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Friedman JK, Taylor BC, Hagel Campbell E, Allen K, Bangerter A, Branson M, Bronfort G, Calvert C, Cross L, Driscoll M, Evans R, Ferguson JE, Haley A, Hennessy S, Meis LA, Burgess DJ. Gender differences in PTSD severity and pain outcomes: baseline results from the LAMP trial. medRxiv 2023:2023.10.13.23296998. [PMID: 37873176 PMCID: PMC10593051 DOI: 10.1101/2023.10.13.23296998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD. Aim Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Methods Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Results Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). Conclusion These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.
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Affiliation(s)
- J K Friedman
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - B C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - E Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - K Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VAHCS, Durham, NC
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - M Branson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - G Bronfort
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - C Calvert
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Ljs Cross
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - M Driscoll
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - R Evans
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - J E Ferguson
- University of Minnesota Medical School, Minneapolis, MN
| | - A Haley
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - S Hennessy
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - L A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
- Women's Health Sciences Division, National Center for PTSD, Boston, MA
| | - D J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
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Piette JD, Newman S, Krein SL, Marinec N, Chen J, Williams DA, Edmond SN, Driscoll M, LaChappelle KM, Kerns RD, Maly M, Kim HM, Farris KB, Higgins DM, Buta E, Heapy AA. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial. JAMA Intern Med 2022; 182:975-983. [PMID: 35939288 PMCID: PMC9361183 DOI: 10.1001/jamainternmed.2022.3178] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022]
Abstract
Importance Cognitive behavioral therapy for chronic pain (CBT-CP) is a safe and effective alternative to opioid analgesics. Because CBT-CP requires multiple sessions and therapists are scarce, many patients have limited access or fail to complete treatment. Objectives To determine if a CBT-CP program that personalizes patient treatment using reinforcement learning, a field of artificial intelligence (AI), and interactive voice response (IVR) calls is noninferior to standard telephone CBT-CP and saves therapist time. Design, Setting, and Participants This was a randomized noninferiority, comparative effectiveness trial including 278 patients with chronic back pain from the Department of Veterans Affairs health system (recruitment and data collection from July 11, 2017-April 9, 2020). More patients were randomized to the AI-CBT-CP group than to the control (1.4:1) to maximize the system's ability to learn from patient interactions. Interventions All patients received 10 weeks of CBT-CP. For the AI-CBT-CP group, patient feedback via daily IVR calls was used by the AI engine to make weekly recommendations for either a 45-minute or 15-minute therapist-delivered telephone session or an individualized IVR-delivered therapist message. Patients in the comparison group were offered 10 therapist-delivered telephone CBT-CP sessions (45 minutes/session). Main Outcomes and Measures The primary outcome was the Roland Morris Disability Questionnaire (RMDQ; range 0-24), measured at 3 months (primary end point) and 6 months. Secondary outcomes included pain intensity and pain interference. Consensus guidelines were used to identify clinically meaningful improvements for responder analyses (eg, a 30% improvement in RMDQ scores and pain intensity). Data analyses were performed from April 2021 to May 2022. Results The study population included 278 patients (mean [SD] age, 63.9 [12.2] years; 248 [89.2%] men; 225 [81.8%] White individuals). The 3-month mean RMDQ score difference between AI-CBT-CP and standard CBT-CP was -0.72 points (95% CI, -2.06 to 0.62) and the 6-month difference was -1.24 (95% CI, -2.48 to 0); noninferiority criterion were met at both the 3- and 6-month end points (P < .001 for both). A greater proportion of patients receiving AI-CBT-CP had clinically meaningful improvements at 6 months as indicated by RMDQ (37% vs 19%; P = .01) and pain intensity scores (29% vs 17%; P = .03). There were no significant differences in secondary outcomes. Pain therapy using AI-CBT-CP required less than half of the therapist time as standard CBT-CP. Conclusions and Relevance The findings of this randomized comparative effectiveness trial indicated that AI-CBT-CP was noninferior to therapist-delivered telephone CBT-CP and required substantially less therapist time. Interventions like AI-CBT-CP could allow many more patients to be served effectively by CBT-CP programs using the same number of therapists. Trial Registration ClinicalTrials.gov Identifier: NCT02464449.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Sean Newman
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Sarah L. Krein
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
| | - Sara N. Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn M. LaChappelle
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert D. Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Marianna Maly
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - H. Myra Kim
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Karen B. Farris
- Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor
| | - Diana M. Higgins
- VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Alicia A. Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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3
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Iverson KM, Danitz SB, Driscoll M, Vogt D, Hamilton AB, Gerber MR, Wiltsey Stirman S, Shayani DR, Suvak MK, Dichter ME. "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women": Correction. Psychol Serv 2022; 19:112. [PMID: 35587426 DOI: 10.1037/ser0000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B. Hamilton, Megan R. Gerber, Shannon Wiltsey Stirman, Danielle R. Shayani, Michael K. Suvak and Melissa E. Dichter (Psychological Services, Advanced Online Publication, Jun 10, 2021, np). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-53476-001). This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Mary Driscoll
- VA Patient Research, Informatics, Multi-morbidities, and Education
| | | | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy
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Bastian LA, Driscoll M, DeRycke E, Edmond S, Mattocks K, Goulet J, Kerns RD, Lawless M, Quon C, Selander K, Snow J, Casares J, Lee M, Brandt C, Ditre J, Becker W. Pain and smoking study (PASS): A comparative effectiveness trial of smoking cessation counseling for veterans with chronic pain. Contemp Clin Trials Commun 2021; 23:100839. [PMID: 34485755 PMCID: PMC8391053 DOI: 10.1016/j.conctc.2021.100839] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Smoking is associated with greater pain intensity and pain-related functional interference in people with chronic pain. Interventions that teach smokers with chronic pain how to apply adaptive coping strategies to promote both smoking cessation and pain self-management may be effective. Methods The Pain and Smoking Study (PASS) is a randomized clinical trial of a telephone-delivered, cognitive behavioral intervention among Veterans with chronic pain who smoke cigarettes. PASS participants are randomized to a standard telephone counseling intervention that includes five sessions focusing on motivational interviewing, craving and relapse management, rewards, and nicotine replacement therapy versus the same components with the addition of a cognitive behavioral intervention for pain management. Participants are assessed at baseline, 6, and 12 months. The primary outcome is smoking cessation. Results The 371 participants are 88% male, a median age of 60 years old (range 24–82), and smoke a median of 15 cigarettes per day. Participants are mainly white (61%), unemployed (70%), 33% had a high school degree or less, and report their overall health as “Fair” (40%) to “Poor” (11%). Overall, pain was moderately high (mean pain intensity in past week = 5.2 (Standard Deviation (SD) = 1.6) and mean pain interference = 5.5 (SD = 2.2)). Pain-related anxiety was high (mean = 47.0 (SD = 22.2)) and self-efficacy was low (mean = 3.8 (SD = 1.6)). Conclusions PASS utilizes an innovative smoking and pain intervention to promote smoking cessation among Veterans with chronic pain. Baseline characteristics reflect a socioeconomically vulnerable population with a high burden of mental health comorbidities.
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Affiliation(s)
- Lori A Bastian
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Eric DeRycke
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Sara Edmond
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Kristin Mattocks
- University of Massachusetts Medical School, Worcester, MA, United States.,VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Joe Goulet
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Mark Lawless
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Caroline Quon
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Kim Selander
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer Snow
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jose Casares
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | - Megan Lee
- Yale University School of Medicine, New Haven, CT, United States
| | - Cynthia Brandt
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
| | - Joseph Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - William Becker
- Pain Research, Informatics, Multimorbidities, Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, United States.,Yale University School of Medicine, New Haven, CT, United States
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5
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Haskell SG, Han L, Abel EA, Bastian L, Driscoll M, Dziura J, Burg MM, Skanderson M, Brandt CA. Sex Differences in Use of a Clinical Complexity Measure to Predict Primary Care Utilization. J Womens Health (Larchmt) 2021; 31:71-78. [PMID: 34388023 DOI: 10.1089/jwh.2021.0103] [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: 11/12/2022] Open
Abstract
Background: The Veterans Affairs (VA)-developed Care Assessment Need (CAN) score, a risk-stratification tool used to identify complex high-risk patients and guide VA care coordination, was designed to predict hospitalization or death. Little is known about its utility in predicting primary care utilization or if gender differences in this metric are detectable. Our objective was to determine association of CAN score quintiles with high primary care visit (PCV) utilization among Veterans, the impact of adding reproductive health and psychosocial variables to the model and the difference between men and women Veterans. Methods: The sample included men and women from the post-9/11 cohort receiving VA care for at least 1 year, 2010-2017 (N = 665,379). PCV data for each year were collected from national Corporate Data Warehouse. A cumulative count ≥6 visits in a year was used as an indication for high PCV utilization in the analyses. Results: After accounting for potential confounding factors, women were associated with 42% higher odds of heavy PCV utilization (adjusted odds ratio: 1.42, 95% confidence interval: 1.37-1.46) than men. However, there was a significant interaction between sex and CAN quintiles (p < 0.001). After adjusting for all the covariates, CAN score quintiles appeared to have stronger associations and better predictive accuracy on the risk of 1-year heavy PCV utilization for men than for women. Conclusion: Further research is needed to understand sex differences in Veterans Health Administration clinical complexity measures and whether they can be successfully used to identify high-risk, high-utilizing women Veterans.
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Affiliation(s)
- Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ling Han
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica A Abel
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Center for Medical Informatics, New Haven, Connecticut, USA
| | - Lori Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mary Driscoll
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - James Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Matthew M Burg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Center for Medical Informatics, New Haven, Connecticut, USA
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6
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Iverson KM, Danitz SB, Driscoll M, Vogt D, Hamilton AB, Gerber MR, Wiltsey Stirman S, Shayani DR, Suvak MK, Dichter ME. Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women. Psychol Serv 2021; 19:102-112. [PMID: 34110870 DOI: 10.1037/ser0000544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Mary Driscoll
- VA Patient Research, Informatics, Multi-morbidities, and Education
| | | | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy
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7
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Mattocks K, Casares J, Brown A, Bean-Mayberry B, Goldstein KM, Driscoll M, Haskell S, Bastian L, Brandt C. Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care. Womens Health Issues 2020; 30:113-119. [DOI: 10.1016/j.whi.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/20/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022]
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8
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Masheb RM, Douglas ME, Kutz AM, Marsh AG, Driscoll M. Pain and emotional eating: further investigation of the Yale Emotional Overeating Questionnaire in weight loss seeking patients. J Behav Med 2020; 43:479-486. [PMID: 32107681 DOI: 10.1007/s10865-020-00143-4] [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] [Received: 10/11/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
Providers frequently report pain as a barrier to weight loss yet the relationship between the pain experience and eating behavior is poorly understood. The current study examines overeating in response to physical pain (Pain Overeating). Weight-loss seeking Veterans (N = 126) completed the Yale Emotional Overeating Questionnaire, a measure used to assess the frequency of overeating in response to a range of emotions that was adapted to include a Pain Overeating item, and validated measures of pain, eating pathology, and mental health. Fifty-one participants (42.5%) engaged in at least one Pain Overeating episode in the past month, and 14.2% engaged in this behavior daily. Pain Overeating was significantly related to pain intensity and interference, and accounted for statistically significant variance in predicting BMI, eating pathology and depression. Findings suggest eating in response to physical pain is common among weight-loss seeking Veterans and may have important implications for weight management treatment.
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Affiliation(s)
- Robin M Masheb
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,Yale School of Medicine, 333 Cedar St., New Haven, CT, 06510, USA.
| | - Megan E Douglas
- Baylor Scott & White Institute for Rehabilitation, 909 N. Washington Ave, Dallas, TX, 75246, USA
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT, 84148, USA
| | - Alison G Marsh
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Mary Driscoll
- The Veterans Initiative for Eating and Weight/11ACSLG, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, 333 Cedar St., New Haven, CT, 06510, USA
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9
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Leapman MS, DeRycke E, Skanderson M, Becker WC, Makarov DV, Gross CP, Driscoll M, Motamedinia P, Bathulapalli H, Mattocks K, Brandt CA, Haskell S, Bastian LA. Variation in National Opioid Prescribing Patterns Following Surgery for Kidney Stones. Pain Med 2019; 19:S12-S18. [PMID: 30203013 DOI: 10.1093/pm/pny125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Opioid misuse is a significant public health problem. As initial exposures to opioids are frequently encountered through the management of postoperative pain, we examined patterns of opioid prescribing following surgical treatment for nephrolithiasis. Methods We identified patients with nephrolithiasis in the national Women Veterans Cohort Study (WVCS) who were treated surgically by diagnosis and procedure codes. Using standard conversion factors, we calculated the morphine milligram equivalent (MME) dose prescribed. We used descriptive statistics to characterize opioid prescription across management strategy and multivariable regression to examine clinical and demographic characteristics associated with dispensed dose. Results We identified 22,609 patients diagnosed with kidney stones during 1999-2014, 1,976 of whom were treated surgically and 1,582 (80.1%) of whom received an opioid prescription. The median age was 39 years, and 1,366 (90%) were male; 1,314 (86.3%) were treated with ureteroscopy, 172 (11.3%) with extracorporeal shockwave lithotripsy, and 36 (2.4%) with percutaneous nephrolithotomy. The median number of days supplied per opioid prescription (interquartile range) was 10 (5-14), and patients were dispensed a median of 180 (140-300) MME. A total of 6.4% of patients received ≥50 MME/d. On multivariable analysis, comorbid diagnosis of post-traumatic stress disorder (PTSD) was associated with higher total dispensed dose, whereas surgery type was not. Conclusions We observed substantial variation in opioid prescribing following surgical treatment of nephrolithiasis. Although type of surgical intervention did not impact opioid dosing, patients with a diagnosis of PTSD were more likely to receive higher doses. This work can inform efforts to improve the safety and efficacy of postoperative opioid prescribing.
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Affiliation(s)
- Michael S Leapman
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Departments of Urology
| | - Eric DeRycke
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Melissa Skanderson
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - William C Becker
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Danil V Makarov
- Departments of Urology.,Population Health, NYU Langone Medical Center, New York, New York.,VA New York, NY Harbor Healthcare System
| | - Cary P Gross
- Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | | | - Harini Bathulapalli
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kristin Mattocks
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Sally Haskell
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut.,Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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10
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Portnoy GA, Relyea MR, Decker S, Shamaskin-Garroway A, Driscoll M, Brandt CA, Haskell SG. Understanding Gender Differences in Resilience Among Veterans: Trauma History and Social Ecology. J Trauma Stress 2018; 31:845-855. [PMID: 30431668 DOI: 10.1002/jts.22341] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 11/10/2022]
Abstract
A social-ecological framework for resilience underscores the importance of conceptualizing individuals embedded within their context when evaluating a person's vulnerability and adaptation to stress. Despite a high level of trauma exposure, most veterans exhibit psychological resilience following a traumatic event. Interpersonal trauma is associated with poorer psychological outcomes than noninterpersonal trauma and is experienced more frequently across the lifespan by women as compared to men. In the present study, we examined gender differences in trauma exposure, resilience, and protective factors among veterans. Participants included 665 veterans who completed a baseline survey assessing traumatic events; 544 veterans (81.8%) completed a 1-year follow-up survey assessing resilience, combat exposure, deployment social support, deployment preparedness, and military sexual trauma (MST). Principal component analyses revealed the Traumatic Life Events Questionnaire categorized into four meaningful components: sexual abuse, interpersonal violence, stranger violence, and accidents/unexpected trauma. Women reported greater exposure to sexual abuse, d = 0.76; interpersonal violence, d = 0.31; and MST, Cramer's V = 0.54; men reported greater exposure to stranger violence, accidents/unexpected trauma, and combat exposure, ds = 0.24-0.55. Compared to women, men also reported greater social support during deployment, d = 0.46. Hierarchical linear regression indicated that men's resilience scores were higher than women's, β = .10, p = .032, yet this association was no longer significant once we accounted for trauma type, β = .07, p = .197. Results indicate that trauma type is central to resilience and suggest one must consider the social-ecological context that can promote or inhibit resilient processes.
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Affiliation(s)
- Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
| | - Mark R Relyea
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Center for Medical Informatics, New Haven, Connecticut, USA
| | - Suzanne Decker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
| | - Andrea Shamaskin-Garroway
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Mary Driscoll
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Department of Psychiatry, New Haven, Connecticut, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Emergency Medicine, Center for Medical Informatics, New Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut, USA
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11
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Phillips P, Lithgow GJ, Driscoll M. REPRODUCIBILITY & ROBUSTNESS IN PURSUING LIFE-EXTENDING COMPOUNDS: CAENORHABDITIS INTERVENTION TESTING PROGRAM. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3009] [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)
- P Phillips
- Department of Biology, University of Oregon, Eugene, Oregon, United States
| | - G J Lithgow
- Buck Institute for Aging Research, Novato, California 94945, USA
| | - M Driscoll
- Rutgers University, Piscataway, New Jersey 08854, USA
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12
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Tang WW, McGee P, Lachin JM, Li DY, Hoogwerf B, Hazen SL, Nathan D, Zinman B, Crofford O, Genuth S, Brown‐Friday J, Crandall J, Engel H, Engel S, Martinez H, Phillips M, Reid M, Shamoon H, Sheindlin J, Gubitosi‐Klug R, Mayer L, Pendegast S, Zegarra H, Miller D, Singerman L, Smith‐Brewer S, Novak M, Quin J, Genuth S, Palmert M, Brown E, McConnell J, Pugsley P, Crawford P, Dahms W, Gregory N, Lackaye M, Kiss S, Chan R, Orlin A, Rubin M, Brillon D, Reppucci V, Lee T, Heinemann M, Chang S, Levy B, Jovanovic L, Richardson M, Bosco B, Dwoskin A, Hanna R, Barron S, Campbell R, Bhan A, Kruger D, Jones J, Edwards P, Bhan A, Carey J, Angus E, Thomas A, Galprin A, McLellan M, Whitehouse F, Bergenstal R, Johnson M, Gunyou K, Thomas L, Laechelt J, Hollander P, Spencer M, Kendall D, Cuddihy R, Callahan P, List S, Gott J, Rude N, Olson B, Franz M, Castle G, Birk R, Nelson J, Freking D, Gill L, Mestrezat W, Etzwiler D, Morgan K, Aiello L, Golden E, Arrigg P, Asuquo V, Beaser R, Bestourous L, Cavallerano J, Cavicchi R, Ganda O, Hamdy O, Kirby R, Murtha T, Schlossman D, Shah S, Sharuk G, Silva P, Silver P, Stockman M, Sun J, Weimann E, Wolpert H, Aiello L, Jacobson A, Rand L, Rosenzwieg J, Nathan D, Larkin M, Christofi M, Folino K, Godine J, Lou P, Stevens C, Anderson E, Bode H, Brink S, Cornish C, Cros D, Delahanty L, eManbey ., Haggan C, Lynch J, McKitrick C, Norman D, Moore D, Ong M, Taylor C, Zimbler D, Crowell S, Fritz S, Hansen K, Gauthier‐Kelly C, Service F, Ziegler G, Barkmeier A, Schmidt L, French B, Woodwick R, Rizza R, Schwenk W, Haymond M, Pach J, Mortenson J, Zimmerman B, Lucas A, Colligan R, Luttrell L, Lopes‐Virella M, Caulder S, Pittman C, Patel N, Lee K, Nutaitis M, Fernandes J, Hermayer K, Kwon S, Blevins A, Parker J, Colwell J, Lee D, Soule J, Lindsey P, Bracey M, Farr A, Elsing S, Thompson T, Selby J, Lyons T, Yacoub‐Wasef S, Szpiech M, Wood D, Mayfield R, Molitch M, Adelman D, Colson S, Jampol L, Lyon A, Gill M, Strugula Z, Kaminski L, Mirza R, Simjanoski E, Ryan D, Johnson C, Wallia A, Ajroud‐Driss S, Astelford P, Leloudes N, Degillio A, Schaefer B, Mudaliar S, Lorenzi G, Goldbaum M, Jones K, Prince M, Swenson M, Grant I, Reed R, Lyon R, Kolterman O, Giotta M, Clark T, Friedenberg G, Sivitz W, Vittetoe B, Kramer J, Bayless M, Zeitler R, Schrott H, Olson N, Snetselaar L, Hoffman R, MacIndoe J, Weingeist T, Fountain C, Miller R, Johnsonbaugh S, Patronas M, Carney M, Mendley S, Salemi P, Liss R, Hebdon M, Counts D, Donner T, Gordon J, Hemady R, Kowarski A, Ostrowski D, Steidl S, Jones B, Herman W, Martin C, Pop‐Busui R, Greene D, Stevens M, Burkhart N, Sandford T, Floyd J, Bantle J, Flaherty N, Terry J, Koozekanani D, Montezuma S, Wimmergren N, Rogness B, Mech M, Strand T, Olson J, McKenzie L, Kwong C, Goetz F, Warhol R, Hainsworth D, Goldstein D, Hitt S, Giangiacomo J, Schade D, Canady J, Burge M, Das A, Avery R, Ketai L, Chapin J, Schluter M, Rich J, Johannes C, Hornbeck D, Schutta M, Bourne P, Brucker A, Braunstein S, Schwartz S, Maschak‐Carey B, Baker L, Orchard T, Cimino L, Songer T, Doft B, Olson S, Becker D, Rubinstein D, Bergren R, Fruit J, Hyre R, Palmer C, Silvers N, Lobes L, Rath PP, Conrad P, Yalamanchi S, Wesche J, Bratkowksi M, Arslanian S, Rinkoff J, Warnicki J, Curtin D, Steinberg D, Vagstad G, Harris R, Steranchak L, Arch J, Kelly K, Ostrosaka P, Guiliani M, Good M, Williams T, Olsen K, Campbell A, Shipe C, Conwit R, Finegold D, Zaucha M, Drash A, Morrison A, Malone J, Bernal M, Pavan P, Grove N, Tanaka E, McMillan D, Vaccaro‐Kish J, Babbione L, Solc H, DeClue T, Dagogo‐Jack S, Wigley C, Ricks H, Kitabchi A, Chaum E, Murphy M, Moser S, Meyer D, Iannacone A, Yoser S, Bryer‐Ash M, Schussler S, Lambeth H, Raskin P, Strowig S, Basco M, Cercone S, Zinman B, Barnie A, Devenyi R, Mandelcorn M, Brent M, Rogers S, Gordon A, Bakshi N, Perkins B, Tuason L, Perdikaris F, Ehrlich R, Daneman D, Perlman K, Ferguson S, Palmer J, Fahlstrom R, de Boer I, Kinyoun J, Van Ottingham L, Catton S, Ginsberg J, McDonald C, Harth J, Driscoll M, Sheidow T, Mahon J, Canny C, Nicolle D, Colby P, Dupre J, Hramiak I, Rodger N, Jenner M, Smith T, Brown W, May M, Lipps Hagan J, Agarwal A, Adkins T, Lorenz R, Feman S, Survant L, White N, Levandoski L, Grand G, Thomas M, Joseph D, Blinder K, Shah G, Burgess D, Boniuk I, Santiago J, Tamborlane W, Gatcomb P, Stoessel K, Ramos P, Fong K, Ossorio P, Ahern J, Gubitosi‐Klug R, Meadema‐Mayer L, Beck C, Farrell K, Genuth S, Quin J, Gaston P, Palmert M, Trail R, Dahms W, Lachin J, Backlund J, Bebu I, Braffett B, Diminick L, Gao X, Hsu W, Klumpp K, Pan H, Trapani V, Cleary P, McGee P, Sun W, Villavicencio S, Anderson K, Dews L, Younes N, Rutledge B, Chan K, Rosenberg D, Petty B, Determan A, Kenny D, Williams C, Cowie C, Siebert C, Steffes M, Arends V, Bucksa J, Nowicki M, Chavers B, O'Leary D, Polak J, Harrington A, Funk L, Crow R, Gloeb B, Thomas S, O'Donnell C, Soliman E, Zhang Z, Li Y, Campbell C, Keasler L, Hensley S, Hu J, Barr M, Taylor T, Prineas R, Feldman E, Albers J, Low P, Sommer C, Nickander K, Speigelberg T, Pfiefer M, Schumer M, Moran M, Farquhar J, Ryan C, Sandstrom D, Williams T, Geckle M, Cupelli E, Thoma F, Burzuk B, Woodfill T, Danis R, Blodi B, Lawrence D, Wabers H, Gangaputra S, Neill S, Burger M, Dingledine J, Gama V, Sussman R, Davis M, Hubbard L, Budoff M, Darabian S, Rezaeian P, Wong N, Fox M, Oudiz R, Kim L, Detrano R, Cruickshanks K, Dalton D, Bainbridge K, Lima J, Bluemke D, Turkbey E, der Geest ., Liu C, Malayeri A, Jain A, Miao C, Chahal H, Jarboe R, Nathan D, Monnier V, Sell D, Strauch C, Hazen S, Pratt A, Tang W, Brunzell J, Purnell J, Natarajan R, Miao F, Zhang L, Chen Z, Paterson A, Boright A, Bull S, Sun L, Scherer S, Lopes‐Virella M, Lyons T, Jenkins A, Klein R, Virella G, Jaffa A, Carter R, Stoner J, Garvey W, Lackland D, Brabham M, McGee D, Zheng D, Mayfield R, Maynard J, Wessells H, Sarma A, Jacobson A, Dunn R, Holt S, Hotaling J, Kim C, Clemens Q, Brown J, McVary K. Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study. J Am Heart Assoc 2018. [PMCID: PMC6015340 DOI: 10.1161/jaha.117.008368] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.
Methods and Results
A random subcohort of 349 participants was selected from the
DCCT
/
EDIC
(Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from
DCCT
baseline, year 1, and closeout of
DCCT
, and 1 to 2 years post‐
DCCT
(
EDIC
years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F
2α
isoprostanes, and its metabolite, 2,3 dinor‐8
iso
prostaglandin F
2α
. Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8
iso
prostaglandin F
2α
, an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase,
P
<0.003; −5.3% risk for 10% higher 2,3 dinor‐8
iso
prostaglandin F
2α
,
P
=0.0092). In contrast, the oxidative markers myeloperoxidase and F
2α
isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between
DCCT
intensive and conventional treatment groups in the change in all biomarkers across time segments.
Conclusions
Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.
Clinical Trial Registration
URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
00360815 and
NCT
00360893.
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Affiliation(s)
- W.H. Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Paula McGee
- The Biostatistics Center, George Washington University, Rockville, MD
| | - John M. Lachin
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Daniel Y. Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Stanley L. Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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13
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Driscoll M, Ramsay CM, Hulse G, Simpson WJ. A Method of Detecting Autolysis of Brewers' Yeast by Measurement of Extracellular Adenylate Kinase Activity. Journal of the American Society of Brewing Chemists 2018. [DOI: 10.1094/asbcj-60-0176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - G. Hulse
- South African Breweries, Beer Division, Sandton, South Africa
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14
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Scioli-Salter ER, Smith BN, McSheffrey S, Bair MJ, Sillice MA, Driscoll M, Higgins DM, Allsup K, Amalathas A, Gerber MR. Self-Efficacy for Adoption and Maintenance of Exercise Among Fibromyalgia Patients: A Pilot Study. Am J Lifestyle Med 2017; 14:437-442. [PMID: 33281524 DOI: 10.1177/1559827617745264] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective. While multimodal treatment approaches for fibromyalgia (FM), incorporating exercise, have been found most effective, information about factors associated with exercise adoption and maintenance is lacking. Design, Setting, and Methods. Women veterans with FM (N = 19) completed an anonymous Internet survey measuring FM impact (FI), adoption of exercise behavior, and self-efficacy for exercise. Using classifications of behavior specified by the transtheoretical model, the self-efficacy of participants classified in the action or maintenance (AM) stages was compared with those in earlier stages (precontemplation through preparation) of exercise readiness. Multivariate analysis of variance analyses examined differences in FI domains by stage of change. Analysis of covariance examined whether exercise self-efficacy differed by stage of change while controlling for FI. Results. Higher levels of self-efficacy were detected among participants in the AM stages. Participants in the AM stages also reported higher levels of FI symptoms. After controlling for FI, self-efficacy did not differ significantly between the 2 groups; however the effect size was large (η2 = .11). Conclusions. Findings of this pilot study suggest a role for self-efficacy in exercise adoption and maintenance, even in the setting of higher FM symptoms. Replication of this study with a larger sample size is warranted.
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Affiliation(s)
- Erica R Scioli-Salter
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Brian N Smith
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Savannah McSheffrey
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Matthew J Bair
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Marie A Sillice
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Mary Driscoll
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Diana M Higgins
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Kelly Allsup
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Aneline Amalathas
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
| | - Megan R Gerber
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts (ERS, BNS, DMH, AA).,Research Service, VA Boston Healthcare System, Boston, Massachusetts (ERS, SM, DMH).,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (ERS, BNS, DMH).,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, Indiana (MJB).,Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, Indiana (MJB).,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island (MAS).,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island (MAS).,VA Connecticut Healthcare System, West Haven, Connecticut (MD).,Yale University School of Medicine, New Haven, Connecticut (MD).,Research Division, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (KA).,Women Veterans Program, VA Boston Healthcare System, Boston, Massachusetts (MRG).,Department of Medicine & General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts (MRG)
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Lucanic M, Guo M, Lithgow G, Driscoll M, Phillips P. CITP: SCREENING CHEMICALS FOR REPRODUCIBLE AND ROBUST EFFECTS ACROSS DIVERSE GENETIC BACKGROUNDS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4490] [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: 11/15/2022] Open
Affiliation(s)
- M. Lucanic
- Buck Institute for Research on Aging, Novato, California,
| | - M. Guo
- Division of Aging Biology, National Institute on Aging, Bethesda, Maryland,
| | - G.J. Lithgow
- Buck Institute for Research on Aging, Novato, California,
| | - M. Driscoll
- Rutgers University, Dept. of Molecular Biology and Biochemistry, Nelson Biological Laboratories, Piscataway, New Jersey,
| | - P. Phillips
- Institute of Ecology and Evolution, University of Oregon, Eugene, Oregon
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Ramsey C, Dziura J, Justice AC, Altalib HH, Bathulapalli H, Burg M, Decker S, Driscoll M, Goulet J, Haskell S, Kulas J, Wang KH, Mattocks K, Brandt C. Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014. Am J Public Health 2016; 107:329-335. [PMID: 27997229 DOI: 10.2105/ajph.2016.303574] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate gender, age, and race/ethnicity as predictors of incident mental health diagnoses among Operations Iraqi Freedom, Enduring Freedom, and New Dawn veterans. METHODS We used US Veterans Health Administration (VHA) electronic health records from 2001 to 2014 to examine incidence rates and sociodemographic risk factors for mental health diagnoses among 888 142 veterans. RESULTS Posttraumatic stress disorder (PTSD) was the most frequently diagnosed mental health condition across gender and age groups. Incidence rates for all mental health diagnoses were highest at ages 18 to 29 years and declined thereafter, with the exceptions of major depressive disorder (MDD) in both genders, and PTSD among women. Risk of incident bipolar disorder and MDD diagnoses were greater among women; risk of incident schizophrenia, and alcohol- and drug-use disorders diagnoses were greater in men. Compared with Whites, risk incident PTSD, MDD, and alcohol-use disorder diagnoses were lower at ages 18 to 29 years and higher at ages 45 to 64 years for both Hispanics and African Americans. CONCLUSIONS Differentiating high-risk demographic and gender groups can lead to improved diagnosis and treatment of mental health diagnoses among veterans and other high-risk groups.
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Affiliation(s)
- Christine Ramsey
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - James Dziura
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Amy C Justice
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Hamada Hamid Altalib
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Harini Bathulapalli
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Matthew Burg
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Suzanne Decker
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Mary Driscoll
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Goulet
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Sally Haskell
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Joseph Kulas
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Karen H Wang
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Kristen Mattocks
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
| | - Cynthia Brandt
- Christine M. Ramsey, Amy C. Justice, Hamada Hamid Altalib, Harini Bathulapalli, Matthew Burg, Suzanne Decker, Mary Driscoll, Joseph Goulet, Sally Haskell, Joseph Kulas, Karen H. Wang, Kristin Mattocks, and Cynthia Brandt are with VA Connecticut Health Care System, West Haven, CT, and Yale University Medical School, New Haven, CT. James Dziura is with Yale University Medical School
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Trick WE, Lin MY, Cheng-Leidig R, Driscoll M, Tang AS, Gao W, Runningdeer E, Arwady MA, Weinstein RA. Electronic Public Health Registry of Extensively Drug-Resistant Organisms, Illinois, USA. Emerg Infect Dis 2016; 21:1725-32. [PMID: 26402744 PMCID: PMC4593443 DOI: 10.3201/eid2110.150538] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In response to clusters of carbapenem-resistant Enterobacteriaceae (CRE) in Illinois, USA, the Illinois Department of Public Health and the Centers for Disease Control and Prevention Chicago Prevention Epicenter launched a statewide Web-based registry designed for bidirectional data exchange among health care facilities. CRE occurrences are entered and searchable in the system, enabling interfacility communication of patient information. For rapid notification of facilities, admission feeds are automated. During the first 12 months of implementation (November 1, 2013-October 31, 2014), 1,557 CRE reports (≈4.3/day) were submitted from 115 acute care hospitals, 5 long-term acute care hospitals, 46 long-term care facilities, and 7 reference laboratories. Guided by a state and local public health task force of infection prevention specialists and microbiologists and a nonprofit informatics entity, Illinois Department of Public Health deployed a statewide registry of extensively drug-resistant organisms. The legal, technical, and collaborative underpinnings of the system enable rapid incorporation of other emerging organisms.
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Altalib HH, Fenton BT, Sico J, Goulet JL, Bathulapalli H, Mohammad A, Kulas J, Driscoll M, Dziura J, Mattocks K, Kerns R, Brandt C, Haskell S. Increase in migraine diagnoses and guideline-concordant treatment in veterans, 2004-2012. Cephalalgia 2016; 37:3-10. [PMID: 26950804 DOI: 10.1177/0333102416631959] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/17/2022]
Abstract
Background and aim Health administrators, policy makers, and educators have attempted to increase guideline adherence of migraine medications while reducing inappropriate use of opioid- and barbiturate-containing medications. We evaluated the burden of migraine and proportion of guideline-concordant care in a large, national health care system over time. Methods We conducted a time-series study using data from the Veterans Health Administration (VHA) electronic health record. Veterans with migraines were identified by ICD-9 code (346.X). Prescriptions and comorbid conditions were evaluated before and after migraine diagnosis. Chi-square tests and logistic regression were performed. Results A total of 57,064 veterans were diagnosed with migraine headache (5.3%), with women significantly more likely diagnosed (11.6% vs. 4.4%, p < 0.0001). The number of veterans diagnosed with migraine has significantly increased over the years. By 2012, triptans were prescribed to 43% of people with migraine, with no difference by gender. However, triptan prescriptions increased from 2004 to 2012 in men, but not women, veterans. Preventive medicines showed a significant increase with the year of migraine diagnosis, after controlling for age, sex, race, and for comorbidities treated with medications used for migraine prevention. Conclusions The burden of migraines is increasing within the VHA, with a corresponding increase in the delivery of guideline-concordant acute and prophylactic migraine-specific medication.
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Affiliation(s)
- H H Altalib
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA.,3 Yale University, Department of Psychiatry, USA
| | - B T Fenton
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - J Sico
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA
| | - J L Goulet
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - H Bathulapalli
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - A Mohammad
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,4 Yale University, Department of Internal Medicine, USA
| | - J Kulas
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - M Driscoll
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,3 Yale University, Department of Psychiatry, USA
| | - J Dziura
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,5 Yale University, Department of Emergency Medicine, USA
| | - K Mattocks
- 6 VA Central Western Massachusetts Healthcare System, USA.,7 University of Massachusetts Medical School, Department of Quantitative Health Science, USA
| | - R Kerns
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,2 Yale University, Department of Neurology, USA.,3 Yale University, Department of Psychiatry, USA
| | - C Brandt
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,5 Yale University, Department of Emergency Medicine, USA
| | - S Haskell
- 1 Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA.,4 Yale University, Department of Internal Medicine, USA
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Martin A, Heapy A, Moore B, Masheb R, Driscoll M, Kerns R. (513) A mediation model of neuropathic pain and sleep quality: the role of depressed affect and pain interference. The Journal of Pain 2014. [DOI: 10.1016/j.jpain.2014.01.425] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Driscoll M, Higgins D, Elizabeth S, Goulet J, Heapy A, Kerns R, Brandt C, Haskell S. (520) Trauma type, social support, and pain in veterans: does gender matter? The Journal of Pain 2014. [DOI: 10.1016/j.jpain.2014.01.432] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- Barbara S. Fischer
- Barbara S. Fischer ( ) is public service administrator of the Division of Patient Safety and Quality; Office of Policy, Planning, and Statistics; at the Illinois Department of Public Health in Chicago
| | - Enrique Martinez
- Enrique Martinez is chief medical officer, Ambulatory, at Cook County Health and Hospitals System in Chicago
| | - Mary Driscoll
- Mary Driscoll is chief of the Division of Patient Safety and Quality; Office of Policy, Planning, and Statistics; Illinois Department of Public Health
| | - Terrence Conway
- Terrence Conway is a principal with Health Management Associates in Chicago
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Zhang W, Bianchi L, Lee WH, Wang Y, Israel S, Driscoll M. Intersubunit interactions between mutant DEG/ENaCs induce synthetic neurotoxicity. Cell Death Differ 2008; 15:1794-803. [PMID: 18670436 DOI: 10.1038/cdd.2008.114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Ion channel hyperactivation can result in neuronal loss in injury, stroke and neurodegenerative disease. Acidosis-associated hyperactivation of the Degenerin/epithelial amiloride-sensitive Na(+) channel (DEG/ENaC) acid-sensing ion channel 1a (ASIC1a), a proton-gated channel expressed in the mammalian brain, contributes significantly to neuronal loss in ischemia. Analogously, in invertebrates, genetic hyperactivation of the Caenorhabditis elegans mechanosensory (MEC) channel (MEC-4(d)) of the DEG/ENaC ion channel superfamily induces neuronal necrosis. Similarly substituted MEC-10(d) mutant subunits of the same MEC channel are only marginally neurotoxic, and we therefore exploited the weak necrosis phenotype of mec-10(d) lines to screen for novel extragenic mutations that enhance neuronal death. Here, we report on one mec-10(d) necrosis enhancer, which we show is MEC-4 variant MEC-4(A149V). MEC-4(A149V) executes normal MEC-4 function in touch sensation and does not induce necrosis on its own, but rather combines with MEC-10(d) to create a strongly neurotoxic channel. The MEC-4(A149V)+MEC-10(d) channel conducts elevated Na(+) and Ca(2+) currents (with a disproportionate increase in Ca(2+) current) in the Xenopus oocyte expression system, and exhibits altered binding of the channel inhibitor amiloride. Our data document the first example of synergistically toxic intersubunit interactions in the DEG/ENaC channel class and provide evidence that Ca(2+) current levels may be decisive factors in tipping the balance between neuronal survival and necrosis.
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Affiliation(s)
- W Zhang
- Department of Molecular Biology and Biochemistry, Rutgers University, Piscataway, NJ 08854, USA
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Potter K, Abedini A, Butterworth S, Driscoll M, Marek P, Baker R, Korbutt GS, Fraser PE, Raleigh DP, Verchere CB. SPECIES-SPECIFIC SEQUENCE VARIATION OF PORCINE ISLET AMYLOID POLYPEPTIDE REDUCES ITS AMYLOIDOGENICITY AND MAY CONTRIBUTE TO IMPROVED FUNCTION AND SURVIVAL OF PIG ISLET XENOGRAFTS. CLIN INVEST MED 2008. [DOI: 10.25011/cim.v31i4.4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Introduction: Long-term success of human islet transplants has been limited. Beta cell mass and function in transplanted islets progressively decline over time, resembling the progressive loss of insulin secretion in type2 diabetes. Transplanted islets, like those in type 2 diabetes, are subject to apoptotic beta cell death and the formation of toxic aggregates of the betacell peptide islet amyloid polypeptide (IAPP). Interestingly, porcine islets consistently maintain long-term normoglycemia when transplanted into immune-deficient, diabetic mice. We hypothesized that transplanted pig islets may not be subject to amyloid formation and amyloid-induced cell death, and that this may contribute to the success of porcine islet grafts.
Methods & Results: Sequencing of porcine IAPP (pIAPP) from neonatal pig islet (NPI)-extracted RNA confirmed notabledifferences from human IAPP (hIAPP), including a proline substitution within the known amyloidogenic region and a glutamine-for-lysine at the N-terminalcleavage site of porcine proIAPP. Fibril formation was assessed by electron miscroscopy (EM) and Thioflavin T fluorescence. While synthetic hIAPP fibrillized within minutes, pIAPP required 6 weeks to form fibrils detectableby EM. Small peptide fragments of pIAPP failed to aggregate. By Thioflavin T fluorescence assay, hIAPP (40 µM) had an average lag time of 1 h and a 1,000-fold increase in fluorescence by 2 h while pIAPP showed little increase in fluorescence after 20 h. Small peptide fragments of pIAPP also failed to aggregate. hIAPP was significantly more toxic to INS-1 cells than pIAPP (20-200 µM), asassessed by TUNEL (16 h) and Alamar blue (24 h). We also failed to detect amyloid in any (0/9) NPI transplanted into streptozotocin diabetic murine recipients, while human islets had extensive amyloid deposition by 8 weeks post-transplant, associated with graft failure.
Conclusion: Porcine IAPP, unlike human IAPP, is only weakly amyloidogenic and cytotoxic. We speculate that decreased fibrillogenicity of porcine compared to human IAPP may underlie the apparent enhanced survival andfunction of pig islet xenografts.
KJP is supported by aChild & Family – Rx & D & CIHR – UBC MD PhD Studentship and a MichaelSmith Foundation for Health Research Junior Trainee Award.
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Abstract
Genetic studies of the nematode Caenorhabditis elegans have uncovered four genes, egl-1 (BH3 only), ced-9 (Bcl-2 related), ced-4 (apoptosis protease activating factor-1), and ced-3 (caspase), which function in a linear pathway to promote developmental cell death in this organism. While this core pathway functions in many cells, recent studies suggest that additional regulators, acting on or in lieu of these core genes, can promote or inhibit the onset of cell death. Here, we discuss the evidence for these noncanonical mechanisms of C. elegans cell death control. We consider novel modes for regulating the core apoptosis genes, and describe a newly identified cell death pathway independent of all known C. elegans cell death genes. The existence of these noncanonical cell death programs suggests that organisms have evolved multiple ways to ensure appropriate cellular demise during development.
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Affiliation(s)
- E S Blum
- Laboratory of Developmental Genetics, The Rockefeller University, New York, NY 10065, USA
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Potter K, Abedini A, Baker R, Butterworth S, Driscoll M, Marek P, Korbutt G, Fraser P, Raleigh D, Verchere C. Lack of amyloidogenicity and altered prohormone processing of porcine islet amyloid polypeptide may promote function and survival of pig islet xenografts. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)24259-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jazwinski SM, Warner HR, Helfand S, Driscoll M, Welsh DA, Faulkner J, Barzilai N, Breitenbach M, McCarter R, Brown WT, Greco N, Mountz J, Olshansky SJ. The Biological Sciences Section Program at the 57th Annual Meeting of The Gerontological Society of America. J Gerontol A Biol Sci Med Sci 2005. [DOI: 10.1093/gerona/60.11.1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
One of the looming mysteries in signal transduction today is the question of how mechanical signals, such as pressure or mechanical force delivered to a cell, are interpreted to direct biological responses. All living organisms, and probably all cells, have the ability to sense and respond to mechanical stimuli. At the single-cell level, mechanical signaling underlies cell-volume control and specialized responses such as the prevention of poly-spermy in fertilization. At the level of the whole organism, mechanotransduction underlies processes as diverse as stretch-activated reflexes in vascular epithelium and smooth muscle; gravitaxis and turgor control in plants; tissue development and morphogenesis; and the senses of touch, hearing, and balance. Intense genetic, molecular, and elecrophysiological studies in organisms ranging from nematodes to mammals have highlighted members of the recently discovered DEG/ENaC family of ion channels as strong candidates for the elusive metazoan mechanotransducer. Here, we discuss the evidence that links DEG/ENaC ion channels to mechanotransduction and review the function of Caenorhabditis elegans members of this family called degenerins and their role in mediating mechanosensitive behaviors in the worm.
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Affiliation(s)
- N Tavernarakis
- Department of Molecular Biology and Biochemistry, Rutgers, The State University of New Jersey, New Brunswick, USA.
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Xu K, Tavernarakis N, Driscoll M. Necrotic cell death in C. elegans requires the function of calreticulin and regulators of Ca(2+) release from the endoplasmic reticulum. Neuron 2001; 31:957-71. [PMID: 11580896 DOI: 10.1016/s0896-6273(01)00432-9] [Citation(s) in RCA: 218] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In C. elegans, a hyperactivated MEC-4(d) ion channel induces necrotic-like neuronal death that is distinct from apoptosis. We report that null mutations in calreticulin suppress both mec-4(d)-induced cell death and the necrotic cell death induced by expression of a constitutively activated Galpha(S) subunit. RNAi-mediated knockdown of calnexin, mutations in the ER Ca(2+) release channels unc-68 (ryanodine receptor) or itr-1 (inositol 1,4,5 triphosphate receptor), and pharmacological manipulations that block ER Ca(2+) release also suppress death. Conversely, thapsigargin-induced ER Ca(2+) release can restore mec-4(d)-induced cell death when calreticulin is absent. We conclude that high [Ca(2+)](i) is a requirement for necrosis in C. elegans and suggest that an essential step in the death mechanism is release of ER-based Ca(2+) stores. ER-driven Ca(2+) release has previously been implicated in mammalian necrosis, suggesting necrotic death mechanisms may be conserved.
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Affiliation(s)
- K Xu
- Department of Molecular Biology and Biochemistry, A232, Nelson Biological Laboratories, Rutgers, The State University of New Jersey, 604 Allison Road, Piscataway, NJ 08855, USA
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29
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Tavernarakis N, Driscoll M. Degenerins. At the core of the metazoan mechanotransducer? Ann N Y Acad Sci 2001; 940:28-41. [PMID: 11458685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Mechanosensory signaling, believed to be mediated by mechanically gated ion channels, constitutes the basis for the senses of touch and hearing, and contributes fundamentally to the development and homeostasis of all organisms. Despite this profound importance in biology, little is known of the molecular identities or functional requirements of mechanically gated ion channels. Genetic analyses of touch sensation and locomotion in Caenorhabditis elegans have implicated a new class of ion channels, the degenerins (DEG) in nematode mechanotransduction. Related fly and vertebrate proteins, the epithelial sodium channel (ENaC) family, have been implicated in several important processes, including transduction of mechanical stimuli, pain sensation, gametogenesis, sodium reabsorption, and blood pressure regulation. Still-to-be-discovered DEG/ENaC proteins may compose the core of the elusive human mechanotransducer.
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Affiliation(s)
- N Tavernarakis
- Department of Molecular Biology and Biochemistry, Rutgers, State University of New Jersey, Piscataway, New Jersey 08855, USA.
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30
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Tavernarakis N, Everett JK, Kyrpides NC, Driscoll M. Structural and functional features of the intracellular amino terminus of DEG/ENaC ion channels. Curr Biol 2001; 11:R205-8. [PMID: 11301263 DOI: 10.1016/s0960-9822(01)00106-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Abstract
The nematode Caenorhabditis elegans has been shown to be an excellent model organism with which to study the mechanisms of programmed cell death because of its powerful genetics and the ability to study cell death with single-cell resolution. In this chapter, we describe methods that are commonly used to examine various aspects of programmed cell death in C. elegans. These methods, in combination with genetic analyses, have helped identify and characterize many components of the C. elegans cell death pathway, illuminating the mechanisms by which these components affect programmed cell death.
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Affiliation(s)
- D Ledwich
- Department of Molecular, Cellular, and Developmental Biology, University of Colorado at Boulder 80309-0437, USA
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32
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Chung S, Gumienny TL, Hengartner MO, Driscoll M. A common set of engulfment genes mediates removal of both apoptotic and necrotic cell corpses in C. elegans. Nat Cell Biol 2000; 2:931-7. [PMID: 11146658 DOI: 10.1038/35046585] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Similar to mammalian excitotoxic cell death, necrotic-like cell death (NCD) in Caenorhabditis elegans can be initiated by hyperactive ion channels. Here we investigate the requirements for genes that execute and regulate programmed cell death (PCD) in necrotic-like neuronal death caused by a toxic MEC-4 channel. Neither the kinetics of necrosis onset nor the total number of necrotic corpses generated is altered by any C. elegans mutation known to block PCD, which provides genetic evidence that the activating mechanisms for NCD and apoptotic cell death are distinct. In contrast, all previously reported ced genes required for phagocytotic removal of apoptotic corpses, as well as ced-12, a new engulfment gene we have identified, are required for efficient elimination of corpses generated by distinct necrosis-inducing stimuli. Our results show that a common set of genes acts to eliminate cell corpses irrespective of the mode of cell death, and provide the first identification of the C. elegans genes that are required for orderly removal of necrotic cells. As phagocytotic mechanisms seem to be conserved from nematodes to humans, our findings indicate that injured necrotic cells in higher organisms might also be eliminated before lysis through a controlled process of corpse removal, a hypothesis that has significant therapeutic implications.
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Affiliation(s)
- S Chung
- Department of Molecular Biology and Biochemistry, Nelson Biological Laboratories, Rutgers University, 604 Allison Road, Piscataway, New Jersey 08854, USA
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33
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Panter AT, Huba GJ, Melchior LA, Anderson D, Driscoll M, Rohweder C, Henderson H, Henderson R, Zalumas J. Healthcare provider characteristics and perceived confidence from HIV/AIDS education. AIDS Patient Care STDS 2000; 14:603-14. [PMID: 11155902 DOI: 10.1089/10872910050193789] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study reports findings from six training projects designed to keep health providers up-to-date on emerging developments and approaches in HIV/AIDS care. Participants were 3,779 individuals who described themselves, their professional background, and their specific experience in the HIV/AIDS field. These characteristics were compared with their self-reported confidence in managing clients, counseling clients, providing services, and the training topics. A repeated-measures design examining level and change of confidence showed little support for links between provider characteristics and confidence due to HIV/AIDS training experience. Thus, knowing a provider's background does not necessarily provide diagnostic information about who might most benefit in improved confidence from HIV/AIDS educational training. These results suggest that HIV/AIDS training programs may be targeted broadly-to a wide range of healthcare providers of diverse backgrounds-with little or no impact on overall levels and changes in provider confidence.
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Affiliation(s)
- A T Panter
- University of North Carolina, Chapel Hill, USA.
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35
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Huba GJ, Panter AT, Melchior LA, Zalumas J, Uldall KK, Henderson R, Henderson H, German VF, Driscoll M, Anderson D, Lalonde B. Do characteristics of HIV/AIDS education and training affect perceived training quality? Lessons from the evaluation of seven projects. AIDS Educ Prev 2000; 12:455-476. [PMID: 11063064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Initial and continuing HIV/AIDS education and training has been a critical way to bring the nation's health providers up to date on emerging developments and approaches. This study reports cross-cutting findings from seven HIV/AIDS education and training projects. Trainers described over 600 training sessions from these projects in terms of their structural characteristics and design elements, while trainees described these sessions on several dimensions related to training quality. Training characteristics were compared to trainee assessments of training quality. Using a decision-tree analytic approach for major training attributes, considerable support emerged for links between training characteristics and perceived quality of the HIV/AIDS training experience. More favorable quality ratings were associated with certain projects, the training setting, the types of trainees served by the training, the intended training impact, discussion of special populations, and training methods involving interactive learning. With increased knowledge regarding how these educational experiences relate to the ways they are perceived and processed, more targeted approaches to training design on HIV/AIDS can be developed.
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Affiliation(s)
- G J Huba
- The Measurement Group, Culver City, California 90230, USA.
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36
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Affiliation(s)
- L A Herndon
- Department of Molecular Biology and Biochemistry, Nelson Biological Laboratories, Rutgers University, Piscataway, NJ 08854, USA
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37
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Panter AT, Huba GJ, Melchior LA, Anderson D, Driscoll M, German VF, Henderson H, Henderson R, Lalonde B, Uldall KK, Zalumas J. Trainee characteristics and perceptions of HIV/AIDS training quality. Eval Health Prof 2000; 23:149-71. [PMID: 10947522 DOI: 10.1177/016327870002300202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
HIV/AIDS education and training have played a vital role in keeping health providers up to date on emerging developments and approaches. This study reports findings from seven HIV/AIDS education and training projects. Participants in more than 600 training sessions described themselves, their professional background, and their general reasons for taking the training. Immediately following the training, they also rated the quality of their educational experience along several dimensions. Trainee characteristics were related to assessments of training quality, using a regression decision-tree analytic approach. Although effect sizes were generally small, quality ratings of the HIV/AIDS training experiences were associated with certain projects, basic trainee demographic characteristics, professional background, and experience in the HIV field. Greater understanding about participant characteristics can provide clues about how these training experiences are perceived and processed and may inform decision making about instructional HIV/AIDS curricula.
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Affiliation(s)
- A T Panter
- University of North Carolina, Chapel Hill, USA.
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38
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Huba GJ, Panter AT, Melchior LA, Anderson D, Colgrove J, Driscoll M, German VF, Henderson H, Henderson R, Lalonde B, Rahimian A, Rohweder C, Uldall KK, Wolfe L, Zalumas J. Effects of HIV/AIDS education and training on patient care and provider practices: a cross-cutting evaluation. AIDS Educ Prev 2000; 12:93-112. [PMID: 10833036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Initial and continuing training in HIV/AIDS service provision is a critical way to enable the nation's health providers to use state-of-the-art developments and perspectives. Typically, the efficacy of HIV/AIDS training programs is evaluated using assessments administered to trainees immediately following the training. This study reports cross-cutting findings from telephone interviews conducted with 218 trainees an average of 8 months after training. Long-term training effects are examined in three domains: (a) general perspectives on HIV/AIDS; (b) health care provider service provision; and (c) changes in procedures and operations at the health care system level. The findings show the different ways that the training experience had long-term positive and observable effects in these three domains. In some cases, background characteristics and job positions predicted the specific type of reported training effects. The pattern of results suggests ways in which training methods can be targeted to specific audiences.
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Affiliation(s)
- G J Huba
- The Measurement Group, Culver City, CA 90230, USA.
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39
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Hong K, Mano I, Driscoll M. In vivo structure-function analyses of Caenorhabditis elegans MEC-4, a candidate mechanosensory ion channel subunit. J Neurosci 2000; 20:2575-88. [PMID: 10729338 PMCID: PMC6772260] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/1999] [Revised: 01/19/2000] [Accepted: 01/26/2000] [Indexed: 02/15/2023] Open
Abstract
Mechanosensory signaling mediated by mechanically gated ion channels constitutes the basis for the senses of touch and hearing and contributes fundamentally to the development and homeostasis of all organisms. Despite this profound importance in biology, little is known of the molecular identities or functional requirements of mechanically gated ion channels. We report a genetically based structure-function analysis of the candidate mechanotransducing channel subunit MEC-4, a core component of a touch-sensing complex in Caenorhabditis elegans and a member of the DEG/ENaC superfamily. We identify molecular lesions in 40 EMS-induced mec-4 alleles and further probe residue and domain function using site-directed approaches. Our analysis highlights residues and subdomains critical for MEC-4 activity and suggests possible roles of these in channel assembly and/or function. We describe a class of substitutions that disrupt normal channel activity in touch transduction but remain permissive for neurotoxic channel hyperactivation, and we show that expression of an N-terminal MEC-4 fragment interferes with in vivo channel function. These data advance working models for the MEC-4 mechanotransducing channel and identify residues, unique to MEC-4 or the MEC-4 degenerin subfamily, that might be specifically required for mechanotransducing function. Because many other substitutions identified by our study affect residues conserved within the DEG/ENaC channel superfamily, this work also provides a broad view of structure-function relations in the superfamily as a whole. Because the C. elegans genome encodes representatives of a large number of eukaryotic channel classes, we suggest that similar genetic-based structure-activity studies might be generally applied to generate insight into the in vivo function of diverse channel types.
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Affiliation(s)
- K Hong
- Department of Molecular Biology and Biochemistry, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854, USA
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40
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Fricke B, Lints R, Stewart G, Drummond H, Dodt G, Driscoll M, von Düring M. Epithelial Na+ channels and stomatin are expressed in rat trigeminal mechanosensory neurons. Cell Tissue Res 2000; 299:327-34. [PMID: 10772247 DOI: 10.1007/s004419900153] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Caenorhabditis elegans MEC-4 and MEC-10 are subunits of the degenerin/epithelial Na+ channel (DEG/ENaC) ion channel superfamily thought to be associated with MEC-2 (a stomatin-like protein) in a mechanotransducing molecular complex in specialized touch sensory neurons. A key question is whether analogous molecular complexes in higher organisms transduce mechanical signals. To address this question, we selected mechanoreceptors of the rat vibrissal follicle-sinus complex in the mystacial pad and the trigeminal ganglia for an immunocytochemical and molecular biological study. RT-PCR of poly(A+) mRNA of rat trigeminal ganglia indicated that alpha-, beta-, and gamma-ENaC and stomatin mRNA are expressed in rat trigeminal ganglia. Using immunocytochemistry, we found that alpha-, beta-, and gamma-ENaC subunits and stomatin are localized in the perikarya of the trigeminal neurons and in a minor fraction of their termination site in the vibrissal follicle-sinus complex, where longitudinal lanceolate endings are immunopositive. We conclude that alpha-, beta-, and gamma-ENaC subunits as well as the candidate interacting protein stomatin are coexpressed in a mammalian mechanoreceptor, a location consistent with a possible role in mechanotransduction.
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Affiliation(s)
- B Fricke
- Department of Neuroanatomy, Institute of Anatomy MA6/152, Ruhr University, Bochum, Germany.
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41
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Tavernarakis N, Wang SL, Dorovkov M, Ryazanov A, Driscoll M. Heritable and inducible genetic interference by double-stranded RNA encoded by transgenes. Nat Genet 2000; 24:180-3. [PMID: 10655066 DOI: 10.1038/72850] [Citation(s) in RCA: 335] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Double-stranded RNA interference (RNAi) is an effective method for disrupting expression of specific genes in Caenorhabditis elegans and other organisms. Applications of this reverse-genetics tool, however, are somewhat restricted in nematodes because introduced dsRNA is not stably inherited. Another difficulty is that RNAi disruption of late-acting genes has been generally less consistent than that of embryonically expressed genes, perhaps because the concentration of dsRNA becomes lower as cellular division proceeds or as developmental time advances. In particular, some neuronally expressed genes appear refractory to dsRNA-mediated interference. We sought to extend the applicability of RNAi by in vivo expression of heritable inverted-repeat (IR) genes. We assayed the efficacy of in vivo-driven RNAi in three situations for which heritable, inducible RNAi would be advantageous: (i) production of large numbers of animals deficient for gene activities required for viability or reproduction; (ii) generation of large populations of phenocopy mutants for biochemical analysis; and (iii) effective gene inactivation in the nervous system. We report that heritable IR genes confer potent and specific gene inactivation for each of these applications. We suggest that a similar strategy might be used to test for dsRNA interference effects in higher organisms in which it is feasible to construct transgenic animals, but impossible to directly or transiently introduce high concentrations of dsRNA.
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Affiliation(s)
- N Tavernarakis
- Department of Molecular Biology and Biochemistry, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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42
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Driscoll M, Maloki L, Parker TE. Introduction to the special issue on frequency control and precision timing. IEEE Trans Ultrason Ferroelectr Freq Control 2000; 47:315-316. [PMID: 18238545 DOI: 10.1109/58.827415] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- M Driscoll
- Northrop Grumman, Electronic Sensors and Systems Sector, Blatimore, MD
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43
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Driscoll M, Maleki L, Parker TE. Introduction to the special issue on frequency control and precision timing-part II. IEEE Trans Ultrason Ferroelectr Freq Control 2000; 47:1091-1092. [PMID: 18238644 DOI: 10.1109/tuffc.2000.869033] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- M Driscoll
- Northrop Grumman Electronic Sensors and Systems
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44
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Tavernarakis N, Driscoll M. Caenorhabditis elegans degenerins and vertebrate ENaC ion channels contain an extracellular domain related to venom neurotoxins. J Neurogenet 2000; 13:257-64. [PMID: 10858823 DOI: 10.3109/01677060009084497] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The DEG/ENaC (DEGenerin/Epithelial Na+ Channel) superfamily includes closely related ion channel subunits from divergent species ranging from the simple nematode Caenorhabditis elegans to humans. Members of this protein group play roles in several important processes including transduction of mechanical stimuli, sodium re-absorption and blood pressure regulation. Structure/function relationships in members of this superfamily are just beginning to be elaborated. Using a bio-informatics approach, we identified a novel structural element in the extracellular region of DEG/ENaC proteins that exhibits significant similarity to venom neurotoxins. Since venom neurotoxins bind to sodium channels at high affinity, we suggest that the related domain embedded in DEG/ENaC channels may interact with other regions of the channel or channel complex to modulate channel function.
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Affiliation(s)
- N Tavernarakis
- Department of Molecular Biology and Biochemistry, Nelson Biological Laboratories, Rutgers University, Piscataway, NJ 08855, USA.
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45
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Henderson H, German VF, Panter AT, Huba GJ, Rohweder C, Zalumas J, Wolfe L, Uldall KK, Lalonde B, Henderson R, Driscoll M, Martin S, Duggan S, Rahimian A, Melchior LA. Systems change resulting from HIV/AIDS education and training. A cross-cutting evaluation of nine innovative projects. Eval Health Prof 1999; 22:405-26. [PMID: 10623398 DOI: 10.1177/01632789922034383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An evaluation of nine diverse HIV/AIDS training programs assessed the degree to which the programs produced changes in the ways that health care systems deliver HIV/AIDS care. Participants were interviewed an average of 8 months following completion of training and asked for specific examples of a resulting change in their health care system. More than half of the trainees gave at least one example of a systems change. The examples included the way patient referrals are made, the manner in which agency collaborations are organized, and the way care is delivered.
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Affiliation(s)
- H Henderson
- University of Mississippi Medical Center, USA
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46
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Winnier AR, Meir JY, Ross JM, Tavernarakis N, Driscoll M, Ishihara T, Katsura I, Miller DM. UNC-4/UNC-37-dependent repression of motor neuron-specific genes controls synaptic choice in Caenorhabditis elegans. Genes Dev 1999; 13:2774-86. [PMID: 10557206 PMCID: PMC317130 DOI: 10.1101/gad.13.21.2774] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The UNC-4 homeoprotein and the Groucho-like corepressor UNC-37 specify synaptic choice in the Caenorhabditis elegans motor neuron circuit. In unc-4 mutants, VA motor neurons are miswired with inputs from interneurons normally reserved for their lineal sisters, the VB motor neurons. Here we show that UNC-4 and UNC-37 function together in VA motor neurons to repress VB-specific genes and that this activity depends on physical contact between UNC-37 and a conserved Engrailed-like repressor domain (eh1) in UNC-4. Missense mutations in the UNC-4 eh1 domain disrupt interactions between UNC-4 and UNC-37 and result in the loss of UNC-4-dependent repressor activity in vivo. A compensatory amino acid substitution in UNC-37 suppresses specific unc-4 alleles by restoring physical interactions with UNC-4 as well as UNC-4-dependent repression of VB-specific genes. We propose that repression of VB-specific genes by UNC-4 and UNC-37 is necessary for the creation of wild-type inputs to VA motor neurons. The existence of mammalian homologs of UNC-4 and UNC-37 indicates that a similar mechanism could regulate synaptic choice in the vertebrate spinal cord.
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Affiliation(s)
- A R Winnier
- Department of Cell Biology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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47
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Tavernarakis N, Driscoll M, Kyrpides NC. The SPFH domain: implicated in regulating targeted protein turnover in stomatins and other membrane-associated proteins. Trends Biochem Sci 1999; 24:425-7. [PMID: 10542406 DOI: 10.1016/s0968-0004(99)01467-x] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- N Tavernarakis
- Department of Molecular Biology and Biochemistry Rutgers, The State University of New Jersey, New Jersey, USA.
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48
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Abstract
To the surprise of many, studies of molecular mechanisms of touch transduction and analyses of epithelial Na+ transport have converged to define a new class of ion channel subunits. Based on the names of the first two identified subfamilies, the Caenorhabditis elegans degenerins and the vertebrate epithelial amiloride-sensitive Na+ channel, this ion channel class is called the DEG/ENaC superfamily. Members of the DEG/ENaC superfamily have been found in nematodes, flies, snails, and vertebrates. Family members share common topology, such that they span the membrane twice and have intracellular N- and C-termini; a large extracellular loop includes a conserved cysteine-rich region. DEG/ENaC channels have been implicated a broad spectrum of cellular functions, including mechanosensation, proprioception, pain sensation, gametogenesis, and epithelial Na+ transport. These channels exhibit diverse gating properties, ranging from near constitutive opening to rapid inactivation. We discuss working understanding of DEG/ENaC functions, channel properties, structure/activity correlations and possible evolutionary relationship to other channel classes.
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Affiliation(s)
- I Mano
- Department of Molecular Biology and Biochemistry, Rutgers, State University of New Jersey, Piscataway 08854, USA
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49
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Rodman J, Weill K, Driscoll M, Fenton T, Alpert H, Salem-Schatz S, Palfrey JS. A nationwide survey of financing health-related services for special education students. J Sch Health 1999; 69:133-139. [PMID: 10354981 DOI: 10.1111/j.1746-1561.1999.tb04169.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Individuals with Disability Education Act (IDEA) requires state educational systems to provide school-based, health related services (RS). This survey determined the financing arrangements used by states for health-related services for school-aged children with disabilities. A survey was sent to directors of special education, Medicaid, and public health departments in each of the 50 states. Financial patterns for RS were sought at the state level for children ages 3-21 with disabilities for the 1993-1994 school year, the most recent year for which complete financial data were available. Univariate analyses probed the relationship between systems' variables and the extent of Medicaid usage by local education agencies. Respondents reported that schools tapped traditional health resources to supplement educational dollars in paying for related services in schools. Medicaid was by far the most common source with 29 states reporting established mechanisms for recouping Medicaid dollars and 10 states reporting phase-in activities. Seventeen states reported that departments of public health played some role in administration, training, and demonstrations, but only six states provided specific dollars for related services through the department. Use of private insurance was reported sporadically with only one state indicating a specific state-level program. Correlates of increased Medicaid usage were presence of interagency agreements (IAAs) (OR 11.1, p = 0.002), having specific personnel for school-based medical assistance (OR 17.7, p = 0.001), and utilizing school nursing services as a Medicaid optional service (OR 4.2, p = 0.048).
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Affiliation(s)
- J Rodman
- SMH Physician Service, Inc., Tamiami Trail, Nokomis, FL 34275, USA
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Rahimian A, Driscoll M, Taylor D. The maternal and child health sites' practices regarding HIV education, counseling, and testing of women of reproductive age in Chicago: barriers to universal implementation. Matern Child Health J 1998; 2:35-44. [PMID: 10728257 DOI: 10.1023/a:1021893525536] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Women of reproductive age are increasingly at risk for human immunodeficiency virus (HIV) infection. Recent advances in reducing perinatal transmission have resulted in official guidelines on universal HIV education, counseling, and voluntary testing of women of reproductive age, especially pregnant women. This study assesses to what extent the maternal child health (MCH) sites are implementing these guidelines with their female patient population (including pregnant women) and examines the barriers that prevent them from implementing these guidelines. METHOD The study uses survey data from 92 hospitals and community health centers offering MCH services in Chicago regarding their providers' practices on HIV education, counseling, and testing, implementation of zidovudine (ZDV) therapy to reduce perinatal transmission, and the barriers to implementing these services. In addition, 20 taped in-depth interviews were conducted with experts to examine the barriers to universal implementation. RESULTS Almost half (45% of perinatal care and 50% of family planning providers) of the institutions are not consistently offering HIV testing. One-third of those institutions that offer testing are not offering pretest counseling. Thirty-nine percent of the perinatal care providers in these institutions are not providing posttest counseling to HIV-negative women. Over one-third (35%) of these institutions reported that they are not set up to implement ZDV therapy during labor and delivery. Almost half (49%) had no protocols for ZDV therapy in place. Barriers to implementation included lack of provider training, limited staff time, physician resistance, unavailability or avoidance to seek perinatal care by high-risk women, cost, absence of a statewide and hospital-specific plan, lack of reproductive choice focus in posttest counseling, lack of provider knowledge about the administration of ZDV or its availability during labor, and lack of consumer education on perinatal risk reduction. CONCLUSIONS MCH sites and their providers need assistance to overcome many barriers they face to implement universal HIV education, counseling, and testing of women of reproductive age.
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Affiliation(s)
- A Rahimian
- University of Illinois at Chicago, School of Public Health, Division of Epidemiology/Biostatistics (M/C 922) 60612, USA.
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