P Whitman
- Department of Internal Medicine, Division of Hematology-Oncology, The Ohio State University, Columbus, OH 43210, USA
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37
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Liu S, Shen T, Huynh L, Klisovic MI, Rush LJ, Ford JL, Yu J, Becknell B, Li Y, Liu C, Vukosavljevic T, Whitman SP, Chang KS, Byrd JC, Perrotti D, Plass C, Marcucci G. Interplay of RUNX1/MTG8 and DNA Methyltransferase 1 in Acute Myeloid Leukemia. Cancer Res 2005; 65:1277-84. [PMID: 15735013 DOI: 10.1158/0008-5472.can-04-4532] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [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: 11/16/2022]
Abstract
The translocation t(8;21)(q22;q22) in acute myeloid leukemia (AML) results in the expression of the fusion protein RUNX1/MTG8, which in turn recruits histone deacetylases (HDAC) to silence RUNX1 target genes [e.g., interleukin-3 (IL-3)]. We previously reported that expression of the RUNX1/MTG8 target gene IL-3 is synergistically restored by the combination of inhibitors of HDACs (i.e., depsipeptide) and DNA methyltransferases (DNMT; i.e., decitabine) in RUNX1/MTG8-positive Kasumi-1 cells. Thus, we hypothesized that DNMT1 is also part of the transcriptional repressor complex recruited by RUNX1/MTG8. By a chromatin immunoprecipitation assay, we identified a RUNX1/MTG8-DNMT1 complex on the IL-3 promoter in Kasumi-1 cells and in primary RUNX1/MTG8-positive AML blasts. The physical association of RUNX1/MTG8 with DNMT1 was shown by coimmunoprecipitation experiments. Furthermore, RUNX1/MTG8 and DNMT1 were concurrently released from the IL-3 promoter by exposure to depsipeptide or stabilized on the promoter by decitabine treatment. Finally, we proved that RUNX1/MTG8 and DNMT1 were functionally interrelated by showing an enhanced repression of IL-3 after coexpression in 293T cells. These results suggest a novel mechanism for gene silencing mediated by RUNX1/MTG8 and support the combination of HDAC and DNMT inhibitors as a novel therapeutic approach for t(8;21) AML.
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Affiliation(s)
- Shujun Liu
- Divisions of Hematology-Oncology, Department of Internal Medicine and the Comprehensive Cancer Center, Ohio State University, Columbus, Ohio, USA
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38
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Rush LJ, Raval A, Funchain P, Johnson AJ, Smith L, Lucas DM, Bembea M, Liu TH, Heerema NA, Rassenti L, Liyanarachchi S, Davuluri R, Byrd JC, Plass C. Epigenetic profiling in chronic lymphocytic leukemia reveals novel methylation targets. Cancer Res 2004; 64:2424-33. [PMID: 15059895 DOI: 10.1158/0008-5472.can-03-2870] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [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: 11/16/2022]
Abstract
CpG island methylation is an epigenetic alteration that contributes to tumorigenesis by transcriptional inactivation of genes. Little is known about the overall levels of CpG island methylation in chronic lymphocytic leukemia (CLL). To provide a baseline estimate of global aberrant methylation and identify target sequences for additional investigation, we performed Restriction Landmark Genomic Scanning on 10 CLL samples. Two methylation-sensitive landmark enzymes were used (NotI and AscI), allowing assessment of over 3000 CpG islands in each sample. Tumor-derived Restriction Landmark Genomic Scanning profiles were compared with profiles from CD19-selected B cells from normal volunteers and matched normal neutrophils from 4 CLL patients. We found 2.5-8.1% (mean 4.8%) of the CpG islands in CLL samples were aberrantly methylated compared with controls, and the methylation events had a nonrandom distribution (P < 0.0001). Furthermore, we identified 193 aberrantly methylated sequences, of which 93% have CpG island characteristics and 90% have homology to genes or expressed sequences. One such gene, the G protein-coupled metabotropic glutamate receptor 7 (GRM7), possibly inhibits cyclic AMP signaling in the induction of apoptosis. Bisulfite sequencing of GRM7 confirmed extensive CpG island methylation, and treatment with 5-aza-2'-deoxycytidine (decitabine) resulted in up-regulated expression of several genes in vitro with concurrent cellular depletion of DNMT1 protein. Our dual-enzyme global methylation study shows that CLL is characterized by widespread nonrandom CpG island methylation similar to other tumors and provides a panel of novel methylation targets that can be used in larger studies designed to assess impact on disease progression and survival.
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Affiliation(s)
- Laura J Rush
- Department of Veterinary Biosciences, Comprehensive Cancer Center and The Ohio State University, Columbus, Ohio 43210, USA
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39
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Gurrieri C, Capodieci P, Bernardi R, Scaglioni PP, Nafa K, Rush LJ, Verbel DA, Cordon-Cardo C, Pandolfi PP. Loss of the tumor suppressor PML in human cancers of multiple histologic origins. J Natl Cancer Inst 2004; 96:269-79. [PMID: 14970276 DOI: 10.1093/jnci/djh043] [Citation(s) in RCA: 267] [Impact Index Per Article: 13.4] [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: 12/15/2022] Open
Abstract
BACKGROUND The PML gene is fused to the RARalpha gene in the vast majority of acute promyelocytic leukemias (APL) and has been implicated in the control of key tumor-suppressive pathways. However, its role in the pathogenesis of human cancers other than APL is still unclear. We therefore assessed the status and expression of the PML gene in solid tumors of multiple histologic origins. METHODS We created tumor tissue microarrays (TTMs) with samples from patients with colon adenocarcinoma (n = 109), lung carcinoma (n = 19), prostate adenocarcinoma (n = 36), breast carcinoma (n = 38), central nervous system (CNS) tumors (n = 51), germ cell tumors (n = 60), thyroid carcinoma (n = 32), adrenal cortical carcinoma (n = 12), and non-Hodgkin's lymphoma (n = 251) and from normal tissue corresponding to each histotype and analyzed PML protein and mRNA expression by immunohistochemistry and in situ hybridization, respectively. Tumor cell lines (n = 64) of various histologic origins were analyzed for PML protein and mRNA expression by immunofluorescence and northern blotting, respectively. DNA from microdissected tumor samples and cell lines was analyzed for PML mutations and loss of heterozygosity (LOH). For some tumor types, the association between PML expression and tumor stage and grade was analyzed. Statistical tests were two-sided. RESULTS All normal tissues expressed PML protein. PML protein expression was reduced or abolished in prostate adenocarcinomas (63% [95% confidence interval [CI] = 48% to 78%] and 28% [95% CI = 13% to 43%], respectively), colon adenocarcinomas (31% [95% CI = 22% to 40%] and 17% [95% CI = 10% to 24%]), breast carcinomas (21% [95% CI = 8% to 34%] and 31% [95% CI = 16% to 46%]), lung carcinomas (36% [95% CI = 15% to 57%] and 21% [95% = 3% to 39%]), lymphomas (14% [95% CI = 10% to 18%] and 69% [95% CI = 63% to 75%]), CNS tumors (24% [95% CI = 13% to 35%] and 49% [95% CI = 36% to 62%]), and germ cell tumors (36% [95% CI = 24% to 48%] and 48% [95% CI = 36% to 60%]) but not in thyroid or adrenal carcinomas. Loss of PML protein expression was associated with tumor progression in prostate cancer (the progression from prostatic intraepithelial neoplasia to invasive carcinoma was associated with complete PML loss; P<.001), breast cancer (complete PML loss was associated with lymph node metastasis; P =.01), and CNS tumors (complete PML loss was associated with high-grade tumors; P =.003). PML mRNA was expressed in all tumor and cell line samples. The PML gene was rarely mutated and was not subject to LOH. CONCLUSIONS PML protein expression is frequently lost in human cancers of various histologic origins, and its loss associates with tumor grade and progression in some tumor histotypes.
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Affiliation(s)
- Carmela Gurrieri
- Molecular Biology Program and Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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40
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Dai Z, Zhu WG, Morrison CD, Brena RM, Smiraglia DJ, Raval A, Wu YZ, Rush LJ, Ross P, Molina JR, Otterson GA, Plass C. A comprehensive search for DNA amplification in lung cancer identifies inhibitors of apoptosis cIAP1 and cIAP2 as candidate oncogenes. Hum Mol Genet 2003; 12:791-801. [PMID: 12651874 DOI: 10.1093/hmg/ddg083] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [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: 12/28/2022] Open
Abstract
Amplification of oncogenes is an important mechanism that can cause gene overexpression and contributes to tumor development. The identification of amplified regions might have both prognostic and therapeutic significance. We used primary lung carcinomas and lung cancer cell lines for restriction landmark genomic scanning (RLGS) to identify novel amplified sequences. Enhanced RLGS fragments that indicate gene amplification were observed in primary tumors and lung cancer cell lines of both non-small cell lung cancer and small cell lung cancer. We identified one novel amplicon on chromosome 11q22, in addition to previously reported amplicons that include oncogenes MYCC, MYCL1 and previously identified amplification of chromosomal regions 6q21 and 3q26-27. Amplification of 11q22 has been reported in other types of cancer and was refined to an approximately 1.19 Mbp region for which the complete sequence is available. Based on a patient sample with a small region of low-level amplification we were able to further narrow this region to 0.92 Mbp. Genes localized in this region include two inhibitors of apoptosis (cIAP1 and cIAP2). Immunohistochemistry and western blot analysis identified cIAP1 and cIAP2 as potential oncogenes in this region as both are overexpressed in multiple lung cancers with or without higher copy numbers.
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MESH Headings
- Blotting, Southern
- Blotting, Western
- Carcinoma, Non-Small-Cell Lung/genetics
- Cell Line, Tumor
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 3
- Chromosomes, Human, Pair 6
- Cloning, Molecular
- DNA/biosynthesis
- DNA/metabolism
- DNA Restriction Enzymes/pharmacology
- Expressed Sequence Tags
- Humans
- Immunohistochemistry
- Inhibitor of Apoptosis Proteins
- Lung Neoplasms/genetics
- Lung Neoplasms/metabolism
- Models, Genetic
- Protein Biosynthesis
- Proteins/physiology
- Ubiquitin-Protein Ligases
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Affiliation(s)
- Zunyan Dai
- Program of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH, 43210, USA
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41
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Klisovic MI, Maghraby EA, Parthun MR, Guimond M, Sklenar AR, Whitman SP, Chan KK, Murphy T, Anon J, Archer KJ, Rush LJ, Plass C, Grever MR, Byrd JC, Marcucci G. Depsipeptide (FR 901228) promotes histone acetylation, gene transcription, apoptosis and its activity is enhanced by DNA methyltransferase inhibitors in AML1/ETO-positive leukemic cells. Leukemia 2003; 17:350-8. [PMID: 12592335 DOI: 10.1038/sj.leu.2402776] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.5] [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] [Received: 06/07/2002] [Accepted: 08/28/2002] [Indexed: 11/08/2022]
Abstract
In t(8;21) acute myeloid leukemia (AML), the AML1/ETO fusion protein promotes leukemogenesis by recruiting histone deacetylase (HDAC) and silencing AML1target genes important for hematopoietic differentiation. We hypothesized that depsipeptide (FR901228), a novel HDAC inhibitor evaluated in ongoing clinical trials, restores gene transcription and cell differentiation in AML1/ETO-positive cells. A dose-dependent increase in H3 and H4 histone acetylation was noted in depsipeptide-treated AML1/ETO-positive Kasumi-1 cells and blasts from a patient with t(8;21) AML. Consistent with this biological effect, we also showed a dose-dependent increase in cytotoxicity, expression of IL-3, here used as read-out for silenced AML1-target genes, upregulation of CD11b with other morphologic changes suggestive of partial cell differentiation in Kasumi-1 cells. Some of these biologic effects were also attained in other myeloid leukemia cell lines, suggesting that depsipeptide has differentiation and cytotoxic activity in AML cells, regardless of the underlying genomic abnormality. Notably, the activity of depsipeptide was enhanced by 5-aza-2'-deoxycytidine, a DNA methyltransferase inhibitor (DNMT). These two agents in combination resulted in enhanced histone acetylation, IL-3 expression, and cytotoxicity, suggesting HDAC and DNMT activities as a potential dual target in future therapeutic strategies for AML1/ETO and other molecular subgroups of AML.
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Affiliation(s)
- M I Klisovic
- Division of Hematology-Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
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42
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Smiraglia DJ, Smith LT, Lang JC, Rush LJ, Dai Z, Schuller DE, Plass C. Differential targets of CpG island hypermethylation in primary and metastatic head and neck squamous cell carcinoma (HNSCC). J Med Genet 2003; 40:25-33. [PMID: 12525538 PMCID: PMC1735270 DOI: 10.1136/jmg.40.1.25] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [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: 11/03/2022]
Abstract
Head and neck squamous cell carcinomas (HNSCC) often metastasise to the cervical lymph nodes. It is known for HNSCC as well as other cancers that progression from normal tissue to primary tumour and finally to metastatic tumour is characterised by an accumulation of genetic mutations. DNA methylation, an epigenetic modification, can result in loss of gene function in cancer, similar to genetic mutations such as deletions and point mutations. We have investigated the DNA methylation phenotypes of both primary HNSCC and metastatic tumours from 13 patients using restriction landmark genomic scanning (RLGS). With this technique, we were able to assess the methylation status of an average of nearly 1300 CpG islands for each tumour. We observed that the number of CpG islands hypermethylated in metastatic tumours is significantly greater than what is found in the primary tumours overall, but not in every patient. Interestingly, the data also clearly show that many loci methylated in a patient's primary tumour are no longer methylated in the metastatic tumour of the same patient. Thus, even though metastatic HNSCC methylate a greater proportion of CpG islands than do the primary tumours, they do so at different subsets of loci. These data show an unanticipated variability in the methylation state of loci in primary and metastatic HNSCCs within the same patient. We discuss two possible explanations for how different epigenetic events might arise between the primary tumour and the metastatic tumour of a person.
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Affiliation(s)
- D J Smiraglia
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA.
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43
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Abstract
The DNA methylation profile of cancer cells is frequently characterized by global hypomethylation and simultaneous hypermethylation of selected CpG island gene promoters. In recent years, the epigenetic phenomenon of DNA promoter methylation has gained increasing recognition as an important mechanism for transcriptional inactivation of cancer related genes. Studies on both liquid and solid tumors have revealed myriad aberrant methylation events, some of which may provide important clues to the pathogenesis of these tumors. The identification of these methylation alterations and elucidation of the mechanistic events surrounding them are of prime importance, as the methylation status of cancer cells can now be manipulated in vivo with demethylating chemotherapeutics.
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Affiliation(s)
- Laura J Rush
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
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44
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Dai Z, Weichenhan D, Wu YZ, Hall JL, Rush LJ, Smith LT, Raval A, Yu L, Kroll D, Muehlisch J, Frühwald MC, de Jong P, Catanese J, Davuluri RV, Smiraglia DJ, Plass C. An AscI boundary library for the studies of genetic and epigenetic alterations in CpG islands. Genome Res 2002; 12:1591-8. [PMID: 12368252 PMCID: PMC187524 DOI: 10.1101/gr.197402] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Knudson's two-hit hypothesis postulates that genetic alterations in both alleles are required for the inactivation of tumor-suppressor genes. Genetic alterations include small or large deletions and mutations. Over the past years, it has become clear that epigenetic alterations such as DNA methylation are additional mechanisms for gene silencing. Restriction Landmark Genomic Scanning (RLGS) is a two-dimensional gel electrophoresis that assesses the methylation status of thousands of CpG islands. RLGS has been applied successfully to scan cancer genomes for aberrant DNA methylation patterns. So far, the majority of this work was done using NotI as the restriction landmark site. Here, we describe the development of RLGS using AscI as the restriction landmark site for genome-wide scans of cancer genomes. The availability of AscI as a restriction landmark for RLGS allows for scanning almost twice as many CpG islands in the human genome compared with using NotI only. We describe the development of an AscI-EcoRV boundary library that supports the cloning of novel methylated genes. Feasibility of this system is shown in three tumor types, medulloblastomas, lung cancers, and head and neck cancers. We report the cloning of 178 AscI RLGS fragments via two methods by use of this library.
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Affiliation(s)
- Zunyan Dai
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA
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45
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Abstract
The field of molecular biology was revolutionized by the advent of gel electrophoresis. Restriction landmark genomic scanning (RLGS) is a type of two-dimensional electrophoresis employed in the genome-wide assessment of genomic alterations. RLGS has been used to study genetic and epigenetic changes in normal tissues, primary tumors, cancer cell lines, and various organisms such as mice, rats, hamsters, bacteria, and plants. An RLGS profile displays over 2000 radiolabeled restriction landmark sites in a single assay. When conducted with methylation-sensitive restriction enzymes whose sites are preferentially located in CpG island regulatory regions, RLGS becomes a very versatile tool for the investigation of both normal and aberrant methylation patterns. Early studies performed on tumor DNA were mainly descriptive in nature, essentially a catalogue of loci that were changed to varying degrees in different tumor types. Over time, as investigators have become more proficient with RLGS and have undertaken high-throughput studies, the need for efficient cloning, imaging, and analysis systems has become paramount. Current studies focus on identifying specific genes and pathways involved in deregulated methylation in cancer. As such, RLGS analysis of tumor samples has made tremendous contributions to our understanding of the role of DNA methylation in cancer. Future directions will take advantage of the abundant genomic sequence data available to link all of the RLGS loci to genes and create biologically relevant methylation profiles of cancer. This review discusses practical considerations of using RLGS as a genome scanning tool and the past, present, and future applications in cancer biology.
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Affiliation(s)
- Laura J Rush
- Department of Veterinary Biosciences, Division of Human Cancer Genetics, The Ohio State University, Columbus, OH 43210, USA.
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46
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Rush LJ, Heinonen K, Mrózek K, Wolf BJ, Abdel-Rahman M, Szymanska J, Peltomäki P, Kapadia F, Bloomfield CD, Caligiuri MA, Plass C. Comprehensive cytogenetic and molecular genetic characterization of the TI-1 acute myeloid leukemia cell line reveals cross-contamination with K-562 cell line. Blood 2002; 99:1874-6. [PMID: 11871388 DOI: 10.1182/blood.v99.5.1874] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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47
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Tanner SM, Austin JL, Leone G, Rush LJ, Plass C, Heinonen K, Mrózek K, Sill H, Knuutila S, Kolitz JE, Archer KJ, Caligiuri MA, Bloomfield CD, de La Chapelle A. BAALC, the human member of a novel mammalian neuroectoderm gene lineage, is implicated in hematopoiesis and acute leukemia. Proc Natl Acad Sci U S A 2001; 98:13901-6. [PMID: 11707601 PMCID: PMC61139 DOI: 10.1073/pnas.241525498] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.0] [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] [Indexed: 11/18/2022] Open
Abstract
The molecular basis of human leukemia is heterogeneous. Cytogenetic findings are increasingly associated with molecular abnormalities, some of which are being understood at the functional level. Specific therapies can be developed based on such knowledge. To search for new genes in the acute leukemias, we performed a representational difference analysis. We describe a human gene in chromosome 8q22.3, BAALC (brain and acute leukemia, cytoplasmic), that is highly conserved among mammals but evidently absent from lower organisms. We characterized BAALC on the genomic level and investigated its expression pattern in human and mouse, as well as its complex splicing behavior. In vitro studies of the protein showing its subcellular localization suggest a function in the cytoskeleton network. Two isoforms are specifically expressed in neuroectoderm-derived tissues, but not in tumors or cancer cell lines of nonneural tissue origin. We show that blasts from a subset of patients with acute leukemia greatly overexpress eight different BAALC transcripts, resulting in five protein isoforms. Among patients with acute myeloid leukemia, those overexpressing BAALC show distinctly poor prognosis, pointing to a key role of the BAALC products in leukemia. Our data suggest that BAALC is a gene implicated in both neuroectodermal and hematopoietic cell functions.
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Affiliation(s)
- S M Tanner
- Human Cancer Genetics Program, Ohio State University, 646 Medical Research Facility, 420 West 12th Avenue, Columbus, OH 43210, USA
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Dai Z, Lakshmanan RR, Zhu WG, Smiraglia DJ, Rush LJ, Frühwald MC, Brena RM, Li B, Wright FA, Ross P, Otterson GA, Plass C. Global methylation profiling of lung cancer identifies novel methylated genes. Neoplasia 2001; 3:314-23. [PMID: 11571631 PMCID: PMC1505864 DOI: 10.1038/sj.neo.7900162] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [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: 03/29/2001] [Accepted: 04/26/2001] [Indexed: 12/25/2022] Open
Abstract
Epigenetic changes, including DNA methylation, are a common finding in cancer. In lung cancers methylation of cytosine residues may affect tumor initiation and progression in several ways, including the silencing of tumor suppressor genes through promoter methylation and by providing the targets for adduct formation of polycyclic aromatic hydrocarbons present in combustion products of cigarette smoke. Although the importance of aberrant DNA methylation is well established, the extent of DNA methylation in lung cancers has never been determined. Restriction landmark genomic scanning (RLGS) is a highly reproducible two-dimensional gel electrophoresis that allows the determination of the methylation status of up to 2000 promoter sequences in a single gel. We selected 1184 CpG islands for RLGS analysis and determined their methylation status in 16 primary non-small cell lung cancers. Some tumors did not show methylation whereas others showed up to 5.3% methylation in all CpG islands of the profile. Cloning of 21 methylated loci identified 11 genes and 6 ESTs. We demonstrate that methylation is part of the silencing process of BMP3B in primary tumors and lung cancer cell lines.
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Affiliation(s)
- Zunyan Dai
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
- Department of Pathology, The Ohio State University, Columbus, OH
| | - Romola R Lakshmanan
- Division of Hematology/Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Wei-Guo Zhu
- Division of Hematology/Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Dominic J Smiraglia
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
| | - Laura J Rush
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH
| | - Michael C Frühwald
- Westfälische Wilhelms-Universität Münster, Klinik und Poliklinik für Kinderheilkunde-Pädiatrische Hämatologie/Onkologie, Münster, Germany
| | - Romulo M Brena
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
- Department of Molecular Genetics and the Comprehensive Cancer Center, The Ohio State University, Columbus, OH
| | - Bin Li
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
| | - Fred A Wright
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
| | - Patrick Ross
- Department of Clinical Surgery, The Ohio State University, Columbus, OH
| | - Gregory A Otterson
- Division of Hematology/Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Christoph Plass
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, Columbus, OH
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Smiraglia DJ, Rush LJ, Frühwald MC, Dai Z, Held WA, Costello JF, Lang JC, Eng C, Li B, Wright FA, Caligiuri MA, Plass C. Excessive CpG island hypermethylation in cancer cell lines versus primary human malignancies. Hum Mol Genet 2001; 10:1413-9. [PMID: 11440994 DOI: 10.1093/hmg/10.13.1413] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.8] [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: 11/13/2022] Open
Abstract
Cancer cell lines are widely used in many types of cancer research, including studies aimed at understanding DNA hypermethylation of gene promoters in cancer. Hypermethylation of promoters is capable of repressing the expression of tumor suppressor genes and may play a role in the development and/or progression of cancer. Although both primary malignancies and cancer cell lines exhibit this epigenetic phenomenon, there has been no direct comparison between them. In order to address this question, we have utilized restriction landmark genomic scanning to measure the hypermethylation phenotypes of cancer cell lines and compared these data with the same analysis performed on primary malignancies. In all cases, cancer cell lines exhibit significantly higher levels of CpG island hypermethylation than the primary malignancies they represent. Colon cancer cell lines are most similar to their respective tumors, with only a 5-fold increase in hypermethylation, while head and neck squamous cell carcinoma cell lines show a 93-fold increase in hypermethylation. Furthermore, >57% of the loci methylated in cell lines are never methylated in 114 primary malignancies studied. Seventy percent of loci hypermethylated in cell lines are hypermethylated in lines from more than one type of cancer. These data indicate that most CpG island hypermethylation observed in cancer cell lines is due to an intrinsic property of cell lines as opposed to the malignant tissue from which they originated.
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Affiliation(s)
- D J Smiraglia
- Division of Human Cancer Genetics, Department of Molecular Virology, Immunology and Medical Genetics, The Ohio State University, 420 West 12th Avenue, Columbus, OH 43210, USA.
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Rush LJ, Dai Z, Smiraglia DJ, Gao X, Wright FA, Frühwald M, Costello JF, Held WA, Yu L, Krahe R, Kolitz JE, Bloomfield CD, Caligiuri MA, Plass C. Novel methylation targets in de novo acute myeloid leukemia with prevalence of chromosome 11 loci. Blood 2001; 97:3226-33. [PMID: 11342453 DOI: 10.1182/blood.v97.10.3226] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [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: 11/20/2022] Open
Abstract
Aberrant DNA methylation is believed to be important in tumorigenesis by causing either transcriptional inactivation of genes or chromosomal instability. Several laboratories have identified promoter hypermethylation of tumor suppressor genes in acute myeloid leukemia (AML). However, these studies do not provide a global assessment of overall methylation changes and do not allow the identification of novel methylated sequences. Previously, nonrandom CpG island methylation was reported in 17 adult de novo AML diagnostic samples when compared with the corresponding remission samples by means of restriction landmark genomic scanning (RLGS). That study has been expanded on by an analysis of a larger set of CpG islands (1740 vs 1184), which now provides details of 33 cloned methylated loci, including 21 known genes or expressed sequence tags. Five of these cloned loci appear to be methylated only in AML and not in the 6 solid tumors studied in this study (more than 98 samples analyzed). Chromosomal location was available for 30 of the 33 loci, and 5 of these 30 (17%) are localized to chromosome 11, suggesting a trend toward overrepresentation of methylation events on this chromosome. These results provide evidence for widespread aberrant methylation in AML, with identification of novel methylation targets, epigenetic changes that appear unique to AML, and apparent preferential methylation on chromosome 11.
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Affiliation(s)
- L J Rush
- Division of Human Cancer Genetics, Department of Molecular Virology, The Ohio State University, Columbus 43210, USA
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