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Schroeder MK, Abushamma S, George AT, Ravella B, Hickman J, Elumalai A, Wise P, Zulfiqar M, Ludwig DR, Shetty A, Viswanath SE, Luo C, Sebastian S, Ballard DH, Deepak P. TOpCLASS Expert Consensus Classification of Perianal Fistulizing Crohn's Disease: A Real-World Application in a Serial Fistula MRI Cohort. J Crohns Colitis 2024:jjae056. [PMID: 38642332 DOI: 10.1093/ecco-jcc/jjae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIMS Perianal fistulizing Crohn's disease (PFCD) is an aggressive phenotype of Crohn's disease defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by the TOpCLASS consortium that seeks to unify disease severity with patient-centered goals but has not yet been validated. We aimed to apply this to a real-world cohort and identify factors that predict transition between classes over time. METHODS We identified all patients with PFCD and at least one baseline and one follow-up pelvic (pMRI). TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs. RESULTS We identified 100 patients with PFCD of which 96 were assigned TOpCLASS Classes 1 - 2c at baseline. Most patients (78.1%) started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex (72.0%, 46.6%, 40.0%, p = 0.03) and prior perianal surgery (52.0% vs 44.6% vs 40.0%, p = 0.02) were more frequently observed in those with improved class. Baseline pMRI indices were not associated with changes in classification, however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modeling identified only male sex (-0.31, 95% CI -0.60 to -0.02) with improvement in class. CONCLUSION The TOpCLASS classification highlights the dynamic nature of PFCD over time, however, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.
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Affiliation(s)
- Matthew K Schroeder
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Suha Abushamma
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Alvin T George
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - John Hickman
- Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Paul Wise
- Section of Colon and Rectal Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Maria Zulfiqar
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Satish E Viswanath
- Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - David H Ballard
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
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Hassanzadeh C, Mirza K, Kalaghchi B, Fallahian F, Chin RI, Roy A, Stowe H, Low G, Pedersen K, Wise P, Glasgow S, Roach M, Henke L, Badiyan S, Mutch M, Kim H. Lateral Pelvic Nodal Management and Patterns of Failure in Patients Receiving Short-Course Radiation for Locally Advanced Rectal Cancer. Dis Colon Rectum 2024; 67:54-61. [PMID: 37787502 DOI: 10.1097/dcr.0000000000002936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Management of lateral pelvic lymph nodes in locally advanced rectal cancer is controversial, with limited data indicating the optimal approach. In addition, no data exist regarding the treatment of lateral nodes in the setting of short-course radiation and nonoperative intent. OBJECTIVE To evaluate a novel approach incorporating simultaneous integrated boost to suspicious lateral nodes. DESIGN A retrospective study. SETTING This study was conducted at a large tertiary referral center. PATIENTS Patients treated with radiation therapy and consolidation chemotherapy were included. All primary tumors underwent biopsy confirmation and disease staging with pelvic MRI. INTERVENTIONS Primary tumors were biopsy proven and staged with pelvic MRI. A subset of lateral pelvic lymph node patients received a simultaneous integrated boost of 35 Gy in 5 fractions. Then, chemotherapy was administered, with the majority receiving modified folinic acid, fluorouracil, and oxaliplatin. Clinical partial response required total mesorectal excision. MAIN OUTCOME MEASURES Patterns of failure and survival analyses by subgroup were assessed. Outcomes based on receipt of radiation were compared across node status. RESULTS Between January 2017 and January 2022, 155 patients were treated with short-course chemotherapy, with 121 included in the final analysis. Forty-nine percent of patients underwent nonoperative management. The median follow-up was 36 months and the median age was 58 years. Thirty-eight patients (26%) had positive lateral pelvic lymph nodes. Comparing lateral node status, progression-free survival was significantly worse for patients with positive disease ( p < 0.001), with a trend for worse overall survival. Receipt of nodal boost in patients with lateral nodes resulted in meaningful locoregional control. Nodal boost did not contribute to additional acute or late GI toxicity. LIMITATIONS Limitations include retrospective nature and lack of lateral node pathology; however, a thorough radiographic review was performed. CONCLUSIONS Lateral node-positive rectal cancer is correlated with worse oncologic outcomes and higher locoregional failure. Boost to clinically positive lateral nodes is a safe approach in the setting of short course radiation and in those receiving nonoperative intent. See Video Abstract. MANEJO DE LOS GANGLIOS PLVICOS LATERALES Y PATRONES DE FALLA EN PACIENTES QUE RECIBEN RADIACIN DE CICLO CORTO PARA EL CNCER DE RECTO LOCALMENTE AVANZADO ANTECEDENTES:El manejo de los ganglios linfáticos pélvicos laterales en el cáncer de recto localmente avanzado es controvertido, con datos limitados que indiquen el abordaje óptimo. Además, no existen datos sobre el tratamiento de los ganglios linfáticos laterales en el contexto de la radiación de curso corto y la intención no operatoria.OBJETIVO:Evaluamos un enfoque novedoso que incorpora sobreimpresión integrada simultánea (SIB) a los linfonodos laterales sospechosos.DISEÑO:Este fue un estudio retrospectivo.ESCENARIO:Este estudio se realizó en un gran centro de referencia terciario.PACIENTES:Se incluyeron pacientes tratados con radiación y quimioterapia de consolidación. Todos los tumores primarios se confirmaron mediante biopsia y la enfermedad se estadificó con resonancia magnética pélvica.INTERVENCIONES:Los tumores primarios se confirmaron mediante biopsia y se estadificaron con RM pélvica. Un subconjunto de pacientes con linfonodos pélvicos laterales (LPLN) recibió SIB a 35 Gy en 5 fracciones. Luego, se administró quimioterapia y la mayoría recibió mFOLFOX. La respuesta clínica parcial requirió la escisión total del mesorrecto.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron los patrones de fracaso y los análisis de supervivencia por subgrupo. Los resultados basados en el esquema de radiación se compararon según el estado de los ganglios.RESULTADOS:Entre enero de 2017 y enero de 2022, 155 pacientes fueron tratados con ciclo corto y quimioterapia con 121 incluidos en el análisis final. El 49% se sometió a manejo no operatorio. La mediana de seguimiento fue de 36 meses y la mediana de edad fue de 58 años. 38 pacientes (26%) tuvieron LPLN positivos. Comparando el estado de los ganglios laterales, la supervivencia libre de progresión fue significativamente peor para los pacientes con LPLN positiva ( p < 0,001) con una tendencia a una peor supervivencia global. La recepción de refuerzo nodal en pacientes con nodos laterales dio como resultado un control locorregional significativo. La sobreimpresión ganglionar no contribuyó a la toxicidad GI aguda o tardía adicional.LIMITACIONES:Las limitaciones incluyeron la naturaleza retrospectiva y la falta de patología de los ganglios linfáticos laterales; sin embargo, se realizó una revisión radiográfica exhaustiva.CONCLUSIONES:El cáncer de recto con ganglio lateral positivo se correlaciona con peores resultados oncológicos y mayor fracaso locorregional. La sobreimpresión a los ganglios laterales clínicamente positivos es un enfoque seguro en el contexto de un curso corto y en aquellos que siguen un manejo no operatorio. (Traducción-Dr. Felipe Bellolio ).
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Affiliation(s)
- Comron Hassanzadeh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kasim Mirza
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bita Kalaghchi
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Fedra Fallahian
- Department of Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Re-I Chin
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Hayley Stowe
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Gregory Low
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Katrina Pedersen
- Department of Medical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Paul Wise
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Sean Glasgow
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Michael Roach
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Shahed Badiyan
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Matthew Mutch
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri
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Warren E, Gamboa AC, Medin C, Hendren S, Regenbogen SE, Holder-Murray J, Kalady M, Ejaz A, Hawkins A, Wise P, Silviera M, Maithel SK, Balch GC. Association of transanal minimally invasive surgical approach with oncologic outcomes over conventional transanal excision for early-stage rectal cancer: An analysis of the US Rectal Cancer Consortium. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.145] [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: 01/26/2023] Open
Abstract
145 Background: For early-stage rectal cancer, minimally invasive surgical (MIS) approaches such as transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) have not been widely adopted over conventional transanal excision (TAE). Direct comparisons are lacking. Our aim was to compare oncologic and perioperative outcomes between the two approaches. Methods: We identified patients with Tis or T1 tumors who underwent TAE or MIS (TEM or TAMIS) between 2007-2017 from the US Rectal Cancer Consortium database. Patients who received neoadjuvant therapy were excluded. Primary outcomes were rate of recurrence and recurrence-free survival (RFS). Results: Of 1881 patients, 89 met inclusion criteria: 44 TAE and 45 MIS (20 TEM, 25 TAMIS). Median age was similar between groups (63.5 years TAE vs 61 years MIS; p=0.582). Patients in each group had similar functional status and tumor size (1.86 cm TAE vs 1.79 cm MIS, p=0.837). The majority of patients had tumors ≤ 6 cm from the anal verge (75.7% TAE vs 65.5% MIS, p=0.544). The TAE group had a 10.3% margin positive rate versus 0% in the MIS group (p=0.049). There was a lower incidence of recurrence in the MIS group (4.5%) compared to TAE (26%, p=0.01); all recurred locally except for one in the TAE group. Median follow-up time was 23.7 months. On Kaplan-Meier analysis, MIS approach was associated with improved 5-year RFS (86.4%, p=0.005) and local RFS (86.4%, p=0.01), versus TAE (46.9% and 50.5%, respectively). On univariate cox regression analysis, lymphovascular invasion was associated with worse RFS (HR 4.23, p=0.033) and local RFS (HR 5.26, p=0.02), while MIS approach was associated with improved RFS (HR 0.15, p=0.015) and local RFS (HR 0.17, p=0.023). On multivariable cox regression, only MIS approach remained associated with improved RFS (HR 0.09, p=0.028) and local RFS (HR 0.11, p=0.045). Perioperative complication and readmission rates were equal between the two groups. Conclusions: In patients with Tis and T1 rectal cancers who undergo local excision, an MIS approach (TEM or TAMIS) is associated with a decreased rate of recurrence and improved RFS and local RFS compared to TAE, with no significant difference in perioperative complication rate. The MIS approach should be more frequently incorporated into standard practice. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Jennifer Holder-Murray
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Matthew Kalady
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Aslam Ejaz
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Paul Wise
- Washington University in St. Louis, St. Louis, MO
| | - Matthew Silviera
- Section of Colon & Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Glen C. Balch
- Division of Colon & Rectal Surgery, Department of Surgery, Emory University, Atlanta, GA
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Cheung M, Deutsch J, Sherman R, Katz S, Wise P. Fermentation on Liking and Phytic Acid Concentration of Millet: A Climate Resistant Grain – A Pilot Study. Curr Dev Nutr 2022. [PMCID: PMC9193747 DOI: 10.1093/cdn/nzac050.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Millet is a nutritious, climate-resistant, and low water-demand grain. It is rich in essential minerals, but also contains high concentrations of phytic acid, an antinutrient. Fermentation can decrease phytic acid but may generate flavors unfamiliar to U.S. consumers in the context of grain products. This preliminary study explored the effects of fermentation on phytic acid and liking in bread models. Methods Bread was made with 100% whole-wheat flour (control), and with partial substitution (10%, 20%, 30%, 40% and 50%) of unfermented and fermented (for 96 hours) millet flour. Healthy adults (n = 8) rated overall liking and liking for appearance, aroma, color, texture, and flavor using a 9-point hedonic scale. Information on food neophobia, willingness to eat whole grain, and bread consumption were collected via questionnaires. Millet samples were analyzed for phytic acid concentration. Results Fermentation significantly reduced phytic acid (by 72%, p < 0.05). Overall liking was significantly lower (p < 0.001) in the models with 50% unfermented millet flour. For the models with fermented millet flour, we observed a significant reduction in liking starting in 40% substitution ratio and above (p < 0.001). Liking for appearance, aroma, color, and texture were associated with overall liking, but texture (r = 0.83, p < 0.001) and flavor (r = 0.75, p < 0.001) had the strongest association with overall liking. In general, fermented samples scored lower in texture, aroma, and flavor compared to unfermented samples. Food neophobia and other diet assessments did not correlate with liking for the breads. Conclusions Fermentation can lower phytic acid concentration in whole grain millet. Consumers may tolerate more unfermented millet compared to fermented millet, but a large sample size is needed to confirm this preliminary finding. Funding Sources NIDCD T32 Training Grant, Monell Sensory Nutrition Institutional Fund.
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Cheung M, Rivers N, Breslin P, Wise P. Individual Differences in Adaptation to Sweet Taste. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab055_013] [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: 11/15/2022] Open
Abstract
Abstract
Objectives
Over-consumption of sugar-sweetened beverages is associated with obesity and related conditions, but low-calorie alternatives are rejected by most consumers. Individual differences in sensitivity to off tastes of low-calorie sweeteners (LCS) have been considered as a factor in consumer choice. However, potential differences in adaptation, i.e., the tendency for sweetness to wane with repeated sips, has received less attention. This study measured sweetness adaption to a sugar and two LCS in the same sample of healthy adults to determine if there are stable individual differences in sweet adaptation.
Methods
Stimuli included three sweeteners at concentrations corresponding to the low (500 mM glucose, 246 µM sucralose, and 303 µM RebA) and high (1.08 M glucose, 870 µM sucralose, and 823 µM RebA) end of the sweetness spectrum for most commercially sold beverages in the US. Each trial participants (n = 38) tasted seven, 10 mL samples of the same stimulus (10 s between samples). For each sample, participants rated sweetness intensity using a general Labeled Magnitude Scale. Tests for all stimuli were repeated three times, on separate days, to assess stability.
Results
All sweeteners showed significant reduction in sweetness with repeated sips, with the exception of the higher concentration glucose (no significant decrease across repeated sips). Sweetness waned with repeated sips more profoundly for the two LCS than for glucose, as expected given previous results. Importantly, there were substantial and stable (across test sessions) individual differences in sweet adaptation.
Conclusions
Sweetness faded more rapidly and completely for LCS than for glucose, and some individuals were more susceptible to sweetness adaptation than others. Whether these individual differences are stable across longer periods of time, or contribute to individual differences in acceptance of beverages sweetened with LCS is currently unclear.
Funding Sources
Funded by a consortium of food and ingredient companies, including Asahi, Kellogg, Kraft, Mondelez, and Suntory. The views expressed are those of the authors, and do not necessarily reflect the views of the sponsors.
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Onufer EJ, Andrade EG, DeClue A, Bochicchio G, Wise P, Klingensmith ME, Eaton S, Kirby J, Punch LJ. COVER: A Curriculum in the Management of Soft Tissue Injury and Infection for Junior Surgery Residents. J Grad Med Educ 2021; 13:95-102. [PMID: 33680307 PMCID: PMC7901621 DOI: 10.4300/jgme-d-20-00278.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/18/2020] [Accepted: 08/29/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND While wound management is a common task for practicing surgeons, there is a paucity of dedicated education on soft tissue management during residency training. OBJECTIVE The COVER (Causes of soft tissue injury, Obstacles to closure, Vacuums and stitches, Epithelialization, Rationale for wound care) curriculum was developed to engage junior surgery residents in the management of soft tissue injury and infection. METHODS Junior surgery residents participated in the COVER lab during academic years 2018-2020. Residents applied appropriate surgical management and wound care to cadaveric models of soft tissue injury and infection. Assessments included a pre-/post-curriculum and pre-/post-lab multiple choice questionnaire and survey. RESULTS All eligible residents (n = 45, 27) participated in the COVER lab for both academic years. Postgraduate year (PGY)-1s, PGY-2s, and PGY-3s showed improvement in wound management knowledge with an average increase in score of 17%, 8%, and 18%, respectively. They also showed a change in their self-reported perceived ability to achieve primary soft tissue closure with confidence levels 22%, 20%, and 16%, respectively. This was again seen in perceived ability to manage soft tissue injuries and infections (28%, 28%, and 23%, respectively). There was a significant increase in performing new wound management skills (PGY-1 mean 51.3%, PGY-2 33.5%, PGY-3 20%; ANOVA, P = .0001). CONCLUSIONS The COVER curriculum provides a systematic approach to soft tissue injury and infection. Residents showed a significant increase in both soft tissue knowledge as well as confidence in ability to perform wound management.
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Duffy S, Norton D, Kelly M, Chavez A, Tun R, Ramírez MNDG, Chen G, Wise P, Svenson J. Using Community Health Workers and a Smartphone Application to Improve Diabetes Control in Rural Guatemala. Glob Health Sci Pract 2020; 8:699-720. [PMID: 33361237 PMCID: PMC7784066 DOI: 10.9745/ghsp-d-20-00076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The global prevalence of diabetes has nearly doubled since 1980. Seventy-five percent of patients with diabetes live in low- and middle-income countries, such as Guatemala, where health care systems are often poorly equipped for chronic disease management. Community health workers (CHWs) and mobile health technology have increasingly been applied to the diabetes epidemic in these settings, although mostly in supportive rather than primary roles in diabetes management. We sought to improve diabetes care in rural Guatemala through the development of a CHW-led diabetes program and a smartphone application to provide CHWs with clinical decision support. METHODS We worked with our local partners to develop a program model and the smartphone application (using the CommCare platform) and to train CHWs. We recruited patients with type 2 diabetes living in rural communities. Program evaluation used a single-group, pre-post design. Primary outcomes were hemoglobin A1c and the percentage of patients meeting A1c goals compared with baseline. We also followed a variety of process metrics, including application reliability. RESULTS Eighty-nine patients enrolled during the study period. The hemoglobin A1c percentage decreased significantly at 3 months (-1.0; 95% CI=-1.7, -0.6), 6 months (-1.5; 95% CI=-2.2, -0.8), 9 months (-1.3; 95% CI=-2.0, -0.6), and 12 months (-1.0; 95% CI=-1.7, -0.4). The percentage of patients with A1c ≤ 8% increased significantly at 3 months (23.6% to 44.4%, P=.007), 6 months (22.0% to 44.0%, P=.015), and 9 months (23.9% to 45.7%, P=.03). CHWs and supervising physicians agreed with application medication recommendations >90% of the time. CONCLUSION Our results suggest that CHWs can safely and effectively manage diabetes with the assistance of a smartphone application and remote physician supervision. This model should be evaluated versus other standards of care and could be adapted to other low-resource settings and chronic diseases.
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Affiliation(s)
- Sean Duffy
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA.
| | - Derek Norton
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Mark Kelly
- University of California-Los Angeles David Geffen School of Medicine, Internal Medicine Residency Program, Los Angeles, CA, USA
| | | | - Rafael Tun
- Hospital Obras Sociales Monseñor Gregorio Schaffer, San Lucas Tolimán, Guatemala
| | - Mariana Niño de Guzmán Ramírez
- University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI, USA
| | - Guanhua Chen
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Paul Wise
- Stanford University School of Medicine, Stanford, CA, USA
| | - Jim Svenson
- University of Wisconsin School of Medicine and Public Health, Department of Emergency Medicine, Madison, WI, USA
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Chin R, Roy A, Pedersen K, Hunt S, Mutch M, Glasgow S, Silviera M, Wise P, Smith R, Wang-Gillam A, Tan B, Lim K, Suresh R, Amin M, Roach M, Badiyan S, Henke L, Kim H. Complete Clinical Response after Short-course Radiation and Sequential Multi-agent Chemotherapy for Non-operative Treatment of Rectal Adenocarcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roy A, Chin R, Chapman W, Bauer P, Mahkdoom B, Hunt S, Glasgow S, Silviera M, Mutch M, Wise P, Smith R, Roach M, Badiyan S, Henke L, Kim H. Baseline Lymphocyte Counts Do Not Predict Oncologic Outcomes and Survival in Patients Receiving Short Course Total Neoadjuvant Therapy for Rectal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1916] [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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Park H, Otegbeye E, Kim H, Mutch M, Pedersen K, Amin M, Tan B, Trikalinos N, Lim KH, Aranha O, Suresh R, Badiyan S, Silviera M, Henke L, Wise P, Hunt S, Mitchem J, Lu E, Wang-Gillam A, Ciorba M. Abstract CT234: Phase I study of epacadostat added to preoperative chemoradiation in patients with locally advanced rectal cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-ct234] [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: Epacadostat is an orally active, potent and selective inhibitor of indoleamine 2, 3-dioxygenase 1 (IDO1). IDO1 inhibition enhances cytotoxic T cell activation by dendritic cells, and significantly decreases regulatory T cell proliferation. We developed preclinical data supporting combination of epacadostat with radiation therapy in rectal cancer. In rectal cancer samples obtained from patients who received hypofractionated radiation, IDO1 was overexpressed in tumor tissue as compensatory response after radiation in both microsatellite stable and unstable cell lines. IDO1 inhibition with epacadostat selectively reduced survival of cancer cells and enhanced radiosensitivity without impacting normal epithelial cells. Epacadostat in addition to radiation showed both increased tumor cytotoxicity and enhanced immune activation in tumor microenvironment in a syngeneic mouse model of colorectal cancer. Literature also supports the choice of high dose, hypofractionated radiation to induce a more favorable anti-tumor immune response. Therefore, we hypothesized that IDO1 expression is a mechanism of radioresistance in rectal cancer and IDO1 inhibition is a safe and well-tolerated combination therapy to enhance tumor radiosensitivity. Methods: Patients with locally advanced rectal cancer who are candidates for neoadjuvant therapy using short-course radiation and chemotherapy are included in this study. Primary objective of the study is to determine the recommended phase II dose (RP2D) of epacadostat for combination with short course radiation and chemotherapy in preoperative treatment of locally advanced rectal cancer. This study includes dose-escalation part of patients receiving epacadostat with radiation and chemotherapy (n=6-18) followed by dose-expansion (n=up to 27 including those treated at RP2D during escalation). Two dose levels of epacadostat (300mg and 600mg orally twice daily) will be explored. Epacadostat will be combined with short-course radiation (5Gy x 5 fractions) followed by 6 cycles of CAPOX chemotherapy, until the day of surgery for a total of approximately 24 weeks of therapy. Research biopsies of tumor and adjacent non-tumor tissue along with blood sample collection will be performed before and after the radiation, and at the time of surgery. Tryptophan pathway metabolites, immune checkpoint biomarkers, markers of cell death, proliferation and potentially prognostic molecular biomarkers will be measured in tumor tissues before and after radiation therapy. In addition, patient-derived organoid and xenograft models from rectal biopsy samples will be used to determine the success rate of organoid generation, to evaluate treatment response and to characterize molecular changes to identify potential predictors of response and mechanisms of resistance. Enrollment began in November 2019. NCT03516708
Citation Format: Haeseong Park, Ebunoluwa Otegbeye, Hyun Kim, Matthew Mutch, Katrina Pedersen, Manik Amin, Benjamin Tan, Nikolaos Trikalinos, Kian-Huat Lim, Olivia Aranha, Rama Suresh, Shahed Badiyan, Matthew Silviera, Lauren Henke, Paul Wise, Steven Hunt, Jonathan Mitchem, Esther Lu, Andrea Wang-Gillam, Matthew Ciorba. Phase I study of epacadostat added to preoperative chemoradiation in patients with locally advanced rectal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT234.
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Affiliation(s)
- Haeseong Park
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Hyun Kim
- 1Washington University in St. Louis, Saint Louis, MO
| | - Matthew Mutch
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Manik Amin
- 1Washington University in St. Louis, Saint Louis, MO
| | - Benjamin Tan
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Kian-Huat Lim
- 1Washington University in St. Louis, Saint Louis, MO
| | - Olivia Aranha
- 1Washington University in St. Louis, Saint Louis, MO
| | - Rama Suresh
- 1Washington University in St. Louis, Saint Louis, MO
| | | | | | - Lauren Henke
- 1Washington University in St. Louis, Saint Louis, MO
| | - Paul Wise
- 1Washington University in St. Louis, Saint Louis, MO
| | - Steven Hunt
- 1Washington University in St. Louis, Saint Louis, MO
| | | | - Esther Lu
- 1Washington University in St. Louis, Saint Louis, MO
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Hoffman RL, Bauer PS, Chan T, Mohanty S, Hunt S, Silviera M, Mutch M, Wise P, Smith R. Patient-provider gender preference in colorectal surgery. Am J Surg 2020; 220:1253-1257. [PMID: 32690209 DOI: 10.1016/j.amjsurg.2020.06.051] [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: 02/14/2020] [Revised: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Preference for a gender concordant surgeon has been demonstrated when the chief complaint is perceived as private. We aimed to investigate this phenomenon among colorectal patients. METHODS A 3-week prospective, observational, quality improvement study was performed. Schedulers recorded all new patient calls and factors influencing patient selection of surgeon. Demographic information was obtained. Descriptive statistics were performed. RESULTS There were 60 new patients scheduled; 35 (58.3%) female. Ten(16.7%) chose a surgeon based on gender; 70% of those with gender requests (GR) were female (70%), and 80% were gender-concordant. Seven (70%) of those with GR had anorectal complaints. Of all patients with anorectal complaints, 20.6% had a GR vs. 11.5% non-anorectal (p = 0.49). CONCLUSIONS A considerable percentage of patients make a GR when seeking treatment, especially for anorectal disease. Departments should be mindful of the sensitive nature of many colorectal diseases and strive to diversify accordingly in order to create safe environments for the optimal delivery of patient-centered care.
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Affiliation(s)
- Rebecca L Hoffman
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Philip S Bauer
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Tiffany Chan
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Sanjay Mohanty
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Steven Hunt
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Matthew Silviera
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Matthew Mutch
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Paul Wise
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
| | - Radhika Smith
- Washington University in St. Louis, Division of Colon & Rectal Surgery, 4921 Parkview Place, St. Louis, MO, 63110, USA.
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Lin C, Colquitt L, Wise P, Breslin PAS, Rawson NE, Genovese F, Maina I, Joseph P, Fomuso L, Slade L, Brooks D, Miclo A, Hayes JE, Sullo A, Reed DR. Studies of human twins reveal genetic variation that affects dietary fat perception. Chem Senses 2020; 45:bjaa036. [PMID: 32516399 PMCID: PMC7339080 DOI: 10.1093/chemse/bjaa036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Indexed: 01/09/2023] Open
Abstract
To learn more about the mechanisms of human dietary fat perception, 398 human twins rated fattiness and liking for six types of potato chips that differed in triglyceride content (2.5, 5, 10, and 15% corn oil); reliability estimates were obtained from a subset (n = 50) who did the task twice. Some chips also had a saturated long-chain fatty acid (hexadecanoic acid, 16:0) added (0.2%) to evaluate its effect on fattiness and liking. We computed the heritability of these measures and conducted a genome-wide association study (GWAS) to identify regions of the genome that co-segregate with fattiness and liking. Perceived fattiness and liking for the potato chips were reliable (r = 0.31-0.62, p < 0.05) and heritable (up to h2 = 0.29, p < 0.001, for liking). Adding hexadecanoic acid to the potato chips significantly increased ratings of fattiness but decreased liking. Twins with the G allele of rs263429 near GATA3-AS1 or the G allele of rs8103990 within ZNF729 reported more liking for potato chips than did twins with the other allele (multivariate GWAS, p < 1×10-5), with results reaching genome-wide suggestive but not significance criteria. Person-to-person variation in the perception and liking of dietary fat was (a) negatively affected by the addition of a saturated fatty acid and (b) related to inborn genetic variants. These data suggest liking for dietary fat is not due solely to fatty acid content and highlight new candidate genes and proteins within this sensory pathway.
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Affiliation(s)
- Cailu Lin
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | | | - Paul Wise
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | | | | | | | - Ivy Maina
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - Paule Joseph
- Sensory Science and Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | | | - Louise Slade
- Food Polymer Science Consultancy, Morris Plains, NJ, USA
| | | | - Aurélie Miclo
- Monell Chemical Senses Center, Philadelphia, PA, USA
| | - John E Hayes
- Sensory Evaluation Center, and Department of Food Science, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
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McLennan EA, Grueber CE, Wise P, Belov K, Hogg CJ. Mixing genetically differentiated populations successfully boosts diversity of an endangered carnivore. Anim Conserv 2020. [DOI: 10.1111/acv.12589] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- E. A. McLennan
- School of Life and Environmental Sciences University of Sydney Sydney NSW Australia
| | - C. E. Grueber
- School of Life and Environmental Sciences University of Sydney Sydney NSW Australia
- San Diego Zoo Global San Diego CA USA
| | - P. Wise
- Save the Tasmanian Devil Program, DPIPWE Hobart Tas Australia
| | - K. Belov
- School of Life and Environmental Sciences University of Sydney Sydney NSW Australia
| | - C. J. Hogg
- School of Life and Environmental Sciences University of Sydney Sydney NSW Australia
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Anand S, Caplin B, Gonzalez-Quiroz M, Schensul SL, Bhalla V, Parada X, Nanayakkara N, Fire A, Levin A, Friedman DJ, Aguilar-Gonzalez A, Abbot K, Abeysekara T, Amann K, Anand S, Ashuntantang G, Bhalla V, Brooks D, Caplin B, Chavarria D, Christoph D, Rotter RC, De Broe M, De Silva PMC, Dominguez J, Eckardt KU, Fader D, Finkelstein F, Fire A, Fischer R, Friedman D, Ganguli A, Garcia Trabinho RA, Glaser J, Gonzalez Quiroz MA, Fischer R, Haider L(L, Harris D, Herath C, Herrera R, Hradsky A, Hoy W, Jakobsson K, Jayasinghe S, Jaysummana C, Jha V, Johnson R, Kambham N, Karanasema N, Kaze F, Kimmel P, Koritzinsky E, Langham R, Le Bellego L, Levin A, Levin N, Lyuckx V, Madero M, Martin E, Malik C, Moist L, Moxey-Mims M, Nanayakkara N, Narva A, Nerbass F, O'Donoghue D, Orantes C, Parada X, Pearce N, Ratnayake C, Roy-Chaudhury P, Ruggiero A, Sanchez-Lozada LG, Saran R, Schensul S, Segantini L, Seksek I, Sheikh-Hamad D, Star R, Strani L, Vlahos P, Wegman DH, Weiss I, Wijewickrama E, Wijkstrom J, Wise P, Wright E, Yang CW, Yeates K. Epidemiology, molecular, and genetic methodologies to evaluate causes of CKDu around the world: report of the Working Group from the ISN International Consortium of Collaborators on CKDu. Kidney Int 2019; 96:1254-1260. [DOI: 10.1016/j.kint.2019.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
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Affiliation(s)
- Sean Duffy
- Corresponding author: Sean Duffy, MD, University of Wisconsin School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI 53715,
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Ghaemi MS, DiGiulio DB, Contrepois K, Callahan B, Ngo TTM, Lee-McMullen B, Lehallier B, Robaczewska A, Mcilwain D, Rosenberg-Hasson Y, Wong RJ, Quaintance C, Culos A, Stanley N, Tanada A, Tsai A, Gaudilliere D, Ganio E, Han X, Ando K, McNeil L, Tingle M, Wise P, Maric I, Sirota M, Wyss-Coray T, Winn VD, Druzin ML, Gibbs R, Darmstadt GL, Lewis DB, Partovi Nia V, Agard B, Tibshirani R, Nolan G, Snyder MP, Relman DA, Quake SR, Shaw GM, Stevenson DK, Angst MS, Gaudilliere B, Aghaeepour N. Multiomics modeling of the immunome, transcriptome, microbiome, proteome and metabolome adaptations during human pregnancy. Bioinformatics 2019; 35:95-103. [PMID: 30561547 PMCID: PMC6298056 DOI: 10.1093/bioinformatics/bty537] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
Motivation Multiple biological clocks govern a healthy pregnancy. These biological mechanisms produce immunologic, metabolomic, proteomic, genomic and microbiomic adaptations during the course of pregnancy. Modeling the chronology of these adaptations during full-term pregnancy provides the frameworks for future studies examining deviations implicated in pregnancy-related pathologies including preterm birth and preeclampsia. Results We performed a multiomics analysis of 51 samples from 17 pregnant women, delivering at term. The datasets included measurements from the immunome, transcriptome, microbiome, proteome and metabolome of samples obtained simultaneously from the same patients. Multivariate predictive modeling using the Elastic Net (EN) algorithm was used to measure the ability of each dataset to predict gestational age. Using stacked generalization, these datasets were combined into a single model. This model not only significantly increased predictive power by combining all datasets, but also revealed novel interactions between different biological modalities. Future work includes expansion of the cohort to preterm-enriched populations and in vivo analysis of immune-modulating interventions based on the mechanisms identified. Availability and implementation Datasets and scripts for reproduction of results are available through: https://nalab.stanford.edu/multiomics-pregnancy/. Supplementary information Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Mohammad Sajjad Ghaemi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Département de Mathématiques et de Génie Industriel, École Polytechnique de Montréal, QC, Canada
- Groupe d’Études et de Recherche en Analyse des Décision (GERAD), Montréal, QC, Canada
- Centre Interuniversitaire de Recherche sur les Réseaux d’Entreprise, la Logistique et le Transport (CIRRELT), Montréal, QC, Canada
| | - Daniel B DiGiulio
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kévin Contrepois
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin Callahan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - Thuy T M Ngo
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Cancer Early Detection Advanced Research Center, Knight Cancer Institute and Department of Molecular and Medical Genetics, Oregon Health Sciences University, Portland, OR, USA
| | | | - Benoit Lehallier
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna Robaczewska
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - David Mcilwain
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Yael Rosenberg-Hasson
- Institute for Immunity, Transplantation and Infection, Human Immune Monitoring Center Stanford, CA, USA
| | - Ronald J Wong
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Cecele Quaintance
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Anthony Culos
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalie Stanley
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Athena Tanada
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy Tsai
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Dyani Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Xiaoyuan Han
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Leslie McNeil
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Martha Tingle
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul Wise
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Ivana Maric
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Marina Sirota
- Institute for Computational Health Sciences, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Tony Wyss-Coray
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Virginia D Winn
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maurice L Druzin
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ronald Gibbs
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary L Darmstadt
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David B Lewis
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Vahid Partovi Nia
- Département de Mathématiques et de Génie Industriel, École Polytechnique de Montréal, QC, Canada
- Groupe d’Études et de Recherche en Analyse des Décision (GERAD), Montréal, QC, Canada
| | - Bruno Agard
- Département de Mathématiques et de Génie Industriel, École Polytechnique de Montréal, QC, Canada
- Centre Interuniversitaire de Recherche sur les Réseaux d’Entreprise, la Logistique et le Transport (CIRRELT), Montréal, QC, Canada
| | - Robert Tibshirani
- Departments of Biomedical Data Sciences and Statistics, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University School of Medicine, Stanford, CA, USA
| | - Garry Nolan
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA
| | - David A Relman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Stephen R Quake
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Gary M Shaw
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - David K Stevenson
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Williams RG, George BC, Meyerson SL, Bohnen JD, Dunnington GL, Schuller MC, Torbeck L, Mullen JT, Auyang E, Chipman JG, Choi J, Choti M, Endean E, Foley EF, Mandell S, Meier A, Smink DS, Terhune KP, Wise P, DaRosa D, Soper N, Zwischenberger JB, Lillemoe KD, Fryer JP. What factors influence attending surgeon decisions about resident autonomy in the operating room? Surgery 2017; 162:1314-1319. [PMID: 28950992 DOI: 10.1016/j.surg.2017.07.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 07/10/2017] [Accepted: 07/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. METHODS We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. RESULTS Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). CONCLUSION Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors.
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Affiliation(s)
- Reed G Williams
- Department of Surgery, Indiana University, Indianapolis, IN.
| | - Brian C George
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Jordan D Bohnen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Laura Torbeck
- Department of Surgery, Indiana University, Indianapolis, IN
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Edward Auyang
- Department of Surgery, University of New Mexico, Albuquerque, NM
| | | | - Jennifer Choi
- Department of Surgery, Indiana University, Indianapolis, IN
| | - Michael Choti
- Department of Surgery, University of Texas Southwestern, Surgery, Dallas, TX
| | - Eric Endean
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Eugene F Foley
- Department of Surgery, University Of Wisconsin, Madison, WI
| | - Samuel Mandell
- Department of Surgery, University of Washington, Surgery, Seattle, WA
| | - Andreas Meier
- Department of Surgery, State University of New York, Surgery, Syracuse, NY
| | - Douglas S Smink
- Department of Surgery, Brigham and Women's Hospital, Surgery, Boston, MA
| | - Kyla P Terhune
- Department of Surgery, Vanderbilt University Medical Center, Surgery, Nashville, TN
| | - Paul Wise
- Department of Surgery, Washington University, Surgery, St. Louis, MO
| | - Debra DaRosa
- Department of Surgery, Northwestern University, Chicago, IL
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Bavinger JC, Wise P, Bendavid E. The relationship between burden of childhood disease and foreign aid for child health. BMC Health Serv Res 2017; 17:655. [PMID: 28915813 PMCID: PMC5602827 DOI: 10.1186/s12913-017-2540-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 08/14/2017] [Indexed: 11/25/2022] Open
Abstract
Background We sought to examine the relationship between child specific health aid (CHA) and burden of disease. Based on existing evidence, we hypothesized that foreign aid for child health would not be proportional to burden of disease. Methods In order to examine CHA and burden of disease, we obtained estimates of these parameters from established sources. Estimates of disability adjusted life years (DALYs) in children (0–5 years) were obtained from the World Health Organization for 2000 and 2012. The 10 most burdensome disease categories in each continent, excluding high-income countries, were identified for study. Descriptions of all foreign aid commitments between 1996 and 2009 were obtained from AidData, and an algorithm to designate the target diseases of the commitments was constructed. Data were examined in scatterplots for trends. Results The most burdensome childhood diseases varied by continent. In all continents, newborn diseases, vaccine-preventable diseases (lower respiratory diseases, measles, meningitis, tetanus, and pertussis), and diarrheal diseases ranked within the four most burdensome diseases. Infectious diseases such as malaria, tuberculosis, and HIV were also among the ten most burdensome diseases in sub-Saharan Africa, and non-communicable diseases were associated with much of the burden in the other continents. CHA grew from $7.4 billion in 1996 to $17.7 billion in 2009 for our study diseases. Diarrheal diseases and malnutrition received the most CHA as well as the most CHA per DALY. CHA directed at HIV increased dramatically over our study period, from $227,000 in 1996 to $3.4 billion in 2008. Little aid was directed at injuries such as drowning, car accidents, and fires, as well as complex medical diseases such as leukemia and endocrine disorders. Conclusion CHA has grown significantly over the last two decades. There is no clear relationship between CHA and burden of disease. This report provides a description of foreign aid for child health, and hopes to inform policy and decision-making regarding foreign aid. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2540-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Paul Wise
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.,The Division of General Medical Disciplines, Stanford University, Stanford, CA, USA
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Alsan M, Xing A, Wise P, Darmstadt GL, Bendavid E. Childhood Illness and the Gender Gap in Adolescent Education in Low- and Middle-Income Countries. Pediatrics 2017; 140:peds.2016-3175. [PMID: 28759395 PMCID: PMC5495535 DOI: 10.1542/peds.2016-3175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Accepted: 04/19/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Achieving gender equality in education is an important development goal. We tested the hypothesis that the gender gap in adolescent education is accentuated by illnesses among young children in the household. METHODS Using Demographic and Health Surveys on 41 821 households in 38 low- and middle-income countries, we used linear regression to estimate the difference in the probability adolescent girls and boys were in school, and how this gap responded to illness episodes among children <5 years old. To test the hypothesis that investments in child health are related to the gender gap in education, we assessed the relationship between the gender gap and national immunization coverage. RESULTS In our sample of 120 708 adolescent boys and girls residing in 38 countries, girls were 5.08% less likely to attend school than boys in the absence of a recent illness among young children within the same household (95% confidence interval [CI], 5.50%-4.65%). This gap increased to 7.77% (95% CI, 8.24%-7.30%) and 8.53% (95% CI, 9.32%-7.74%) if the household reported 1 and 2 or more illness episodes, respectively. The gender gap in schooling in response to illness was larger in households with a working mother. Increases in child vaccination rates were associated with a closing of the gender gap in schooling (correlation coefficient = 0.34, P = .02). CONCLUSIONS Illnesses among children strongly predict a widening of the gender gap in education. Investments in early childhood health may have important effects on schooling attainment for adolescent girls.
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Affiliation(s)
- Marcella Alsan
- Center for Health Policy and the Center for Primary Care and Outcomes Research, .,Center for Innovation in Global Health.,National Bureau of Economic Research, Cambridge, Massachusetts
| | - Anlu Xing
- Center for Health Policy and the Center for Primary Care and Outcomes Research
| | - Paul Wise
- Center for Health Policy and the Center for Primary Care and Outcomes Research,,Center for Innovation in Global Health,,Department of Pediatrics, Stanford University School of Medicine, and,Freeman Spogli Institute for International Studies, Stanford University, Stanford, California; and
| | - Gary L. Darmstadt
- Center for Innovation in Global Health,,Department of Pediatrics, Stanford University School of Medicine, and,Freeman Spogli Institute for International Studies, Stanford University, Stanford, California; and
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes Research,,Center for Innovation in Global Health,,Division of General Medical Disciplines
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Alvarez EM, Keegan T, Johnston EE, Haile R, Sanders L, Wise P, Saynina O, Chamberlain LJ. The Affordable Care Act Dependent Coverage Expansion (ACA-DCE): Disparities in impact in young adult oncology patients. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6561] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6561 Background: Private health insurance is associated with improved outcomes in cancer patients. We know little, however, about the impact of the ACA-DCE, which extended private insurance to young adults (up to age 26) beginning in 2010, on the insurance status of young adults with cancer. This study sought to determine the effect of the ACA-DCE on having private insurance coverage among hospitalized young adult oncology patients. Methods: We performed a retrospective, population-based analysis of hospitalized young adult oncology patients (22-30 years-old) in California during 2006-2014 (n = 11,062) using the Office of Statewide Health Planning and Development database. Multivariable regression analyses examined the social and clinical predictors of having private insurance. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CIs). A difference-in-difference analysis examined the influence of the ACA-DCE on insurance coverage by race/ethnicity and zip code federal poverty level. Results: Multivariable regression demonstrated patients of black and Hispanic race/ethnicity were less likely to have private insurance both before and after the ACA-DCE, compared to non-Hispanic white patients. Younger age (22-25 years) was associated with having private insurance after the ACA-DCE implementation (OR 1.18, CI 1.05-1.33; reference, 27-30 years). In the difference-in-difference analysis, private insurance increased among non-Hispanic whites aged 22-25 living in medium- (2006-2009: 64.6% versus (vs) 2011-2014: 69.1%; p = 0.003) and high-income zip codes (80.4% vs 82%; p = 0.043) and among Asian patients aged 22-25 living in high-income zip codes (73.2 vs 85.7%; p = 0.022). Private insurance decreased for all Hispanic patients aged 22-25 between the two time periods. Conclusions: The ACA-DCE provision was an important first step in increasing coverage, but it was not universal and generated disparity in coverage as gains occurred for non-Hispanic white and Asian patients living in higher income zip codes. This policy change was shown to increase coverage for a traditionally underinsured population and attention should now focus on those remaining uninsured.
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Affiliation(s)
| | - Theresa Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), UC Davis Comprehensive Cancer Center, Sacramento, CA
| | | | | | - Lee Sanders
- Stanford University Medical Center, Palo Alto, CA
| | - Paul Wise
- Stanford University School of Medicine, Palo Alto, CA
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21
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Wells KO, Hawkins AT, Krishnamurthy DM, Dharmarajan S, Glasgow SC, Hunt SR, Mutch MG, Wise P, Silviera ML. Omission of Adjuvant Chemotherapy Is Associated With Increased Mortality in Patients With T3N0 Colon Cancer With Inadequate Lymph Node Harvest. Dis Colon Rectum 2017; 60:15-21. [PMID: 27926553 DOI: 10.1097/dcr.0000000000000729] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 02/08/2023]
Abstract
BACKGROUND Adjuvant chemotherapy for T3N0 colon cancer is controversial. National guidelines recommend its use in patients with stage II with high-risk features, including lymph node harvest of less than 12, yet this treatment is underused. OBJECTIVE The purpose of this study was to demonstrate that the use of adjuvant chemotherapy in patients with T3N0 adenocarcinoma with inadequate lymph node harvest is beneficial. DESIGN This was a retrospective population-based study of patients with resected T3N0 adenocarcinoma of the colon. SETTINGS The National Cancer Database was queried from 2003 to 2012. PATIENTS A total of 134,567 patients with T3N0 colon cancer were included in this analysis. MAIN OUTCOME MEASURES The use of chemotherapy, short-term outcomes, and overall survival was evaluated. Clinicopathologic factors associated with omission of chemotherapy were also analyzed. RESULTS Inadequate lymph node harvest was observed in 23.3% of patients, and this rate decreased over the study period from 46.8% in 2003 to 12.5% in 2012 (p < 0.0001). Overall 5-year survival for patients with T3N0 cancer was 66.8%. Inadequate lymph node harvest among these patients was associated with lower overall 5-year survival (58.7% vs 69.8%; p < 0.001). The use of adjuvant chemotherapy among patients with T3N0 cancer after inadequate lymph node harvest was only 16.7%. In a multivariable analysis, factors associated with failure to receive chemotherapy included advanced age (OR = 0.44 (95% CI, 0.43-0.45)), increased comorbidities (OR = 0.7 (95% CI, 0.66-0.76)), and postoperative readmission (OR = 0.78 (95% CI, 0.67-0.91)). Patients with inadequate lymph node harvest who received adjuvant chemotherapy had improved 5-year survival (chemotherapy, 78.4% vs no chemotherapy, 54.7%; p < 0.001). Even when controlling for all of the significant variables, the administration of chemotherapy remained a predictor of decreased mortality (HR = 0.57 (95% CI, 0.54-0.60); p < 0.001). LIMITATIONS This study was limited by its retrospective, population-based design. CONCLUSIONS Patients with T3N0 colon cancer with inadequate lymph node harvest who receive adjuvant chemotherapy have increased overall survival. Despite this survival benefit, a fraction of these patients receive adjuvant chemotherapy. Barriers to chemotherapy are multifactorial.
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Affiliation(s)
- Katerina O Wells
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
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Yang J, Baer RJ, Berghella V, Chambers C, Chung P, Coker T, Currier RJ, Druzin ML, Kuppermann M, Muglia LJ, Norton ME, Rand L, Ryckman K, Shaw GM, Stevenson D, Wise P, Jelliffe-Pawlowski LL. 848: Association between gestational duration in first pregnancies and birth timing in second pregnancies. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.898] [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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Affiliation(s)
- Tina L. Cheng
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; Department of Population, Family and Reproductive Health, Bloomberg School of Public Health
| | - Paul Wise
- Department of Pediatrics, Stanford University, Palo Alto, CA; Center for Policy Outcomes and Prevention
| | - Neal Halfon
- Department of Pediatrics, David Geffen UCLA School of Medicine, Los Angeles, CA; Department of Health Policy and Management, Fielding School of Public Health, Department of Public Policy, Luskin School of Public AffairsCenter for Healthier Children, Families and Communities
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Bavinger C, Wise P, Bendavid E. Relation between disease-specific foreign aid for child health and burden of disease in sub-Saharan African countries. The Lancet Global Health 2014. [DOI: 10.1016/s2214-109x(15)70050-1] [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: 11/29/2022] Open
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Abstract
Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups.
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Affiliation(s)
- Rajaie Batniji
- Department of Medicine, Stanford University, Stanford, CA, USA.
| | - Lina Khatib
- Carnegie Middle East Center, Beirut, Lebanon
| | - Melani Cammett
- Department of Political Science, Brown University, Providence, RI, USA
| | - Jeffrey Sweet
- Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Sanjay Basu
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Amaney Jamal
- Department of Political Science, Princeton University, Princeton, NJ, USA
| | - Paul Wise
- Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Rita Giacaman
- Institute for Community and Public Health, Birzeit University, Birzeit, West Bank, occupied Palestinian territory
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Alvarez E, Chamberlain LJ, Marina N, Saynina O, Wise P. Utilization of subspecialty care by Hispanic pediatric oncology patients, California 1983-2010. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e17504] [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: 11/20/2022] Open
Abstract
e17504 Background: Previous analysis has shown that Hispanic pediatric oncology patients in California have decreased utilization of pediatric cancer specialty centers (PCSC). The purpose of this study was to examine the clinical and non-clinical factors associated with decreased inpatient utilization of PCSCs by Hispanic pediatric oncology patients. Methods: Using the California Office of Statewide Health Planning and Development private database we performed a retrospective population based analysis of Hispanic patient discharges 0-18 years of age to explore the influence of age, gender, payer, income, distance to admission site, tumor type and diagnosis of fever and neutropenia on the utilization of PCSCs by Hispanic patients. Results: Analysis of 82,832 Hispanic pediatric oncology discharges showed concentration of hospitalization in PCSCs increasing from 64% in 1983 to 94% in 2010. In addition, an increased percentage of acute lymphoblastic leukemia discharges was seen for Hispanics (28.3%) compared to all discharges (22.4%). The adjusted regression analysis revealed decreased utilization of PCSCs for patients ages 15-18 (OR 0.466; CI 0.441-0.493) and for those residing 6 - 10 miles from a PCSC (OR 0.927; CI 0.883 - 0.974). Increased utilization of PCSCs was seen for Hispanic patients living in zip codes where household income was >4 times the Federal Poverty Level. Payer status was not significantly associated with discharge from a PCSC. None of these findings changed when Los Angeles County was removed from the analysis. A separate analysis was done on Hispanic pediatric oncology patients with a discharge diagnosis of fever and neutropenia. For this subset decreased utilization was seen for those with private insurance (OR 0.84; CI 0.81-0.887), age <1 (OR 0.719; CI 0.64-0.808), ages 15-18 (OR 0.596; CI 0.558-0.636) and those residing >40 miles from a PCSC (OR 0.913; CI 0.854-0.975). Conclusions: Utilization of inpatient pediatric oncology care by Hispanic patients in California has become regionalized in PCSCs since 1983 and is influenced by age, and geography, with payer status not being a significant contributor. Clinical outcomes as they relate to access to PCSCs for Hispanic patients should be examined.
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Affiliation(s)
| | | | - Neyssa Marina
- Stanford University, School of Medicine, Palo Alto, CA
| | - Olga Saynina
- Stanford University, School of Medicine, Palo Alto, CA
| | - Paul Wise
- Stanford University, School of Medicine, Palo Alto, CA
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Wang XB, Wang GF, Zhang LX, Luo RF, Tian HC, Tang LN, Wang JJ, Medina A, Wise P, Rozelle S. [Investigation on prevalence of soil-transmitted nematode infections and influencing factors for children in southwest areas of China]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2012; 24:268-293. [PMID: 23012947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To understand the infection status and main risk factors of soil-transmitted nematodes in southwest China so as to provide the evidence for making the control programs for soil-transmitted nematodiasis. METHODS The prevalence of soil-transmitted nematode infections was determined by Kato-Katz technique and influencing factors were surveyed by using a standardized questionnaire, and in part of the children, the examination of Enterobius vermicularis eggs was performed by using the cellophane swab method. The relationship between soil-transmitted nematode infections and influencing factors was analyzed by the multiple probit estimated method. RESULTS A total of 1 707 children were examined, with a soil-transmitted nematode infection rate of 22.2%, the crowd infection rates ofAscaris lumbricoides, hookworm, and Trichuris trichiura were 16.0%, 3.8% and 6.6% respectively and 495 children were examined on Enterobius vermicularis eggs, with the infection rate of 5.1%. The results of probit estimated analysis suggested that the effects of 4 factors on soil-transmitted nematode infections were significant (all P values were less than 0.05), namely the number of sib, educational level of mother, drinking unboiled water and raising livestock and poultry. Among the factors above, the educational level of mother could reduce the probability of infection (ME = -0.074), while the number of sib, drinking unboiled water and raising livestock and poultry could increase the probability of the infections (with ME of 0.028, -0.112 and 0.080, respectively). CONCLUSIONS Soil-transmitted nematode infection rates are still in a high level for children in southwest poor areas of China, with Ascaris lumbricoides as a priority. The changes of children's bad health habits, raising livestock and poultry habits, and implementing the health education about parasitic diseases in mothers would be of great significance for the prevention and control of soil-transmitted nematodiasis.
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Affiliation(s)
- Xiao-Bing Wang
- Center for Chinese Agricultural Policy, Chinese Academy of Science, Beijing 100101, China
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28
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Lundstrom JN, Gordon AR, Wise P, Frasnelli J. Individual Differences in the Chemical Senses: Is There a Common Sensitivity? Chem Senses 2012; 37:371-8. [DOI: 10.1093/chemse/bjr114] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bellcross CA, Bedrosian SR, Daniels E, Duquette D, Hampel H, Jasperson K, Joseph DA, Kaye C, Lubin I, Meyer LJ, Reyes M, Scheuner MT, Schully SD, Senter L, Stewart SL, St Pierre J, Westman J, Wise P, Yang VW, Khoury MJ. Implementing screening for Lynch syndrome among patients with newly diagnosed colorectal cancer: summary of a public health/clinical collaborative meeting. Genet Med 2011; 14:152-62. [PMID: 22237445 DOI: 10.1038/gim.0b013e31823375ea] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lynch syndrome is the most common cause of inherited colorectal cancer, accounting for approximately 3% of all colorectal cancer cases in the United States. In 2009, an evidence-based review process conducted by the independent Evaluation of Genomic Applications in Practice and Prevention Working Group resulted in a recommendation to offer genetic testing for Lynch syndrome to all individuals with newly diagnosed colorectal cancer, with the intent of reducing morbidity and mortality in family members. To explore issues surrounding implementation of this recommendation, the Centers for Disease Control and Prevention convened a multidisciplinary working group meeting in September 2010. This article reviews background information regarding screening for Lynch syndrome and summarizes existing clinical paradigms, potential implementation strategies, and conclusions which emerged from the meeting. It was recognized that widespread implementation will present substantial challenges, and additional data from pilot studies will be needed. However, evidence of feasibility and population health benefits and the advantages of considering a public health approach were acknowledged. Lynch syndrome can potentially serve as a model to facilitate the development and implementation of population-level programs for evidence-based genomic medicine applications involving follow-up testing of at-risk relatives. Such endeavors will require multilevel and multidisciplinary approaches building on collaborative public health and clinical partnerships.
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Affiliation(s)
- Cecelia A Bellcross
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Pietsch J, Bauer J, Egli M, Infanger M, Wise P, Ulbrich C, Grimm D. The effects of weightlessness on the human organism and mammalian cells. Curr Mol Med 2011; 11:350-64. [PMID: 21568935 DOI: 10.2174/156652411795976600] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/20/2011] [Indexed: 11/22/2022]
Abstract
It has always been a desire of mankind to conquest Space. A major step in realizing this dream was the completion of the International Space Station (ISS). Living there for several months confirmed early observations of short-term spaceflights that a loss of gravity affects the health of astronauts. Space medicine tries to understand the mechanism of microgravity-induced health problems and to conceive potent countermeasures. There are four different aspects which make space medicine appealing: i) finding better strategies for adapting astronauts to weightlessness; ii) identification of microgravity-induced diseases (e.g. osteoporosis, muscle atrophy, cardiac problems and others); iii) defining new therapies to conquer these diseases which will benefit astronauts as well as people on Earth in the end; and iv) on top of that, unveiling the mechanisms of weightlessness-dependent molecular and cellular changes is a requirement for improving space medicine. In mammalian cells, microgravity induces apoptosis and alters the cytoskeleton and affects signal transduction pathways, cell differentiation, growth, proliferation, migration and adhesion. This review focused on gravi-sensitive signal transduction elements and pathways as well as molecular mechanisms in human cells, aiming to understand the cellular changes in altered gravity. Moreover, the latest information on how these changes lead to clinically relevant health problems and current strategies of countermeasures are reviewed.
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Affiliation(s)
- J Pietsch
- FU-Berlin, Division of Biology, Chemistry, Pharmacy, Berlin, Germany
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31
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Hsia RY, Wang E, Saynina O, Wise P, Pérez-Stable EJ, Auerbach A. Factors associated with trauma center use for elderly patients with trauma: a statewide analysis, 1999-2008. ACTA ACUST UNITED AC 2011; 146:585-92. [PMID: 21242421 DOI: 10.1001/archsurg.2010.311] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To estimate the likelihood of trauma center admission for injured elderly patients with trauma, determine trends in trauma center admissions, and identify factors associated with trauma center use for elderly patients with trauma. DESIGN Retrospective analysis. SETTING Acute care hospitals in California. PATIENTS All patients hospitalized for acute traumatic injuries during the period from January 1, 1999, to December 31, 2008 (n = 430,081). Patients who had scheduled admissions for nonacute or minor trauma were excluded. MAIN OUTCOME MEASURE Likelihood of admission to level I or II trauma center was calculated according to age categories after adjusting for patient and system factors. RESULTS Of 430,081 patients admitted to California acute care hospitals for trauma-related diagnoses, 27% were older than 65 years. After adjusting for demographic, clinical, and system factors, compared with trauma patients aged 18-25 years, the odds of admission to a trauma center decreased with increasing age; patients aged 26-45 years had lower odds (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80) of being admitted to a trauma center for their injuries than did patients 46-65 years of age (OR, 0.57; 95% CI, 0.54-0.60), patients 66-85 years of age (OR, 0.35; 95% CI, 0.30-0.41), and patients older than 85 years (OR, 0.30; 95% CI, 0.25-0.36). Similar patterns were found when stratifying the analysis by trauma type and severity. Living more than 50 miles away from a trauma center (OR, 0.03; 95% CI, 0.01-0.06) and lack of county trauma center (OR, 0.17; 95% CI, 0.09-0.35) were also predictors of not receiving trauma care. CONCLUSION Age and likelihood of admission to a trauma center for injured patients were observed to be inversely proportional after controlling for other factors. System-level factors play a major role in determining which injured patients receive trauma care.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine, University of California, San Francisco, USA.
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Faircloth DC, Lawrie S, Letchford AP, Gabor C, Wise P, Whitehead M, Wood T, Westall M, Findlay D, Perkins M, Savage PJ, Lee DA, Pozimski JK. The front end test stand high performance H- ion source at Rutherford Appleton Laboratory. Rev Sci Instrum 2010; 81:02A721. [PMID: 20192390 DOI: 10.1063/1.3271169] [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: 05/28/2023]
Abstract
The aim of the front end test stand (FETS) project is to demonstrate that chopped low energy beams of high quality can be produced. FETS consists of a 60 mA Penning Surface Plasma Ion Source, a three solenoid low energy beam transport, a 3 MeV radio frequency quadrupole, a chopper, and a comprehensive suite of diagnostics. This paper details the design and initial performance of the ion source and the laser profile measurement system. Beam current, profile, and emittance measurements are shown for different operating conditions.
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Affiliation(s)
- D C Faircloth
- STFC, Rutherford Appleton Laboratory, Chilton, Didcot, Oxfordshire OX14 0QX, United Kingdom.
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Wise P, Sturgeon D, Ness R. Aggressive gastric cancer in a patient with an APC mutation and a monoallelic MYH mutation. Hered Cancer Clin Pract 2010. [PMCID: PMC2876295 DOI: 10.1186/1897-4287-8-s1-p22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 2009; 24:653-61. [PMID: 19688390 DOI: 10.1007/s00464-009-0652-7] [Citation(s) in RCA: 64] [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] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 05/13/2009] [Accepted: 06/20/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although evidence suggests that laparoscopic colectomy (LC) results in faster gastrointestinal (GI) recovery than open bowel resection, previous studies were performed at single institutions or generally not controlled for diet introduction or perioperative care, making the results difficult to interpret. A prospective, observational, multicenter study was planned to investigate GI recovery, length of hospital stay (LOS), and postoperative ileus (POI)-related morbidity after LC. METHODS Patients scheduled to undergo LC or hand-assisted laparoscopic (HAL) bowel resection and to receive opioid-based postoperative intravenous patient-controlled analgesia were enrolled in 16 U.S. centers. The study design was similar to that for trials of alvimopan phase 3 open laparotomy bowel resection using a standardized accelerated postoperative care pathway. The primary end points were time to upper and lower GI recovery (GI-2: toleration of solid food and bowel movement) and postoperative LOS. The secondary end points included POI-related morbidity (postoperative nasogastric tube insertion or investigator-assessed POI resulting in prolonged hospital stay or readmission), conversion rate, and protocol-defined prolonged POI (GI-2 > 5 postoperative days). RESULTS In this study, 148 patients received hemicolectomy by the LC (42 left and 67 right) or HAL (39 left) approach. The conversion rate was 18.8% (25.4% LC left, 17.3% HAL left, 15% LC right). The mean time to GI-2 recovery was 4.4 days, and the mean postoperative LOS was 4.9 days, neither of which varied substantially by surgical approach. Prolonged POI occurred for 15 patients (10.1%), and POI-related morbidity occurred for 17 patients (11.5%). No patients were readmitted because of POI, whereas 3 patients (2%) were readmitted for all other causes. CONCLUSIONS Mean GI recovery and LOS after LC were accelerated compared with those for patients in open laparotomy bowel resection clinical trials or those reported in large hospital databases (0.7 and 1.7-2.2 days, respectively). Overall POI-related morbidity was similar between the open bowel resection and LC populations, demonstrating that POI continues to present with important morbidity regardless of the surgical approach.
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Affiliation(s)
- Conor P Delaney
- Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
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Thomas KT, Welch D, Trueblood A, Sulur P, Wise P, Gorden DL, Chari RS, Wright JK, Washington K, Pinson CW. Effective treatment of biliary cystadenoma. Ann Surg 2005; 241:769-73; discussion 773-5. [PMID: 15849512 PMCID: PMC1357131 DOI: 10.1097/01.sla.0000161982.57360.1b] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [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: 12/24/2022]
Abstract
OBJECTIVE Evaluate experience over 15 years with treatment of this lesion. SUMMARY BACKGROUND DATA Biliary cystadenoma, a benign hepatic tumor arising from Von Meyenberg complexes, usually present as septated intrahepatic cystic lesions. METHODS Data were collected concurrently and retrospectively on patients identified from hospital medical records reviewed for pertinent International Classification of Diseases, Ninth Revision, Clinical Modification and CPT codes, pathology logs, and from operative case logs. Pathology specimens were rereviewed to confirm the diagnosis of biliary cystadenoma or biliary cystadenocarcinoma by 2 GI pathologists. RESULTS From October 1989 to April 2004 at our institution, 19 (18F:1M) patients had pathologically confirmed biliary cystadenomas, including one with a biliary cystadenocarcinoma. The mean age was 48 +/- 15 years at initial evaluation. Complaints included abdominal pain in 74%, abdominal distension in 26%, and nausea/vomiting in 11%. Only 1 patient presented with an incidental finding. Symptoms had been present for 3 +/- 5 years, with 1 to 4 different surgeons and many other physicians involved in the diagnosis or treatment prior to definitive ablation. Eight patients had undergone 20 previous treatments, including multiple percutaneous aspirations in 4 and 11 operative procedures. CT or US was diagnostic in 95%, with internal septations present in the hepatic cysts. Definitive operative intervention consisted of hepatic resection in 12 patients, enucleation in 6 patients, and fenestration and complete fulguration in 1 patient. There were no perioperative deaths. No recurrences were observed after definitive therapy, with follow-up of 4 +/- 4 years. CONCLUSIONS Biliary cystadenoma must be recognized and treated differently than most hepatic cysts. There remains a need for education about the imaging findings for biliary cystadenoma to reduce the demonstrated delay in appropriate treatment. Traditional treatment of simple cysts such as aspiration, drainage, and marsupialization results in near universal recurrence and occasional malignant degeneration. This experience demonstrates effective options include total ablation by standard hepatic resection and cyst enucleation.
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Affiliation(s)
- K Tyson Thomas
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-5545, USA
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Affiliation(s)
- Davuluri Venkateswarlu
- Glocal Research and Consultancy Services, Physicians for Human Rights, Boston, MA 02116, USA
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Kizilisik AT, Feurer ID, VanBuren DH, Wise P, Van Buren D, Hopkins J, Ray J, Nylander W, Shaffer D, Helderman JH, Langone AJ, Speroff T, Pinson CW. Effects of diabetes and cadaveric organs on functional performance and health-related quality of life after kidney transplantation. Am J Surg 2003; 186:535-9. [PMID: 14599621 DOI: 10.1016/j.amjsurg.2003.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current study was undertaken to identify factors specific to kidney transplantation that are associated with posttransplant functional performance (FP) and health-related quality of life (HRQOL). METHODS Karnofsky FP status was assessed longitudinally in 86 adult kidney transplant recipients. Patients reported HRQOL using the Short Form-36 (SF-36) health survey and the Psychosocial Adjustment to Illness Scale (PAIS). RESULTS FP improved (P <0.001) after kidney transplantation (from 75 +/- 1 to 77 +/- 1, 81 +/- 1, and 82 +/- 1 at 0, 3, 6, and 12 months, respectively). Patients receiving organs from living donors showed continued improvement through posttransplant year 1 while those receiving cadaveric organs stabilized at month 6 (simple interaction contrast, year 1 versus pretransplant; P <0.05). Patients receiving dialysis therapy for 6 months or more prior to transplantation demonstrated lower SF-36 posttransplant physical component scores in comparison with patients who were transplanted preemptively (38 +/- 1 versus 45 +/- 2, P <0.05). Path analysis demonstrated the positive direct effect of time on FP with kidney transplantation (beta = 0.23, P <0.05), and the negative direct effects on FP of diabetes (beta = -0.22) and cadaveric organs (beta = -0.22, both P <0.05). In turn, FP had a positive direct effect on HRQOL (beta = 0.40, P <0.001). CONCLUSIONS Overall improvement in FP is attenuated 1 year after kidney transplantation in recipients of organs from cadaveric donors. The positive effect of time after transplantation, and the negative effects of cadaveric organs and diabetes on posttransplant HRQOL, are indirect and are mediated by the direct effects of these variables on posttransplant FP.
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Affiliation(s)
- A Tarik Kizilisik
- Vanderbilt University Transplant Center, 912 Oxford House, Nashville, TN 37232-4753, USA.
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Huycke MM, Moore D, Joyce W, Wise P, Shepard L, Kotake Y, Gilmore MS. Extracellular superoxide production by Enterococcus faecalis requires demethylmenaquinone and is attenuated by functional terminal quinol oxidases. Mol Microbiol 2001; 42:729-40. [PMID: 11722738 DOI: 10.1046/j.1365-2958.2001.02638.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.0] [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: 12/12/2022]
Abstract
The intestinal commensal bacterium, Enterococcus faecalis, is unusual among prokaryotic organisms in its ability to produce substantial extracellular superoxide. Transposon mutagenesis, allelic replacement, and electron spin resonance (ESR)-spin trapping showed that superoxide production and generation of derivative hydroxyl radical were dependent on membrane-associated demethylmenaquinone. Extracellular superoxide was generated through univalent reduction of oxygen by reduced demethylmenaquinone. Moreover, extracellular superoxide production was inhibited by exogenous haematin, an essential cofactor for cytochrome bd, and by fumarate, a substrate for fumarate reductase. As integral membrane quinol oxidases, cytochrome bd and fumarate reductase redox cycle demethylmenaquinone, and are necessary for aerobic and anaerobic respiration respectively. A rat model of intestinal colonization demonstrated that conditions exist in the mammalian intestinal tract that permit a mode of respiration for E. faecalis that results in the formation of hydroxyl radical. These results identify and characterize the mechanism by which E. faecalis generates extracellular free radicals.
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Affiliation(s)
- M M Huycke
- The Muchmore Laboratories for Infectious Diseases Research, Research Service, Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104, USA.
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Abstract
Preterm delivery (PTD) appears to be a complex trait determined by both genetic and environmental factors. Few studies have examined genetic influence on PTD. The overall goal of our study is to examine major candidate genes of PTD and to test gene-environment interactions. Our study includes 500 preterm trios, including 500 preterm babies and their parents and 500 maternal age-matched term controls. We will perform the transmission/disequilibrium test (TDT) on candidate genes thought to be important in each of the four biological pathways of PTD: (1) decidual chorioamionotic inflammation: interleukin 1 (IL-1), IL-6, and tumour necrosis factor (TNF); (2) maternal and fetal stress: corticotropin-releasing hormone (CRH); (3) uteroplacental vascular lesions: methylenetereahydrofolate reductase (MTHFR); and (4) susceptibility to environmental toxins: GSTM1, GSTT1, CYP1A1, CYP2D6, CYP2E1, NAT2, NQO1, ALDH2, and EPHX. We will also perform standard case-control analyses on the 500 preterm cases and 500 term controls to examine gene-environment interactions. The major environmental, nutritional and social factors as well as clinical variables known or suspected to be associated with PTD will be used to test for gene-environment interactions. This study integrates epidemiological and clinical data as well as genetic markers along major pathogenic pathways of PTD. The findings from this study should improve our understanding of genetic influences on PTD and gene-environment interactions.
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Affiliation(s)
- X Wang
- Department of Pediatrics, Boston University School of Medicine, 91 E. Concord Street, Boston, MA 02118, USA.
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Reaney IM, Wise P, Ubic R, Breeze J, Alford NM, Iddles D, Cannell D, Price T. On the temperature coefficient of resonant frequency in microwave dielectrics. ACTA ACUST UNITED AC 2001. [DOI: 10.1080/01418610108214318] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [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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Zuckerman B, Sharfstein J, Wise P. Child health initiatives and journal narrow-mindedness. Lancet 2000; 356:1626. [PMID: 11089819 DOI: 10.1016/s0140-6736(00)03154-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Zuckerman
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, MA 02118, USA
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Abstract
OBJECTIVES The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. METHODS The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. RESULTS State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions. CONCLUSIONS Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.
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Affiliation(s)
- P Wise
- Department of Pediatrics, Boston University School of Medicine, Mass., USA
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Wise P, Duke K. Informing patients about the PSA test: a new requirement. West J Med 1998; 169:166-7. [PMID: 9771156 PMCID: PMC1305201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Abstract
OBJECTIVES To determine how changes in the structure of the hospital care of infants, such as shortened post-natal stays, affect the completeness of newborn screening. DESIGN Cohort. SETTING Two large maternity hospitals. PARTICIPANTS 8751 consecutive births at the study hospitals during 1993. MAIN OUTCOME MEASURE The completeness of initial specimen collection and processing as determined by matching of birth and screening records. RESULTS At least one specimen was received by the screening program for 8675 (99.1%) of the births. Most non-screened patients (71/76, 93%) had been admitted to the neonatal intensive care unit (NICU). Of these, 53/71 (75%) were low birth weight infants who died within 48 h of birth. Even after excluding these non-survivors, NICU patients were 37 times more likely to be unscreened than their healthy counterparts (22 vs. 0.6 per 1000 infants, 95% C.I. 12.8, 92.8 P < 0.01). A common characteristic of non-screened NICU survivors, (12/18) was interhospital transfer for sub-specialty care. Among patients in the healthy-baby nursery, early discharge (i.e. < 24 h of age) accounted for 2/5 (40%) of the cases of non-screening. The non-screening rate among patients discharged early was 25 times higher than for those discharged after 24 h (9.8 vs. 0.4 per 1000 infants, 95% C.I. 4.2, 149 P < 0.01). CONCLUSIONS Although the overall rate of screening was high, NICU patients, especially those requiring transfer, are disproportionately at risk for non-screening. Early discharge of healthy newborns was also significantly associated with non-screening. This latter finding is of special importance given the current trend toward shorter hospital stays for newborns. Increased attention to ensuring the collection of specimens from these two high-risk populations is warranted.
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Affiliation(s)
- J E Gray
- Joint Program in Neonatology, Harvard Medical School, Boston, MA, USA.
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Wise P, Drury M. Pharmaceutical trials in general practice: the first 100 protocols. An audit by the clinical research ethics committee of the Royal College of General Practitioners. BMJ 1996; 313:1245-8. [PMID: 8939118 PMCID: PMC2352557 DOI: 10.1136/bmj.313.7067.1245] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [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: 02/03/2023]
Abstract
OBJECTIVE To assess the outcome of 100 general practice based, multicentre research projects submitted to the ethics committee of the Royal College of General Practitioners by pharmaceutical companies or their agents between 1984 and 1989. DESIGN Analysis of consecutive submitted protocols for stated objectives, study design, and outcomes; detailed review of committee minutes and correspondence in relation to amendment and approval; assessment of final reports submitted at conclusion of studies. SUBJECTS 82 finally approved protocols, embracing 34,523 proposed trial subjects and 1195 proposed general practice investigators. MAIN OUTCOME MEASURES Success at enrolling subjects and investigators; commencement and completion data; validity of final report's assessment of efficacy, safety, tolerability, and acceptability; and method of use and dissemination of findings. RESULTS 18 studies were not approved and 45 had to be amended. Randomised controlled trials comprised 46 of the original submissions. Remuneration considerations, inadequate information or consent sheets, pregnancy safety, the need to discontinue existing therapy, and suboptimal scientific content were major reasons for rejecting studies or asking for amendments. Of the 82 approved studies 8 were not started. Shortfalls of investigators (of 39%) and trial subjects (of 37%) and an overall 23% withdrawal rate were responsible for a significant incidence of inconclusive results. Within the six year follow up interval, only 19 of the studies had been formally published. CONCLUSIONS This audit identified substantial ethical concerns in the process of approving multicentre general practice pharmaceutical research.
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Affiliation(s)
- P Wise
- Royal College of General Practitioners, London
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Sharfstein J, Wise P. Cost-effectiveness of hepatitis B virus immunization. JAMA 1996; 275:908; author reply 909. [PMID: 8598611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Chavkin W, Breitbart V, Wise P. Efforts to reduce perinatal mortality, HIV, and drug addiction: surveys of the states. J Am Med Womens Assoc (1972) 1995; 50:164-6. [PMID: 7499705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Wallace HM, Micik S, Wise P. Community study of infant mortality in San Diego County. J Trop Pediatr 1994; 40:172-8. [PMID: 8078117 DOI: 10.1093/tropej/40.3.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Infant mortality in San Diego County (USA) in 1988 was 6.9 per 1000 live births. This rate had remained unchanged since 1980. It rose to 8.3 in 1989 and fell to 7.0 in 1990. This study describes the results of an investigation into the causes of infant mortality during 1985. A total of 333 infant deaths were recorded. Nearly half the neonatal deaths were related to perinatal causes and more than half the post-neonatal deaths were attributed to the Sudden Infant Death Syndrome. Two-thirds of all infant deaths occurred in the neonatal period. The contribution of factors in the maternal background and those related to care during labour, as well as postnatally, is described.
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Affiliation(s)
- H M Wallace
- Graduate School of Public Health, San Diego State University, California
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Breitbart V, Chavkin W, Layton C, Wise P. Model Programs Addressing Perinatal Drug Exposure and Human Immunodeficiency Virus Infection: Integrating Women's and Children's Needs. Bull N Y Acad Med 1994; 71:236-251. [PMID: 19313104 PMCID: PMC2359281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Many of the efforts to address perinatal drug exposure and human immunodeficiency virus infection have been influenced by a perspective of conflict between the interests of mother and infant. This article highlights several programs that integrate women's and children's services while dealing with these health issues. It discusses the challenges encountered by these programs, such as funding restrictions, institutional barriers, professional attitudes, regulatory constraints, and local political issues. It presents strategies for overcoming these barriers including the creative coordination of funding streams, innovative relationships with child protective agencies, effective collaboration with other agencies, and advocacy on behalf of clients and programs, and makes recommendations for certain policy changes, which could foster the development of programs that serve women and children together.
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Wise P. Male infertility update. West J Med 1991; 155:635-6. [PMID: 1812637 PMCID: PMC1003119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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