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Chen ML, Rezaei SJ, Kim J, Rodriguez C, Swetter SM, O'Hara R, Linos E. Incidence of Suicide Among Melanoma and Non-Keratinocyte Skin Cancer Patients in the US, 2000-2020. J Am Acad Dermatol 2024:S0190-9622(24)00787-4. [PMID: 38768863 DOI: 10.1016/j.jaad.2024.05.028] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Michael L Chen
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA; Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Shawheen J Rezaei
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA; Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Jiyeong Kim
- Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Carolyn Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Susan M Swetter
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA; Center for Digital Health, Stanford University, Stanford, CA, USA.
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Joy R, Phair K, O'Hara R, Brady D. Recent advances and current challenges in CAR-T cell therapy. Biotechnol Lett 2024; 46:115-126. [PMID: 38150098 DOI: 10.1007/s10529-023-03461-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
Rapid advancements in the field of immunotherapy have significantly improved cancer treatments. Specifically, an individualized cell-based modality which involves the removal of some of the patient's own white blood cells, including T cells, has revolutionized research in this field. This study focuses on the recent advances and current challenges of Chimeric Antigen Receptor- T (CAR-T) cell therapy and its regulations in the United States (US) and European Union (EU). Understanding the regulatory regimes of CAR-T cell therapy is critical for researchers and manufacturers as they navigate the hurdles of bringing CAR-T cell therapy to the global market. Benefits of CAR-T cell therapy include high response rates and the potential of long-term remissions in some haematological malignancies. However, the drawbacks are still evident including high costs, adverse reactions, and limited efficacy to solid tumours. CAR-T cell therapy is rapidly advancing, with 1231 clinical trials launched globally according to www.clinicalTrial.gov . The future of CAR-T cell therapy holds enormous promise but improving its safety, effectiveness, and availability are still barriers to its successful implementation.
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Affiliation(s)
- R Joy
- EnviroCORE, Department of Applied Science, South East Technological University, SETU Carlow, Kilkenny Road, Carlow, R93V960, Ireland
| | - K Phair
- EnviroCORE, Department of Applied Science, South East Technological University, SETU Carlow, Kilkenny Road, Carlow, R93V960, Ireland
| | - R O'Hara
- EnviroCORE, Department of Applied Science, South East Technological University, SETU Carlow, Kilkenny Road, Carlow, R93V960, Ireland
| | - D Brady
- EnviroCORE, Department of Applied Science, South East Technological University, SETU Carlow, Kilkenny Road, Carlow, R93V960, Ireland.
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Jordan JT, Chick CF, Rolle CE, Hantke N, Gould CE, Lutz J, Kawai M, Cotto I, Karna R, Pirog S, Berk M, Sudheimer K, O'Hara R, Beaudreau SA. Neurocognitive markers of passive suicidal ideation in late-life depression. Int Psychogeriatr 2023; 35:421-431. [PMID: 33118918 DOI: 10.1017/s1041610220003610] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES (1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression. DESIGN Cross-sectional study. SETTING University medical school. PARTICIPANTS Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara). MEASUREMENTS Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains. RESULTS The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume. CONCLUSIONS Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychology, Dominican University of California, San Rafael, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Camarin E Rolle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan Hantke
- Mental Health and Clinical Neuroscience Division, VA Portland Health Care System, Portland, OR, USA
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Geriatric Research, Education, and Clinical Centers (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Julie Lutz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosy Karna
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sophia Pirog
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michelle Berk
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Keith Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
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4
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Avelar-Pereira B, Belloy ME, O'Hara R, Hosseini SMH. Decoding the heterogeneity of Alzheimer's disease diagnosis and progression using multilayer networks. Mol Psychiatry 2023; 28:2423-2432. [PMID: 36539525 PMCID: PMC10279806 DOI: 10.1038/s41380-022-01886-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/19/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022]
Abstract
Alzheimer's disease (AD) is a multifactorial and heterogeneous disorder, which makes early detection a challenge. Studies have attempted to combine biomarkers to improve AD detection and predict progression. However, most of the existing work reports results in parallel or compares normalized findings but does not analyze data simultaneously. We tested a multi-dimensional network framework, applied to 490 subjects (cognitively normal [CN] = 147; mild cognitive impairment [MCI] = 287; AD = 56) from ADNI, to create a single model capable of capturing the heterogeneity and progression of AD. First, we constructed subject similarity networks for structural magnetic resonance imaging, amyloid-β positron emission tomography, cerebrospinal fluid, cognition, and genetics data and then applied multilayer community detection to find groups with shared similarities across modalities. Individuals were also followed-up longitudinally, with AD subjects having, on average, 4.5 years of follow-up. Our findings show that multilayer community detection allows for accurate identification of present and future AD (≈90%) and is also able to identify cases that were misdiagnosed clinically. From all MCI participants who developed AD or reverted to CN, the multilayer model correctly identified 90.8% and 88.5% of cases respectively. We observed similar subtypes across the full sample and when examining multimodal data from subjects with no AD pathology (i.e., amyloid negative). Finally, these results were also validated using an independent testing set. In summary, the multilayer framework is successful in detecting AD and provides unique insight into the heterogeneity of the disease by identifying subtypes that share similar multidisciplinary profiles of neurological, cognitive, pathological, and genetics information.
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Affiliation(s)
- Bárbara Avelar-Pereira
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, 94304, USA.
| | - Michael E Belloy
- Department of Neurology and Neurological Sciences, School of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, 94304, USA
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, 94304, USA.
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5
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Ollila HM, Sharon E, Lin L, Sinnott-Armstrong N, Ambati A, Yogeshwar SM, Hillary RP, Jolanki O, Faraco J, Einen M, Luo G, Zhang J, Han F, Yan H, Dong XS, Li J, Zhang J, Hong SC, Kim TW, Dauvilliers Y, Barateau L, Lammers GJ, Fronczek R, Mayer G, Santamaria J, Arnulf I, Knudsen-Heier S, Bredahl MKL, Thorsby PM, Plazzi G, Pizza F, Moresco M, Crowe C, Van den Eeden SK, Lecendreux M, Bourgin P, Kanbayashi T, Martínez-Orozco FJ, Peraita-Adrados R, Benetó A, Montplaisir J, Desautels A, Huang YS, Jennum P, Nevsimalova S, Kemlink D, Iranzo A, Overeem S, Wierzbicka A, Geisler P, Sonka K, Honda M, Högl B, Stefani A, Coelho FM, Mantovani V, Feketeova E, Wadelius M, Eriksson N, Smedje H, Hallberg P, Hesla PE, Rye D, Pelin Z, Ferini-Strambi L, Bassetti CL, Mathis J, Khatami R, Aran A, Nampoothiri S, Olsson T, Kockum I, Partinen M, Perola M, Kornum BR, Rueger S, Winkelmann J, Miyagawa T, Toyoda H, Khor SS, Shimada M, Tokunaga K, Rivas M, Pritchard JK, Risch N, Kutalik Z, O'Hara R, Hallmayer J, Ye CJ, Mignot EJ. Narcolepsy risk loci outline role of T cell autoimmunity and infectious triggers in narcolepsy. Nat Commun 2023; 14:2709. [PMID: 37188663 DOI: 10.1038/s41467-023-36120-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2023] [Indexed: 05/17/2023] Open
Abstract
Narcolepsy type 1 (NT1) is caused by a loss of hypocretin/orexin transmission. Risk factors include pandemic 2009 H1N1 influenza A infection and immunization with Pandemrix®. Here, we dissect disease mechanisms and interactions with environmental triggers in a multi-ethnic sample of 6,073 cases and 84,856 controls. We fine-mapped GWAS signals within HLA (DQ0602, DQB1*03:01 and DPB1*04:02) and discovered seven novel associations (CD207, NAB1, IKZF4-ERBB3, CTSC, DENND1B, SIRPG, PRF1). Significant signals at TRA and DQB1*06:02 loci were found in 245 vaccination-related cases, who also shared polygenic risk. T cell receptor associations in NT1 modulated TRAJ*24, TRAJ*28 and TRBV*4-2 chain-usage. Partitioned heritability and immune cell enrichment analyses found genetic signals to be driven by dendritic and helper T cells. Lastly comorbidity analysis using data from FinnGen, suggests shared effects between NT1 and other autoimmune diseases. NT1 genetic variants shape autoimmunity and response to environmental triggers, including influenza A infection and immunization with Pandemrix®.
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Affiliation(s)
- Hanna M Ollila
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Eilon Sharon
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Ling Lin
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Nasa Sinnott-Armstrong
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
- Department of Biology, Stanford University, Stanford, CA, 94305, USA
| | - Aditya Ambati
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Selina M Yogeshwar
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
- Department of Neurology, Charité-Universitätsmedizin, 10117, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, 10117, Berlin, Germany
| | - Ryan P Hillary
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Otto Jolanki
- Department of Genetics, Stanford University, Stanford, CA, 94305, USA
| | - Juliette Faraco
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Mali Einen
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Guo Luo
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Jing Zhang
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA
| | - Fang Han
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Han Yan
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Xiao Song Dong
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, The Peking University People's Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, The Peking University People's Hospital, Beijing, China
| | - Seung-Chul Hong
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Tae Won Kim
- Department of Psychiatry, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Center, National Reference Network for Narcolepsy, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier; Institute for Neurosciences of Montpellier (INM), INSERM, Université Montpellier 1, Montpellier, France
| | - Gert Jan Lammers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Sleep-Wake Centre, Heemstede, The Netherlands
| | - Geert Mayer
- Hephata Klinik, Schimmelpfengstr. 6, 34613, Schwalmstadt, Germany
- Philipps Universität Marburg, Baldinger Str., 35043, Marburg, Germany
| | - Joan Santamaria
- Neurology Service, Institut de Neurociències Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Isabelle Arnulf
- Sleep Disorder Unit, Pitié-Salpêtrière Hospital, Assistance Publique-Hopitaux de Paris, 75013, Paris, France
| | - Stine Knudsen-Heier
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - May Kristin Lyamouri Bredahl
- Norwegian Centre of Expertise for Neurodevelopment Disorders and Hypersomnias (NevSom), Department of Rare Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Per Medbøe Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Monica Moresco
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via Ugo Foscolo 7, 40123, Bologna, Italy
- IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | | | - Michel Lecendreux
- Pediatric Sleep Center and National Reference Center for Narcolepsy and Idiopathic Hypersomnia Hospital Robert Debre, Paris, France
| | - Patrice Bourgin
- Department of Sleep Medicine, Strasbourg University Hospital, Strasbourg University, Strasbourg, France
| | - Takashi Kanbayashi
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Japan
| | - Francisco J Martínez-Orozco
- Sleep Unit. Clinical Neurophysiology Service. San Carlos University Hospital. University Complutense of Madrid, Madrid, Spain
| | - Rosa Peraita-Adrados
- Sleep and Epilepsy Unit, Clinical Neurophysiology Service, Gregorio Marañón University General Hospital and Research Institute, University Complutense of Madrid (UCM), Madrid, Spain
| | | | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur and Department of Neurosciences, University of Montréal, Montréal, QC, Canada
| | - Yu-Shu Huang
- Department of Child Psychiatry and Sleep Center, Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark
| | - Sona Nevsimalova
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - David Kemlink
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Alex Iranzo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Neurology, Barcelona, Spain
- Multidisciplinary Sleep Disorders Unit, Barcelona, Spain
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, P.O. Box 61, 5590 AB, Heeze, The Netherlands
- Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aleksandra Wierzbicka
- Department of Clinical Neurophysiology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Peter Geisler
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Karel Sonka
- Department of Neurology and Centre of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hosptal, Prague, Czech Republic
| | - Makoto Honda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Seiwa Hospital, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Birgit Högl
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University Innsbruck (MUI), Innsbruck, Austria
| | | | - Vilma Mantovani
- Center for Applied Biomedical Research (CRBA), St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eva Feketeova
- Neurology Department, Medical Faculty of P. J. Safarik University, University Hospital of L. Pasteur Kosice, Kosice, Slovak Republic
| | - Mia Wadelius
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans Smedje
- Division of Child and Adolescent Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Pär Hallberg
- Department of Medical Sciences and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - David Rye
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zerrin Pelin
- Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Division of Neuroscience, Ospedale San Raffaele, Università Vita-Salute, Milan, Italy
| | - Claudio L Bassetti
- Neurology Department, EOC, Ospedale Regionale di Lugano, Lugano, Ticino, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Mathis
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Ramin Khatami
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG, Barmelweid, Switzerland
| | - Adi Aran
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences & Research Centre, Kerala, India
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Centre, Helsinki, Finland
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Markus Perola
- University of Helsinki, Institute for Molecular Medicine, Finland (FIMM) and Diabetes and Obesity Research Program. University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Birgitte R Kornum
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Sina Rueger
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Juliane Winkelmann
- Institute of Neurogenomics, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Taku Miyagawa
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Toyoda
- Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Seik-Soon Khor
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mihoko Shimada
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsushi Tokunaga
- Department of Human Genetics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Manuel Rivas
- Department of Biomedical Data Science-Administration, Stanford University, Palo Alto, CA, USA
| | | | - Neil Risch
- Dept. Epidemiology and Biostatistics, UCSF, 513 Parnassus Avenue, San Francisco, CA, 94117, USA
| | - Zoltan Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- University Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland, Lausanne, 1010, Switzerland
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- Mental Illness Research Education Clinical Centers (MIRECC), VA Palo Alto, Palo Alto, CA, USA
| | - Chun Jimmie Ye
- Department of Epidemiology & Biostatistics, Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel J Mignot
- Stanford University, Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA, 94304, USA.
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6
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Beaudreau SA, Lutz J, Wetherell JL, Nezu AM, Nezu CM, O'Hara R, Gould CE, Roelk B, Jo B, Hernandez B, Samarina V, Otero MC, Gallagher A, Hirsch J, Funderburk J, Pigeon WR. Beyond maintaining safety: Examining the benefit of emotion-centered problem solving therapy added to safety planning for reducing late life suicide risk. Contemp Clin Trials 2023; 128:107147. [PMID: 36921689 PMCID: PMC10164054 DOI: 10.1016/j.cct.2023.107147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
Few clinical trials have examined brief non-pharmacological treatments for reducing suicide risk in older Veterans, a high-risk group. Problem Solving Therapy (PST) is a promising psychosocial intervention for reducing late life suicide risk by increasing adaptive coping to problems through effective problem solving and related coping skills. The current randomized clinical trial will compare the efficacy of six telephone-delivered sessions of Safety Planning (enhanced usual care; EUC) only or an updated version of PST (emotion-centered PST [EC-PST]) + EUC to determine the added clinical benefit of EC-PST for reducing severity of suicidal ideation and for increasing reasons for living, a critical protective factor. Participants randomized to EC-PST + EUC or EUC only will be 150 Veterans (75 each) with active suicidal ideation who are aged 60 or older; have a current DSM-5 anxiety, depressive, and/or trauma-related disorder; and without significant cognitive impairment. Primary outcomes (Geriatric Suicide Ideation Scale and Reasons for Living-Older Adults scale) will be assessed at 11 timepoints: baseline, after each of 6 treatment sessions, posttreatment, and at follow-up at 1, 3, and 6 months posttreatment, and analyzed using mixed effects modeling. Additionally, moderators and mediators of primary outcomes will be examined-functional disability, executive dysfunction, and problem-solving ability. Qualitative feedback from participants will identify potential Veteran-centric changes to the EC-PST protocol and to EUC. Ultimately, the goal of this study is to inform the evidence-based clinical practice guidelines for treatments to reduce suicide risk in older Veterans and specifically to inform clinical decision-making regarding the merit of adding EC-PST to EUC.
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Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| | - Julie Lutz
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Julie Loebach Wetherell
- Mental Health Service, Veterans Affairs San Diego Health Care System, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Arthur M Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Christine Maguth Nezu
- Department of Psychological and Brain Sciences, Drexel University, 3141 Chestnut Street, Philadelphia, PA 19104, USA
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Christine E Gould
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Brandi Roelk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA
| | - Booil Jo
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Beatriz Hernandez
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Viktoriya Samarina
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Marcela C Otero
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305-5717, USA
| | - Alana Gallagher
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA; Psychology Department, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA 94304, USA
| | - James Hirsch
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
| | - Jennifer Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Wilfred R Pigeon
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, 800 Irving Ave, Syracuse, NY 13210, USA; Department of Psychiatry, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA; VA Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, 400 Fort Hill Ave, Canandaigua, NY 14624, USA
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7
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Hantke NC, Samarina V, Hallmayer J, Anker L, O'Hara R, Beaudreau SA. Preparing the Next Generation of Academic Researchers During the Pandemic: Lessons from a National Mental Health Research Postdoctoral Fellowship. Acad Psychiatry 2022; 46:466-469. [PMID: 35257319 PMCID: PMC8901092 DOI: 10.1007/s40596-022-01613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has severely disrupted all aspects of academic medicine, including post-doctoral research fellowship training. The current survey examined ways in which research fellows across 28 U.S. nationally diverse sites have been impacted. METHODS Survey participants included 62 M.D. and Ph.D. post-doctoral fellows and 27 local fellowship center directors within the Veterans Affairs (VA) Advanced Fellowship in Mental Illness Research and Treatment (MIRT), a national fellowship program tasked to develop academic clinician researchers within the field of mental health. Survey questions focused on productivity and challenges experienced by fellows during the pandemic. RESULTS Half of fellows reported working entirely off-site during the COVID-19 pandemic. All fellows reported some level of disruption in productivity during the pandemic; 73% reported a disruption in data collection, 69% reported decreased scholarly output, 41% reported disruption in grant writing, and 73% reported disruption in ability to provide clinical care. Yet, the majority of fellows (66%) reported not having to change their research goals, pivoting to telehealth-based data collection, and employing extant data for research projects and peer-reviewed publications. CONCLUSIONS The results of the fellow and director surveys highlight the associated disruption of the COVID-19 pandemic on fellowship-related activities and parallel ingenuity of programs to continue conducting research and clinical services in a modified fashion. While many research goals continued unabated, the findings suggest alterations in data collection methodology and a focus on using extant data, which may have a residual influence on future early career research grant applications.
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Affiliation(s)
| | | | | | - Lauren Anker
- Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth O'Hara
- Stanford University School of Medicine, Stanford, CA, USA
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8
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Li C, Lee A, Grigoryan L, Arunachalam PS, Scott MKD, Trisal M, Wimmers F, Sanyal M, Weidenbacher PA, Feng Y, Adamska JZ, Valore E, Wang Y, Verma R, Reis N, Dunham D, O'Hara R, Park H, Luo W, Gitlin AD, Kim P, Khatri P, Nadeau KC, Pulendran B. Mechanisms of innate and adaptive immunity to the Pfizer-BioNTech BNT162b2 vaccine. Nat Immunol 2022; 23:543-555. [PMID: 35288714 PMCID: PMC8989677 DOI: 10.1038/s41590-022-01163-9] [Citation(s) in RCA: 172] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/17/2022] [Indexed: 01/26/2023]
Abstract
Despite the success of the BNT162b2 mRNA vaccine, the immunological mechanisms that underlie its efficacy are poorly understood. Here we analyzed the innate and adaptive responses to BNT162b2 in mice, and show that immunization stimulated potent antibody and antigen-specific T cell responses, as well as strikingly enhanced innate responses after secondary immunization, which was concurrent with enhanced serum interferon (IFN)-γ levels 1 d following secondary immunization. Notably, we found that natural killer cells and CD8+ T cells in the draining lymph nodes are the major producers of this circulating IFN-γ. Analysis of knockout mice revealed that induction of antibody and T cell responses to BNT162b2 was not dependent on signaling via Toll-like receptors 2, 3, 4, 5 and 7 nor inflammasome activation, nor the necroptosis or pyroptosis cell death pathways. Rather, the CD8+ T cell response induced by BNT162b2 was dependent on type I interferon-dependent MDA5 signaling. These results provide insights into the molecular mechanisms by which the BNT162b2 vaccine stimulates immune responses.
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Affiliation(s)
- Chunfeng Li
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Audrey Lee
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Lilit Grigoryan
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Prabhu S Arunachalam
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Madeleine K D Scott
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
- Center for Biomedical Informatics, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Meera Trisal
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Florian Wimmers
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Mrinmoy Sanyal
- Department of Biochemistry & Stanford, ChEM-H, Stanford University, Stanford, CA, USA
| | - Payton A Weidenbacher
- Department of Biochemistry & Stanford, ChEM-H, Stanford University, Stanford, CA, USA
| | - Yupeng Feng
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Julia Z Adamska
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Erika Valore
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Yanli Wang
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Rohit Verma
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Noah Reis
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
| | - Diane Dunham
- Sean N. Parker Center for Allergy & Asthma Research, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Park
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Wei Luo
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alexander D Gitlin
- Department of Physiological Chemistry, Genentech, South San Francisco, CA, USA
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Kim
- Department of Biochemistry & Stanford, ChEM-H, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA
- Center for Biomedical Informatics, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy & Asthma Research, Stanford, CA, USA
- Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Stanford, CA, USA
| | - Bali Pulendran
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA, USA.
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA.
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9
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Le X, O'Hara R, Paz-Ares L, Van Meerbeeck J, Viteri Ramirez S, Cabrera Galvez C, Vincente Baz D, Kim Y, Kang J, Schumacher K, Karachaliou N, Adrian S, Bruns R, Paik P. Tepotinib in Patients with Advanced NSCLC with MET Amplification (METamp). Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.172] [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: 10/19/2022]
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10
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Paik P, O'Hara R, Veillon R, Felip E, Cortot A, Sakai H, Mazières J, Thomas M, Reinmuth N, Raskin J, Conte P, Garassino M, Iams W, Griesinger F, Kowalski D, Stroh C, Juraeva D, Scheuenpflug J, Johne A, Le X. METex14 ctDNA Dynamics & Resistance Mechanisms Detected in Liquid Biopsy (LBx) From Patients (pts) With METex14 Skipping NSCLC Treated With Tepotinib. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Ram-Mohan N, Kim D, Zudock EJ, Hashemi MM, Tjandra KC, Rogers AJ, Blish CA, Nadeau KC, Newberry JA, Quinn JV, O'Hara R, Ashley E, Nguyen H, Jiang L, Hung P, Blomkalns AL, Yang S. SARS-CoV-2 RNAemia Predicts Clinical Deterioration and Extrapulmonary Complications from COVID-19. Clin Infect Dis 2022; 74:218-226. [PMID: 33949665 PMCID: PMC8135992 DOI: 10.1093/cid/ciab394] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The determinants of coronavirus disease 2019 (COVID-19) disease severity and extrapulmonary complications (EPCs) are poorly understood. We characterized relationships between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNAemia and disease severity, clinical deterioration, and specific EPCs. METHODS We used quantitative and digital polymerase chain reaction (qPCR and dPCR) to quantify SARS-CoV-2 RNA from plasma in 191 patients presenting to the emergency department with COVID-19. We recorded patient symptoms, laboratory markers, and clinical outcomes, with a focus on oxygen requirements over time. We collected longitudinal plasma samples from a subset of patients. We characterized the role of RNAemia in predicting clinical severity and EPCs using elastic net regression. RESULTS Of SARS-CoV-2-positive patients, 23.0% (44 of 191) had viral RNA detected in plasma by dPCR, compared with 1.4% (2 of 147) by qPCR. Most patients with serial measurements had undetectable RNAemia within 10 days of symptom onset, reached maximum clinical severity within 16 days, and symptom resolution within 33 days. Initially RNAemic patients were more likely to manifest severe disease (odds ratio, 6.72 [95% confidence interval, 2.45-19.79]), worsening of disease severity (2.43 [1.07-5.38]), and EPCs (2.81 [1.26-6.36]). RNA loads were correlated with maximum severity (r = 0.47 [95% confidence interval, .20-.67]). CONCLUSIONS dPCR is more sensitive than qPCR for the detection of SARS-CoV-2 RNAemia, which is a robust predictor of eventual COVID-19 severity and oxygen requirements, as well as EPCs. Because many COVID-19 therapies are initiated on the basis of oxygen requirements, RNAemia on presentation might serve to direct early initiation of appropriate therapies for the patients most likely to deteriorate.
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Affiliation(s)
- Nikhil Ram-Mohan
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - David Kim
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Elizabeth J Zudock
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Marjan M Hashemi
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kristel C Tjandra
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Angela J Rogers
- Department of Medicine-Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Catherine A Blish
- Department of Medicine/Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kari C Nadeau
- Department of Medicine-Pulmonary, Allergy & Critical Care Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer A Newberry
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - James V Quinn
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Euan Ashley
- Department of Medicine-Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | | | - Paul Hung
- Combinati Inc, Palo Alto, California, USA
| | - Andra L Blomkalns
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Samuel Yang
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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12
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Eggert LE, He Z, Collins W, Lee AS, Dhondalay G, Jiang SY, Fitzpatrick J, Snow TT, Pinsky BA, Artandi M, Barman L, Puri R, Wittman R, Ahuja N, Blomkalns A, O'Hara R, Cao S, Desai M, Sindher SB, Nadeau K, Chinthrajah RS. Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19. Allergy 2022; 77:173-185. [PMID: 34080210 PMCID: PMC8222896 DOI: 10.1111/all.14972] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is unclear whether asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS-CoV-2. METHODS All patients over 28 days old testing positive for SARS-CoV-2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub-cohort was followed prospectively to evaluate long-term COVID-19 symptoms. RESULTS 168,190 patients underwent SARS-CoV-2 testing, and 6,976 (4.15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1.12 [95% CI 0.86, 1.45], p = .40). Among SARS-CoV-2-positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared with non-allergic asthma (OR 0.52 [0.28, 0.91], p = .026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID-19 disease had lower eosinophil levels during hospitalization compared with patients with mild or asymptomatic disease, independent of asthma status (p = .0014). In a patient sub-cohort followed longitudinally, asthmatics and non-asthmatics had similar time to resolution of COVID-19 symptoms, particularly lower respiratory symptoms. CONCLUSIONS Asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID-19 compared with non-allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with a more severe COVID-19 disease trajectory. Recovery was similar among asthmatics and non-asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms 3 months post-infection.
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Affiliation(s)
- Lauren E. Eggert
- Division of Pulmonary, Allergy and Critical Care MedicineStanford UniversityStanfordCAUSA,Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Ziyuan He
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - William Collins
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA,Division of Hospital MedicineStanford UniversityStanfordCAUSA
| | - Alexandra S. Lee
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Gopal Dhondalay
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Shirley Y. Jiang
- Department of Internal MedicineSanta Clara Valley Medical CenterSan JoseCAUSA
| | - Jessica Fitzpatrick
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Theo T. Snow
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Benjamin A. Pinsky
- Department of PathologyStanford University School of MedicineStanfordCAUSA,Division of Infectious Diseases and Geographic MedicineStanford UniversityStanfordCAUSA
| | - Maja Artandi
- Medicine/Primary Care and Population HealthStanford UniversityStanfordCAUSA
| | - Linda Barman
- Medicine/Primary Care and Population HealthStanford UniversityStanfordCAUSA
| | - Rajan Puri
- Medicine/Primary Care and Population HealthStanford UniversityStanfordCAUSA
| | | | - Neera Ahuja
- Division of Hospital MedicineStanford UniversityStanfordCAUSA
| | - Andra Blomkalns
- Department of Emergency MedicineStanford UniversityStanfordCAUSA
| | - Ruth O'Hara
- Psychiatry/Public Mental Health & Population SciencesStanford UniversityStanfordCAUSA
| | - Shu Cao
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Manisha Desai
- Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA,Medicine, Biomedical Informatics ResearchStanford UniversityStanfordCAUSA
| | - Sayantani B. Sindher
- Division of Pulmonary, Allergy and Critical Care MedicineStanford UniversityStanfordCAUSA,Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
| | - Kari Nadeau
- Division of Pulmonary, Allergy and Critical Care MedicineStanford UniversityStanfordCAUSA,Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA,Division of Hospital MedicineStanford UniversityStanfordCAUSA
| | - R. Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care MedicineStanford UniversityStanfordCAUSA,Sean N. Parker Center for Allergy and Asthma ResearchStanford UniversityStanfordCAUSA
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13
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Gould C, Carlson C, Anker L, O'Hara R, Wetherell J, Goldstein M, Beaudreau S. Brief Video-Delivered Interventions to Reduce Anxiety in Older Veterans: A Pilot RCT. Innov Aging 2021. [PMCID: PMC8681180 DOI: 10.1093/geroni/igab046.2178] [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: 11/12/2022] Open
Abstract
Older Veterans with anxiety disorders encounter barriers to receiving mental health services that may be overcome by using brief technology-delivered interventions. To address this, we conducted a pilot randomized controlled trial (RCT) comparing the effects of a guided self-management intervention called BREATHE, a 4-week video-delivered (DVD/internet) intervention and a psychoeducation control (Healthy Living; HL) on anxiety symptom severity. Older Veterans with anxiety disorders (N = 48; 87.5% men; Mean age = 71.77 ± 6.2 years) were randomized to BREATHE or HL. Regarding intervention delivery modality, 67% used DVDs, 23% used the internet, 4% used both to access their assigned intervention. Both groups experienced significant declines in affective anxiety from baseline to 8 weeks followed by an increase in symptoms (i.e., quadratic pattern). HL had significant declines in somatic anxiety, whereas BREATHE did not experience such declines. The longitudinal effects and Veteran satisfaction will be further described in the presentation.
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Affiliation(s)
- Christine Gould
- VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Chalise Carlson
- VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Lauren Anker
- VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Ruth O'Hara
- Stanford University School of Medicine, Palo Alto, California, United States
| | - Julie Wetherell
- VA San Diego / UCSD, La Jolla Village, California, United States
| | | | - Sherry Beaudreau
- VA Palo Alto / Stanford University School of Medicine, VA Palo Alto, California, United States
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14
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Gould CE, Carlson C, Wetherell JL, O'Hara R, Goldstein MK, Loup JR, Ma F, Beaudreau SA. Guided self-management targeting anxiety and activity participation in older Veterans. Aging Ment Health 2021; 25:1913-1922. [PMID: 32397822 DOI: 10.1080/13607863.2020.1758905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES This study examined the acceptance, feasibility, and preliminary effects of a guided self-management intervention using video delivery and a telephone coach on anxiety and activity engagement. METHOD Ten Veterans aged 60 years or older with anxiety disorders determined by Structured Clinical Interview for Diagnostic and Statistical Manual 5th edition (SCID-5) at baseline visit participated in this non-randomized study examining a 4-week guided self-management intervention for anxiety. Feasibility was examined using participation engagement with the intervention. Measures of anxiety (Geriatric Anxiety Scale, PROMIS Anxiety Scale, Anxiety Control Questionnaire), depression (Patient Health Questionnaire 9-item), and activity participation (modified Activity Card Sort) administered at baseline and final (week 8) visit provided estimates of preliminary intervention effects. The Geriatric Anxiety Scale also was administered by phone at week 4. Participants completed a semi-structured qualitative interview at the final visit, which provided information about the acceptability, benefits of intervention, and barriers to engagement. RESULTS All participants (N = 10) reported that the intervention somewhat or completely met their expectations, demonstrating intervention acceptability. Intervention completers (n = 9) experienced reduced anxiety over the first 4 weeks, alongside significant improvements in anxiety control and personalized activity goals across 8 weeks. However, anxiety symptoms tended to return to baseline at follow-up. Participants identified the relaxation videos and promotion of a daily relaxation routine as the most helpful intervention components. CONCLUSIONS Findings indicate that the intervention may improve activity participation and reduce anxiety. Thus, guided self-management interventions show promise for reducing distress and maintaining engagement later in life.
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Affiliation(s)
- Christine E Gould
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Chalise Carlson
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Julie Loebach Wetherell
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Mary K Goldstein
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Primary Care and Outcomes Research (PCOR), Stanford University, Stanford, CA, USA
| | - Julia R Loup
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Flora Ma
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
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15
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Kalinowski A, Liliental J, Anker LA, Linkovski O, Culbertson C, Hall JN, Pattni R, Sabatti C, Noordsy D, Hallmayer JF, Mellins ED, Ballon JS, O'Hara R, Levinson DF, Urban AE. Increased activation product of complement 4 protein in plasma of individuals with schizophrenia. Transl Psychiatry 2021; 11:486. [PMID: 34552056 PMCID: PMC8458380 DOI: 10.1038/s41398-021-01583-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
Structural variation in the complement 4 gene (C4) confers genetic risk for schizophrenia. The variation includes numbers of the increased C4A copy number, which predicts increased C4A mRNA expression. C4-anaphylatoxin (C4-ana) is a C4 protein fragment released upon C4 protein activation that has the potential to change the blood-brain barrier (BBB). We hypothesized that elevated plasma levels of C4-ana occur in individuals with schizophrenia (iSCZ). Blood was collected from 15 iSCZ with illness duration < 5 years and from 14 healthy controls (HC). Plasma C4-ana was measured by radioimmunoassay. Other complement activation products C3-ana, C5-ana, and terminal complement complex (TCC) were also measured. Digital-droplet PCR was used to determine C4 gene structural variation state. Recombinant C4-ana was added to primary brain endothelial cells (BEC) and permeability was measured in vitro. C4-ana concentration was elevated in plasma from iSCZ compared to HC (mean = 654 ± 16 ng/mL, 557 ± 94 respectively, p = 0.01). The patients also carried more copies of the C4AL gene and demonstrated a positive correlation between plasma C4-ana concentrations and C4A gene copy number. Furthermore, C4-ana increased the permeability of a monolayer of BEC in vitro. Our findings are consistent with a specific role for C4A protein in schizophrenia and raise the possibility that its activation product, C4-ana, increases BBB permeability. Exploratory analyses suggest the novel hypothesis that the relationship between C4-ana levels and C4A gene copy number could also be altered in iSCZ, suggesting an interaction with unknown genetic and/or environmental risk factors.
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Affiliation(s)
- Agnieszka Kalinowski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Joanna Liliental
- Translational Applications Service Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Translational Research and Applied Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Lauren A Anker
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Omer Linkovski
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Collin Culbertson
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jacob N Hall
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, 94305, USA
- The Neurology Center of Southern California, Temecula, CA, 92592, USA
| | - Reenal Pattni
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Chiara Sabatti
- Department of Biomedical Data Science and Statistics, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Douglas Noordsy
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Joachim F Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Elizabeth D Mellins
- Department of Pediatrics, Stanford Program in Immunology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Jacob S Ballon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
- Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Alexander E Urban
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
- Department of Genetics, Stanford University School of Medicine, Stanford, CA, 94305, USA.
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16
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Bunning B, Hedlin H, Purington N, Sundaram V, Kapphahn K, Weng Y, Cunanan K, Maldonado Y, Singh U, Khosla C, O'Hara R, Nicolls M, Springman E, Parsonnet J, Rogers A, Levitt J, Desai M. The COVID-19 Outpatient Pragmatic Platform Study (COPPS): Study design of a multi-center pragmatic platform trial. Contemp Clin Trials 2021; 108:106509. [PMID: 34274494 PMCID: PMC8282451 DOI: 10.1016/j.cct.2021.106509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022]
Abstract
More than 3000 clinical trials related to COVID-19 have been registered through clinicaltrials.gov. With so many trials, there is a risk that many will be inconclusive due to being underpowered or due to an inability to recruit patients. At academic medical centers, multiple trials are competing for the same resources; the success of one may come at the expense of another. The COVID-19 Outpatient Pragmatic Protocol Study (COPPS) is a flexible phase 2, multi-site, randomized, blinded trial based at Stanford University designed to overcome these issues by simultaneously evaluating multiple COVID-19 treatments in the outpatient setting in one common platform with shared controls. This approach reduces the overall number of patients required for statistical power, while improving the likelihood that any enrolled patient receives active treatment. The platform study has two main domains designed to evaluate COVID-19 treatments by assessing their ability to reduce viral shedding (Viral Domain), measured with self-collected nasal swabs, or improve clinical outcomes (Clinical Domain), measured through self-reported symptomology data. Data are collected on both domains for all participants enrolled. Participants are followed over a 28-day period. COPPS has the advantage of pragmatism created around its workflow that is also appealing to potential participants because of a lower probability of inactive treatment. At the conclusion of this clinical trial we expect to have identified potentially effective therapeutic strategy/ies for treating COVID-19 in the outpatient setting, which will have a transformative impact on medicine and public health.
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Affiliation(s)
- Bryan Bunning
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Natasha Purington
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Kristen Cunanan
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Yvonne Maldonado
- Divison of Infectious Diseases, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Upinder Singh
- Divison of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Chaitan Khosla
- Department of Chemical Engineering, Stanford Unviersity, Stanford, CA, USA; Stanford ChEM-H, Stanford University, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Mark Nicolls
- Divison of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Julie Parsonnet
- Divison of Infectious Diseases, Department of Medicine, Stanford University, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Angela Rogers
- Divison of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Joseph Levitt
- Divison of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University, Palo Alto, CA, USA.
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17
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Schüssler-Fiorenza Rose SM, Bott NT, Heinemeyer EE, Hantke NC, Gould CE, Hirst RB, Jordan JT, Beaudreau SA, O'Hara R. Depression, health comorbidities, cognitive symptoms and their functional impact: Not just a geriatric problem. J Psychiatr Res 2021; 139:185-192. [PMID: 34087515 PMCID: PMC8253546 DOI: 10.1016/j.jpsychires.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 04/16/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the prevalence of cognitive symptoms and their functional impact by age group accounting for depression and number of other health conditions. METHODS We analyzed data from the 2011 Behavioral Risk Factor Surveillance System, a population-based, cross-sectional telephone survey of US adults. Twenty-one US states asked participants (n = 131, 273) about cognitive symptoms (worsening confusion or memory loss in the past year) and their functional impact (interference with activities and need for assistance). We analyzed the association between age, depression history and cognitive symptoms and their functional impact using logistic regression and adjusted for demographic characteristics and other health condition count. RESULTS There was a significant interaction between age and depression (p < 0.0001). In adults reporting depression, the adjusted odds of cognitive symptoms in younger age groups (<75 years) were comparable or greater to those in the oldest age group (≥75 years) with a peak in the middle age (45-54 years) group (OR 1.9 (95% Confidence Interval: 1.4-2.5). In adults without depression, adults <75 years had a significantly lower adjusted odds of cognitive symptoms compared to the oldest age group with the exception of the middle-aged group where the difference was not statistically significant. Over half of adults under age 65 with depression reported that cognitive symptoms interfered with life activities compared to 35.7% of adults ≥65 years. CONCLUSIONS Cognitive symptoms are not universally higher in older adults; middle-aged adults are also particularly vulnerable. Given the adverse functional impact associated with cognitive symptoms in younger adults, clinicians should assess cognitive symptoms and their functional impact in adults of all ages and consider treatments that impact both cognition and functional domains.
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Affiliation(s)
| | - Nicholas T Bott
- Clinical Excellence Research Center, Stanford University School of Medicine, 365 Lasuen St, Stanford, CA, 94305, USA
| | - Erin E Heinemeyer
- PGSP-Stanford PsyD Consortium, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, USA
| | - Nathan C Hantke
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA; Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Christine E Gould
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA; Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA
| | - Rayna B Hirst
- School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA
| | - Joshua T Jordan
- Department of Psychology, Domincan University of California, 50 Acacia Avenue, San Rafael, CA, 94901, USA
| | - Sherry A Beaudreau
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA; School of Psychology, University of Queensland, Brisbane, QLD, 4072, Australia
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, USA; School of Psychology, University of Queensland, Brisbane, QLD, 4072, Australia
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18
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Gozdas E, Fingerhut H, Wu H, Bruno JL, Dacorro L, Jo B, O'Hara R, Reiss AL, Hosseini SMH. Quantitative measurement of macromolecular tissue properties in white and gray matter in healthy aging and amnestic MCI. Neuroimage 2021; 237:118161. [PMID: 34000394 DOI: 10.1016/j.neuroimage.2021.118161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022] Open
Abstract
Healthy and pathological aging influence brain microstructure via complex processes. Discerning these processes requires measurements that are sensitive to specific biological properties of brain tissue. We integrated a novel quantitative R1 measure with multi-shell diffusion weighted imaging to map age-associated changes in macromolecular tissue volume (MTV) along major white matter tracts in healthy older adults and patients with amnestic Mild Cognitive Impairment (aMCI). Reduced MTV in association tracts was associated with older age in healthy aging, was correlated with memory performance, and distinguished aMCI from controls. We also mapped changes in gray matter tissue properties using quantitative R1 measurements. We documented a widespread decrease in R1 with advancing age across the cortex and decreased R1 in aMCI compared with controls in regions implicated in episodic memory. Our data are the first to characterize MTV loss along major white matter tracts in aMCI and suggest that qMRI is a sensitive measure for detecting subtle degeneration of white and gray matter tissue that cannot be detected by conventional MRI and diffusion measures.
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Affiliation(s)
- Elveda Gozdas
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.
| | - Hannah Fingerhut
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Hua Wu
- Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, CA, United States
| | - Jennifer L Bruno
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Lauren Dacorro
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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19
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Newkirk LA, Dao VL, Jordan JT, Alving LI, Davies HD, Hewett L, Beaudreau SA, Schneider LD, Gould CE, Chick CF, Hirst RB, Rose SMSF, Anker LA, Tinklenberg JR, O'Hara R. Factors Associated with Supportive Care Service Use Among California Alzheimer's Disease Patients and Their Caregivers. J Alzheimers Dis 2021; 73:77-86. [PMID: 31743997 DOI: 10.3233/jad-190438] [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] [Indexed: 01/07/2023]
Abstract
BACKGROUND Existing literature on factors associated with supportive care service (SCS) use is limited. A better understanding of these factors could help tailor SCS to the needs of frequent users, as well as facilitate targeted outreach to populations that underutilize available services. OBJECTIVE To investigate the prevalence of SCS use and to identify factors associated with, and barriers to, service use. METHODS California Alzheimer's Disease Center patients with AD (n = 220) participated in the study from 2006-2009. Patients and their caregivers completed assessments to determine SCS use. Cognitive, functional, and behavioral status of the patients were also assessed. A two-part hurdle analysis identified 1) factors associated with any service use and 2) service use frequency among users. RESULTS Forty percent of participants reported using at least one SCS. Patients with more impaired cognition and activities of daily living and more of the following: total number of medications, comorbid medical conditions, and years of education were more likely to use any SCS (p < 0.05). Factors associated with more frequent SCS use included younger age, more years of education, older age of AD onset, female gender, and having a spouse or relative for a caregiver (p < 0.05). Caregivers frequently indicated insufficient time as a reason for not receiving enough services. CONCLUSION Factors associated with any SCS use mostly differed from those associated with SCS frequency, suggesting different characteristics between those who initiate versus those who continue SCS use. Our findings highlight the importance of targeted education on services and identifying barriers to long-term SCS use.
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Affiliation(s)
- Lori A Newkirk
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Virginia L Dao
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA
| | - Joshua T Jordan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Loren I Alving
- California Alzheimer's Disease Center, University of California San Francisco at Fresno, Fresno, CA, USA
| | - Helen D Davies
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Linda Hewett
- California Alzheimer's Disease Center, University of California San Francisco at Fresno, Fresno, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Logan D Schneider
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Geriatric Research Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christina F Chick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | - Rayna B Hirst
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | | | - Lauren A Anker
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jared R Tinklenberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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20
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Fockler J, Kwang W, Ashford MT, Flenniken D, Hwang J, Truran D, Mackin RS, Jin C, O'Hara R, Hallmayer JF, Yesavage JA, Weiner MW, Nosheny RL. Brain health registry GenePool study: A novel approach to online genetics research. Alzheimers Dement (N Y) 2021; 7:e12118. [PMID: 33614891 PMCID: PMC7882536 DOI: 10.1002/trc2.12118] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
Introduction Remote data collection, including the establishment of online registries, is a novel approach to efficiently identify risk for cognitive decline and Alzheimer's disease (AD) in older adults, with growing evidence for feasibility and validity. Addition of genetic data to online registries has the potential to facilitate identification of older adults at risk and to advance the understanding of genetic contributions to AD. Methods 573 older adult participants with longitudinal online Brain Health Registry (BHR) data underwent apolipoprotein E (APOE) genotyping using remotely collected saliva samples and a novel, automated Biofluid Collection Management Portal. We evaluated acceptability of genetic sample collection and estimated associations between (1) sociodemographic variables and willingness to participate in genetics research and (2) APOE results and online cognitive and functional assessments. We also assessed acceptance of hypothetical genetics research participation by surveying a larger sample of 25,888 BHR participants. Results 51% of invited participants enrolled in the BHR genetics study, BHR‐GenePool Study (BHR‐GPS); 27% of participants had at least one APOE ε4 allele. Older participants and those with higher educational attainment were more likely to participate. In the remotely administered Cogstate Brief Battery, APOE ε4/ε4 homozygotes (HM) had worse online learning scores, and greater decline in processing speed and attention, compared to ε3/ε4 heterozygotes (HT) and ε4 non‐carriers (NC). Discussion APOE genotyping of more than 500 older adults enrolled in BHR supports the feasibility and validity of a novel, remote biofluids collection approach from a large cohort of older adults, with data linkage to longitudinal online cognitive data. This approach can be expanded for efficient collection of genetic data and other information from biofluids in the future.
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Affiliation(s)
- Juliet Fockler
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Winnie Kwang
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Miriam T Ashford
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Derek Flenniken
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Joshua Hwang
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Diana Truran
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - R Scott Mackin
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Psychiatry University of California, San Francisco San Francisco California USA
| | - Chengshi Jin
- San Francisco Department of Biostatistics and Epidemiology University of California, San Francisco San Francisco California USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences Stanford University Stanford California USA
| | - Joachim F Hallmayer
- Department of Psychiatry and Behavioral Sciences Stanford University Stanford California USA
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences Stanford University Stanford California USA
| | - Michael W Weiner
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California USA
| | - Rachel L Nosheny
- VA Advanced Imaging Research Center San Francisco Veteran's Administration Medical Center San Francisco California USA.,San Francisco Department of Psychiatry University of California, San Francisco San Francisco California USA
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21
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Kawai M, Schneider LD, Linkovski O, Jordan JT, Karna R, Pirog S, Cotto I, Buck C, Giardino WJ, O'Hara R. High-Resolution Spectral Sleep Analysis Reveals a Novel Association Between Slow Oscillations and Memory Retention in Elderly Adults. Front Aging Neurosci 2021; 12:540424. [PMID: 33505299 PMCID: PMC7829345 DOI: 10.3389/fnagi.2020.540424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Objective: In recognition of the mixed associations between traditionally scored slow wave sleep and memory, we sought to explore the relationships between slow wave sleep, electroencephalographic (EEG) power spectra during sleep and overnight verbal memory retention in older adults. Design, Setting, Participants, and Measurements: Participants were 101 adults without dementia (52% female, mean age 70.3 years). Delayed verbal memory was first tested in the evening prior to overnight polysomnography (PSG). The following morning, subjects were asked to recall as many items as possible from the same List (overnight memory retention; OMR). Partial correlation analyses examined the associations of delayed verbal memory and OMR with slow wave sleep (SWS) and two physiologic EEG slow wave activity (SWA) power spectral bands (0.5-1 Hz slow oscillations vs. 1-4 Hz delta activity). Results: In subjects displaying SWS, SWS was associated with enhanced delayed verbal memory, but not with OMR. Interestingly, among participants that did not show SWS, OMR was significantly associated with a higher slow oscillation relative power, during NREM sleep in the first ultradian cycle, with medium effect size. Conclusions: These findings suggest a complex relationship between SWS and memory and illustrate that even in the absence of scorable SWS, older adults demonstrate substantial slow wave activity. Further, these slow oscillations (0.5-1 Hz), in the first ultradian cycle, are positively associated with OMR, but only in those without SWS. Our findings raise the possibility that precise features of slow wave activity play key roles in maintaining memory function in healthy aging. Further, our results underscore that conventional methods of sleep evaluation may not be sufficiently sensitive to detect associations between SWA and memory in older adults.
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Affiliation(s)
- Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Logan D. Schneider
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Omer Linkovski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Josh T. Jordan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
- Department of Psychology, Dominican University of California, San Rafael, CA, United States
| | - Rosy Karna
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Sophia Pirog
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Casey Buck
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - William J. Giardino
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, United States
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22
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Khan TA, Revah O, Gordon A, Yoon SJ, Krawisz AK, Goold C, Sun Y, Kim CH, Tian Y, Li MY, Schaepe JM, Ikeda K, Amin ND, Sakai N, Yazawa M, Kushan L, Nishino S, Porteus MH, Rapoport JL, Bernstein JA, O'Hara R, Bearden CE, Hallmayer JF, Huguenard JR, Geschwind DH, Dolmetsch RE, Paşca SP. Neuronal defects in a human cellular model of 22q11.2 deletion syndrome. Nat Med 2020; 26:1888-1898. [PMID: 32989314 PMCID: PMC8525897 DOI: 10.1038/s41591-020-1043-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/30/2020] [Indexed: 11/09/2022]
Abstract
22q11.2 deletion syndrome (22q11DS) is a highly penetrant and common genetic cause of neuropsychiatric disease. Here we generated induced pluripotent stem cells from 15 individuals with 22q11DS and 15 control individuals and differentiated them into three-dimensional (3D) cerebral cortical organoids. Transcriptional profiling across 100 days showed high reliability of differentiation and revealed changes in neuronal excitability-related genes. Using electrophysiology and live imaging, we identified defects in spontaneous neuronal activity and calcium signaling in both organoid- and 2D-derived cortical neurons. The calcium deficit was related to resting membrane potential changes that led to abnormal inactivation of voltage-gated calcium channels. Heterozygous loss of DGCR8 recapitulated the excitability and calcium phenotypes and its overexpression rescued these defects. Moreover, the 22q11DS calcium abnormality could also be restored by application of antipsychotics. Taken together, our study illustrates how stem cell derived models can be used to uncover and rescue cellular phenotypes associated with genetic forms of neuropsychiatric disease.
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Affiliation(s)
- Themasap A Khan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Program in Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA, USA
| | - Omer Revah
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Aaron Gordon
- Program in Neurogenetics, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Se-Jin Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Anna K Krawisz
- Department of Neurobiology, Stanford University, Stanford, CA, USA
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carleton Goold
- Department of Neurobiology, Stanford University, Stanford, CA, USA
| | - Yishan Sun
- Department of Neurobiology, Stanford University, Stanford, CA, USA
| | - Chul Hoon Kim
- Department of Neurobiology, Stanford University, Stanford, CA, USA
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuan Tian
- Program in Neurogenetics, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Interdepartmental PhD Program in Bioinformatics, University of California Los Angeles, Los Angeles, CA, USA
| | - Min-Yin Li
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Julia M Schaepe
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Kazuya Ikeda
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Neal D Amin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Noriaki Sakai
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Masayuki Yazawa
- Department of Neurobiology, Stanford University, Stanford, CA, USA
- Columbia Stem Cell Initiative, Department of Rehabilitation and Regenerative Medicine, Department of Molecular Pharmacology and Therapeutics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Seiji Nishino
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - Judith L Rapoport
- National Institute of Mental Health, Child Psychiatry Branch, Bethesda, MD, USA
| | | | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Joachim F Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - John R Huguenard
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Daniel H Geschwind
- Program in Neurogenetics, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Center for Autism Research and Treatment, Semel Institute, University of California Los Angeles, Los Angeles, CA, USA
- Institute of Precision Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Sergiu P Paşca
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Stanford Brain Organogenesis Program, Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA.
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23
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Dixon F, O'Hara R, Ghuman N, Strachan J, Khanna A, Keeler BD. Major colorectal resection is feasible using a new robotic surgical platform: the first report of a case series. Tech Coloproctol 2020; 25:285-289. [PMID: 33156413 PMCID: PMC7645403 DOI: 10.1007/s10151-020-02366-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022]
Abstract
Background The number of abdominal procedures performed via a robotic-assisted approach is increasing as potential advantages of the modality are recognised. We report the first in human case series of major colorectal resection performed using a new system, Versius®, and assess the feasibility of its use. Methods The initial cases performed using Versius® at a single centre in the UK were included in the study. Anonymised data were prospectively collected including patient demographics, operative details and postoperative outcomes. Results Twenty-three operations were performed, including left (n = 14) and right (n = 9)-sided colonic resections. Rectal mobilisation was performed in 13. Fifty-seven percent of the patients were male, with a malignant indication for surgery in 70% of cases. Overall mean age was 59.1 ± 15.3 (range 23–89) years. Overall mean body mass index was 28.9 ± 5.2 with a mean of 31.3 ± 4.5 for left-sided resections. The median console operating time was 166 min (range 75–320 min). All malignant cases had negative resection margins and the mean lymph node yield was 18 (SD 9.4). Only one operation (4%) was converted from robotic to open approach. Postoperative length of stay was a median of 5 days (range 3–34 days) and there were no readmissions within 30 days. Conclusions These results compare favourably with the literature on existing robotic systems and also conventional laparoscopic surgery; hence, we believe that this series indicates the Versius® system is feasible for use in major colorectal resection. These early results from a robot-naïve centre show exciting promise for an expanding robotic market and highlight the need for further evaluation.
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Affiliation(s)
- F Dixon
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - R O'Hara
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - N Ghuman
- Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - J Strachan
- Department of Anaesthetics, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - A Khanna
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - B D Keeler
- Department of Surgery, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, MK6 5LD, UK.
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24
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Gozdas E, Fingerhut H, Chromik LC, O'Hara R, Reiss AL, Hosseini SMH. Focal white matter disruptions along the cingulum tract explain cognitive decline in amnestic mild cognitive impairment (aMCI). Sci Rep 2020; 10:10213. [PMID: 32576866 PMCID: PMC7311416 DOI: 10.1038/s41598-020-66796-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/27/2020] [Indexed: 12/11/2022] Open
Abstract
White matter abnormalities of the human brain are implicated in typical aging and neurodegenerative diseases. However, our understanding of how fine-grained changes in microstructural properties along white matter tracts are associated with memory and cognitive decline in normal aging and mild cognitive impairment remains elusive. We quantified tract profiles with a newer method that can reliably measure fine-grained changes in white matter properties along the tracts using advanced multi-shell diffusion magnetic resonance imaging in 25 patients with amnestic mild cognitive impairment (aMCI) and 23 matched healthy controls (HC). While the changes in tract profiles were parallel across aMCI and HC, we found a significant focal shift in the profile at specific locations along major tracts sub-serving memory in aMCI. Particularly, our findings depict white matter alterations at specific locations on the right cingulum cingulate, the right cingulum hippocampus and anterior corpus callosum (CC) in aMCI compared to HC. Notably, focal changes in white matter tract properties along the cingulum tract predicted memory and cognitive functioning in aMCI. The results suggest that white matter disruptions at specific locations of the cingulum bundle may be a hallmark for the early prediction of Alzheimer’s disease and a predictor of cognitive decline in aMCI.
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Affiliation(s)
- Elveda Gozdas
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Hannah Fingerhut
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lindsay C Chromik
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
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25
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Etkin A, Maron-Katz A, Wu W, Fonzo GA, Huemer J, Vértes PE, Patenaude B, Richiardi J, Goodkind MS, Keller CJ, Ramos-Cejudo J, Zaiko YV, Peng KK, Shpigel E, Longwell P, Toll RT, Thompson A, Zack S, Gonzalez B, Edelstein R, Chen J, Akingbade I, Weiss E, Hart R, Mann S, Durkin K, Baete SH, Boada FE, Genfi A, Autea J, Newman J, Oathes DJ, Lindley SE, Abu-Amara D, Arnow BA, Crossley N, Hallmayer J, Fossati S, Rothbaum BO, Marmar CR, Bullmore ET, O'Hara R. Using fMRI connectivity to define a treatment-resistant form of post-traumatic stress disorder. Sci Transl Med 2020; 11:11/486/eaal3236. [PMID: 30944165 DOI: 10.1126/scitranslmed.aal3236] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/01/2018] [Accepted: 11/07/2018] [Indexed: 12/14/2022]
Abstract
A mechanistic understanding of the pathology of psychiatric disorders has been hampered by extensive heterogeneity in biology, symptoms, and behavior within diagnostic categories that are defined subjectively. We investigated whether leveraging individual differences in information-processing impairments in patients with post-traumatic stress disorder (PTSD) could reveal phenotypes within the disorder. We found that a subgroup of patients with PTSD from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) as revealed by functional magnetic resonance imaging (fMRI) neuroimaging and impaired verbal memory on a word list learning task. This combined phenotype was not associated with differences in symptoms or comorbidities, but nonetheless could be used to predict a poor response to psychotherapy, the best-validated treatment for PTSD. Using concurrent focal noninvasive transcranial magnetic stimulation and electroencephalography, we then identified alterations in neural signal flow in the VAN that were evoked by direct stimulation of that network. These alterations were associated with individual differences in functional fMRI connectivity within the VAN. Our findings define specific neurobiological mechanisms in a subgroup of patients with PTSD that could contribute to the poor response to psychotherapy.
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Affiliation(s)
- Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA. .,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Adi Maron-Katz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Wei Wu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong 510640, China
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Julia Huemer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Petra E Vértes
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,School of Mathematical Sciences, Queen Mary University of London, London E1 4NS, UK.,The Alan Turing Institute, London NW1 2DB, UK
| | - Brian Patenaude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jonas Richiardi
- Department of Medical Radiology, Lausanne University Hospital, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Madeleine S Goodkind
- New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Corey J Keller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jaime Ramos-Cejudo
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Yevgeniya V Zaiko
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Kathy K Peng
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Emmanuel Shpigel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Parker Longwell
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Russ T Toll
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Allison Thompson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Sanno Zack
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Bryan Gonzalez
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Raleigh Edelstein
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jingyun Chen
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Irene Akingbade
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Elizabeth Weiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Roland Hart
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Silas Mann
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Kathleen Durkin
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Steven H Baete
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,New Mexico Veterans Affairs Healthcare System, Albuquerque, NM 87108, USA.,Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - Fernando E Boada
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), NYU School of Medicine, New York, NY 10016, USA.,Center for Biomedical Imaging, Department of Radiology, NYU School of Medicine, New York, NY 10016, USA
| | - Afia Genfi
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jillian Autea
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA.,Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Jennifer Newman
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Desmond J Oathes
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Steven E Lindley
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Duna Abu-Amara
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Bruce A Arnow
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Nicolas Crossley
- Department of Psychiatry, School of Medicine, Pontificia Universidad Católica de Chile, 6513677 Santiago, Chile.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Wu Tsai Neurosciences Institute at Stanford, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
| | - Silvia Fossati
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Barbara O Rothbaum
- Trauma and Anxiety Recovery Program, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Charles R Marmar
- Steven and Alexandra Cohen Veterans Center for Post-traumatic Stress and Traumatic Brain Injury, New York University Langone School of Medicine, New York, NY 10016, USA.,Department of Psychiatry, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Edward T Bullmore
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge CB2 0SZ, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge CB21 5EF, UK.,ImmunoPsychiatry, Alternative Discovery and Development, GlaxoSmithKline, Stevenage SG1 2NY, UK
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA.,Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94394, USA
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26
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Hantke N, Lajoy M, Gould CE, Magwene EM, Sordahl J, Hirst R, O'Hara R. Patient Satisfaction With Geriatric Psychiatry Services via Video Teleconference. Am J Geriatr Psychiatry 2020; 28:491-494. [PMID: 31530457 DOI: 10.1016/j.jagp.2019.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective for the current study is to examine patient satisfaction with geropsychiatry services provided via video telehealth. METHODS Participants included community-dwelling older Veterans receiving geriatric psychiatry services via telehealth across regions of the Pacific Northwest and Southwestern United States. Participants completed a paper-based survey examining satisfaction with services following the completion of two medication management visits with a geropsychiatrist. RESULTS The majority of participants (90%) reported liking or even preferring geriatric telepsychiatry, despite the experience being novel for the majority of patients. Eighty-three percent of participants reported that receiving telegeropsychiatry services was the same (n = 30) or better (n = 3) than being seen in-person. Participants saved an average of 168 driving miles (means and standard deviations = 59.2; range 2-480) each visit. CONCLUSION The findings of the current study suggest that older adults accept and are broadly satisfied with telegeropsychiatry services. This modality of care increased access to specialty care and decreased travel hardship.
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Affiliation(s)
- Nathan Hantke
- Department of Neurology (NH), Oregon Health and Science University, Portland, OR; Department of Psychiatry (NH, ML), Oregon Health and Science University, Portland, OR; Mental Health and Clinical Neurosciences Division (NH), Veterans Affairs Portland Health Care System, Portland, OR.
| | - M Lajoy
- Department of Psychiatry (NH, ML), Oregon Health and Science University, Portland, OR; Western Telemental Health Network (ML), Veteran Affairs Portland Health Care System, Portland, OR
| | - Christine E Gould
- Department of Psychiatry & Behavioral Sciences (CEG, RO'H), Stanford University School of Medicine, Stanford, CA; Geriatric Research Education and Clinical Center (GRECC) (CEG), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Elena M Magwene
- Veteran Affairs Puget Sound Health Care System (EMM), Seattle, WA
| | - J Sordahl
- Boise Veteran Affairs Medical Center (JS), Boise, ID
| | - R Hirst
- Palo Alto University (RH), Palo Alto, CA
| | - R O'Hara
- Department of Psychiatry & Behavioral Sciences (CEG, RO'H), Stanford University School of Medicine, Stanford, CA; Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC) (RO'H), Veteran Affairs Palo Alto Health Care System, Palo Alto, CA; School of Psychology (RO'H), University of Queensland, Brisbane, Queensland, Australia
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Gould CE, Loup J, Kuhn E, Beaudreau SA, Ma F, Goldstein MK, Wetherell JL, Zapata AML, Choe P, O'Hara R. Technology use and preferences for mental health self-management interventions among older veterans. Int J Geriatr Psychiatry 2020; 35:321-330. [PMID: 31854029 DOI: 10.1002/gps.5252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/07/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The United States Department of Veterans Affairs offers numerous technology-delivered interventions to self-manage mental health problems. It is unknown, however, what barriers older military veterans face to using these technologies and how willing they would be to use technologies for mental health concerns. METHODS Seventy-seven veterans (Mage = 69.16 years; SD = 7.10) completed interviews in a concurrent mixed methods study. Interviewers asked about technology ownership and described four modalities of delivering self-management interventions: printed materials, DVDs, Internet, and mobile apps. Interviewers obtained feedback about each modality's benefits, barriers, and facilitators. Participants ranked their self-management modalities preferences alone and compared with counseling. Multivariable adjusted logistic regression and qualitative analyses were conducted to investigate the reasons contributing to preferences. RESULTS Most reported owning a computer (84.4%), having home Internet (80.5%), and a smartphone (70.1%). Participants preferred printed materials (35.1%) over mobile apps (28.6%), Internet (24.7%), and DVDs (13.0%). Lower computer proficiency was associated with preferring DVDs; higher proficiency was associated with Internet and mobile interventions. Residing in an urban area was associated with mobile apps. When counseling was an option, 66% identified this as their first preference. Qualitative findings showed veterans' desire for information, training, and provider support with technology. CONCLUSIONS Older veterans reported high technology ownership rates but varied preferences for self-management interventions. Notably, two-thirds preferred some form of technology, which points to the importance of ensuring that providers offer existing technology-delivered interventions to older veterans. Veterans' strong preference for counseling emphasizes the need for human support alongside self-management.
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Affiliation(s)
- Christine E Gould
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Julia Loup
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eric Kuhn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Flora Ma
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Mary K Goldstein
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Stanford University, Center for Primary Care and Outcomes Research (PCOR), Stanford, CA, USA
| | - Julie Loebach Wetherell
- Psychology Service, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA
| | - Aimee Marie L Zapata
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Philip Choe
- Palo Alto Geriatric Research, Education, and Clinical Center (GRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA, USA
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Affiliation(s)
- Sharon Naparstek
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif.; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Omer Linkovski
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif.; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, Calif
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif.; Sierra-Pacific Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, Calif
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Naparstek S, El-Said D, Eisenberg ML, Jordan JT, O'Hara R, Etkin A. Development of VM-REACT: Verbal memory RecAll computerized test. J Psychiatr Res 2019; 114:170-177. [PMID: 31096177 DOI: 10.1016/j.jpsychires.2019.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/15/2022]
Abstract
When tracking the progression of neuropsychiatric or neurodegenerative diseases, assessment tools that enable repeated measures of cognition and require little examiner burden are increasingly important to develop. In the current study, we describe the development of the VM-REACT (Verbal Memory REcAll Computerized Test), which assesses verbal memory recall abilities using a computerized, automated version. Four different list versions of the test were applied on a cohort of 798 healthy adults (ages 20-80). Recall and learning scores were computed and compared to existing gender- and age-matched published norms for a similar paper-and-pencil test. Performance was similar to existing age-matched norms for all but the two oldest age groups. These adults (ages 60-80) outperformed their age-matched norms. Processing speed, initiation speed, and number of recall errors are also reported for each age group. Our findings suggest that VM-REACT can be utilized to study verbal memory abilities in a standardized and time efficient manner, and thus holds great promise for assessment in the 21st century.
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Affiliation(s)
- Sharon Naparstek
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Dawlat El-Said
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Michelle L Eisenberg
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Joshua T Jordan
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Department of Psychiatry, University of California, San Francisco, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, 94304, USA
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, 94304, USA; Sierra Pacific Mental Illness, Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, 94304, USA.
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Gould CE, Spira AP, Liou-Johnson V, Cassidy-Eagle E, Kawai M, Mashal N, O'Hara R, Beaudreau SA. Association of Anxiety Symptom Clusters with Sleep Quality and Daytime Sleepiness. J Gerontol B Psychol Sci Soc Sci 2019; 73:413-420. [PMID: 28379498 DOI: 10.1093/geronb/gbx020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives To better understand links between anxiety and sleep disturbances in older adults, we examined the association of different phenotypic presentations of anxiety (i.e., affective, cognitive, and somatic clusters) with global sleep quality and daytime sleepiness. Methods 109 community-dwelling adults aged 66-92 years old (57% female) completed assessments of global sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), affective anxiety symptoms (Geriatric Anxiety Scale (GAS) affective subscale), cognitive anxiety symptoms (GAS cognitive subscale), and somatic anxiety symptoms (GAS somatic subscale). Results In hierarchical regression models adjusted for depressive symptoms and health status, greater affective and somatic anxiety were associated with poorer global sleep quality (affective B = 0.30, p = .01; somatic B = 0.41, p = .01). Somatic and cognitive anxiety were associated with greater daytime sleepiness (somatic B = 0.74, p < .001; cognitive B = 0.30, p = .03), but these associations were attenuated by covariates added to the models. Discussion These findings indicate that anxiety symptom clusters are differentially associated with specific sleep-related disturbances, underscoring the complex relationship of late-life anxiety to sleep. Results suggest that personalized treatments, such as targeted sleep interventions, may improve specific anxiety-symptom domains, or vice versa.
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Affiliation(s)
- Christine E Gould
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Palo Alto Health Care System, California.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
| | - Adam P Spira
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Victoria Liou-Johnson
- Pacific Graduate School of Psychology, Palo Alto University, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, California
| | - Erin Cassidy-Eagle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
| | - Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, California
| | - Nehjla Mashal
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, California
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, California
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), Veterans Affairs Palo Alto Health Care System, California
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Pașca AM, Park JY, Shin HW, Qi Q, Revah O, Krasnoff R, O'Hara R, Willsey AJ, Palmer TD, Pașca SP. Human 3D cellular model of hypoxic brain injury of prematurity. Nat Med 2019; 25:784-791. [PMID: 31061540 PMCID: PMC7020938 DOI: 10.1038/s41591-019-0436-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/25/2019] [Indexed: 12/20/2022]
Abstract
Owing to recent medical and technological advances in neonatal care, infants born extremely premature have increased survival rates1,2. After birth, these infants are at high risk of hypoxic episodes because of lung immaturity, hypotension and lack of cerebral-flow regulation, and can develop a severe condition called encephalopathy of prematurity3. Over 80% of infants born before post-conception week 25 have moderate-to-severe long-term neurodevelopmental impairments4. The susceptible cell types in the cerebral cortex and the molecular mechanisms underlying associated gray-matter defects in premature infants remain unknown. Here we used human three-dimensional brain-region-specific organoids to study the effect of oxygen deprivation on corticogenesis. We identified specific defects in intermediate progenitors, a cortical cell type associated with the expansion of the human cerebral cortex, and showed that these are related to the unfolded protein response and changes. Moreover, we verified these findings in human primary cortical tissue and demonstrated that a small-molecule modulator of the unfolded protein response pathway can prevent the reduction in intermediate progenitors following hypoxia. We anticipate that this human cellular platform will be valuable for studying the environmental and genetic factors underlying injury in the developing human brain.
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Affiliation(s)
- Anca M Pașca
- Department of Pediatrics, Division of Neonatology, Stanford University, Stanford, CA, USA
| | - Jin-Young Park
- Department of Psychiatry and Behavioral Sciences & Stanford Human Brain Organogenesis Program, Stanford University, Stanford, CA, USA
| | - Hyun-Woo Shin
- Department of Psychiatry and Behavioral Sciences & Stanford Human Brain Organogenesis Program, Stanford University, Stanford, CA, USA
- Department of Pharmacology and Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Qihao Qi
- Institute for Neurodegenerative Diseases and Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Omer Revah
- Department of Psychiatry and Behavioral Sciences & Stanford Human Brain Organogenesis Program, Stanford University, Stanford, CA, USA
| | - Rebecca Krasnoff
- Institute for Neurodegenerative Diseases and Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences & Stanford Human Brain Organogenesis Program, Stanford University, Stanford, CA, USA
| | - A Jeremy Willsey
- Institute for Neurodegenerative Diseases and Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Theo D Palmer
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Sergiu P Pașca
- Department of Psychiatry and Behavioral Sciences & Stanford Human Brain Organogenesis Program, Stanford University, Stanford, CA, USA.
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Kawai M, Schneider L, O'Hara R. 0271 Ultradian Cycle Of Slow-Wave Activity In Older Adults. Sleep 2019. [DOI: 10.1093/sleep/zsz067.270] [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: 11/14/2022] Open
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Beaudreau SA, Jordan JT, O'Hara R. Commentary on "High Occurrence of Psychiatric Disorders and Suicidal Behavior Across Dementia Subtypes". Am J Geriatr Psychiatry 2018; 26:1202-1203. [PMID: 30401607 DOI: 10.1016/j.jagp.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Sherry A Beaudreau
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (SAB, RO), VA Palo Alto Health Care System, Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (SAB, RO), Stanford University School of Medicine, Stanford, CA; School of Psychology (SAB), University of Queensland, Brisbane, Australia.
| | - Joshua T Jordan
- Department of Psychiatry (JTJ), University of California, CA
| | - Ruth O'Hara
- Sierra Pacific Mental Illness Research, Education and Clinical Centers (SAB, RO), VA Palo Alto Health Care System, Palo Alto, CA; Department of Psychiatry and Behavioral Sciences (SAB, RO), Stanford University School of Medicine, Stanford, CA
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Zapata AML, Beaudreau SA, O'Hara R, Bereknyei Merrell S, Bruce J, Garrison-Diehn C, Gould CE. Information-Seeking about Anxiety and Perceptions about Technology to Teach Coping Skills in Older Veterans. Clin Gerontol 2018; 41:346-356. [PMID: 28967837 DOI: 10.1080/07317115.2017.1359716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills. METHODS Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology. RESULTS Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability. CONCLUSION Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans. CLINICAL IMPLICATIONS Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.
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Affiliation(s)
- Aimee Marie L Zapata
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,b Pacific Graduate School of Psychology , Palo Alto University , Palo Alto , California , USA
| | - Sherry A Beaudreau
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Ruth O'Hara
- c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Sierra Pacific Mental Illness Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA
| | - Sylvia Bereknyei Merrell
- e Department of Medicine, Division of General Medical Disciplines , Stanford University School of Medicine , Stanford , California , USA
| | - Janine Bruce
- f Department of Pediatrics, Division of General Pediatrics , Stanford University School of Medicine , Stanford , California , USA
| | - Christina Garrison-Diehn
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Christine E Gould
- a Palo Alto Geriatric Research, Education, and Clinical Center , VA Palo Alto Health Care System , Palo Alto , California , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
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Cassidy-Eagle E, Siebern A, Unti L, Glassman J, O'Hara R. Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group. Clin Gerontol 2018; 41:136-144. [PMID: 29220627 DOI: 10.1080/07317115.2017.1384777] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Improving the sleep of older adults with mild cognitive impairment (MCI) represents a first step in discovering whether interventions directed at modifying this risk factor also have the potential to alter the cognitive decline trajectory. METHODS A six-session, adapted version of a cognitive behavioral therapy for insomnia (CBT-I) was administered to older adults (N = 28; 14 per group) with MCI across two residential facilities. Participants were randomly assigned to either the sleep intervention or an active control group and completed a neuropsychological battery at three time points (e.g., baseline-T1, post-intervention-T2, 4 month follow-up-T3). RESULTS Results showed a significant improvement in sleep and a change (p < .05) on a key measure of executive functioning sub task of inhibition (Condition 3 of D-KEF Color-Word Interference Test), a positive trend on the inhibition-switching task (p < .10; Condition 4 of D-KEF Color-Word Interference Test), an no change in a measure of verbal memory (HVLT-R Delayed Recall) compared with the active control group. CONCLUSIONS CBT-I is a nonpharmacological intervention that has the potential to cognitively benefit individuals with MCI suffering from comorbid insomnia. CLINICAL IMPLICATIONS Results suggest that a non-pharmacological intervention to improve sleep in older adults with MCI also improve cognitive functioning. Further exploration of the mechanisms underlying these improvements is warranted.
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Affiliation(s)
- Erin Cassidy-Eagle
- a Department of Psychiatry & Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Allison Siebern
- a Department of Psychiatry & Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,c Fayetteville Veterans Affairs Medical Center , Fayetteville , North Carolina , USA
| | - Lisa Unti
- b ETR , Scotts Valley , California , USA
| | - Jill Glassman
- a Department of Psychiatry & Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,b ETR , Scotts Valley , California , USA
| | - Ruth O'Hara
- a Department of Psychiatry & Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA.,d Veterans Affairs Palo Alto Health Care System , Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC) , Palo Alto , California , USA
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Beaudreau SA, Hantke NC, Mashal N, Gould CE, Henderson VW, O'Hara R. Unlocking Neurocognitive Substrates of Late-Life Affective Symptoms Using the Research Domain Criteria: Worry Is an Essential Dimension. Front Aging Neurosci 2017; 9:380. [PMID: 29249958 PMCID: PMC5715397 DOI: 10.3389/fnagi.2017.00380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/06/2017] [Indexed: 12/23/2022] Open
Abstract
While investigations have sought to identify the distinct and shared contributions of anxiety and depression to neurocognitive processes in late life, less is known regarding the further contribution of worry, a unique and critical dimension of affective dysregulation. Capturing the full range of symptoms, as inspired by the NIH Research Domain Criteria (RDoC), may provide finer-grained information on inter-relationships among worry, anxiety and depression on neurocognitive processing in later life. The objective of this study was to determine if the dimensional trait of worry intensifies known negative associations of dimensional measures of anxiety and depressive symptoms with neurocognitive processes, specifically cognitive control and memory processes. Using a cross-sectional and observational design, this study was conducted within a translational research center located with a Veterans medical center in Northern California. One hundred and nineteen community-residing older adults ages 65-91 years participated, and were characterized with psychiatric and neurocognitive dimensional measures. Affective symptom severity was assessed with the Penn State Worry Questionnaire, the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory-II. Primary neurocognitive outcomes were inhibitory control assessed using a Stroop paradigm and delayed verbal memory assessed with the Rey Auditory Verbal Learning Test. Secondary outcomes included other less frequently examined cognitive control mechanisms (working memory, information processing, and verbal fluency) and memory processes (visual delayed memory). Contrary to prediction, the dimensional trait of worry attenuated negative associations between anxiety and depressive symptoms and inhibitory control on the one hand, and between depressive symptoms and delayed verbal memory processes on the other. In the secondary models, symptom dimensions were not associated with other cognitive control or visual delayed memory processes. Our fine-grained approach, in line with the NIMH RDoC model, suggests the neurocognitive processes associated with dimensional measures of late-life affective symptoms are dissociable. Specifically, dimensional measures of worry operate independently from other anxiety and depression symptoms to reveal differential patterns of neurocognitive processes associated with affective dysregulation.
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Affiliation(s)
- Sherry A. Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, United States
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Nathan C. Hantke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Nehjla Mashal
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Christine E. Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Palo Alto Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Victor W. Henderson
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, United States
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Bro D, O'Hara R, Primeau M, Hanson-Kahn A, Hallmayer J, Bernstein JA. Sleep Disturbances in Individuals With Phelan-McDermid Syndrome: Correlation With Caregivers' Sleep Quality and Daytime Functioning. Sleep 2017; 40:2662320. [PMID: 28364490 DOI: 10.1093/sleep/zsw062] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 01/05/2023] Open
Abstract
Study Objectives The aims of this study were to document sleep disturbances in individuals with Phelan-McDermid syndrome (PMS), to assess whether these individuals had been evaluated for sleep disorders, and to examine relationships between the sleep behavior of these individuals and the sleep behavior and daytime functioning of their caregivers. Methods Participants were 193 caregivers of individuals with PMS recruited by the Phelan-McDermid Syndrome Foundation. Data were collected through a survey comprising 2 questionnaires: the Children's Sleep Habits Questionnaire (CSHQ) and the Parents' Sleep Habits Questionnaire. Data were analyzed using multiple linear regression analyses, Pearson correlation analyses, and independent-samples t-tests. Results Ninety percent of individuals with PMS showed evidence of marked sleep disturbance based on caregiver responses to the CSHQ. However, only 22% of individuals had undergone a formal sleep assessment. Reported increased sleep disturbance in individuals with PMS was a statistically significant predictor of reported increased sleep disturbance and daytime sleepiness in their caregivers. Conclusions Sleep disturbance may be present in a substantial proportion of individuals with PMS and is negatively associated with caregivers' well-being. However, most individuals with PMS have not been evaluated for sleep disorders. When properly diagnosed, many sleep disorders can be alleviated with intervention. Thus, routine screening for and evaluation of sleep disturbances in individuals with PMS may have long-term positive impacts on the well-being of these individuals and their caregivers.
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Affiliation(s)
- Della Bro
- Virginia Piper Cancer Institute, Allina Health, Minneapolis, MN
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Michelle Primeau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.,Department of Sleep Medicine, Palo Alto Medical Foundation, Sunnyvale, CA
| | - Andrea Hanson-Kahn
- Department of Genetics, Stanford University School of Medicine, Stanford, CA.,Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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Hantke NC, Gyurak A, Van Moorleghem K, Waring JD, Adamson MM, O'Hara R, Beaudreau SA. Disentangling cognition and emotion in older adults: the role of cognitive control and mental health in emotional conflict adaptation. Int J Geriatr Psychiatry 2017; 32:840-848. [PMID: 27445036 DOI: 10.1002/gps.4535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent research suggests cognition has a bidirectional relationship with emotional processing in older adults, yet the relationship is still poorly understood. We aimed to examine a potential relationship between late-life cognitive function, mental health symptoms, and emotional conflict adaptation. We hypothesized that worse cognitive control abilities would be associated with poorer emotional conflict adaptation. We further hypothesized that a higher severity of mental health symptoms would be associated with poorer emotional conflict adaptation. METHODS Participants included 83 cognitively normal community-dwelling older adults who completed a targeted mental health and cognitive battery, and emotion and gender conflict-adaptation tasks. RESULTS Consistent with our hypothesis, poorer performance on components of cognitive control, specifically attention and working memory, was associated with poorer emotional conflict adaptation. This association with attention and working memory was not observed in the non-affective-based gender conflict adaptation task. Mental health symptoms did not predict emotional conflict adaptation, nor did performance on other cognitive measures. CONCLUSION Our findings suggest that emotion conflict adaptation is disrupted in older individuals who have poorer attention and working memory. Components of cognitive control may therefore be an important potential source of inter-individual differences in late-life emotion regulation and cognitive affective deficits. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nathan C Hantke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, CA, USA.,War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Anett Gyurak
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, CA, USA
| | | | - Jill D Waring
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, CA, USA.,Department of Psychology, Saint Louis University, Saint Louis, MO, USA
| | - Maheen M Adamson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,War Related Illness and Injury Study Center (WRIISC), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, CA, USA.,University of Queensland, Brisbane, Australia
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, CA, USA.,University of Queensland, Brisbane, Australia
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Primeau M, Gershon A, Talbot L, Cotto I, Lotspeich L, Hardan A, Hallmayer J, O'Hara R. Individuals with Autism Spectrum Disorders Have Equal Success Rate But Require Longer Periods of Systematic Desensitization than Control Patients to Complete Ambulatory Polysomnography. J Clin Sleep Med 2017; 12:357-62. [PMID: 26564388 DOI: 10.5664/jcsm.5584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/17/2014] [Accepted: 10/02/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is the gold standard for the assessment of sleep, yet the extensive apparatus required for monitoring with PSG can be difficult to tolerate, particularly in children. Clinical populations, such as those with anxiety or tactile sensitivity, may have even greater difficulty tolerating the PSG equipment. This study evaluated an innovative protocol for obtaining full PSG in individuals diagnosed autism spectrum disorders (ASD) or developmental delay (DD), as well as typically developing controls (TD). The primary aim was to assess whether this protocol was equally successful for obtaining PSG between these groups. METHODS One hundred sixty-one individuals were recruited for participation; 93 with a diagnosis of ASD, 23 with a diagnosis of DD, and 45 TD. The participants and families were instructed on a procedure of systematic desensitization to the ambulatory PSG equipment; PSG was performed in the home of the participant. RESULTS PSG was successfully attained in 144 (89.4%) participants. There was no difference in completion rate by diagnosis (p = 0.1), though younger age (p = 0.018) and duration of desensitization (p = 0.024) did predict PSG failure. Further, it was found that individuals with ASD took longer to desensitize to the equipment (16.08 d), than those with DD (8.04 d) or TD (0.98 d). CONCLUSIONS Systematic desensitization to PSG equipment, in combination with PSG completed in the home, allows for individuals with ASD to be equally successful in completing PSG, though they do take longer to acclimate to the equipment.
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Affiliation(s)
- Michelle Primeau
- Palo Alto Medical Foundation, Department of Sleep Medicine, Sunnyvale, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Anda Gershon
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Lisa Talbot
- San Francisco VA Medical Center, San Francisco, CA
| | - Isabelle Cotto
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Linda Lotspeich
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Antonio Hardan
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford, CA
| | - Joachim Hallmayer
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford, CA
| | - Ruth O'Hara
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,San Francisco VA Medical Center, San Francisco, CA.,Mental Illness Research, Education, and Clinical Center (MIRECC): VISN 21: Sierra Pacific Network, Department of Veterans Affairs, Palo Alto, CA
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40
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Kawai M, Beaudreau SA, Gould CE, Hantke NC, Cotto I, Jordan JT, Hirst RB, O'Hara R. Longitudinal association of delta activity at sleep onset with cognitive and affective function in community-dwelling older adults. Int J Geriatr Psychiatry 2016; 31:1124-35. [PMID: 27554208 DOI: 10.1002/gps.4554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/10/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This investigation sought to determine whether delta activity at sleep onset (DASO) in the sleep electroencephalography of older adults represents normal variation or is associated with clinical pathology. To this end, we examined its longitudinal associations with cognitive and affective function in older adults without dementia. METHODS Participants were 153 community-dwelling older adults without dementia. We evaluated polysomnography (PSG), cognitive performance, and affective function at four time points: baseline, 12, 24, and 36 months. All participants completed PSG and measures of global cognition, delayed verbal memory, information processing speed, attention, inhibition, verbal naming, visuospatial ability, and measures of anxiety and depression. DASO was defined as sequences of rhythmic anterior delta activity on PSG in the transition from awake to sleep during the baseline assessment (Figure ). RESULTS At the baseline, 83 women and 70 men, mean age 71.3 ± 0.6 years participated and 19.6% of participants exhibited DASO. Age, years of education, gender, and body mass index did not differ according to DASO status. Linear mixed modeling showed that the presence of DASO was actually associated with lower levels of anxiety and depression. Further, participants with DASO, versus those without DASO, exhibited a trend towards better cognitive performance over time, although none of these associations reached statistical significance. CONCLUSIONS Whereas DASO was associated with better affective function, no significant association was found between DASO and cognitive change over time. These longitudinal findings support the view that the presence of DASO in healthy older adults represents normal variation rather than pathological aging. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, USA.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.,Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nathan C Hantke
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Isabelle Cotto
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA
| | - Josh T Jordan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.,California School of Professional Psychology at Alliant, International University, San Francisco, CA, USA
| | | | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA, USA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA, USA.,School of Psychology, University of Queensland, Brisbane, Australia
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Gould CE, O'Hara R, Goldstein MK, Beaudreau SA. Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. Int J Geriatr Psychiatry 2016; 31:1105-15. [PMID: 27441851 PMCID: PMC5312684 DOI: 10.1002/gps.4532] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms. METHODS A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models' outcome was elevated anxiety (≥12 on five-item Beck Anxiety Inventory) or depressive symptoms (≥12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses. RESULTS Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads. CONCLUSION Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Christine E. Gould
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center (GRECC), Palo Alto, CA, United States,Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,Corresponding Author: Christine E. Gould, PhD, Veterans Affairs Palo Alto Health Care System, GRECC (182B), 3801 Miranda Ave., Palo Alto, CA 94304.
| | - Ruth O'Hara
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,VA Palo Alto Health Care System, Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto, CA, United States,School of Psychology, University of Queensland, Brisbane, Australia
| | - Mary K. Goldstein
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center (GRECC), Palo Alto, CA, United States,Stanford University, Center for Primary Care and Outcomes Research (PCOR), Stanford, CA, United States
| | - Sherry A. Beaudreau
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,VA Palo Alto Health Care System, Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto, CA, United States,School of Psychology, University of Queensland, Brisbane, Australia
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Abstract
OBJECTIVE This study examined the extent to which perceived anxiety control was related to subjective sleep disturbance in young and older adults. METHOD Fifty-one young adults (18 to 30 years old) and 48 older adults (aged 65 years and older) completed questionnaires including the Pittsburgh Sleep Quality Index (PSQI) to assess sleep disturbance, Anxiety Control Questionnaire to assess perceived control over anxiety, a perceived health rating, and demographic questionnaire. Correlation and multivariable adjusted hierarchical regression analyses examined the extent to which anxiety control was associated with sleep disturbance. RESULTS Anxiety control and health status were associated with global sleep quality on the PSQI, but no age differences in PSQI scores were found. In post hoc analyses, greater anxiety control was related to shorter sleep latency. Both older age and greater anxiety control were associated with less daytime dysfunction, whereas only older age was associated with better sleep quality. DISCUSSION Although some variations in sleep quality by age were found, overall findings suggest that perceived anxiety control contributes to sleep disturbance in young and older adults. Greater anxiety control could lead to shorter sleep latency through reduced anxiety and worry symptoms at bedtime. Future studies should examine whether improved anxiety control with psychological treatments is one mechanism through which beneficial and lasting effects on sleep disturbance can be achieved.
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Affiliation(s)
- Christine E Gould
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Sherry A Beaudreau
- b Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA.,d School of Psychology , University of Queensland , Brisbane , Australia
| | - Ruth O'Hara
- b Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System , Palo Alto , CA , USA.,c Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA.,d School of Psychology , University of Queensland , Brisbane , Australia
| | - Barry A Edelstein
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
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Kawai M, Beaudreau SA, Gould CE, Hantke NC, Jordan JT, O'Hara R. Delta Activity at Sleep Onset and Cognitive Performance in Community-Dwelling Older Adults. Sleep 2016; 39:907-14. [PMID: 26943464 DOI: 10.5665/sleep.5652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 02/06/2015] [Accepted: 12/08/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Frontal intermittent rhythmic delta activity (FIRDA) has long been considered to be an abnormal variant in the electroencephalogram (EEG) among older adults. Prior work also indicates a predominance of slow wave EEG activity among patients with dementia. However, instability of state control occurring with aging generally and among many neurodegenerative diseases raises the possibility that FIRDA might represent the intrusion of sleep related elements of the EEG into the waking state. We examined delta activity at sleep onset (DASO) in community-dwelling, older adults without dementia, and examined whether this activity is related to poorer cognitive performance. METHODS 153 community-dwelling, older adults without dementia underwent overnight polysomnography and measures of global cognition, delayed verbal memory, information processing speed, attention, inhibition, verbal naming, and visuospatial ability. Delta activity during sleep/wake transitions (scored either as Waking or N1) was analyzed visually. RESULTS Participants were 83 women and 70 men, mean age 71.3 ± 0.6 y. DASO was present in 30 participants (19.6%). Age, years of education, sex, and body mass index did not differ between DASO (+) and (-) groups. Multiple regression analyses indicated faster reading of the Stroop color words in DASO (+) subjects (P = 0.007). None of the other cognitive domains differed between the two groups. CONCLUSIONS DASO was relatively common in our sample of community-dwelling, older adults without dementia. DASO was not associated with poorer performance on any cognitive domain. Instead, individuals with DASO demonstrated better performance on a simple reading task. Although these findings suggest that an abnormal EEG activity may represent normal variation, our work underscores the importance of distinguishing DASO from FIRDA when examining sleep in older adults. COMMENTARY A commentary on this article appears in this issue on page 725.
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Affiliation(s)
- Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA
| | - Sherry A Beaudreau
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Christine E Gould
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Geriatric Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
| | - Nathan C Hantke
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA
| | - Josh T Jordan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,California School of Professional Psychology at Alliant International University, Alhambra, CA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA.,School of Psychology, University of Queensland, Brisbane, Australia
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Abstract
STUDY OBJECTIVES Although narcolepsy affects 0.02-0.05% of individuals in various ethnic groups, clinical presentation in different ethnicities has never been fully characterized. Our goal was to study phenotypic expression across ethnicities in the United States. DESIGN/SETTING Cases of narcolepsy from 1992 to 2013 were identified from searches of the Stanford Center for Narcolepsy Research database. International Classification of Sleep Disorders, Third Edition diagnosis criteria for type 1 and type 2 narcolepsy were used for inclusion, but subjects were separated as with and without cataplexy for the purpose of data presentation. Information extracted included demographics, ethnicity and clinical data, HLA-DQB1*06:02, polysomnography (PSG), multiple sleep latency test (MSLT) data, and cerebrospinal fluid (CSF) hypocretin-1 level. PATIENTS 182 African-Americans, 839 Caucasians, 35 Asians, and 41 Latinos with narcolepsy. RESULTS Sex ratio, PSG, and MSLT findings did not differ across ethnicities. Epworth Sleepiness Scale (ESS) score was higher and age of onset of sleepiness earlier in African Americans compared with other ethnicities. HLA-DQB1*06:02 positivity was higher in African Americans (91.0%) versus others (76.6% in Caucasians, 80.0% in Asians, and 65.0% in Latinos). CSF hypocretin-1 level, obtained in 222 patients, was more frequently low (≤ 110 pg/ml) in African Americans (93.9%) versus Caucasians (61.5%), Asians (85.7%) and Latinos (75.0%). In subjects with low CSF hypocretin-1, African Americans (28.3%) were 4.5 fold more likely to be without cataplexy when compared with Caucasians (8.1%). CONCLUSIONS Narcolepsy in African Americans is characterized by earlier symptom onset, higher Epworth Sleepiness Scale score, higher HLA-DQB1*06:02 positivity, and low cerebrospinal fluid hypocretin-1 level in the absence of cataplexy. In African Americans, more subjects without cataplexy have type 1 narcolepsy.
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Affiliation(s)
- Makoto Kawai
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Stanford, CA.,Sierra Pacific Mental Illness Research Education and Clinical Centers, VA Palo Alto Health Care System, Palo Alto, CA
| | - Mali Einen
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA
| | - Ling Lin
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA
| | - Emmanuel Mignot
- Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, Palo Alto, CA
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Garrett A, Gupta S, Reiss AL, Waring J, Sudheimer K, Anker L, Sosa N, Hallmayer JF, O'Hara R. Impact of 5-HTTLPR on hippocampal subregional activation in older adults. Transl Psychiatry 2015; 5:e639. [PMID: 26393485 PMCID: PMC5068801 DOI: 10.1038/tp.2015.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022] Open
Abstract
Studies have shown that a functional polymorphism of the serotonin transporter gene (5-HTTLPR) impacts performance on memory-related tasks and the hippocampal structures that subserve these tasks. The short (s) allele of 5-HTTLPR has been linked to greater susceptibility for impaired memory and smaller hippocampal volume compared to the long allele (l). However, previous studies have not examined the associations between 5-HTTLPR allele and activation in subregions of the hippocampus. In this study, we used functional magnetic resonance imaging (fMRI) to measure activation in hippocampal and temporal lobe subregions in 36 elderly non-clinical participants performing a face-name encoding and recognition task. Although there were no significant differences in task performance between s allele carriers and l homozygotes, right CA1 and right parahippocampal activation during recognition errors was significantly greater in individuals bearing the s allele. In an exploratory analysis, we determined that these effects were more pronounced in s allele carriers with the apolipoprotein ɛ4 allele. Our results suggest that older individuals with the s allele inefficiently allocate neural resources while making errors in recognizing face-name associations, which could negatively impact memory performance during more challenging tasks.
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Affiliation(s)
- A Garrett
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, USA
| | - S Gupta
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - A L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for Interdisciplinary Brain Sciences Research, Stanford University School of Medicine, Stanford, CA, USA
| | - J Waring
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Sierra Pacific Mental Illness, Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - K Sudheimer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Sierra Pacific Mental Illness, Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - L Anker
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Sierra Pacific Mental Illness, Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - N Sosa
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - J F Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Sierra Pacific Mental Illness, Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - R O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Sierra Pacific Mental Illness, Research, Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5485, USA. E-mail:
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O'Neill L, Rankin P, O'Hara R. AB0285 Can Assessment of Synovial Fluid and Blood Samples for Pro- and Anti-Inflammatory Markers Help Predict the Type of Arthritis that a Patient May Develop? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4092] [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: 11/03/2022]
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O'Hara R, Johnson M, Hirst E, Weyman A, Shaw D, Mortimer P, Newman C, Storey M, Turner J, Mason S, Quinn T, Shewan J, Siriwardena AN. DECISION MAKING AND SAFETY IN AMBULANCE SERVICE TRANSITIONS. Emerg Med J 2015. [DOI: 10.1136/emermed-2015-204880.4] [Citation(s) in RCA: 3] [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: 11/04/2022]
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Russ M, O'Hara R, Setlur Nagesh SV, Mokin M, Jimenez C, Siddiqui A, Bednarek D, Rudin S, Ionita C. Treatment Planning for Image-Guided Neuro-Vascular Interventions Using Patient-Specific 3D Printed Phantoms. Proc SPIE Int Soc Opt Eng 2015; 9417. [PMID: 26778878 DOI: 10.1117/12.2081997] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Minimally invasive endovascular image-guided interventions (EIGIs) are the preferred procedures for treatment of a wide range of vascular disorders. Despite benefits including reduced trauma and recovery time, EIGIs have their own challenges. Remote catheter actuation and challenging anatomical morphology may lead to erroneous endovascular device selections, delays or even complications such as vessel injury. EIGI planning using 3D phantoms would allow interventionists to become familiarized with the patient vessel anatomy by first performing the planned treatment on a phantom under standard operating protocols. In this study the optimal workflow to obtain such phantoms from 3D data for interventionist to practice on prior to an actual procedure was investigated. Patient-specific phantoms and phantoms presenting a wide range of challenging geometries were created. Computed Tomographic Angiography (CTA) data was uploaded into a Vitrea 3D station which allows segmentation and resulting stereo-lithographic files to be exported. The files were uploaded using processing software where preloaded vessel structures were included to create a closed-flow vasculature having structural support. The final file was printed, cleaned, connected to a flow loop and placed in an angiographic room for EIGI practice. Various Circle of Willis and cardiac arterial geometries were used. The phantoms were tested for ischemic stroke treatment, distal catheter navigation, aneurysm stenting and cardiac imaging under angiographic guidance. This method should allow for adjustments to treatment plans to be made before the patient is actually in the procedure room and enabling reduced risk of peri-operative complications or delays.
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Affiliation(s)
- M Russ
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - R O'Hara
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - S V Setlur Nagesh
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - M Mokin
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - C Jimenez
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY; University of Antioquia-GIB-Eafit, Medellin, Colombia
| | - A Siddiqui
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - D Bednarek
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - S Rudin
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
| | - C Ionita
- Toshiba Stroke and Vascular Research Center, University of Buffalo, Buffalo, NY
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Thompson WK, Gershon A, O'Hara R, Bernert RA, Depp CA. The prediction of study-emergent suicidal ideation in bipolar disorder: a pilot study using ecological momentary assessment data. Bipolar Disord 2014; 16:669-77. [PMID: 24903771 PMCID: PMC4213287 DOI: 10.1111/bdi.12218] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 11/12/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Bipolar disorder is associated with idiosyncratic precursors of clinically important states such as suicidal ideation. Ecological momentary assessment (EMA) - high frequency data collection in a subject's usual environment - provides the potential for development of temporal, individualized prediction of risk states. The present study tested the ability of EMA data to predict individual symptom change in clinician-rated suicidal ideation. METHODS Thirty-five adults diagnosed with inter-episode bipolar disorder completed daily measures of affect in their home environments using diaries administered over an eight-week assessment timeline. Suicidal ideation was assessed monthly at in-person visits using the Inventory of Depressive Symptomatology-Clinician Rated. We used a novel application of functional linear models (FLMs) to generate prospective predictions of suicidal ideation at in-person clinician assessments based on intensively sampled trajectories of daily affect. RESULTS Eight instances of suicidal ideation scores > 0 were recorded during the study period on six participants. Utilizing trajectories of negative and positive affect, cross-validated predictions attained 88% sensitivity with 95% specificity for elevated suicidal ideation one week prior to in-person clinician assessment. This model strongly outperformed prediction models using cross-sectional data obtained at study visits alone. CONCLUSIONS Utilizing EMA data with FLM prediction models substantially increases the accuracy of prediction of study-emergent suicidal ideation. Prediction algorithms employing intensively sampled longitudinal EMA data could sensitively detect the warning signs of suicidal ideation to facilitate improved suicide risk assessment and the timely delivery of preventative interventions.
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Affiliation(s)
- Wesley K Thompson
- Stein Center for Research on Aging, University of California, San Diego School of Medicine, La Jolla, CA, USA,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA,VA Sierra–Pacific Mental Illness Education and Clinical Center, Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA,VA Sierra–Pacific Mental Illness Education and Clinical Center, Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Rebecca A Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA,VA Sierra–Pacific Mental Illness Education and Clinical Center, Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Colin A Depp
- Stein Center for Research on Aging, University of California, San Diego School of Medicine, La Jolla, CA, USA,Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA,San Diego Veterans Affairs Healthcare System, La Jolla, CA, USA
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Affiliation(s)
- Ruth O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA; Sierra-Pacific Mental Illness Research, Education, Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA.
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA; Sierra-Pacific Mental Illness Research, Education, Clinical Center (MIRECC), VA Palo Alto Health Care System, Palo Alto, CA
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