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Kim Y, Murphy J, Craft K, Waters L, Gooden BI. "It's just a constant concern in the back of my mind": Lived experiences of college food insecurity. J Am Coll Health 2024; 72:980-987. [PMID: 35471945 DOI: 10.1080/07448481.2022.2064714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/18/2021] [Revised: 03/23/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
Objective: Food insecurity is a growing concern to the health and wellbeing of college students. This study aims to examine the lived experiences of students at-risk of food insecurity and associated challenges in a public urban campus. Participants: The study recruited 21 college students at risk of food insecurity using purposive sampling. Methods: We performed qualitative interviews with three focus groups and conducted a thematic analysis to explore themes that emerged from participant discussions. Results: Three central themes emerged from our qualitative analysis: (a) barriers to accessing stable and healthy food; (b) impacts of food insecurity on academic performance and physical and mental health; and (c) coping strategies for navigating food insecurity. Conclusions: The study highlights the distinct natures of food hardship and responses specific to urban public college students. Suggestions for academics and college administrators to mitigate college food insecurity are discussed.
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Affiliation(s)
- Youngmi Kim
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jennifer Murphy
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kaija Craft
- Christopher Newport University, Newport News, Virginia, USA
| | - Leland Waters
- Virginia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Basil I Gooden
- United States Department of Agriculture, Washington, DC, USA
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2
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Rhodes A, Novak AC, Caprio TV, Zanjani F, Marrs S, Gendron T, Waters L. Special Focus Facilities vs Special Focus Facility Candidates: What is the Difference? J Am Med Dir Assoc 2024; 25:390-395. [PMID: 37951582 DOI: 10.1016/j.jamda.2023.10.005] [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: 07/04/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES This study compares Special Focus Facilities (SFFs) and Special Focus Facility Candidate Facilities (SFFcs) on organizational traits and quality outcomes to evaluate the effectiveness of the SFF program as a quality improvement intervention and inform potential areas for program reform. DESIGN This is a retrospective analysis. SETTINGS AND PARTICIPANTS Using data from the Centers for Medicare and Medicaid Services archives for 2020, this retrospective study analyzed 247 nursing facilities (50 SFFs and 197 SFFcs). METHODS Variables of interest were staffing, profit status, facility size, certification status, number of residents, and complaint citations: t tests, χ2, Fisher's Exact test, and multivariate analysis of variance were used to compare the 2 groups. RESULTS From an organizational perspective, SFFs and SFFcs are minimally different. Both groups had similar facility size, profit status, hospital affiliation, continuing care retirement community status, and Medicare/Medicaid certification. Large and for-profit facilities were overrepresented in both groups. SFFs and SFFcs exhibited statistical differences in the number of complaint deficiencies. The groups had no significant difference in staffing levels, category, severity of complaints, or incident reports. CONCLUSIONS AND IMPLICATION The study's findings suggest that the SFF program, while resource-intensive, is minimally impactful. The similarities between SFFs and SFFcs raise questions about the program's effectiveness in improving nursing facility care. Previous adjustments to the program may not have successfully achieved the desired quality improvements. This research highlights the need to further evaluate the SFF program's effectiveness as a quality improvement intervention. It also underscores the importance of addressing biases and subjectivity in state survey agency processes, which affect the enrollment of nursing facilities. The study underscores the flaws within the nursing home monitoring system and the 5-star quality rating system, especially when comparing small samples between states.
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Affiliation(s)
- Annie Rhodes
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Thomas V Caprio
- University of Rochester Medical Center: Home Care and Medicine Hospice Program, Rochester, NY, USA
| | - Faika Zanjani
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Marrs
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA
| | - Tracey Gendron
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA
| | - Leland Waters
- Department of Gerontology, Virginia Commonwealth University, Richmond, VA, USA
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3
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Hayes R, Dakin F, Smuk M, Paparini S, Apea V, Dewsnap C, Waters L, Anderson J, Orkin CM. Cross-sectional survey of sexual health professionals' experiences and perceptions of the 2022 mpox outbreak in the UK. BMJ Open 2024; 14:e080250. [PMID: 38216201 PMCID: PMC10806624 DOI: 10.1136/bmjopen-2023-080250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE To understand the experiences and perceptions of sexual health professionals responding to the May 2022 mpox outbreak in the UK. DESIGN Cross-sectional, anonymous, online survey collecting quantitative and qualitative data. Convenience sample recruited via an international network of sexual health and HIV clinicians responding to mpox and promoted through clinical associations and social media. Survey domains included: clinical workload; preparedness, support, and training; safety at work; vaccination; and well-being. Qualitative descriptive analysis of open-text responses was conducted to support interpretation of the quantitative data. PARTICIPANTS Participants who were employed as sexual health professionals in the UK and had direct clinical experience of mpox were included in the analysis. The survey was completed between 11 August and 31 October 2022 by 139 respondents, the majority of whom were doctors (72.7%), cis-female (70.5%) and White (78.4%). RESULTS 70.3% reported that they were required to respond to mpox in addition to their existing clinical responsibilities, with 46.8% working longer hours as a result. In the open-text data, respondents highlighted that workload pressures were exacerbated by a lack of additional funding for mpox, pre-existing pressures on sexual health services, and unrealistic expectations around capacity. 67.6% of respondents reported experiencing negative emotional impact due to their mpox work, with stress (59.0%), fatigue (43.2%) and anxiety (36.0%) being the most common symptoms. 35.8% stated that they were less likely to remain in their profession because of their experiences during the mpox outbreak. In the open-text data, these feelings were ascribed to post-COVID exhaustion, understaffing and frustration among some participants at the handling of the mpox response. CONCLUSIONS These findings indicate that sexual health services require increased funding and resources, along with evidence-based well-being interventions, to support sexual health professionals' outbreak preparedness and recovery.
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Affiliation(s)
- Rosalie Hayes
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Francesca Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Melanie Smuk
- SHARE Collaborative, Blizard Institute, Queen Mary University of London, London, UK
| | - Sara Paparini
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Vanessa Apea
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Claire Dewsnap
- Sexual Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- The University of Sheffield, Sheffield, UK
| | - L Waters
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
- Institute for Global Health, University College London, London, UK
| | - Jane Anderson
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Chloe M Orkin
- SHARE Collaborative, Blizard Institute, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
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Diallo AF, Mackiewicz M, Sargent L, Roman YM, Slattum PW, Waters L, Bennett J, Battle K, Zanjani F, Gendron T, Winship J, Ford G, Falls K, Price ET, Parsons P, Chung J. Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership. Fam Community Health 2024; 47:32-40. [PMID: 37831622 PMCID: PMC10841158 DOI: 10.1097/fch.0000000000000383] [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] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.
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Affiliation(s)
- Ana F. Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Marissa Mackiewicz
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Youssef M. Roman
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Patricia W. Slattum
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
- Virginia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Leland Waters
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
- Virginia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | | | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Jodi Winship
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, USA
| | - Gregory Ford
- Community member
- Beacon Communities, LLC, Richmond, Virginia, USA
| | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Elvin T. Price
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, USA
| | - Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, USA
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Waters L, Sohmer D, Goldman RE, Bluestein D, Burnham K, Clark PG, Slattum PW, Helm F, Marks J. Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care. Gerontol Geriatr Educ 2023:1-14. [PMID: 37929922 DOI: 10.1080/02701960.2023.2278097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.
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Affiliation(s)
- Leland Waters
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dana Sohmer
- Alzheimer's Association, Chicago, Illinois, USA
| | - Roberta E Goldman
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Bluestein
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Phillip G Clark
- Rhode Island Geriatric Education Center, University of Rhode Island, Kingston, USA
| | - Patricia W Slattum
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faith Helm
- Rhode Island Geriatric Education Center, University of Rhode Island, Kingston, USA
| | - Jane Marks
- Johns Hopkins Geriatrics Workforce Enhancement Program, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Maryland, Baltimore, USA
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Marrs SA, Inker J, McIntyre M, Waters L, Gendron T. "I like being young, active, alive": first-year medical students' attitudes to their own aging. Gerontol Geriatr Educ 2023:1-14. [PMID: 36863393 DOI: 10.1080/02701960.2023.2184811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND OBJECTIVES Senior Mentoring programs have been developed to expose students to older adults, increase knowledge of geriatrics, and prepare them to provide patient-centered care. However, even while participating in a senior mentoring program, health professions students demonstrate discriminatory language toward older adults and the aging process. In fact, research suggests ageist practices occur, intentionally or not, among all health professionals and within all healthcare settings. Senior mentoring programs have primarily focused on improving attitudes about older people. The current study evaluated a different approach to anti-ageism by examining medical students' perceptions of their own aging. RESEARCH DESIGN AND METHODS This qualitative, descriptive study explored medical students' beliefs about their own aging at the beginning of their medical education using an open-ended prompt immediately before beginning a Senior Mentoring program. RESULTS Thematic analysis identified six themes: Biological, Psychological, Social, Spiritual, Neutrality and Ageism. Responses suggest that students enter medical school with a complex view of aging that goes beyond biological considerations. DISCUSSION AND IMPLICATIONS Understanding that students enter medical school with a multi-faceted view of aging provides an opportunity for future work to explore senior mentoring programs as a way to tap into this complex view of aging by changing the way students think not just about older patients but about aging more broadly, and specifically about themselves as aging individuals.
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Affiliation(s)
- Sarah A Marrs
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jenny Inker
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Madeline McIntyre
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Leland Waters
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Tracey Gendron
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, United States
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Mackiewicz M, Slattum P, Waters L. COMBATING STIGMA: AN EDUCATIONAL RESOURCE ON SUBSTANCE USE DISORDER IN OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9766307 DOI: 10.1093/geroni/igac059.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Substance Use Disorder (SUD) affects people from all walks of life and age groups. Special considerations for older adults with SUD should be made secondary to the unique pathophysiological and socio-economic complexities of aging populations. Successful SUD treatment and recovery depends on access to essential support systems comprised of interprofessional teams as well as family, friends, and caregivers. Education on SUD for healthcare providers, caregivers and the community is a key component for combating the national opioid epidemic and the stigma that can be a barrier to recovery. A ten-minute video and an accompanying discussion guide were developed to present to clinical faculty and students participating in an interprofessional care coordination wellness clinic servicing low-income older adults living independently in the community setting. The video was designed to highlight stigma and ageism facing older adults with SUD and serve as the basis for discussion among learners. The process for creating and evaluating the video and discussion guide will be shared including the role of older adults with lived experience of SUD in the process. Information will be provided on SUD as a chronic disease and the importance of interprofessional and individualized patient care in recovery. Participants will be able to identify the significance of SUD related stigma in providing and seeking care, asses the role of mental/behavioral health in SUD, and learn about treatment options for SUD. This will allow for better identification of characteristics of older adult populations that place them at greater harm from the consequences SUD.
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Affiliation(s)
| | - Patricia Slattum
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
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Rhodes A, Zanjani F, Caprio T, Gendron T, Waters L. STAFFING DIFFERENCES IN NURSING HOME SPECIAL FOCUS FACILITIES AND SPECIAL FOCUS FACILITY CANDIDATES. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Introduction
Centers for Medicare and Medicaid Services designates “Special Focus Facilities” (SFF), which are nursing homes receiving special oversight for persistent quality problems. “Special Focus Facility Candidates” (SFFc) are nursing homes with quality problems that are designated as candidates to be future SFFs. Recent academic literature has not examined if SFF and SFFc have significant differences in staffing hours per resident day (HPRD).
Methods
Nursing homes that were SFF or SFFc in 2020 were matched to 5-star nursing homes. Monthly staffing averages were aggregated, and two-way ANOVAs with Tukey Post Hoc were conducted to detect level differences in HPRD across the three facility groups. Gross and Case-Mix staffing HPRD were analyzed, along with daily resident census.
Results
The final sample was n=197 SFFc, and n= 50 SFF, which were matched with n=247 5-star nursing homes for a total sample of Nf494. Over 2020, daily census for 5-star nursing homes was lower (M=72.36, SD=52.5) than SFFc (M=93.77, SD=68.34) or SFFs (M=97.88, SD=44.06). There was a significant difference between SFF and SFFc HPRD in Case-Mix Aide F(2, 5748)=187.6, p= < .005, and Registered Nurse (RN), F(2,5748)=323,p=.003 care. There were no significant differences between SFF and SFFc in HPRD Aide F(2,5748)=380,p=.63, Practical Nurse F(2,5748)=1.1, p=.211, Case-Mix Practical Nurse F(2,5748)=19.57,p=.39, Case-Mix RN F(2,5748)=9.51,p=.91 or Total HPRD F(2,5748)=472.6,p=.16, care. Discussion: There is only a significant difference in staffing levels observed between SFF and SFFc for Aide staffing and RN staffing. This information supports researchers and policymakers in delineating the differences and similarities between SFF and SFFcs.
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Affiliation(s)
- Annie Rhodes
- Virginia Commonwealth University , Richmond, Virginia , United States
| | - Faika Zanjani
- Virginia Commonwealth University , Richmond, Virginia , United States
| | - Thomas Caprio
- University of Rochester , Rochester, New York , United States
| | | | - Leland Waters
- Virginia Commonwealth University , Richmond, Virginia , United States
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Waters L, Berish D, Rhodes A, Bellantoni M. AGE-FRIENDLY CARE: A FRAMEWORK TO ADDRESS HEALTH DISPARITIES IN NURSING HOMES. Innov Aging 2022. [PMCID: PMC9770299 DOI: 10.1093/geroni/igac059.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Three Geriatrics Workforce Enhancement Programs (Johns Hopkins, Penn State and Virginia Commonwealth) within Health and Human Services Region-3, implemented a project providing tailored educational content designed to meet the regional needs of nursing home staff, residents, and carepartners within the context of the COVID-19 pandemic. Semi-Structured, recorded focus groups were conducted with direct care workers, and family and resident counsels. All groups were interviewed about familiarity and comfort with the 3Ds (Dementia, Delirium, and Depression) as well as what mattered most to them as workers, residents and care partners. The overall goal was to enhance development of the nursing home workforce thus creating a meaningful clinical improvement in care. We aim to go beyond the improvement of routine clinical care and address the long-standing behavioral and mental health disparities observed in this resident population. Policy implications around education, engagement of workforce, resident, and carepartner voices will be discussed.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Diane Berish
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Annie Rhodes
- Virginia Commonwealth University, Richmond, Virginia, United States
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Sargent L, Zanjani F, Winship J, Gendron T, Mackiewicz M, Diallo A, Waters L, Battle K, Ford G, Falls K, Chung J, Price ET, Cisewski M, Parsons P, Health VCUIC. Socioeconomic Effects on Psychosocial Factors Among Low-Income Older Adults. Gerontol Geriatr Med 2022; 8:23337214221084866. [PMID: 35299880 PMCID: PMC8921758 DOI: 10.1177/23337214221084866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/23/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: Older adults have been disproportionately affected by COVID-19. The primary goal of this study is to determine the socioeconomic effects on psychosocial factors among low-income independent-living older adults, in an urban setting, during the COVID-pandemic. Methods: Participants were recruited through Virginia Commonwealth University’s Richmond Health and Wellness Program. Telephone surveys (n=100) were conducted using the Epidemic – Pandemic Impacts Inventory Geriatric with the Racial/Ethnic Discrimination addendum. Responses were analyzed for income and education effects across seven domains: home life, social activities/isolation, economic, emotional health-wellbeing, physical health, COVID-infection history, and positive change behaviors/experiences. Results: The sample population was between 51 and 87 years of age, 88% were Black, 57% reported incomes of $10,000/year or less, and 60% reported a high-school education or less. There were income effects for social activities/isolation (f = 3.69, p<.05) and positive change (f = 8.40, p<.01), and education effects for COVID History (f = 4.20, p <.04). Discussion: Overall results highlight the social patterns for a diverse sample of low-income urban older adults; education and income are identified as risk factors for social losses, COVID-infection experiences, racial/ethnic discrimination during the COVID-pandemic, and positive change behaviors.
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Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Jodi Winship
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Marissa Mackiewicz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Leland Waters
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Elvin T. Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa Cisewski
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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11
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Winship JM, Gendron T, Waters L, Chung J, Battle K, Cisewski M, Gregory M, Sargent L, Zanjani F, Slattum P, Mackiewicz M, Diallo A, Ford G, Falls K, Price ET, Parsons PL. COVID in Context: The Lived Experience of Richmond’s Low-Income Older Adults. Gerontol Geriatr Med 2022; 8:23337214221079208. [PMID: 35252474 PMCID: PMC8891881 DOI: 10.1177/23337214221079208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/15/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Taking a phenomenological approach, this qualitative study describes the lived experiences of low-income older adults during the COVID-19 pandemic. A socio-ecological model was used to organize the five identified themes describing the lived experience: socio-economic context, Black Lives Matter and the politics of race, COVID and polarized views of COVID, interpersonal context (social connections), and individual context (feelings, beliefs, and behaviors). Study findings illustrate the intersectionality of contextual influences on the experience of low-income older adults. Study participants demonstrated remarkable resilience and coping strategies developed in response to the challenges they experienced throughout their lifetime which benefited them when faced with the pandemic, social unrest, and political events that took place in 2020. This study highlights the importance of understanding the larger context of COVID-19 which has significant implications for policy makers and public health leaders.
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Affiliation(s)
- Jodi M. Winship
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Leland Waters
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa Cisewski
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Melody Gregory
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Patrica Slattum
- Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Marissa Mackiewicz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Elvin T. Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
- Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Pamela L. Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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12
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Waters L, Preston G, Nedungayil S. A retrospective review of the use of text message communication for a musculoskeletal service during COVID-19. Physiotherapy 2022. [PMCID: PMC8848179 DOI: 10.1016/j.physio.2021.12.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Alexander C, Slattum P, Williams I, Waters L. Reflection Leading to Action on Diversity, Equity, and Inclusion at the Virginia GWEP. Innov Aging 2021. [PMCID: PMC8969306 DOI: 10.1093/geroni/igab046.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Last year’s Black Lives Matter protests inspired the Virginia Geriatric Education Center (VGEC) GWEP’s plenary to engage in reflection and discussion on diversity, equity, and inclusion (DEI) in our work together. During each bi-monthly meeting, we dedicate time to generate ideas to improve our programming, how we work together, and how we partner and recruit for our programs. Champions for DEI on our plenary led an effort to develop a DEI newsletter clarifying DEI concepts and introducing resources thematically related to the monthly VGEC faculty development program curriculum. By incorporating these resources into our monthly curriculum, facilitators have a new access point to incorporate content on health equity and policy into our curriculum. The intentional focus on DEI is opening the door to deeper reflection and conversation with a goal of improving all our programming, cultivating a new social awareness, and bringing new voices and perspectives to the table.
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Affiliation(s)
- Chuck Alexander
- Virginia Commonwealth University, Richmond, Virginia, United States
| | | | - Ishan Williams
- University of Virginia, Charlottesville, Virginia, United States
| | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
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14
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Rhodes A, Waters L, Zanjani F, Gendron T, Moore R. The Effect of Testing Turnaround Time on COVID-19 Outbreak Severity Within U.S. Nursing Homes. Innov Aging 2021. [PMCID: PMC8681283 DOI: 10.1093/geroni/igab046.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
COVID-19 has brought renewed attention to infectious diseases in U.S. nursing homes (NHs). The Testing turnaround time (TAT) of SARS-CoV-2 is vital information, supporting staff ability to make decisions regarding resource allocation. Methods: Using data obtained from the National Healthcare Safety Network’s COVID-19 nursing home data set, we analyzed the TAT of laboratory polymerase chain reaction (PCR) testing on outbreak severity (number of people infected) for residents and staff. A MANOVA was performed on NHs submitting data over 26 weeks (May-November 2020). The independent variable was the average TAT for the two weeks prior (<24 hours, 1-2 days, 3-7 days, or 7+ days). Results: N = 15,363 NHs. The TAT for the combined dependent variables of staff and resident COVID-19 cases. F(10,781,354) = 3161.265, Pillai’s trace = .078, p<.0005, partial η2=.4. The average outbreak severity for staff was 13.93 cases when TAT was < 24 hours, compared to 15.29 cases at 1-2 days. For residents, the difference was less pronounced but still significant. The average outbreak severity for residents was 17.07 cases when TAT was<24 hours, compared to 18.61 cases when the TAT was 1-2 days. Tukey post-hoc tests found significance for all levels of testing for residents and staff at p<.0005. Discussion: Time differences to receive PCR test results from a laboratory are significant in outbreak severity for staff and residents. The most meaningful result positively impacting the ultimate spread and severity of gross cases is when the TAT for PCR results is < 1 day.
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Affiliation(s)
- Annie Rhodes
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Faika Zanjani
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Tracey Gendron
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Rick Moore
- Virginia Commonwealth University, Richmond, Virginia, United States
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15
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Waters L, Rhodes A, Arnette S, Bluestein D, Ihara E, Inoue M, Tompkins C. Virginia’s Response to the Nursing Home COVID Action Network. Innov Aging 2021. [PMCID: PMC8680430 DOI: 10.1093/geroni/igab046.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Virginia Geriatric Education Center’s GWEP recruited 195 of Virginia's 273 eligible nursing homes, using two Project ECHO Nursing Home Training Centers located at George Mason University and Virginia Commonwealth University. These sessions promoted collaboration, allowed for sharing of successes and challenges, and nurtured quality improvement projects. Our next steps are to survey Virginia’s nursing homes to see if they are interested in future ECHO sessions with other topics. We plan to share these results with the Institute for Healthcare Improvement so that we may be able to continue to enhance this national network of Training Centers with faculty and staffing dedicated to quality assurance and performance improvement. The program has initiated new collaborations with nursing homes across many healthcare disciplines, strengthened connections between nursing homes and research institutions, and will help foster innovative ways to collaborate in this post-pandemic virtually connected world.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Anne Rhodes
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Shannon Arnette
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Dan Bluestein
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Emily Ihara
- George Mason University, Fairfax, Virginia, United States
| | - Megumi Inoue
- George Mason University, Fairfax, Virginia, United States
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16
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Parsons P, King Horne K, Popovich A, Waters L, Price E, Diallo A, Sargent L, McQueen-Gibson E, Prom-Wormley E, Wilkerson T, Zanjani F. Creating structural community cohesion: Addressing racial equity in older adult homelessness. J Prev Interv Community 2021:1-13. [PMID: 34033741 DOI: 10.1080/10852352.2021.1930819] [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] [Indexed: 10/21/2022]
Abstract
Older adults and racial minorities are overrepresented in homeless populations. Shelter and housing options for homeless older adults who have complex health and social needs are necessary, but not readily available. Older homeless adults that require, but do not receive, health-sensitive, age-sensitive, and racial equity housing, remain vulnerable to poor outcomes and premature mortality. Accordingly, this study examines the development of a coalition to better address older adult homelessness within a racial equity framework. A community coalition was established to better address older adult homelessness within the lens of age-sensitivity and racial equity, due to a disconnect between healthcare and senior housing placement programs, creating unaddressed multifaceted health issues/complications. The community coalition development is described, including the coalition process, activities, and outcomes. Local rehoused older adults are also interviewed and described to better understand their central life circumstances.
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Affiliation(s)
- Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Amy Popovich
- Richmond City Health District, Richmond, Virginia, USA
| | - Leland Waters
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elvin Price
- School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | - Taylor Wilkerson
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faika Zanjani
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
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17
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Sargent L, Slattum P, Brooks M, Gendron T, Mackiewicz M, Diallo A, Waters L, Winship J, Battle K, Ford G, Falls K, Chung J, Zanjani F, Pretzer-Aboff I, Price ET, Prom-Worley E, Parsons P. Bringing Transdisciplinary Aging Research from Theory to Practice. Gerontologist 2020; 62:159-168. [PMID: 33349850 DOI: 10.1093/geront/gnaa214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/16/2020] [Indexed: 11/12/2022] Open
Abstract
There is a growing emphasis to use a transdisciplinary team approach to accelerate innovations in science to solve complex conditions associated with aging. However, the optimal organizational structure and process for how to accomplish transdisciplinary team science is unclear. In this forum, we illustrate our team's experience using transdisciplinary approaches to solve challenging and persistent problems for older adults living in urban communities. We describe our challenges and successes using the National Institutes of Health four-phase model of transdisciplinary team-based research. Using a de-identified survey, the team conducted an internal evaluation to identify features that created challenges including structural incongruities, inter-professional blind spots, group function, and group dynamics. This work resulted in the creation of the team's Transdisciplinary Conceptual Model. This model became essential to understanding the complex interplay between societal factors, community partners, and academic partners. Conducting internal evaluations of transdisciplinary team processes are integral for teams to move beyond the multi- and interdisciplinary niche and to reach true transdisciplinary success. More research is needed to develop measures that assess team transdisciplinary integration. Once the process of transdisciplinary integration can be reliably assessed, the next step would be to determine the impact of transdisciplinary team-science initiatives on aging communities.
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Affiliation(s)
- Lana Sargent
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.,Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia Slattum
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Virgnia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Marshall Brooks
- School of Medicine, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Tracey Gendron
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Marissa Mackiewicz
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Ana Diallo
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Leland Waters
- Virgnia Geriatric Education Center, Virginia Center on Aging, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Jodi Winship
- Department of Occupational Therapy, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Kimberly Battle
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Katherine Falls
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Faika Zanjani
- Department of Gerontology, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Ingrid Pretzer-Aboff
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA.,Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Elvin T Price
- Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA.,Geriatric Pharmacotherapy Program, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth Prom-Worley
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Pamela Parsons
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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18
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Waters L, Perweiler E. The Development of a Stakeholder Member Organization to Advocate for Geriatrics Education. Innov Aging 2020. [PMCID: PMC7740119 DOI: 10.1093/geroni/igaa057.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The National Association of Geriatric Education Centers organization was established in 1990, to promote interdisciplinary geriatric education and to provide a unified voice for Geriatric Education Centers (GECs). In 2005, the GECs voted to form two non-profit organizations due to restrictions related to lobbying activities. An umbrella organization was created, the National Association for Geriatric Education, that includes all geriatric related education programs, and maintain a lobbyist in Washington DC to protect the GECs interests. It was a pivotal time, as we had a year (2006) without federal funding that summarily dismantled the DHHS-HRSA geriatrics programs, including the entire GEC network, the geriatric fellowship program, and Geriatric Academic Career Awards. This resulted in a GEC-wide and national geriatrics movement that succeeded in restoring the geriatrics line item in the President’s budget. Our advocacy efforts not only had the line item restored, but obtained an increase in funding for geriatrics.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Elyse Perweiler
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, United States
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19
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Slattum P, Parsons P, Rubino M, Waters L. Partnerships Connecting Healthcare and Community-Based Organizations in Virginia. Innov Aging 2020. [PMCID: PMC7741021 DOI: 10.1093/geroni/igaa057.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The Virginia Geriatric Education Center (VGEC)’s Geriatrics Workforce Enhancement Program (GWEP) partners with two programs, Senior Strong at Eastern Virginia Medical School in Norfolk, VA and the Richmond Health and Wellness Program at Virginia Commonwealth University in Richmond VA to support their age-friendly initiatives. These programs enhance primary care for an older population experiencing adverse social determinants of health by providing screening around the 4Ms pillars of age-friendly healthcare and connecting participants with healthcare and community-based organizations. These programs offer a rich learning environment for interprofessional students. The VGEC GWEP strengthens these programs by developing faculty and student training in collaboration with the programs and facilitating program participation in the GWEP-CC Age-Friendly Action Community to develop and refine age-friendly practice workflows, referral pathways and documentation.
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Affiliation(s)
- Patricia Slattum
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Pamela Parsons
- Virginia Commonwealth, Richmond, Virginia, United States
| | - Mary Rubino
- Family and Community Medicine, Eastern Virginia Medical School, Norfolk, Virginia, United States
| | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
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20
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Marrs S, Inker J, McIntyre M, Waters L, Gendron T. A Theoretical Framework for the Development of Views of One’s Own Aging. Innov Aging 2020. [PMCID: PMC7741689 DOI: 10.1093/geroni/igaa057.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Senior mentoring programs have been established that provide medical students exposure to a community-dwelling older adult mentor. The goal of these programs is to expose students to healthy older adults, increase knowledge of geriatrics, and prepare them to care for an aging population. However, even while participating in a senior mentoring program, health professions students still demonstrate some discriminatory language towards older adults (e.g., Gendron, Inker, & Welleford, 2018). In fact, research suggests ageist practices occur, intentionally or not, among all health professions and within assisted living and long-term care facilities (e.g., Bowling, 1999; Dobbs et al., 2008; Kane & Kane, 2005). There is reason to believe that how we feel about other older adults is a reflection of how we feel about ourselves as aging individuals. As part of an evaluation of a Senior Mentoring program, we found that students’ attitudes towards older adults were not significantly improved (t (92) = .38, p = .70). To further explore this, we collected subsequent qualitative data. Specifically, we asked students to respond to the open-ended prompt before and after completing their senior mentoring program: How do you feel about your own aging? Our findings have revealed just how complex students’ views towards aging and elderhood are, pointing to a need to develop a theoretical framework for how these views are formed. Thus, the results of this qualitative grounded theory study illustrate the stages of development medical students’ progress through as they come to accept themselves as aging humans.
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Affiliation(s)
- Sarah Marrs
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jennifer Inker
- Virginia Commonwealth University, Richmond, Virginia, United States
| | | | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Tracey Gendron
- Virginia Commonwealth University, Richmond, Virginia, United States
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21
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Inker J, Marrs S, McIntyre M, Waters L, Gendron T. My Heart Has Always Been Set on Pediatrics, and Other Insights From First-Year Medical Students. Innov Aging 2020. [PMCID: PMC7741070 DOI: 10.1093/geroni/igaa057.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Senior mentoring programs provide medical students exposure to a community-dwelling older adult mentor with whom they meet multiple times throughout the program. The goal of these programs is to expose students to healthy older adults, increase their knowledge of topics in geriatrics and aging, and increase the likelihood that students will pursue geriatric specialties. Though research findings show that senior mentoring programs have the potential to increase medical students’ attitudes towards older adults (Samra et al., 2013) and their willingness to consider working with older patients in the future (McManus et al., 2017), a critical shortage of doctors who specialize in geriatrics still exists. Moreover, the demand for geriatrically-trained physicians is expected to continue to increase (American Geriatrics Society, 2018). In order to develop avenues for successfully fostering interest in and pursuit of geriatrics specialties, we need to fully understand students’ perceptions of working with older adults. The purpose of this qualitative content analysis was to explore first-year medical students’ (n = 216) perceptions of working with older adults. We asked students to respond to the following reflection at the beginning and end of their Senior Mentoring program: How do you feel about working with older patients after you complete your training? Our findings suggest that while students feel more comfortable with and open to caring for older adults, they do not feel compelled to pursue geriatrics. Themes and sub-categories emerging from the data provide insight into why students continue to dismiss pursuing geriatrics.
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Affiliation(s)
- Jennifer Inker
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Sarah Marrs
- Virginia Commonwealth University, Richmond, Virginia, United States
| | | | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Tracey Gendron
- Virginia Commonwealth University, Richmond, Virginia, United States
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22
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Carpenter D, Natesan D, Floyd W, Niedzwiecki D, Waters L, Godfrey D, Moravan M, Lee W, Salama J. Long-Term Experience in an Equal Access Health Care System Using Moderately Hypofractionated Radiotherapy for High Risk Prostate Cancer in a Predominately African American Population With Unfavorable Disease. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Ibrahim F, Samarawickrama A, Hamzah L, Vincent R, Gilleece Y, Waters L, Kegg S, Barbini B, Campbell L, Post FA. Bone mineral density, kidney function, weight gain and insulin resistance in women who switch from TDF/FTC/NNRTI to ABC/3TC/DTG. HIV Med 2020; 22:83-91. [PMID: 32985122 DOI: 10.1111/hiv.12961] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Tenofovir disoproxil fumarate (TDF) is associated with reduced bone mineral density (BMD). We evaluated changes in BMD in women who switched from TDF, emtricitabine and a nonnucleoside reverse transcriptase inhibitor (TDF/FTC/NNRTI) to abacavir, lamivudine and dolutegravir (ABC/3TC/DTG). METHODS We conducted a randomized controlled trial in which women aged ≥40 years were randomized 1:2 to continue TDF/FTC/NNRTI or switch to ABC/3TC/DTG. The primary endpoint was change in total hip BMD measured by dual-energy X-ray absorptiometry at week 48. Secondary endpoints were changes in BMD of the lumbar spine and femoral neck and markers of bone turnover and kidney function up to week 48. We conducted exploratory analyses of weight gain, insulin resistance and metabolic syndrome. Primary and secondary endpoints were analysed by linear regression, with multiple imputation for missing time points. RESULTS In all, 91 women [mean age = 50.4 (standard deviation [SD] = 6.6) years, median CD4 cell count = 600 (interquartile range: 479-800) cells/µL] were randomized. Women who switched to ABC/3TC/DTG maintained viral suppression and experienced improvements in total hip BMD (mean adjusted difference = 1%, P = 0.027) and lumbar spine BMD (3%, P = 0.002), with no change in specific markers of bone turnover or renal tubular function. Although participants in the ABC/3TC/DTG arm gained more weight (1.8 kg, P = 0.046), the switch strategy was not associated with reduced insulin sensitivity or new-onset metabolic syndrome. CONCLUSIONS Switching from TDF/FTC/NNRTI to ABC/3TC/DTG resulted in improved BMD. Although weight gain was common in women who switched from TDF/FTC/NNRTI to ABC/3TC/DTG, we did not detect adverse effects on glucose homeostasis. Larger studies need to confirm these findings.
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Affiliation(s)
| | | | - L Hamzah
- St George's Healthcare NHS Trust, London, UK
| | - R Vincent
- North Middlesex University Hospital, London, UK
| | - Y Gilleece
- Brighton and Sussex University Hospitals, Brighton, UK
| | - L Waters
- Mortimer Market Centre, London, UK
| | - S Kegg
- Lewisham and Greenwich NHS Trust, London, UK
| | - B Barbini
- King's College Hospital NHS Foundation Trust, London, UK
| | - L Campbell
- King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - F A Post
- King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
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24
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Totea AM, Dorin I, Laity PR, Sabin J, Conway BR, Waters L, Asare-Addo K. A molecular understanding of magnesium aluminium silicate - drug, drug - polymer, magnesium aluminium silicate - polymer nanocomposite complex interactions in modulating drug release: Towards zero order release. Eur J Pharm Biopharm 2020; 154:270-282. [PMID: 32717386 DOI: 10.1016/j.ejpb.2020.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/18/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
This study reports the use of ITC in understanding the thermodynamics occurring for a controlled release system in which complexation has been exploited. In this study, a model drug, propranolol hydrochloride (PPN) was complexed with magnesium aluminium silicate (MAS) and these complexes were used in combination with polyethylene oxide (PEO) as a hydrophilic carrier at various concentrations to sustain the release of PPN. DSC, XRPD, ATR-FTIR and SEM/EDX were successfully used in characterising the produced complexes. 2D- SAXS data patterns for MAS and the produced complexes were shown to be symmetric and circular with the particles showing no preferred orientation at the nanometre scale. ITC studies showed differences between PPN adsorption onto MAS compared with PPN adsorption onto a MAS-PEO mixture. At both temperatures studied the binding affinity Ka was greater for the titration of PPN into the MAS-PEO mixture (5.37E + 04 ± 7.54E + 03 M at 25 °C and 8.63E + 04 ± 6.11E + 03 M at 37 °C), compared to the affinity obtained upon binding between PPN and MAS as previously reported suggesting a stronger binding with implications for the dissolution process. MAS-PPN complexes with the PEO polymer compacts displayed desired manufacturing and formulation properties for a formulator including, reduced plastic recovery therefore potentially reducing the risk of cracking/splitting and on tooling wear, controlled release of PPN at a significantly low (5%) polymer level as well as a zero-order release profile (case II transport) using up to 50% polymer level.
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Affiliation(s)
- A M Totea
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - I Dorin
- Biomolecular Formulation and Characterization Sciences, UCB, Slough SL3WE, UK
| | - P R Laity
- Department of Materials Science and Engineering, University of Sheffield, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK
| | - Juan Sabin
- AFFINImeter, Edificio Emprendia, Campus Vida, Santiago de Compostela, Spain
| | - B R Conway
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - L Waters
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - K Asare-Addo
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
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25
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Ibrahim F, Campbell L, Bailey AC, Stockwell S, Waters L, Orkin C, Johnson M, Gompels M, De Burgh-Thomas A, Jones R, Schembri G, Mallon PW, Post FA. Estimated glomerular filtration rate slopes on tenofovir alafenamide. HIV Med 2020; 21:607-612. [PMID: 33021067 DOI: 10.1111/hiv.12899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of the study was to analyse and compare estimated glomerular filtration rate (eGFR) slopes during exposure to tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) in individuals who initiated TAF, regardless of prior regimen, before October 2016. METHODS An observational cohort study was conducted at 11 clinics in the UK and Ireland. Mixed effects models with random intercept and time terms fitted were used to generate and compare eGFR slopes while participants were exposed to TDF and TAF, with adjustment for age, eGFR at TDF/TAF initiation, gender, ethnicity, and time-updated CD4 cell count and HIV RNA measurements. RESULTS Data were available for 357 subjects (median age 50 years; 80% male; 82% white/other ethnicity; 51% men who have sex with men; median nadir CD4 count 216 cells/µL). The median duration of exposure to TAF was 2.0 (interquartile range 1.6, 2.3) years. At TAF initiation, the median CD4 count was 557 cells/µL, the median eGFR was 80 mL/min/1.73 m2, and 86% had suppressed HIV infection. The mean adjusted eGFR slope during TDF and TAF exposure was -2.08 [95% confidence interval (CI) -2.24, -1.92] and 1.18 (95% CI 0.20, 1.52) mL/min/1.73 m2/year, respectively (P < 0.001). Individuals who experienced rapid eGFR decline (> 3 or 5 mL/min/1.73 m2/year) while receiving TDF experienced significant eGFR recovery while on TAF (P < 0.001). CONCLUSIONS Significant improvement in eGFR slope was observed in patients who switched from TDF- to TAF-containing antiretroviral regimens. These data provide further support for the renal safety of TAF, and for switching those who experience progressive worsening of renal function from TDF to TAF.
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Affiliation(s)
| | - L Campbell
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - L Waters
- Mortimer Market Centre, London, UK
| | - C Orkin
- Barts Health NHS Trust, London, UK
| | - M Johnson
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - M Gompels
- North Bristol NHS Trust, Bristol, UK
| | | | - R Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - G Schembri
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - P W Mallon
- University College Dublin, Dublin, Ireland
| | - F A Post
- King's College London, London, UK.,King's College Hospital NHS Foundation Trust, London, UK
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Abstract
The unprecedented global scale of COVID‐19 globally has triggered a race to discover interventions to reduce associated morbidity and mortality and rapid release of research findings prior to any degree of critical review. As with previous novel infection outbreaks, antiretrovirals are just one drug class that has been held up as a potential strategy for prophylaxis and treatment with scant evidence and risk of harm. Here we summarize the evidence for antiretrovirals to treat COVID‐19 and, as a drug that has also been studied in HIV, hydroxychloroquine, and flag some of the pitfalls of using therapies that have not been evaluated robustly.
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Affiliation(s)
- L Waters
- Department of HIV & Sexual Health, Mortimer Market Centre, Central & North West London NHS Trust, London, UK
| | - J K Rockstroh
- Department of Medicine I, Universitätsklinikum Bonn, Bonn, Germany
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Zanjani F, Brooks M, Waters L, Parsons P, Slattum P. Geriatric Opioid Harm Reduction: Interprofessional Student Learning Outcomes. Gerontol Geriatr Med 2020; 6:2333721420908985. [PMID: 32284953 PMCID: PMC7139179 DOI: 10.1177/2333721420908985] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/07/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective: Opioid harm reduction is increasingly important in the care of the older adults, who are at higher risk for negative opioid-related outcomes due to high prevalence of pain, multimorbidity, polypharmacy, and age-changes in metabolism. Our project aims to develop, implement, and evaluate an interprofessional opioid harm reduction service training. Method: This evaluation occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional wellness care coordination equity initiative, within buildings designated for low-income and disabled older adults. The geriatric opioid harm reduction training was delivered online and inperson, and followed up with case-discussions and practice. Findings: Pre (n = 69)/post (n = 62) student assessments indicated that after the training, there was an increase in knowledge. At follow-up, 60% recognized tramadol as an opioid, 50% at baseline. About 97% correctly indicated that MME represents morphine milligram equivalent, 80% at baseline. About 93% indicated that 50 MME level greatly increases opioid overdose risk, 62% at baseline. Only 20%, change from 60% at baseline, reported not being able to calculate MME at post assessment. Conclusion: Findings indicate that geriatric opioid harm reduction training within community-based wellness care coordination is feasible. Future works need to explore the impact on student practice in clinical settings and resident health.
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Totea A, Dorin I, Gavrilov G, Laity P, Conway B, Waters L, Asare-Addo K. Real time calorimetric characterisation of clay – drug complex dispersions and particles. Int J Pharm X 2019; 1:100003. [PMID: 31545854 PMCID: PMC6733304 DOI: 10.1016/j.ijpx.2018.100003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/13/2018] [Accepted: 12/15/2018] [Indexed: 11/17/2022] Open
Abstract
Single loaded and double loaded MAS-PPN complexes successfully made. ATR-FTIR confirmed adsorption of PPN onto MAS via hydrogen bonding. SEM/EDX showed changes in MAS microstructure upon complexation. Drug recovery varied in three media types. SIM and MIM experiments showed overall change in enthalpy to be exothermic SIM and MIM showed small entropic contribution to the total change in Gibbs free energy.
Isothermal titration calorimetry (ITC) along with attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX) and high-performance liquid chromatography (HPLC) were employed to investigate the process of adsorption of propranolol hydrochloride (PPN) onto magnesium aluminium silicate (MAS) and to characterise the MAS-PPN particles formed upon complexation. The composition of MAS was confirmed by infrared (IR) spectroscopy and a calcimeter. The calorimetric results confirmed the binding between PPN and MAS at various pHs and temperatures. The overall change in enthalpy was found to be exothermic with a comparatively small entropic contribution to the total change in Gibbs free energy. These findings suggest that the binding process was enthalpically driven and entropically unfavourable (lower affinity) suggesting hydrogen bonding and electrostatic interactions dominating the interaction. The variation of pH and temperature did not have a great impact on the thermodynamics of the binding process, as observed from the similarity in enthalpy (ΔH), entropy (ΔS) or Gibbs free energy (ΔG). A slight reduction in the binding affinity (Ka) with varing pH and temperature was however observed. SEM/EDX studies showed the occurrence of changes in the microstructural properties of MAS following complexation which may explain the potential of MAS-PPN complexes for controlled drug release promoting pharmaceutical innovation.
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Affiliation(s)
- A.M. Totea
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - I. Dorin
- Malvern Panalytical Ltd., Malvern, UK
| | - G. Gavrilov
- Wienerberger, Baneasa Business & Technology Park, Bucharest, Romania
| | - P.R. Laity
- Department of Materials Science and Engineering, University of Sheffield, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK
| | - B.R. Conway
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - L. Waters
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
| | - K. Asare-Addo
- School of Applied Sciences, Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK
- Corresponding author.
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Marrs S, Gendron T, Waters L, Inker J, McIntyre M. KNOWLEDGE OF AGEISM AND ATTITUDES ABOUT AGING AS A CORE COMPETENCY FOR HEALTH PROFESSIONALS. Innov Aging 2019. [PMCID: PMC6845175 DOI: 10.1093/geroni/igz038.3067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Senior mentoring programs have been established that provide medical students exposure to a community-dwelling older adult mentor with whom they meet multiple times throughout the program. The goal of these programs is to expose students to healthy older adults, increase knowledge of geriatrics, and prepare them to care for an aging population. However, even while participating in a senior mentoring program, health professions students still demonstrate some discriminatory language towards older adults (e.g., Gendron, Inker, & Welleford, 2018). In fact, research suggests ageist practices occur, intentionally or not, among health professions in disciplines such as medicine, nursing, and social work and even within assisted and long-term care facilities (e.g., Bowling, 1999; Dobbs et al., 2008; Kane & Kane, 2005). We evaluated a senior mentoring program to gauge the impact of a new pedagogical approach and to gain a deeper understanding of the learning gained in relation to ageism and elderhood. This qualitative content analysis explored first-year medical students’ opinions of their own aging and attitudes towards caring for older adults. Students (n = 216) participating in a brief curriculum model of a senior mentoring program responded to the following open-ended prompts before and after the program: 1) How do you feel about your own aging?; 2) How do you feel about working with older adult patients after you complete your medical training? Responses suggest that students’ views of their own aging and views towards towards working with older patients are positively impacted by their experiences in the senior mentoring program.
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Affiliation(s)
- Sarah Marrs
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Tracey Gendron
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Jenny Inker
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Maddie McIntyre
- Virginia Commonwealth University, Richmond, Virginia, United States
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Abstract
The Health Resources and Services Administration recently announced a notice of funding opportunity (NOFO) for the Geriatrics Academic Career Award Program (GACA). The purpose of the GACA program is to support the career development of individual junior faculty in geriatrics as academic geriatrics specialists and to provide clinical training in geriatrics, including the training of interprofessional teams of health care professionals. The GACA program is a mentorship model where the awardee is guided through a faculty career development plan, with required project deliverables, over the course of four years. The GACA supported 222 junior faculty members between 1998 and 2006, when it was discontinued. This initial NOFO provides funding for up to 26 awardees in the schools of allopathic medicine, osteopathic medicine, nursing, social work, psychology, dentistry, pharmacy, and allied health. This presentation will provide an up-to-date overview of the program with awardee demographics and project deliverables.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Maura Brennan
- University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, United States
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Zanjani FA, Brooks M, Waters L, Parsons P, Slattum P. REDUCING OPIOID OVERDOSE RISK IN A COMMUNITY CARE COORDINATION CLINIC: RICHMOND HEALTH AND WELLNESS PROGRAM. Innov Aging 2019. [PMCID: PMC6841528 DOI: 10.1093/geroni/igz038.2453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective Opioid safety is increasingly important in the care of older adults due to higher risk for negative opioid-related outcomes related to higher prevalence of chronic pain, multimorbidity, polypharmacy, and age-associated changes in drug metabolism and elimination. Evidence-based practices for screening and safe opioid use for older adults are needed. Our project aims to develop, implement, and evaluate a care-coordination workflow and interprofessional clinical opioid misuse screening, support, and referral training to support older adult care. Methods Our research occurs in context of the Richmond Health and Wellness Program (RHWP), a community-based interprofessional care coordination initiative, with interprofessional faculty and students providing on-site integrated care to residents in low-income senior housing communities. Curriculum development, and interprofessional clinical faculty, peer support, and health professions student training have been conducted. Results will discuss the findings from the health professions student training. Findings The Opioid Overdose Risk Reduction Curriculum was delivered via Blackboard and in-person during student orientation. Pre (n=66)/Post (n=59) assessment indicated that after the training, there was an increase in knowledge, specifically change from 50% at baseline, 60% recognized Tramadol as an opioid, change from 80% to 97% understanding that MME represents Morphine Milligram Equivalent, and change from 62% to 93% understanding that 50 MME level greatly increases overdose risk. Only 20%, change from 60%, reported not being able to calculate MME. Conclusions Our findings indicate that opioid safety training within community care coordination is feasible. Future works needs to explore the impact on resident health as the workflow is implemented.
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Affiliation(s)
| | | | - Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Pamela Parsons
- Virginia Commonwealth, Richmond, Virginia, United States
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Waters L, Tumosa N. PARTNERING IN GERIATRICS WORKFORCE ENHANCEMENT PROGRAMS: MODELS TO ENHANCE COLLABORATION AND ENGAGEMENT. Innov Aging 2019. [PMCID: PMC6845271 DOI: 10.1093/geroni/igz038.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To achieve their healthcare system transformational goals to improve care for older adults, Geriatrics Workforce Enhancement Programs (GWEPs) facilitate the building of strong relationships among academia, community-based organizations, and primary care networks. Each GWEP develops strategies to formalize collaborations and build sustainable networks to meet program goals while addressing partner needs. Unique models from four GWEPs addressing stakeholder engagement are described, and factors facilitating collaboration are explored. One GWEP achieves mutual goals by collaborating with statewide coalitions that have a history of successful partnerships. Another GWEP achieves programmatic goals through an “all-in” interprofessional model called the Plenary. A third GWEP has capitalized on a shared complex outcome that requires multi-level stakeholder engagement to support aging in place. The final GWEP has coopted the resource exchange model as a conceptual foundation in order to enhance collaboration. Themes emerging from these four models include: (1) the enhancement of interpersonal relationships through communication, trust, and engagement; (2) the importance of commitment to the overall partnership itself; (3) the critical component of resource sharing and synergy across projects; and (4) strategies for sustainability in the face of changes and challenges across healthcare systems. Given the complex nature of person-centered interventions in geriatrics, it truly takes a village to develop and provide services for a heterogeneous, targeted population. This symposium emphasizes key elements of the structures and processes of these transformational GWEP villages.
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Affiliation(s)
- Leland Waters
- Virginia Commonwealth University, Richmond, Virginia, United States
| | - Nina Tumosa
- Health Resources and Services Administration, Rockville, Maryland, United States
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Eron JJ, Orkin C, Cunningham D, Pulido F, Post FA, De Wit S, Lathouwers E, Hufkens V, Jezorwski J, Petrovic R, Brown K, Van Landuyt E, Opsomer M, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girardy PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas J, Perez-Valero I, Berenguer J, Casado J, Gatell J, Gutierrez F, Galindo M, Gutierrez M, Iribarren J, Knobel H, Negredo E, Pineda J, Podzamczer D, Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard B, Johnson M, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek U, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry W, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 96 efficacy and safety results of the phase 3, randomized EMERALD trial to evaluate switching from boosted-protease inhibitors plus emtricitabine/tenofovir disoproxil fumarate regimens to the once daily, single-tablet regimen of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) in treatment-experienced, virologically-suppressed adults living with HIV-1. Antiviral Res 2019; 170:104543. [DOI: 10.1016/j.antiviral.2019.104543] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/27/2022]
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35
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Ong KJ, van Hoek AJ, Harris RJ, Figueroa J, Waters L, Chau C, Croxford S, Kirwan P, Brown A, Postma MJ, Gill ON, Delpech V. HIV care cost in England: a cross-sectional analysis of antiretroviral treatment and the impact of generic introduction. HIV Med 2019; 20:377-391. [PMID: 31034159 DOI: 10.1111/hiv.12725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Reliable and timely HIV care cost estimates are important for policy option appraisals of HIV treatment and prevention strategies. As HIV clinical management and outcomes have changed, we aimed to update profiles of antiretroviral (ARV) usage pattern, patent/market exclusivity details and management costs in adults (≥ 18 years old) accessing HIV specialist care in England. METHODS The data reported quarterly to the HIV and AIDS Reporting System in England was used to identify ARV usage pattern, and were combined with British National Formulary (BNF) prices, non-ARV care costs and patent/market exclusivity information to generate average survival-adjusted lifetime care costs. The cumulative budget impact from 2018 to the year in which all current ARVs were expected to lose market exclusivity was calculated for a hypothetical 85 000 (± 5000) person cohort, which provided an illustration of potential financial savings afforded by bioequivalent generic switches. Price scenarios explored BNF70 (September 2015) prices and generics at 10/20/30/50% of proprietary prices. The analyses took National Health Service (NHS) England's perspective (as the payer), and results are presented in 2016/2017 British pounds. RESULTS By 2033, most currently available ARVs would lose market exclusivity; that is, generics could be available. Average per person lifetime HIV cost was ~£200 000 (3.5% annual discount) or ~£400 000 (undiscounted), reducing to ~£70 000 (3.5% annual discount; ~£120 000 undiscounted) with the use of generics (assuming that generics cost 10% of proprietary prices). The cumulative budget to cover 85 000 (± 5000) persons for 16 years (2018-2033) was £10.5 (± 0.6) billion, reducing to £3.6 (± 0.2) billion with the use of generics. CONCLUSIONS HIV management costs are high but financial efficiency could be improved by optimizing generic use for treatment and prevention to mitigate the high cost of lifelong HIV treatment. Earlier implementation of generics as they become available offers the potential to maximize the scale of the financial savings.
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Affiliation(s)
- K J Ong
- National Infection Service, Public Health England, London, UK
| | - A J van Hoek
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Infectious Diseases, Rijksinstituut voor Volksgezondheid en Milieu, RIVM (Netherlands National Institute for Public Health and the Environment), Bilthoven, The Netherlands
| | - R J Harris
- National Infection Service, Public Health England, London, UK
| | | | - L Waters
- Central and North West London NHS Foundation Trust, London, UK
| | - C Chau
- National Infection Service, Public Health England, London, UK
| | - S Croxford
- National Infection Service, Public Health England, London, UK
| | - P Kirwan
- National Infection Service, Public Health England, London, UK
| | - A Brown
- National Infection Service, Public Health England, London, UK
| | - M J Postma
- Unit of Pharmacotherapy, Epidemiology & Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - O N Gill
- National Infection Service, Public Health England, London, UK
| | - V Delpech
- National Infection Service, Public Health England, London, UK
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Owens M, Coogle C, Gentili A, Marrs S, Slattum P, Parsons P, Waters L, Ansello E. EVIDENCE-BASED FALLS PREVENTION TRAINING AT A REGIONAL MEDICAL CENTER. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Owens
- Virginia Commonwealth University
| | - C Coogle
- Virginia Commonwealth University
| | | | - S Marrs
- Virginia Commonwealth University
| | - P Slattum
- School of Pharmacy, Virginia Commonwealth University
| | | | - L Waters
- Virginia Commonwealth University
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Dobbs DJ, Waters L. ADVANCE CARE PLANNING TOOLS AND RESOURCES FOR THE PEOPLE CARING FOR PERSONS WITH SERIOUS ILLNESS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D J Dobbs
- University of South Florida, Tampa, Florida
| | - L Waters
- Virginia Commonwealth University, Richmond, Virginia
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Casey P, Zolfaghar K, Eckert C, Waters L, Sonntag H, McKelvey T, Mark N. 12 Predicting Patients at Risk for Leaving Without Being Seen Using Machine Learning. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cassar GE, Knowles S, Youssef GJ, Moulding R, Uiterwijk D, Waters L, Austin DW. Examining the mediational role of psychological flexibility, pain catastrophizing, and visceral sensitivity in the relationship between psychological distress, irritable bowel symptom frequency, and quality of life. PSYCHOL HEALTH MED 2018; 23:1168-1181. [DOI: 10.1080/13548506.2018.1476722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- G. E. Cassar
- School of Psychology, Deakin University, Geelong, Australia
| | - S. Knowles
- Faculty Health, Arts, and Design, Department of Psychology, Swinburne University of Technology, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Psychiatry,St Vincent’s Hospital, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - G. J. Youssef
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia
| | - R. Moulding
- School of Psychology, Deakin University, Geelong, Australia
| | - D. Uiterwijk
- School of Psychology, Deakin University, Geelong, Australia
| | - L. Waters
- School of Psychology, Deakin University, Geelong, Australia
| | - D. W. Austin
- School of Psychology, Deakin University, Geelong, Australia
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Di Marco A, Dasdia T, Giuliani F, Necco A, Casazza AM, Mora PT, Luborsky SW, Waters L. Biological Properties of Cell Lines Derived from Moloney Virus-Induced Sarcoma. Tumori 2018; 62:415-28. [PMID: 1020048 DOI: 10.1177/030089167606200408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cell lines derived from a primary MSV-M-induced tumor in a BALB/c mouse were studied. One line (MS-2) was subject only to continuous tissue culture transfer (tct). After 21 tct, MS-2 cells produced progressive tumors (MS-2 tumors) in syngeneic hosts. The second cell line (MS-2T) was established by cultivation of a MS-2 tumor. The ability to produce progressive tumors decreased with increased number of tct, in both cell lines. The virus content of MS-2 and MS-2T cells was very low, as shown by uridine incorporation and electron microscopy. Immunofluorescence tests demonstrated that antigens different from the viral MSV-M antigens were present on the cell lines, and that antigenic changes occurred with increased number of tct. Serum of mice bearing progressive MS-2 tumors reacted with MS-2T cells when these cells produced progressive tumors and did not react with MS-2 cells when they produced regressing tumors. MS-2 cells producing regressing tumors reacted with serum from mice in which the MS-2 tumor had regressed and with serum from mice immunized with MS-2T cells at late tct when they were poorly oncogenic. The antigenic changes seemed, therefore, to parallel the decrease of malignancy. A chromosomal analysis carried out on MS-2 and MS-2T cells, when both produced progressive tumors, showed a modal number of 48 and 44, respectively. MS-2T cells showed a large acrocentric chromosome. In contrast, the MS-2 cells at late tct, when they gave regressing tumors, showed a modal number of 60 and a wide range of distribution of chromosome number.
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41
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Waters L, Cameron M, Padula MP, Marks DC, Johnson L. Refrigeration, cryopreservation and pathogen inactivation: an updated perspective on platelet storage conditions. Vox Sang 2018; 113:317-328. [PMID: 29441601 DOI: 10.1111/vox.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Conventional storage of platelet concentrates limits their shelf life to between 5 and 7 days due to the risk of bacterial proliferation and the development of the platelet storage lesion. Cold storage and cryopreservation of platelets may facilitate extension of the shelf life to weeks and years, and may also provide the benefit of being more haemostatically effective than conventionally stored platelets. Further, treatment of platelet concentrates with pathogen inactivation systems reduces bacterial contamination and provides a safeguard against the risk of emerging and re-emerging pathogens. While each of these alternative storage techniques is gaining traction individually, little work has been done to examine the effect of combining treatments in an effort to further improve product safety and minimize wastage. This review aims to discuss the benefits of alternative storage techniques and how they may be combined to alleviate the problems associated with conventional platelet storage.
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Affiliation(s)
- L Waters
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M Cameron
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - D C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - L Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
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Goorley T, James M, Booth T, Brown F, Bull J, Cox LJ, Durkee J, Elson J, Fensin M, Forster RA, Hendricks J, Hughes HG, Johns R, Kiedrowski B, Martz R, Mashnik S, McKinney G, Pelowitz D, Prael R, Sweezy J, Waters L, Wilcox T, Zukaitis T. Initial MCNP6 Release Overview. NUCL TECHNOL 2017. [DOI: 10.13182/nt11-135] [Citation(s) in RCA: 718] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- T. Goorley
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - M. James
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - T. Booth
- Los Alamos National Laboratory, XCP-4 Methods and Algorithms MS A143, Los Alamos, New Mexico, 87545
| | - F. Brown
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - J. Bull
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - L. J. Cox
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - J. Durkee
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - J. Elson
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - M. Fensin
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - R. A. Forster
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - J. Hendricks
- Los Alamos National Laboratory, D-5 Radiation Applications Team, contractor MS A143, Los Alamos, New Mexico, 87545
| | - H. G. Hughes
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - R. Johns
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - B. Kiedrowski
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - R. Martz
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - S. Mashnik
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - G. McKinney
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - D. Pelowitz
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - R. Prael
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes, contractor MS A143, Los Alamos, New Mexico, 87545
| | - J. Sweezy
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
| | - L. Waters
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - T. Wilcox
- Los Alamos National Laboratory, D-5 Radiation Applications Team MS A143, Los Alamos, New Mexico, 87545
| | - T. Zukaitis
- Los Alamos National Laboratory, XCP-3 Monte Carlo Codes MS A143, Los Alamos, New Mexico, 87545
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Raffi F, Esser S, Nunnari G, Pérez-Valero I, Waters L. Switching regimens in virologically suppressed HIV-1-infected patients: evidence base and rationale for integrase strand transfer inhibitor (INSTI)-containing regimens. HIV Med 2017; 17 Suppl 5:3-16. [PMID: 27714978 DOI: 10.1111/hiv.12440] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
Abstract
In an era when most individuals with treated HIV infection can expect to live into old age, clinicians should proactively review their patients' current and future treatment needs and challenges. Clinical guidelines acknowledge that, in the setting of virological suppression, treatment switch may yield benefits in terms of tolerability, regimen simplification, adherence, convenience and long-term health considerations, particularly in the context of ageing. In this paper, we review evidence from six key clinical studies on switching virologically suppressed patients to regimens based on integrase strand transfer inhibitors (INSTIs), the antiretroviral class increasingly preferred as initial therapy in clinical guidelines. We review these studies and focus on the virological efficacy, safety, and tolerability of switching to INSTI-based regimens in suppressed HIV-positive individuals. We review the early switch studies SWITCHMRK and SPIRAL [assessing a switch from a ritonavir-boosted protease inhibitor (PI/r) to raltegravir (RAL)-containing regimens], together with data from STRATEGY-PI [assessing a switch to elvitegravir (EVG)-containing regimens; EVG/cobicistat (COBI)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) vs. remaining on a PI/r-containing regimen], STRATEGY-NNRTI [assessing a switch to EVG/COBI/FTC/TDF vs. continuation of a nonnucleoside reverse transcriptase inhibitor (NNRTI) and two nucleoside reverse transcriptase inhibitors (NRTIs)], STRIIVING [assessing a switch to a dolutegravir (DTG)-containing regimen (abacavir (ABC)/lamivudine (3TC)/DTG) vs. staying on the background regimen], and GS study 109 [assessing a switch to EVG/COBI/FTC/tenofovir alafenamide fumarate (TAF) vs. continuation of FTC/TDF-based regimens]. Switching to INSTI-containing regimens has been shown to support good virological efficacy, with evidence from two studies demonstrating superior virological efficacy for a switch to EVG-containing regimens. In addition, switching to INSTI regimens was associated with improved tolerability and greater reported patient satisfaction and outcomes in some studies. INSTI-based regimens offer an important contemporary switch option that may be tailored to meet and optimize the needs of many patients.
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Affiliation(s)
- F Raffi
- Infectious Diseases Department, University Hospital Hotel Dieu, Nantes, France.
| | - S Esser
- Department of Dermatology and Venerology, University HIV/STD Center Essen, University Hospital Essen, Essen, Germany
| | - G Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, Policlinico 'G. Martino', University of Messina, Messina, Italy
| | | | - L Waters
- Mortimer Market Centre, Central & North West London NHS Trust, London, UK
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Barber TJ, Moyle G, Hill A, Jagjit Singh G, Scourfield A, Yapa HM, Waters L, Asboe D, Boffito M, Nelson M. A cross-sectional study to evaluate the association of hyperbilirubinaemia on markers of cardiovascular disease, neurocognitive function, bone mineral density and renal markers in HIV-1 infected subjects on protease inhibitors. HIV Clin Trials 2017; 17:123-30. [PMID: 27125367 DOI: 10.1080/15284336.2016.1176305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ongoing inflammation in controlled HIV infection contributes to non-AIDS comorbidities. High bilirubin appears to exhibit an anti-inflammatory effect in vivo. We therefore examined whether increased bilirubin in persons with HIV was associated with differences in markers of inflammation and cardiovascular, bone, renal disease, and neurocognitive (NC) impairment. METHODS This cross-sectional study examined inflammatory markers in individuals with stable HIV infection treated with two nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Individuals recruited were those with a normal bilirubin (NBR; 0-17 μmol/L) or high bilirubin (>2.5 × upper limit of normal). Demographic and anthropological data were recorded. Blood and urine samples were taken for analyses. Pulse wave velocity (PWV) measurement, carotid intimal thickness (CIT), and calcaneal stiffness (CSI) were measured. Males were asked to answer a questionnaire about sexual function; NC testing was performed using CogState. RESULTS 101 patients were screened, 78 enrolled (43 NBR and 35 HBR). Atazanavir use was significantly higher in HBR. Whilst a trend for lower CIT was seen in those with HBR, no significant differences were seen in PWV, bone markers, calculated cardiovascular risk (Framingham), or erectile dysfunction score. VCAM-1 levels were significantly lower in the HBR group. HBR was associated with lower LDL and triglyceride levels. NBR was associated with a calculated FRAX significantly lower than HBR although no associations were found after adjusting for tenofovir use. No difference in renal markers was observed. Component tests of NC testing revealed differences favouring HBR but overall composite scores were similar. DISCUSSION High bilirubin in the context of boosted PI therapy was found not to be associated with differences in with the markers examined in this study. Some trends were noted and, on the basis of these, a larger, clinical end point study is warranted.
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Affiliation(s)
- T J Barber
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Moyle
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Hill
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - G Jagjit Singh
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - A Scourfield
- b University College London Hospitals NHS Foundation Trust , London , UK
| | - H M Yapa
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - L Waters
- c Mortimer Market Centre , Central and North West London NHS Foundation Trust, London , UK
| | - D Asboe
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK
| | - M Boffito
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
| | - M Nelson
- a St Stephen's Centre, Chelsea and Westminster NHS Foundation Trust , London , UK.,d Imperial College School of Medicine , London , UK
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Yermakhanova G, Absattarova K, Waters L, Ansello E. EDUCATIONAL LEADERS IN GERONTOLOGY: INTRODUCING COMPETENCY-BASED GERONTOLOGY EDUCATION IN KAZAKHSTAN. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G. Yermakhanova
- Virginia Commonwealth University, Richmond, Virginia,
- National Center for Health Development, Ministry of Health, Astana, Kazakhstan
| | - K. Absattarova
- Virginia Commonwealth University, Richmond, Virginia,
- National Center for Health Development, Ministry of Health, Astana, Kazakhstan
| | - L. Waters
- Virginia Commonwealth University, Richmond, Virginia,
| | - E.F. Ansello
- Virginia Commonwealth University, Richmond, Virginia,
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King MF, Noakes C, Sleigh P, Bale S, Waters L. Relationship between healthcare worker surface contacts, care type and hand hygiene: an observational study in a single-bed hospital ward. J Hosp Infect 2016; 94:48-51. [DOI: 10.1016/j.jhin.2016.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
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Goorley T, James M, Booth T, Brown F, Bull J, Cox L, Durkee J, Elson J, Fensin M, Forster R, Hendricks J, Hughes H, Johns R, Kiedrowski B, Martz R, Mashnik S, McKinney G, Pelowitz D, Prael R, Sweezy J, Waters L, Wilcox T, Zukaitis T. Features of MCNP6. ANN NUCL ENERGY 2016. [DOI: 10.1016/j.anucene.2015.02.020] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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De Santis E, Edwards AA, Alexander BD, Holder SJ, Biesse-Martin AS, Nielsen BV, Mistry D, Waters L, Siligardi G, Hussain R, Faure S, Taillefumier C. Selective complexation of divalent cations by a cyclic α,β-peptoid hexamer: a spectroscopic and computational study. Org Biomol Chem 2016; 14:11371-11380. [DOI: 10.1039/c6ob01954d] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The first report on metal binding ability of a cyclic α,β-peptoid hexamer towards a selection of metal cations is presented.
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Affiliation(s)
- E. De Santis
- Medway School of Pharmacy
- Universities of Kent and Greenwich at Medway
- Chatham Maritime
- UK
| | - A. A. Edwards
- Medway School of Pharmacy
- Universities of Kent and Greenwich at Medway
- Chatham Maritime
- UK
| | | | - S. J. Holder
- Functional Materials Group
- School of Physical Sciences
- University of Kent
- Canterbury
- UK
| | - A.-S. Biesse-Martin
- Université Clermont Auvergne
- Université Blaise Pascal
- Institut de Chimie de Clermont-Ferrand
- F-63000 Clermont-Ferrand
- France
| | - B. V. Nielsen
- School of Science
- University of Greenwich
- Chatham Maritime
- UK
| | - D. Mistry
- Division of Pharmacy and Pharmaceutical Sciences
- University of Huddersfield
- Huddersfield
- UK
| | - L. Waters
- Division of Pharmacy and Pharmaceutical Sciences
- University of Huddersfield
- Huddersfield
- UK
| | | | | | - S. Faure
- Université Clermont Auvergne
- Université Blaise Pascal
- Institut de Chimie de Clermont-Ferrand
- F-63000 Clermont-Ferrand
- France
| | - C. Taillefumier
- Université Clermont Auvergne
- Université Blaise Pascal
- Institut de Chimie de Clermont-Ferrand
- F-63000 Clermont-Ferrand
- France
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Waters L, Blanckley S, Fountain J, Goodson N. THU0480 Screening for the Presence of Sacroiliitis is Recommended for Young Patients Undergoing HIP Arthroplasty. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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50
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El Bouzidi K, Grant P, Edwards S, Benn P, Pillay D, Waters L, Nastouli E. Pooled Specimens for HIV RNA Monitoring: Cheaper, but Is It Reliable? Clin Infect Dis 2014; 59:1346-7. [DOI: 10.1093/cid/ciu562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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