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Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Chau BL, LaGuardia JS, Kim S, Zhang SC, Pletcher E, Sanford NN, Raldow AC, Singer L, Gong J, Padda SK, Kamrava M, Cohen T, Mitra D, Atkins KM. Association of Parental Status and Gender With Burden of Multidisciplinary Tumor Boards Among Oncology Physicians. JAMA Netw Open 2023; 6:e2340663. [PMID: 37906191 PMCID: PMC10618838 DOI: 10.1001/jamanetworkopen.2023.40663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/19/2023] [Indexed: 11/02/2023] Open
Abstract
Importance Tumor boards are integral to the care of patients with cancer. However, data investigating the burden of tumor boards on physicians are limited. Objective To investigate what physician-related and tumor board-related factors are associated with higher tumor board burden among oncology physicians. Design, Setting, and Participants Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3 and April 3, 2022. Tumor board start times were independently collected by email from 22 top cancer centers. Main Outcomes and Measures Tumor board burden was measured on a 4-point scale (1, not at all burdensome; 2, slightly burdensome; 3, moderately burdensome; and 4, very burdensome). Univariable and multivariable probabilistic index (PI) models were performed. Results Surveys were completed by 111 physicians (median age, 42 years [IQR, 36-50 years]; 58 women [52.3%]; 60 non-Hispanic White [54.1%]). On multivariable analysis, factors associated with higher probability of tumor board burden included radiology or pathology specialty (PI, 0.68; 95% CI, 0.54-0.79; P = .02), attending 3 or more hours per week of tumor boards (PI, 0.68; 95% CI, 0.58-0.76; P < .001), and having 2 or more children (PI, 0.65; 95% CI, 0.52-0.77; P = .03). Early or late tumor boards (before 8 am or at 5 pm or after) were considered very burdensome by 33 respondents (29.7%). Parents frequently reported a negative burden on childcare (43 of 77 [55.8%]) and family dynamics (49 of 77 [63.6%]). On multivariable analysis, a higher level of burden from early or late tumor boards was independently associated with identifying as a woman (PI, 0.69; 95% CI, 0.57-0.78; P = .003) and having children (PI, 0.75; 95% CI, 0.62-0.84; P < .001). Independent assessment of 358 tumor boards from 22 institutions revealed the most common start time was before 8 am (88 [24.6%]). Conclusions and Relevance This survey study of tumor board burden suggests that identifying as a woman or parent was independently associated with a higher level of burden from early or late tumor boards. The burden of early or late tumor boards on childcare and family dynamics was commonly reported by parents. Having 2 or more children, attending 3 or more hours per week of tumor boards, and radiology or pathology specialty were associated with a significantly higher tumor board burden overall. Future strategies should aim to decrease the disparate burden on parents and women.
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Affiliation(s)
- Brittney L. Chau
- Department of Medicine, New York Medical College, New York, New York
| | - Jonnby S. LaGuardia
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sungjin Kim
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel C. Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric Pletcher
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nina N. Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Ann C. Raldow
- Department of Radiation Oncology, University of California Los Angeles Medical Center, Los Angeles
| | - Lisa Singer
- Department of Radiation Oncology, University of California San Francisco Medical Center, San Francisco
| | - Jun Gong
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sukhmani K. Padda
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Devarati Mitra
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Katelyn M. Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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Chau BL, LaGuardia JS, Kim S, Zhang SC, Pletcher E, Sanford NN, Raldow A, Singer L, Gong J, Padda S, Kamrava M, Cohen T, Mitra D, Atkins KM. Association of Parental Status and Gender with Burden of Multidisciplinary Tumor Boards. Int J Radiat Oncol Biol Phys 2023; 117:S113-S114. [PMID: 37784297 DOI: 10.1016/j.ijrobp.2023.06.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tumor boards are an integral part of the management of patients with cancer. However, there is limited data investigating the burden of tumor boards on physicians. Our objective was to determine what physician-related, and tumor board-related factors associate with higher burden. MATERIALS/METHODS Tumor board start times were collected by email from 22 National Cancer Institute-designated cancer centers and/or U.S. World and News Report Top 40 hospitals for cancer. Tumor board burden was assessed by a cross-sectional convenience survey posted on social media and by email to Cedars-Sinai Medical Center cancer physicians between March 3, 2022, and April 3, 2022. Tumor board burden was measured on a 4-point scale (1, not at all; 2, slightly; 3, moderately; 4, very burdensome). Univariable and multivariable analyses were performed using a probabilistic index model. RESULTS The timing of 392 tumor boards was collected from 22 institutions. The most common tumor board start time was at or before 0730 (24.6%). Surveys were completed by 111 physicians, of which 52.3% identified as women and 42.3% as men. Reported specialties were radiation oncology (39.6%), medical oncology (18.0%), surgery (15.3%), radiology (12.6%), and pathology (9.9%). On average, 41.4% attended ≥3 hours/week total of tumor boards and 1-2 hours/week of early/late tumor boards (defined as starting before 0800 or 1700 or after). Overall, 37.8% reported tumor boards were at least moderately burdensome. On multivariable analysis, radiology/pathology specialty (probability 0.68; 95% confidence interval [CI], 0.54-0.79; p = 0.015), attending ≥3 hours/week of tumor boards (probability 0.68; 95% CI, 0.58-0.76; p<.001), and having ≥2 children (probability 0.65; 95% CI, 0.52-0.77; p = 0.029), were associated with higher burden. Early/late tumor boards were frequently considered burdensome (20.7% moderately, 29.7% very burdensome). On multivariable analysis, identifying as a woman (probability 0.69; 95% CI, 0.57-0.78; p = 0.003) and having children (probability 0.75; 95% CI, 0.62-0.84; p<.001) remained associated with a higher level of burden from early/late tumor boards. Further, parents frequently reported that early/late tumor boards negatively affected childcare (55.8%), feeding and/or sleep logistics (33.8%), and overall family dynamics (63.7%). CONCLUSION Identifying as a woman and having children were associated with a higher level of burden from early/late tumor boards. The negative impact of early/late tumor boards on overall family dynamics, including children feeding, sleeping, and childcare logistics, was commonly reported by parents. Having ≥2 children, attending ≥3 hours/week of tumor boards, and radiology/pathology specialty were associated with a higher level of burden overall. Future strategies should aim to decrease burden, particularly the disparate impact on parents and women.
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Affiliation(s)
- B L Chau
- Department of Medicine, New York Medical College, Valhalla, NY
| | - J S LaGuardia
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - S Kim
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - S C Zhang
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - E Pletcher
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - N N Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Raldow
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA
| | - L Singer
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - J Gong
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - S Padda
- Department of Thoracic Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - M Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - T Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - D Mitra
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K M Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Leggett CB, Cohen T, Sauro E, Wong MS. The POCKET study: personal-device-based point-of-care-ultrasound versus standard ultrasound machine use for inpatient obstetric workflow: a time and motion study. Am J Obstet Gynecol MFM 2023; 5:101100. [PMID: 37536443 DOI: 10.1016/j.ajogmf.2023.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/15/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Cecilia B Leggett
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Erica Sauro
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
| | - Melissa S Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048
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Dubinskaya A, Heard JR, Choi E, Cohen T, Anger J, Eilber K, Scott V. Female sexual health digital resources: women and health care providers need more options. Sex Med Rev 2023:7143623. [PMID: 37102305 DOI: 10.1093/sxmrev/qead016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Female sexual health and female sexual dysfunction (FSD) are usually poorly diagnosed and treated because of the numerous barriers providers and patients face. Internet platforms, such as mobile applications (apps) are potential tools that help overcome these barriers and improve patient access to education and management options for FSD. OBJECTIVES The aim of this review was to identify existing applications on female sexual health and evaluate their educational content and services. METHODS We searched the internet and Apple App Store using multiple keywords. A panel of physicians specialized in the treatment of FSD reviewed the apps for content quality, the scientific basis of provided information, interactivity, usability, and whether they would recommend it as a reference tool for patients. RESULTS Of the 204 apps identified, 17 met the inclusion criteria and were reviewed further. The selected apps were organized into groups based on common themes such as educational (n = 6), emotions and communication (n = 2), relaxation and meditation (n = 4), general sexual health (n = 2), and social and fun (n = 3). All apps from the educational category provided scientific information in collaboration with health experts. When assessed for usability, 1 app received good and 5 received excellent scores based on the System Usability Scale. Most apps (n = 5) provided information on pathology and treatments of orgasmic dysfunction, but only 1 app, created by a physician, provided comprehensive information on all the types of FSD. CONCLUSION Digital technology could be an effective way to overcome barriers to accessing information and ultimately care for female sexual health. Our review demonstrated that there is still a need for more accessible educational resources addressing female sexual health and FSD for patients and providers.
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Affiliation(s)
- Alexandra Dubinskaya
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - John R Heard
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Eunice Choi
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Tara Cohen
- Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Jennifer Anger
- Department of Urology, University of California San Diego, La Jolla, CA 92037, United States
| | - Karyn Eilber
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | - Victoria Scott
- Division of Urology, Department of Surgery, Cedar-Sinai Medical Center, Los Angeles, CA, United States
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Cates L, Codreanu A, Ciobanu N, Fosburgh H, Allender CJ, Centner H, Engelthaler DM, Crudu V, Cohen T, Menzies NA. Budget impact of next-generation sequencing for diagnosis of TB drug resistance in Moldova. Int J Tuberc Lung Dis 2022; 26:963-969. [PMID: 36163669 DOI: 10.5588/ijtld.22.0104] [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: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and routine use of NGS in the Moldovan National TB Programme. We conducted an empirical costing study and collated price and operating characteristics for NGS platforms. We examined multiple NGS scenarios in comparison to the current approach (pDST) for pre-treatment drug resistance testing over 2021-2025.RESULTS Annual testing volume ranged from 912 to 1,926 patients. For the pDST scenario, we estimated total costs of US$362,000 (2021 USD) over the 5-year study period. Total costs for NGS scenarios ranged from US$475,000 to US$1,486,000. Lowest cost NGS options involved targeted sequencing as a replacement for pDST, and excluded individuals diagnosed as RIF-susceptible on Xpert® MTB/RIF. For all NGS scenarios, the majority (55-80%) of costs were devoted to reagent kits. Start-up costs of NGS were small relative to routine costs borne each year.CONCLUSION NGS adoption will require expanded resources compared to conventional pDST. Further work is required to better understand the feasibility of NGS in settings such as Moldova.
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Affiliation(s)
- L Cates
- Department of Global Health and Population Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - A Codreanu
- Institute of Phthisiopneumology, Chisinau, Moldova
| | - N Ciobanu
- Institute of Phthisiopneumology, Chisinau, Moldova
| | - H Fosburgh
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - C J Allender
- Translational Genomics Research Institute, Flagstaff, AZ, USA
| | - H Centner
- Translational Genomics Research Institute, Flagstaff, AZ, USA
| | - D M Engelthaler
- Translational Genomics Research Institute, Flagstaff, AZ, USA
| | - V Crudu
- Institute of Phthisiopneumology, Chisinau, Moldova
| | - T Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - N A Menzies
- Department of Global Health and Population Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Haymet AB, Pinto N, Peden S, Cohen T, Vallely MP, McGiffin D, Naidoo R, Jenkins J, Suen JY, Fraser JF. Current intraoperative storage and handling practices of autologous bypass conduit: A survey of the royal australasian college of surgeons. Front Surg 2022; 9:956177. [PMID: 36090334 PMCID: PMC9458927 DOI: 10.3389/fsurg.2022.956177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022] Open
Abstract
During bypass surgery for peripheral arterial occlusive disease and ischaemic heart disease, autologous graft conduit including great saphenous veins and radial arteries are frequently stored in solution. Endothelial damage adversely affects the performance and patency of autologous bypass grafts, and intraoperative graft storage solutions have been shown to influence this process. The distribution of storage solutions currently used amongst Cardiothoracic and Vascular Surgeons from Australia and New Zealand is not well defined in the literature. The aim of this study was to determine current practices regarding autologous graft storage and handling amongst this cohort of surgeons, and discuss their potential relevance in the context of early graft failure. From this survey, the most frequently used storage solutions were heparinized saline for great saphenous veins, and pH-buffered solutions for radial arteries. Duration of storage was 30–45 min for almost half of respondents, although responses to this question were limited. Further research is required to investigate whether ischaemic endothelial injury generates a prothrombotic state, whether different storage media can alter this state, and whether this is directly associated with clinical outcomes of interest such as early graft failure.
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Affiliation(s)
- AB Haymet
- Department of Vascular Surgery, The Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
- Correspondence: Andrew B Haymet
| | - N Pinto
- Department of Vascular Surgery, The Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Herston Biofabrication Institute, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - S Peden
- Department of Vascular Surgery, The Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - T Cohen
- Department of Vascular Surgery, The Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - MP Vallely
- Department of Cardiovascular Surgery, Mount Sinai Morningside/Icahn School of Medicine, New York, NY, United States
| | - D McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, Australia
| | - R Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, QLD, Australia
| | - J Jenkins
- Department of Vascular Surgery, The Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
- Herston Biofabrication Institute, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - JY Suen
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - JF Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
- Faculty of Medicine, University of Queensland, St Lucia, QLD, Australia
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Alfred M, Del Gaizo J, Kanji F, Lawton S, Caron A, Nemeth LS, Alekseyenko AV, Shouhed D, Savage S, Anger JT, Catchpole K, Cohen T. A better way: training for direct observations in healthcare. BMJ Qual Saf 2022; 31:744-753. [DOI: 10.1136/bmjqs-2021-014171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
Abstract
Direct observation is valuable for identifying latent threats and elucidating system complexity in clinical environments. This approach facilitates prospective risk assessment and reveals workarounds, near-misses and recurrent safety problems difficult to diagnose retrospectively or via outcome data alone. As observers are an instrument of data collection, developing effective and comprehensive observer training is critical to ensuring the reliability of the data collection and reproducibility of the research. However, methodological rigour for ensuring these data collection properties remains a key challenge in direct observation research in healthcare. Although prior literature has offered key considerations for observational research in healthcare, operationalising these recommendations may pose a challenge and unless guidance is also provided on observer training. In this article, we offer guidelines for training non-clinical observers to conduct direct observations including conducting a training needs analysis, incorporating practice observations and evaluating observers and inter-rater reliability. The operationalisation of these guidelines is described in the context of a 5-year multisite observational study investigating technology integration in the operating room. We also discuss novel tools developed during the course our project to support data collection and examine inter-rater reliability among observers in direct observation studies.
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Dubinskaya A, Heard J, Choi E, Cohen T, Anger J, Eilber K, Scott V. Female Sexual Dysfunction Resources: Women and Healthcare Providers Need More Options. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.107] [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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Chockalingam S, Lem J, Cohen T. Thermo-chemo-mechanically coupled cavity dynamics and the emergence of multi-phase bursts. Proc Math Phys Eng Sci 2022. [DOI: 10.1098/rspa.2022.0247] [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: 11/12/2022] Open
Abstract
Understanding the dynamics induced by confined thermo-chemical processes occurring inside a solid medium is a fundamental problem of interest in several applications, such as hotspot formation and micro-explosions in energetic materials and laser-induced cavitation for energy focusing and material characterization. In recent years, advanced experimental capabilities have uncovered elusive behaviours in such systems, including temperature spikes that emerge at short timescales, and multi-phase explosions. By coupling the mechanics of the solid, the thermodynamics, and the chemical kinetics of the decomposition reactions, the theoretical model developed here explains and demonstrates these phenomena. The dimensionless response of the system is studied numerically and analytical expressions for the mechanical response limits are derived. These results should be useful in guiding future experiments and in explaining phenomena that may emerge at various length and timescales.
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Affiliation(s)
- S. Chockalingam
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - J. Lem
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - T. Cohen
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Marx S, May JH, Cohen T, Kamber B, McGowan H, Petherick L. Dust emissions from Kati Thanda-Lake Eyre: a review. T ROY SOC SOUTH AUST 2022. [DOI: 10.1080/03721426.2022.2054918] [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: 10/18/2022]
Affiliation(s)
- S.K. Marx
- GeoQuEST Research Centre - School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - J-H May
- School of Geography, University of Melbourne, Melbourne, Victoria, Australia
| | - T. Cohen
- GeoQuEST Research Centre - School of Earth, Atmospheric and Life Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- ARC Centre of Excellence for Australian Biodiversity and Heritage, University of Wollongong, Wollongong, New South Wales, Australia
| | - B.S. Kamber
- School of Earth and Atmospheric Sciences, Queensland University of Technology, Wellington, Queensland, Australia
| | - H.A. McGowan
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - L. Petherick
- School of Geography, Environment and Earth Sciences, Victoria University of Wellington, Wellington, New Zealand
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Nuckols T, Seferian E, Coleman B, Berdahl C, Cohen T, Henreid A. Conducting a Cluster RCT on Medication Safety in Nursing Units Overtaxed by the COVID-19 Pandemic. Innov Aging 2021. [PMCID: PMC8680583 DOI: 10.1093/geroni/igab046.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Medication errors continue to harm many hospitalized patients. In other high-risk industries, voluntary incident reporting is widely used to improve safety. Reporting is widely used in hospitals, but not as effectively. This AHRQ-funded cluster RCT will assess the effects of the SAFE Loop, which includes five enhancements in incident reporting implemented on hospital nursing units. Analyses will compare changes in nurses’ attitudes toward reporting, event reporting rates, report quality, and medication event rates between intervention and control arms. The COVID-19 pandemic has created both obstacles and opportunities. The intervention requires study staff to engage nursing unit directors, attend daily nursing “huddles”, and train overtaxed front-line nurses in a geographic area greatly impacted by COVID-19 surges. This created uncertainty around the best time to start the trial. Conversely, we have collected unique data on the implications of COVID-19 for medication safety while testing our instruments during the trial preparation phase.
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Affiliation(s)
- Teryl Nuckols
- Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Ed Seferian
- Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Bernice Coleman
- Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Carl Berdahl
- Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, California, United States
| | - Andrew Henreid
- Cedars-sinai Medical Center, Los Angeles, California, United States
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Shiyovich A, Cohen T, Hamdan A, Klempfner R, Skalsky K, Porter A, Orvin K, Kornowski R, Eisen A. Worse outcomes of ACS patients without versus with traditional cardiovascular risk factors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1136] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Approximately 5–15% patients presenting with acute coronary syndrome were found to have no traditional cardiovascular risk factors (RFs). Data regarding the determinants, management and outcomes of these patients are scarce.
Purpose
To evaluate the management, outcomes and time dependent changes of ACS patients without RFs.
Methods
Evaluation of clinical characteristics, management strategies, and outcomes as well as time dependent changes (by 3 time periods: early [2000–2006], mid [2008–2013], and late [2016–2018]) of ACS patients without RFs (diabetes mellitus, hypertension, dyslipidemia, family history of IHD and current or past smoking) or known coronary artery disease, enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2018. We compared ACS patients without RFs (RF−) to those ≥1 RFs (RF+).
Results
Overall 583 out of 10,324 (5.6%) eligible ACS patients did not have any RFs (median age 64 [IQR 52–77], 25% females]. The RF− group were older, more educated, with lower BMI and prevalence of another cardiovascular comorbidity and chronic kidney disease compared with the RF+ group. The in-hospital PCI rates were lower among the RF− vs. the RF+ group (55% vs. 66%, respectively p<0.001). Furthermore, lower rate of guideline-recommended medical therapy upon discharge were prescribed in the RF− vs. the RF+ group. The rate of in-hospital complications was greater in the RF− vs. RF+ group (31.4% vs. 26.1%, respectively p=0.006). The rates of 30-day major adverse cardiac events (MACE) were significantly higher among patients with RF− vs. RF+ (18.1% vs.12.8%, respectively p<0.001). Similarly, the rates of 30-day and 1-year all-cause mortality (figure 1) were higher among patients with RF− vs. RF+ (8.7% vs. 4.2%, p<0.001 and 11.9% vs. 7.7% p<0.001 respectively). A trend of decline in the rate of MACE was observed between the early and the late study period in the RF− group (22% vs. 10.7% p=0.002 respectively). One-year mortality did not decrease significantly in the RF− group during the study periods (13.6% vs. 10% early vs. late period respectively p=0.16).
Conclusions
ACS patients without traditional cardiovascular risk factors comprise a unique group with reduced prevalence of comorbidities yet significantly worse short-and long-term outcomes. Additional research to identify unique risk factors and targets for interventions to improve outcomes of this group of patients is warranted.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Shiyovich
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - T Cohen
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - A Hamdan
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - R Klempfner
- Sheba Medical Center, Cardiology, Ramat Gan, Israel
| | - K Skalsky
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - A Porter
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - K Orvin
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - R Kornowski
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Medicine E, Petah Tikva, Israel
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14
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Catchpole K, Lusk C, Weigl M, Anger J, Cohen T. Addressing misconceptions of flow disruption studies in "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery". J Robot Surg 2021; 16:989-990. [PMID: 34626319 DOI: 10.1007/s11701-021-01318-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
This letter to the editor provides a response to "Is non-stop always better? Examining assumptions behind the concept of flow disruptions in studies of robot-assisted surgery." The authors provide much needed clarification on misconceptions of flow disruption studies. The evolving methodology is not aimed at creating a "non-stop" flow, or optimizing efficiency, but understanding the clinical process from a systems perspective.
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Affiliation(s)
- Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA
| | - Connor Lusk
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Ave., Suite 301, MSC 912, Charleston, SC, 29425, USA.
| | - Matthias Weigl
- Institute for Patient Safety, Bonn University Hospital, Bonn, Germany
| | - Jennifer Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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15
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Boquet A, Cohen T, Diljohn F, Cabrera J, Reeves S, Shappell S. A Theoretical Model of Flow Disruptions for the Anesthesia Team During Cardiovascular Surgery. J Patient Saf 2021; 17:e534-e539. [PMID: 28678115 DOI: 10.1097/pts.0000000000000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This investigation explores flow disruptions observed during cardiothoracic surgery and how they serve to disconnect anesthesia providers from their primary task. We can improve our understanding of this disengagement by exploring what we call the error space or the accumulated time required to resolve disruptions. METHODS Trained human factors students observed 10 cardiac procedures for disruptions impacting the anesthesia team and recorded the time required to resolve these events. Observations were classified using a human factors taxonomy. RESULTS Of 301 disruptions observed, interruptions (e.g., those events related to alerts, distractions, searching activity, spilling/dropping, teaching moment, and task deviations) accounted for the greatest frequency of events (39.20%). The average amount of time needed for each disruption to be resolved was 48 seconds. Across 49.87 hours of observation, more than 4 hours were spent resolving disruptions to the anesthesia team's work flow. CONCLUSIONS By defining a calculable error space associated with these disruptions, this research provides a conceptual metric that can serve in the identification and design of targeted interventions. This method serves as a proactive approach for recognizing systemic threats, affording healthcare workers the opportunity to mitigate the development and incidence of preventable errors precedently.
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Affiliation(s)
- Albert Boquet
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Tara Cohen
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Fawaaz Diljohn
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Jennifer Cabrera
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
| | - Scott Reeves
- Medical University of South Carolina, Charleston, South Carolina
| | - Scott Shappell
- From the Embry-Riddle Aeronautical University, Daytona Beach, Florida
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16
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Kanji F, Cohen T, Alfred M, Caron A, Lawton S, Savage S, Shouhed D, Anger JT, Catchpole K. Room Size Influences Flow in Robotic-Assisted Surgery. Int J Environ Res Public Health 2021; 18:7984. [PMID: 34360275 PMCID: PMC8345669 DOI: 10.3390/ijerph18157984] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
The introduction of surgical technology into existing operating rooms (ORs) can place novel demands on staff and infrastructure. Despite the substantial physical size of the devices in robotic-assisted surgery (RAS), the workspace implications are rarely considered. This study aimed to explore the impact of OR size on the environmental causes of surgical flow disruptions (FDs) occurring during RAS. Fifty-six RAS procedures were observed at two academic hospitals between July 2019 and January 2021 across general, urologic, and gynecologic surgical specialties. A multiple regression analysis demonstrated significant effects of room size in the pre-docking phase (t = 2.170, df = 54, β = 0.017, p = 0.035) where the rate of FDs increased as room size increased, and docking phase (t = -2.488, df = 54, β = -0.017, p = 0.016) where the rate of FDs increased as room size decreased. Significant effects of site (pre-docking phase: p = 0.000 and docking phase: p = 0.000) were also demonstrated. Findings from this study demonstrate hitherto unrecognized spatial challenges involved with introducing surgical robots into the operating domain. While new technology may provide benefits towards patient safety, it is important to consider the needs of the technology prior to integration.
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Affiliation(s)
- Falisha Kanji
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
| | - Ashley Caron
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Samuel Lawton
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
| | - Stephen Savage
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Jennifer T. Anger
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; (T.C.); (A.C.); (D.S.); (J.T.A.)
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; (M.A.); (S.L.); (K.C.)
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Abstract
Early in the COVID-19 pandemic, models predicted hundreds of thousands of additional TB deaths as a result of health service disruption. To date, empirical evidence on the effects of COVID-19 on TB outcomes has been limited. Here we summarise the evidence available at a country level, identifying broad mechanisms by which COVID-19 may modify TB burden and mitigation efforts. From the data, it is clear that there have been substantial disruptions to TB health services and an increase in vulnerability to TB. Evidence for changes in Mycobacterium tuberculosis transmission is limited, and it remains unclear how the resources required and available for the TB response have changed. To advocate for additional funding to mitigate the impact of COVID-19 on the global TB burden, and to efficiently allocate resources for the TB response, requires a significant improvement in the TB data available.
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Affiliation(s)
- C F McQuaid
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - A Vassall
- Department of Global Health Development, Faculty of Public Health and Policy, LSHTM, London, UK
| | - T Cohen
- Yale School of Public Health, Laboratory of Epidemiology and Public Health, New Haven, CT, USA
| | - K Fiekert
- KNCV Tuberculosefonds, The Hague, the Netherlands
| | - R G White
- TB Modelling Group, TB Centre and Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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18
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Gunasekera K, Cohen T, Gao W, Ayles H, Godfrey-Faussett P, Claassens M. Smoking and HIV associated with subclinical tuberculosis: analysis of a population-based prevalence survey. Int J Tuberc Lung Dis 2021; 24:340-346. [PMID: 32228765 DOI: 10.5588/ijtld.19.0387] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Despite multiple tuberculosis (TB) prevalence surveys reporting a relatively high frequency of bacteriologically confirmed, active TB among individuals reporting no typical symptoms of disease, our understanding of this phenomenon is limited.OBJECTIVE: To quantify the epidemiological burden and estimate associations between individual-level variables and this "subclinical" presentation.METHODS: We performed a secondary analysis of TB prevalence survey data from the South African communities of the Zambia, South Africa Tuberculosis and AIDS Reduction trial. Generalized estimating equations were used to estimate the association between individual-level demographic, behavioral, socio-economic, and medical variables and the risk of bacteriologically positive TB among participants not reporting any symptoms consistent with active TB.RESULTS: The crude prevalence of TB was 2222.1 cases per 100 000 population (95% CI 2053.4-2388.5); 44.7% (295/660) of all documented prevalent cases of TB were subclinical. Current tobacco smoking (OR 2.37, 95% CI 1.41-3.99) and HIV-positive status (OR 3.26, 95% CI 2.31-4.61) were significantly associated with subclinical TB.CONCLUSION: Individuals who smoke or have HIV may be at increased risk of active TB and not report typical symptoms consistent with disease. This suggests possible shortcomings of symptom-based case finding which may need to be addressed in similar settings.
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Affiliation(s)
| | - T Cohen
- Department of Epidemiology of Microbial Disease
| | - W Gao
- Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - H Ayles
- ZAMBART, University of Zambia School of Public Health, Lusaka, Zambia, Clinical Research Department, London School of Tropical Medicine & Hygiene, London, UK
| | - P Godfrey-Faussett
- Clinical Research Department, London School of Tropical Medicine & Hygiene, London, UK
| | - M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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19
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Cates L, Crudu V, Codreanu A, Ciobanu N, Fosburgh H, Cohen T, Menzies NA. Laboratory costs of diagnosing TB in a high multidrug-resistant TB setting. Int J Tuberc Lung Dis 2021; 25:228-230. [PMID: 33688812 PMCID: PMC7948759 DOI: 10.5588/ijtld.20.0586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- L Cates
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - V Crudu
- Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - A Codreanu
- Chiril Draganiuc Institute of Phthisiopneumology, Chisinau
| | - N Ciobanu
- Chiril Draganiuc Institute of Phthisiopneumology, Chisinau, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - H Fosburgh
- Yale University School of Public Health, New Haven, CT, USA
| | - T Cohen
- Yale University School of Public Health, New Haven, CT, USA
| | - N A Menzies
- Harvard T H Chan School of Public Health, Boston, MA, USA
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20
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Dubreucq J, Faraldo M, Abbes M, Ycart B, Richard-Lepouriel H, Favre S, Jermann F, Attal J, Bakri M, Cohen T, Cervello C, Chereau I, Cognard C, De Clercq M, Douasbin A, Giordana JY, Giraud-Baro E, Guillard-Bouhet N, Legros-Lafarge E, Polosan M, Pouchon A, Rolland M, Rainteau N, Roussel C, Wangermez C, Yanos PT, Lysaker PH, Franck N. Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial. Trials 2021; 22:124. [PMID: 33557924 PMCID: PMC7869198 DOI: 10.1186/s13063-021-05067-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. Methods This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. Discussion NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. Trial registration ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France. .,Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France. .,Fondation FondaMental, Créteil, France. .,Réseau Handicap Psychique, Grenoble, France.
| | - M Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - M Abbes
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - B Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - H Richard-Lepouriel
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - S Favre
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - F Jermann
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - J Attal
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - M Bakri
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - T Cohen
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - C Cervello
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - C Cognard
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - M De Clercq
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - A Douasbin
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - J Y Giordana
- Centre Hospitalier Sainte Marie de Nice, 87 Avenue Joseph Raybaud, 06100, Nice, France
| | - E Giraud-Baro
- Clinique du Dauphiné- Groupe Sinoué, 252 Route de Saint-Nizier, 38180, Seyssins, France
| | | | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - M Polosan
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - A Pouchon
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - M Rolland
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - N Rainteau
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - C Roussel
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - C Wangermez
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - P T Yanos
- John Jay College of Criminal Justice, City University of New York, New York, USA
| | - P H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, USA
| | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
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21
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Shen X, Sha W, Yang C, Pan Q, Cohen T, Cheng S, Cai Q, Kan X, Zong P, Zeng Z, Tan S, Liang R, Bai L, Xia J, Wu S, Sun P, Wu G, Cai C, Wang X, Ai K, Liu J, Yuan Z. Continuity of TB services during the COVID-19 pandemic in China. Int J Tuberc Lung Dis 2021; 25:81-83. [PMID: 33384053 DOI: 10.5588/ijtld.20.0632] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- X Shen
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai
| | - W Sha
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for infectious disease, Shanghai
| | - C Yang
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Q Pan
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai
| | - T Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - S Cheng
- Chinese Center for Diseases Control and Prevention, Beijing
| | - Q Cai
- Division of Tuberculosis, Zhejiang Provincial Integrated Chinese and Western Medicine Hospital, Hangzhou, Zhejiang Province
| | - X Kan
- Department of Scientific Research and Education, Anhui Chest Hospital, Hefei, Anhui Province
| | - P Zong
- Division of Tuberculosis, Jiangxi Chest Hospital, Nanchang, Jiangxi Province
| | - Z Zeng
- Division of Tuberculosis, The Fifth People´s Hospital, Gangzhou, Jiangxi Province
| | - S Tan
- Department of Tuberculosis, Guangzhou Chest Hospital. Guangzhou, Guangdong Province
| | - R Liang
- Department of Tuberculosis, Henan Provincial Chest Hospital, Zhengzhou, Henan Province
| | - L Bai
- Hunan Chest Hospital, Changsha, Hunan Province
| | - J Xia
- South Five Disease Zones, Wuhan Jinyintan Hospital, Wuhan, Hubei Province
| | - S Wu
- Hebei Province Chest Hospital, Shijiazhuang, Hebei Province
| | - P Sun
- Tuberculosis Hospital of Jilin Province, Changchun, Jilin Province
| | - G Wu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, Sichuan Province
| | - C Cai
- Tuberculosis Diagnosis and Treatment Quality Control Center, Guiyang Public Health Treatment Center, Zunyi Medical University, Zunyi, Guizhou Province
| | - X Wang
- The Fourth People´s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China
| | - K Ai
- Department of Tuberculosis, Shanghai Pulmonary Hospital, Shanghai Clinical Research Center for infectious disease, Shanghai
| | - J Liu
- Chinese Center for Diseases Control and Prevention, Beijing
| | - Z Yuan
- Division of TB and HIV/AIDS Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai
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22
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Kanji F, Catchpole K, Choi E, Alfred M, Cohen K, Shouhed D, Anger J, Cohen T. Work-system interventions in robotic-assisted surgery: a systematic review exploring the gap between challenges and solutions. Surg Endosc 2021; 35:1976-1989. [PMID: 33398585 DOI: 10.1007/s00464-020-08231-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of a robot into the surgical suite changes the dynamics of the work-system, creating new opportunities for both success and failure. An extensive amount of research has identified a range of barriers to safety and efficiency in Robotic Assisted Surgery (RAS), such as communication breakdowns, coordination failures, equipment issues, and technological malfunctions. However, there exists very few solutions to these barriers. The purpose of this review was to identify the gap between identified RAS work-system barriers and interventions developed to address those barriers. METHODS A search from three databases (PubMed, Web of Science, and Ovid Medline) was conducted for literature discussing system-level interventions for RAS that were published between January 1, 1985 to March 17, 2020. Articles describing interventions for systems-level issues that did not involve technical skills in RAS were eligible for inclusion. RESULTS A total of 30 articles were included in the review. Only seven articles (23.33%) implemented and evaluated interventions, while the remaining 23 articles (76.67%) provided suggested interventions for issues in RAS. Major barriers identified included disruptions, ergonomic issues, safety and efficiency, communication, and non-technical skills. Common solutions involved team training, checklist development, and workspace redesign. CONCLUSION The review identified a significant gap between issues and solutions in RAS. While it is important to continue identifying how the complexities of RAS affect operating room (OR) and team dynamics, future work will need to address existing issues with interventions that have been tested and evaluated. In particular, improving RAS-associated non-technical skills, task management, and technology management may lead to improved OR dynamics associated with greater efficiency, reduced costs, and better systems-level outcomes.
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Affiliation(s)
- Falisha Kanji
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, USA
| | - Eunice Choi
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Myrtede Alfred
- Medical University of South Carolina, Charleston, SC, USA
| | - Kate Cohen
- Enterprise Information Services, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Shouhed
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Jennifer Anger
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd Suite 8215NT, Los Angeles, CA, 90048, USA.
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Marx FM, Cohen T, Lombard C, Hesseling AC, Dlamini SS, Beyers N, Naidoo P. Notification of relapse and other previously treated tuberculosis in the 52 health districts of South Africa. Int J Tuberc Lung Dis 2020; 23:891-899. [PMID: 31533878 DOI: 10.5588/ijtld.18.0609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE: To investigate the extent to which relapse and other previously treated tuberculosis (TB) contribute to the notified TB burden in South Africa.DESIGN: We conducted an ecological analysis at the level of the 52 South African health districts using national electronic TB register data. We included all bacteriologically confirmed TB cases treated for presumed drug-susceptible TB in 2011. Treatment history information was based on recorded patient categories (new vs. retreatment).RESULTS: Relapse and other previously treated TB cases constituted between 7.6% and 40% (median 17%, interquartile range 12-22) of all bacteriologically confirmed TB cases in the 52 South African districts. Multivariable analysis suggested that districts with higher proportions of previously treated TB cases had higher TB case notification rates (P < 0.001), lower estimates of antenatal human immunodeficiency virus (HIV) prevalence in the district population (P < 0.001) as well as lower HIV co-infection rates (P < 0.001) among new TB cases.CONCLUSION: Relapse and other previously treated TB cases contributed substantially to the notified TB burden in several South African health districts, particularly those with high case notification rates and lower antenatal HIV prevalence. Additional efforts to prevent TB among previously treated people, such as strengthening treatment monitoring and/or secondary preventive therapy, should be considered.
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Affiliation(s)
- F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - T Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S S Dlamini
- Research, Information Monitoring, Evaluation & Surveillance (RIMES), National TB Programme (NTP), National Department of Health, Pretoria, South Africa
| | - N Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - P Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Manor I, Magen A, Keidar D, Rosen S, Tasker H, Cohen T, Richter Y, Zaaroor-Regev D, Manor Y, Weizman A. Safety of phosphatidylserine containing omega3 fatty acids in ADHD children: A double-blind placebo-controlled trial followed by an open-label extension. Eur Psychiatry 2020; 28:386-91. [DOI: 10.1016/j.eurpsy.2012.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/25/2012] [Accepted: 11/04/2012] [Indexed: 10/27/2022] Open
Abstract
AbstractObjective:To evaluate the safety of phosphatidylserine (PS) enriched with omega3 fatty acids, mainly eicosapentaenoic (PS-Omega3) in children with attention-deficit hyperactivity disorder (ADHD).Methods:Two hundred children diagnosed with ADHD were randomised to receive either PS-Omega3 (300 mg PS-Omega3/day) or placebo for 15 weeks. One hundred and fifty children continued into an open-label extension for an additional 15 weeks in which they all consumed PS-Omega3 (150 mg PS-Omega3/day). Standard blood biochemical and haematological safety parameters, blood pressure, heart rate, weight and height were evaluated. Adverse events and the Side Effect Rating Scale were also assessed.Results:One hundred and sixty-two participants completed the double-blind phase. No significant differences were noted between the two study groups in any of the safety parameters evaluated. One hundred and forty participants completed the open-label phase. At the end of this phase, no significant changes from baseline were observed in any of the studied parameters among participants who consumed PS-Omega3 for 30 weeks.Conclusions:Study results demonstrate that consumption of PS-Omega3 by children with ADHD, as indicated in a 30-week evaluation period, is safe and well tolerated, without any negative effect on body weight or growth.
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Burton* CS, Lo EM, Kanji F, Caron A, Cohen T, Miller D, Wenger N, Scott V, Ackerman AL, Eilber KS, Anger JT. PD05-07 IMPLEMENTATION OF A PRIMARY CARE INTERVENTION TO IMPROVE CARE FOR WOMEN WITH URINARY INCONTINENCE. J Urol 2020. [DOI: 10.1097/ju.0000000000000825.07] [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: 11/25/2022]
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Zhao H, Quach A, Cohen T, Anger JT. Characteristics, Burden, and Necessity of Inpatient Consults for Academic and Private Practice Urologists. Urology 2020; 139:60-63. [PMID: 32109497 DOI: 10.1016/j.urology.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/27/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists. MATERIALS AND METHODS We performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of consult, reasons for consult, requesting physicians, and procedures performed were analyzed and compared. RESULTS A total of 613 consults were identified. The most common consults were for a Foley catheter/suprapubic tube (16%), urinary retention (15%), kidney/bladder stones (11%), and hematuria (11%). Seventy-seven percent of the consults were seen in the day time and 79% were seen on the weekdays. One hundred and ten (18%) consults resulted in an operative intervention during the same admission. The others required a Foley catheter placement or suprapubic exchange (17%), bedside procedure (9%), or interventional radiology procedure (4%). The remaining 319 consults (52%) required no intervention and were considered potentially unnecessary. There were no differences in the timing of the consults and the need for intervention between academic and private practice urologists (P = .20). Only 37% of patients followed up as an outpatient. These potentially unnecessary consults resulted an annual loss of 265.8 hours for the urologists and $44,376.09 in excess health care costs. CONCLUSION Over half of inpatient urologic consultations required no urologic intervention and therefore represented potential overuse of urgent inpatient specialty care. This may contribute towards the growing epidemic of burnout in urology. Further work needs to be done to educate other hospital services and nurses to minimize these unnecessary consults.
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Affiliation(s)
- Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Alan Quach
- University of Colorado School of Medicine, Aurora, CO
| | - Tara Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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Abstract
Due to greater exposure to Mycobacterium tuberculosis infection before migration, migrants moving to low-incidence settings can experience substantially higher tuberculosis (TB) rates than the native-born population. This review describes the impact of migration on TB epidemiology in the United States, and how the TB burden differs between US-born and non-US-born populations. The United States has a long history of receiving migrants from other parts of the world, and TB among non-US-born individuals now represents the majority of new TB cases. Based on an analysis of TB cases among individuals from the top 30 countries of origin in terms of non-US-born TB burden between 2003 and 2015, we describe how TB risks vary within the non-US-born population according to age, years since entry, entry year, and country of origin. Variation along each of these dimensions is associated with more than 10-fold differences in the risk of developing active TB, and this risk is also positively associated with TB incidence estimates for the country of origin and the composition of the migrant pool in the entry year. Approximately 87 000 lifetime TB cases are predicted for the non-US-born population resident in the United States in 2015, and 5800 lifetime cases for the population entering the United States in 2015.
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Affiliation(s)
- N A Menzies
- Department of Global Health and Population, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - A N Hill
- Division of TB Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - T Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - J A Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
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Berenbeim J, Boldissar S, Owens S, Haggmark M, Gate G, Siouri F, Cohen T, Rode MF, Patterson CS, de Vries M. Excited state intramolecular proton transfer in hydroxyanthraquinones: Toward predicting fading of organic red colorants in art. Sci Adv 2019; 5:eaaw5227. [PMID: 31523708 PMCID: PMC6731090 DOI: 10.1126/sciadv.aaw5227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 08/02/2019] [Indexed: 05/14/2023]
Abstract
Compositionally similar organic red colorants in the anthraquinone family, whose photodegradation can cause irreversible color and stability changes, have long been used in works of art. Different organic reds, and their multiple chromophores, suffer degradation disparately. Understanding the details of these molecules' degradation therefore provides a window into their behavior in works of art and may assist the development of improved conservation methods. According to one proposed model of photodegradation dynamics, intramolecular proton transfer provides a kinetically favored decay pathway in some photoexcited chromophores, preventing degradation-promoting electron transfer (ET). To further test this model, we measured excited state lifetimes of substituted gas-phase anthraquinones using high-level theory to explain the experimental results. The data show a general structural trend: Anthraquinones with 1,4-OH substitution are long-lived and prone to damaging ET, while excited state intramolecular proton transfers promote efficient quenching for hydroxyanthraquinones that lack this motif.
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Affiliation(s)
- J.A. Berenbeim
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - S. Boldissar
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - S. Owens
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - M.R. Haggmark
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - G. Gate
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - F.M. Siouri
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - T. Cohen
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - M. F. Rode
- Institute of Physics, Polish Academy of Sciences, al. Lotników 32/46, PL-02668 Warsaw, Poland
| | - C. Schmidt Patterson
- Getty Conservation Institute, 1200 Getty Center Drive, Suite 700, Los Angeles, CA, USA
| | - M.S. de Vries
- Department of Chemistry and Biochemistry, University of California, Santa Barbara, Santa Barbara, CA, USA
- Corresponding author.
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Tseng J, Cohen T, Melo N, Alban RF. Imaging utilization affects negative appendectomy rates in appendicitis: An ACS-NSQIP study. Am J Surg 2019; 217:1094-1098. [DOI: 10.1016/j.amjsurg.2018.12.072] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 10/17/2018] [Accepted: 12/29/2018] [Indexed: 12/29/2022]
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Souders CP, Catchpole K, Hannemann A, Lyon R, Eilber KS, Bresee C, Cohen T, Weigl M, Anger JT. Flow disruptions in robotic-assisted abdominal sacrocolpopexy: does robotic surgery introduce unforeseen challenges for gynecologic surgeons? Int Urogynecol J 2019; 30:2177-2182. [PMID: 31041500 DOI: 10.1007/s00192-019-03929-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/13/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to apply a human factors research approach to identify flow disruptions, deviations in the optimal course of care, in robotic abdominal sacrocolpopexy procedures with the ultimate goal of developing system interventions to improve the safety and efficiency of robotic surgery. METHODS Twenty-four robotic abdominal sacrocolpopexy procedures were observed for flow disruptions. Surgeries were divided into four phases: (1) patient arrival and induction of anesthesia; (2) port placement and robot docking; (3) console time; (4) undocking of robot, incision closure, and patient exiting the OR. RESULTS Flow disruptions were observed at a rate of 10.9 ± 5.1 per hour. The most frequently observed flow disruptions involved training issues (2.8 ± 2.4 flow disruptions per hour), equipment (2.2 ± 1.6 flow disruptions per hour), and poor coordination (2.0 ± 1.3 flow disruptions per hour). The rate of flow disruptions was highest in phase 2 (19.2 ± 14.4 flow disruptions per hour). Cases with more experienced surgeons involved shorter console times by 1.5 h (95% CI: 0.1, 3.0, p = 0.033) and 1.8 fewer (95% CI: 1.2, 2.6, p = 0.001) flow disruptions per hour. Surgeries were 1 h shorter on average (95% CI: 0.1, 1.9, p = 0.034) in cases in which the patient was > 65 years old. Da Vinci S console times were 0.8 h longer (95% CI: 0.01, 1.5, p = 0.047) than Si. CONCLUSIONS Flow disruptions in robotic abdominal sacrocolpopexy surgery occur about every 6 min. Flow disruption rates are highest during the most complex portions of the surgery. More experienced surgeons have lower flow disruption rates and operate more quickly.
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Affiliation(s)
| | - Ken Catchpole
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Ronit Lyon
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Matthias Weigl
- Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jennifer T Anger
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- , Beverly Hills, USA.
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Peled Y, Lavee J, Shlomo N, Cohen T, Kogan A, Maor E, Shechter M, Freimark D, Klempfner R. Low Serum Magnesium is Associated with Increased Mortality and Cardiac Allograft Vasculopathy Following Heart Transplantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.230] [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] Open
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Marcuschamer IA, Iakobishvili Z, Assali A, Vaknin-Assa H, Zusman O, Cohen T, Goldenberg I, Beigel R, Kornowski R, Eisen A. P814Temporal trends analysis of patients with prior coronary artery bypass graft surgery who are admitted with an acute coronary syndrome - the ACSIS registry 2000-2016. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I A Marcuschamer
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - Z Iakobishvili
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - A Assali
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - H Vaknin-Assa
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - O Zusman
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - T Cohen
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - I Goldenberg
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - R Beigel
- Sheba Medical Center, Cardiology Department, Ramat Gan, Israel
| | - R Kornowski
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
| | - A Eisen
- Rabin Medical Center, Cardiology Department, Petah Tikva, Israel
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Itzhaki Ben Zadok O, Hasdai D, Gottlieb S, Porter A, Beigel R, Shlomo N, Cohen T, Kornowski R, Iakobishvili Z. P3501Characteristics and outcomes of cancer patients presenting with myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - D Hasdai
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - S Gottlieb
- Shaare Zedek Medical Center, Department of Cardiology, Jerusalem, Israel
| | - A Porter
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - R Beigel
- Sheba Medical Center, Department of Cardiology, Ramat Gan, Israel
| | - N Shlomo
- Neufeld Cardiac Research Institute, Tel Aviv, Israel
| | - T Cohen
- Neufeld Cardiac Research Institute, Tel Aviv, Israel
| | - R Kornowski
- Rabin Medical Center, Department of Cardiology, Petah Tikva, Israel
| | - Z Iakobishvili
- Holon Medical Center, Clalit Health Services, Department of Cardiology, Holon, Israel
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Ortines R, Liu H, Cheng L, Cohen T, Lawlor H, Gami A, Wang Y, Dillen C, Archer N, Miller R, Ashbaugh A, Pinsker B, Marchitto M, Tkaczyk C, Stover C, Sellman B, Miller L. 1431 Neutralizing α-toxin accelerates healing of Staphylococcus aureus-infected wounds in normal and diabetic mice. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1449] [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]
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Andre E, Isaacs C, Affolabi D, Alagna R, Brockmann D, de Jong BC, Cambau E, Churchyard G, Cohen T, Delmee M, Delvenne JC, Farhat M, Habib A, Holme P, Keshavjee S, Khan A, Lightfoot P, Moore D, Moreno Y, Mundade Y, Pai M, Patel S, Nyaruhirira AU, Rocha LEC, Takle J, Trébucq A, Creswell J, Boehme C. Connectivity of diagnostic technologies: improving surveillance and accelerating tuberculosis elimination. Int J Tuberc Lung Dis 2018; 20:999-1003. [PMID: 27393530 DOI: 10.5588/ijtld.16.0015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In regard to tuberculosis (TB) and other major global epidemics, the use of new diagnostic tests is increasing dramatically, including in resource-limited countries. Although there has never been as much digital information generated, this data source has not been exploited to its full potential. In this opinion paper, we discuss lessons learned from the global scale-up of these laboratory devices and the pathway to tapping the potential of laboratory-generated information in the field of TB by using connectivity. Responding to the demand for connectivity, innovative third-party players have proposed solutions that have been widely adopted by field users of the Xpert(®) MTB/RIF assay. The experience associated with the utilisation of these systems, which facilitate the monitoring of wide laboratory networks, stressed the need for a more global and comprehensive approach to diagnostic connectivity. In addition to facilitating the reporting of test results, the mobility of digital information allows the sharing of information generated in programme settings. When they become easily accessible, these data can be used to improve patient care, disease surveillance and drug discovery. They should therefore be considered as a public health good. We list several examples of concrete initiatives that should allow data sources to be combined to improve the understanding of the epidemic, support the operational response and, finally, accelerate TB elimination. With the many opportunities that the pooling of data associated with the TB epidemic can provide, pooling of this information at an international level has become an absolute priority.
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Affiliation(s)
- E Andre
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium; European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland
| | - C Isaacs
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Affolabi
- Faculty of Health Sciences, Abomey-Calavi University, Cotonou, National Tuberculosis Programme, Cotonou, Benin
| | - R Alagna
- TB Supranational Reference Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - D Brockmann
- Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany; Epidemiological Modelling of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - B C de Jong
- Unit of Mycobacteriology, Department of Biomedical Sciences, Institute of Tropical Medicine, Belgium
| | - E Cambau
- European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycobacterial Infections (ESGMYC), ESCMID, Basel, Switzerland; Université Paris Diderot, Institut National de la Santé et de la Recherche Médicale, Unité mixte de recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, Bactériologie, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
| | | | - T Cohen
- Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - M Delmee
- Pôle de Microbiologie Médicale, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Service de Microbiologie, Département de Biologie Clinique, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J-C Delvenne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Centre for Operations Research and Econometrics, Université Catholique de Louvain, Belgium
| | - M Farhat
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - A Habib
- Interactive Health Solutions, Karachi, Pakistan
| | - P Holme
- Sungkyunkwan University, Seoul, South Korea
| | - S Keshavjee
- Harvard Medical School Center for Global Health Delivery, Dubai, United Arab Emirates
| | - A Khan
- Interactive Research and Development, Karachi, Pakistan
| | - P Lightfoot
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - D Moore
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Moreno
- Institute for Biocomputation and Physics of Complex Systems (BIFI), Department of Theoretical Physics, Faculty of Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - M Pai
- McGill International TB Centre & McGill Global Health Programs, McGill University, Montreal, Quebec, Canada
| | - S Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - L E C Rocha
- Karolinska Institutet, Stockholm, Sweden, Université de Namur, Namur, Belgium
| | - J Takle
- Global Connectivity LLC, Somerville, Massachusetts, USA
| | - A Trébucq
- International Union Against Tuberculosis and Lung Disease, France
| | - J Creswell
- Stop TB Partnership, Geneva, Switzerland
| | - C Boehme
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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Amir H, Hazan SB, Kalma Y, Cohen T, Frumkin T, Malcov M, Reches A, Hasson J, Azem F, Ben-Yosef D. Time-lapse imaging reveals delayed development of embryos carrying unbalanced chromosomal translocations. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.453] [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]
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Soysal E, Lee HJ, Zhang Y, Huang LC, Chen X, Wei Q, Zheng W, Chang JT, Cohen T, Sun J, Xu H. CATTLE (CAncer treatment treasury with linked evidence): An integrated knowledge base for personalized oncology research and practice. CPT Pharmacometrics Syst Pharmacol 2017; 6:188-196. [PMID: 28296354 PMCID: PMC5351410 DOI: 10.1002/psp4.12174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 01/15/2023]
Abstract
Despite the existence of various databases cataloging cancer drugs, there is an emerging need to support the development and application of personalized therapies, where an integrated understanding of the clinical factors and drug mechanism of action and its gene targets is necessary. We have developed CATTLE (CAncer Treatment Treasury with Linked Evidence), a comprehensive cancer drug knowledge base providing information across the complete spectrum of the drug life cycle. The CATTLE system collects relevant data from 22 heterogeneous databases, integrates them into a unified model centralized on drugs, and presents comprehensive drug information via an interactive web portal with a download function. A total of 2,323 unique cancer drugs are currently linked to rich information from these databases in CATTLE. Through two use cases, we demonstrate that CATTLE can be used in supporting both research and practice in personalized oncology.
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Affiliation(s)
- E Soysal
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - H-J Lee
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Y Zhang
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - L-C Huang
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - X Chen
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Q Wei
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - W Zheng
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - J T Chang
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - T Cohen
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - J Sun
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - H Xu
- University of Texas Health Science Center at Houston, Houston, Texas, USA
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39
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Phalen T, Dong M, Alsaloum M, Costa D, Cohen T, Wong A. 344 A Novel System for the Characterization and Tracking of Protective Services Utilization in the Emergency Department. Ann Emerg Med 2016. [DOI: 10.1016/j.annemergmed.2016.08.360] [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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40
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Seddon JA, Jenkins HE, Liu L, Cohen T, Black RE, Vos T, Becerra MC, Graham SM, Sismanidis C, Dodd PJ. Counting children with tuberculosis: why numbers matter. Int J Tuberc Lung Dis 2016; 19 Suppl 1:9-16. [PMID: 26564535 DOI: 10.5588/ijtld.15.0471] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In the last 5 years, childhood tuberculosis (TB) has received increasing attention from international organisations, national TB programmes and academics. For the first time, a number of different groups are developing techniques to estimate the burden of childhood TB. We review the challenges in diagnosing TB in children and the reasons why cases in children can go unreported. We discuss the importance of an accurate understanding of burden for identifying problems in programme delivery, targeting interventions, monitoring trends, setting targets, allocating resources appropriately and providing strong advocacy. We briefly review the estimates produced by new analytical methods, and outline the reasons for recent improvements in our understanding and potential future directions. We conclude that while innovation, collaboration and better data have improved our understanding of the childhood TB burden, it remains substantially incomplete.
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Affiliation(s)
- J A Seddon
- Department of Paediatrics, Imperial College London, London, UK
| | - H E Jenkins
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - L Liu
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - T Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - R E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - T Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - M C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - S M Graham
- Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - C Sismanidis
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - P J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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41
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Dowdy DW, Houben R, Cohen T, Pai M, Cobelens F, Vassall A, Menzies NA, Gomez GB, Langley I, Squire SB, White R. Impact and cost-effectiveness of current and future tuberculosis diagnostics: the contribution of modelling. Int J Tuberc Lung Dis 2016; 18:1012-8. [PMID: 25189546 PMCID: PMC4436823 DOI: 10.5588/ijtld.13.0851] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The landscape of diagnostic testing for tuberculosis (TB) is changing rapidly, and stakeholders need urgent guidance on how to develop, deploy and optimize TB diagnostics in a way that maximizes impact and makes best use of available resources. When decisions must be made with only incomplete or preliminary data available, modelling is a useful tool for providing such guidance. Following a meeting of modelers and other key stakeholders organized by the TB Modelling and Analysis Consortium, we propose a conceptual framework for positioning models of TB diagnostics. We use that framework to describe modelling priorities in four key areas: Xpert® MTB/RIF scale-up, target product profiles for novel assays, drug susceptibility testing to support new drug regimens, and the improvement of future TB diagnostic models. If we are to maximize the impact and cost-effectiveness of TB diagnostics, these modelling priorities should figure prominently as targets for future research.
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Affiliation(s)
- D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - R Houben
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
| | - T Cohen
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - M Pai
- Department of Epidemiology and Biostatistics & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - F Cobelens
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vassall
- SAME Modelling and Economics, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - N A Menzies
- Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts, USA
| | - G B Gomez
- Department of Global Health and Amsterdam Institute for Global Health and Development, Academic Medical Center, Amsterdam, The Netherlands
| | - I Langley
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S B Squire
- Department of Clinical Sciences and Centre for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R White
- Department of Infectious Disease Epidemiology and TB Modelling Group, London School of Hygiene & Tropical Medicine, London, UK
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Preis M, Schneiderman J, Koren B, Ben-Yosef Y, Levin-Ashkenazi D, Shapiro S, Cohen T, Blich M, Israeli-Amit M, Sarnatzki Y, Gershtein D, Shofti R, Lewis BS, Shaul Y, Flugelman MY. Co-expression of fibulin-5 and VEGF165 increases long-term patency of synthetic vascular grafts seeded with autologous endothelial cells. Gene Ther 2015; 23:237-46. [PMID: 26588709 DOI: 10.1038/gt.2015.104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 10/12/2015] [Accepted: 10/15/2015] [Indexed: 12/30/2022]
Abstract
Small caliber synthetic vascular grafts are commonly used for bypass surgery and dialysis access sites but have high failure rates because of neointima formation and thrombosis. Seeding synthetic grafts with endothelial cells (ECs) provides a biocompatible surface that may prevent graft failure. However, EC detachment following exposure to blood flow still remains a major obstacle in the development of biosynthetic grafts. We tested the hypothesis that induced expression by the seeded EC, of vascular endothelial growth factor165 (VEGF165) and of fibulin-5, an extracellular matrix glycoprotein that has a crucial role in elastin fiber organization and increase EC adherence to surfaces, may improve long-term graft patency. Autologous ECs were isolated from venous segments, and were transduced with retroviral vectors expressing fibulin-5 and VEGF165. The modified cells were seeded on expanded polytetrafluoroethylene (ePTFE) grafts and implanted in a large animal model. Three months after transplantation, all grafts seeded with modified EC were patent on a selective angiography, whereas only a third of the control grafts were patent. Similar results were shown at 6 months. Thus, seeding ePTFE vascular grafts with genetically modified EC improved long-term small caliber graft patency. The biosynthetic grafts may provide a novel therapeutic modality for patients with peripheral vascular disease and patients requiring vascular access for hemodialysis.
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Affiliation(s)
- M Preis
- Institute of Hematology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - J Schneiderman
- Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Koren
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - Y Ben-Yosef
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - D Levin-Ashkenazi
- The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - S Shapiro
- Immunology Research Unit, Lady Davis Carmel Medical Center, Haifa, Israel
| | - T Cohen
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - M Blich
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - M Israeli-Amit
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - Y Sarnatzki
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - D Gershtein
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel
| | - R Shofti
- The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - B S Lewis
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Y Shaul
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - M Y Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,MultiGene Vascular Systems Ltd, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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43
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Yu D, Blocker RC, Sir MY, Hallbeck MS, Hellmich TR, Cohen T, Nestler DM, Pasupathy KS. Intelligent Emergency Department: Validation of Sociometers to Study Workload. J Med Syst 2015; 40:53. [PMID: 26645317 DOI: 10.1007/s10916-015-0405-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
Sociometers are wearable sensors that continuously measure body movements, interactions, and speech. The purpose of this study is to test sociometers in a smart environment in a live clinical setting, to assess their reliability in capturing and quantifying data. The long-term goal of this work is to create an intelligent emergency department that captures real-time human interactions using sociometers to sense current system dynamics, predict future state, and continuously learn to enable the highest levels of emergency care delivery. Ten actors wore the devices during five simulated scenarios in the emergency care wards at a large non-profit medical institution. For each scenario, actors recited prewritten or structured dialogue while independent variables, e.g., distance, angle, obstructions, speech behavior, were independently controlled. Data streams from the sociometers were compared to gold standard video and audio data captured by two ward and hallway cameras. Sociometers distinguished body movement differences in mean angular velocity between individuals sitting, standing, walking intermittently, and walking continuously. Face-to-face (F2F) interactions were not detected when individuals were offset by 30°, 60°, and 180° angles. Under ideal F2F conditions, interactions were detected 50 % of the time (4/8 actor pairs). Proximity between individuals was detected for 13/15 actor pairs. Devices underestimated the mean duration of speech by 30-44 s, but were effective at distinguishing the dominant speaker. The results inform engineers to refine sociometers and provide health system researchers a tool for quantifying the dynamics and behaviors in complex and unpredictable healthcare environments such as emergency care.
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Affiliation(s)
- Denny Yu
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - Renaldo C Blocker
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - Mustafa Y Sir
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - M Susan Hallbeck
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - Thomas R Hellmich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - Tara Cohen
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David M Nestler
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA
| | - Kalyan S Pasupathy
- Department of Health Sciences Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Clinical Engineering Learning Lab, Mayo Clinic, Rochester, MN, USA.
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Lifshitz Y, Levi L, Eyal I, Cohen T, Tessler S. Sub-chronic (13-week) oral toxicity study, preceded by an in utero exposure phase and genotoxicity studies with fish source phosphatidylserine in rats. Food Chem Toxicol 2015; 86:234-44. [PMID: 26498410 DOI: 10.1016/j.fct.2015.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/21/2015] [Accepted: 10/15/2015] [Indexed: 11/17/2022]
Abstract
The safety of fish phosphatidylserine (PS) conjugated to DHA (InCog™) was examined in a series of toxicology studies as first step to support future use in infants and general population using in vitro genotoxicity tests and in a sub-chronic toxicity study with an in-utero exposure phase. PS is a major lipid in the cell membrane, active in various membrane-mediated processes. PS-DHA, present in human milk, has been suggested to be important for early brain development. Rats were exposed to diets containing 1.5%, 3% or 4.5% InCog or two control diets. Parental (F0) animals were fed throughout mating, gestation and lactation. Subsequently, a subchronic, 13-week study was conducted on the F1 animals followed by 4 weeks of recovery. The genotoxicity tests showed no mutagenicity potential. No significant toxicological findings were found in the F0 rats or the F1 pups. In the 13-weeks study, an increase in the presence of renal minimal-mild multifocal corticomedullary mineralization was noted in nine females of the high-dose group. This change was not associated with any inflammatory or degenerative changes in the kidneys. The no-observed-adverse-effect level (NOAEL) in the present study was placed at 3% in the diet (mid-dose group), equivalent to an overall intake of at least 2.1 g InCog/kg bw/day in the F1 generation.
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Affiliation(s)
- Y Lifshitz
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel.
| | - L Levi
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - I Eyal
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - T Cohen
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
| | - S Tessler
- Nutrition R&D, Enzymotec, Migdal HaEmeq, Israel
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45
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Mears J, Vynnycky E, Lord J, Borgdorff MW, Cohen T, Crisp D, Innes JA, Lilley M, Maguire H, McHugh TD, Woltmann G, Abubakar I, Sonnenberg P. The prospective evaluation of the TB strain typing service in England: a mixed methods study. Thorax 2015; 71:734-41. [DOI: 10.1136/thoraxjnl-2014-206480] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/16/2015] [Indexed: 11/04/2022]
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46
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Houben RMGJ, Dowdy DW, Vassall A, Cohen T, Nicol MP, Granich RM, Shea JE, Eckhoff P, Dye C, Kimerling ME, White RG. How can mathematical models advance tuberculosis control in high HIV prevalence settings? Int J Tuberc Lung Dis 2015; 18:509-14. [PMID: 24903784 PMCID: PMC4436821 DOI: 10.5588/ijtld.13.0773] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Existing approaches to tuberculosis (TB) control have been no more than partially successful in areas with high human immunodeficiency virus (HIV) prevalence. In the context of increasingly constrained resources, mathematical modelling can augment understanding and support policy for implementing those strategies that are most likely to bring public health and economic benefits. In this paper, we present an overview of past and recent contributions of TB modelling in this key area, and suggest a way forward through a modelling research agenda that supports a more effective response to the TB-HIV epidemic, based on expert discussions at a meeting convened by the TB Modelling and Analysis Consortium. The research agenda identified high-priority areas for future modelling efforts, including 1) the difficult diagnosis and high mortality of TB-HIV; 2) the high risk of disease progression; 3) TB health systems in high HIV prevalence settings; 4) uncertainty in the natural progression of TB-HIV; and 5) combined interventions for TB-HIV. Efficient and rapid progress towards completion of this modelling agenda will require co-ordination between the modelling community and key stakeholders, including advocates, health policy makers, donors and national or regional finance officials. A continuing dialogue will ensure that new results are effectively communicated and new policy-relevant questions are addressed swiftly.
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Affiliation(s)
- R M G J Houben
- TB Modelling Group, TB Centre, and Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - D W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Vassall
- Department of Global Health and Development, LSHTM, London, UK
| | - T Cohen
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - M P Nicol
- Division of Medical Microbiology and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town and National Health Laboratory Service, South Africa
| | - R M Granich
- Joint United Nations Programme on HIV/AIDS, World Health Organization (WHO), Geneva, Switzerland
| | - J E Shea
- Oxford-Emergent Tuberculosis Consortium, Wokingham, UK
| | - P Eckhoff
- Intellectual Ventures Laboratory, Bellevue, Washington, USA
| | - C Dye
- HIV, TB Malaria and Neglected Tropical Diseases Cluster, WHO, Geneva, Switzerland
| | - M E Kimerling
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - R G White
- TB Modelling Group, TB Centre, and Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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47
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Marty VN, Vlkolinsky R, Minassian N, Cohen T, Nelson GA, Spigelman I. Radiation-Induced Alterations in Synaptic Neurotransmission of Dentate Granule Cells Depend on the Dose and Species of Charged Particles. Radiat Res 2014; 182:653-65. [DOI: 10.1667/rr13647.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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48
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Huang CC, Tchetgen ET, Becerra MC, Cohen T, Galea J, Calderon R, Yataco R, Contreras C, Zhang ZB, Lecca L, Murray M. Cigarette smoking among tuberculosis patients increases risk of transmission to child contacts. Int J Tuberc Lung Dis 2014; 18:1285-91. [DOI: 10.5588/ijtld.14.0309] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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49
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Cohen T, Widdows D, Stephan C, Zinner R, Kim J, Rindflesch T, Davies P. Predicting high-throughput screening results with scalable literature-based discovery methods. CPT Pharmacometrics Syst Pharmacol 2014; 3:e140. [PMID: 25295575 PMCID: PMC4474167 DOI: 10.1038/psp.2014.37] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/20/2014] [Indexed: 11/10/2022]
Abstract
The identification of new therapeutic uses for existing agents has been proposed as a means to mitigate the escalating cost of drug development. A common approach to such repurposing involves screening libraries of agents for activities against cell lines. In silico methods using knowledge from the biomedical literature have been proposed to constrain the costs of screening by identifying agents that are likely to be effective a priori. However, results obtained with these methods are seldom evaluated empirically. Conversely, screening experiments have been criticized for their inability to reveal the biological basis of their results. In this paper, we evaluate the ability of a scalable literature-based approach, discovery-by-analogy, to identify a small number of active agents within a large library screened for activity against prostate cancer cells. The methods used permit retrieval of the knowledge used to infer their predictions, providing a plausible biological basis for predicted activity.
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Affiliation(s)
- T Cohen
- University of Texas School of Biomedical Informatics at Houston, Houston, Texas, USA
| | - D Widdows
- Microsoft Bing, Redmond, Washington, USA
| | - C Stephan
- Center for Translational Cancer Research, Texas A&M Health Sciences Center, Institute of Biosciences and Technology, Houston, Texas, USA
| | - R Zinner
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - J Kim
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - T Rindflesch
- National Library of Medicine, Bethesda, Maryland, USA
| | - P Davies
- Center for Translational Cancer Research, Texas A&M Health Sciences Center, Institute of Biosciences and Technology, Houston, Texas, USA
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50
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Ben-Yosef D, Bar-El L, Shwartz T, Cohen T, Carmon A, Mey Raz N, Raviv S, Malcov M, Almog B, Azem F, Amit A. Time-lapse microscopic analysis to verify how blastomere biopsy for PGD affects the dynamics of embryonic development. Fertil Steril 2014. [DOI: 10.1016/j.fertnstert.2014.07.073] [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: 10/24/2022]
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