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Miner SA, Berkman BE, Altiery de Jesus V, Jamal L, Grady C. Navigating Pandemic Moral Distress at Home and at Work: Frontline Workers' Experiences. AJOB Empir Bioeth 2022; 13:215-225. [PMID: 35472000 DOI: 10.1080/23294515.2022.2064000] [Citation(s) in RCA: 2] [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] [Indexed: 01/29/2023]
Abstract
Background: During the COVID-19 pandemic, frontline workers faced a series of challenges balancing family and work responsibilities. These challenges included making decisions about how to reduce COVID-19 exposure to their families while still carrying out their employment duties and caring for their children. We sought to understand how frontline workers made these decisions and how these decisions impacted their experiences.Methods: Between October 2020 and May 2021, we conducted 61 semi-structured interviews in English or Spanish, with individuals who continued to work outside of the home during the pandemic and had children living at home. Interviews were recorded, transcribed verbatim, and analyzed using abductive methods.Results: Frontline workers experienced moral distress, the inability to act in accordance with their values and obligations because of internal or external constraints. Their moral distress was a result of the tensions they felt as workers and parents, which sometimes led them to feel like they had to compromise on either or both responsibilities. Individuals felt morally conflicted because 1) their COVID-19 work exposures presented risk that often jeopardized their family's health; 2) their work hours often conflicted with their increased childcare responsibilities; and 3) they felt a duty to their colleagues, patients/customers, and communities to continue to show-up to work.Conclusions: Our findings point to a need to expand the concept of moral distress to include the perspectives of frontline workers outside of the healthcare professions and the fraught decisions that workers make outside of work that may impact their moral distress. Expanding the concept of moral distress also allows for a justice-based framing that can focus attention on the disparities inherent in much frontline work and can justify programmatic recommendations, like increasing paid childcare opportunities, to alleviate moral distress.
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Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,Department of Medical Humanities and Bioethics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - V Altiery de Jesus
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA.,John Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - L Jamal
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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2
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Maas SLN, Stichel D, Hielscher T, Sievers P, Berghoff AS, Schrimpf D, Sill M, Euskirchen P, Blume C, Patel A, Dogan H, Reuss D, Dohmen H, Stein M, Reinhardt A, Suwala AK, Wefers AK, Baumgarten P, Ricklefs F, Rushing EJ, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Greenway FEA, Bridges LR, Jones T, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Jungwirth G, Herold-Mende C, Unterberg A, Harter PN, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape KD, Brandner S, Hench J, Frank S, Pfister SM, Jones DTW, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. Integrated Molecular-Morphologic Meningioma Classification: A Multicenter Retrospective Analysis, Retrospectively and Prospectively Validated. J Clin Oncol 2021; 39:3839-3852. [PMID: 34618539 PMCID: PMC8713596 DOI: 10.1200/jco.21.00784] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for individual patients is of pivotal importance. However, only biomarkers for highly aggressive tumors are established (CDKN2A/B and TERT), whereas no molecularly based stratification exists for the broad spectrum of patients with low- and intermediate-risk meningioma. METHODS DNA methylation data and copy-number information were generated for 3,031 meningiomas (2,868 patients), and mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNVs), mutations, and WHO grading were analyzed. Prediction power for outcome was assessed in a retrospective cohort of 514 patients, validated on a retrospective cohort of 184, and on a prospective cohort of 287 multicenter cases. RESULTS Both CNV- and methylation family-based subgrouping independently resulted in increased prediction accuracy of risk of recurrence compared with the WHO classification (c-indexes WHO 2016, CNV, and methylation family 0.699, 0.706, and 0.721, respectively). Merging all risk stratification approaches into an integrated molecular-morphologic score resulted in further substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference P = .005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (hazard ratio 4.34 [2.48-7.57] and 3.34 [1.28-8.72] retrospective and prospective validation cohorts, respectively). CONCLUSION Merging these layers of histologic and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision making for patients with meningioma on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren L N Maas
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Philipp Euskirchen
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Blume
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Areeba Patel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Helin Dogan
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hildegard Dohmen
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Marco Stein
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany.,Department of Neurosurgery, University Hospital Gießen, Giessen, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Abigail K Suwala
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Department of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Severina Leu
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Fay E A Greenway
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, London, United Kingdom
| | - Timothy Jones
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Gerhard Jungwirth
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Exp. Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI) and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Miriam Ratliff
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York, NY
| | | | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jürgen Hench
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University Medical Faculty, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany
| | - Till Acker
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
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3
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Maas S, Stichel D, Hielscher T, Sievers P, Berghoff A, Schrimpf D, Sill M, Euskirchen P, Reuss D, Dohmen H, Stein M, Baumgarten P, Ricklefs F, Rushing E, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Unterberg A, Harter P, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape K, Brandner S, Hench J, Frank S, Pfister S, Jones D, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. PATH-39. INTEGRATED MOLECULAR-MORPHOLOGICAL MENINGIOMA CLASSIFICATION: A MULTICENTER RETROSPECTIVE ANALYSIS, RETRO- AND PROSPECTIVELY VALIDATED. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
PURPOSE
Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from cases with benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for the individual patient is of pivotal importance in clinical management. However, only biomarkers for highly aggressive tumors are established at present (CDKN2A/B and TERT), while no molecularly-based stratification exists for the broad spectrum of low- and intermediate-risk meningioma patients.
PATIENTS AND METHODS
DNA methylation data and copy-number information were generated for 3,031 meningiomas of 2,868 individual patients, with mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNV), mutations and WHO grading were comparatively analyzed. Prediction power for outcome of these parameters was assessed in an initial retrospective cohort of 514 patients, and validated on a retrospective cohort of 184, and on a prospective cohort of 287 multi-center cases, respectively.
RESULTS
Both CNV and methylation family- (MF)-based subgrouping independently resulted in an increase in prediction accuracy of risk of recurrence compared to the WHO classification (c-indexes WHO 2016, CNV, and MF 0.699, 0.706 and 0.721, respectively). Merging all independently powerful risk stratification approaches into an integrated molecular-morphological score resulted in a further, substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference p=0.005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (HR 4.56 [2.97;7.00], 4.34 [2.48;7.57] and 3.34 [1.28; 8.72] for discovery, retrospective, and prospective validation cohort, respectively).
CONCLUSIONS
Merging these layers of histological and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision-making for meningioma patients on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren Maas
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Hielscher
- Dept. of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | - David Reuss
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hildegard Dohmen
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Marco Stein
- Dept. of Neurosurgery, University Hospital Giessen, Germany, Gießen, Germany
| | - Peter Baumgarten
- Dept. of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Dept. of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Elizabeth Rushing
- Dept. of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Dept. of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Eberhard-Karls University Tübingen, Department of Neuropathology, Tübingen, Germany
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, University College London, London, United Kingdom
| | - Severina Leu
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Christian Mawrin
- Dept. of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Dept. of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Dept. of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Division of Experimental Neurosurgery, Department of Neurosurgery, Ruprechts-Karls-University Heidelberg, Heidelberg, Germany
| | - Patrick Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Dept. of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | | | - Miriam Ratliff
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matija Snuderl
- Department of Pathology at NYU Grossman School of Medicine, New York City, NY, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - Jürgen Hench
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - David Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
| | - Till Acker
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Dept. of Medicine, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
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Levine C, Grady C, Block T, Hurley H, Russo R, Peixoto B, Frees A, Ruiz A, Alland D. Use, re-use or discard? Quantitatively defined variance in the functional integrity of N95 respirators following vaporized hydrogen peroxide decontamination during the COVID-19 pandemic. J Hosp Infect 2021; 107:50-56. [PMID: 33075406 PMCID: PMC7566697 DOI: 10.1016/j.jhin.2020.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 has stretched the ability of many institutions to supply needed personal protective equipment, especially N95 respirators. N95 decontamination and re-use programmes provide one potential solution to this problem. Unfortunately, a comprehensive evaluation of the effects of decontamination on the fit of various N95 models using a quantitative fit test (QNFT) approach is lacking. AIMS To investigate the effects of up to eight rounds of vaporized hydrogen peroxide (VHP) decontamination on the fit of N95 respirators currently in use in a hospital setting, and to examine if N95 respirators worn by one user can adapt to the face shape of a second user with no compromise to fit following VHP decontamination. METHODS The PortaCount Pro+ Respirator Fit Tester Model 8038 was used to quantitatively define functional integrity, measured by fit, of N95 respirators following decontamination with VHP. FINDINGS There was an observable downward trend in the functional integrity of Halyard Fluidshield 46727 N95 respirators throughout eight cycles of decontamination with VHP. Functional integrity of 3M 1870 N95 respirators was reduced significantly after the respirator was worn, decontaminated with VHP, and then quantitatively fit tested on a second user. Furthermore, inconsistencies between qualitative fit test and QNFT results were uncovered that may have strong implications on the fit testing method used by institutions. CONCLUSIONS The data revealed variability in the functional integrity of different N95 models after VHP decontamination, and exposed potential limitations of N95 decontamination and re-use programmes.
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Affiliation(s)
- C Levine
- Rutgers New Jersey Medical School, Newark, NJ, USA; Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - C Grady
- Rutgers New Jersey Medical School, Newark, NJ, USA; Rutgers Biomedical and Health Sciences, Newark, NJ, USA
| | - T Block
- Rutgers New Jersey Medical School, Newark, NJ, USA; Rutgers Environmental Health and Safety, Newark, NJ, USA
| | - H Hurley
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - R Russo
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - B Peixoto
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - A Frees
- Rutgers New Jersey Medical School, Newark, NJ, USA; Rutgers Environmental Health and Safety, Newark, NJ, USA
| | - A Ruiz
- Rutgers New Jersey Medical School, Newark, NJ, USA; Rutgers Environmental Health and Safety, Newark, NJ, USA
| | - D Alland
- Rutgers New Jersey Medical School, Newark, NJ, USA.
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Russo R, Levine C, Grady C, Peixoto B, McCormick-Ell J, Block T, Gresko A, Delmas G, Chitale P, Frees A, Ruiz A, Alland D. Decontaminating N95 respirators during the COVID-19 pandemic: simple and practical approaches to increase decontamination capacity, speed, safety and ease of use. J Hosp Infect 2020; 109:52-57. [PMID: 33347939 PMCID: PMC7748974 DOI: 10.1016/j.jhin.2020.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022]
Abstract
Background The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed. Aims (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers. Methods We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process. Findings: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process. Conclusions Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination.
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Affiliation(s)
- R Russo
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - C Levine
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - C Grady
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - B Peixoto
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - J McCormick-Ell
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - T Block
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - A Gresko
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - G Delmas
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - P Chitale
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA
| | - A Frees
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - A Ruiz
- Rutgers Environmental Health and Safety, Rutgers University, Newark, NJ, USA
| | - D Alland
- Center for Emerging Pathogens, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
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Abstract
BACKGROUND In 2014, companies began covering the costs of egg freezing for their employees. The adoption of this benefit was highly contentious. Some argued that it offered women more reproductive autonomy, buying time to succeed in their careers and postpone childbearing. Others suggested this benefit might place inappropriate pressure on women, unduly influencing them to freeze their eggs to prioritize their career over reproduction. Although ethical problems with this benefit have been explored, there has not been research analyzing the perspectives of women working for companies that offer employer-based egg freezing. Furthermore, existing empirical studies often focus on the experiences of egg freezers rather than the young women thinking about, but not yet using, this technology. Methods: Through in-depth semi-structured interviews, we explore the perceptions and attitudes of 25 women employees of companies with employer-based egg freezing. Results: These women describe delaying childbearing for a multitude of reasons, including not having a partner, and the desire to achieve social and career goals. Many women did not know that their employers covered egg freezing before the interview (44%; 11/24), suggesting this benefit is not essential to their career and family-building decisions. While women did not describe pressure to use this technology, they did describe how this benefit would not solve the difficulties of becoming a mother while excelling in their careers. Conclusion: Although women may not feel pressure to freeze their eggs and delay childbearing, they still feel constricted in their reproductive options. While employer programs may offer women the ability to delay childbearing, many saw this delay as postponing problems with work-life balance rather than solving them. We suggest that sociocultural shifts, such as workplace daycare, flexible workplace hours, and acceptability of non-biological parenthood, might allow women to feel more empowered about their reproduction choices.
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Affiliation(s)
- S A Miner
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - W K Miller
- Doximity, San Francisco, California, USA
| | - C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - B E Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
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Grady C, Wang H, Schnurman Z, Qu T, Kondziolka D. Predicting Growth Trajectory in Vestibular Schwannoma From Radiomic Data Using Supervised Machine Learning Techniques. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Intracranial dural arteriovenous malformations (DAVFs) are relatively uncommon vascular lesions characterized by the direct connection of dural arteries into dural venous sinuses or leptomeningeal veins. Strategies for the treatment of these complex lesions have evolved significantly over the past three decades, and include open surgical disconnection, endovascular embolization, stereotactic radiosurgery (SRS), or a combination of these approaches. Radiosurgical intervention is unique in offering significant benefits to patients while exposing them to few of the risks associated with more invasive interventions. In this chapter we provide an overview of DAVFs and discuss the features of these lesions that affect management. We focus, in particular, on radiosurgical management of these lesions, describing present treatment paradigms, the procedure for the treatment of DAVFs with SRS, and expected clinical outcomes using SRS.
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Affiliation(s)
- Conor Grady
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA
| | | | - Douglas Kondziolka
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA; Center for Advanced Radiosurgery, NYU Langone Medical Center, New York, NY, USA.
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Grady C, Tanweer O, Zagzag D, Jafar JJ, Huang PP, Kondziolka D. Delayed hemorrhage from the tissue of an occluded arteriovenous malformation after stereotactic radiosurgery: report of 3 cases. J Neurosurg 2016; 126:1899-1904. [DOI: 10.3171/2016.4.jns152320] [Citation(s) in RCA: 10] [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] [Indexed: 11/06/2022]
Abstract
Stereotactic radiosurgery is widely used to treat cerebral arteriovenous malformations (AVMs), with the goal of complete angiographic obliteration. A number of case series have challenged the assumption that absence of residual AVM on follow-up angiograms is consistent with elimination of the risk of hemorrhage. The authors describe 3 cases in which patients who had angiographic evidence of AVM occlusion presented with late hemorrhage in the area of their prior lesions. They compare the radiographic, angiographic, and histological features of these patients with those previously described in the literature.Delayed hemorrhage from the tissue of occluded AVMs has been reported as early as 4 and as late as 11 years after initial stereotactic radiosurgery. In all cases for which data are available, hemorrhage occurred in the area of persistent imaging findings despite negative findings on conventional angiography. The hemorrhagic lesions that were resected demonstrated a number of distinct histological findings.While rare, delayed hemorrhage from the tissue of occluded AVMs may occur from a number of distinct, angiographically occult postirradiation changes. The hemorrhages in the authors' 3 cases were symptomatic and localized. The correlation of histological and imaging findings in delayed hemorrhage from occluded AVMs is an area requiring further investigation.
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Affiliation(s)
| | | | - David Zagzag
- Departments of 1Neurosurgery and
- 2Neuropathology, NYU Langone Medical Center, New York University, New York, New York
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10
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Denning E, Sharma S, Smolskis M, Touloumi G, Walker S, Babiker A, Clewett M, Emanuel E, Florence E, Papadopoulos A, Sánchez A, Tavel J, Grady C. Reported consent processes and demographics: a substudy of the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:24-9. [PMID: 25711320 DOI: 10.1111/hiv.12230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Efforts are needed to improve informed consent of participants in research. The Strategic Timing of AntiRetroviral Therapy (START) study provides a unique opportunity to study the effect of length and complexity of informed consent documents on understanding and satisfaction among geographically diverse participants. METHODS Interested START sites were randomized to use either the standard consent form or the concise consent form for all of the site's participants. RESULTS A total of 4473 HIV-positive participants at 154 sites world-wide took part in the Informed Consent Substudy, with consent given in 11 primary languages. Most sites sent written information to potential participants in advance of clinic visits, usually including the consent form. At about half the sites, staff reported spending less than an hour per participant in the consent process. The vast majority of sites assessed participant understanding using informal nonspecific questions or clinical judgment. CONCLUSIONS These data reflect the interest of START research staff in evaluating the consent process and improving informed consent. The START Informed Consent Substudy is by far the largest study of informed consent intervention ever conducted. Its results have the potential to impact how consent forms are written around the world.
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Affiliation(s)
- E Denning
- Coordinating Centers for Biometric Research, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Willson TJ, Grady C, Braxton E, Weitzel E. Air Travel with Known Pneumocephalus Following Outpatient Sinus Surgery. ACTA ACUST UNITED AC 2014; 85:75-7. [DOI: 10.3357/asem.3795.2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Adachi K, Sasaki H, Nagahisa S, Yoshida K, Hattori N, Nishiyama Y, Kawase T, Hasegawa M, Abe M, Hirose Y, Alentorn A, Marie Y, Poggioli S, Alshehhi H, Boisselier B, Carpentier C, Mokhtari K, Capelle L, Figarella-Branger D, Hoang-Xuan K, Sanson M, Delattre JY, Idbaih A, Yust-Katz S, Anderson M, Olar A, Eterovic A, Ezzeddine N, Chen K, Zhao H, Fuller G, Aldape K, de Groot J, Andor N, Harness J, Lopez SG, Fung TL, Mewes HW, Petritsch C, Arivazhagan A, Somasundaram K, Thennarasu K, Pandey P, Anandh B, Santosh V, Chandramouli B, Hegde A, Kondaiah P, Rao M, Bell R, Kang R, Hong C, Song J, Costello J, Bell R, Nagarajan R, Zhang B, Diaz A, Wang T, Song J, Costello J, Bie L, Li Y, Li Y, Liu H, Luyo WFC, Carnero MH, Iruegas MEP, Morell AR, Figueiras MC, Lopez RL, Valverde CF, Chan AKY, Pang JCS, Chung NYF, Li KKW, Poon WS, Chan DTM, Wang Y, Ng HAK, Chaumeil M, Larson P, Yoshihara H, Vigneron D, Nelson S, Pieper R, Phillips J, Ronen S, Clark V, Omay ZE, Serin A, Gunel J, Omay B, Grady C, Youngblood M, Bilguvar K, Baehring J, Piepmeier J, Gutin P, Vortmeyer A, Brennan C, Pamir MN, Kilic T, Krischek B, Simon M, Yasuno K, Gunel M, Cohen AL, Sato M, Aldape KD, Mason C, Diefes K, Heathcock L, Abegglen L, Shrieve D, Couldwell W, Schiffman JD, Colman H, D'Alessandris QG, Cenci T, Martini M, Ricci-Vitiani L, De Maria R, Larocca LM, Pallini R, de Groot J, Theeler B, Aldape K, Lang F, Rao G, Gilbert M, Sulman E, Luthra R, Eterovic K, Chen K, Routbort M, Verhaak R, Mills G, Mendelsohn J, Meric-Bernstam F, Yung A, MacArthur K, Hahn S, Kao G, Lustig R, Alonso-Basanta M, Chandrasekaran S, Wileyto EP, Reyes E, Dorsey J, Fujii K, Kurozumi K, Ichikawa T, Onishi M, Ishida J, Shimazu Y, Kaur B, Chiocca EA, Date I, Geisenberger C, Mock A, Warta R, Schwager C, Hartmann C, von Deimling A, Abdollahi A, Herold-Mende C, Gevaert O, Achrol A, Gholamin S, Mitra S, Westbroek E, Loya J, Mitchell L, Chang S, Steinberg G, Plevritis S, Cheshier S, Gevaert O, Mitchell L, Achrol A, Xu J, Steinberg G, Cheshier S, Napel S, Zaharchuk G, Plevritis S, Gevaert O, Achrol A, Chang S, Harsh G, Steinberg G, Cheshier S, Plevritis S, Gutman D, Holder C, Colen R, Dunn W, Jain R, Cooper L, Hwang S, Flanders A, Brat D, Hayes J, Droop A, Thygesen H, Boissinot M, Westhead D, Short S, Lawler S, Bady P, Kurscheid S, Delorenzi M, Hegi ME, Crosby C, Faulkner C, Smye-Rumsby T, Kurian K, Williams M, Hopkins K, Faulkner C, Palmer A, Williams H, Wragg C, Haynes HR, Williams M, Hopkins K, Kurian KM, Haynes HR, Crosby C, Williams H, White P, Hopkins K, Williams M, Kurian KM, Ishida J, Kurozumi K, Ichikawa T, Onishi M, Fujii K, Shimazu Y, Oka T, Date I, Jalbert L, Elkhaled A, Phillips J, Chang S, Nelson S, Jensen R, Salzman K, Schabel M, Gillespie D, Mumert M, Johnson B, Mazor T, Hong C, Barnes M, Yamamoto S, Ueda H, Tatsuno K, Aihara K, Jalbert L, Nelson S, Bollen A, Hirst M, Marra M, Mukasa A, Saito N, Aburatani H, Berger M, Chang S, Taylor B, Costello J, Popov S, Mackay A, Ingram W, Burford A, Jury A, Vinci M, Jones C, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Reifenberger G, Pietsch T, Sultan M, Lehrach H, Yaspo ML, Borkhardt A, Landgraf P, Eils R, Korshunov A, Zapatka M, Radlwimmer B, Pfister SM, Lichter P, Joy A, Smirnov I, Reiser M, Shapiro W, Mills G, Kim S, Feuerstein B, Jungk C, Mock A, Geisenberger C, Warta R, Friauf S, Unterberg A, Herold-Mende C, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Lautenschlaeger T, Kim BY, Jiang W, Beiko J, Prabhu S, DeMonte F, Lang F, Gilbert M, Aldape K, Sawaya R, Cahill D, McCutcheon I, Lau C, Wang L, Terashima K, Yamaguchi S, Burstein M, Sun J, Suzuki T, Nishikawa R, Nakamura H, Natsume A, Terasaka S, Ng HK, Muzny D, Gibbs R, Wheeler D, Lautenschlaeger T, Juratli TA, McElroy J, Meng W, Huebner A, Geiger KD, Krex D, Schackert G, Chakravarti A, Zhang XQ, Sun S, Lam KF, Kiang KMY, Pu JKS, Ho ASW, Leung GKK, Loebel F, Curry WT, Barker FG, Lelic N, Chi AS, Cahill DP, Lu D, Yin J, Teo C, McDonald K, Madhankumar A, Weston C, Slagle-Webb B, Sheehan J, Patel A, Glantz M, Connor J, Maire C, Francis J, Zhang CZ, Jung J, Manzo V, Adalsteinsson V, Homer H, Blumenstiel B, Pedamallu CS, Nickerson E, Ligon A, Love C, Meyerson M, Ligon K, Mazor T, Johnson B, Hong C, Barnes M, Jalbert LE, Nelson SJ, Bollen AW, Smirnov IV, Song JS, Olshen AB, Berger MS, Chang SM, Taylor BS, Costello JF, Mehta S, Armstrong B, Peng S, Bapat A, Berens M, Melendez B, Mollejo M, Mur P, Hernandez-Iglesias T, Fiano C, Ruiz J, Rey JA, Mock A, Stadler V, Schulte A, Lamszus K, Schichor C, Westphal M, Tonn JC, Unterberg A, Herold-Mende C, Morozova O, Katzman S, Grifford M, Salama S, Haussler D, Nagarajan R, Zhang B, Johnson B, Bell R, Olshen A, Fouse S, Diaz A, Smirnov I, Kang R, Wang T, Costello J, Nakamizo S, Sasayama T, Tanaka H, Tanaka K, Mizukawa K, Yoshida M, Kohmura E, Northcott P, Hovestadt V, Jones D, Kool M, Korshunov A, Lichter P, Pfister S, Otani R, Mukasa A, Takayanagi S, Saito K, Tanaka S, Shin M, Saito N, Ozawa T, Riester M, Cheng YK, Huse J, Helmy K, Charles N, Squatrito M, Michor F, Holland E, Perrech M, Dreher L, Rohn G, Goldbrunner R, Timmer M, Pollo B, Palumbo V, Calatozzolo C, Patane M, Nunziata R, Farinotti M, Silvani A, Lodrini S, Finocchiaro G, Lopez E, Rioscovian A, Ruiz R, Siordia G, de Leon AP, Rostomily C, Rostomily R, Silbergeld D, Kolstoe D, Chamberlain M, Silber J, Roth P, Keller A, Hoheisel J, Codo P, Bauer A, Backes C, Leidinger P, Meese E, Thiel E, Korfel A, Weller M, Saito K, Mukasa A, Nagae G, Nagane M, Aihara K, Takayanagi S, Tanaka S, Aburatani H, Saito N, Salama S, Sanborn JZ, Grifford M, Brennan C, Mikkelsen T, Jhanwar S, Chin L, Haussler D, Sasayama T, Tanaka K, Nakamizo S, Nishihara M, Tanaka H, Mizukawa K, Kohmura E, Schliesser M, Grimm C, Weiss E, Claus R, Weichenhan D, Weiler M, Hielscher T, Sahm F, Wiestler B, Klein AC, Blaes J, Weller M, Plass C, Wick W, Stragliotto G, Rahbar A, Soderberg-Naucler C, Sulman E, Won M, Ezhilarasan R, Sun P, Blumenthal D, Vogelbaum M, Colman H, Jenkins R, Chakravarti A, Jeraj R, Brown P, Jaeckle K, Schiff D, Dignam J, Atkins J, Brachman D, Werner-Wasik M, Gilbert M, Mehta M, Aldape K, Terashima K, Shen J, Luan J, Yu A, Suzuki T, Nishikawa R, Matsutani M, Liang Y, Man TK, Lau C, Trister A, Tokita M, Mikheeva S, Mikheev A, Friend S, Rostomily R, van den Bent M, Erdem L, Gorlia T, Taphoorn M, Kros J, Wesseling P, Dubbink H, Ibdaih A, Sanson M, French P, van Thuijl H, Mazor T, Johnson B, Fouse S, Heimans J, Wesseling P, Ylstra B, Reijneveld J, Taylor B, Berger M, Chang S, Costello J, Prabowo A, van Thuijl H, Scheinin I, van Essen H, Spliet W, Ferrier C, van Rijen P, Veersema T, Thom M, Meeteren ASV, Reijneveld J, Ylstra B, Wesseling P, Aronica E, Kim H, Zheng S, Mikkelsen T, Brat DJ, Virk S, Amini S, Sougnez C, Chin L, Barnholtz-Sloan J, Verhaak RGW, Watts C, Sottoriva A, Spiteri I, Piccirillo S, Touloumis A, Collins P, Marioni J, Curtis C, Tavare S, Weiss E, Grimm C, Schliesser M, Hielscher T, Claus R, Sahm F, Wiestler B, Klein AC, Blaes J, Tews B, Weiler M, Weichenhan D, Hartmann C, Weller M, Plass C, Wick W, Yeung TPC, Al-Khazraji B, Morrison L, Hoffman L, Jackson D, Lee TY, Yartsev S, Bauman G, Zheng S, Fu J, Vegesna R, Mao Y, Heathcock LE, Torres-Garcia W, Ezhilarasan R, Wang S, McKenna A, Chin L, Brennan CW, Yung WKA, Weinstein JN, Aldape KD, Sulman EP, Chen K, Koul D, Verhaak RGW. OMICS AND PROGNSTIC MARKERS. Neuro Oncol 2013; 15:iii136-iii155. [PMCID: PMC3823898 DOI: 10.1093/neuonc/not183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
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Affiliation(s)
- T. Gosden
- Clinical and Health Psychology; School of Health in Social Science; University of Edinburgh; UK
| | - P.G. Morris
- Clinical and Health Psychology; School of Health in Social Science; University of Edinburgh; UK
| | - N.B. Ferreira
- Clinical and Health Psychology; School of Health in Social Science; University of Edinburgh; UK
| | - C. Grady
- Clinical and Health Psychology; School of Health in Social Science; University of Edinburgh; UK
| | - D.T. Gillanders
- Clinical and Health Psychology; School of Health in Social Science; University of Edinburgh; UK
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Clark VE, Erson-Omay EZ, Serin A, Yin J, Cotney J, Ozduman K, Avşar T, Li J, Murray PB, Henegariu O, Yilmaz S, Günel JM, Carrión-Grant G, Yilmaz B, Grady C, Tanrikulu B, Bakircioğlu M, Kaymakçalan H, Caglayan AO, Sencar L, Ceyhun E, Atik AF, Bayri Y, Bai H, Kolb LE, Hebert RM, Omay SB, Mishra-Gorur K, Choi M, Overton JD, Holland EC, Mane S, State MW, Bilgüvar K, Baehring JM, Gutin PH, Piepmeier JM, Vortmeyer A, Brennan CW, Pamir MN, Kiliç T, Lifton RP, Noonan JP, Yasuno K, Günel M. Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO. Science 2013; 339:1077-80. [PMID: 23348505 DOI: 10.1126/science.1233009] [Citation(s) in RCA: 589] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report genomic analysis of 300 meningiomas, the most common primary brain tumors, leading to the discovery of mutations in TRAF7, a proapoptotic E3 ubiquitin ligase, in nearly one-fourth of all meningiomas. Mutations in TRAF7 commonly occurred with a recurrent mutation (K409Q) in KLF4, a transcription factor known for its role in inducing pluripotency, or with AKT1(E17K), a mutation known to activate the PI3K pathway. SMO mutations, which activate Hedgehog signaling, were identified in ~5% of non-NF2 mutant meningiomas. These non-NF2 meningiomas were clinically distinctive-nearly always benign, with chromosomal stability, and originating from the medial skull base. In contrast, meningiomas with mutant NF2 and/or chromosome 22 loss were more likely to be atypical, showing genomic instability, and localizing to the cerebral and cerebellar hemispheres. Collectively, these findings identify distinct meningioma subtypes, suggesting avenues for targeted therapeutics.
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Affiliation(s)
- Victoria E Clark
- Department of Neurosurgery, Yale Program in Brain Tumor Research, Yale School of Medicine, New Haven, CT 06510, USA
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Borrero S, Grady C, Schwarz E, Emeremni C, Moore C, Zite N. Is prior unintended pregnancy associated with less sterilization regret? Contraception 2012. [DOI: 10.1016/j.contraception.2012.05.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Petrican R, English T, Gross JJ, Grady C, Hai T, Moscovitch M. Friend or Foe? Age Moderates Time-Course Specific Responsiveness to Trustworthiness Cues. J Gerontol B Psychol Sci Soc Sci 2012; 68:215-23. [DOI: 10.1093/geronb/gbs064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McIntosh AR, Kovacevic N, Lippe S, Garrett D, Grady C, Jirsa V. The development of a noisy brain. Arch Ital Biol 2010; 148:323-337. [PMID: 21175017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Early in life, brain development carries with it a large number of structural changes that impact the functional interactions of distributed neuronal networks. Such changes enhance information processing capacity, moving the brain from a deterministic system to one that is more stochastic. The evidence from empirical studies with EEG and functional MRI suggests that this stochastic property is a result of an increased number of possible functional network configurations for a given situation. This is captured in the variability of endogenous and evoked responses or "brain noise ". In empirical data from infants and children, brain noise increases with maturation and correlates positively with stable behavior and accuracy. The noise increase is best explained through increased noise from network level interactions with a concomitant decrease of local noise. In old adults, brain noise continues to change, although the pattern of changes is not as global as in early development. The relation between high brain noise and stable behavior is maintained, but the relationships differ by region, suggesting changes in local dynamics that then impact potential network configurations. These data, when considered in concert with our extant modeling work, suggest that maturational changes in brain noise represent the enhancement offunctional network potential--the brain's dynamic repertoire.
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Affiliation(s)
- A R McIntosh
- Rotman Research Institute of Baycrest Centre, University of Toronto, Ontario, Canada.
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Fojo T, Grady C. Response: Re: How Much Is Life Worth: Cetuximab, Non-Small Cell Lung Cancer, and the $440 Billion Question. J Natl Cancer Inst 2010. [DOI: 10.1093/jnci/djq247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee Y, Paleja M, Grady C, Moscovitch M. Deficits in face and object processing manifest differently in normal aging and developmental prosopagnosia. J Vis 2010. [DOI: 10.1167/9.8.484] [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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Ulrich C, James J, Grady C, Byron C, Hanlon A, Watkins-Bruner D, Curran W. Factors Associated with Attrition in RTOG Clinical Trials. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yourganov G, Lukic A, Grady C, Wernick M, Strother S. Optimizing Activation Detection with Better Dimensionality Estimation in BOLD fMRI. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Rochon E, Leonard C, Laird L, Burianova H, Soros P, Graham S, Grady C. Investigation of a phonologically based treatment for anomia: Behavioral and neural changes. Brain Cogn 2007. [DOI: 10.1016/j.bandc.2006.08.034] [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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Affiliation(s)
- M. Agrawal
- NIH/NCI, Bethesda, DC; NIH, Bethesda, MD; Univ of Colorado, Denver, CO; NIH, Bethesda, DC
| | - C. Grady
- NIH/NCI, Bethesda, DC; NIH, Bethesda, MD; Univ of Colorado, Denver, CO; NIH, Bethesda, DC
| | - D. Fairclough
- NIH/NCI, Bethesda, DC; NIH, Bethesda, MD; Univ of Colorado, Denver, CO; NIH, Bethesda, DC
| | - E. Emanauel
- NIH/NCI, Bethesda, DC; NIH, Bethesda, MD; Univ of Colorado, Denver, CO; NIH, Bethesda, DC
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Horstmann E, Grady C, McCabe M, Emanuel EJ. Phase I participants as a vulnerable population. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Horstmann
- National Institutes of Health, Bethesda, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Grady
- National Institutes of Health, Bethesda, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. McCabe
- National Institutes of Health, Bethesda, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - E. J. Emanuel
- National Institutes of Health, Bethesda, MD; Memorial Sloan-Kettering Cancer Center, New York, NY
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Lie RK, Emanuel E, Grady C, Wendler D. The standard of care debate: the Declaration of Helsinki versus the international consensus opinion. J Med Ethics 2004; 30:190-193. [PMID: 15082816 PMCID: PMC1733825 DOI: 10.1136/jme.2003.006031] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The World Medical Association's revised Declaration of Helsinki endorses the view that all trial participants in every country are entitled to the worldwide best standard of care. In this paper the authors show that this requirement has been rejected by every national and international committee that has examined this issue. They argue that the consensus view now holds that it is ethically permissible, in some circumstances, to provide research participants less than the worldwide best care. Finally, the authors show that there is also consensus regarding the broad conditions under which this is acceptable.
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Affiliation(s)
- R K Lie
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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26
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Mandzia J, Black S, Grady C, McAndrews MP, Graham S. Encoding and retrieval in aging and memory loss, a fMRI study. Brain Cogn 2002; 49:225-8. [PMID: 15259396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Mild cognitive impairment (MCI) is a term for nondemented individuals with memory complaints and deficits greater than age-adjusted normal performance. Functional MRI (fMRI) may be a more sensitive method than other techniques to reveal functional abnormalities in individuals with MCI, only a proportion of whom progress to Alzheimer's disease (AD). fMRI was carried out while subjects (four MCI, five age-matched normal controls, and one AD) performed incidental encoding (deep and shallow) and recognition tasks for colored and black and white photographs contrasted to baseline fixation. fMRI revealed interesting dissociations between activation patterns and behavioral performance when comparing the MCI and AD to the NC.
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Abstract
At a time when there was great attention and intense public controversy surrounding clinical (especially multinational) research, the 52nd general assembly of the World Medical Association (WMA) adopted the 5th revision of the Declaration of Helsinki (in October, 2000)-available at www.wma.net. These revisions are the most substantial adaptations since those adopted by the 29th WMA assembly in October, 1975. The commitment to revision of the declaration acknowledged that deficiencies and disagreements in interpretation needed to be corrected and that ethical standards evolve. Nevertheless, this revision process resulted in a controversial version of the declaration. Reports on the revisions have focused mainly on clinical trials that use placebos; but because of the role of the Declaration of Helsinki in the ethics of research, a more thorough examination is needed. Here, we analyse the process of revision and the major changes made to the declaration.
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Affiliation(s)
- H P Forster
- Department of Clinical Bioethics, Warren G Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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28
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Abstract
Challenge experiments that induce infections in healthy volunteers are an important method for initial efficacy testing of candidate vaccines and for study of the pathogenesis of infectious diseases. Although these studies can be conducted safely for selected infectious diseases that are either fully treatable or self-limiting, they raise significant ethical issues. An ethical framework is offered for evaluating infection-inducing challenge experiments, which focuses on the scientific and public health rationale for conducting these studies, the risks that they pose and the ways in which these risks can be minimized, the symptoms experienced by healthy volunteers that may cause discomfort or distress, the exclusion of vulnerable research subjects, the informed consent process, the payment of volunteers, and the use of isolation of volunteers to prevent infection of others.
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Affiliation(s)
- F G Miller
- Department of Clinical Bioethics, National Institutes of Health, Bethesda, MD 20892-1156, USA.
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Affiliation(s)
- C Grady
- Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
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Abstract
Some are concerned about the possibility that offering money for research participation can constitute coercion or undue influence capable of distorting the judgment of potential research subjects and compromising the voluntariness of their informed consent. The author recognizes that more often than not there are multiple influences leading to decisions, including decisions about research participation. The concept of undue influence is explored, as well as the question of whether or not there is something uniquely distorting about money as opposed to a chance for treatment or medical care. An amount of money that is not excessive and is calculated on the basis of time or contribution may, rather than constitute an undue inducement, be an indication of respect for the time and contribution that research subjects make.
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Affiliation(s)
- C Grady
- National Institutes of Health, USA
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31
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Grady C, Ramjee G, Pape J, Hofman K, Speers M. Ethical and legal issues in infectious disease research and control. Emerg Infect Dis 2001; 7:534. [PMID: 11485651 PMCID: PMC2631819 DOI: 10.3201/eid0707.017713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- C Grady
- National Institutes of Health, Bethesda, Maryland 20892-6705, USA
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32
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Abstract
Many believe that informed consent makes clinical research ethical. However, informed consent is neither necessary nor sufficient for ethical clinical research. Drawing on the basic philosophies underlying major codes, declarations, and other documents relevant to research with human subjects, we propose 7 requirements that systematically elucidate a coherent framework for evaluating the ethics of clinical research studies: (1) value-enhancements of health or knowledge must be derived from the research; (2) scientific validity-the research must be methodologically rigorous; (3) fair subject selection-scientific objectives, not vulnerability or privilege, and the potential for and distribution of risks and benefits, should determine communities selected as study sites and the inclusion criteria for individual subjects; (4) favorable risk-benefit ratio-within the context of standard clinical practice and the research protocol, risks must be minimized, potential benefits enhanced, and the potential benefits to individuals and knowledge gained for society must outweigh the risks; (5) independent review-unaffiliated individuals must review the research and approve, amend, or terminate it; (6) informed consent-individuals should be informed about the research and provide their voluntary consent; and (7) respect for enrolled subjects-subjects should have their privacy protected, the opportunity to withdraw, and their well-being monitored. Fulfilling all 7 requirements is necessary and sufficient to make clinical research ethical. These requirements are universal, although they must be adapted to the health, economic, cultural, and technological conditions in which clinical research is conducted. JAMA. 2000;283:2701-2711.
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Affiliation(s)
- E J Emanuel
- Warren G. Magnuson Clinical Center, Bldg 10, Room 1C118, National Institutes of Health, Bethesda, MD 20892-1156, USA
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33
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Affiliation(s)
- N Dickert
- National Institutes of Health, Bethesda, MD 20892, USA
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34
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Grady C. Ethics and genetic testing. Adv Intern Med 1999; 44:389-411. [PMID: 9929717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The tremendous growth in knowledge about genes and genetic technologies will eventually enable us to know individual genotypes and susceptibilities to disease, perhaps even before birth. Each new genetic test developed raises serious issues for individuals and society on the circumstances under which genetic information should be sought and the uses that should be made of such information. Ethical reflection and analysis will help us to prepare for the responsible use of information about genotypes so that individuals, both now and in the future, are benefited and not harmed, so that justice is served, and so that confidentiality and privacy, and respect for the autonomy, dignity, and differences of each individual, are preserved.
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Affiliation(s)
- C Grady
- Department of Clinical Bioethics, W.G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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35
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Abstract
There is a need for increasing international collaboration in the search for a safe and effective HIV vaccine. In addition to the ethical issues that must be considered in conducting any clinical research, unique issues arise in vaccine research and in international research. Careful deliberation and guideline development regarding the ethics of international vaccine research was the focus of a series of recent consultations sponsored by Joint United Nations Programme on HIV/AIDS (UNAIDS) around the world.
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36
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Grady C. Science in the service of healing. Hastings Cent Rep 1998; 28:34-8. [PMID: 9868609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Affiliation(s)
- J S Greenberg
- Department of Radiology, Georgetown University Medical Center, Washington, DC 20007, USA
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Abstract
BACKGROUND Although fatigue is an almost universal clinical complaint of people with human immunodeficiency virus (HIV) infection, little has been done to study systematically the etiology, frequency, severity, response to, or management of HIV-related fatigue. In addition, HIV-related treatments may contribute to fatigue. OBJECTIVES To describe the extent and severity of perceived fatigue in a cohort of HIV-infected men (N= 50) who, as participants in a randomized clinical trial, were randomized to receive or not to receive investigational interleukin-2 (IL-2). METHOD A modified Piper Fatigue Scale was used to measure fatigue at baseline, at the end of 5 days of IL-2 therapy, 1 week later at home, and 1 month later for three consecutive cycles of IL-2 therapy. RESULTS Against a variable background of baseline fatigue in all subjects, those receiving IL-2 reported a significant increase in their level of fatigue after receiving IL-2. Fatigue levels remained elevated 1 week later but returned to baseline by 1 month. Fatigue was related to the dose of IL-2 but not to the reported amount or quality of sleep. CONCLUSIONS Against a background of fatigue related to HIV infection and its multiple manifestations and treatments, therapy with IL-2 dramatically increases the experience of fatigue. Although this increase is transient and tends to return to baseline by 1 month, during that month the patient's life function and quality may be severely affected.
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Affiliation(s)
- C Grady
- Clinical Therapeutics Laboratory, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Abstract
The incidence of human immunodeficiency virus (HIV) infection in women worldwide is increasing rapidly. Assumptions about HIV-related immunologic and nutritional changes are primarily based on data derived from men infected with HIV. The article reports a pilot study designed to examine the immunologic and nutritional responses of a small group of women with HIV infection and to suggest the Roy adaptation model as a framework for understanding HIV-related changes in women. A cross-sectional descriptive design was used to study physiologic mode responses in women seropositive for HIV. Results indicated that the subjects had lower than normal total CD4+ counts. The mean body mass index and midarm muscle area of this cohort of women fell between the 50th and 75th percentiles, and the triceps skinfold thickness was slightly below the 50th percentile, compared with age-matched norms derived from NHANES II data. Although wasting and nutritional problems are common in men with HIV disease the results suggest that women at the midlevel of the disease may not yet have major problems with nutritional adaptation to HIV. Future studies using the Roy adaptation model with larger samples of women who are followed over time are needed to determine whether the decline in physiologic mode adaptation level noted in men infected with HIV is also experienced by women infected with HIV.
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Affiliation(s)
- A J Orsi
- Department of Nursing, Temple University, Philadelphia, Pennsylvania, USA
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41
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Murphy DG, Mentis MJ, Pietrini P, Grady C, Daly E, Haxby JV, De La Granja M, Allen G, Largay K, White BJ, Powell CM, Horwitz B, Rapoport SI, Schapiro MB. A PET study of Turner's syndrome: effects of sex steroids and the X chromosome on brain. Biol Psychiatry 1997; 41:285-98. [PMID: 9024951 DOI: 10.1016/s0006-3223(95)00660-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Women with Turner's syndrome (TS) allow us to study the neurobiological associates of cognitive and behavioral abnormalities because they lack one/part of one X chromosome, and endogenous estrogen. We studied 13 healthy controls (mean age +/- SD, 28 +/- 6 years) and 16 TS subjects (mean age +/- SD, 26 +/- 6 years). We measured cognitive abilities using neuropsychological tests, and cerebral metabolic rates for glucose with positron emission tomography. Compared to controls, TS subjects had significant absolute hypermetabolism in most brain areas; however, normalized metabolism was significantly lower in TS subjects than controls in the insula and association neocortices bilaterally, and there were significant differences in functional metabolic associations of brain region pairs originating in occipital cortex bilaterally, and within the right hemisphere. There were significant correlations between right-left cognitive and metabolic asymmetries in the TS group. Also, within TS a preliminary analysis demonstrated "X chromosome dosage" effects in language ability and left temporal metabolism, asymmetry of right-left test scores, and parietal metabolism. We hypothesize that within TS: i) generalized brain hypermetabolism reflects global abnormalities in neuron packing; ii) neuronal abnormalities occur in association neocortex that differ in nature or extent from whole brain and are associated with significant differences in normalized metabolism; iii) cognitive deficits are related to brain metabolic abnormalities; and iv) social-behavioral problems may be related to abnormalities of brain metabolism. Moreover, in human brain the X chromosome involved in development of the association neocortices.
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Affiliation(s)
- D G Murphy
- Department of Psychological Medicine, Institute of Psychiatry, London, U.K
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42
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Abstract
Clinically stable HIV-infected men (N = 106) receiving investigational antiretrovirals were recruited. Subjects were divided into three HIV disease severity groups by CD4+ cell count. Standard measures of body composition were assessed, as well as serum measures of visceral protein stores and kilocalorie intake. Group 1 subjects (CD4+ T cells < 200) had significantly lower measures of body fat as compared with Group 2 (CD4 between 200 and 600) and Group 3 (CD4 > 600) despite adequate kilocalorie intake. Group 2 and Group 3 were not significantly different from each other. Our entire cohort had significantly lower muscle mass compared to norms. Our data demonstrate that people with advanced HIV disease have reduced muscle and fat.
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Affiliation(s)
- C Grady
- Clinical Therapeutics Laboratory, National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA
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43
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Beason-Held L, Purpura K, Azari N, Meter JV, Mangot D, Optican L, Grady C, Horwitz B, Rapoport S, Schapiro M. Repeated visual stimulation results in passive memory processing in humans. Neuroimage 1996. [DOI: 10.1016/s1053-8119(96)80530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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44
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Abstract
Normal aging is associated with the degeneration of specific neural systems. We used [18F] fluorodeoxyglucose (FDG)/positron emission tomography (PET) and a statistical model of regional covariation to explore the metabolic topography of this process. We calculated global and regional metabolic rates for glucose (GMR and rCMRglc) in two groups of normal subjects studied independently on different tomographs: Group 1--130 normal subjects (62 men and 68 women; range 21-90 years); Group 2--20 normal subjects (10 men and 10 women; range 24-78 years). In each of the two groups, the Scaled Subprofile Model (SSM) was applied to rCMRglc data to identify specific age-related profiles. The validity of these profiles as aging markers was assessed by correlating the associated subject scores with chronological age in both normal populations. SSM analysis disclosed two significant topographic profiles associated with aging. The first topographic profile, extracted in an analysis of group 1 normals, was characterized by relative frontal hypometabolism associated with covariate metabolic increases in the parietooccipital association areas, basal ganglia, mid-brain, and cerebellum. Subject scores for this profile correlated significantly with age in both normal groups (R2 = 0.48 and 0.33, p < 0.0001 for groups 1 and 2, respectively). Because of clinical similarities between normal motoric aging and parkinsonism, we explored the possibility of shared elements in the metabolic topography of both processes. We performed a combined group SSM analysis of the 20 group 2 normals and 22 age-matched Parkinson's disease patients, and identified another aging-related topographic profile. This profile was characterized by relative basal ganglia hypermetabolism associated with covariate decreases in frontal premotor cortex. Subject scores for this profile also correlated significantly with age in both normal groups (group 1: R2 = 0.30, p < 0.00001; group 2: R2 = 0.59, p < 0.01). Healthy aging is associated with reproducible topographic covariation profiles associated with specific neural systems. FDG/PET may provide a useful metabolic marker of the normal aging process.
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Affiliation(s)
- J R Moeller
- Department of Psychiatry, New York State Psychiatric Institute, Columbia College of Physicians and Surgeons, New York, USA
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45
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Grady C, Kelly G. State of the science. HIV vaccine development. Nurs Clin North Am 1996; 31:25-39. [PMID: 8604385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Developing a vaccine able to prevent HIV infection would be a great benefit to the world. Vaccines have contributed to substantially reduced morbidity and mortality from several important infectious diseases. However, HIV has some characteristics that distinguish it from many other viruses and make vaccine development challenging. This article discusses scientific strategies, obstacles, and progress to date towards the development of a preventive HIV vaccine.
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Affiliation(s)
- C Grady
- National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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46
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Love NG, Grady C. Impact of Growth in Benzoate and m-Toluate Liquid Media on Culturability of Pseudomonas putida on Benzoate and m-Toluate Plates. Appl Environ Microbiol 1995; 61:3142-4. [PMID: 16535111 PMCID: PMC1388565 DOI: 10.1128/aem.61.8.3142-3144.1995] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pseudomonas putida grown in continuous culture on benzoate or m-toluate lost the ability to grow on benzoate or m-toluate plates. A similar effect was not seen with a glucose continuous culture. Cells carrying and expressing a TOL plasmid rapidly lost their ability to grow on benzoate solid medium.
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47
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Salerno JA, Grady C, Mentis M, Gonzalez-Aviles A, Wagner E, Schapiro MB, Rapoport SI. Brain metabolic function in older men with chronic essential hypertension. J Gerontol A Biol Sci Med Sci 1995; 50:M147-54. [PMID: 7743400 DOI: 10.1093/gerona/50a.3.m147] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND METHODS. To determine the effects of hypertension on brain function, positron emission tomography (PET) studies using (18F)-2-fluoro-2-deoxy-D-glucose (FDG) were performed on a group of 17 otherwise healthy older hypertensive men (mean age +/- SD = 69 +/- 8 yr) and 25 age- and gender-matched controls. Subjects had medically treated essential hypertension for a minimum of 10 years (range = 10 to 24 yr) with no evidence of end-organ impairment from hypertension by routine clinical screening and by history. All hypertensive and control subjects were determined to be cognitively normal by extensive neuropsychological testing. The hypertensive subjects previously had been reported to have lateral ventricle enlargement and left hemisphere brain atrophy by quantitative MRI. PET data were analyzed using t-tests to look at group differences.
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Affiliation(s)
- J A Salerno
- Laboratory of Neurosciences, National Institute on Aging, NIH, Bethesda, Maryland, USA
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48
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Abstract
Because of improved life expectancy for people with HIV infection, today's clinician needs to understand and manage chronic symptoms that limit function and quality of life. The authors describe two collaborative HIV symptom-management studies conducted by the Division of Intramural Research of the National Institute of Nursing Research. Studies such as these are necessary to provide nurses and other healthcare personnel with the knowledge essential for appropriate, comprehensive, and quality patient care.
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Affiliation(s)
- K Hench
- Maternal and Child Bureau, Health Resources and Services Administration, Public Health Service, Rockville, MD, USA
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49
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Abstract
This paper explores three selected issues which present ethical challenges unique to the development and testing of preventive HIV vaccines. The issues are: when to move forward with large scale efficacy testing of vaccines, how to incorporate behavioral interventions into the study of vaccine efficacy, and how to plan for and mitigate social harms associated with participation in an HIV vaccine trial. Careful and ongoing consideration must be given to the ethical implications of these decisions. Proposed solutions include planning for a more complex prevention trial which would integrate the evaluation of behavioral interventions and vaccine efficacy; scrupulous attention to the process of individual informed consent and community participation; and serious and deliberate attempts to plan for, educate about, and minimize the social harms.
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Affiliation(s)
- C Grady
- Clinical Therapeutics Laboratory, National Institute of Nursing Research, National Institute of Health, Bethesda, MD 20892, USA
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50
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Anderson R, Grady C, Ropka M. A comparison of calculated energy requirements to measured resting energy expenditure in HIV-1-infected subjects. J Assoc Nurses AIDS Care 1994; 5:30-4. [PMID: 7865804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Twenty HIV-infected outpatients participating in clinical drug trials of the National Institute of Allergy and Infectious Diseases (NIAID) and enrolled in the collaborative National Institute of Nursing Research (NINR) nutrition study underwent indirect calorimetry measurements. Energy requirements for these subjects also were calculated using the Harris Benedict Equation (HBE). In all 20 subjects, the calculated energy requirements underestimated actual resting expenditure as determined by indirect calorimetry.
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Affiliation(s)
- R Anderson
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD
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