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Murphy RJ, Sumner R, Evans W, Ponton R, Ram S, Godfrey K, Forsyth A, Cavadino A, Krishnamurthy Naga V, Smith T, Hoeh NR, Menkes DB, Muthukumaraswamy S. Acute Mood-Elevating Properties of Microdosed Lysergic Acid Diethylamide in Healthy Volunteers: A Home-Administered Randomized Controlled Trial. Biol Psychiatry 2023; 94:511-521. [PMID: 36997080 DOI: 10.1016/j.biopsych.2023.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Microdosing psychedelic drugs is a widespread social phenomenon with diverse benefits claimed for mood and cognition. Randomized controlled trials have failed to support these claims, but the laboratory-based dosing in trials conducted to date may have limited ecological validity. METHODS Healthy male volunteers were randomized into lysergic acid diethylamide (LSD) (n = 40) and placebo (n = 40) groups and received 14 doses of either 10 μg LSD or an inactive placebo every 3 days for 6 weeks. First doses were given in a supervised laboratory setting, with other doses self-administered in a naturalistic setting. Results of safety data, blinding, daily questionnaires, expectancy, and pre-/postintervention psychometrics and cognitive tasks are presented here. RESULTS The most notable reported adverse event was treatment-related anxiety, which prompted the withdrawal of 4 participants from the LSD group. Daily questionnaires showed credible evidence (>99% posterior probability) of improved ratings of creativity, connectedness, energy, happiness, irritability, and wellness on dose days compared with nondose days, and these effects remained when controlling for preintervention expectancy. No questionnaire or cognitive task showed a credible change between baseline and 6-week assessment time points. CONCLUSIONS Microdosing LSD appears to be relatively safe in healthy adult men, notwithstanding a risk of anxiety. While microdosing elicited transient increases in scales associated with mood-elevating effects, it was not sufficient to promote enduring changes to overall mood or cognition in healthy adults. Future microdosing trials in clinical populations will require the use of active placebos to control for placebo effects and dose titration to adjust for interindividual variability in drug response.
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Affiliation(s)
- Robin J Murphy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
| | - Rachael Sumner
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Rhys Ponton
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kate Godfrey
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; Centre for Psychedelic Research, Department of Psychiatry, Imperial College London, London, England, UK
| | - Anna Forsyth
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Venkat Krishnamurthy Naga
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Nicholas R Hoeh
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - David B Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Suresh Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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Foroutan F, Guyatt G, Stehlik J, Gustafsson F, Greig D, McDonald M, Bertolotti A, Kugathasan L, Rayner D, Cook A, Zlatanoski D, Ram S, Demas-Clarke P, Kozuszko S, Alba A. Use of Induction Therapy Post Heart Transplantation - Clinical Practice Recommendations Based on Systematic Review and Network Meta-Analysis of Evidence. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1267] [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: 04/05/2023] Open
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Prabu N, Petciappan V, Anand G, Ram S, Kumar A. AB1250 TOFACITINIB IS A SAFE AND EFFECTIVE TREATMENT OPTION FOR JUVENILE IDIOPATHIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe management of juvenile idiopathic arthritis(JIA) is often constrained by the limited number of oral drugs available. Whether JAK inhibitors would add a much needed therapeutic armamentarium in this regard needs to be explored.ObjectivesTo assess the safety and efficacy of tofacitinib in juvenile idiopathic arthritis (JIA) patient who were prescribed during the period January 2021 to December 2021.MethodsIt’s a retrospective study of JIA patients who were prescribed tofacitinib during the period Jan 21 to Dec 21 with minimum of 3 months’ follow-up after prescribing tofacitinib. The demographics,details of medications,investigations parameters and any adverse events were noted.ResultsThere were a total of 35 patients who were given tofacitinib during this period. Male is to female ratio is 25:10, mean age of 12.91(4.81) yrs., the mean disease duration was 58.6 months. Enthesitis related arthritis(ERA) was the commonest seen in 12, followed by oligo articular in 10, polyarticular in 7 and systemic onset in 6. In the ERA group 10 were HLA B27 +VE, of the oligo articular 6 were ANA +VE, in the polyarticular one was RF +ve. Out of the 35,14 were already on biologicals (tocilizumab and anti TNFs). Tofacitinib was stopped in 8 patients during this period, 5 as they achieved remission, 2 with no response and one because of itching and abdominal pain. There were no documented infections. There was significant reduction in the inflammatory markers (ESR, CRP), leucocyte count and platelet count.Before tofaAfter tofap valueMethotrexate in mg (week) mean(stdev)9.64(1.94)8.88(3.34)0.66Steroid in mg mean (stdev)3(2.35)2.8(1.8)0.91Leucocyte count mean(stdev)11242(1858)7884(1471)0.005Platelet count in lakhsMean(stdev)4.51(0.48)3.37(0.82)0.017ESR mm/1hr57.75(17.25)30.83(11.48)0.009CRP mg/L25.36(10.9)12.36(7.97)0.05ConclusionTofacitinib seems to be a promising drug in the management of JIA with good safety profile and efficacy.References[1] Brunner HI, Schanberg LE, Kimura Y et al. New medications are needed for children with juvenile idiopathic arthritis. Arthritis Rheumatol. 2020; 72: 1945-1951.Disclosure of InterestsNone declared
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Foroutan F, Guyatt G, Stehlik J, Gustafsson F, Greig D, McDonald M, Badiwala M, Bertolotti A, Kugathasan L, Cook A, Zlatanoski D, Ram S, Demas-Clarke P, Kozuszko S, Alba A. Use of Induction Therapy Post Heart Transplantation: A Heart Transplant Rapid Recommendations. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Shalev Ram H, Ram S, Wiser I, Tchernin N, Chodick G, Cohen Y, Rofe G. Associations between breast implants and postpartum lactational mastitis in breastfeeding women: retrospective study. BJOG 2021; 129:267-272. [PMID: 34486797 DOI: 10.1111/1471-0528.16902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the putative associations between breast implants and postpartum lactational mastitis. DESIGN Observational retrospective study. SETTING Digital database of Maccabi Healthcare Services, integrated health maintenance organisation in Israel. POPULATION Breastfeeding mothers from 2003 to 2016 based on an initial health maintenance organisation data set of 28 383 singleton live births in Israel. METHODS Multivariate analysis and propensity score matching were used to test the extent to which breast implants were associated with lactational mastitis during the 6-month postpartum period in breastfeeding mothers. Analyses for potential confounders were adjusted for socio-economic status, smoking and parity. MAIN OUTCOME MEASURE Lactational mastitis among breastfeeding women with breast implants compared with women without breast implants. RESULTS Mothers with breast implants (n = 6099) were significantly (P < 0.001) more likely to be diagnosed with postpartum mastitis (8.3%) than mothers with no breast implants(n = 22 284) (6.6%) at an odds ratio of 1.22 (95% CI 1.09-1.35) after adjusting for confounders. CONCLUSION Breast augmentation is associated with an increased risk of postpartum lactational mastitis in the 6-month postpartum period. In light of these findings, it is important for health professionals to instruct women who have undergone breast augmentation on correct breastfeeding techniques, ways to avoid risk factors, and to be alert to signs permitting the early detection of lactational mastitis. TWEETABLE ABSTRACT A study of over 28,000 breastfeeding women has shown that breast augmentation is associated with an increased risk of postpartum lactational mastitis in the six-month postpartum period.
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Affiliation(s)
- H Shalev Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynaecology, Meir Medical Centre, Kfar Saba, Israel
| | - S Ram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynaecology, Lis Maternity Hospital, Sourasky Medical Centre, Tel Aviv, Israel
| | - I Wiser
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Tchernin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Hillel Yaffe Medical Center, Hadera, Israel
| | - G Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Healthcare Services, Tel Aviv, Israel
| | - Y Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynaecology, Meir Medical Centre, Kfar Saba, Israel
| | - G Rofe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hissariya R, Babu S, Ram S, Mishra SK. Spin-up conversion, exchange-interactions, and tailored magnetic properties in core-shell La 2NiMnO 6of small crystallites. Nanotechnology 2021; 32:435702. [PMID: 34256367 DOI: 10.1088/1361-6528/ac13eb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
La2NiMnO6-a ferromagnetic (FM) insulator offers tunable charge carriers and spins useful to devise its multiple properties and applications. In this view, we studied a core-shell La2NiMnO6(2-3 nm shell on 65 - 80 nm core) of a Ni2+/Ni3+(d7) to Mn4+/Mn3+(d4) spin-up conversion- revived a new FM phase-2, raising a spin-densityσs = 0.7 s a-1over the Ni2+/Mn4+species (phase-1),σs = 0.5 s a-1, i.e. 2.12μB/f.u. larger spin moment. HRTEM images studied with x-ray diffraction characterizing core-shell structure that plays a crucial role in tuning the high spin FM phase-2 of profound properties. Below 110 K, the dc magnetization and ac magnetic susceptibilityχ(ω,T) reveal a metastable magnetic behavior on an antiferromagnetic canting of a spin-glass nature. The results follow a Vogel-Fulcher type relaxation with a relaxation timeτ0∼ 10-13s, confirming a spin-glass freezing behavior. Uniquely, FM field of phase-1 controls magnetics of phase 2 of a coupled magnet, modulating joint features with small thermal magnetic hysteresis on heating-cooling cycles.
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Affiliation(s)
- R Hissariya
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi- 221 005, India
| | - S Babu
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi- 221 005, India
| | - S Ram
- Materials Science Centre, Indian Institute of Technology, Kharagpur-721 302, India
| | - S K Mishra
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi- 221 005, India
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Murphy RJ, Sumner RL, Evans W, Menkes D, Lambrecht I, Ponton R, Sundram F, Hoeh N, Ram S, Reynolds L, Muthukumaraswamy S. Correction to: MDLSD: study protocol for a randomised, double-masked, placebo-controlled trial of repeated microdoses of LSD in healthy volunteers. Trials 2021; 22:334. [PMID: 33971929 PMCID: PMC8108445 DOI: 10.1186/s13063-021-05307-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Robin J Murphy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Rachael L Sumner
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - William Evans
- Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand
| | - David Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, Waikato Clinical Campus, Peter Rothwell Academic Centre, University of Auckland, Pembroke Street, Hamilton, 3240, New Zealand
| | - Ingo Lambrecht
- Regional Cancer & Blood Service, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Rhys Ponton
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Nicholas Hoeh
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lisa Reynolds
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Suresh Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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Murphy RJ, Sumner RL, Evans W, Menkes D, Lambrecht I, Ponton R, Sundram F, Hoeh N, Ram S, Reynolds L, Muthukumaraswamy S. MDLSD: study protocol for a randomised, double-masked, placebo-controlled trial of repeated microdoses of LSD in healthy volunteers. Trials 2021; 22:302. [PMID: 33892777 PMCID: PMC8062934 DOI: 10.1186/s13063-021-05243-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 03/31/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Regular ingestion of sub-hallucinogenic doses of psychedelics, referred to as "microdosing", has gained increasing popularity and attention in the press and in online forums, with reported benefits across multiple cognitive and emotional domains. Rigorously controlled studies to date, however, have been limited in scope and have failed to produce results comparable to those reported in the grey literature. METHODS Eighty healthy male participants will receive 14 doses of placebo or 10 μg lysergic acid diethylamide orally every 3rd day over a 6-week treatment protocol. A battery of personality, creativity, mood, cognition, and EEG plasticity measures, as well as resting-state fMRI imaging, will be administered at baseline and at the end of the protocol. Creativity, mood, and plasticity measures will additionally be assessed in the acute phase of the first dose. Daily functioning will be monitored with questionnaires and a wearable sleep and activity tracker. DISCUSSION This study will rigorously examine the claims presented in the microdosing grey literature by pairing a comparable dosing protocol with objective measures. Potential therapeutic implications include future clinical trials to investigate microdosed psychedelics as a standalone treatment or as an augmentation of psychotherapy in the treatment of depression, addiction, eating disorders, obsessive-compulsive disorders, and palliative care. TRIAL REGISTRATION ACTRN12621000436875 . Registered on 19 February 2021.
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Affiliation(s)
- Robin J Murphy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Rachael L Sumner
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - William Evans
- Mana Health, 7 Ruskin St, Parnell, Auckland, 1052, New Zealand
| | - David Menkes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, Waikato Clinical Campus, Peter Rothwell Academic Centre, University of Auckland, Pembroke Street, Hamilton, 3240, New Zealand
| | - Ingo Lambrecht
- Regional Cancer & Blood Service, Auckland District Health Board, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Rhys Ponton
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 2 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Nicholas Hoeh
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lisa Reynolds
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Suresh Muthukumaraswamy
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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Venkata C, Ram S. Dr Norman M. Kaplan (1931–2020): a giant in the field of hypertension has departed. Eur Heart J 2020; 41:3395-3396. [DOI: 10.1093/eurheartj/ehaa469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Venkata
- University of Texas South-Western Medical School, Dallas, Texas, USA, Apollo Medical College and Hospitals, Apollo Institute for Blood Pressure Management, Hyderabad, Telangana, India, Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia
| | - S Ram
- University of Texas South-Western Medical School, Dallas, Texas, USA, Apollo Medical College and Hospitals, Apollo Institute for Blood Pressure Management, Hyderabad, Telangana, India, Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia
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Tiwari B, Rajeswari PV, Ram S, Banerji P, Khan R. Green Synthesis of Cr 3+ Doped CaIn₂O₄-Carbon Hybrid Nanostructure and Its Light Absorption and Emission Properties. J Nanosci Nanotechnol 2019; 19:8120-8125. [PMID: 31196334 DOI: 10.1166/jnn.2019.16865] [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: 06/09/2023]
Abstract
In this research article, we have used a novel route for synthesis of a greenish phosphor C-CaIn₂O₄ doped with Cr3+ ions using green plant (aloe vera gel) and measured its light absorption and emission properties. Our main aim was to enhance the light absorption and emission properties of undoped C-CaIn₂O₄ in order to widen its applications. The introduction of CrO₃ ions can produce Cr ion defects that favor charge balance in Cr3+:C-CaIn₂O₄ to facilitate its photoluminescence. The effect of doping in core-shell nanostructure can effectively transfer energy from charge-transfer absorption band of optical host material to characteristic transition of Cr3+ ions, utilizing more energy from host absorption for the photoluminescence of Cr3+ ions. As-prepared Cr3+:C-CaIn₂O₄ exhibits two bands at 270 nm and 370 nm, which are shifted to at 265 and 370 nm when it is annealed at higher dosage of Cr3+ ions. These are the ligand-to-metal O2- to Cr3+ charge transfer bands. The light-emission is studied in analyzing migration, transfer and recombination processes of light-induced e--h+ pairs. The results are described in correlation to a Cr3+:C-CaIn₂O₄ core-shell nanostructure.
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Affiliation(s)
- B Tiwari
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - P V Rajeswari
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - S Ram
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - P Banerji
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - R Khan
- Materials Science Programme, Indian Institute of Technology, Kanpur 208016, India
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Ram S. The importance of ensuring artificial intelligence and machine learning can be understood at the human level. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.259] [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: 11/14/2022] Open
Abstract
Abstract
With rapid developments in big data technology and the prevalence of large-scale datasets from diverse sources, the healthcare predictive analytics (HPA) field is witnessing a dramatic surge in interest. In healthcare, it is not only important to provide accurate predictions, but also critical to provide reliable explanations to the underlying black-box models making the predictions. Such explanations can play a crucial role in not only supporting clinical decision-making but also facilitating user engagement and patient safety. If users and decision makers do not have faith in the HPA model, it is highly likely that they will reject its use. Furthermore, it is extremely risky to blindly accept and apply the results derived from black-box models, which might lead to undesirable consequences or life-threatening outcomes in domains with high stakes such as healthcare. As machine learning and artificial intelligence systems are becoming more capable and ubiquitous, explainable artificial intelligence and machine learning interpretability are garnering significant attention among practitioners and researchers. The introduction of policies such as the General Data Protection Regulation (GDPR), has amplified the need for ensuring human interpretability of prediction models. In this talk I will discuss methods and applications for developing local as well as global explanations from machine learning and the value they can provide for healthcare prediction.
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Affiliation(s)
- S Ram
- College of Management, University of Arizona, Tucson, USA
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Tiwari B, Sharma SK, Ram S, Banerji P. Synthesis of Broad Band Violet-Blue Light-Emitting Core-Shell Cr 3+:C-CaIn₂O₄ Nanowires. J Nanosci Nanotechnol 2019; 19:5769-5773. [PMID: 30961737 DOI: 10.1166/jnn.2019.16596] [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: 06/09/2023]
Abstract
We developed a simple, effective and green method for synthesis of broad band violet-blue lightemitting core-shell Cr3+:C-CaIn²O⁴ nanowires (1-10 mol% of Cr3+) using aloe vera nectar. Calcium indate (CaIn²O⁴) is an important wideband gap semiconductor that could be explored for optical doping such as transition metals and/or rare-earths useful to make light-emitters, optical data storage, and other devices. The nectar embeds the cations in a gel so as it controls an ionic conversion Cr6+ to Cr3+ in ambient air. When grafting a carbon layer on surface of Cr3+:CaIn²O⁴ crystallites it yields a core-shell structure of tailored dielectric, optical and other properties. Asprepared Cr3+:CaIn²O⁴-C exhibits two bands at 270 nm and 360 nm, which got shifted-to at 265 and 370 nm when annealed at higher dosage of Cr3+ ions. These are the ligand-to-metal O2- to Cr3+ charge transfer bands. We studied the light-emission properties in analyzing migration, transfer and recombination processes of light-induced e--h+ pairs in detail in correlation to a Cr3+:CaIn²O⁴-C core-shell nanostructure.
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Affiliation(s)
- B Tiwari
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - S K Sharma
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - S Ram
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
| | - P Banerji
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
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Curley LE, Jensen M, McNabb C, Ram S, Torrie J, Jowsey T, McDonald M. Pharmacy Students' Perspectives on Interprofessional Learning in a Simulated Patient Care Ward Environment. Am J Pharm Educ 2019; 83:6848. [PMID: 31507282 PMCID: PMC6718511 DOI: 10.5688/ajpe6848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/15/2018] [Indexed: 05/22/2023]
Abstract
Objective. To assess pharmacy students' opinions of an interprofessional learning (IPL) course in their final year of the Bachelor of Pharmacy program at The University of Auckland. Methods. Pharmacy students participated in the second day of a two-day simulation-based course, WardSim, alongside medical and nursing students in an acute care, hospital ward setting. After finishing the course, all students were asked to complete a questionnaire. The responses of pharmacy, nursing, and medical students on the scaled questions were compared. An in-depth thematic analysis of the pharmacy students' responses to the open-ended questions was completed using an iterative process. Results. Significant differences were found among the students' responses regarding the prioritization of care, systematic assessment of patients, and communication strategies. Pharmacy students had less favourable responses regarding the IPL experience than medical and nursing students. However, overall responses were positive. Some of the themes that emerged among the pharmacy students' responses included: learning communication tools, being assertive in communicating with other health care professionals, and understanding their own and others' roles in the health care team. Furthermore, some pharmacy students reported feeling underprepared for and underutilized during patient care scenarios. Conclusion. An IPL experience in an acute patient care setting demonstrated clear and beneficial learning outcomes for pharmacy students, especially in regards to communicating and understanding their roles and those of others on their team. Tailoring the pre-work or scenarios for the IPL experience to be more pharmacy orientated and having pharmacy students participate on both days may improve the preparedness for IPL.
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Affiliation(s)
- Louise E. Curley
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maree Jensen
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Carolyn McNabb
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jane Torrie
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maureen McDonald
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Abstract
There is strong evidence that dishonesty occurs amongst medical students, and other allied health students and growing evidence that it occurs amongst medical academics. We believe that accidental dishonesty (or not knowing about the rules of regulations governing academic integrity) is a common attribution describing engagement in dishonesty; however, we believe that dishonest action is more often influenced and determined according to circumstance. In this paper, we aim to work through the literature that frames dishonest action with a focus on medical education, research and publication. We argue that the implications for medical education are far reaching and the root causes of many instances of dishonesty need to be more fully understood so that comprehensive, case-by-case ameliorative strategies can be developed.
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Affiliation(s)
- Marcus A. Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Yan Chen
- Centre for Medical and Health Sciences Education, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Sanya Ram
- School of Pharmacy, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
| | - Phillipa Malpas
- Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142 New Zealand
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15
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Kan Z, Lal S, Ding Y, Lee JE, Lee SH, Lee SK, Yu JH, Choi YL, Kim SW, Nam SJ, Kim JY, Ram S, Powell E, Ching K, Cho SY, Bonato V, Deng S, Park WY, Rejto P, Bienkowska J, Park YH. Abstract PD5-08: Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd5-08] [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
Understanding how standard-of-care drug treatments affect tumor intrinsic biology and microenvironment is critical for elucidating drug resistance mechanisms and developing better combination therapies as well as new therapies. To characterize the effects of neoadjuvant chemotherapy (NAC) on the genome, transcriptome and tumor infiltrating leukocytes (TILs), we have conducted whole exome and whole transcriptome sequencing of a large longitudinal breast cancer cohort consisting of 146 cases and 281 paired tumor samples. In total, 52 (38%) patients achieved pathologic complete response (pCR) while 85 patients (62%) had residual disease with standard chemotherapy regimen. Tumor biopsies were collected for each patient at three time points – pre-treatment, three weeks after the first cycle of anthracycline and cyclophosphamide (AC) and at the time of surgery after 3 more cycles of AC followed by 4 cycles of taxane or taxane plus Herceptin in case of HER2+ subtype. We detected 5,955 protein-altering somatic mutations affecting 4,414 genes in pretreatment samples and 502 acquired mutations in surgery samples affecting 477 genes including 19recurrently mutated genes such as TP53 and NOTCH1. Across all subtypes, 4,346 genes were differentially expressed (DE) following NAC treatment and significantly enriched in pathways such as cell cycle, ER signaling, PI3K/mTOR, immune and metabolism. Expression-based virtual microdissection analysis indicated that NAC treatment induced an increase in the fractions of stromal and adjacent normal tissue compartment, consistent with observed reduction in tumor cellularity. To assess the NAC induced changes in the molecular landscape of these tumors, we compared molecular features including gene expression signatures, mutation prevalence and copy number alteration between three time points while adjusting for confounding effects of molecular subtype and tumor cellularity. We found that NAC induced dynamic changes in gene expression signatures associated with proliferation and immunomodulatory treatment response. We further validated the observed pattern of change in TILs through histopathology and digital imaging analyses. In pretreatment tumors, 116 genes were DE between patients with pCR vs. those with residual disease with significant enrichment in immune/inflammatory pathways. Further, pre-treatment TIL levels were found to be significantly associated with pCR, echoing previous reports in breast cancers that implicated anti-tumor immunity in mediating the efficacy of chemotherapies. Our analyses also revealed associations between NAC response and baseline genomic attributes such as genomic alterations that affect DNA damage repair pathways. Taken together, these results suggest that NAC induced a multitude of changes on the genomic landscape and immune microenvironment of breast cancers, some of which point to combination strategies with immunomodulatory therapies and therapies that target DNA damage repair.
Citation Format: Kan Z, Lal S, Ding Y, Lee JE, Lee S-H, Lee SK, Yu JH, Choi Y-l, Kim SW, Nam SJ, Kim J-Y, Ram S, Powell E, Ching K, Cho SY, Bonato V, Deng S, Park W-Y, Rejto P, Bienkowska J, Park Y-H. Neoadjuvant chemotherapy alters the genomic landscape and immune microenvironment of breast cancers [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD5-08.
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Affiliation(s)
- Z Kan
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Lal
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y Ding
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - JE Lee
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S-H Lee
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SK Lee
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - JH Yu
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y-l Choi
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SW Kim
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SJ Nam
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - J-Y Kim
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Ram
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - E Powell
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - K Ching
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SY Cho
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - V Bonato
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Deng
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - W-Y Park
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - P Rejto
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - J Bienkowska
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y-H Park
- Pfizer, San Diego, CA; Samsung Medical Center, Seoul, Korea
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Kan Z, Powell E, Ram S, Ching K, Ding Y, Vizcarra P, Nichols T, Hardwick J, Lee SH, Cho SY, Choi YL, Yu JH, Park YH. Abstract P2-07-01: Integrative analyses of immunophenotypes and multi-omics profiles in breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-07-01] [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
The advent of immuno-oncology (IO) therapies has made it an imperative to characterize intratumoral immune microenvironment in addition to oncogenic alterations through molecular profiling of the tumor. To elucidate the baseline profiles of tumor infiltrating leukocytes (TILs) in breast cancer (BC) in the context of molecular subtypes and oncogenic alterations, we performed whole-exome sequencing (WES) and RNA-Seq of an Asian BC cohort (SMC) consisting of 178 treatment naïve primary tumors. A subset of 120 tumors was further analyzed by H&E and IHC using a panel of 8 TIL markers (CD45, CD4, CD8, CD163, PD1, PD-L1, IDO1 and FOXP3). Using expression signatures representing distinct immune cell types, we classified an expression compendium of 2,781 tumor samples, including SMC and multiple cancers from TCGA, into three immune subtypes with high, medium and low levels of TILs. Basal and HER2 subtypes show higher levels of TILs than Luminal subtypes, consistent with observed clinical responses to checkpoint blockade in clinical trials. Moreover, Asian BCs were significantly enriched in TIL-high subtype (35.3%) compared to the primarily Caucasian TCGA BC cohort (20.2%) while 50.6% of the highly immunogenic Lung adenocarcinoma was TIL-high. We then applied machine learning methods to detect and quantify TILs from H&E images of 120 SMC and 349 TCGA BC tumors. The expression signature analysis results were concordant with independently derived histology based TIL data. Taken together, our findings suggest that IO therapies may be more effective in HR negative BC subtypes and Asian BCs.
Leukocyte exclusion (LE), an immunophenotype where TILs concentrate at the tumor periphery, has been linked to worse prognosis and resistance to IO therapies. Visual assessment of whole tumor IHC images identified LE patterns in 25% of SMC cases. We observed differential distribution of LE by molecular subtype and evidence for selective exclusion of immune cell subsets. Covariate analyses with clinical and molecular data while controlling for subtype as a confounder identified significant associations with tumor proliferation index, percent tumor purity and TP53 mutations. LE is also significantly associated with expression signatures of chemokine signaling, macrophages, angiogenesis and hypoxia, indicating that marked distinctions exist in both tumor intrinsic and microenvironment characteristics between TIL excluded and TIL infiltrated tumors. To validate these findings, we independently identified LE for 200 cases of TCGA BCs based on patterns of TILs extracted from H&E images and saw significant concordance of covariate relationships identified between TCGA and SMC. Our study provided a rare comprehensive resource for studying tumor associated immunity in breast cancers by generating the integrated multi-omics and IO profiles for a large cohort of primary tumors. Comparative analyses revealed that TIL activities are highly variable across different intrinsic subtypes and geographic origins of BC, with potential implications for IO therapeutic application. Correlative analyses of immunophenotypes with molecular data further yielded insights into LE's role in immune escape and identified hallmark signatures for LE indicative of causal molecular mechanisms.
Citation Format: Kan Z, Powell E, Ram S, Ching K, Ding Y, Vizcarra P, Nichols T, Hardwick J, Lee S-H, Cho SY, Choi Y-L, Yu J-H, Park YH. Integrative analyses of immunophenotypes and multi-omics profiles in breast cancers [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-07-01.
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Affiliation(s)
- Z Kan
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - E Powell
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - S Ram
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - K Ching
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - Y Ding
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - P Vizcarra
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - T Nichols
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - J Hardwick
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - S-H Lee
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - SY Cho
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - Y-L Choi
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - J-H Yu
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
| | - YH Park
- Pfizer Oncology Research, San Diego, CA; Pfizer Korea, Seoul, Korea; Samsung Medical Center, Seoul, Korea
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17
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Shankar R, Ram S. An evidenced based checklist to support anti-dementia medication withdrawal in people with down syndrome (DS), intellectual disability (Id) and dementia. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
DS with aging is associated with greatly increased risk of developing dementia similar to Alzheimer's. Anti-dementia drug discontinuation is recommended when clinical benefit is not determined. In DS it is more complex as medication ill effects of stopping needs to be weighed in balance to extraneous processes such as environment changes, sensory impediments and physical ill health and natural progression of dementia.AimCan identified risk factors extracted from a comprehensive literature review be developed into an evidence based check list to support risk minimized person centered withdrawal of anti-dementia drugs when considered not to be efficacious in DS?MethodA detailed literature review using Medline, PsychInfo, Cinahl and Embase with relevant search terms in various permutations and combinations without any date limit enquiring current evidence base on anti-dementia medication withdrawal was conducted. The review also looked to extract the common risk factors in stopping medication. All risk factors were collated, reviewed by a focus group of experts, developed into a checklist.ResultsThirty abstracts were obtained following the search. Six papers were short-listed. No papers identified a structured approach to medication reduction. An 18-factor checklist was applied prospectively to 30 cases. The checklist was sensitive to identify change to guide clinical decision-making.ConclusionsCurrently, decision to peg medication withdrawal risk is arbitrary and clinical in dementia especially in DS dementia. The evidenced based developed checklist is useful to support and structure clinical decisions. It helps clinicians and patients to focus on promoting safety, reduce harm and guide treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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18
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Kan Z, Ding Y, Cho S, Lee SH, Powell E, Jung HH, Chung W, Deng S, Choi YL, Kim J, Park WY, Vizcarra P, Fernandez-Banet J, Nichols T, Ram S, Lee SK, Kim SW, Lee JE, Ching KA, Kim JY, Ahn JS, Im YH, Nam SJ, Park YH. Abstract P1-05-15: Multi-omics and immuno-oncology profiling reveal distinct molecular signatures of young Asian breast cancers. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-05-15] [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
Breast cancers (BC) in younger, premenopausal patients (YBC) tend to be more aggressive with worse prognosis, higher chance of relapse and poorer response to endocrine therapies compared to breast cancers in older patients. The proportion of YBC (age ≤ 40) among BC in East Asia is estimated to be 16-32%, significantly higher than the 7% reported in Western countries. To characterize the molecular bases of Asian YBC, we have performed whole-exome sequencing (WES) and whole-transcriptome sequencing (WTS) on tumor and matched normal samples from 134 Korean BC patients consisting of 74 YBC cases (age ≤ 40) and 60 OBC cases (age > 40). We then performed comparison analyses and integrative analyses with the TCGA BC cohort consisting of 1,116 tumors from primarily Caucasian patients, also grouped by age into YBC (age ≤ 40), IBC (40 < age ≤ 60) and OBC (age > 60).
Somatic mutation prevalence analysis identified 7 significantly mutated genes and the same top three genes – TP53, GATA3 and PIK3CA – were reported by the TCGA BC study. To identify differentially expressed (DE) genes and pathways in YBCs vs. OBCs, we performed logistic regression analyses while controlling for the confounding effects of tumor purity and stage. We were surprised to see a significant overlap in DE pathways between a comparison of adjacent normal tissues in younger vs. older TCGA cohorts and a comparison of YBC vs. OBC tumors, indicating that normal tissue compartment could contribute to observed differences between bulk tumors. To separately examine molecular signatures from tumor, stroma and normal compartments, we used non-negative matrix factorization (NMF) analyses to virtually dissect bulk tumor expression data and identified 14 factors including 3 factors associated with normal tissues, 1 factor associated with stroma and 1 factor associated with tumor infiltrating lymphocytes (TIL). Integrative analyses of tumor associated factors and DE pathways revealed that estrogen response, endocrine therapy resistance, and oxidative phosphorylation pathways are up-regulated in YBCs compared to OBCs while cell cycle and proliferation pathways are up-regulated in Asian OBCs. Interestingly, many immune and inflammation pathways correlated with the TIL factor were significantly upregulated in OBCs vs. YBCs. Using gene expression signatures representing distinct immune cell types, we classified our cohort into four subtypes of varying TIL activities and observed significant enrichment of the TIL-high subtype in OBCs compared to YBCs. These observations were confirmed by IHC analyses of four TIL markers (CD45, CD4, CD8 and CD163) in 120 tumors.
To our knowledge, this is the first large-scale multi-omics study of Asian breast cancer and would significantly contribute to the compendium of molecular data available for studying young breast cancers. The major landmarks in the molecular landscape looked similar across BCs of different ethnicities and ages, however, we have identified a number of distinguishing molecular characteristics associated with Asian YBC. The sources for some signatures were further traced to non-tumor intrinsic compartments, indicating that tumor microenvironment may play potentially important roles in driving the carcinogenesis of young breast cancers.
Citation Format: Kan Z, Ding Y, Cho S, Lee S-H, Powell E, Jung HH, Chung W, Deng S, Choi Y-l, Kim J, Park W-Y, Vizcarra P, Fernandez-Banet J, Nichols T, Ram S, Lee SK, Kim SW, Lee JE, Ching KA, Kim J-Y, Ahn JS, Im Y-H, Nam SJ, Park YH. Multi-omics and immuno-oncology profiling reveal distinct molecular signatures of young Asian breast cancers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-05-15.
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Affiliation(s)
- Z Kan
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y Ding
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Cho
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S-H Lee
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - E Powell
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - HH Jung
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - W Chung
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Deng
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y-l Choi
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - J Kim
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - W-Y Park
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - P Vizcarra
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | | | - T Nichols
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - S Ram
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SK Lee
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SW Kim
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - JE Lee
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - KA Ching
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - J-Y Kim
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - JS Ahn
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - Y-H Im
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - SJ Nam
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
| | - YH Park
- Pfizer Inc., San Diego, CA; Samsung Medical Center, Seoul, Korea
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Henning MA, Malpas P, Ram S, Rajput V, Krstić V, Boyd M, Hawken SJ. Students' responses to scenarios depicting ethical dilemmas: a study of pharmacy and medical students in New Zealand. J Med Ethics 2016; 42:466-473. [PMID: 27154898 DOI: 10.1136/medethics-2015-103253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
One of the key learning objectives in any health professional course is to develop ethical and judicious practice. Therefore, it is important to address how medical and pharmacy students respond to, and deal with, ethical dilemmas in their clinical environments. In this paper, we examined how students communicated their resolution of ethical dilemmas and the alignment between these communications and the four principles developed by Beauchamp and Childress. Three hundred and fifty-seven pharmacy and medical students (overall response rate=63%) completed a questionnaire containing four clinical case scenarios with an ethical dilemma. Data were analysed using multiple methods. The findings revealed that 73% of the qualitative responses could be exclusively coded to one of the 'four principles' determined by the Beauchamp and Childress' framework. Additionally, 14% of responses overlapped between the four principles (multiple codes) and 13% of responses could not be coded using the framework. The subsequent subgroup analysis revealed different response patterns depending on the case being reviewed. The findings showed that when students are faced with challenging ethical dilemmas their responses can be aligned with the Beauchamp and Childress framework, although more contentious dilemmas involving issues of law are less easily categorised. The differences between year and discipline groups show students are developing ethical frames of reference that may be linked with their teaching environments and their levels of understanding. Analysis of these response patterns provides insight into the way students will likely respond in 'real' settings and this information may help educators prepare students for these clinical ethical dilemmas.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Vijay Rajput
- Ross University School of Medicine, Miramar, Florida, USA
| | - Vladimir Krstić
- Department of Philosophy, University of Auckland, Auckland, New Zealand
| | - Matt Boyd
- Independent researcher, formerly University of Auckland, Auckland, New Zealand
| | - Susan J Hawken
- Department of General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland New Zealand
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Chaudhary R, Narain R, Singh G, Kumar A, Ram S. The role of toxin-antitoxin systems in the survival of multidrug tolerant pathogens and designing of new approaches to treat them. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.609] [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: 10/22/2022] Open
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21
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Defang RR, Brostrom R, Ram S, Johnson E, Perman PS. Screening for tuberculosis and LTBI in diabetes patients, Pohnpei, Federated States of Micronesia. Public Health Action 2015; 4:S53-5. [PMID: 26477289 DOI: 10.5588/pha.13.0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
A retrospective cohort study was performed in Pohnpei, a small Pacific Island, to evaluate the feasibility and results of screening adult diabetes (DM) patients for tuberculosis (TB) and latent tuberculous infection (LTBI) using a symptom screen, tuberculin skin testing and chest radiography. Of 79 patients, 65 (82%) completed screening. Two (3%) patients with active TB and 16 (25%) with LTBI were referred for anti-tuberculosis treatment and isoniazid preventive therapy, respectively. It is feasible and worthwhile to screen diabetes patients for TB, but a number of changes are needed to improve both the screening process and the diagnostic yield.
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Affiliation(s)
- R R Defang
- Pohnpei State Department of Health Services, Kolonia, Pohnpei, Federated States of Micronesia
| | - R Brostrom
- Division of TB Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA ; TB Branch, Hawaii Department of Health, Honolulu, Hawaii, USA
| | - S Ram
- Fiji National University, Suva, Fiji
| | - E Johnson
- Pohnpei State Department of Health Services, Kolonia, Pohnpei, Federated States of Micronesia
| | - P S Perman
- Pohnpei State Department of Health Services, Kolonia, Pohnpei, Federated States of Micronesia
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22
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Tagaro M, Harries AD, Kool B, Ram S, Viney K, Marais B, Tarivonda L. Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007-2011. Public Health Action 2015; 4:S14-8. [PMID: 26477280 DOI: 10.5588/pha.13.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/10/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING All five DOTS centres in Vanuatu. OBJECTIVES To determine across the age spectrum the tuberculosis (TB) case burden, disease pattern and treatment outcomes in patients registered between 2007 and 2011. DESIGN Retrospective cohort study involving reviews of TB registers and treatment cards. RESULTS Of 588 TB patients, 142 (24%) were children (aged 0-14 years), 327 (56%) adults (aged 15-54 years) and 119 (20%) were older adults (aged ⩾55 years; subdivided into 55-64 and ⩾65 years); 568 were new patients, 13 had been treated previously and 7 had unknown status. Compared with adults, children with new TB had a higher prevalence of extra-pulmonary TB (75% vs. 34%, OR 5.7, 95%CI 3.6-9.0) and a lower prevalence of smear-positive pulmonary TB (11% vs. 45%, OR 0.15, 95%CI 0.1-0.3), while older adults with new TB had a higher prevalence of smear-negative pulmonary TB (38% vs. 21%, OR 2.4, 95%CI 1.5-3.8). Overall TB treatment success was 83%, but in the second category of older adults (⩾65 years) treatment success was 67% and case fatality was 18%. CONCLUSION Children and older adults constitute 45% of the TB burden in Vanuatu. Differences in disease patterns and poorer treatment outcomes in older adults have implications for policy and practice.
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Affiliation(s)
- M Tagaro
- National TB Control Programme, Port Vila, Vanuatu
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - K Viney
- Secretariat of the Pacific Community, Nouméa, New Caledonia
| | - B Marais
- The Sydney Emerging Infections and Biosecurity Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - L Tarivonda
- Department of Public Health, Ministry of Health, Port Vila, Vanuatu
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Nasa JN, Brostrom R, Ram S, Kumar AMV, Seremai J, Hauma M, Paul IA, Langidrik JR. Screening adult tuberculosis patients for diabetes mellitus in Ebeye, Republic of the Marshall Islands. Public Health Action 2015; 4:S50-2. [PMID: 26477288 DOI: 10.5588/pha.13.0079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 11/03/2013] [Indexed: 01/06/2023] Open
Abstract
A retrospective cohort study was conducted to evaluate the screening of adult TB patients for diabetes (DM) using glycated haemoglobin (HbA1C) in Ebeye, Republic of the Marshall Islands. Of 62 patients registered between July 2010 and December 2012, 28 (45%) had DM. The only significant difference in baseline characteristics between those with and those without DM was higher age in those with DM. Two-month sputum smears and cultures were also not different between the two groups. Despite the limited sample size, this study shows that screening TB patients for DM in Ebeye is feasible and worthwhile and that it should be continued.
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Affiliation(s)
- J N Nasa
- Ebeye Community Health Center, Ministry of Health, Ebeye, Republic of the Marshall Islands
| | - R Brostrom
- Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, USA ; Hawaii Department of Health, TB Branch, Honolulu, Hawaii, USA
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - J Seremai
- Ebeye Community Health Center, Ministry of Health, Ebeye, Republic of the Marshall Islands
| | - M Hauma
- Ebeye Community Health Center, Ministry of Health, Ebeye, Republic of the Marshall Islands
| | - I A Paul
- Ebeye Community Health Center, Ministry of Health, Ebeye, Republic of the Marshall Islands
| | - J R Langidrik
- Ministry of Health, Majuro, Republic of the Marshall Islands
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Harries AD, Marais B, Kool B, Ram S, Kumar AMV, Gounder S, Viney K, Brostrom R, Roseveare C, Bissell K, Reid AJ, Zachariah R, Hill PC. Mentorship for operational research capacity building: hands-on or hands-off? Public Health Action 2015; 4:S56-8. [PMID: 26477290 DOI: 10.5588/pha.13.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/19/2013] [Indexed: 11/10/2022] Open
Abstract
Mentorship is a key feature of operational research training courses run by the International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières. During the recent South Pacific paper writing module, the faculty discussed 'hands-on' mentorship (direct technical assistance) vs. 'hands-off' mentorship (technical advice). This article explores the advantages and disadvantages of each approach. Our collective experience indicates that 'hands-on' mentorship is a valuable learning experience for the participant and a rewarding experience for the mentor. This approach increases the likelihood of successful course completion, including publishing a well written paper. However, mentors must allow participants to lead and take ownership of the paper, in keeping with a first author position.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - B Marais
- The Sydney Emerging Infections and Biosecurity Institute, University of Sydney, Sydney, NSW, Australia
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | - S Gounder
- National Tuberculosis Programme, Ministry of Health, Suva, Fiji
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Centers for Disease Control and Prevention, Division of TB Elimination, Atlanta, Georgia, USA
| | - C Roseveare
- Department of Statistics, Regional Public Health, Lower Hutt, New Zealand
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - A J Reid
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Zachariah
- Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - P C Hill
- Centre for International Health, The University of Otago, Dunedin, New Zealand
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Bissell K, Viney K, Brostrom R, Gounder S, Khogali M, Kishore K, Kool B, Kumar AMV, Manzi M, Marais B, Marks G, Linh NN, Ram S, Reid S, Roseveare C, Tayler-Smith K, Van den Bergh R, Harries AD. Building operational research capacity in the Pacific. Public Health Action 2015; 4:S2-S13. [PMID: 26477282 DOI: 10.5588/pha.13.0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
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Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, the University of Auckland, Auckland, New Zealand
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Gounder
- National Tuberculosis Programme, Fiji Ministry of Health, Suva, Fiji
| | - M Khogali
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - K Kishore
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - B Kool
- School of Population Health, the University of Auckland, Auckland, New Zealand
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - M Manzi
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - B Marais
- Marie Bashir Institute for Emerging Infections and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - G Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - N N Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland ; Division of Pacific Technical Support, WHO Representative Office in the South Pacific, Suva, Fiji
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - S Reid
- Australian Centre for International and Tropical Health, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Kumar K, Snowdon W, Ram S, Khan S, Cornelius M, Tukana I, Reid S. Descriptive analysis of diabetes-related amputations at the Colonial War Memorial Hospital, Fiji, 2010-2012. Public Health Action 2015; 4:155-8. [PMID: 26400802 DOI: 10.5588/pha.14.0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/02/2014] [Indexed: 12/30/2022] Open
Abstract
SETTING The Colonial War Memorial Hospital (CWMH) in Fiji. OBJECTIVE To determine the characteristics of patients with diabetes mellitus (DM) who underwent lower limb amputations at the CWMH from 2010 to 2012. DESIGN This was a retrospective review of data contained in operating theatre registers and clinical records of DM patients who had undergone amputations during the study period. RESULT Of the 938 amputations performed at the CWMH during the study period, significantly more patients were male than female (54.1% vs. 45.9%) and more i-Taukei (indigenous Fijian) than Indo-Fijian (71% vs. 26.2%); 15.9% of patients had not previously been diagnosed as having DM when they presented with foot sepsis. The rate of smoking was highest in male i-Taukei patients. A large proportion of patients (76.8%) had poor glycaemic control. CONCLUSION This study suggests that male i-Taukeis are most at risk, and that uncontrolled DM is a significant factor associated with amputations. There is a need to strengthen DM screening and improve glycaemic control. Foot care education needs to be implemented at diagnosis and re-enforced with regular clinic visits and complication screening sessions.
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Affiliation(s)
- K Kumar
- Ministry of Health Fiji/Diabetes Fiji Inc, Suva, Fiji
| | - W Snowdon
- C-POND, Deakin, University and Fiji National University, Suva, Fiji
| | - S Ram
- Fiji National University, Suva, Fiji
| | - S Khan
- Fiji National University, Suva, Fiji
| | - M Cornelius
- Fiji Health Sector Support Program Fiji, Suva, Fiji
| | | | - S Reid
- The Australian Centre for International and Tropical Health School of Population Health, The University of Queensland, Herston, Queensland, Australia
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Ram S, Kishore K, Batio I, Bissell K, Zachariah R, Satyanarayana S, Harries AD. Pre-treatment loss to follow-up among smear-positive pulmonary tuberculosis cases: a 10-year audit of national data from Fiji. Public Health Action 2015; 2:138-41. [PMID: 26392972 DOI: 10.5588/pha.12.0034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 01/07/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING All tuberculosis (TB) diagnostic and treatment centres in Fiji. OBJECTIVES To report on pre-treatment loss to follow-up rates over a 10-year period (2001-2010) and to examine if patients' age, sex and geographic origin are associated with the observed shortcomings in the health services. METHODS A retrospective review of routine programme data reconciling TB laboratory and treatment registers. RESULTS A total of 690 sputum smear-positive TB patients were diagnosed in the laboratory, of whom 579 (84%) were started on anti-tuberculosis treatment-an overall pre-treatment loss to follow-up of 111 (16%). Peak loss to follow-up rates were seen in 2003, 2004 and 2010. Pre-treatment losses were all aged ≥15 years. In the Western Division of Fiji, 33% of sputum-positive patients were declared pre-treatment loss to follow-up; this division had over five times the risk of such an adverse outcome compared to the Central Division (OR 5.2, 95%CI 3.1-8.9, P < 0.0001). CONCLUSION This study has identified an important shortcoming in programme linkage, communication and feedback between TB diagnostic and treatment services, leading to high pre-treatment loss to follow-up rates. This negatively influences TB services, and ways to rectify this situation are discussed.
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Affiliation(s)
- S Ram
- Fiji National University, Suva, Fiji
| | - K Kishore
- Fiji National University, Suva, Fiji
| | - I Batio
- Fiji National Tuberculosis Programme, Suva, Fiji
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - R Zachariah
- Médecins Sans Frontières (MSF)-Operational Centre Brussels, Luxembourg
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Henning MA, Ram S, Malpas P, Sisley R, Thompson A, Hawken SJ. Reasons for academic honesty and dishonesty with solutions: a study of pharmacy and medical students in New Zealand. J Med Ethics 2014; 40:702-709. [PMID: 23955289 DOI: 10.1136/medethics-2013-101420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/02/2023]
Abstract
This paper presents students' views about honest and dishonest actions within the pharmacy and medical learning environments. Students also offered their views on solutions to ameliorating dishonest action. Three research questions were posed in this paper: (1) what reasons would students articulate in reference to engaging in dishonest behaviours? (2) What reasons would students articulate in reference to maintaining high levels of integrity? (3) What strategies would students suggest to decrease engagement in dishonest behaviours and/or promote honest behaviours? The design of the study incorporated an initial descriptive analysis to interpret students' responses to an 18-item questionnaire about justifications for dishonest action. This was followed by a qualitative analysis of students' commentaries in reference to why students would engage in either honest or dishonest action. Finally a qualitative analysis was conducted on students' views regarding solutions to dishonest action. The quantitative results showed that students were more likely to use time management and seriousness justifications for dishonest actions. The qualitative findings found that students' actions (honest or dishonest) were guided by family and friends, the need to do well, issues of morality and institutional guidelines. Students suggested that dishonest action could be ameliorated by external agencies and polarised views between punitive and rewards-based mechanisms were offered. These results suggest that these students engaged in dishonest action for various reasons and solutions addressing dishonest action need to consider diverse mechanisms that likely extend beyond the educational institution.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sanya Ram
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Phillipa Malpas
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Richard Sisley
- School of Business, AUT University, Auckland, New Zealand
| | - Andrea Thompson
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan J Hawken
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, School of Medicine, University of Auckland, Auckland, New Zealand
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Waloki M, Roseveare C, Tikolevu L, Ram S, Bissell K. Stroke rehabilitation in Fiji: are patients receiving services? Public Health Action 2014; 4:150-4. [DOI: 10.5588/pha.14.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/04/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- M. Waloki
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - C. Roseveare
- Regional Public Health Service, Hutt Valley, Lower Hutt, New Zealand
| | - L. Tikolevu
- Colonial War Memorial Hospital, Fiji Ministry of Health, Suva, Fiji
| | - S. Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - K. Bissell
- International Union against Tuberculosis and Lung Disease, Paris, France
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Norris P, Horsburgh S, Sides G, Ram S, Fraser J. Geographical access to community pharmacies in New Zealand. Health Place 2014; 29:140-5. [PMID: 25087053 DOI: 10.1016/j.healthplace.2014.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
Geographic access to community pharmacies is an important aspect of access to appropriate medicines. This study aimed to explore changes in the number and location of pharmacies in New Zealand and determine whether some populations have poor geographical access to pharmacies. Pharmacy numbers in New Zealand have been declining since the mid-1980s, and, adjusted for population growth, there are now only half the number there was in 1965. While the urbanisation of pharmacies has been matched by loss of population in rural areas, the loss of pharmacies from smaller rural towns leaves many people with poor access to pharmacy services.
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Affiliation(s)
- Pauline Norris
- School of Pharmacy, University of Otago, Box 56, Dunedin, New Zealand.
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, University of Otago, Box 56, Dunedin, New Zealand.
| | - Gerald Sides
- School of Pharmacy, University of Otago, Box 56, Dunedin, New Zealand.
| | - Sanya Ram
- School of Pharmacy, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - John Fraser
- School of Pharmacy, University of Otago, Box 56, Dunedin, New Zealand.
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Girin N, Brostrom R, Ram S, McKenzie J, Kumar AMV, Roseveare C. Describing the burden of non-communicable disease risk factors among adults with diabetes in Wallis and Futuna. Public Health Action 2014; 4:S39-43. [PMID: 26477286 DOI: 10.5588/pha.13.0082] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The South Pacific Territory of Wallis and Futuna has a high burden of non-communicable diseases (NCD): 18% of adults have diabetes mellitus (DM) and 87% are classified as overweight or obese. OBJECTIVE To characterise the burden of additional World Health Organization (WHO) recognised NCD risk factors, such as smoking, obesity, high blood pressure, eating less than five fruit or vegetable servings per day and a sedentary lifestyle, among adults with DM. DESIGN Re-analysis of cross-sectional data from a 2009 national survey. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS Of 487 adults sampled, 87 (18%) had DM. Nearly 99% of individuals with DM had at least one additional NCD risk factor, and 62% had three or more concurrent NCD risk factors. Individuals with DM were more likely to be obese (OR 1.66, 95%CI 1.01-2.74) and had a much higher prevalence of high blood pressure (OR 3.02, 95%CI 1.87-4.86). CONCLUSION DM is rarely identified in the absence of other NCD risk factors. We recommend an integrated approach to the management of DM and other NCD risk factors in routine care rather than a disease-specific approach.
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Affiliation(s)
- N Girin
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA ; Hawaii Department of Health, TB Control Program, Honolulu, Hawaii, USA
| | - S Ram
- Fiji National University, Suva, Fiji
| | - J McKenzie
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - A M V Kumar
- The International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
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Kalyan Kamal SS, Vimala J, Sahoo PK, Ghosal P, Ram S, Durai L. A green chemical approach for synthesis of shape anisotropic gold nanoparticles. Int Nano Lett 2014. [DOI: 10.1007/s40089-014-0109-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bajpai OP, Kamdi JB, Selvakumar M, Ram S, Khastgir D, Chattopadhyay S. Effect of surface modification of BiFeO3 on the dielectric, ferroelectric, magneto-dielectric properties of polyvinylacetate/BiFeO3 nanocomposites. EXPRESS POLYM LETT 2014. [DOI: 10.3144/expresspolymlett.2014.70] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Phule AD, Ram S, Tyagi AK. Anchoring Silver with Poly(vinylidene fluoride) Molecules in Model Flocculates and Its Effects on Rheology in Stable Nanofluids. J Nanofluids 2013. [DOI: 10.1166/jon.2013.1067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Susrutha B, Ram S, Tyagi A. Percolative effects of poly(vinylidene fluoride) molecules on CO group vibrations in N,N-dimethylformamide in molecular assemblies. J Mol Liq 2013. [DOI: 10.1016/j.molliq.2013.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prasanna AA, Ram S, Fecht HJ. Consecutive magnetic and magnetocaloric transitions in herringbone nanostructured Heusler Mn50Ni41Sn9 alloy. J Nanosci Nanotechnol 2013; 13:5351-5359. [PMID: 23882763 DOI: 10.1166/jnn.2013.7494] [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: 06/02/2023]
Abstract
A herringbone nanostructured Mn-rich Heusler Mn50Ni50-Sndelta (8 - 9) alloy exhibits tailored magnetocaloric properties in the martensite and ferro <-> paramagnetic transitions concur in a narrow temperature window. In a Sn --> Ni substitution 8 - 9, the martensite (M) <-- austenite (A) transition up-lifts adequately well above the room temperature - 310.5 K in the DSC thermogram and magnetization scanned with temperature. A noninterrupted heating following a cooling in DSC at a given rate gives a smaller enthalpy change deltaH(M <-- A) - deltaH(M --> A approximately equal to 282 mJ/g (deltaC(P)(M <-- A) - deltaC(P)(M --> A) approximately equal to 0.025 mJ/g-K in the heat capacity), i.e., the M <-> A transition process lacks a complete reversibility. Warming a zero-field cooled sample retains lower magnetization (sigma) at low fields B, e.g., by 58% over the field cooled value at 5 mT, wherein merely low field magnetic susceptibility imparts the magnetization process. A reversible thermal hysteresis thus the transition traces in cooling and heating. The field diminishes difference in two sigma-values progressively, e.g., only - 12% lasts at 5 T. The two curves bifurcate below 160 K (B-5 mT) and the gap grows exponentially over lower temperatures before sigma(M <-- A) gets steady near 60 K in a superparamagnetic (SPM) behavior. The SPM feature (follows the Langevin model) below a paramagnetic regime begins (> or = 250 K) before a ferromagnetic A-state lines-up the successive transitions. Temperature and frequency dependence ac and dc susceptibilities describe the surface spins dynamics.
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Affiliation(s)
- A A Prasanna
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
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Abstract
The New Zealand government has proposed a new psychoactive substances regime, which will place the onus onto manufacturers to prove that their products pose a low risk of harm, prior to receiving approval which allows the products to be legally manufactured and sold. This is an innovative and unique development in the regulation of emerging psychoactive substances, and offers an alternative response to prohibition. The details of the new regime and how it will operate are now emerging, and this offers an opportunity to critically explore some of the issues related to the proposed new regime and to speculate on some of the outcomes. This paper brings together a group of New Zealand based researchers from a range of disciplines with experience of 'legal high' research to discuss this innovative new regime.
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Affiliation(s)
- Chris Wilkins
- SHORE and Whariki Research Centre, School of Public Health, Massey University, Auckland, New Zealand.
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Henning MA, Ram S, Malpas P, Shulruf B, Kelly F, Hawken SJ. Academic dishonesty and ethical reasoning: pharmacy and medical school students in New Zealand. Med Teach 2013; 35:e1211-7. [PMID: 23146078 DOI: 10.3109/0142159x.2012.737962] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is ample evidence to suggest that academic dishonesty remains an area of concern and interest for academic and professional bodies. There is also burgeoning research in the area of moral reasoning and its relevance to the teaching of pharmacy and medicine. AIMS To explore the associations between self-reported incidence of academic dishonesty and ethical reasoning in a professional student body. METHODS Responses were elicited from 433 pharmacy and medicine students. A questionnaire eliciting responses about academic dishonesty (copying, cheating, and collusion) and their decisions regarding an ethical dilemma was distributed. Multivariate analysis procedures were conducted. RESULTS The findings suggested that copying and collusion may be linked to the way students make ethical decisions. Students more likely to suggest unlawful solutions to the ethical dilemma were more likely to disclose engagement in copying information and colluding with other students. CONCLUSIONS These findings imply that students engaging in academic dishonesty may be using different ethical frameworks. Therefore, employing ethical dilemmas would likely create a useful learning framework for identifying students employing dishonest strategies when coping with their studies. Increasing understanding through dialog about engagement in academic honesty will likely construct positive learning outcomes in the university with implications for future practice.
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Affiliation(s)
- Marcus A Henning
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland 1142, New Zealand.
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Abstract
The Ponseti and French taping methods have reduced the incidence of major surgery in congenital idiopathic clubfoot but incur a significant burden of care, including heel-cord tenotomy. We developed a non-operative regime to reduce treatment intensity without affecting outcome. We treated 402 primary idiopathic clubfeet in patients aged < three months who presented between September 1991 and August 2008. Their Harrold and Walker grades were 6.0% mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient taping regime over five weeks based on Ponseti manipulation, modified Jones strapping and home exercises. Feet with residual equinus (six feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent one to three additional tapings. Correction was maintained with below-knee splints, exercises and shoes. The clinical outcome at three years of age (385 feet, 95.8% follow-up) showed that taping alone corrected 357 feet (92.7%, 'good'). Late relapses or failure of taping required limited posterior release in 20 feet (5.2%, 'fair') or posteromedial release in eight feet (2.1%, 'poor'). The long-term (> 10 years) outcomes in 44 feet (23.8% follow-up) were assessed by the Laaveg-Ponseti method as excellent (23 feet, 52.3%), good (17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%). These compare favourably with published long-term results of the Ponseti or French methods. This dynamic taping regime is a simple non-operative method that delivers improved medium-term and promising long-term results.
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Affiliation(s)
- A K Singh
- King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Behera M, Ram S. Inquiring the mechanism of formation, encapsulation, and stabilization of gold nanoparticles by poly(vinyl pyrrolidone) molecules in 1-butanol. Appl Nanosci 2013. [DOI: 10.1007/s13204-013-0198-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Naraian R, Ram S, Kaistha SD, Srivastava J. Occurrence of plasmid linked multiple drug resistance in bacterial isolates of tannery effluent. Cell Mol Biol (Noisy-le-grand) 2012; 58:134-141. [PMID: 23273203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/10/2012] [Indexed: 06/01/2023]
Abstract
Effluents of three different tanneries (T-1, T-2, & T-3) were investigated to isolate and scrutinize antibiotic, chromate and salinity resistant bacteria. Total 18 isolates of 9 different bacterial genera were screened out and identified; some strains established in all effluents. Amongst the three effluents tested; T-1 exhibited largest population of all isolates compared to T-2 and T-3 effluents. The T-1 effluent contained largest 4.4 x10(6) cfu/ml population of Pseudomonas aeruginosa followed by 3.9 x10(6) cfu/ml in T-2 effluent. The lowest 0.7 x10(6) cfu/ml count of Aeromonas spp. was recorded in T-3 effluent. Furthermore, antibiotic susceptibility tests were performed with 7 antibiotics which include ampicillin, sulfafurazole, ciprofloxacin, norfloxacin, tetracycline and amikacin. Three strains of P. aeruginosa and one strain of Escherichia coli deserved as multiple drug resistant (MDR). The P. aeruginosaT-3 and E. coliT-1 showed strongest MDR feature for 5 antibiotics. The response of chromate (50, 100, 200, 250 and 300 μg/ml) and NaCl concentrations (20, 40, 60 and 80 g/l) was incredible for 4 MDR isolates. Nearly each strain showed tolerance up to 300 μg/ml of chromate and 80 g/l of NaCl. The P. aeruginosaT-1, P. aeruginosaT-2, P. aeruginosaT-3 and E. coliT-1 were most tolerant isolates. Plasmid profiling of resistant strains was conducted with agarose gel electrophoresis. As consequence, plasmids from two strains of P. aeruginosa and E. coliT-1 represented different bands. At least for confirmation of plasmids nature; these were transformed and transformants were screened on medium having antibiotics. The study of plasmid transformation has confirmed the plasmid mediated resistance in isolates.
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Affiliation(s)
- R Naraian
- Department of Biotechnology, Faculty of Science, Veer Bahadur Singh Purvanchal University, Jaunpur-222001, (U.P.), India.
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Susrutha B, Ram S, Tyagi AK. Effects of Gold Nanoparticles on Rheology of Nanofluids Containing Poly(vinylidene fluoride) Molecules. J Nanofluids 2012. [DOI: 10.1166/jon.2012.1023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Perepelkin J, Ram S, Scahill S. Assessment of Students in Pharmacy Management Courses. Res Social Adm Pharm 2012. [DOI: 10.1016/j.sapharm.2012.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Behera M, Ram S. Intense quenching of fluorescence intensity of poly(vinyl pyrrolidone) molecules in presence of gold nanoparticles. Appl Nanosci 2012. [DOI: 10.1007/s13204-012-0159-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pervez A, Ahmed M, Ram S, Torres C, Work J, Zaman F, Abreo K. Antibiotic lock technique for prevention of cuffed tunnel catheter associated bacteremia. J Vasc Access 2012; 3:108-13. [PMID: 17639471 DOI: 10.1177/112972980200300305] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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
BACKGROUND Central venous cuffed tunnel catheters are commonly used for short term or long term hemodialysis access. However, catheter-associated bacteremia is a common complication. It has been suggested that the addition of antibiotics to the catheter during the interdialytic interval results in a decrease in bacterial colonization and thereby a decrease in catheter associated infections. To test this hypothesis, a prospective, randomized study was performed comparing a gentamicin citrate mixture to standard heparin as the catheter lock. The effect of covering the catheter hub in a sterile bag on the infection rate was additionally tested. METHODS From January 1999 to April 2000, all patients who underwent tunnel catheter placement or change (55 catheters) in the Nephrology Interventional Laboratory at Louisiana State University Health Sciences Center in Shreveport, were prospectively randomized as follows: group 1 (n=14): Antibiotic lock with tricitrasol (46.7%), gentamicin (40 mg/ml) and saline in a ratio of 1:5:5 and catheter hub covered with a sterile plastic bag after cleaning with a 10% povidone iodine solution; group 2 (n=22): Heparin lock and sterile plastic bag over catheter hub after cleaning with povidone iodine; and group 3 (n=19): Heparin lock alone. The primary end points of the study were catheter-associated bacteremia and thrombosis. Catheter loss due to access maturation, transplant or transfer were censored. RESULTS There were a total of 4,805 at risk patient-days. The total number of catheter associated bacteremias were one in group 1, four in group 2 and four in group 3. The number of catheter associated bacteremias per 1000 patient-days in each group was 0.62, 3.05, and 2.11 respectively. The sixty day percent survival of catheters in each group was 74 +/- 12, 55 +/- 12 and 59 +/- 11 respectively. CONCLUSIONS 1) Tricitrasol and gentamicin as an antibiotic lock reduced the incidence of catheter associated bacteremia; 2) Covering the catheter hub with a sterile bag did not provide an additional advantage; 3) The antibiotic lock improved overall survival of catheters.
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Affiliation(s)
- A Pervez
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA - USA
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Zachariah R, Harries AD, Srinath S, Ram S, Viney K, Singogo E, Lal P, Mendoza-Ticona A, Sreenivas A, Aung NW, Sharath BN, Kanyerere H, van Soelen N, Kirui N, Ali E, Hinderaker SG, Bissell K, Enarson DA, Edginton ME. Language in tuberculosis services: can we change to patient-centred terminology and stop the paradigm of blaming the patients? Int J Tuberc Lung Dis 2012; 16:714-7. [PMID: 22613683 DOI: 10.5588/ijtld.11.0635] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The words 'defaulter', 'suspect' and 'control' have been part of the language of tuberculosis (TB) services for many decades, and they continue to be used in international guidelines and in published literature. From a patient perspective, it is our opinion that these terms are at best inappropriate, coercive and disempowering, and at worst they could be perceived as judgmental and criminalising, tending to place the blame of the disease or responsibility for adverse treatment outcomes on one side-that of the patients. In this article, which brings together a wide range of authors and institutions from Africa, Asia, Latin America, Europe and the Pacific, we discuss the use of the words 'defaulter', 'suspect' and 'control' and argue why it is detrimental to continue using them in the context of TB. We propose that 'defaulter' be replaced with 'person lost to follow-up'; that 'TB suspect' be replaced by 'person with presumptive TB' or 'person to be evaluated for TB'; and that the term 'control' be replaced with 'prevention and care' or simply deleted. These terms are non-judgmental and patient-centred. We appeal to the global Stop TB Partnership to lead discussions on this issue and to make concrete steps towards changing the current paradigm.
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Affiliation(s)
- R Zachariah
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, MSF-Luxembourg, Luxembourg.
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Bhargav KK, Ram S, Majumder SB. Nanomagnets La0.8Pb0.2(Fe0.8Co0.2)O3 assembled with a bonded surface graphene oxide: sensitive for sensing small gas molecules. J Nanosci Nanotechnol 2012; 12:2973-2982. [PMID: 22849054 DOI: 10.1166/jnn.2012.5819] [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: 06/01/2023]
Abstract
Nanocrystallites La0.8Pb0.2(Fe0.8Co0.2)O3 (LPFC) when bonded through a surface layer (carbon) in small ensembles display surface sensitive magnetism useful for biological probes, electrodes, and toxic gas sensors. A simple dispersion and hydrolysis of the salts in ethylene glycol (EG) in water is explored to form ensembles of the nanocrystallites (NCs) by combustion of a liquid precursor gel slowly in microwave at 70-80 dgrees C (apparent) in a closed container in air. In a dilute sample, the EG molecules mediate hydrolyzed species to configure in small groups in process to form a gel. Proposed models describe how a residual carbon bridges a stable bonded layer of a graphene-oxide-like hybrid structure on the LPFC-NCs in attenuating the magnetic structure. SEM images, measured from a pelletized sample which was used to study the gas sensing features in terms of the electrical resistance, describe plate shaped NCs, typically 30-60 nm widths, 60-180 nm lengths and -50 m2/g surface area (after heating at -750 degrees C). These NCs are arranged in ensembles (200-900 nm size). As per the X-ray diffraction, the plates (a Pnma orthorhombic structure) bear only small strain -0.0023 N/m2 and oxygen vacancies. The phonon and electronic bands from a bonded surface layer disappear when it is etched out slowly by heating above 550 degrees C in air. The surface layer actively promotes selective H2 gas sensor properties.
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Affiliation(s)
- K K Bhargav
- Materials Science Centre, Indian Institute of Technology, Kharagpur 721302, India
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De D, Rawat R, Ram S, Banerjee A, Roy SK. A change from second- to first-order transition in (La(1-x)Eu(x))0.67Ca0.33MnO3 (0 ≤ x ≤ 0.2). J Phys Condens Matter 2012; 24:076001. [PMID: 22252017 DOI: 10.1088/0953-8984/24/7/076001] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A detailed investigation of the paramagnetic to ferromagnetic transition in (La(1-x)Eu(x))(0.67)Ca(0.33)MnO(3) having small Eu(3+)-content (0 ≤ x ≤ 0.2) has been carried out through resistivity and magnetization measurements. X-ray diffraction patterns of the compounds reveal a single phase (La(1-x)Eu(x))(0.67)Ca(0.33)MnO(3) (0 ≤ x ≤ 0.2) of an orthorhombic crystal structure after annealing the precursor at 800 °C for 2 h in air. With increasing Eu(3+)-content, the second-order transition (at x = 0 and 0.1) changes to first-order at x = 0.2. The experimental results demonstrate thermomagnetic irreversibility of the transition for x = 0.2 composition. This arises between the supercooling and superheating regimes where both the ferromagnetic and paramagnetic phases coexist.
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Affiliation(s)
- Debasis De
- Materials Science Centre, IIT Kharagpur, Kharagpur, WB, India
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Susrutha B, Ram S, Tyagi A. Local vibration assisted molecular configurations in poly(vinylidene fluoride) of ordered ferroelectric phase in N,N-dimethylformamide. J Mol Liq 2011. [DOI: 10.1016/j.molliq.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ram S, Vajpayee P, Dwivedi PD, Shanker R. Culture-free detection and enumeration of STEC in water. Ecotoxicol Environ Saf 2011; 74:551-557. [PMID: 21459445 DOI: 10.1016/j.ecoenv.2011.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 11/04/2010] [Accepted: 01/30/2011] [Indexed: 05/30/2023]
Abstract
Shiga toxin-producing Escherichia coli (STEC) causes worldwide outbreaks of food and waterborne diseases. Rapid identification of causative agents is critical for early intervention in the case of widespread diarrheal epidemics to prevent mortality. In this study, a Molecular-Beacon targeting stx2 gene (highly associated with human illness) was designed to develop a culture-independent real-time PCR assay for detection and quantification of STEC in water samples. The assay could detect lowest 10 genomic equivalent (GE) of the reference strain (E. coli I.T.R.C.-18) per PCR or 100 GE/mL. The presence of 10(6)CFU/mL of non-pathogenic E. coli DH5α has no impact on sensitivity of the assay. The assay could successfully enumerate STEC in surface water (collected from a sewage impacted river) and potable water samples collected from Lucknow city without prior enrichment. The assay will be useful in pre-emptive monitoring of surface/potable waters to prevent waterborne outbreaks caused by STEC.
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Affiliation(s)
- S Ram
- Environmental Microbiology, Indian Institute of Toxicology Research (C.S.I.R), Post Box 80, Mahatma Gandhi Marg, Lucknow 226001, UP, India
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