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Young S, Sanghvi T, Ragulojan R, Torkian P, Todatry S, D'Souza D, Flanagan S, Golzarian J. Local recurrence following a complete radiologic response in hepatocellular carcinoma patients: comparison of transarterial chemoembolisation and transarterial radioembolisation. Clin Radiol 2024; 79:371-377. [PMID: 38341344 DOI: 10.1016/j.crad.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
AIM To evaluate and compare the rates of local recurrence in hepatocellular carcinoma (HCC) patients who undergo selective transarterial radioembolisation (TARE) or transarterial chemoembolisation (TACE) and achieve a complete response (CR) radiologically. MATERIALS AND METHODS All patients undergoing treatment with TARE or TACE at a single academic institution were reviewed retrospectively. Those who had been treated previously, presented with multifocal disease, had non-selective TARE or TACE, or did not achieve a complete response (CR) radiologically were excluded. RESULTS In total 110 patients were included (TACE n=60 [54.5%]; TARE n=50 [45.5%]). TARE patients were older (66.4 ± 9.4 versus 61.2 ± 5.6 years, p<0.001) and had larger tumours (4.4 ± 2.2 versus 3 ± 1.4 cm, p=0.002). TACE patients were significantly more likely to suffer a local recurrence (31/60, 51.7% versus 9/50, 18%, p<0.001) and had a significantly shorter time to recurrence (median 8.3 {interquartile range [IQR]}: 12 versus median 17.9 [IQR: 23.5] months, p=0.001). A local time to progression (TTP) Kaplan-Meier curve demonstrated TACE patients had a significantly shorter local TTP (hazard ratio [HR]: 7.2; 95% confidence interval [CI]: 3.64-14.24; p<0.001) and treatment modality (TACE or TARE; HR: 0.05; 95% CI: 0.005-0.5; p=0.01) was found to be associated with local recurrences on multivariate Cox proportional HR analysis. When overall TTP was evaluated, again TACE patients were found to have a significantly shorter TTP (HR: 2.13 [1.28-3.53], p=0.004). CONCLUSION In HCC patients undergoing selective treatment who achieve a CR radiologically, those treated with TARE may be less likely to suffer recurrence, either local or general, than those treated with TACE.
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Affiliation(s)
- S Young
- Department of Radiology, University of Arizona, Division of Interventional Radiology, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724, USA.
| | - T Sanghvi
- Minneapolis VA Hospital, 1 Veterans Dr, Minneapolis, MN 55417, USA
| | - R Ragulojan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - P Torkian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Todatry
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - D D'Souza
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - S Flanagan
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
| | - J Golzarian
- Department of Radiology, University of Minnesota, Division of Interventional Radiology, 420 Delaware St SE, MMC 292, MN 55455, USA
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Rea CJ, Toomey SL, Hauptman M, Rosen M, Samuels RC, Karpowicz K, Flanagan S, Shah SN. Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2024; 63:512-521. [PMID: 37309813 PMCID: PMC10863332 DOI: 10.1177/00099228231179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Ronald C. Samuels
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Snehal N. Shah
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Finkelstein JB, Hauptman M, Acosta K, Flanagan S, Cahill D, Smith B, Bernstein A, Shah SH, Kaur R, Meyers H, Shah AS, Meara JG, Estrada CR. Environmental Impact of a Pediatric and Young Adult Virtual Medicine Program: A Lesson from the COVID-19 Pandemic. Acad Pediatr 2024; 24:408-416. [PMID: 37499794 PMCID: PMC10809144 DOI: 10.1016/j.acap.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES The Coronavirus Disease 2019 (COVID-19) pandemic led to the expansion of virtual medicine as a method to provide patient care. We aimed to determine the impact of pediatric and young adult virtual medicine use on fossil fuel consumption, greenhouse gas, and nongreenhouse traffic-related air pollutant emissions. METHODS We conducted a retrospective analysis of all virtual medicine patients at a single quaternary-care children's hospital with a geocoded address in the Commonwealth of Massachusetts prior to (March 16, 2019-March 15, 2020) and during the COVID-19 pandemic (March 16, 2020-March 15, 2021). Primary outcomes included patient travel distance, gasoline consumption, carbon dioxide and fine particulate matter emissions as well as savings in main hospital energy use. RESULTS There were 3,846 and 307,273 virtual visits performed with valid Massachusetts geocoded addresses prior to and during the COVID-19 pandemic, respectively. During 1 year of the pandemic, virtual medicine services resulted in a total reduction of 620,231 gallons of fossil fuel use and $1,620,002 avoided expenditure as well as 5,492.9 metric tons of carbon dioxide and 186.3 kg of fine particulate matter emitted. There were 3.1 million fewer kilowatt hours used by the hospital intrapandemic compared to the year prior. Accounting for equipment emissions, the combined intrapandemic emission reductions are equivalent to the electricity required by 1,234 homes for 1 year. CONCLUSIONS Widespread pediatric institutional use of virtual medicine provided environmental benefits. The true potential of virtual medicine for decreasing the environmental footprint of health care lies in scaling this mode of care to patient groups across the state and nation when medically feasible.
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Affiliation(s)
- Julia B Finkelstein
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass.
| | - Keith Acosta
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Shelby Flanagan
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | | | - Brian Smith
- Department of Engineering (B Smith), Boston Children's Hospital, Boston, Mass
| | - Aaron Bernstein
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass; Center for Climate, Health, and the Global Environment (C-CHANGE) (A Bernstein), Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Shalini H Shah
- Division of General Pediatrics (M Hauptman, K Acosta, S Flanagan, A Bernstein, and SH Shah), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (M Hauptman, S Flanagan, A Bernstein, and SH Shah), Harvard Medical School, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit (M Hauptman, K Acosta, S Flanagan, A Bernstein, SH Shah), Boston, Mass
| | - Ravneet Kaur
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Heather Meyers
- Innovation and Digital Health Accelerator (R Kaur and H Meyers), Boston Children's Hospital, Boston, Mass
| | - Ankoor S Shah
- Department of Ophthalmology (AS Shah), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - John G Meara
- Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass; Department of Plastic & Oral Surgery (JG Meara), Boston Children's Hospital, Boston, Mass
| | - Carlos R Estrada
- Department of Urology (JB Finkelstein and CR Estrada), Boston Children's Hospital, Boston, Mass; Department of Surgery (JB Finkelstein, CR Estrada, and JG Meara), Harvard Medical School, Boston, Mass
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Woolf AD, Jacobson J, Flanagan S, Weinstock P. Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform. Clin Pediatr (Phila) 2024; 63:257-262. [PMID: 37082793 DOI: 10.1177/00099228231169262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.
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Affiliation(s)
- Alan D Woolf
- Division of General Pediatrics, Pediatric Environmental Health Center, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Jeffrey Jacobson
- Immersive Design Systems (formerly SIMPeds), Boston Children's Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Pediatric Environmental Health Center, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Weinstock
- Harvard Medical School, Boston, MA, USA
- Immersive Design Systems (formerly SIMPeds), Boston Children's Hospital, Boston, MA, USA
- Division of Critical Care Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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Kelly MS, Mohammed A, Okin D, Alba GA, Jesudasen SJ, Flanagan S, Dandawate NA, Gavralidis A, Chang LL, Moin EE, Witkin AS, Hibbert KA, Kadar A, Gordan PL, Bebell LM, Hauptman M, Valeri L, Lai PS. Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19. Crit Care Explor 2023; 5:e0927. [PMID: 37332365 PMCID: PMC10270487 DOI: 10.1097/cce.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear. OBJECTIVES We hypothesized that preferred language mediates the association between race, ethnicity and delays to care. DESIGN SETTING AND PARTICIPANTS Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020. MAIN OUTCOME AND MEASURES Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics. RESULTS Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission. CONCLUSIONS AND RELEVANCE Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.
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Affiliation(s)
- Michael S Kelly
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Adna Mohammed
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Okin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - George A Alba
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Shelby Flanagan
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- New England Pediatric Environmental Health Specialty Unit, Boston, MA
| | - Nupur A Dandawate
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Alexander Gavralidis
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Leslie L Chang
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily E Moin
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alison S Witkin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aran Kadar
- Division of Pulmonary Medicine and Critical Care, Newton-Wellesley Hospital, Newton, MA
| | - Patrick L Gordan
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Lisa M Bebell
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marissa Hauptman
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Peggy S Lai
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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Shah SH, Woolf AD, Manning K, Holder-Niles F, Tully B, Flanagan S, Spence MC, Hauptman M. The more you know: Insights from integrated pre-visit surveys in a pediatric environmental health center. Int Public Health J 2023; 15:297-306. [PMID: 38362063 PMCID: PMC10868725] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The Pediatric Environmental Health Center (PEHC) at Boston Children's Hospital is a specialty referral clinic that provides consultation for approximately 250 patients annually. Identifying environmental hazards is key for clinical management. Exposure concerns include lead, mold, pesticides, perfluoroalkyl substances (PFAS), impaired air quality, and more. Our goal was to identify concerns and visit priorities of our patient population to guide visits. A 47-question pre-visit survey was created exploring potential environmental hazards and administered prior to visits using a platform integrated into the electronic medical record (EMR). The study group was a convenience sample of patients from June 2021 to June 2022. Of 204 total visits, 101 surveys were submitted, yielding a response rate of 49.5%. 66/101 (65.3%) were surveys from initial consultations used for descriptive analysis. The majority of patients were seen for a chief complaint of lead exposure (90.1%). Most respondents had concerns about peeling paint (40.0%), and those reporting peeling paint were more likely to report additional concerns [75.0%, p < 0.001]. Other concerns highlighted were mold (15.2%), pests (15.2%), asbestos (10.6%), air pollution (9.1%), temperature regulation (7.6%), pesticides (6.1%), PFAS (4.5%), and formaldehyde (4.5%). A knowledge gap was identified; 45.5% (30/66) respondents responded "no" to the question asking if the Poison Control Center phone number was stored in their phone. This study illustrates how the implementation of a pre-visit EMR integrated survey engages families, informs clinical care, and serves as a point-of-care education tool for specific knowledge gaps. Findings will guide development of future environmental health screeners.
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Affiliation(s)
- Shalini H Shah
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan D Woolf
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Manning
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Faye Holder-Niles
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bridget Tully
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelby Flanagan
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew C Spence
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Marissa Hauptman
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Banzon TM, Sheehan WJ, Petty CR, Hauptman M, Flanagan S, Bell D, Shamosh B, Bartnikas LM, Phipatanakul W. The Coronavirus Disease 2019 Pandemic and Mental Health-Related School-Nurse Visits in United States Schools. Acad Pediatr 2022; 23:681-685. [PMID: 36100180 PMCID: PMC9464315 DOI: 10.1016/j.acap.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE No studies have examined school-nurse visits related to mental health (MH) during the coronavirus disease 2019 (COVID-19) pandemic. We examined changes in the rate of MH-related school-nurse visits before and during the COVID-19 pandemic. METHODS We analyzed school-nurse visit data (n = 3,445,240) for subjects Grade K-12 in US public schools using electronic health record software (SchoolCare, Ramsey, NJ). Data between January 1 and December 31 in 2019 (pre-COVID-19 pandemic) versus January 1 to December 31 in 2020 (during COVID-19 pandemic) were compared. For each year, total visits to a school-nurse were calculated for general MH, anxiety, and self-harm. The exposure was number of school-nurse visits in each time period (2019 vs 2020). The main outcome was change in the rate of general MH, anxiety, and self-harm visits in 2019 versus 2020. RESULTS There were 2,302,239 total school-nurse visits in 2019 versus 1,143,001 in 2020. During the COVID-19 pandemic, the rate of visits for general MH increased by 30% (4.7-6.1 per 10,000 visits, 95% confidence interval [CI] {18%, 43%}; P < .001), and visits for anxiety increased by 25% (24.8-31 per 10,000 visits, 95% CI [20%,30%]; P < .001). There was no significant difference in self-harm visits across all ages during the COVID-19 pandemic. CONCLUSIONS Our study found a significant increase in the rate of school-nurse visits for MH and anxiety during the COVID-19 pandemic, suggesting the pediatric population is at-risk for increased negative MH-effects associated with the pandemic and highlights a critical role of school-nurses in identifying youth with potential MH-needs.
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Affiliation(s)
- Tina M. Banzon
- Division of Allergy and Immunology, Boston Children's Hospital (TM Banzon, M Hauptman, S Flanagan, LM Bartnikas, and W Phipatanakul), Boston, Mass,Harvard Medical School (TM Banzon, D Bell, LM Bartnikas, and W Phipatanakul), Boston, Mass
| | - William J. Sheehan
- Division of Allergy and Immunology, Children's National Hospital (WJ Sheehan), Washington, DC,George Washington University School of Medicine and Health Sciences (WJ Sheehan), Washington, DC
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital (CR Petty), Boston, Mass
| | - Marissa Hauptman
- Division of Allergy and Immunology, Boston Children's Hospital (TM Banzon, M Hauptman, S Flanagan, LM Bartnikas, and W Phipatanakul), Boston, Mass,Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital (M Hauptman and S Flanagan), Boston, Mass
| | - Shelby Flanagan
- Division of Allergy and Immunology, Boston Children's Hospital (TM Banzon, M Hauptman, S Flanagan, LM Bartnikas, and W Phipatanakul), Boston, Mass,Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital (M Hauptman and S Flanagan), Boston, Mass
| | - Darin Bell
- Harvard Medical School (TM Banzon, D Bell, LM Bartnikas, and W Phipatanakul), Boston, Mass
| | | | - Lisa M. Bartnikas
- Division of Allergy and Immunology, Boston Children's Hospital (TM Banzon, M Hauptman, S Flanagan, LM Bartnikas, and W Phipatanakul), Boston, Mass,Harvard Medical School (TM Banzon, D Bell, LM Bartnikas, and W Phipatanakul), Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital (TM Banzon, M Hauptman, S Flanagan, LM Bartnikas, and W Phipatanakul), Boston, Mass; Harvard Medical School (TM Banzon, D Bell, LM Bartnikas, and W Phipatanakul), Boston, Mass.
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Flanagan S, Young S. Abstract No. 584 Recanalization of chronically occluded portal and mesenteric veins: a non-transplant pediatric cohort. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.566] [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] Open
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Young S, Sanghvi T, Ragulojan R, Torkian P, Todarty S, D’Souza D, Flanagan S, Golzarian J. Abstract No. 30 Local recurrence following complete radiologic response: a comparison of transarterial radioembolization and transarterial chemoembolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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10
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Young S, Ragulojan R, Torkian P, Todarty S, Sanghvi T, D’Souza D, Golzarian J, Flanagan S. Abstract No. 559 Planar vs 3D: comparison of two lung shunt fraction calculation methods utilized for radioembolization. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Moran P, Young S, Pontolillo J, Chen T, Sharma P, Owen J, Golzarian J, Flanagan S, D’Souza D, Sanghvi T. Abstract No. 153 Neutrophil-to-lymphocyte ratio may predict survival and radiologic response in those undergoing radioembolization for hepatocellular carcinoma. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.159] [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: 10/21/2022] Open
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12
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Pontolillo J, Young S, Sharma P, Chen T, Moran P, Owen J, Golzarian J, D’Souza D, Flanagan S, Sanghvi T. Abstract No. 168 Platelet-to-lymphocyte ratio: utility in metastatic colorectal patients undergoing radioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.174] [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: 11/17/2022] Open
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13
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Young S, Flanagan S, D’Souza D, Golzarian J, Pontolillo J, Chen T, Sharma P, Owen J, Moran P, Sanghvi T. Abstract No. 445 Dose distribution in radioembolization: a comparison between glass and resin microspheres. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.254] [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: 10/21/2022] Open
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14
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Sharma P, Young S, Chen T, Pontolillo J, Moran P, Owen J, Golzarian J, D’Souza D, Flanagan S, Sanghvi T. Abstract No. 38 Novel composite score of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and aspartate-aminotransferase-lymphocyte ratio predicts overall survival in metastatic colorectal patients undergoing radioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Sharma P, Young S, Pontolillo J, Chen T, Moran P, Owen J, D’Souza D, Golzarian J, Flanagan S, Sanghvi T. Abstract No. 35 Platelet-to-lymphocyte ratio: evaluation of relevancy in hepatocellular carcinoma patients undergoing radioembolization. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.451] [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: 11/27/2022] Open
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16
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Spano A, Young S, Flanagan S. Abstract No. 523 Pre-operative Botox injection for ventral hernia repair: early experience at a single institution. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.332] [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: 10/21/2022] Open
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17
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Flanagan S, Rogers ML, Carlson L, Jelalian E, Vivier PM. Childhood Overweight/Obesity and the Physical Activity Environment in Rhode Island. R I Med J (2013) 2021; 104:42-46. [PMID: 33517599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study seeks to better understand the relationship between the physical activity environment and child overweight/obesity in Rhode Island. METHODS Using geographic information systems (GIS), this study calculated distances from residences to physical activity resources to assess the relationship distance has with childhood overweight/obesity. RESULTS Mean distances in high-risk towns ranged from 0.61 to 3.15 miles compared to physical activity resources in low-risk towns, where distances ranged from 1.25 to 7.43 miles. For each additional mile to reach the closest indoor facility, there is a 0.41 (95% CI: -0.78, -0.03) percentage point decrease in the child overweight/obesity rate. Conclusion: High-risk block groups and towns have higher rates of child overweight/obesity and show shorter distances to physical activity resources. This study demonstrates that simply having physical activity structures in place is not enough to reduce child overweight/obesity and further research should examine the quality and usage patterns of these resources.
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Affiliation(s)
- Shelby Flanagan
- School of Public Health, Brown University; Hassenfeld Child Health Innovation Institute, Brown University, Providence, RI
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Brown University; Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI
| | - Lynn Carlson
- Hassenfeld Child Health Innovation Institute, Brown University; Institute at Brown for Environment & Society, Brown University, Providence, RI
| | - Elissa Jelalian
- Hassenfeld Child Health Innovation Institute, Brown University; Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI
| | - Patrick M Vivier
- School of Public Health, Brown University; Hassenfeld Child Health Innovation Institute, Brown University; Department of Health Services, Policy and Practice, School of Public Health, Brown University; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI
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Berman Z, Fischman A, Young L, Flanagan S, Katz M, Diiulio M, Kuban J, Golzarian J, Rose S. Abstract No. 390 Feasibility, safety, and efficacy of in-line balloon occlusion assisted delivery of ethylene-vinyl alcohol copolymer (Onyx) for peripheral arterial applications: a multicenter case series. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Young S, Taylor A, Golzarian J, Flanagan S, D'Souza D, Sanghvi T. Clinical utility of one month imaging following selective internal radiation therapy. Diagn Interv Imaging 2019; 100:39-46. [DOI: 10.1016/j.diii.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/06/2018] [Indexed: 01/15/2023]
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Grover H, Qian Y, Boada FE, Lakshmanan K, Flanagan S, Lui YW. MRI Evidence of Altered Callosal Sodium in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol 2018; 39:2200-2204. [PMID: 30498019 DOI: 10.3174/ajnr.a5903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 07/30/2017] [Accepted: 09/27/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Mild traumatic brain injury is a leading cause of death and disability worldwide with 42 million cases reported annually, increasing the need to understand the underlying pathophysiology because this could help guide the development of targeted therapy. White matter, particularly the corpus callosum, is susceptible to injury. Animal models suggest stretch-induced mechanoporation of the axonal membrane resulting in ionic shifts and altered sodium ion distribution. The purpose of this study was to compare the distribution of total sodium concentration in the corpus callosum between patients with mild traumatic brain injury and controls using sodium (23Na) MR imaging. MATERIALS AND METHODS Eleven patients with a history of mild traumatic brain injury and 10 age- and sex-matched controls underwent sodium (23Na) MR imaging using a 3T scanner. Total sodium concentration was measured in the genu, body, and splenium of the corpus callosum with 5-mm ROIs; total sodium concentration of the genu-to-splenium ratio was calculated and compared between patients and controls. RESULTS Higher total sodium concentration in the genu (49.28 versus 43.29 mmol/L, P = .01) and lower total sodium concentration in the splenium (which was not statistically significant; 38.35 versus 44.06 mmol/L, P = .08) was seen in patients with mild traumatic brain injury compared with controls. The ratio of genu total sodium concentration to splenium total sodium concentration was also higher in patients with mild traumatic brain injury (1.3 versus 1.01, P = .001). CONCLUSIONS Complex differences are seen in callosal total sodium concentration in symptomatic patients with mild traumatic brain injury, supporting the notion of ionic dysfunction in the pathogenesis of mild traumatic brain injury. The total sodium concentration appears to be altered beyond the immediate postinjury phase, and further work is needed to understand the relationship to persistent symptoms and outcome.
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Affiliation(s)
- H Grover
- From the New York University Langone Medical Center, New York, New York
| | - Y Qian
- From the New York University Langone Medical Center, New York, New York
| | - F E Boada
- From the New York University Langone Medical Center, New York, New York
| | - K Lakshmanan
- From the New York University Langone Medical Center, New York, New York
| | - S Flanagan
- From the New York University Langone Medical Center, New York, New York
| | - Y W Lui
- From the New York University Langone Medical Center, New York, New York.
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Flanagan S, Anthony J, Dyson L, Page N, Williams M, Brady P. VETERAN-CENTRIC VD-HCBS: HOW VETERANS USE FLEXIBLE SPENDING BUDGETS TO MEET INDEPENDENT LIVING GOALS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Ohtsuki M, Flanagan S, Freedberg IM, Blumenberg M. A cluster of five nuclear proteins regulates keratin gene transcription. Gene Expr 2018; 3:201-13. [PMID: 7505672 PMCID: PMC6081630] [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: 01/25/2023]
Abstract
A common feature of all epithelial cells is the presence of keratin proteins that assemble into an intermediate filament cytoskeletal network. Whereas other cell types often use a specific master transcription factor to coordinate cell type-specific transcription, analysis of transcriptional regulation of keratin genes suggests that specific groupings of widely expressed transcription factors, acting on clusters of recognition elements in the promoter regions, confer epithelia-specific transcription. We define such a cluster of three sites that binds five transcription factors in the human K5 keratin gene. Within this cluster, an unusual Sp1 site binds the Sp1 transcription factor and two additional proteins. Flanking the Sp1 site are an AP2 site and another sequence, Site A; each binds a transcription factor. Similar clusters of recognition sites for the same five transcription factors have been also identified in other keratin genes. Such clusters may play a role in epithelia-specific expression of keratins.
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Affiliation(s)
- M Ohtsuki
- Ronald O. Perelman Department of Dermatology, New York University Medical Center, NY 10016
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23
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Flanagan S, Feng A, Young S, Hunter D. 3:27 PM Abstract No. 364 Recanalization of chronic visceral venous occlusions. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.404] [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: 10/17/2022] Open
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24
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Young S, Golzarian J, Flanagan S, Sanghvi T. Is 1-month treatment imaging of benefit in yttrium-90 therapy. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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25
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Orkin C, Flanagan S, Wallis E, Ireland G, Dhairyawan R, Fox J, Nandwani R, O'Connell R, Lascar M, Bulman J, Reeves I, Palfreeman A, Foster GR, Ahmad K, Anderson J, Tong CYW, Lattimore S. Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. HIV Med 2016; 17:222-30. [PMID: 26919291 DOI: 10.1111/hiv.12364] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.
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Affiliation(s)
- C Orkin
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - S Flanagan
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - E Wallis
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - R Dhairyawan
- Sexual Health Department, Barking, Havering and Redbridge NHS Trust, London, UK
| | - J Fox
- Sexual Health Department, Kings College Hospital, London, UK
| | - R Nandwani
- Sexual Health Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R O'Connell
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - M Lascar
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - J Bulman
- Sexual Health Department, Leeds Teaching Hospital, Leeds, UK
| | - I Reeves
- Sexual Health Department, Homerton University Hospital, London, UK
| | - A Palfreeman
- Sexual Health Department, University Hospital of Leicester NHS Trust, Leicester, UK
| | - G R Foster
- Hepatology Department, Queen Mary University London, London, UK
| | - K Ahmad
- Emergency Department, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - C Y W Tong
- Virology Department, Barts Health NHS Trust, Royal London Hospital, London, UK
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Flanagan S, Hunter D, Alper S. Use of Onyx in the treatment of peripheral arteriovenous malformations (AVMs). J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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27
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Perry MEO, Taylor GP, Sabin CA, Conway K, Flanagan S, Dwyer E, Stevenson J, Mulka L, McKendry A, Williams E, Barbour A, Dermont S, Roedling S, Shah R, Anderson J, Rodgers M, Wood C, Sarner L, Hay P, Hawkins D, deRuiter A. Lopinavir and atazanavir in pregnancy: comparable infant outcomes, virological efficacies and preterm delivery rates. HIV Med 2015. [PMID: 26200570 DOI: 10.1111/hiv.12277] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to identify differences in infant outcomes, virological efficacy, and preterm delivery (PTD) outcome between women exposed to lopinavir/ritonavir (LPV/r) and those exposed to atazanavir/ritonavir (ATV/r). METHODS A retrospective case note review was carried out. The case notes of 493 women who conceived while on LPV/r or ATV/r or initiated LPV/r or ATV/r during pregnancy and who delivered between 1 September 2007 and 30 August 2012 were reviewed. Data collected included demographics, antiretroviral use, HIV markers, and pregnancy and infant outcomes. Infant outcomes, virological efficacies and PTD rates for LPV/r and ATV/r were compared. RESULTS A total of 306 women received LPV/r (82 conceiving while on the drug and 224 commencing it post-conception) and 187 received ATV/r (96 conceiving while on the drug and 91 commencing it post-conception). Comparing the two protease inhibitors (PIs), viral suppression rates were similar and, in women starting antiretroviral therapy (ART) post-conception, the median times to first undetectable HIV viral load were not significantly different (P = 0.64). PTD rates did not differ by therapy overall (ATV/r, 13%; LPV/r, 14%) or when considering the timing of first exposure (conceiving on ART, P = 0.81; commencing ART in pregnancy, P = 0.08). Poor fetal outcomes were very uncommon. There were two transmissions, giving a mother-to-child transmission (MTCT) rate of 0.4% (95% confidence interval 0.05-1.5%). CONCLUSIONS Both ART regimens were well tolerated and successful in preventing MTCT. No significant differences in tolerability or in pregnancy or infant outcomes were observed, which supports the provision of a choice of PI in pregnancy.
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Affiliation(s)
- M E O Perry
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G P Taylor
- Imperial College Healthcare NHS Trust, London, UK
| | - C A Sabin
- Research Department of Infection and Population Health, University College London, London, UK
| | - K Conway
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S Flanagan
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - E Dwyer
- Croydon University Hospital NHS Trust, London, UK
| | - J Stevenson
- Croydon University Hospital NHS Trust, London, UK
| | - L Mulka
- Imperial College Healthcare NHS Trust, London, UK
| | - A McKendry
- The North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - S Dermont
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Roedling
- (Mortimer Market Centre) Central and North West London NHS Foundation Trust, London, UK
| | - R Shah
- Barnet and Chase Farm Hospital NHS Trust, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - M Rodgers
- Croydon University Hospital NHS Trust, London, UK
| | - C Wood
- The North Middlesex University Hospital NHS Trust, London, UK
| | - L Sarner
- Barts Health NHS Trust, London, UK
| | - P Hay
- St George's NHS Trust, London, UK
| | - D Hawkins
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A deRuiter
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kyaw Tun J, Khwaja S, Flanagan S, Fotheringham T, Low D. Current practice of periprocedural haematological management for patients undergoing image-guided procedures. Br J Radiol 2015; 88:20140778. [PMID: 25587917 DOI: 10.1259/bjr.20140778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate current UK practice of periprocedural haematological management for image-guided procedures in relation to Cardiovascular and Interventional Radiological Society guidelines, which provide recommendations according to bleeding risk of procedures from Category 1 (lowest) to 3 (highest). METHODS Survey of practice in UK radiology departments conducted over a 1-year period RESULTS 48 radiology departments responded. The percentage of departments that stop antithrombotics pre-procedurally are as follows (for Category 1, 2 and 3, respectively): aspirin (31.3%, 43.8%, 54.2%); clopidogrel (54.2%, 68.8%, 72.9%); therapeutic low-molecular-weight heparin (56.3%, 77.1%, 75.0%). The percentage of departments that perform pre-procedural laboratory testing are as follows (for Category 1, 2 and 3, respectively): international normalized ratio (INR; 81.3%, 95.8%, 93.8%); activated partial thrombin time ratio (APTTR; 60.4%, 75.0%, 93.8%); platelet (77.1%, 91.7%, 95.7%); haemoglobin (70.8%, 85.4%, 87.5%). Mean threshold (standard deviation) of laboratory results for conducting procedures (Level 1, 2 and 3, respectively) are as follows: INR [1.53 (0.197), 1.47 (0.186), 1.47 (0.188)]; APTTR [1.50 (0.392), 1.50 (0.339), 1.48 (0.344)]; platelet count (x10(3) cells per microlitre) [74.4 (28.7), 79.9 (29.1), 80.5 (29.3)]; haemoglobin (grams per decilitre) [9.05 (1.40), 9.00 (1.33), 8.92 (1.21)]. No department practices conformed to current recommendations for (1) pre-procedural cessation of antithrombotics and (2) pre-procedural laboratory testing. Two (4.2%) department practices conformed to recommendations for thresholds of haematological parameters. CONCLUSION Current peri-procedural haematological management is variable and often does not conform to existing recommendations. Further research into the impact of this variation in practice on patient outcome is required. ADVANCES IN KNOWLEDGE This study demonstrates wide variation in practice in haematological management for image-guided procedures.
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Affiliation(s)
- J Kyaw Tun
- 1 Department of Diagnostic Imaging, Barts Health NHS Trust, London, UK
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Kennedy G, Osborn J, Flanagan S, Alsayed N, Bertolami S. Stability of crushed tedizolid phosphate tablets for nasogastric tube administration. Crit Care 2015. [PMCID: PMC4472820 DOI: 10.1186/cc14194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Flanagan S, Kennedy N, Kelly G. AB1187-HPR Rheumatologist and Rheumatology Health Care Professionals' Current Practice and Beliefs around Physical Activity Promotion in Rheumatoid Arthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3296] [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: 11/04/2022]
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Hilz M, Koehn J, Ammon F, Marcus J, Flanagan S, De Fina P, Baltadzhieva R, Schwab S, Moeller S. Valsalva maneuver shows prolonged sympathetic outflow in patients with a history of mild traumatic brain injury. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Flanagan S, Morris D, Boyea T, Dreskin H, Minassian SL, Alcorn H, Marbury T, Abdelhameed M, Fang E, Prokocimer P. A phase 1 study of intravenously administered TR-701 FA in subjects with advanced renal impairment. Crit Care 2013. [PMCID: PMC3891555 DOI: 10.1186/cc12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lim SH, Hong JYH, Fuziah MZ, Flanagan S, Ellard S, Hussain K. Short term outcome of congenital hyperinsulinism: case series. Int J Pediatr Endocrinol 2013. [PMCID: PMC3850233 DOI: 10.1186/1687-9856-2013-s1-p176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Song Hai Lim
- Endocrine Unit, Paediatric Department, Putrajaya Hospital, Malaysia
| | - Janet YH Hong
- Endocrine Unit, Paediatric Department, Putrajaya Hospital, Malaysia
| | - MZ Fuziah
- Endocrine Unit, Paediatric Department, Putrajaya Hospital, Malaysia
| | - S Flanagan
- Molecular Genetics Laboratory, Royal Devon and Exeter NHS Healthcare Trust, Exeter, UK
| | - S Ellard
- Molecular Genetics Laboratory, Royal Devon and Exeter NHS Healthcare Trust, Exeter, UK
| | - K Hussain
- Molecular Genetics Laboratory, Royal Devon and Exeter NHS Healthcare Trust, Exeter, UK
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Hilz M, Moeller S, Ammon F, Markus J, Flanagan S, De Fina P, Schwab S, Koehn J. Valsalva Maneuver Identifies Subtle Sympathetic Cardiac Dysfunction in Patients with Mild Traumatic Brain Injury (P05.200). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.200] [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] Open
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Gupta R, Flanagan S, Lee M, Stankovic R, Buckland M. IDH gene testing in gliomas: rare and novel mutations in an australian cohort. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32816-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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37
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Li C, Lee M, Flanagan S, Gupta R, Suter C, Buckland M. MGMT Hydroxymethylation in glioblastoma. Pathology 2012. [DOI: 10.1016/s0031-3025(16)32781-7] [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: 10/22/2022]
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Gupta R, Webb-Myers R, Flanagan S, Buckland ME. Isocitrate dehydrogenase mutations in diffuse gliomas: clinical and aetiological implications. J Clin Pathol 2011; 64:835-44. [PMID: 21752797 DOI: 10.1136/jclinpath-2011-200227] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The discovery of isocitrate dehydrogenase (IDH) mutations in gliomas is one example of the large impact that next-generation sequencing is having on the understanding of tumour biology and human disease in general. IDH mutations are early and common events in the development of astrocytomas, oligodendrogliomas and oligoastrocytomas. IDH mutations are also found in some myeloid malignancies and soft tissue tumours, but are rare in other malignancies. IDH mutation detection can be incorporated into routine pathology practice via immunohistochemistry and/or standard sequencing techniques and has great diagnostic value. An emerging theme is that IDH mutation status in gliomas is of great prognostic relevance, and there are proposals to include IDH mutation status in the next iteration of the WHO classification of gliomas. The mechanisms of action(s) of mutant IDH are not fully understood, but the understanding is progressing rapidly, and may provide a mechanism to link diverse proneoplastic processes such as oxidative damage and epigenetic dysregulation. There are exciting prospects of novel therapies for glioma patients emerging from the elucidation of these mechanisms. Given the diagnostic and prognostic implications of IDH mutation, and the potential for new therapies, all gliomas should be assessed for IDH mutation status in the future.
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Affiliation(s)
- R Gupta
- Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, Australia
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Schissel DP, Abla G, Flanagan S, Kim L, Lee X. The Between-Pulse Data Analysis Infrastructure at the DIII-D National Fusion Facility. Fusion Science and Technology 2010. [DOI: 10.13182/fst10-a10920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- D. P. Schissel
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - G. Abla
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - S. Flanagan
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - L. Kim
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - X. Lee
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
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Abstract
New material combinations and designs of artificial hip implants are being introduced in an effort to improve proprioception and functional longevity. Larger joints in particular are being developed to improve joint stability, and it is thought that these larger implants will be more satisfactory for younger and more physically active patients. The study detailed here used a hip friction simulator to assess the friction and lubrication properties of large-diameter hip bearings of metal-on-metal and ceramic-on-reinforced-polymer couplings. Joints of different diameters were evaluated to determine what effect, if any, bearing diameter had on lubrication. In addition, the effects of lubricant type are considered, using carboxymethyl cellulose and bovine calf serum, and the physiological lubricant is shown to be considerably more effective at reducing friction. The frictional studies showed that the metal-on-metal joints worked under a mixed lubrication regime, producing similar friction factor values to each other. The addition of bovine calf serum (BCS) reduced the friction. The ceramic-on-reinforced-polymer samples were shown to operate with high friction factors and mixed lubrication. When tested with BCS, the larger-diameter bearings showed a decrease in friction compared with the smaller-size bearings, and the addition of BCS resulted in an increase in friction, unlike the metal-on-metal system. The study demonstrated that the component's diameter had little or no influence on the lubrication and friction of the large bearing combinations tested.
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Affiliation(s)
- S Flanagan
- Department of Materials, Science and Technology, University of Limerick, Limerick, Ireland
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Hilz M, Anders S, Aurnhammer F, Marthol H, Blaszczynska P, Schroeder T, Roßmeißl A, Schwab S, Flanagan S, De Fina P. P1.24 Orthostatic challenge identifies subtle sympathetic cardiac dysfunction in patients after mild traumatic brain-injury. Auton Neurosci 2009. [DOI: 10.1016/j.autneu.2009.05.120] [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: 10/20/2022]
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Hilz M, Aurnhammer F, Anders S, Marthol H, Blaszczynska P, Schroeder T, Roßmeißl A, Schwab S, Flanagan S, De Fina P. P1.25 Ocular pressure test unveils subtle autonomic cardiovascular dysfunction in patients after mild traumatic brain injury. Auton Neurosci 2009. [DOI: 10.1016/j.autneu.2009.05.121] [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: 11/24/2022]
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Köhle J, Wiedemann B, Schober E, Ellard S, Flanagan S, Meraner D, Steichen E, Zimmerhackl LB, Hofer S. Neonataler Diabetes in Österreich – aktuelle Inzidenzberechnung. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221916] [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: 10/20/2022]
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Burruss JR, Abla G, Flanagan S, Keahey K, Leggett T, Ludesche C, McCune D, Papka ME, Peng Q, Randerson L, Schissel DP. Developments in Remote Collaboration and Computation. Fusion Science and Technology 2005. [DOI: 10.13182/fst05-a787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. R. Burruss
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - G. Abla
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - S. Flanagan
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - K. Keahey
- Argonne National Laboratory, Argonne, Illinois 60439-4844
| | - T. Leggett
- Argonne National Laboratory, Argonne, Illinois 60439-4844
| | - C. Ludesche
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - D. McCune
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - M. E. Papka
- Argonne National Laboratory, Argonne, Illinois 60439-4844
| | - Q. Peng
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - L. Randerson
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - D. P. Schissel
- General Atomics, PO Box 85608, San Diego, California 92186-5608
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Burruss J, Flanagan S, Keahey K, Ludescher C, McCune D, Peng Q, Randerson L, Schissel D, Thompson M. Remote computing using the National Fusion Grid. Fusion Engineering and Design 2004. [DOI: 10.1016/j.fusengdes.2004.04.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Munns CFJ, Glass IA, Flanagan S, Hayes M, Williams B, Berry M, Vickers D, O'Rourke P, Rao E, Rappold GA, Hyland VJ, Batch JA. Familial growth and skeletal features associated with SHOX haploinsufficiency. J Pediatr Endocrinol Metab 2003; 16:987-96. [PMID: 14513875 DOI: 10.1515/jpem.2003.16.7.987] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to determine the intrafamilial effect of SHOX haploinsufficiency on stature, by comparing the growth and phenotype of 26 SHOX haploinsufficient individuals with 45 relatives and population standards. It confirmed that SHOX haploinsufficiency leads to growth restriction from birth to final height. Compared to unaffected siblings, the SHOX haploinsufficient cohort was 2.14 SDS (3.8 cm) shorter at birth and 2.1 SDS shorter through childhood. At final height females were 2.4 SDS (14.4 cm) shorter and males 0.8 SDS (5.3 cm) shorter than normal siblings. The family height analysis suggests that the effect of SHOX haploinsufficiency on growth may have been previously underestimated at birth and overestimated in males at final height. SHOX haploinsufficiency leads to short arms in 92%, bilateral Madelung deformity in 73% and short stature in 54%. Females were more severely affected than males. We conclude that SHOX is a major growth gene and that mutations are associated with a broad range of phenotype.
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Affiliation(s)
- C F J Munns
- Endocrine and Diabetes Research Unit, Royal Children's Hospital Foundation Research Centre, Department of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.
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Chuah T, Tan K, Flanagan S, Hyland V, Sullivan A, Henderson R, MacMillan J, Lander C. Erratum to “CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalapathy): an Australian perspective” Journal of Clinical Neuroscience 2001; 8: 404–406. J Clin Neurosci 2003. [DOI: 10.1016/s0967-5868(03)00084-5] [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: 10/27/2022]
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Haufler RE, Conceicao J, Chibante LPF, Chai Y, Byrne NE, Flanagan S, Haley MM, O'Brien SC, Pan C, et al. .. Efficient production of C60 (buckminsterfullerene), C60H36, and the solvated buckide ion. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100387a005] [Citation(s) in RCA: 832] [Impact Index Per Article: 37.8] [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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Chuah TL, Tan KM, Tan SM, Flanagan S, Hyland V, Sullivan AA, Henderson R, MacMillan J, Lander C. CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy): an Australian perspective. J Clin Neurosci 2001; 8:404-6. [PMID: 11535004 DOI: 10.1054/jocn.2000.0848] [Citation(s) in RCA: 3] [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: 11/18/2022]
Abstract
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL) is a recently described cause of stroke or stroke-like episodes. It is caused by mutations in the Notch3 gene on chromosome 19p. We sought to demonstrate mutations of the Notch3 gene in Australian patients suspected of having CADASIL. Patients from several families were referred to the study. A diagnosis was determined clinically and by neuroimaging. Those suspected of having CADASIL had sequencing of exons 3 and 4 of the Notch3 gene. Eight patients, two of whom were siblings, were suspected of having CADASIL. Five patients (including the siblings) had mutations. Because of strong clustering of Notch3 mutations in CADASIL, this has potential as a reliable test for the disease in Australian patients.
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Affiliation(s)
- T L Chuah
- Department of Neurology, Royal Brisbane Hospital, Herston, QLD 4029, Australia
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