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Tuvia G, Burshtein A, Silber I, Aharony A, Entin-Wohlman O, Goldstein M, Dagan Y. Enhanced Nonlinear Response by Manipulating the Dirac Point at the (111) LaTiO_{3}/SrTiO_{3} Interface. Phys Rev Lett 2024; 132:146301. [PMID: 38640380 DOI: 10.1103/physrevlett.132.146301] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Tunable spin-orbit interaction (SOI) is an important feature for future spin-based devices. In the presence of a magnetic field, SOI induces an asymmetry in the energy bands, which can produce nonlinear transport effects (V∼I^{2}). Here, we focus on such effects to study the role of SOI in the (111) LaTiO_{3}/SrTiO_{3} interface. This system is a convenient platform for understanding the role of SOI since it exhibits a single-band Hall response through the entire gate-voltage range studied. We report a pronounced rise in the nonlinear longitudinal resistance at a critical in-plane field H_{cr}. This rise disappears when a small out-of-plane field component is present. We explain these results by considering the location of the Dirac point formed at the crossing of the spin-split energy bands. An in-plane magnetic field pushes this point outside of the Fermi contour, and consequently changes the symmetry of the Fermi contours and intensifies the nonlinear transport. An out-of-plane magnetic field opens a gap at the Dirac point, thereby significantly diminishing the nonlinear effects. We propose that magnetoresistance effects previously reported in interfaces with SOI could be comprehended within our suggested scenario.
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Affiliation(s)
- G Tuvia
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - A Burshtein
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - I Silber
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - A Aharony
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - O Entin-Wohlman
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
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Silber I, Mathimalar S, Mangel I, Nayak AK, Green O, Avraham N, Beidenkopf H, Feldman I, Kanigel A, Klein A, Goldstein M, Banerjee A, Sela E, Dagan Y. Two-component nematic superconductivity in 4Hb-TaS 2. Nat Commun 2024; 15:824. [PMID: 38280890 PMCID: PMC10821864 DOI: 10.1038/s41467-024-45169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
Most superconductors have an isotropic, single component order parameter and are well described by the standard (BCS) theory for superconductivity. Unconventional, multiple-component superconductors are exceptionally rare and are much less understood. Here, we combine scanning tunneling microscopy and angle-resolved macroscopic transport for studying the candidate chiral superconductor, 4Hb-TaS2. We reveal quasi-periodic one-dimensional modulations in the tunneling conductance accompanied by two-fold symmetric superconducting critical field. The strong modulation of the in-plane critical field, Hc2, points to a nematic, unconventional order parameter. However, the imaged vortex core is isotropic at low temperatures. We suggest a model that reconciles this apparent discrepancy and takes into account previously observed spontaneous time-reversal symmetry breaking at low temperatures. The model describes a competition between a dominating chiral superconducting order parameter and a nematic one. The latter emerges close to the normal phase. Our results strongly support the existence of two-component superconductivity in 4Hb-TaS2 and can provide valuable insights into other systems with coexistent charge order and superconductivity.
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Affiliation(s)
- I Silber
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - S Mathimalar
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Mangel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A K Nayak
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - O Green
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - N Avraham
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - H Beidenkopf
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Feldman
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Kanigel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Klein
- Department of Physics, Faculty of Natural Sciences, Ariel University, Ariel, 40700, Israel
- Department of Chemical Physics, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - A Banerjee
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - E Sela
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel.
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LeCompte MC, Chen H, Shaaban S, Goldstein M, Lubelski D, Kleinberg LR, Hooker T, Li H, Redmond KJ. RBE Model Based Proton Planning of Stereotactic Body Radiotherapy for Spine Metastasis: A Dosimetric Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e124-e125. [PMID: 37784677 DOI: 10.1016/j.ijrobp.2023.06.917] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Study of proton stereotactic body radiotherapy (SBRT) for spine metastasis is limited, largely due to theorized increased risk of spinal cord injury with higher end of range RBE. Though the 1.1 RBE constant for proton beam is clinically used, data indicate that proton RBE is variable and dependent on technical-, tissue-, and patient-factors. To better understand safety of proton SBRT for spine metastasis, we performed a dosimetric analysis comparing plans delivered by photon robotic technique versus intensity modulated proton therapy (IMPT) and accounting for RBE weighted dose. MATERIALS/METHODS A total of 9 patients with spine metastasis (3 cervical, 3 thoracic, 3 lumbar) previously treated with a frameless robotic radiosurgery system (Sunnyvale, CA) were identified. Each level contained a case with paraspinal extension, a reirradiation case, and a case with epidural extension (Bilsky grade ≥1c) as such cases in current practice often require planning target volume (PTV) under-coverage in order to meet organ at risk (OAR) dose constraints. Given these challenges, selected cases were clinically treated with 30 Gy in 5 fractions despite an institutional preference of further dose escalation. Comparative IMPT plans were generated using 30 GyE in 5 fractions and 1.1 RBE constant. IMPT plans were then made using 1.1 RBE and 45 GyE in 5 fractions: a prescription dose associated with a 2-yr local control rate of 95% on prior tumor control probability modelling. A treatment planning system was used to separately generate and optimize RBE weighted plans based on Carabe-, McNamara-, or Wedenberg models for prescription doses of 30 GyE and 45 GyE. IMPT plans used robust optimization parameters of ± 3.5% range and 2-mm setup uncertainties. PTV coverage and OAR sparing were compared using Wilcoxon signed-rank tests. RESULTS PTV coverage (PTV volume receiving prescription dose) was significantly improved with IMPT at 30 GyE / 1.1 RBE (median PTV V30: 93%) compared to CK at 30 Gy (median: 88.5%, p = .02). PTV coverage was similar when comparing CK at 30 Gy with IMPT at 45 GyE / 1.1 RBE (median PTV V45: 90%, p = .23). When comparing maximum spinal cord dose (cord Dmax), there was improved OAR sparing with IMPT at 30 GyE / 1.1 RBE (median: 17.6 GyE, p = .04) and IMPT at 45 GyE / 1.1 RBE (median: 16.1 GyE, p = .04) when respectively compared to CK at 30 Gy (median: 18 Gy). No difference was seen in cord Dmax when comparing CK at 30 Gy to RBE weighted plans at 30 GyE using Carabe- (median: 17.3 GyE, p = .22), McNamara- (median: 17.4 GyE, p = .22), or Wedenberg (median: 17.0 GyE, p = .08) model. Median cord Dmax values for RBE weighted plans at 45 GyE were numerically equivalent. The average increase in variable RBE plans' maximum dose compared to fixed RBE plans was 105.3% +/- 3.5%. CONCLUSION We report the first dosimetric analysis of proton SBRT for spine metastasis using variable RBE dose models. IMPT may provide improved target coverage and better sparing of adjacent OARs compared to CK though fixed RBE computation may underestimate maximum dose to adjacent OARs.
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Affiliation(s)
- M C LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Shaaban
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Goldstein
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T Hooker
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - H Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Kong AM, Winer IH, Zimmerman NM, Diakun D, Bloomfield A, Gonzales T, Fergie J, Goldstein M, Krilov LR. Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data. Am J Perinatol 2023; 40:1529-1536. [PMID: 34704241 PMCID: PMC10556298 DOI: 10.1055/s-0041-1736581] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks of gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. STUDY DESIGN A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November-March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. RESULTS There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67-2.27, p <0.001; 1.70, 95% CI: 1.55-1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. CONCLUSION We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. KEY POINTS · Immunoprophylaxis rates decreased after the 2014 American Academy of Pediatrics guidelines update.. · Rate of RSV hospitalization increased among preterm infants after the 2014 AAP guidelines update.. · Increase in RSV hospitalization persisted for at least 5 years after AAP guidelines update..
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Affiliation(s)
- Amanda M. Kong
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | | | | | - David Diakun
- IBM Watson Health, Life Sciences Division, Cambridge, Massachusetts
| | - Adam Bloomfield
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Tara Gonzales
- Swedish Orphan Biovitrum Sobi, NA, Medical Affairs, Waltham, Massachusetts
| | - Jaime Fergie
- Infectious Diseases Service, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California
| | - Leonard R. Krilov
- Department of Pediatrics, NYU Langone Hospital—Long Island, and the NYU Long Island School of Medicine, Mineola, New York
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Goldstein M, Gabriel N, Buchser W, Sentmanat M, Markovina S, Schwarz JK, Cui X. HPV Infection Causes Dependence on Alternative DNA Damage Response Pathways Providing Cancer Specific Targets for Radiosensitization. Int J Radiat Oncol Biol Phys 2023; 117:e231-e232. [PMID: 37784926 DOI: 10.1016/j.ijrobp.2023.06.1147] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cancer-specific radiosensitization is an attractive approach to improving the efficacy of radiotherapy. However, drugs targeting ubiquitous DNA damage response pathways are not cancer specific and can increase radiation related side effects. Thus, there is an unmet need for tumor specific molecular targets. This approach requires an identification of DNA damage signaling pathways that are unique to cancer cells. We hypothesized that by expressing its genome in the host cells HPV infection can rewire DNA damage signaling making HPV-positive tumor cells dependent on alternative pathways to survive radiation, which can be exploited for radiosensitization of HPV-induced cancers. MATERIALS/METHODS We have performed a CRISPR/Cas9 screen in HPV-positive SiHa cells that either express HPV16 proteins E6 and E7 or contain a selective knock-out of E6 or E7. We used next-generation sequencing to determine the abundance of gRNA in cells that were mock-treated or irradiated. We identified genes that were required for survival of radiation specifically in the context of E6 or E7 expression. Results of the screen were validated by generating knock-outs of the discovered genes using CRISPR/Cas9. By applying an array of molecular tools to analyze cell survival, cell cycle progression and mitotic progression we assessed the role of these genes in radiation response in HPV-positive cancer cells. RESULTS We have identified genes that are required for survival of radiation-induced DNA damage in the context of either E6 or E7 expression. We demonstrate that targeting these genes results in hypersensitization of cervical cancer cells to radiation specifically in the presence of E6 or E7. We show that the gene product required for survival in E6-expressing cells is critical for mitotic progression after radiation exposure serving as a member of a protein complex stabilizing the attachment of mitotic spindle to centromeres. CONCLUSION We have uncovered specific genes that are critical for DNA damage response and cell survival after radiation exposure in HPV-positive cells. Our findings suggest that expression of the HPV proteins E6 and E7 rewires DNA damage signaling causing dependence on alternative response pathways. We propose that these pathways can be targeted for a tumor-specific radiosensitization of HPV-induced cancers.
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Affiliation(s)
- M Goldstein
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N Gabriel
- Washington University, Department of Radiation Oncology, St. Louis, MO
| | - W Buchser
- Washington University in St. Louis, St. Louis, MO
| | - M Sentmanat
- Washington University in St. Louis, St. Louis, MO
| | - S Markovina
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J K Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - X Cui
- Washington University in St. Louis, St. Louis, MO
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Provenzano N, Trimble ET, Zeitzer K, Williamson C, Goldstein M. A Once-Thought Lipoma Turned Malignant Chondroid Syringoma. Cureus 2023; 15:e37526. [PMID: 37193437 PMCID: PMC10182779 DOI: 10.7759/cureus.37526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2023] [Indexed: 05/18/2023] Open
Abstract
Chondroid syringoma is a relatively rare benign skin appendageal tumor with an incidence of <0.098%. Malignant chondroid syringoma (MCS) arises from cutaneous sweat glands and occurs on the extremities or trunk more commonly in women with only 51 reported cases. Due to the rarity of the disease and lack of published cases of MCS, the diagnostic criteria and treatment protocols are not clear. Based on available recommendations and histological criteria, MCS was diagnosed in a previously classified elbow lipoma following increased size and pain, and skin color changes in a 65-year-old woman.
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Affiliation(s)
- Noelle Provenzano
- Internal Medicine, Einstein Medical Center Montgomery, East Norriton, USA
| | - Emerson T Trimble
- Family Medicine, Touro College of Osteopathic Medicine, New York, USA
| | - Kenneth Zeitzer
- Radiation Oncology, Einstein Medical Center Montgomery, East Norriton, USA
| | | | - Mitchell Goldstein
- Hematology and Medical Oncology, Einstein Medical Center Montgomery, East Norriton, USA
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DeVylder JE, Ryan TC, Cwik M, Wilson ME, Jay S, Nestadt PS, Goldstein M, Wilcox HC. Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department. Focus (Am Psychiatr Publ) 2023; 21:217-224. [PMID: 37201139 PMCID: PMC10172558 DOI: 10.1176/appi.focus.23021007] [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] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design Setting and Participants In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure Positive ASQ screen at baseline ED visit. Main Outcomes and Measures The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results The complete sample was 15003 youths (7044 47.0%] male; 10209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.Appeared originally in JAMA Netw Open 2019; 2:e1914070.
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Affiliation(s)
- Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Taylor C Ryan
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mary Cwik
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mary Ellen Wilson
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Samantha Jay
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Paul S Nestadt
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Mitchell Goldstein
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
| | - Holly C Wilcox
- Graduate School of Social Service, Fordham University, New York, New York (DeVylder); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Ryan, Nestadt, Wilcox); Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Cwik); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland (Cwik, Nestadt, Wilcox); Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Wilson, Goldstein); Department of Psychology, University of Maryland Baltimore County, Baltimore (Jay)
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Packnett ER, Winer IH, Larkin H, Oladapo A, Gonzales T, Wojdyla M, Goldstein M, Smith VC. RSV-related hospitalization and outpatient palivizumab use in very preterm (born at <29 wGA) infants: 2003-2020. Hum Vaccin Immunother 2022; 18:2140533. [PMID: 36412253 DOI: 10.1080/21645515.2022.2140533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of bronchiolitis and pneumonia in children under one year and a leading cause of infant hospitalization. Palivizumab was approved by the FDA in 1998 as RSV immunoprophylaxis to prevent severe RSV disease in children with specific health conditions and those born at <35 weeks gestational age (wGA). This study compared RSV-related hospitalization (RSVH) and RSVH characteristics in very preterm (<29 wGA) and term (>37 wGA) infants. Using the MarketScan Commercial and Multi-State Medicaid administrative claims databases, infants born between 7/1/2003 and 6/30/2020 were identified and classified as very preterm or term. Infants with evidence of health conditions, such as congenital heart disease and cystic fibrosis, were excluded. During 2003-2020 RSV seasons (November to March), claims incurred by infants while they were <12 months old were evaluated for outpatient administration of palivizumab and RSVH. The study included 40,123 very preterm infants and 4,421,942 term infants. Rate of RSVH in very preterm infants ranged 1.5-3.8 per 100 infant-seasons in commercially insured infants and 3.5-8.4 in Medicaid insured infants and were inversely related to wGA at birth. Relative risk of RSVH in very preterm was 3-4 times higher, and ICU admissions and mechanical ventilation were more common during RSVH in very preterm infants relative to term infants. However, these outcomes were less common or less severe in very preterm infants who received outpatient palivizumab administration, despite evidence of higher baseline risk of RSVH in these infants.
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Affiliation(s)
| | - Isabelle H Winer
- Real World Data Research & Analytics, Merative, Cambridge, MA, USA
| | - Heather Larkin
- Real World Data Research & Analytics, Merative, Cambridge, MA, USA
| | | | | | | | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Vincent C Smith
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
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9
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Angeles DM, Boskovic DS, Deming D, Hopper A, Peverini R, Czynski A, Hoch E, Phillips R, Tan JB, Camberos V, Bahjri K, Pegis P, Goldstein M, Truong G, Fayard E. A pilot study on the biochemical effects of repeated administration of 24% oral sucrose vs. 30% oral dextrose on urinary markers of adenosine triphosphate degradation. J Perinatol 2021; 41:2761-2765. [PMID: 34671099 DOI: 10.1038/s41372-021-01239-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/26/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Premature neonates often receive oral sucrose or dextrose before tissue-damaging procedures (TDPs). Previous work showed that a single dose of sucrose, but not dextrose, increased cellular energy utilization and ATP degradation. This pilot study probes the effects of repeated administration of sucrose or dextrose on energy metabolism. METHODS Urinary markers of ATP metabolism (hypoxanthine, xanthine, uric acid) are measured in premature neonates randomized to receive: (a) standard of care, (b) 0.2 ml 24% oral sucrose, or (c) 0.2 ml 30% oral dextrose, before every painful procedure on days-of-life 3-7. RESULTS Standard of care is associated with highest xanthine/creatinine and uric acid/creatinine, likely because of fewer pain treatments. Benefits of repeated oral sucrose are unclear. Neonates receiving oral dextrose had lower xanthine/creatinine and uric acid/creatinine. CONCLUSIONS Repeated treatments of neonatal procedural pain with 30% oral dextrose are less energetically demanding. Larger clinical studies are needed for comparison with sucrose treatments.
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Affiliation(s)
- Danilyn M Angeles
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA.
| | - Danilo S Boskovic
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Douglas Deming
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andrew Hopper
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ricardo Peverini
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Adam Czynski
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Erin Hoch
- Neonatal Intensive Care Unit, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Raylene Phillips
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - John B Tan
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Victor Camberos
- Department of Basic Sciences, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Khaled Bahjri
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University, Loma Linda, CA, USA
| | - Priscilla Pegis
- Neonatal Intensive Care Unit, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Giang Truong
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Elba Fayard
- Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
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10
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Goldstein M, Harding B, Fayard E. Guidance for palivizumab prophylaxis and implications for compliance. Pediatr Pulmonol 2021; 56:3575-3576. [PMID: 34547834 DOI: 10.1002/ppul.25634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Mitchell Goldstein
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Benjamin Harding
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA
| | - Elba Fayard
- Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, California, USA
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11
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Goldstein M, Saxena S. M285 EXERCISE-INDUCED LARYNGOPHARYNGEAL REFLUX (EILPR). Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.393] [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: 11/16/2022]
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12
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Goldstein M, Krilov LR, Fergie J, Brannman L, Wade SW, Kong AM, Ambrose CS. Unintended Consequences Following the 2014 American Academy of Pediatrics Policy Change for Palivizumab Prophylaxis among Infants Born at Less than 29 Weeks' Gestation. Am J Perinatol 2021; 38:e201-e206. [PMID: 32299107 PMCID: PMC8397527 DOI: 10.1055/s-0040-1709127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study is to compare outpatient respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and relative RSV hospitalization (RSVH) rates for infants <29 weeks' gestational age (wGA) versus term infants before and after the 2014 American Academy of Pediatrics (AAP) policy change. STUDY DESIGN Infants were identified in the MarketScan Commercial and Multi-State Medicaid databases. Outpatient RSV IP receipt and relative <29 wGA/term hospitalization risks in 2012 to 2014 and 2014 to 2016 were assessed using rate ratios and a difference-in-difference model. RESULTS Outpatient RSV IP receipt by infants <29 wGA and aged <3 months in the Commercial and Medicaid populations and those aged 3 to <6 months in the Medicaid population declined after 2014. Relative RSVH risks for infants <29 wGA were numerically greater after 2014, with infants aged <3 months and Medicaid infants experiencing the greatest increases. Difference-in-difference results indicated a significantly increased relative risk of RSVH for infants <29 wGA versus term (both cohorts aged 0 to <6 months) in the Medicaid-insured population (1.68, p = 0.0054). A nonsignificant increase of similar magnitude occurred in the commercially insured population (1.57, p = 0.2867). CONCLUSION The 2014 policy change was associated with a decrease in RSV IP use and an increase in RSVH risk among otherwise healthy infants <29 wGA.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Division of Neonatology, Department of Pediatrics, Loma Linda University Children's Hospital11175 Campus Street, Suite #11121, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Lance Brannman
- Biopharmaceutical Medical Department, AstraZeneca, Gaithersburg, Maryland
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda M. Kong
- Life Sciences Department, IBM Watson Health, Cambridge, Massachusetts
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13
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Frosch E, Goldstein M. Using a learning community model for virtual medical student support during the COVID19 pandemic. Int J Med Educ 2021; 12:136-139. [PMID: 34318760 PMCID: PMC8411346 DOI: 10.5116/ijme.60e2.c777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/05/2021] [Indexed: 05/28/2023]
Affiliation(s)
- Emily Frosch
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins Universi-ty School of Medicine, Baltimore MD, USA
| | - Mitchell Goldstein
- Department of Pediatrics Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore MD, USA
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14
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Nang Q, Basourakos S, Punjani N, Al Hussein O, Barone M, Goldstein M, Li P, Lee R. Listening to the parents as key to early infant male circumcision efforts in fight against HIV: Perspectives of a contemporary cohort of legal adult representatives of infants enrolled in the ShangRing vs. mogen clamp trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01455-x] [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: 11/16/2022]
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15
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Kuzmin R, Grabon N, Mehta N, Burshtein A, Goldstein M, Houzet M, Glazman LI, Manucharyan VE. Inelastic Scattering of a Photon by a Quantum Phase Slip. Phys Rev Lett 2021; 126:197701. [PMID: 34047614 DOI: 10.1103/physrevlett.126.197701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Spontaneous decay of a single photon is a notoriously inefficient process in nature irrespective of the frequency range. We report that a quantum phase-slip fluctuation in high-impedance superconducting waveguides can split a single incident microwave photon into a large number of lower-energy photons with a near unit probability. The underlying inelastic photon-photon interaction has no analogs in nonlinear optics. Instead, the measured decay rates are explained without adjustable parameters in the framework of a new model of a quantum impurity in a Luttinger liquid. Our result connects circuit quantum electrodynamics to critical phenomena in two-dimensional boundary quantum field theories, important in the physics of strongly correlated systems. The photon lifetime data represent a rare example of verified and useful quantum many-body simulation.
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Affiliation(s)
- R Kuzmin
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - N Grabon
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - N Mehta
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - A Burshtein
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - M Goldstein
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - M Houzet
- Univ. Grenoble Alpes, CEA, Grenoble INP, IRIG, PHELIQS, 38000 Grenoble, France
| | - L I Glazman
- Departments of Physics and Applied Physics, Yale University, New Haven, Connecticut 06520, USA
| | - V E Manucharyan
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
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16
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Cwik M, Jay S, Ryan TC, DeVylder J, Edwards S, Wilson ME, Virden J, Goldstein M, Wilcox HC. Lowering the Age Limit in Suicide Risk Screening: Clinical Differences and Screening Form Predictive Ability. J Am Acad Child Adolesc Psychiatry 2021; 60:537-540. [PMID: 33667604 DOI: 10.1016/j.jaac.2020.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
Our research provides preliminary evidence that suicide risk screening is warranted in patients as young as 8-9 years old presenting to the emergency department (ED) with behavioral and mental health symptoms. The goal of this retrospective cohort study (N = 2,466 unique patient visits) was to assess the value of suicide risk screening in children younger than 10 years old who present to the ED with behavioral and mental health concerns. The Johns Hopkins Hospital pediatric ED began screening with the Ask Suicide-Screening Questions (ASQ) for patients 8-21 years old who presented with a behavioral or mental health concern in March 2013 as ED standard of care. We examined the demographic and clinical differences between younger (8-9 years old; n = 270) and older (10-21 years old; n = 2,196) youths who were screened for suicide risk with the ASQ (from March 13, 2013 through December 31, 2016). In summary, 36% of 8- and 9-year-old patients who came to the ED for behavioral and mental health concerns screened positive for suicide risk on the ASQ. The younger patients who screened positive were more likely to present with externalizing symptoms and hallucinations and less likely to present with suicidal ideation or an attempt than their older counterparts. Importantly, 71.1% of 8- to 9-year-old patients who screened positive did not present to the ED for suicidal ideation or attempt vs 50.1% (614/1,226) of patients older than age 10 years.
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Affiliation(s)
- Mary Cwik
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | | | - Taylor C Ryan
- Forefront Suicide Prevention, University of Washington School of Social Work, Seattle, Washington; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jordan DeVylder
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Edwards
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Ellen Wilson
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jane Virden
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mitchell Goldstein
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Holly C Wilcox
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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17
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Domachowske JB, Anderson EJ, Goldstein M. The Future of Respiratory Syncytial Virus Disease Prevention and Treatment. Infect Dis Ther 2021; 10:47-60. [PMID: 33656652 PMCID: PMC7926075 DOI: 10.1007/s40121-020-00383-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/31/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in infants, young children, and older or immunocompromised adults. Although aerosolized ribavirin was licensed for RSV treatment on the basis of data demonstrating a reduced need for supplemental oxygen, ribavirin use is limited because of issues with efficacy, safety, and cost. Currently, the treatment of RSV is primarily supportive. New antiviral treatments for RSV are in the early stages of development, but it will be years until any of these may be licensed by the US Food and Drug Administration (FDA). Palivizumab, an RSV monoclonal antibody [immunoprophylaxis (IP)], has demonstrated effectiveness in disease prevention and is the only licensed IP for RSV disease in specific high-risk pediatric populations. Although its efficacy is well established, some challenges that may interfere with its clinical use include cost, need for monthly injections, and changing policy for use by the American Academy of Pediatrics (AAP). Preventing RSV disease would be possible through RSV vaccine development (e.g., live-attenuated, vector-based subunit, or particle-based). Alternatively, new long-acting monoclonal antibodies have demonstrated promising results in early clinical trials. Despite scientific advances, until new agents become available, palivizumab should continue to be used to reduce RSV disease burden in high-risk patients for whom it is indicated.
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Affiliation(s)
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA.
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18
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Krilov LR, Forbes ML, Goldstein M, Wadhawan R, Stewart DL. Severity and Cost of RSV Hospitalization Among US Preterm Infants Following the 2014 American Academy of Pediatrics Policy Change. Infect Dis Ther 2021; 10:27-34. [PMID: 33656650 PMCID: PMC8017024 DOI: 10.1007/s40121-020-00389-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
The American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID) periodically publishes recommendations for respiratory syncytial virus (RSV) immunoprophylaxis (IP) use in pediatric patients considered to be at highest risk for severe RSV infection. In 2014, for the first time, the AAP COID stopped recommending the use of RSV IP for otherwise healthy infants born at 29 weeks’ gestational age (wGA) or later, stating that RSV hospitalization (RSVH) rates in this population are similar to those of term infants. Subsequently, epidemiological studies in the US at national and regional levels provided evidence of the impact of the policy change in 29–34 wGA infants. The results of these studies demonstrated a significant decrease in IP use after 2014 that was associated with an increased rate of RSVH in 29–34 wGA infants and an increase in morbidities. RSVH-related morbidities included pediatric intensive care unit (ICU) admissions, an increased need for mechanical ventilation, and an increase in the length of stay. After the change in recommendations, the costs of RSVH also rose among 29–34 wGA infants. The severity of the illness and expenses associated with RSVH were generally higher among 29–34 wGA infants of younger chronologic age compared with older preterm infants. Overall, these studies underscore that 29–34 wGA infants continue to be a high-risk pediatric population that could benefit from the protection provided by RSV IP. On the basis of these data, in 2018, the National Perinatal Association developed guidelines that recommended RSV IP for all ≤ 32 wGA infants and 32–35 wGA infants with additional risk factors. Re-evaluation of the AAP COID policy is warranted in light of these observations.
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Affiliation(s)
- Leonard R Krilov
- Department of Pediatrics, NYU Langone Hospital - Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA.
| | - Michael L Forbes
- Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Rajan Wadhawan
- Department of Pediatrics, AdventHealth for Children, Orlando, FL, USA
| | - Dan L Stewart
- Department of Pediatrics, Norton Children's Hospital and University of Louisville Hospital, Louisville, KY, USA
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19
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Goldstein M, Mindel R. M150 KOUNIS SYNDROME (KS) AND MAST CELL ACTIVATION TREATED WITH OMALIZUMAB. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.222] [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: 11/28/2022]
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20
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Goldstein M, Gabriel N, Wang X, Wong N, Dahiya S. SETD2 Histone Methyltransferase Mutation Status Predicts Treatment Response In Glioblastoma: Strategies To Overcome Chemoresistance. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Fergie J, Goldstein M, Krilov LR, Wade SW, Kong AM, Brannman L. Update on respiratory syncytial virus hospitalizations among U.S. preterm and term infants before and after the 2014 American Academy of Pediatrics policy on immunoprophylaxis: 2011-2017. Hum Vaccin Immunother 2020; 17:1536-1545. [PMID: 33090914 PMCID: PMC8078654 DOI: 10.1080/21645515.2020.1822134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Palivizumab is the only licensed respiratory syncytial virus (RSV) immunoprophylaxis (IP) available to prevent severe RSV disease in high-risk pediatric populations, including infants born at 29-34 weeks' gestational age (wGA). In 2014, the American Academy of Pediatrics (AAP) stopped recommending RSV IP use for otherwise healthy 29-34 wGA infants and stated that 29-34 wGA infants and term infants have similar RSV hospitalization (RSVH) rates. This study aimed to compare RSV IP use and RSVH rates in 29-34 wGA infants and term infants during the 3 RSV seasons before and after the 2014 AAP policy change. RSV IP use in otherwise healthy infants 29-30, 31-32, and 33-34 wGA was estimated from pharmacy or outpatient medical claims for palivizumab. RSVH rates in the first 6 months of life were calculated per 100 infant-seasons. RSVH rate ratios were used to compare preterm infants and term infants before and after the policy change. Across infant cohorts (29-34 wGA) and chronologic age groups (<3 months and 3-<6 months), absolute decreases in RSV IP use between the combined 2011-2014 seasons and 2014-2017 seasons ranged from 7% to 38% and from 68% to 97%, respectively. Compared with 2011-2014, the RSVH risk increased 2.09-fold (P< .001) and 1.76-fold (P< .001) in 2014-2017 for infants born at 29-34 wGA and aged <6 months with commercial and Medicaid insurance, respectively. Overall, RSV IP use declined in the RSV seasons following the 2014 RSV IP policy change, and RSVH increased among 29-34 wGA infants aged <6 months.
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Affiliation(s)
- Jaime Fergie
- Infectious Diseases Service, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Mitchell Goldstein
- Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Leonard R Krilov
- Department of Pediatrics, NYU Winthrop Hospital and the NYU Long Island School of Medicine, Mineola, NY, USA
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, UT, USA
| | - Amanda M Kong
- Department of Life Sciences, IBM Watson Health, Cambridge, MA, USA
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22
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Wilf-Yarkoni A, Elkayam O, Aizenstein O, Oron Y, Furer V, Zur D, Goldstein M, Barequet D, Hallevi H, Karni A, Habot-Wilner Z, Regev K. Increased incidence of Susac syndrome: a case series study. BMC Neurol 2020; 20:332. [PMID: 32878610 PMCID: PMC7465403 DOI: 10.1186/s12883-020-01892-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Susac syndrome (SuS) is a rare condition characterized by a clinical triad of sensorineural hearing loss, branch artery occlusion and encephalopathy. This study reports an increased incidence of SuS in Israel. We describe the clinical characteristics of these patients, diagnostic procedures and the use and subsequent outcomes of newly published treatment guidelines. METHODS This is a single center retrospective study. Patients who were diagnosed with SuS between July 2017 and August 2018 were enrolled in this study. RESULTS Seven patients were diagnosed with SuS according to the diagnostic criteria in a time period of 13 months. The annual incidence was recently evaluated in Austria to be 0.024/100000, therefore, our case series represent at least a 5.4- fold increase in the annual incidence of SuS expected in Israel and a 7-fold increase in the annual incidence expected in our medical center. Mean time from the onset of the symptoms to diagnosis was three weeks and follow-up time was twenty four months. Recent exposure to cytomegalovirus was serologically evident in three patients and one patient had high titer of anti-streptolysin antibody. All patients underwent brain MRI, fluorescein angiography and audiometry. All patients were treated according to the newly recommended guidelines. All patients achieved clinical and radiological stability. CONCLUSIONS We report of an increased incidence of SuS in Israel. Infectious serological findings may imply a post infectious mechanism. The use of the recommended diagnostic procedures reduced the time to diagnosis. Newly published treatment guidelines led to favorable clinical outcomes.
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Affiliation(s)
- A Wilf-Yarkoni
- Neuro-Immunology Service and Department of Neurology Rabin Medical Center, 4941492, Petach Tikva, Israel.
| | - O Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Aizenstein
- Neuroradiology unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Oron
- Department of ENT, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - V Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Zur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Barequet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Hallevi
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Karni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel Aviv, Israel
| | - Z Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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23
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Al Hussein Alawamlh O, Punjani N, Barone M, Awori Q, Goldstein M, Li P, Lee R. Acceptability of no-flip ShangRing male circumcision in a WHO mandated population for HIV prevention. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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24
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Al Hussein Alawamlh O, Punjani N, Chen H, Barone M, Awori Q, Goldstein M, Lee R, Li P. Feasibility of no-flip ShangRing male circumcision in adolescent boys with phimosis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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DeVylder JE, Ryan TC, Cwik M, Jay SY, Wilson ME, Goldstein M, Wilcox HC. Screening for Suicide Risk Among Youths With a Psychotic Disorder in a Pediatric Emergency Department. Psychiatr Serv 2020; 71:205-208. [PMID: 31795855 DOI: 10.1176/appi.ps.201900290] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
National Patient Safety Goal 15.01.01 requires all Joint Commission-accredited organizations to screen patients treated for behavioral health conditions for suicide risk. However, little is known about the ability of screening tools to identify suicide risk among youths with psychotic disorders. As part of this quality improvement initiative, youths in a pediatric emergency department with psychotic disorder diagnoses (N=87) were screened with the Ask Suicide-Screening Questions. Almost half (48%, N=42) screened positive. Most positive screens (62%, N=26) were not detected through treatment as usual, suggesting that systematic screening improves the detection of suicide risk among youths with psychotic disorders.
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Affiliation(s)
- Jordan E DeVylder
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Taylor C Ryan
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Mary Cwik
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Samantha Y Jay
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Mary Ellen Wilson
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Mitchell Goldstein
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
| | - Holly C Wilcox
- Graduate School of Social Service, Fordham University, New York (DeVylder); Department of Mental Health (Ryan, Wilcox) and Department of International Health (Cwik), Johns Hopkins Bloomberg School of Public Health, Baltimore; Department of Psychiatry and Behavioral Sciences (Cwik, Wilcox) and Department of Pediatrics (Wilson, Goldstein), Johns Hopkins School of Medicine, Baltimore; Department of Psychology, University of Maryland, Baltimore County, Baltimore (Jay). Marcela Horvitz-Lennon, M.D., and Kenneth Minkoff, M.D., are editors of this column
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Daveson AJM, Popp A, Taavela J, Goldstein KE, Isola J, Truitt KE, Mäki M, Anderson RP, Adams A, Andrews J, Behrend C, Brown G, Chen Yi Mei S, Coates A, Daveson A, DiMarino A, Elliott D, Epstein R, Feyen B, Fogel R, Friedenberg K, Gearry R, Gerdis M, Goldstein M, Gupta V, Holmes R, Holtmann G, Idarraga S, James G, King T, Klein T, Kupfer S, Lebwohl B, Lowe J, Murray J, Newton E, Quinn D, Radin D, Ritter T, Stacey H, Strout C, Stubbs R, Thackwray S, Trivedi V, Tye‐Din J, Weber J, Wilson S. Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ygh2.380] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alina Popp
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu‐Rusescu" Bucharest Romania
| | - Juha Taavela
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- Department of Internal Medicine Central Finland Central Hospital Jyväskylä Finland
| | | | - Jorma Isola
- Laboratory of Cancer Biology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Jilab Inc. Tampere Finland
| | | | - Markku Mäki
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
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Angeles DM, Boskovic DS, Tan JC, Shih W, Hoch E, Forde D, Phillips RM, Hopper A, Deming DD, Goldstein M, Truong G, Febre A, Pegis P, Lavery A, Kadri M, Banerji A, Mousselli I, Farha V, Fayard E. Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: a prospective randomized trial. J Perinatol 2020; 40:888-895. [PMID: 32103160 PMCID: PMC7253349 DOI: 10.1038/s41372-020-0634-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the effects of 30% oral dextrose on biochemical markers of pain, adenosine triphosphate (ATP) degradation, and oxidative stress in preterm neonates experiencing a clinically required heel lance. STUDY DESIGN Utilizing a prospective study design, preterm neonates that met study criteria (n = 169) were randomized to receive either (1) 30% oral dextrose, (2) facilitated tucking, or (3) 30% oral dextrose and facilitated tucking 2 min before heel lance. Plasma markers of ATP degradation (hypoxanthine, uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the premature infant pain profile-revised (PIPP-R). RESULTS Oral dextrose, administered alone or with facilitated tucking, did not alter plasma markers of ATP utilization and oxidative stress. CONCLUSION A single dose of 30% oral dextrose, given before a clinically required heel lance, decreased signs of pain without increasing ATP utilization and oxidative stress in premature neonates.
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Affiliation(s)
- Danilyn M. Angeles
- 0000 0000 9852 649Xgrid.43582.38Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Danilo S. Boskovic
- 0000 0000 9852 649Xgrid.43582.38Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - John C. Tan
- 0000 0000 9852 649Xgrid.43582.38Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Wendy Shih
- 0000 0000 9852 649Xgrid.43582.38School of Public Health, Loma Linda Univeristy, Loma Linda, CA USA
| | - Erin Hoch
- 0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Dorothy Forde
- 0000 0001 2297 6811grid.266102.1School of Nursing, University of California, San Francisco, CA USA
| | - Raylene M. Phillips
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Andrew Hopper
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Douglas D. Deming
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Mitchell Goldstein
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Giang Truong
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Aprille Febre
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Priscilla Pegis
- 0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Adrian Lavery
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Munaf Kadri
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Anamika Banerji
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Iman Mousselli
- 0000 0000 9852 649Xgrid.43582.38Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Vora Farha
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
| | - Elba Fayard
- 0000 0000 9852 649Xgrid.43582.38Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA USA ,0000 0004 0443 5757grid.411392.cLoma Linda University Children’s Hospital, Loma Linda, CA USA
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Krilov LR, Fergie J, Goldstein M, Brannman L. Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants. Am J Perinatol 2020; 37:174-183. [PMID: 31430818 DOI: 10.1055/s-0039-1694008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. STUDY DESIGN Preterm (29-34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. RESULTS In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10-2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. CONCLUSION RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.
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Affiliation(s)
- Leonard R Krilov
- Division of Pediatric Infectious Disease, Children's Medical Center, NYU Winthrop Hospital, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California
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Goldstein M, Vadaketh K. M151 IGG4-RELATED DISEASE PRESENTING AS PERIORBITAL SWELLING. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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DeVylder JE, Ryan TC, Cwik M, Wilson ME, Jay S, Nestadt PS, Goldstein M, Wilcox HC. Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department. JAMA Netw Open 2019; 2:e1914070. [PMID: 31651971 PMCID: PMC6822088 DOI: 10.1001/jamanetworkopen.2019.14070] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/08/2019] [Indexed: 12/03/2022] Open
Abstract
Importance According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design, Setting, and Participants In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure Positive ASQ screen at baseline ED visit. Main Outcomes and Measures The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results The complete sample was 15 003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.
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Affiliation(s)
- Jordan E. DeVylder
- Graduate School of Social Service, Fordham University, New York, New York
| | - Taylor C. Ryan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Cwik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mary Ellen Wilson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Samantha Jay
- Department of Psychology, University of Maryland Baltimore County, Baltimore
| | - Paul S. Nestadt
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mitchell Goldstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Holly C. Wilcox
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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Plumb AA, Eason D, Goldstein M, Lowe A, Morrin M, Rudralingam V, Tolan D, Thrower A. Computed tomographic colonography for diagnosis of early cancer and polyps? Colorectal Dis 2019; 21 Suppl 1:23-28. [PMID: 30809907 DOI: 10.1111/codi.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023]
Affiliation(s)
- A A Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - D Eason
- Department of Radiology, Raigmore Hospital, Inverness, UK
| | - M Goldstein
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - A Lowe
- Department of Radiology, Musgrove Park Hospital, Taunton, UK
| | - M Morrin
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - V Rudralingam
- Department of Radiology, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - D Tolan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Thrower
- Department of Radiology, Basingstoke Hospital, Basingstoke, UK
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Wang R, Singh J, Sterlin V, Goldstein M, Lake D, Wong S, Baselga J, Norton L, Dang C. Abstract P6-18-30: Phase Ib/II study of capecitabine 7/7 schedule with neratinib in patients with HER2-positive metastatic breast cancer (MBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-30] [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: 11/16/2022]
Abstract
Abstract
Background: Neratinib (N) is a potent irreversible inhibitor of HER1, HER2, and HER4 and has been shown to have antitumor activity in patients (pts) with human epidermal growth factor receptor 2 (HER2) - positive breast cancer. A previous study of combination of neratinib with capecitabine (X) was associated with > G 3 diarrhea in > 20% of patients. Currently, the NALA study is evaluating this combination of N with X at standard schedule against control. X at 7 day on and 7 day off schedule (7/7) has been shown to be well-tolerated with less ≥G3 toxicities. We are conducting a phase Ib/II study of N with X (7/7) in pts with pretreated HER2+ MBC (NCT03377387). Methods: Eligible pts had HER2+ MBC, normal left ventricular ejection fraction (LVEF ≥ 50%); pts can have any and up to 4 prior chemotherapy-based treatments in phase Ib and II portions, respectively. Primary endpoints are to define maximum tolerated dose and efficacy in phase I and phase II portions, respectively. Secondary endpoints include safety and tolerability; exploratory endpoint is to quantify cell-free DNA to correlate with response for phase II portion. There were 4 cohorts for phase Ib with dose level 1 with starting dose of X at 1500 mg BID at 7/7 schedule with N at 240 mg daily. Results: As of July 1, 2018 8 pts have been enrolled in 2 cohorts. The median age is 63y (range: 57-79), and median ECOG is 0 (range: 0-1). 4 patients were treated at dose level 1 and 2 of 4 patients experienced dose-limiting toxicity with G3 diarrhea during cycle 1. Other significant toxicities included G3 hand foot syndrome (n=1), G3 fatigue (n=1) and G3 nausea (n=1). Three pts have now been treated at dose level -1 (X at 1000 mg twice daily 7/7 and N at 240 mg daily) and no ≥ G3 toxicities has been noted. Once MTD is reached, the phase II portion will occur to assess the efficacy and to further establish the safety and tolerability of capecitabine and neratinib at the MTD. Conclusions: The phase Ib/II study combining neratinib and capecitabine 7/7 is ongoing and updated result will be presented.
Citation Format: Wang R, Singh J, Sterlin V, Goldstein M, Lake D, Wong S, Baselga J, Norton L, Dang C. Phase Ib/II study of capecitabine 7/7 schedule with neratinib in patients with HER2-positive metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-30.
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Affiliation(s)
- R Wang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Singh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - V Sterlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Goldstein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Lake
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Wong
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Norton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
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Frosch E, Goldstein M. Relationship-Centered Advising in a Medical School Learning Community. J Med Educ Curric Dev 2019; 6:2382120519827895. [PMID: 30937384 PMCID: PMC6434435 DOI: 10.1177/2382120519827895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND Medical schools are required to have formal advising structures; however, there are limited data on how to optimally meet that mandate. Learning communities (LC), with their emphasis on longitudinal relationships, offer a unique scaffold for advising. PROGRAM DESCRIPTION The Johns Hopkins School of Medicine (JHSOM) LC focuses on curricular and extracurricular longitudinal connections between students and advisors. A core component of the LC is a relationship-centered advising (RCA) model drawing from best practices in physician-patient relationships, life coaching, and social contract theories. The key elements of the model include dyadic and small group advising, while the LC structure allows for faculty development in these domains. Relationship-centered advising approaches the collaborative advising work between students and advisors through explicit valuing of personal experiences, mutual respect, and earned trust. Framing the advising relationship in this way allows it to grow with the student along their medical school journey. PROGRAM EVALUATION & RESULTS Student and faculty satisfaction with this model is high. Data from annual, anonymous student evaluations consistently indicate high degree of trust in and satisfaction from these relationships. DISCUSSION Relationship-centered advising aims to create a relationally anchored platform on which students can develop their personal and professional identities. This LC-based advising model is adaptable across schools regardless of structure and resources.
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Affiliation(s)
- Emily Frosch
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Emily Frosch, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1600 McElderry Street, AMEB Suite 202, Baltimore, MD 21205, USA.
| | - Mitchell Goldstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Goldstein M, Krilov LR, Fergie J, McLaurin KK, Wade SW, Diakun D, Lenhart GM, Bloomfield A, Kong AM. Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012-2016. Am J Perinatol 2018; 35:1433-1442. [PMID: 29920638 PMCID: PMC6260117 DOI: 10.1055/s-0038-1660466] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. STUDY DESIGN Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November-March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. RESULTS In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). CONCLUSION In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.
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Affiliation(s)
- Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Loma Linda, California,Address for correspondence Mitchell Goldstein, MD Loma Linda University Children's Hospital11175 Campus Street, Loma Linda, CA 92354
| | - Leonard R. Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | | | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - David Diakun
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | | | | | - Amanda M. Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Goldstein M, Krilov LR, Fergie J, Brannman L, Ambrose CS, Wade S, Kong A. 740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants <29 Weeks Gestational Age at Birth: 2012–2016. Open Forum Infect Dis 2018. [PMCID: PMC6255659 DOI: 10.1093/ofid/ofy210.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at <29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants <29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy <29 wGA infants.
Methods
Infants born from July 1, 2011 to June 30, 2016 were followed from birth hospitalization discharge through their first year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and <29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across three chronologic age (CA) groups: <3 months, 3–<6 months, and 6–<12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for <29 wGA infants using healthy term infants 0–<12 months of age as a reference category.
Results
Outpatient RSV IP receipt fell after 2014 for <29 wGA infants across all CA categories, with the greatest decline observed among infants <3 months CA (Table 1). Greater RSVH rates for <29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants <3 months CA experiencing the greatest percentage increases in relative RSVH risks.
Conclusion
Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy <29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants <3 months CA and those insured by Medicaid.
Funded by AstraZeneca
Disclosures
M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. L. Brannman, AstraZeneca: Employee, Salary and Stocks. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant, Consulting fee. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.
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Affiliation(s)
| | | | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | | | - Sally Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Goldstein M, Krilov LR, Fergie J, Ambrose CS, Wade S, Kong A, Brannman L. 735. Severity and Healthcare Costs of Respiratory Syncytial Virus Hospitalizations in US Preterm Infants Born at 29–34 Weeks Gestation: 2014–2016. Open Forum Infect Dis 2018. [PMCID: PMC6253181 DOI: 10.1093/ofid/ofy210.742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background In 2014, the American Academy of Pediatrics recommended against the use of respiratory syncytial virus (RSV) immunoprophylaxis in infants 29–34 weeks gestational age (wGA) at birth without chronic lung disease/bronchopulmonary dysplasia (CLD/BPD) or congenital heart disease (CHD). To inform discussions of the clinical and economic value of RSV immunoprophylaxis in these infants, we compared RSV hospitalization (RSVH) severity and costs incurred by infants hospitalized from 2014–2016 at <6 months chronologic age (CA) for two groups: 29–34 wGA infants without CLD/BPD or CHD and term infants (≥37 wGA) without major health problems. Methods Births were identified in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. Term and 29–34 wGA infants without CLD/BPD or CHD were selected using DRG and ICD-9/10-CM diagnosis codes. RSVH occurring from Julu 1, 2014 to June 30, 2016 while infants were <6 months CA (the period of highest RSVH incidence) were identified by ICD-9/10-CM diagnosis codes. Severity measures were length of stay (LOS) in days, intensive care unit (ICU) admissions, and healthcare costs (paid amounts on reimbursed hospital claims in 2016 US$). Comparisons between term and 29–34 wGA infants were made with t-tests and chi-squared tests. Results There were 1,114 RSVH in the COM data and 3,167 RSVH in the MED data during the study period. Mean LOS was longer for 29–34 wGA infants than term infants for each age category (P < 0.05) and tended to be longer for MED infants vs. COM infants (Figure 1). Thirty-eight percent of COM 29–34 wGA infants and 52% of MED 29–34 wGA infants hospitalized for RSV at <3 months CA were admitted to the ICU (Figure 2). RSVH costs for 29–34 wGA infants were greater than term RSVH costs for each age category (P < 0.05) and were greatest among 29–34 wGA infants hospitalized at <3 months CA: $41,104 for 29–34 wGA COM infants and $24,049 for 29–34 wGA MED infants (Figure 3). Conclusion RSVH severity and costs were significantly higher for 29–34 wGA infants without CLD/BPD or CHD relative to term infants. Infants hospitalized at <3 months CA experienced the most severe hospitalizations and incurred the highest costs. This study was funded by AstraZeneca. ![]()
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Disclosures M. Goldstein, AstraZeneca/MedImmune: Consultant, Research grant and Research support. L. R. Krilov, AstraZeneca/MedImmune: Consultant, Research grant and Research support. J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker’s Bureau, Research grant and Research support. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting: Employee, Salary. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary. L. Brannman, AstraZeneca: Employee, Salary and Stocks.
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Affiliation(s)
| | | | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | - Sally Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Amanda Kong
- Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
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Krilov LR, Fergie J, Goldstein M, Rizzo C, Brannman L, McPheeters J, Korrer S, Burton T, Sharpsten L. 743. Severity and Costs of Respiratory Syncytial Virus and Bronchiolitis Hospitalization in Commercially Insured Preterm and Term Infants Before and After the 2014 American Academy of Pediatrics Guidance Change on Immunoprophylaxis. Open Forum Infect Dis 2018. [PMCID: PMC6254027 DOI: 10.1093/ofid/ofy210.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | - Jaime Fergie
- Driscoll Children’s Hospital, Corpus Christi, Texas
| | | | | | | | | | | | - Tanya Burton
- Health Economics and Outcomes Research (HEOR), Optum, Eden Prairie, Minnesota
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Goldstein M, Freeman C, Belecanech N, Belecanech L, Dvorin D. LATE SUMMER/FALL GRASS POLLEN SEASON: RETROSPECTIVE ANALYSIS OVER A 6 YEAR PERIOD. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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39
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Olchanski N, Hansen RN, Pope E, D'Cruz B, Fergie J, Goldstein M, Krilov LR, McLaurin KK, Nabrit-Stephens B, Oster G, Schaecher K, Shaya FT, Neumann PJ, Sullivan SD. Palivizumab Prophylaxis for Respiratory Syncytial Virus: Examining the Evidence Around Value. Open Forum Infect Dis 2018. [PMID: 29516023 PMCID: PMC5833316 DOI: 10.1093/ofid/ofy031] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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] [Indexed: 01/11/2023] Open
Abstract
Respiratory syncytial virus (RSV) infection is the most common cause of lower respiratory tract infection and the leading cause of hospitalization among young children, incurring high annual costs among US children under the age of 5 years. Palivizumab has been found to be effective in reducing hospitalization and preventing serious lower respiratory tract infections in high-risk infants. This paper presents a systematic review of the cost-effectiveness studies of palivizumab and describes the main highlights of a round table discussion with clinical, payer, economic, research method, and other experts. The objectives of the discussion were to (1) review the current state of clinical, epidemiology, and economic data related to severe RSV disease; (2) review new cost-effectiveness estimates of RSV immunoprophylaxis in US preterm infants, including a review of the field’s areas of agreement and disagreement; and (3) identify needs for further research.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Ryan N Hansen
- University of Washington School of Pharmacy, Seattle, Washington
| | - Elle Pope
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Brittany D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatology-Perinatal Medicine, Loma Linda University, Loma Linda, California
| | - Leonard R Krilov
- Pediatric Infectious Disease, NYU Winthrop Hospital, Mineola, New York
| | - Kimmie K McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | | | | | | | - Fadia T Shaya
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, Massachusetts
| | - Sean D Sullivan
- University of Washington School of Pharmacy, Seattle, Washington
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40
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Goldstein M, Leibovitch I, Varssano D, Rothkoff L, Feitt N, Loewenstein A. Axial Length, Refractive Error, and Keratometry in Patients with Branch Retinal Vein Occlusion. Eur J Ophthalmol 2018; 14:37-9. [PMID: 15005583 DOI: 10.1177/112067210401400106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Purpose To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO). METHODS This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 ±1.57 years (range 1–6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test. Results Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings. CONCLUSIONS The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.
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Affiliation(s)
- M Goldstein
- Department of Ophthalmology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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41
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Kong AM, Krilov LR, Fergie J, Goldstein M, Diakun D, Wade SW, Pavilack M, McLaurin KK. The 2014-2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States. Am J Perinatol 2018; 35:192-200. [PMID: 28881376 PMCID: PMC6193366 DOI: 10.1055/s-0037-1606352] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full-term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks' gestational age (wGA). STUDY DESIGN Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infant's age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. RESULTS Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014-2015 season relative to the 2013-2014 season. Compared with the 2013-2014 season, RSVH increased by 2.7-fold (p = 0.02) and 1.4-fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014-2015 season with commercial and Medicaid insurance, respectively. In the 2014-2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full-term infants without high-risk conditions. CONCLUSION Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.
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Affiliation(s)
- Amanda M. Kong
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Leonard R. Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas,Address for correspondence Jaime Fergie, MD Driscoll Children's Hospital3533 S Alameda Street, Corpus Christi, TX 78411
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Linda Loma, California
| | - David Diakun
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Sally W. Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Melissa Pavilack
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | - Kimmie K. McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
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Cofrancesco J, Barone MA, Serwint JR, Goldstein M, Westman M, Lipsett PA. Development and Implementation of a School-Wide Institute for Excellence in Education to Enable Educational Scholarship by Medical School Faculty. Teach Learn Med 2018; 30:103-111. [PMID: 28753084 DOI: 10.1080/10401334.2017.1325741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PROBLEM Educational scholarship is an important component for faculty at Academic Medical Centers, especially those with single-track promotion systems. Yet, faculty may lack the skills and mentorship needed to successfully complete projects. In addition, many educators feel undervalued. INTERVENTION To reinvigorate our school's educational mission, the Institute for Excellence in Education (IEE) was created. Here we focus on one of the IEE's strategic goals, that of inspiring and supporting educational research, scholarship, and innovation. CONTEXT Using the 6-step curriculum development process as a framework, we describe the development and outcomes of IEE programs aimed at enabling educational scholarship at the Johns Hopkins University School of Medicine. OUTCOME Four significant programs that focused on educational scholarship were developed and implemented: (a) an annual conference, (b) a Faculty Education Scholars' Program, (c) "Shark Tank" small-grant program, and (d) Residency Redesign Challenge grants. A diverse group of primarily junior faculty engaged in these programs with strong mentorship, successfully completing and disseminating projects. Faculty members have been able to clarify their personal goals and develop a greater sense of self-efficacy for their desired paths in teaching and educational research. LESSONS LEARNED Faculty require programs and resources for educational scholarship and career development, focused on skills building in methodology, assessment, and statistical analysis. Mentoring and the time to work on projects are critical. Key to the IEE's success in maintaining and building programs has been ongoing needs assessment of faculty and learners and a strong partnership with our school's fund-raising staff. The IEE will next try to expand opportunities by adding additional mentoring capacity and further devilment of our small-grants programs.
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Affiliation(s)
- Joseph Cofrancesco
- a Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Michael A Barone
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
- c Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Janet R Serwint
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
- c Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Mitchell Goldstein
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
- c Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Michael Westman
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
| | - Pamela A Lipsett
- b Johns Hopkins University School of Medicine Institute for Excellence in Education, Johns Hopkins University School of Medicine , Baltimore , Maryland , USA
- d Department of Surgery, Anesthesiology, and Critical Care Medicine and Nursing , Johns Hopkins University Schools of Medicine and Nursing , Baltimore , Maryland , USA
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Amitay M, Goldstein M. Evaluating the peptide structure prediction capabilities of a purely ab-initio method. Protein Eng Des Sel 2017; 30:723-727. [PMID: 29040794 DOI: 10.1093/protein/gzx052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/08/2017] [Indexed: 01/25/2023] Open
Abstract
DEEPSAM is a relatively new global optimization algorithm aimed to predict the structure of bio-molecules from sequence, without any additional preliminary assumption. It is an evolutionary algorithm whose mutation operators are built by hybridizing the diffusion equation method, molecular dynamics simulated annealing, and a quasi-Newton local minimization method. The goal of this study was to evaluate the structure prediction capabilities of DEEPSAM by running it upon NMR structures of linear peptides (10-20 residues). The results indicate that DEEPSAM successfully predicted the conformations of these peptides, using modest computing resources.
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Affiliation(s)
- M Amitay
- Department of Bioinformatics, Jerusalem College of Technology, Havaad Haleumi 21, Jerusalem 9372115, Israel
| | - M Goldstein
- Department of Computer Science, Jerusalem College of Technology, Havaad Haleumi 21, Jerusalem 9372115, Israel
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44
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Goldstein M, Vadaketh K, Dvorin D, Belecanech G. P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA). Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Dvorin D, Vadaketh K, Goldstein M, Belecanech G. P256 Hypogammaglobulinemia as presenting sign of nephrotic syndrome. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.263] [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: 11/26/2022]
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46
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Ong P, Wald R, Goldstein M, Leipsic J, Kiaii M, Deva D, Connelly K, Kirpalani A, Jimenez-Juan L, Bello O, Azizi P, Wald R, Yan A. LEFT VENTRICULAR STRAIN ANALYSIS USING CARDIAC MRI IN PATIENTS UNDERGOING IN-CENTRE NOCTURNAL HEMODIALYSIS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.060] [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: 11/16/2022] Open
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47
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Kong AM, Krilov LR, Fergie J, Goldstein M, Diakun D, Wade SW, Pavilack M, McLaurin KK. The 2014-2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States. Am J Perinatol 2017. [PMID: 28881376 DOI: 10.1055/s‐0037‐1606352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
OBJECTIVE This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full-term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks' gestational age (wGA). STUDY DESIGN Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infant's age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. RESULTS Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014-2015 season relative to the 2013-2014 season. Compared with the 2013-2014 season, RSVH increased by 2.7-fold (p = 0.02) and 1.4-fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014-2015 season with commercial and Medicaid insurance, respectively. In the 2014-2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full-term infants without high-risk conditions. CONCLUSION Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.
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Affiliation(s)
- Amanda M Kong
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Leonard R Krilov
- Pediatric Infectious Diseases, Children's Medical Center, NYU Winthrop, Mineola, New York
| | - Jaime Fergie
- Department of Pediatric Infectious Disease, Driscoll Children's Hospital, Corpus Christi, Texas
| | - Mitchell Goldstein
- Division of Neonatal Medicine, Loma Linda University Children's Hospital, Linda Loma, California
| | - David Diakun
- Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts
| | - Sally W Wade
- Wade Outcomes Research and Consulting, Salt Lake City, Utah
| | - Melissa Pavilack
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
| | - Kimmie K McLaurin
- Health Economics and Outcomes Research, AstraZeneca, Gaithersburg, Maryland
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48
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Parrella A, O'Neill C, Chow S, Goldstein M, Rosenwaks Z, Palermo G. Sperm source influences the extent of DNA fragmentation and shapes reproductive outcome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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49
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Flannigan R, Bach P, Goldstein M. Microsurgical varicocele repair induces spermatogenesis among men with non obstructive azoospermia: a 25 year experience. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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50
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Ng P, McGowan M, Goldstein M, Kassardjian CD, Steinhart BD. The impact of CT head scans on ED management and length of stay in bizarre behavior patients. Am J Emerg Med 2017; 36:213-217. [PMID: 28789887 DOI: 10.1016/j.ajem.2017.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 12/21/2022] Open
Abstract
METHODS A 5-year retrospective chart review was conducted at 3 EDs. Inclusion criteria were patients ≥18years old triaged as "mental health - bizarre behavior" (deviation from normal cognitive behaviour with no obvious cause) with a CT head scan ordered in the ED. Exclusion criteria were focal neurologic deficits on exam, alternative medical etiology (i.e. delirium, trauma) and/or pre-existing CNS disease. Clinical, demographic and administrative data were extracted with 10% of charts independently reviewed by an Emergency Physician for inter-rater reliability. RESULTS 266 cases met study criteria. Population demographics: 49% percent female, average age 51years old, 28% homeless, 58% arrived by police or ambulance. CT head results: 1 (0.4%) case with possible acute findings, 105 (39%) with incidental findings (i.e. cerebral atrophy) that did not impact clinical management. Average time to physician assessment was 1:48 (hour:min) (sd 1:11), time to CT completion was 5:05 (sd 7:28) and an average delay of 3:17 awaiting results. Subgroup analysis revealed a net increase in ED length of stay (ED LOS) of 5:02 from obtaining neuroimaging. 85% of patients were referred to a consultant, 92% were to psychiatry. CONCLUSIONS CT head results prolonged ED LOS, delayed patient disposition and did not change the patient's clinical management. A prospective trial for ordering CT head scans in these patients is warranted.
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Affiliation(s)
- P Ng
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Canada.
| | - M McGowan
- Emergency Medicine, St. Michael's Hospital, Canada
| | - M Goldstein
- Department of Psychiatry, University of Toronto, Canada
| | - C D Kassardjian
- Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - B D Steinhart
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Canada; Emergency Medicine, St. Michael's Hospital, Canada
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