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Grinberg AS, Damush TM, Lindsey H, Burrone L, Baird S, Takagishi SC, Snyder I, Goldman RE, Sico JJ, Seng EK. The Headache Psychologists' Role in Pediatric and Adult Headache Care: A Qualitative Study of Expert Practitioners. J Clin Psychol Med Settings 2023:10.1007/s10880-023-09972-2. [PMID: 37839060 DOI: 10.1007/s10880-023-09972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We examined the perspectives of expert headache psychologists to inform best practices for integrating headache psychologists into the care of children and adults with headache disorders within medical settings. BACKGROUND Headache disorders are prevalent, chronic, and disabling neurological conditions. As clinical providers trained in evidence-based behavior change interventions with expertise in headache disorders, headache psychologists are uniquely positioned to provide behavioral headache treatment. METHODS In 2020, we conducted semi-structured interviews with a purposive sample of expert headache psychologists working across the United States. Open-ended questions focused on their roles, clinical flow, and treatment content. Interviews were audio-recorded, transcribed, de-identified, and analyzed using a rapid qualitative analysis method. RESULTS We interviewed seven expert headache psychologists who have worked for an average of 18 years in outpatient settings with pediatric (n = 4) and adult (n = 3) patients with headache. The themes that emerged across the clinical workflow related to key components of behavioral headache treatment, effective behavioral treatment referral practices, and barriers to patient engagement. The expert headache psychologists offered evidence-based behavioral headache interventions such as biofeedback, relaxation training, and cognitive behavioral therapy emphasizing lifestyle modification as standalone options or concurrently with pharmacological treatment and were of brief duration. Participants reported many of their patients appeared reluctant to seek behavioral treatment for headache. Participants believed referrals were most effective when the referring provider explained to the patient the rationale for behavioral treatment, treatment content, and positive impact on headache activity, functioning, and quality of life. Barriers cited by participants to integrating headache psychology into headache care included the paucity of psychologists with specialized headache training, lack of insurance reimbursement, limited patient time to seek behavioral treatment, and inadequate patient knowledge of what behavioral treatment entails. CONCLUSION Headache psychologists are often core members of multidisciplinary headache teams offering short-term, evidence-based behavioral interventions, both as a standalone treatment or in conjunction with pharmacotherapy. However, barriers to care persist. Enhancing referring providers' familiarity with psychologists' role in headache care may aid successful referrals for behavioral interventions for headache.
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Affiliation(s)
- Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, USA.
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA.
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA.
- VA Connecticut Healthcare System Headache Center of Excellence, National Programs Center-Mailing Code 689GF VA Annex, 200 Edison Road, Orange, CT, 06477, USA.
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
| | - Laura Burrone
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | | | - Ivy Snyder
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
| | - Roberta E Goldman
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Warren Alpert Medical School of Brown University, Providence, USA
- Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, USA
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, USA
- Yale School of Medicine, New Haven, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, USA
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Lindsey HM, Goldman RE, Riley SD, Baird S, Burrone L, Grinberg AS, Fenton BT, Sico JJ, Damush TM. Complex Patient Navigation by Veteran Patients in the Veterans Health Administration (VHA) for Chronic Headache Disease: A Qualitative Study. J Patient Exp 2023; 10:23743735231151547. [PMID: 36710997 PMCID: PMC9880564 DOI: 10.1177/23743735231151547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Patients living with headache diseases often have difficulty accessing evidence-based care. Authors conducted a qualitative research study with 20 patients receiving headache care at seven Headache Centers of Excellence within the Veterans Health Administration to examine their experiences navigating headache care. This study employed thematic qualitative analysis and conducted cross-case comparisons. Several key findings emerged. 1) Most patients saw multiple healthcare providers over numerous years before reaching a headache specialist to manage chronic headaches. 2) Receipt of high-quality and comprehensive headache specialty care was associated with high satisfaction. 3) Patients with headache diseases reported oftentimes they experienced an arduous journey across multiple healthcare systems and between several healthcare providers before receiving evidence-based headache treatment that they found acceptable. Results demonstrate that most patients were satisfied with their current specialty headache care in the Veterans Health Administration. Authors discuss implications for future studies and highlight ways to improve patient satisfaction and timely access to appropriate headache care.
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Affiliation(s)
- Hayley M Lindsey
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- University of Rhode Island, Kingston, RI, USA
- Hayley M Lindsey, VHA Headache Centers of
Excellence Research and Evaluation Center, VA Connecticut Healthcare System 200
Edison Road Orange, CT, 06477, USA; Pain, Research, Informatics, Medical
Comorbidities and Education (PRIME) Center, VA Connecticut Healthcare System,
200 Edison Road Orange, CT, 06477, USA; University of Rhode Island, Kingston,
RI, 02881, USA.
| | - Roberta E Goldman
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Samantha D Riley
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Sean Baird
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Laura Burrone
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Amy S Grinberg
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Brenda T Fenton
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
| | - Jason J Sico
- VHA Headache Centers of Excellence Research and Evaluation Center, VA Connecticut Healthcare
System, Orange, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Teresa M Damush
- Veterans Health Administration Health Services Research and
Development (HSR&D) Center for Health Information and Communication and Quality
Enhancement Research Initiative Expanding expertise Through E-health Network
Development (EXTEND) QUERI Centers, Roudebush VA Medical Center, Indianapolis, IN, USA
- Indiana University School of
Medicine, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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Elitzur S, Vora A, Burkhardt B, Inaba H, Attarbaschi A, Baruchel A, Escherich G, Gibson B, Liu H, Loh M, Moorman A, Moricke A, Pieters R, Uyttebroeck A, Baird S, Bartram J, Ben-Harosh M, Bertrand Y, Buitenkamp T, Caldwell K, Drut R, Geerlinks A, Grainger J, Haouy S, Heaney N, Huang M, Ingham D, Krenova Z, Kuhlen M, Lehrnbecher T, Manabe A, Niggli F, Paris C, Revel-Vilk S, Rohrlich P, Sandeep B, Sinno M, Szczepanski T, Tamesberger M, Warrier R, Wolfl M, Nirel R, Izraeli S, Borkhardt A, Schmiegelow K. EBV-DRIVEN LYMPHOID NEOPLASMS ASSOCIATED WITH ALL MAINTENANCE THERAPY: AN INTERNATIONAL OBSERVATINAL STUDY. Leuk Res 2022. [DOI: 10.1016/s0145-2126(22)00201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Grinberg AS, Fenton BT, Wang K, Lindsey H, Goldman RE, Baird S, Riley S, Burrone L, Seng EK, Damush TM, Sico JJ. Telehealth perceptions and utilization for the delivery of headache care before and during the COVID-19 pandemic: A mixed-methods study. Headache 2022; 62:613-623. [PMID: 35545754 PMCID: PMC9348149 DOI: 10.1111/head.14310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the utilization of telehealth for headache services within the Veterans Health Administration's facilities housing a Headache Centers of Excellence and multiple stakeholder's perspectives to inform future telehealth delivery. BACKGROUND Telehealth delivery of headache treatment may enhance patient access to headache care, yet little is known about the utilization or patient and provider perceptions of telehealth for veterans with headache. METHODS This mixed-methods study analyzed multiple data sources: (1) administrative data, which included 58,798 patients with medically diagnosed headache disorders, documented in at least one outpatient visit, from August 2019 through September 2020 from the 12 Veterans Health Administration's facilities with a Headache Center of Excellence and (2) qualitative semistructured interviews with 20 patients and 43 providers 6 months before the coronavirus disease 2019 (COVID-19) pandemic, and 10 patients and 20 providers 6 months during the beginning of the pandemic. RESULTS During the pandemic, in-person visits declined from 12,794 to 6099 (52.0%), whereas video (incidence rate ratio [IRR] = 2.05, 95% confidence interval [CI] = 1.66, 2.52), and telephone visits (IRR = 15.2, 95% CI = 10.7, 21.6) significantly increased. Utilization differed based on patient age, race/ethnicity, and rurality. Patients and providers perceived value in using telehealth, yet had limited experience with this modality pre-pandemic. Providers preferred in-person appointments for initial encounters and telehealth for follow-up visits. Providers and patients identified benefits and challenges of telehealth delivery, often relying on multiple delivery methods for telehealth to enhance patient engagement. CONCLUSIONS The uptake of telehealth delivery of headache-related care rapidly expanded in response to the pandemic. Patients and providers were amenable to utilizing telehealth, yet also experienced technological barriers. To encourage equitable access to telehealth and direct resources to those in need, it is crucial to understand patient preferences regarding in-person versus telehealth visits and identify patient groups who face barriers to access.
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Affiliation(s)
- Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaicheng Wang
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Roberta E Goldman
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Laura Burrone
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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Goldman RE, Damush TM, Kuruvilla DE, Lindsey H, Baird S, Riley S, Burrone Bs L, Grinberg AS, Seng EK, Fenton BT, Sico JJ. Essential components of care in a multidisciplinary headache center: Perspectives from headache neurology specialists. Headache 2022; 62:306-318. [PMID: 35293614 DOI: 10.1111/head.14277] [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: 10/05/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. METHODS Qualitative, semi-structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open-ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. RESULTS Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow-up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. CONCLUSION While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center.
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Affiliation(s)
- Roberta E Goldman
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA
| | - Teresa M Damush
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Deena E Kuruvilla
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Westport Headache Institute, Westport, Connecticut, USA
| | - Hayley Lindsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sean Baird
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Samantha Riley
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Laura Burrone Bs
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Amy S Grinberg
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA
| | - Elizabeth K Seng
- Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA.,The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brenda T Fenton
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Headache Centers of Excellence Research and Evaluation Center, Veterans Health Administration, West Haven, Connecticut, USA.,Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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Kuruvilla DE, Lindsey H, Grinberg AS, Goldman RE, Riley S, Baird S, Fenton BT, Sico JJ, Damush TM. Complementary and integrative medicine perspectives among veteran patients and VHA healthcare providers for the treatment of headache disorders: a qualitative study. BMC Complement Med Ther 2022; 22:22. [PMID: 35078450 PMCID: PMC8790919 DOI: 10.1186/s12906-022-03511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate veteran patient and provider perceptions and preferences on complementary and integrative medicine (CIM) for headache management. Background The Veterans Health Administration (VHA) has spearheaded a Whole Health system of care focusing on CIM-based care for veteran patients. Less is known about patients’ and providers’ CIM perceptions and preferences for chronic headache management. Methods We conducted semi-structured interviews with 20 veteran patients diagnosed with headache and 43 clinical providers, across 12 VHA Headache Centers of Excellence (HCoE), from January 2019 to March 2020. We conducted thematic and case comparative analyses. Results Veteran patients and VHA clinical providers viewed CIM favorably for the treatment of chronic headache. Specific barriers to CIM approaches included: (1) A lack of personnel specialized in specific CIM approaches for timely access, and (2) variation in patient perceptions and responses to CIM treatment efficacy for headache management. Conclusion Veteran patients and VHA clinical providers in this study viewed CIM favorably as a safe addition to mainstream headache treatments. Advantages to CIM include favorable adverse effect profiles and patient autonomy over the treatment. By adding more CIM providers and resources throughout the VHA, CIM modalities may be recommended more routinely in the management of veterans with headache. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03511-6.
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Penney LS, Homoya BJ, Damush TM, Rattray NA, Miech EJ, Myers LJ, Baird S, Cheatham A, Bravata DM. Seeding Structures for a Community of Practice Focused on Transient Ischemic Attack (TIA): Implementing Across Disciplines and Waves. J Gen Intern Med 2021; 36:313-321. [PMID: 32875499 PMCID: PMC7878647 DOI: 10.1007/s11606-020-06135-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Community of Practice (CoP) model represents one approach to address knowledge management to support effective implementation of best practices. OBJECTIVE We sought to identify CoP developmental strategies within the context of a national quality improvement project focused on improving the quality for patients receiving acute transient ischemic attack (TIA) care. DESIGN Stepped wedge trial. PARTICIPANTS Multidisciplinary staff at six Veterans Affairs medical facilities. INTERVENTIONS To encourage site implementation of a multi-component quality improvement intervention, the trial included strategies to improve the development of a CoP: site kickoff meetings, CoP conference calls, and an interactive website (the "Hub"). APPROACH Mixed-methods evaluation included data collected through a CoP attendance log; semi-structured interviews with site participants at 6 months (n = 32) and 12 months (n = 30), and CoP call facilitators (n = 2); and 22 CoP call debriefings. KEY RESULTS The critical seeding structures that supported the cultivation of the CoP were the kickoffs which fostered relationships (key to the community element of CoPs) and provided the evidence base relevant to TIA care (key to the domain element of CoPs). The Hub provided the forum for sharing quality improvement plans and other tools which were further highlighted during the CoP calls (key to the practice element of CoPs). CoP calls were curated to create a positive context around participants' work by recognizing team successes. In addition to improving care at their local facilities, the community created a shared set of tools which built on their collective knowledge and could be shared within and outside the group. CONCLUSIONS The PREVENT CoP advanced the mission of the learning healthcare system by successfully providing a forum for shared learning. The CoP was grown through seeding structures that included kickoffs, CoP calls, and the Hub. A CoP expands upon the learning collaborative implementation strategy as an effective implementation practice.
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Affiliation(s)
- Lauren S Penney
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA.
- VA HSR&D Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, TX, USA.
- School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
| | - Barbara J Homoya
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Teresa M Damush
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas A Rattray
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anthropology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Edward J Miech
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laura J Myers
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Sean Baird
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Ariel Cheatham
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Dawn M Bravata
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, USA
- VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Lee JL, Williams CE, Baird S, Matthias MS, Weiner M. Too Many Don'ts and Not Enough Do's? A Survey of Hospitals About Their Portal Instructions for Patients. J Gen Intern Med 2020; 35:1029-1034. [PMID: 31720967 PMCID: PMC7174450 DOI: 10.1007/s11606-019-05528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patient portals present the opportunity to expand patients' access to their clinicians and health information. Yet patients and clinicians have expressed the need for more guidance on portal and secure messaging procedures to avoid misuse. Little information is currently available concerning whether and how expectations of portal and messaging usage are communicated to patients. OBJECTIVE To identify the information made available to patients about patient portal use, and to assess ease in accessing such information. DESIGN A national survey of publicly available portal information from hospital websites. The study team followed up with phone calls to each hospital to request any additional patient-directed materials (e.g., pamphlets) not located in the web search. PARTICIPANTS A random sample of 200 acute-care hospitals, 50 from each of four US Census regions, selected from the US Centers for Medicare & Medicaid Hospital Compare dataset. MAIN MEASURES Availability of patient portals, secure messaging, and related functionality; the content and ease of access to patient-directed information about portals. KEY RESULTS Of the hospitals sampled, 177 (89%) had a patient portal; 116 (66%) of these included secure messaging functionality. Most portals with secure messaging (N = 65, 58%) did not describe appropriate patient messaging conduct. Although many included disclaimers that the service is not for emergencies, 23 hospitals only included this within the fine prints of their "Terms and Conditions" section. Content analysis of additional patient-directed materials revealed a focus on logistical content, features of the portals, and parameters of use. Of the three categories, logistical content (e.g., creating an account) was the most thorough. CONCLUSIONS Although most of the sampled hospitals had patient portals, many fail to educate patients fully and set expectations for secure messaging. To improve patient engagement and minimize harm, hospitals and clinicians need to provide more information and set clearer guidelines for patients.
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Affiliation(s)
- Joy L Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, 1101 W. 10th St., Indianapolis, IN, 46151, USA. .,Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | | | - Sean Baird
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Marianne S Matthias
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, 1101 W. 10th St., Indianapolis, IN, 46151, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, USA.,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michael Weiner
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, 1101 W. 10th St., Indianapolis, IN, 46151, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
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Bravata DM, Myers LJ, Perkins AJ, Zhang Y, Homoya BJ, Miech EJ, Rattray NA, Giacherio B, Kumar M, Penney LS, Cheng E, Levine D, Sico JJ, Myers J, Austin C, Baird S, Damush T. Abstract WP347: The Effectiveness and Implementation of the Protocol-Guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) Quality Improvement Program: An Exampleofa Learning Healthcare System in Action. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp347] [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
Objectives:
Transient ischemic attack (TIA) patients are at high risk of recurrent vascular events; timely management can reduce that risk by 70%. The Protocol-guided Rapid Evaluation of Veterans Experiencing New Transient Neurological Symptoms (PREVENT) trial evaluated the implementation of a quality improvement (QI) program aligned with Learning Healthcare System principles to improve TIA care.
Methods:
A facility-based, stepped-wedge trial was conducted at six diverse sites. The intervention included five components: clinical programs, data feedback, professional education, electronic health record tools, and QI support. Implementation strategies included: team activation via audit and feedback, goal setting, reflecting and evaluating, and planning; external facilitation; and building a community of practice. The primary effectiveness outcome was the Without Fail rate (WFR); proportion of TIA patients who received all processes of care for which they were eligible among: brain imaging, carotid artery imaging, neurology consultation, hypertension control, anticoagulation for atrial fibrillation, antithrombotics, high/moderate potency statins. The primary implementation outcomes were the number of improvement activities completed and the Group Organization (GO) scores for providing and improving care (scale of 1-10).
Results:
The 6 PREVENT facilities cared for N=162 control period TIA patients and N=191 intervention period TIA patients. The mean facility WFR increased from 36.7% (baseline) to 53.9% (active implementation); p=0.002 (adjusted for temporal trend, hospital admission). The mean number of improvement activities completed during the 1-year implementation period was 26 (range 11-39). The mean facility GO scores increased: providing care, 1.2 to 6.5; improving care, 1.0 to 6.7.
Conclusions:
PREVENT advances three aspects of a learning healthcare system:
Learning from Data
(teams interacted with their facility’s performance data to explore hypotheses, plan QI activities, and evaluate change over time);
Learning from Each Other
(teams participated in monthly virtual collaborative conferences), and
Sharing Best Practices
(teams shared tools and protocols).
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Affiliation(s)
| | | | | | - Ying Zhang
- Biostatistics, Univ of Nebraska Med Cntr, Omaha, NE
| | | | | | | | | | | | - Lauren S Penney
- Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Eric Cheng
- Neurology, Univ of California, Los Angeles, Los Angeles, CA
| | - Deb Levine
- Medicine, Univ of Michigan, Ann Arbor, MI
| | - Jason J Sico
- NEUROLOGY, VA Connecticut Healthcare System, West Haven, CT
| | | | | | - Sean Baird
- Richard L Roudebush VAMC, Indianapolis, IN
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10
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Cox MJ, Sewell K, Egan KL, Baird S, Eby C, Ellis K, Kuteh J. A systematic review of high-risk environmental circumstances for adolescent drinking. Journal of Substance Use 2019. [DOI: 10.1080/14659891.2019.1620890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. J. Cox
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - K. Sewell
- Laupus Health Sciences Library, East Carolina University, Greenville, NC, USA
| | - K. L. Egan
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - S. Baird
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - C. Eby
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - K. Ellis
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - J. Kuteh
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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11
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Giovannetti E, Sandberg S, Angelia B, Baird S, Clair C, Scholle S. WHAT MATTERS MOST: A PILOT STUDY TO DEVELOP QUALITY MEASURES FOR OLDER ADULTS WITH COMPLEX NEEDS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - S Sandberg
- National Committee for Quality Assurance (NCQA)
| | - B Angelia
- National Committee for Quality Assurance (NCQA)
| | - S Baird
- National Committee for Quality Assurance (NCQA)
| | - C Clair
- National Committee for Quality Assurance (NCQA)
| | - S Scholle
- National Committee for Quality Assurance (NCQA)
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12
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Whigham DF, Walker CM, Maurer J, King RS, Hauser W, Baird S, Keuskamp JA, Neale PJ. Watershed influences on the structure and function of riparian wetlands associated with headwater streams - Kenai Peninsula, Alaska. Sci Total Environ 2017; 599-600:124-134. [PMID: 28475906 DOI: 10.1016/j.scitotenv.2017.03.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/30/2017] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
Riparian wetlands are dynamic components of landscapes. Located between uplands and aquatic environments, riparian habitats intercept sediments and nutrients before they enter aquatic environments. They are a source of organic matter and nutrients to aquatic systems, and they provide important habitat for animals, often serving as corridors for the movement of animals between habitats in fragmented landscapes. In this project, we focused on the structure and function of riparian wetlands associated with headwater streams in Alaska that serve as nursery habitats for juvenile salmonids. We asked whether or not the structure and function of headwater wetlands differed between watersheds with and without nitrogen-fixing Alder (Alnus spp.). We found that the aboveground biomass of riparian vegetation was higher in the watershed with Alder, but the largest differences were in the litter layer and belowground where vegetation in the watershed with no Alder had significantly higher root biomass. Interstitial water chemistry also differed between the study sites with significantly higher inorganic N and significantly different characteristics of colored dissolved organic matter at the site with Alder on the watershed. The biomass of litter that hung over the creek bank was less at the site with Alder on the watershed and an in situ decomposition experiment showed significant differences between the two systems. Results of the research demonstrates that watershed characteristics can impact the ecology of headwater streams in ways that had not been previously recognized.
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Affiliation(s)
- D F Whigham
- Smithsonian Environmental Research Center, 647 Contees Wharf Road, Edgewater, MD 21037, USA.
| | - C M Walker
- Kachemak Bay National Estuarine Research Reserve, University of Alaska, 2181 Kachemak Drive, Homer, AK 99603, USA.
| | - J Maurer
- Kachemak Bay National Estuarine Research Reserve, University of Alaska, 2181 Kachemak Drive, Homer, AK 99603, USA.
| | - R S King
- Baylor University, Department of Biology, One Bear Place #97388, Waco, TX 76798, USA.
| | - W Hauser
- Smithsonian Environmental Research Center, 647 Contees Wharf Road, Edgewater, MD 21037, USA; Wabash College, Biology Department, Crawfordsville, IN 47933, USA.
| | - S Baird
- Kachemak Bay National Estuarine Research Reserve, University of Alaska, 2181 Kachemak Drive, Homer, AK 99603, USA.
| | - J A Keuskamp
- Netherlands Institute of Ecology (NIOO-KNAW), P.O. Box 59, 6700 AB Wageningen, The Netherlands; Ecology & Biodiversity Group, Department of Biology, Utrecht University, P.O. Box 80.056, 3508 TB Utrecht, The Netherlands.
| | - P J Neale
- Smithsonian Environmental Research Center, 647 Contees Wharf Road, Edgewater, MD 21037, USA.
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13
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Jull J, Whitehead M, Petticrew M, Kristjansson E, Gough D, Petkovic J, Volmink J, Weijer C, Taljaard M, Edwards S, Mbuagbaw L, Cookson R, McGowan J, Lyddiatt A, Boyer Y, Cuervo LG, Armstrong R, White H, Yoganathan M, Pantoja T, Shea B, Pottie K, Norheim O, Baird S, Robberstad B, Sommerfelt H, Asada Y, Wells G, Tugwell P, Welch V. When is a randomised controlled trial health equity relevant? Development and validation of a conceptual framework. BMJ Open 2017; 7:e015815. [PMID: 28951402 PMCID: PMC5623521 DOI: 10.1136/bmjopen-2016-015815] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Randomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of improving the design and reporting of such trials. METHODS An interdisciplinary and international research team engaged in an iterative consensus building process to develop and refine the conceptual framework via face-to-face meetings, teleconferences and email correspondence, including findings from a validation exercise whereby two independent reviewers used the emerging framework to classify a sample of randomised trials. RESULTS A randomised trial can usefully be classified as 'health equity relevant' if it assesses the effects of an intervention on the health or its determinants of either individuals or a population who experience ill health due to disadvantage defined across one or more social determinants of health. Health equity-relevant randomised trials can either exclusively focus on a single population or collect data potentially useful for assessing differential effects of the intervention across multiple populations experiencing different levels or types of social disadvantage. Trials that are not classified as 'health equity relevant' may nevertheless provide information that is indirectly relevant to assessing equity impact, including information about individual level variation unrelated to social disadvantage and potentially useful in secondary modelling studies. CONCLUSION The conceptual framework may be used to design and report randomised trials. The framework could also be used for other study designs to contribute to the evidence base for improved health equity.
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Affiliation(s)
- J Jull
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - M Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - M Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - E Kristjansson
- Centre for Research on Educational and Community Services, School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - D Gough
- Department of Social Science, Evidence for Policy and Practice Information and Co-ordinating Centre, Social Science Research Unit, University College London, London, UK
| | - J Petkovic
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Volmink
- The South African Cochrane Center, South African Medical Research Council, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - C Weijer
- Rotman Institute of Philosophy, University of Western Ontario, Ontario, Canada
| | - M Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - S Edwards
- Research Ethics and Governance, University College London, London, UK
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - R Cookson
- Centre for Health Economics, University of York, York, UK
| | - J McGowan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - A Lyddiatt
- Cochrane Musculoskeletal Group, Ontario, Canada
| | - Y Boyer
- Brandon University, Brandon, Manitoba, Canada
| | - L G Cuervo
- Office of Knowledge Management, Bioethics and Research, Pan American Health Organization/World Health Organization, Washington, District of Columbia, USA
| | - R Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - H White
- Campbell Collaboration, New Delhi, India
| | - M Yoganathan
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - T Pantoja
- Department of Family Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - B Shea
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | - O Norheim
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - S Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - B Robberstad
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
| | - H Sommerfelt
- Centre for Intervention Science in Matnernal and Child Health (CISMAC), University of Bergen, Bergen, Norway
- Centre for International Health, University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Y Asada
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - G Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - P Tugwell
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - V Welch
- Bruyère Continuing Care, Bruyère Research Institute, Elisabeth Bruyere Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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14
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Baird S, Nagyova-Rajnicova I. Quality of life profiles across five chronic diseases: implications for chronic condition management. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Scullin C, McElnay JC, Scott MG, Ryan M, Trouton TG, Baird S. Cost implications of the use of troponin I (cTnI) measurement to diagnose heart conditions. International Journal of Pharmacy Practice 2011. [DOI: 10.1111/j.2042-7174.2001.tb01128.x] [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: 11/30/2022]
Abstract
Abstract
Focal points
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Affiliation(s)
- C Scullin
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - J C McElnay
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL
| | - M G Scott
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - M Ryan
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - T G Trouton
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
| | - S Baird
- Antrim Area Hospital, United Hospitals trust, 45 Bush Road, Antrim BT42 2RL
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16
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Baird M, Shirley T, Baird S, Smithhart L, Mayronne N, Green D, Vijayakumar S. Benefits of Aggressive Patient Management on Radiation Therapy in Socio-economically Disadvantaged Populations. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
DNA damage, chromosomal abnormalities, oncogene activation, viral infection, substrate detachment and hypoxia can all trigger apoptosis in normal cells. However, cancer cells acquire mutations that allow them to survive these threats that are part and parcel of the transformation process or that may affect the growth and dissemination of the tumor. Eventually, cancer cells accumulate further mutations that make them resistant to apoptosis mediated by standard cytotoxic chemotherapy or radiotherapy. The inhibitor of apoptosis (IAP) family members, defined by the presence of a baculovirus IAP repeat (BIR) protein domain, are key regulators of cytokinesis, apoptosis and signal transduction. Specific IAPs regulate either cell division, caspase activity or survival pathways mediated through binding to their BIR domains, and/or through their ubiquitin-ligase RING domain activity. These protein-protein interactions and post-translational modifications are the subject of intense investigations that shed light on how these proteins contribute to oncogenesis and resistance to therapy. In the past several years, we have seen multiple approaches of IAP antagonism enter the clinic, and the rewards of such strategies are about to reap benefit. Significantly, small molecule pan-IAP antagonists that mimic an endogenous inhibitor of the IAPs, called Smac, have demonstrated an unexpected ability to sensitize cancer cells to tumor necrosis factor-alpha and to promote autocrine or paracrine production of this cytokine by the tumor cell and possibly, other cells too. This review will focus on these and other developmental therapeutics that target the IAPs in cancer.
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Affiliation(s)
- E C LaCasse
- Apoptosis Research Centre, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
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18
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Baird S, Sinnott N, Mohammad A, Walshaw M, Ledson M. Growing up with TIVADs: effect on line position. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Asim M, Navi A, Sinnott N, Baird S, Walshaw M, Ledson M. “Adult onset CF”: previous misdiagnoses. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Baird S, Sinnott N, Mohammad A, Ledson M, Walshaw M. CF Education for respiratory trainees in one UK region. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60450-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Asim M, Navi A, Baird S, Sinnott N, Walshaw M, Ledson M. Prognosis and clinical features of adult diagnosis CF. J Cyst Fibros 2008. [DOI: 10.1016/s1569-1993(08)60041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Larsson D, Baird S, Nyhalah J, Li W, Yuan XM. Th-P15:166 The 7-oxysterols, at atheroma relevant proportion, confer synergistic and pro-apoptotic effect in vitro. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)82126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Brown EG, Liu H, Kit LC, Baird S, Nesrallah M. Pattern of mutation in the genome of influenza A virus on adaptation to increased virulence in the mouse lung: identification of functional themes. Proc Natl Acad Sci U S A 2001; 98:6883-8. [PMID: 11371620 PMCID: PMC34447 DOI: 10.1073/pnas.111165798] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The genetic basis for virulence in influenza virus is largely unknown. To explore the mutational basis for increased virulence in the lung, the H3N2 prototype clinical isolate, A/HK/1/68, was adapted to the mouse. Genomic sequencing provided the first demonstration, to our knowledge, that a group of 11 mutations can convert an avirulent virus to a virulent variant that can kill at a minimal dose. Thirteen of the 14 amino acid substitutions (93%) detected among clonal isolates were likely instrumental in adaptation because of their positive selection, location in functional regions, and/or independent occurrence in other virulent influenza viruses. Mutations in virulent variants repeatedly involved nuclear localization signals and sites of protein and RNA interaction, implicating them as novel modulators of virulence. Mouse-adapted variants with the same hemagglutinin mutations possessed different pH optima of fusion, indicating that fusion activity of hemagglutinin can be modulated by other viral genes. Experimental adaptation resulted in the selection of three mutations that were in common with the virulent human H5N1 isolate A/HK/156/97 and that may be instrumental in its extreme virulence. Analysis of viral adaptation by serial passage appears to provide the identification of biologically relevant mutations.
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Affiliation(s)
- E G Brown
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON, Canada.
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25
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Bernie JE, Albers L, Baird S, Parsons CL. Synchronous ipsilateral renal adenocarcinoma, transitional cell carcinoma of the renal pelvis and metastatic renal lymphoma. J Urol 2000; 164:773-4. [PMID: 10953146 DOI: 10.1097/00005392-200009010-00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J E Bernie
- Division of Urology, Department of Surgery and Department of Pathology, University of California, San Diego, USA
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26
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Harbinson MT, Baird S, Trouton TG, Webb SW. Spontaneous coronary dissection by coronary stenting. Int J Cardiol 1999; 71:87-8. [PMID: 10522570 DOI: 10.1016/s0167-5273(99)00076-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The MRL-Fas(lpr) mouse, a model of multisystemic, organ nonspecific autoimmune disease, has been proposed as a model of immune-mediated inner ear disease. A preliminary study employing light microscopy indicated that it develops cochlear pathology that appeared most striking in the stria vascularis, where cells underwent edema and degeneration. However, other structures, including the inner and outer hair cells and the supporting cells, also appeared to display pathology. The current study analyzed cochlear ultrastructure using transmission electron microscopy to better delineate the cochlear lesions found in these animals. MRL-Fas(lpr) animals were allowed to develop systemic disease (20 weeks old) and then had auditory brainstem response (ABR) thresholds determined. Animals were then killed and their cochleas prepared for electron microscopy. Age-matched MRL-+/+ and BALB/c mice served as controls. Results indicated that MRL-Fas(lpr) mice demonstrated elevated ABR thresholds. In contrast to a preliminary report, the cochlear pathology was observed exclusively in the stria vascularis, where cells demonstrated hydropic degeneration. Strial capillary structure was normal as were the rest of the cellular cochlear constituents. No inflammatory infiltrate was noted. These studies confirm that the MRL-Fas(lpr) mouse develops cochlear abnormalities focused in the stria vascularis. Whether the mechanism of the cellular degeneration involves autoimmune, genetic, or uremic processes has yet to be determined.
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Affiliation(s)
- M J Ruckenstein
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
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Abstract
The inhibitor of apoptosis protein family has been characterized over the past 5 years, initially in baculovirus and more recently in metazoans. The IAPs are a widely expressed gene family of apoptotic inhibitors from both phylogenic and physiologic points of view. The diversity of triggers against which the IAPs suppress apoptosis is greater than that observed for any other family of apoptotic inhibitors including the bcl-2 family. The central mechanisms of IAP apoptotic suppression appear to be through direct caspase and pro-caspase inhibition (primarily caspase 3 and 7) and modulation of and by the transcription factor NF-kappaB. Although evidence for a direct oncogenic role for the IAPs has yet to be delineated, a number of lines of evidence point towards this class of protein playing a role in oncogenesis. The strongest evidence for IAP involvement in cancer is seen in the IAP called survivin. Although not observed in adult differentiated tissue, survivin is present in most transformed cell lines and cancers tested to date. Survivin has been shown to inhibit caspase directly and apoptosis in general, moreover survivin protein levels correlate inversely with 5 year survival rates in colorectal cancer. Recent data has also implicated survivin in cell cycle control. The second line of evidence for IAP involvement in cancer comes from their emerging role as mediators and regulators of the anti-apoptotic activity of v-Rel and NF-kappaB transcription factor families. The IAPs have been shown to be induced by NF-kappaB or v-Rel in multiple cell lines and conversely, HIAP1 and HIAP2 have been shown to activate NF-kappaB possibly forming a positive feed-back loop. Overall a picture consistent with an IAP role in tumour progression rather than tumour initiation is emerging making the IAPs an attractive therapeutic target.
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Affiliation(s)
- E C LaCasse
- Apoptogen Inc, CHEO Research Institute, Ottawa, Ontario, Canada
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29
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Baird S. The unique role of the baccalaureate prepared nurse. The Colorado Association of Colleges in Nursing. Colo Nurse 1998; 98:28. [PMID: 10614221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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30
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Terkeltaub R, Baird S, Sears P, Santiago R, Boisvert W. The murine homolog of the interleukin-8 receptor CXCR-2 is essential for the occurrence of neutrophilic inflammation in the air pouch model of acute urate crystal-induced gouty synovitis. Arthritis Rheum 1998; 41:900-9. [PMID: 9588743 DOI: 10.1002/1529-0131(199805)41:5<900::aid-art18>3.0.co;2-k] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute neutrophil-dependent inflammation is central to acute gout. Urate crystals induce different classes of neutrophil chemotaxins, including certain chemokines (e.g., interleukin-8 [IL-8], growth-related oncogene alpha [GROalpha]) that share CXCR-2 as a receptor. This study was undertaken to assess the role of CXCR-2 ligands in a model of acute gout. METHODS Urate crystals were injected into subcutaneous air pouches in mice that expressed or lacked the murine CXCR-2 homolog (mIL-8RH), and the development of neutrophilic inflammation was assessed. RESULTS In normal mice, urate crystals induced a 10-fold increase (P < 0.01) in pouch fluid leukocytes (principally neutrophils) at 4 hours. Leukocytes adhered to the pouch lining, where crystals, the mIL-8RH ligand KC/GROalpha, and cells bearing mIL-8RH were abundant. In mIL-8RH(-/-) mice, urate crystals induced a proteinaceous leukocyte-poor exudate at 4 hours, despite crystal-induced activation of resident cells (documented by KC/GROalpha expression). CONCLUSION Chemokines that bind the IL-8 receptor CXCR-2 are essential for the development of acute neutrophilic inflammation in response to urate crystals in the subcutaneous air pouch model.
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Affiliation(s)
- R Terkeltaub
- San Diego VA Medical Center and University of California, 92161, USA
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31
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Bulloch K, McEwen BS, Nordberg J, Diwa A, Baird S. Selective regulation of T-cell development and function by calcitonin gene-related peptide in thymus and spleen. An example of differential regional regulation of immunity by the neuroendocrine system. Ann N Y Acad Sci 1998; 840:551-62. [PMID: 9629282 DOI: 10.1111/j.1749-6632.1998.tb09594.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the course of our studies, we have shown the presence of calcitonin gene related peptide (CGRP) by immunocytochemistry in cell bodies and nerve fibers of the murine thymus and in a sparse innervation of the spleen. Receptors for CGRP have been characterized within these glands, and their activation by physiological levels of CGRP was found to suppress Con A-stimulated proliferation of thymocytes and splenic T cells as well as antigen-specific T-cell proliferation. This suppression is blocked by the antagonist for CGRP (CGRP 8-37). Within the thymus cultures, the antagonist CGRP (8-37) alone enhanced proliferation of thymocytes during Con A stimulation, most likely by inhibiting the endogenous release of CGRP into the culture medium by resident thymocytes. Some of the CGRP-induced suppression of mitogenic stimulation of thymocytes, but not of splenocytes, was due to apoptosis. The antagonist, CGRP(8-37), did not block apoptosis caused by Con A or CGRP but rather enhanced it. Flow cytometric analysis of CGRP-treated cultures using antibodies to cluster determinates (CD) showed that the majority of thymocytes undergoing apoptosis induced by CGRP were of the CD4/CD8 double-positive type. These data indicate that apoptosis in the thymocytes is mediated by a CGRP receptor not sensitive to the antagonist CGRP(8-37). Because proliferation of thymocytes and splenocytes induced by Con A is blocked by this antagonist and splenocytes are refractory to CGRP induced apoptosis, CGRP appears to mediate at least two separate functions on subpopulations of thymocytes and T cells via two different CGRP receptors within the gland. These effects of a neuropeptide exemplify the phenomenon of differential regional regulation of immunity by the autonomic and neuroendocrine systems.
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Affiliation(s)
- K Bulloch
- Laboratory of Neuroendocrinology, Rokefeller University, New York, NY 10021, USA.
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32
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Maisel A, Cesario D, Baird S, Rehman J, Haghighi P, Carter S. Experimental autoimmune myocarditis produced by adoptive transfer of splenocytes after myocardial infarction. Circ Res 1998; 82:458-63. [PMID: 9506706 DOI: 10.1161/01.res.82.4.458] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
One possible mechanism for neurohumoral activation after myocardial infarction may be the generation of an immune response against cardiac self-antigens. We hypothesize that if there is a T cell-mediated reaction to self-antigens, the transfer of splenic lymphocytes from postinfarct rats into syngeneic rats with normal hearts should result in a T cell-mediated autoimmune myocarditis in the healthy syngeneic rats. Rats were killed 6 weeks after coronary ligation. Splenocytes from animals with large and small infarcts were purified from spleens, activated with concanavalin A, and injected in varying doses into normal syngeneic rats. These recipient rats were killed 6 weeks later, and histopathological studies were performed. Our results demonstrate in vivo evidence of lymphocyte-mediated myocardial injury by adoptive transfer of sensitized lymphocytes from rats who developed congestive heart failure after acute myocardial infarction. The amount of infiltrate and necrosis in the recipient rats appeared directly related to the size of the infarct from the donor rats. This suggests that larger infarcts lead to a greater inflammatory response as well as a greater propensity for alteration of cardiac surface antigens or the emergence of previously sequestered antigens. None of the other organs (kidney, liver, lung, or brain) had evidence of infiltrates. Two-dimensional echocardiography did not reveal systolic dysfunction. This study provides direct evidence of autoimmune myocardial injury produced by adoptive transfer of concanavalin A-activated splenocytes after myocardial infarction. We propose that neurohumoral activation early in the postinfarction period triggers a series of specific inflammatory and immunological events that lead to formation of specific clones of T cells. When these are activated and transferred into normal rats, cardiac-specific cellular infiltration occurs, occasionally accompanied by myocardial necrosis. This model should help to further explore the link between neurohumoral activation after myocardial infarction and the subsequent immune alterations that might be associated with the development and/or progression of congestive heart failure. Additionally, this might be a useful model in which to study other immune-mediated cardiomyopathies.
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Affiliation(s)
- A Maisel
- Department of Medicine, Veterans Affairs Medical Center and University of California, San Diego 921161, USA.
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33
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Lafrenière RG, Kibar Z, Rochefort DL, Han FY, Fon EA, Dubé MP, Kang X, Baird S, Korneluk RG, Rommens JM, Rouleau GA. Genomic structure of the human GT334 (EHOC-1) gene mapping to 21q22.3. Gene X 1997; 198:313-21. [PMID: 9370297 DOI: 10.1016/s0378-1119(97)00333-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Several inherited diseases have been mapped to the distal tip of human chromosome 21. In our recent efforts to clone candidate genes for some of these disorders, we have assembled a cosmid and BAC contig spanning 770 kb. We have identified expressed sequences from this contig by means of a cDNA hybrid selection scheme. We present here the isolation, cDNA sequence, genomic organization, and polymorphisms analysis of one such expressed sequence, GT334, which had been identified independently and designated EHOC-1. GT334 is split into 23 exons, and spans an estimated 95 kb of genomic DNA. A pseudogene of the histone H2AZ gene has been identified, and maps within the third intron. We have identified an ORF potentially encoding a protein 1259 amino acids in length, longer than that described in the EHOC-1 gene. The GT334 gene was screened for single base pair changes using single-strand conformation polymorphism (SSCP) analysis and we have identified seven sequence variations within this gene. These polymorphisms can be used as markers in the genetic mapping of other diseases localized to this region.
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Affiliation(s)
- R G Lafrenière
- Centre for Research in Neuroscience, McGill University and Department of Neurology, Montreal General Hospital Research Institute, Canada.
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34
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Wheeler T, Graves C, Troiano N, Baird S. Left ventricular dysfunction recognized in severe preeclampsia. Am J Obstet Gynecol 1997. [DOI: 10.1016/s0002-9378(97)80418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Lafrenière RG, Rochefort DL, Kibar Z, Fon EA, Han F, Cochius J, Kang X, Baird S, Korneluk RG, Andermann E, Rommens JM, Rouleau GA. Isolation and characterization of GT335, a novel human gene conserved in Escherichia coli and mapping to 21q22.3. Genomics 1996; 38:264-72. [PMID: 8975701 DOI: 10.1006/geno.1996.0627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
As part of efforts to identify candidate genes for disorders mapped to 21q22.3, we have constructed a 405-kb cosmid contig encompassing five tightly linked markers mapping to this region. A subset of these cosmids was used to identify cDNA fragments by the method of hybrid selection. We present here the cDNA sequence of one such gene (GT335) mapping to this region. The gene is expressed as a 1.7-kb transcript predominantly in heart and skeletal muscle, potentially displays alternate splicing, and is predicted to encode a protein 268 amino acids in length. GT335 spans an estimated 13 kb of genomic DNA and is split into seven exons. Five of the six introns conform to the GT . . . AG consensus for intronic splice junctions; the sixth contains nonconventional (AT . . . AC) intronic junctions. We screened this gene for single-basepair mutations using single-strand conformation polymorphism and sequence analysis of both cDNA and genomic DNA from a number of unrelated individuals and have identified several sequence variations, two of which cause conservative amino acid substitutions. This gene is well conserved evolutionarily, with homologs identified in zebrafish and Escherichia coli, suggesting that it plays an important role in basic cellular metabolism.
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Affiliation(s)
- R G Lafrenière
- Centre for Research in Neuroscience, McGill University, Montreal, Quebec, H3G 1A4, Canada.
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36
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Abstract
CYP2E1 is involved in the activation of various carcinogens, including N-nitrosamines, which are believed to be important in human carcinogenesis. Humans exhibit wide interindividual variability in levels of CYP2E1 mRNA and protein, which might explain interindividual differences in susceptibility to carcinogens activated by CYP2E1. Such variability could be due either to genetic polymorphisms observed in the CYP2E1 gene (Rsa I in the 5'-flanking region, Dra I in intron 6 and Taq I in intron 7) or to varying inducibility by xenobiotics. The aim of the present study was to establish whether, in a Caucasian population (n = 93), there existed a relationship between allelic forms of the CYP2E1 gene and the phenotype determined in vitro by hepatic ability to 6-hydroxylate chlorzoxazone. Rates of chlorzoxazone-6-hydroxylation were significantly correlated with levels of immunochemically measured CYP2E1 (p < 0.001). CYP1A2, 2C8, 2C9, 2C18, 2D6, 3A4 and 3A5 did not appear to be significantly involved in chlorzoxazone metabolism, whereas the participation of CYP1A1 could not be excluded. Frequencies of the rare alleles for the three polymorphism sites were 2.2% for RsaI, 7.5% for DraI and 8.5% for TaqI. Despite substantial interindividual variations in chlorzoxazone hydroxylase activity, no relationship between any of the three polymorphisms and CYP2E1 activity was established. Therefore, in humans, interindividual variability in CYP2E1 levels is probably due to differing induction levels as a result of environmental factors, or to genetic factors other than those studied in this work.
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Affiliation(s)
- V Carrière
- INSERM U75, CHU-Necker, Université René Descartes, Paris, France
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37
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Phelan CM, Larsson C, Baird S, Futreal PA, Ruttledge MH, Morgan K, Tonin P, Hung H, Korneluk RG, Pollak MN, Narod SA. The human mammary-derived growth inhibitor (MDGI) gene: genomic structure and mutation analysis in human breast tumors. Genomics 1996; 34:63-8. [PMID: 8661024 DOI: 10.1006/geno.1996.0241] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The mammary-derived growth inhibitor (MDGI) gene is a candidate tumor suppressor gene for human breast cancer. It has been shown to reduce the tumorigenicity of breast cancer cell lines in nude mice, and loss of expression of this gene has been shown in primary breast tumors. Furthermore, the human MDGI gene has been mapped to human chromosome 1p32-p35, a common region of deletion in sporadic breast tumors. We have determined the genomic structure of the human MDGI gene from a cosmid clone mapping to chromosome 1p32-p35 and have more finely mapped the MDGI gene relative to chromosome 1p microsatellite markers. The gene covers approximately 8 kb of genomic DNA and is divided into four exons. In an attempt to identify possible inactivating mutations in the MDGI gene in human breast cancer, we have sequenced all four exons and their surrounding splice junctions in 30 sporadic breast tumors. Ten of these tumors showed loss of heterozygosity (LOH) in the 1p32-p35 region, with 5 tumors showing LOH in the subregion containing the MDGI gene. No mutations were found in this analysis. A polymorphism was identified in exon 2 in the constitutional DNA of 1/30 cases in this study, which resulted in the conversion of a lysine to an arginine residue at codon 53. This variant was present in the constitutional DNA of a further 3/26 women with sporadic breast cancer and 2/90 control individuals (P = 0.20). Despite experimental evidence that MDGI has tumor suppressor activity, our data suggest that mutations in the coding region are uncommon in human breast tumorigenesis.
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Affiliation(s)
- C M Phelan
- Department of Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
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38
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Iribarne C, Berthou F, Baird S, Dréano Y, Picart D, Bail JP, Beaune P, Ménez JF. Involvement of cytochrome P450 3A4 enzyme in the N-demethylation of methadone in human liver microsomes. Chem Res Toxicol 1996; 9:365-73. [PMID: 8839037 DOI: 10.1021/tx950116m] [Citation(s) in RCA: 174] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Methadone has become one of the most widely used drugs for opiate dependency treatment. This drug is extensively metabolized by the cytochrome P450 hepatic enzyme family in man, yielding an N-demethylated metabolite that cyclizes spontaneously into 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine. The specific forms of cytochrome P450 involved in this oxidative N-demethylation were examined in a panel of 20 human liver microsomal preparations previously characterized with respect to their P450 enzyme contents. Methadone was demethylated with an apparent Km of 545 +/- 258 microM (n = 3). The metabolic rates were 745 +/- 574 pmol/(min.mg of protein). This metabolic pathway was strongly correlated with estradiol 2-hydroxylation, testosterone 6 beta-hydroxylation, nifedipine oxidation, erythromycin N-demethylation, and toremifene N-demethylation, all of these monooxygenase activities being supported by P450 3A4. Furthermore, the total P450 3A content of liver microsomal samples, determined by immuno-quantification using a monoclonal anti-human P450 3A4 antibody, was correlated with methadone demethylation (r = 0.72; p < 0.003). Methadone metabolism was 60-72% inhibited either by three mechanism-based inhibitors of P450 3A4 (gestodene, TAO, and erythralosamine) or by four reversible inhibitors of P450 3A (ketoconazole, dihydroergotamine, quercetin, and diazepam with an apparent Ki of 50 microM) and by two nonspecific inhibitors (metyrapone and SKF-525A). Conversely, quinidine (inhibitor of P450 2D6), 7,8-benzoflavone (inhibitor of P450 1A), or sulfaphenazole (inhibitor of P450 2C) did not significantly inhibit, and may even have activated, methadone metabolism. Four heterologously expressed P450 proteins were able to catalyze the N-demethylation of methadone, namely, P450 2C8, P450 2C18, P450 2D6, and P450 3A4. However, referring to their relative liver content, it can be asserted that P450 3A4 is the major enzyme involved in the N-demethylation of methadone on average. Accordingly, caution should be advised in the clinical use of methadone when other drugs are also administered that induce or inhibit P450 3A4, such as rifampicin or diazepam, respectively.
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Affiliation(s)
- C Iribarne
- Laboratoires de Biochimie-Nutrition, Faculté de Médecine, Brest, France
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39
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Liston P, Roy N, Tamai K, Lefebvre C, Baird S, Cherton-Horvat G, Farahani R, McLean M, Ikeda JE, MacKenzie A, Korneluk RG. Suppression of apoptosis in mammalian cells by NAIP and a related family of IAP genes. Nature 1996; 379:349-53. [PMID: 8552191 DOI: 10.1038/379349a0] [Citation(s) in RCA: 740] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Dysregulation of apoptosis can result in inappropriate suppression of cell death, as occurs in the development of some cancers, or in failure to control the extent of cell death, as is believed to occur in acquired immunodeficiency and certain neurodegenerative disorders, such as spinal muscular atrophy (SMA). Recently, we isolated a candidate gene, encoding neuronal apoptosis inhibitor protein (NAIP), for SMA. This gene is homologous to two baculovirus inhibitor of apoptosis proteins (Cp-IAP and Op-IAP) and is partly deleted in individuals with type I SMA. A second SMA candidate gene encoding survival motor neuron (SMN), which is contiguous with the NAIP locus on 5q13.1, was also reported. Here we demonstrate a NAIP-mediated inhibition of apoptosis induced by a variety of signals, and have identified three additional human complementary DNAs and a Drosophila melanogaster sequence that are also homologous to the baculovirus IAPs. The four open reading frames (ORFs) possess three baculoviral inhibition of apoptosis protein repeat (BIR) domains and a carboxy-terminal RING zinc-finger. The human iap genes have a distinct but overlapping pattern of expression in fetal and adult tissues. These proteins significantly increase the number of known apoptotic suppressors.
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Affiliation(s)
- P Liston
- Molecular Genetics Research Laboratory, Children's Hospital of Eastern Ontario, Ottawa, Canada
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40
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Potapova O, Fakhrai H, Baird S, Mercola D. Platelet-derived growth factor-B/v-sis confers a tumorigenic and metastatic phenotype to human T98G glioblastoma cells. Cancer Res 1996; 56:280-6. [PMID: 8542581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Autocrine stimulation by platelet-derived growth factor-B (PDGF-B)-like factors has been widely implicated as an important mechanism in the cause and/or maintenance of a variety of human tumors. However, normal human cells appear to be resistant to transformation by PDGF-B-like molecules, and a direct demonstration of the tumor-promoting or tumor-maintaining property of a PDGF-B autocrine system is lacking. T98G human glioblastoma cells are nontumorigenic in athymic mice. We show that these cells express predominantly PDGF-beta type receptors and continuously secrete small amount of PDGF-B/c-sis. Addition of suramin or specific anti-PDGF-B/v-sis antibody inhibits proliferation in culture. Conversely, multiple clonal lines that stably overexpress PDGF-B/v-sis (T98Gsis cells) exhibit a striking 200-250% increased proliferation rate and an enhanced colony-forming frequency in soft agar. Clonal lines with stable expression of PDGF-B/v-sis (T98Gsis cells) reliably (80%) develop tumors in 4-6 weeks, whereas the empty-vector control cells are nontumorigenic. Moreover, in some cases, T98Gsis cells disseminate to form bilateral and multifocal pulmonary metastases. The results show that T98G cells contain functional PDGF receptors that, upon sufficient stimulation, can cause greatly increased mitogenic response, which may account for the development of the malignant phenotype. Metastatic tumor formation in athymic mice by PDGF stimulation has not been reported previously. The mechanism may depend on preexisting changes such as the lost p53 function of these cells. T98Gsis cells provide a model of growth factor-dependent tumorigenesis and metastases, which may be helpful in elucidating these relationships.
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Affiliation(s)
- O Potapova
- Sidney Kimmel Cancer Center, San Diego, California 92121, USA
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41
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Belloc C, Baird S, Cosme J, Lecoeur S, Gautier JC, Challine D, de Waziers I, Flinois JP, Beaune PH. Human cytochromes P450 expressed in Escherichia coli: production of specific antibodies. Toxicology 1996; 106:207-19. [PMID: 8571393 DOI: 10.1016/0300-483x(95)03178-i] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cytochromes P450 (CYP) constitute a superfamily of enzymes involved in the metabolism of xenobiotics. Within the same subfamily, the isoforms present strong similarities, making them difficult to characterize and differentiate. Using heterologous expression in bacteria, five pure human CYP (1A1, 1A2, 2C9, 2E1, 3A4) were easily obtained and used as antigens to raise specific antibodies. These antibodies were characterized for their specificity and sensitivity by immunoblots; anti-CYP3A4 was immunoinhibitor. These antibodies could be used in association with other means to identify the CYPs responsible for production of a given metabolite. The use of our human recombinant CYP1A2 as antigen and the corresponding specific antibody enabled us to quantify the CYP1A2 content in 43 human livers. The average level was 69 pmol of CYP1A2/mg of microsomal proteins. Finally, these antibodies were also used to evaluate the level of heme incorporation in human microsomal CYP expressed in yeasts.
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Affiliation(s)
- C Belloc
- Institut National de la Santé et de la Recherche Médicale Unité 75, Université René Descartes, Paris, France
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42
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Amet Y, Berthou F, Baird S, Dreano Y, Bail JP, Menez JF. Validation of the (omega-1)-hydroxylation of lauric acid as an in vitro substrate probe for human liver CYP2E1. Biochem Pharmacol 1995; 50:1775-82. [PMID: 8615855 DOI: 10.1016/0006-2952(95)02040-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The (omega-1)-hydroxylation of lauric acid (11-OH-LA), a model substrate of fatty acids, was previously shown to be due to CYP2E1 in rat liver microsomes. The present study examined changes in hepatic CYP2E1 content and 11-OH-LA in a panel of 29 human liver microsomes. The 11-OH-LA activity was strongly correlated with the CYP2E1 content, quantitated by immunoblot (r = 0.75) and with four monooxygenase activities known to be mediated by CYP2E1: chlorzoxazone-6-hydroxylation (r = 0.73), 4-nitrophenol hydroxylation (r = 0.84), N-nitrosodimethylamine demethylation (r = 0.79) and n-butanol oxidation (r = 0.73). The (omega-1)-hydroxylation of lauric acid was inhibited by ethanol (Ki = 3.5 mM), acetone (IC50 = 10 mM) dimethylsulfoxide, chlorzoxazone (competitive inhibitors of CYP2E1), diethyldithiocarbamate, and diallylsulfide (both selective mechanism-based inactivators of CYP2E1). The weak value of ethanol Ki on the (omega-1)-hydroxylation of lauric acid suggested that low levels of alcohol could modify fatty acid metabolism in the liver. Furafylline and gestodene, suicide substrates of CYP1A and CYP3A4, respectively, did not modify the 11-hydroxylation of lauric acid. Polyclonal antibody directed against rat CYP2E1 inhibited the formation of 11-OH-LA without affecting 12-OH-LA activity. Taken together, these results suggest that CYP2E1 is involved in the (omega-1)-hydroxylation of lauric acid in human liver microsomes, and omega-hydroxylation is mediated by another enzyme. Finally, the use of yeasts and mammalian cells genetically engineered for expression of 9 human P450s demonstrated that CYP2E1 was the one enzyme involved in the (omega-1)-hydroxylation of lauric acid.
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Affiliation(s)
- Y Amet
- Equipe d'Accueil DGRT EA 948, Laboratoire de Biochimie-Nutrition Faculté de Médecine, Brest, France
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43
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Mahadevan MS, Baird S, Bailly JE, Shutler GG, Sabourin LA, Tsilfidis C, Neville CE, Narang M, Korneluk RG. Isolation of a novel G protein-coupled receptor (GPR4) localized to chromosome 19q13.3. Genomics 1995; 30:84-8. [PMID: 8595909 DOI: 10.1006/geno.1995.0013] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We present the cloning and sequencing of the human gene for a novel G-protein coupled receptor (GPR4), from the critical myotonic dystrophy (DM) region on chromosome 19q13.3. The homologous porcine gene was isolated and sequenced as well. The genes of both species are intronless and contain an open reading frame encoding a protein of 362 amino acids. In human, two isoforms of GPR4 are expressed, differing in their 3' untranslated region due to the use of alternate polyadenylation signals and measuring approximately 2.8 and 1.8 kb, respectively. Northern blot analysis showed that GPR4 is widely expressed, with higher levels in kidney, heart, and especially lung, where it is at least fivefold greater than in other tissues. Sequence analysis suggests that GPR4 is a peptide receptor and shares strongest homologies with purinergic receptors and receptors for angiotensin II, platelet activating factor, thrombin, and bradykinin.
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MESH Headings
- Amino Acid Sequence
- Animals
- Base Sequence
- Blotting, Northern
- Chromosomes, Human, Pair 19
- Cloning, Molecular
- DNA Mutational Analysis
- Gene Expression
- Humans
- Molecular Sequence Data
- Myotonic Dystrophy/genetics
- Open Reading Frames
- Platelet Membrane Glycoproteins/chemistry
- Protein Biosynthesis
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/isolation & purification
- Receptors, G-Protein-Coupled
- Receptors, Thrombin/chemistry
- Restriction Mapping
- Sequence Analysis, DNA
- Sequence Homology, Amino Acid
- Swine
- Tissue Distribution
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Affiliation(s)
- M S Mahadevan
- Department of Pediatrics, University of Ottawa, Ontario, Canada
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Baird S. Preparing nursing students for the future. Colo Nurse 1995; 95:10. [PMID: 7585790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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45
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Abstract
The singular ability of immunoglobulin genes to hypermutate their variable regions, while permitting the generation of high-affinity antibodies against foreign antigens, poses a problem in terms of maintenance of immunological self-tolerance. Immunoglobulin gene hypermutation driven by a foreign antigen has the potential to generate antibodies that cross-react with self-components. Consequently, there must exist a mechanism in the periphery for inactivation of mature autoreactive B cell clones. The classical experimental system used to address this problem is the induction of tolerance to soluble, deaggregated human IgG. We have analyzed the mechanism of induction of tolerance to human IgG using transgenic mice that express a human IgM rheumatoid factor (IgM RF) on a large proportion of their B cells. Injection of deaggregated human IgG caused a specific deletion of those B cells that express an intact IgM RF on their cell surface. The degree of RF B cell deletion was proportional to the reduction in the proliferative response of splenocytes to antigen (aggregated human IgG), or to F(ab')2 fragments of anti-human IgM antibodies. Control experiments showed that IgG administration had little effect on the numbers of mouse Ig-bearing cells or their ability to proliferate to a nonspecific mitogen. Thus, the effects of IgG on the human IgM RF B cell are antigen specific and are not due to nonspecific toxic effects of the human IgG preparation. These experiments demonstrate that peripheral exposure to IgG induces deletion of reactive B cells, without any evidence for anergy, and differ from data obtained by other investigators studying tolerance to soluble protein antigens. The results imply that human Igs have distinct properties as soluble antigens, and that peripheral nonresponsiveness to IgG may be due to lymphocyte deletion.
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Affiliation(s)
- H Tighe
- Department of Medicine, University of California, San Diego, La Jolla 92093
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Roy N, Mahadevan MS, McLean M, Shutler G, Yaraghi Z, Farahani R, Baird S, Besner-Johnston A, Lefebvre C, Kang X. The gene for neuronal apoptosis inhibitory protein is partially deleted in individuals with spinal muscular atrophy. Cell 1995; 80:167-78. [PMID: 7813013 DOI: 10.1016/0092-8674(95)90461-1] [Citation(s) in RCA: 743] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The spinal muscular atrophies (SMAs), characterized by spinal cord motor neuron depletion, are among the most common autosomal recessive disorders. One model of SMA pathogenesis invokes an inappropriate persistence of normally occurring motor neuron apoptosis. Consistent with this hypothesis, the novel gene for neuronal apoptosis inhibitory protein (NAIP) has been mapped to the SMA region of chromosome 5q13.1 and is homologous with baculoviral apoptosis inhibitor proteins. The two first coding exons of this gene are deleted in approximately 67% of type I SMA chromosomes compared with 2% of non-SMA chromosomes. Furthermore, RT-PCR analysis reveals internally deleted and mutated forms of the NAIP transcript in type I SMA individuals and not in unaffected individuals. These findings suggest that mutations in the NAIP locus may lead to a failure of a normally occurring inhibition of motor neuron apoptosis resulting in or contributing to the SMA phenotype.
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Affiliation(s)
- N Roy
- Molecular Genetics Laboratory, Children's Hospital of Eastern Ontario, Ottawa, Canada
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47
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Bulloch K, McEwen BS, Diwa A, Baird S. Relationship between dehydroepiandrosterone and calcitonin gene-related peptide in the mouse thymus. Am J Physiol 1995; 268:E168-73. [PMID: 7840175 DOI: 10.1152/ajpendo.1995.268.1.e168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Dehydroepiandrosterone (DHEA) and calcitonin gene-related peptide (CGRP) are naturally occurring substances that are reported to have both opposing and complementary effects on immune functions. In the current study, we sought to determine how they might work together to influence the mitogen-stimulated proliferation of thymocytes. In concanavalin A (ConA)-induced thymocyte proliferation assays, CGRP and DHEA each inhibited proliferation. When the CGRP antagonist CGRP-(8-37) was added to Con A-stimulated thymocytes, the proliferative response was significantly greater than the ConA response alone across a range of ConA doses. Moreover, CGRP-(8-37) blocked the inhibitory effect of DHEA. Individually, CGRP-(8-37), CGRP, DHEA, or their combination did not stimulate thymocyte proliferation in the absence of ConA. CGRP affects the proliferation of CD4+ T cells and thus may be a regional endogenous inhibitor of the proliferation of virgin mature T cells while they remain in the thymus. Furthermore, DHEA may act via endogenous CGRP on the thymus CD4+ T cell population.
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Affiliation(s)
- K Bulloch
- Department of Psychiatry and Pathology, University of California, San Diego
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Abstract
Calcitonin gene-related peptide has been identified by immunocytochemistry within the thymus of fetal through aged adult mice. Calcitonin gene-related peptide positive nerves are observed from embryonic day 17 throughout the lifespan of the mouse. A sparse cell population positive for CGRP is first observed during the late embryonic period at the corticomedullary boundary and the medulla, and it becomes more densely distributed in this region in the adult. In the thymus of the aged mouse the number of CGRP-positive cells diminishes. Pharmacologic studies demonstrated that fresh thymocytes display a receptor Kd for CGRP of 1.17 +/- 0.06 x 10(-10)M and a Bmax of 12.7 +/- 4.7 fmol/mg protein. Functional studies indicate that CGRP is a potent inhibitor of mitogen and antigen-stimulated proliferation of T cells and that it inhibits IL-2 production in cloned splenic T cells. Recent studies suggest that endogenous CGRP may serve as a natural inhibitor of inappropriate induction of mature, antigen-sensitive cells in the thymus as well as play a role in thymocyte education. These findings are discussed in terms of the distribution of CGRP cells and nerve terminals within the thymus and their relationship to positive and negative selection of the T-cell repertoire.
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Affiliation(s)
- K Bulloch
- Department of Psychiatry, University of California, San Diego
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Abstract
The purpose of this study was to determine the accuracy of FirstTemp (Intelligent Medical Systems, Carlsbad, CA) tympanic thermometer readings compared with core body temperatures obtained via pulmonary artery catheter (PAC). Five measurements were obtained on 19 cardiovascular surgery patients. Tympanic thermometer measurements tended to be higher than PAC measurements. However, most of the differences were not clinically significant. Differences found between right and left ear measurements were most likely due to poor measurement technique. When the correct technique is used, nurses can be confident that tympanic temperature readings are clinically accurate.
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Affiliation(s)
- N White
- School of Nursing, University of Northern Colorado 80639
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Burchell B, Ebner T, Baird S, Bin Senafi S, Clarke D, Brierley C, Sutherland L. Use of cloned and expressed human liver UDP-glucuronosyltransferases for analysis of drug glucuronide formation and assessment of drug toxicity. Environ Health Perspect 1994; 102 Suppl 9:19-23. [PMID: 7698078 PMCID: PMC1566788 DOI: 10.1289/ehp.94102s919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Five cloned human hepatic UDP-glucuronosyltransferase (UGT) cDNAs were stably expressed in tissue culture cell lines. More than 100 drugs and xenobiotics were used as substrates for glucuronidation catalyzed by the cloned human transferases to determine the chemical structures accepted as substrates. UGT-HP1 exhibited a limited substrate specificity for planar phenolic compounds, whereas UGT-HP4 was more accepting of nonplanar phenols, anthraquinones, flavones, alphatic alcohols, aromatic carboxylic acids, steroids and many drugs of varied structure. UGT-HP3 (bilirubin UGT) catalyzed the glucuronidation of ethinylestradiol. UGT-H6 and UGT-H25 (steroid/bile acid UGTs) also catalyzed the glucuronidation of some xenobiotics. Levels of UGT-HP4 activity towards some substrates were sufficient to allow determination of kinetic parameters for the enzyme reaction. Further, metabolism of drugs could be studied by addition to the recombinant cell lines in culture and extraction of the media allowed analysis of glucuronide formation. The protection afforded against cytotoxic drugs was observed. The data presented here demonstrate the potential of using these recombinant cell lines for investigation of phase II metabolism by human UGTs and subtle differences in protein structure which affect their specificity.
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Affiliation(s)
- B Burchell
- Department of Biochemical Medicine, Nimewells Medical School, University of Dundee, Scotland
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