51
|
Xu T, Park A, Bai G. Services Provided By Internal Medicine Physicians Compared With Emergency Physicians: Flawed Data-Reply. JAMA Intern Med 2018; 178:297. [PMID: 29404617 DOI: 10.1001/jamainternmed.2017.7966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
52
|
Jasuja GK, Bhasin S, Rose AJ, Reisman JI, Hanlon JT, Miller DR, Morreale AP, Pogach LM, Cunningham FE, Park A, Wiener RS, Gifford AL, Berlowitz DR. Provider and Site-Level Determinants of Testosterone Prescribing in the Veterans Healthcare System. J Clin Endocrinol Metab 2017; 102:3226-3233. [PMID: 28911150 PMCID: PMC5587071 DOI: 10.1210/jc.2017-00468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/26/2017] [Indexed: 01/05/2023]
Abstract
CONTEXT Testosterone prescribing rates have increased substantially in the past decade. However, little is known about the context within which such prescriptions occur. OBJECTIVE We evaluated provider- and site-level determinants of receipt of testosterone and of guideline-concordant testosterone prescribing. DESIGN This study was cross-sectional in design. SETTING This study was conducted at the Veterans Health Administration (VA). PARTICIPANTS Study participants were a national cohort of male patients who had received at least one outpatient prescription within the VA during fiscal year (FY) 2008 to FY 2012. A total of 38,648 providers and 130 stations were associated with these patients. MAIN OUTCOME MEASURE This study measured receipt of testosterone and guideline-concordant testosterone prescribing. RESULTS Providers ranging in age from 31 to 60 years, with less experience in the VA [all adjusted odds ratio (AOR), <2; P < 0.01] and credentialed as medical doctors in endocrinology (AOR, 3.88; P < 0.01) and urology (AOR, 1.48; P < 0.01) were more likely to prescribe testosterone compared with older providers, providers of longer VA tenure, and primary care providers, respectively. Sites located in the West compared with the Northeast [AOR, 1.75; 95% confidence interval (CI), 1.45-2.11] and care received at a community-based outpatient clinic compared with a medical center (AOR, 1.22; 95% CI, 1.20-1.24) also predicted testosterone use. Although they were more likely to prescribe testosterone, endocrinologists were also more likely to obtain an appropriate workup before prescribing compared with primary care providers (AOR, 2.14; 95% CI, 1.54-2.97). CONCLUSIONS Our results highlight the opportunity to intervene at both the provider and the site levels to improve testosterone prescribing. This study also provides a useful example of how to examine contributions to prescribing variation at different levels of the health care system.
Collapse
|
53
|
Xu T, Park A, Bai G, Joo S, Hutfless SM, Mehta A, Anderson GF, Makary MA. Variation in Emergency Department vs Internal Medicine Excess Charges in the United States. JAMA Intern Med 2017; 177:1139-1145. [PMID: 28558093 PMCID: PMC5818801 DOI: 10.1001/jamainternmed.2017.1598] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. OBJECTIVE To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. MAIN OUTCOMES AND MEASURES Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. RESULTS Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen (median, 5.0; IQR, 3.5-6.7 for ≥20% uninsured), and location (median, 5.3; IQR, 3.8-6.8 for the southeastern United States). CONCLUSIONS AND RELEVANCE Across hospitals, there is wide variation in excess charges on ED services, which are often priced higher than internal medicine services. Our results inform policy efforts to protect uninsured and out-of-network patients from highly variable pricing.
Collapse
|
54
|
McDaid D, Park A. MAKING AN ECONOMIC CASE FOR TACKLING LONELINESS IN LATER LIFE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
55
|
Comas-Herrera A, McDaid D, Park A, Adelaja B, Lombard D, Knapp M. MODEM DEMENTIA EVIDENCE TOOLKIT: WEB-BASED RESOURCE OF DEMENTIA CARE, TREATMENT, AND SUPPORT EVIDENCE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
56
|
Krishnan A, Xu T, Hutfless S, Park A, Stasko T, Vidimos AT, Leshin B, Coldiron BM, Bennett RG, Marks VJ, Brandt R, Makary MA, Albertini JG. Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution. JAMA Dermatol 2017; 153:565-570. [PMID: 28453605 PMCID: PMC5817605 DOI: 10.1001/jamadermatol.2017.1450] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/03/2017] [Indexed: 11/14/2022]
Abstract
Importance Outlier physician practices in health care can represent a significant burden to patients and the health system. Objective To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors. Design, Setting, and Participants This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients. Main Outcomes and Measures Characteristics of outlier physicians, defined as those whose mean number of stages for MMS was 2 standard deviations greater than the mean number for all physicians billing MMS. Logistic regression was used to study the physician characteristics associated with outlier status. Results Our analysis included 2305 individual billing physicians performing MMS. The mean number of stages per MMS case for all physicians practicing from January 2012 to December 2014 was 1.74, the median was 1.69, and the range was 1.09 to 4.11. Overall, 137 physicians who perform Mohs surgery were greater than 2 standard deviations above the mean (2 standard deviations above the mean = 2.41 stages per case) in at least 1 of the 3 examined years, and 49 physicians (35.8%) were persistent high outliers in all 3 years. Persistent high outlier status was associated with performing Mohs surgery in a solo practice (odds ratio, 2.35; 95% CI, 1.25-4.35). Volume of cases per year, practice experience, and geographic location were not associated with persistent high outlier status. Conclusions and Relevance Marked variation exists in the number of stages per case for MMS for head and neck, genitalia, hands, and feet skin cancers, which may represent an additional financial burden and unnecessary surgery on individual patients. Providing feedback to physicians may reduce unwarranted variation on this metric of quality.
Collapse
|
57
|
Rogal SS, Yakovchenko V, Waltz TJ, Powell BJ, Kirchner JE, Proctor EK, Gonzalez R, Park A, Ross D, Morgan TR, Chartier M, Chinman MJ. The association between implementation strategy use and the uptake of hepatitis C treatment in a national sample. Implement Sci 2017; 12:60. [PMID: 28494811 PMCID: PMC5425997 DOI: 10.1186/s13012-017-0588-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/25/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally. METHODS A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed. RESULTS A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment. CONCLUSIONS These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems.
Collapse
|
58
|
Chambers D, Simpson L, Neta G, Schwarz UVT, Percy-Laurry A, Aarons GA, Neta G, Brownson R, Vogel A, Stirman SW, Sherr K, Sturke R, Norton WE, Varley A, Chambers D, Vinson C, Klesges L, Heurtin-Roberts S, Massoud MR, Kimble L, Beck A, Neely C, Boggs J, Nichols C, Wan W, Staab E, Laiteerapong N, Moise N, Shah R, Essock S, Handley M, Jones A, Carruthers J, Davidson K, Peccoralo L, Sederer L, Molfenter T, Scudder A, Taber-Thomas S, Schaffner K, Herschell A, Woodward E, Pitcock J, Ritchie M, Kirchner J, Moore JE, Khan S, Rashid S, Park J, Courvoisier M, Straus S, Blonigen D, Rodriguez A, Manfredi L, Nevedal A, Rosenthal J, Smelson D, Timko C, Stadnick N, Regan J, Barnett M, Lau A, Brookman-Frazee L, Guerrero E, Fenwick K, Kong Y, Aarons G, Lengnick-Hall R, Fenwick K, Henwood B, Sayer N, Rosen C, Orazem R, Smith B, Rosen C, Zimmerman L, Lounsbury D, Rosen C, Kimerling R, Trafton JA, Lindley S, Bhargava R, Roberts H, Gibson L, Escobar GJ, Liu V, Turk B, Ragins A, Kipnis P, Gruszkowski AK, Kennedy MW, Drobek ER, Turgeman L, Milicevic AS, Hubert TL, Myaskovsky L, Tjader YC, Monte RJ, Sapnas KG, Ramly E, Lauver DR, Bartels CM, Elnahal S, Ippolito A, Peabody H, Clancy C, Cebul R, Love T, Einstadter D, Bolen S, Watts B, Yakovchenko V, Park A, Lukesh W, Miller DR, Thornton D, Drainoni ML, Gifford AL, Smith S, Kyle J, Bauer MS, Eisenberg D, Liebrecht C, Barbaresso M, Kilbourne A, Park E, Perez G, Ostroff J, Greene S, Parchman M, Austin B, Larson E, Ferreri S, Shea C, Smith M, Turner K, Bacci J, Bigham K, Curran G, Ferreri S, Frail C, Hamata C, Jankowski T, Lantaff W, McGivney MS, Snyder M, McCullough M, Gillespie C, Petrakis BA, Jones E, Park A, Lukas CV, Rose A, Shoemaker SJ, Curran G, Thomas J, Teeter B, Swan H, Teeter B, Thomas J, Curran G, Balamurugan A, Lane-Fall M, Beidas R, Di Taranti L, Buddai S, Hernandez ET, Watts J, Fleisher L, Barg F, Miake-Lye I, Olmos T, Chuang E, Rodriguez H, Kominski G, Yano B, Shortell S, Hook M, Fleisher L, Fiks A, Halkyard K, Gruver R, Sykes E, Vesco K, Beadle K, Bulkley J, Stoneburner A, Leo M, Clark A, Smith J, Smyser C, Wolf M, Trivedi S, Hackett B, Rao R, Cole FS, McGonigle R, Donze A, Proctor E, Mathur A, Sherr K, Gakidou E, Gloyd S, Audet C, Salato J, Vermund S, Amico R, Smith S, Nyirandagijimana B, Mukasakindi H, Rusangwa C, Franke M, Raviola G, Cummings M, Goldberg E, Mwaka S, Kabajaasi O, Cattamanchi A, Katamba A, Jacob S, Kenya-Mugisha N, Davis JL, Reed J, Ramaswamy R, Parry G, Sax S, Kaplan H, Huang KY, Cheng S, Yee S, Hoagwood K, McKay M, Shelley D, Ogedegbe G, Brotman LM, Kislov R, Humphreys J, Harvey G, Wilson P, Lieberthal R, Payton C, Sarfaty M, Valko G, Bolton R, Lukas CV, Hartmann C, Mueller N, Holmes SK, Bokhour B, Ono S, Crabtree B, Gordon L, Miller W, Balasubramanian B, Solberg L, Cohen D, McGraw K, Blatt A, Pittman D, McCullough M, Hartmann C, Kales H, Berlowitz D, Hudson T, Gillespie C, Helfrich C, Finley E, Garcia A, Rosen K, Tami C, McGeary D, Pugh MJ, Potter JS, Helfrich C, Stryczek K, Au D, Zeliadt S, Sayre G, Gillespie C, Leeman J, Myers A, Grant J, Wangen M, Queen T, Morshed A, Dodson E, Tabak R, Brownson RC, Sheldrick RC, Mackie T, Hyde J, Leslie L, Yanovitzky I, Weber M, Gesualdo N, Kristensen T, Stanick C, Halko H, Dorsey C, Powell B, Weiner B, Lewis C, Powell B, Weiner B, Stanick C, Halko H, Dorsey C, Lewis C, Weiner B, Dorsey C, Stanick C, Halko H, Powell B, Lewis C, Stirman SW, Carreno P, Mallard K, Masina T, Monson C, Swindle T, Curran G, Patterson Z, Whiteside-Mansell L, Hanson R, Saunders B, Schoenwald S, Moreland A, Birken S, Powell B, Presseau J, Miake-Lye I, Ganz D, Mittman B, Delevan D, Finley E, Hill JN, Locatelli S, Bokhour B, Fix G, Solomon J, Mueller N, Lavela SL, Scott V, Scaccia J, Alia K, Skiles B, Wandersman A, Wilson P, Sales A, Roberts M, Kennedy A, Chambers D, Khoury MJ, Sperber N, Orlando L, Carpenter J, Cavallari L, Denny J, Elsey A, Fitzhenry F, Guan Y, Horowitz C, Johnson J, Madden E, Pollin T, Pratt V, Rakhra-Burris T, Rosenman M, Voils C, Weitzel K, Wu R, Damschroder L, Lu C, Ceccarelli R, Mazor KM, Wu A, Rahm AK, Buchanan AH, Schwartz M, McCormick C, Manickam K, Williams MS, Murray MF, Escoffery NC, Lebow-Skelley E, Udelson H, Böing E, Fernandez ME, Wood RJ, Mullen PD, Parekh J, Caldas V, Stuart EA, Howard S, Thomas G, Jennings JM, Torres J, Markham C, Shegog R, Peskin M, Rushing SC, Gaston A, Gorman G, Jessen C, Williamson J, Ward D, Vaughn A, Morris E, Mazzucca S, Burney R, Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K, Barker M, Fahim M, Ebnahmady A, Dragonetti R, Selby P, Farrell M, Tompkins J, Norton W, Rapport K, Hargreaves M, Lee R, Ramanadhan S, Kruse G, Deutsch C, Lanier E, Gray A, Leppin A, Christiansen L, Schaepe K, Egginton J, Branda M, Gaw C, Dick S, Montori V, Shah N, Korn A, Hovmand P, Fullerton K, Zoellner N, Hennessy E, Tovar A, Hammond R, Economos C, Kay C, Gazmararian J, Vall E, Cheung P, Franks P, Barrett-Williams S, Weiss P, Kay C, Gazmararian J, Hamilton E, Cheung P, Kay C, Vall E, Gazmararian J, Marques L, Dixon L, Ahles E, Valentine S, Monson C, Shtasel D, Stirman SW, Parra-Cardona R, Northridge M, Kavathe R, Zanowiak J, Wyatt L, Singh H, Islam N, Monteban M, Freedman D, Bess K, Walsh C, Matlack K, Flocke S, Baily H, Harden S, Ramalingam N, Alia K, Scaccia J, Scott V, Ramaswamy R, Wandersman A, Gold R, Cottrell E, Hollombe C, Dambrun K, Bunce A, Middendorf M, Dearing M, Cowburn S, Mossman N, Melgar G, Hopfer S, Hecht M, Ray A, Miller-Day M, BeLue R, Zimet G, Nelson EL, Kuhlman S, Doolittle G, Krebill H, Spaulding A, Levin T, Sanchez M, Landau M, Escobar P, Minian N, Selby P, Noormohamed A, Zawertailo L, Baliunas D, Giesbrecht N, Le Foll B, Samokhvalov A, Meisel Z, Polsky D, Schackman B, Mitchell J, Sevarino K, Gimbel S, Mwanza M, Nisingizwe MP, Michel C, Hirschhorn L, Lane-Fall M, Beidas R, Di Taranti L, Choudhary M, Thonduparambil D, Fleisher L, Barg F, Meissner P, Pinnock H, Barwick M, Carpenter C, Eldridge S, Grandes-Odriozola G, Griffiths C, Rycroft-Malone J, Murray E, Patel A, Sheikh A, Taylor SJC, Mittman B, Guilliford M, Pearce G, Korngiebel D, West K, Burke W, Hannon P, Harris J, Hammerback K, Kohn M, Chan GKC, Mafune R, Parrish A, Helfrich C, Beresford S, Pike KJ, Shelton R, Jandorf L, Erwin D, Charles TA, Parchman M, Baldwin LM, Ike B, Fickel J, Lind J, Cowper D, Fleming M, Sadler A, Dye M, Katzburg J, Ong M, Tubbesing S, McCullough M, Simmons M, Yakovchenko V, Harnish A, Gabrielian S, McInnes K, Smith J, Smelson D, Ferrand J, Torres E, Green A, Aarons G, Bradbury AR, Patrick-Miller LJ, Egleston BL, Domchek SM, Olopade OI, Hall MJ, Daly MB, Fleisher L, Grana G, Ganschow P, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber RS, Gulden C, Horte J, Long J, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Seelaus C, Stoll J, Stopfer J, Yao XS, Savage M, Miech E, Damush T, Rattray N, Myers J, Homoya B, Winseck K, Klabunde C, Langer D, Aggarwal A, Neilson E, Gunderson L, Escobar GJ, Gardner M, O’Sulleabhain L, Kroenke C, Liu V, Kipnis P. Proceedings from the 9th annual conference on the science of dissemination and implementation. Implement Sci 2017. [PMCID: PMC5414666 DOI: 10.1186/s13012-017-0575-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
59
|
Song CQ, Li Y, Mou H, Moore J, Park A, Pomyen Y, Hough S, Kennedy Z, Fischer A, Yin H, Anderson DG, Conte D, Zender L, Wang XW, Thorgeirsson S, Weng Z, Xue W. Genome-Wide CRISPR Screen Identifies Regulators of Mitogen-Activated Protein Kinase as Suppressors of Liver Tumors in Mice. Gastroenterology 2017; 152:1161-1173.e1. [PMID: 27956228 PMCID: PMC6204228 DOI: 10.1053/j.gastro.2016.12.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS It has been a challenge to identify liver tumor suppressors or oncogenes due to the genetic heterogeneity of these tumors. We performed a genome-wide screen to identify suppressors of liver tumor formation in mice, using CRISPR-mediated genome editing. METHODS We performed a genome-wide CRISPR/Cas9-based knockout screen of P53-null mouse embryonic liver progenitor cells that overexpressed MYC. We infected p53-/-;Myc;Cas9 hepatocytes with the mGeCKOa lentiviral library of 67,000 single-guide RNAs (sgRNAs), targeting 20,611 mouse genes, and transplanted the transduced cells subcutaneously into nude mice. Within 1 month, all the mice that received the sgRNA library developed subcutaneous tumors. We performed high-throughput sequencing of tumor DNA and identified sgRNAs increased at least 8-fold compared to the initial cell pool. To validate the top 10 candidate tumor suppressors from this screen, we collected data from patients with hepatocellular carcinoma (HCC) using the Cancer Genome Atlas and COSMIC databases. We used CRISPR to inactivate candidate tumor suppressor genes in p53-/-;Myc;Cas9 cells and transplanted them subcutaneously into nude mice; tumor formation was monitored and tumors were analyzed by histology and immunohistochemistry. Mice with liver-specific disruption of p53 were given hydrodynamic tail-vein injections of plasmids encoding Myc and sgRNA/Cas9 designed to disrupt candidate tumor suppressors; growth of tumors and metastases was monitored. We compared gene expression profiles of liver cells with vs without tumor suppressor gene disrupted by sgRNA/Cas9. Genes found to be up-regulated after tumor suppressor loss were examined in liver cancer cell lines; their expression was knocked down using small hairpin RNAs, and tumor growth was examined in nude mice. Effects of the MEK inhibitors AZD6244, U0126, and trametinib, or the multi-kinase inhibitor sorafenib, were examined in human and mouse HCC cell lines. RESULTS We identified 4 candidate liver tumor suppressor genes not previously associated with liver cancer (Nf1, Plxnb1, Flrt2, and B9d1). CRISPR-mediated knockout of Nf1, a negative regulator of RAS, accelerated liver tumor formation in mice. Loss of Nf1 or activation of RAS up-regulated the liver progenitor cell markers HMGA2 and SOX9. RAS pathway inhibitors suppressed the activation of the Hmga2 and Sox9 genes that resulted from loss of Nf1 or oncogenic activation of RAS. Knockdown of HMGA2 delayed formation of xenograft tumors from cells that expressed oncogenic RAS. In human HCCs, low levels of NF1 messenger RNA or high levels of HMGA2 messenger RNA were associated with shorter patient survival time. Liver cancer cells with inactivation of Plxnb1, Flrt2, and B9d1 formed more tumors in mice and had increased levels of mitogen-activated protein kinase phosphorylation. CONCLUSIONS Using a CRISPR-based strategy, we identified Nf1, Plxnb1, Flrt2, and B9d1 as suppressors of liver tumor formation. We validated the observation that RAS signaling, via mitogen-activated protein kinase, contributes to formation of liver tumors in mice. We associated decreased levels of NF1 and increased levels of its downstream protein HMGA2 with survival times of patients with HCC. Strategies to inhibit or reduce HMGA2 might be developed to treat patients with liver cancer.
Collapse
MESH Headings
- Animals
- Benzimidazoles/pharmacology
- Blotting, Western
- Butadienes/pharmacology
- CRISPR-Cas Systems
- Carcinoma, Hepatocellular/genetics
- Cell Line, Tumor
- Cytoskeletal Proteins
- DNA, Neoplasm/genetics
- Enzyme Inhibitors
- Gene Expression Regulation, Neoplastic
- Genes, Neurofibromatosis 1
- Genome-Wide Association Study
- HMGA Proteins/genetics
- HMGA2 Protein/genetics
- Hepatocytes/metabolism
- High-Throughput Nucleotide Sequencing
- Humans
- Immunohistochemistry
- Liver Neoplasms/genetics
- Liver Neoplasms, Experimental/genetics
- Membrane Glycoproteins/genetics
- Mice
- Mice, Knockout
- Mice, Nude
- Mitogen-Activated Protein Kinases/genetics
- Nerve Tissue Proteins/genetics
- Niacinamide/analogs & derivatives
- Niacinamide/pharmacology
- Nitriles/pharmacology
- Phenylurea Compounds/pharmacology
- Prognosis
- Protein Kinase Inhibitors/pharmacology
- Proto-Oncogene Proteins c-myc/genetics
- Pyridones/pharmacology
- Pyrimidinones/pharmacology
- Real-Time Polymerase Chain Reaction
- Receptors, Cell Surface/genetics
- Sequence Analysis, DNA
- Sorafenib
- Survival Analysis
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Proteins/genetics
- ras Proteins/genetics
Collapse
|
60
|
Salinas C, Sabri S, Stein D, Wilkins L, Park A, Angle J. Balloon retrograde transvenous obliteration (BRTO): effects on recurrent bleeding, liver function, and portal hypertension progression. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
61
|
Lopez J, Musavi L, Quan A, Calotta N, Juan I, Park A, Tufaro AP, May JW, Dorafshar AH. Abstract P22. Trends & Frequency of Surgeon-Reported Conflicts-of-Interest in the Plastic Surgery Literature. Plast Reconstr Surg Glob Open 2017. [PMCID: PMC5361307 DOI: 10.1097/01.gox.0000513396.04451.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
62
|
Baheti A, Singh R, Nicholson D, Patrie J, Uflacker A, Park A, Sabri S, Stone J, Angle J, Wilkins L. IVC filter retrieval: comparing the ease of retrieval of Denali and Tulip filters. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
63
|
Rose AJ, Park A, Gillespie C, Van Deusen Lukas C, Ozonoff A, Petrakis BA, Reisman JI, Borzecki AM, Benedict AJ, Lukesh WN, Schmoke TJ, Jones EA, Morreale AP, Ourth HL, Schlosser JE, Mayo-Smith MF, Allen AL, Witt DM, Helfrich CD, McCullough MB. Results of a Regional Effort to Improve Warfarin Management. Ann Pharmacother 2016; 51:373-379. [PMID: 28367699 DOI: 10.1177/1060028016681030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improved anticoagulation control with warfarin reduces adverse events and represents a target for quality improvement. No previous study has described an effort to improve anticoagulation control across a health system. OBJECTIVE To describe the results of an effort to improve anticoagulation control in the New England region of the Veterans Health Administration (VA). METHODS Our intervention encompassed 8 VA sites managing warfarin for more than 5000 patients in New England (Veterans Integrated Service Network 1 [VISN 1]). We provided sites with a system to measure processes of care, along with targeted audit and feedback. We focused on processes of care associated with site-level anticoagulation control, including prompt follow-up after out-of-range international normalized ratio (INR) values, minimizing loss to follow-up, and use of guideline-concordant INR target ranges. We used a difference-in-differences (DID) model to examine changes in anticoagulation control, measured as percentage time in therapeutic range (TTR), as well as process measures and compared VISN 1 sites with 116 VA sites located outside VISN 1. RESULTS VISN 1 sites improved on TTR, our main indicator of quality, from 66.4% to 69.2%, whereas sites outside VISN 1 improved from 65.9% to 66.4% (DID 2.3%, P < 0.001). Improvement in TTR correlated strongly with the extent of improvement on process-of-care measures, which varied widely across VISN 1 sites. CONCLUSIONS A regional quality improvement initiative, using performance measurement with audit and feedback, improved TTR by 2.3% more than control sites, which is a clinically important difference. Improving relevant processes of care can improve outcomes for patients receiving warfarin.
Collapse
|
64
|
Forsman AK, Nordmyr J, Park A, Matosevic T, McDaid D, Wahlbeck K. Technology-based interventions for mental health promotion in later life: An evidence review. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
65
|
Park A, Barrera-Ramirez J, Ranasinghe I, Pilon S, Sy R, Fergusson D, Allan DS. Use of Statins to Augment Progenitor Cell Function in Preclinical and Clinical Studies of Regenerative Therapy: a Systematic Review. Stem Cell Rev Rep 2016; 12:327-39. [PMID: 26873165 DOI: 10.1007/s12015-016-9647-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mesenchymal stromal cells (MSCs) and endothelial progenitor cells (EPCs) are used in cell-based regenerative therapy. HMG CoA reductase inhibitors (statins) appear promising in blocking apoptosis, prolonging progenitor cell survival and improving their capacity to repair organ function. METHODS We performed a systematic review of preclinical and clinical studies to clarify whether statins can improve cell-based repair of organ injury. MEDLINE, EMBASE, and PUBMED databases were searched (1947 to June 25, 2013). Controlled clinical and pre-clinical studies were included that evaluated statin therapy used alone or in combination with MSCs or EPCs in patients or animals with organ injury. RESULTS After screening 771 citations, 100 records underwent full eligibility screening of which 38 studies met eligibility and were included in the review: Studies were grouped into pre-clinical studies that involved statin treatment in combination with cell therapy (18 studies), preclinical studies of statin therapy alone (13 studies) and clinical studies of statin therapy (7 studies). Studies addressed cardiac injury (14 studies), vascular disorders (15 studies), neurologic conditions (8 studies) and bone fractures (1 study). Pre-clinical studies of statins in combination with MSC infusion (15 studies) or EPC therapy (3 studies) were described and despite marked heterogeneity in reporting outcomes of cellular analysis and organ function, all of these cell-based pre-clinical studies reported improved organ recovery with the addition of statin therapy. Moreover, 13 pre-clinical studies involved the administration of a statin drug alone to animals. An increase in EPC number and/or function (no studies of MSCs) was reported in 11 of these studies (85 %) and improved organ function in 12 studies (92 %). We also identified 7 clinical studies and none involved the administration of cells but described an increased number and/or function of EPCs (no studies of MSCs) and improved organ function with statin therapy (1.2-fold to 35-fold improvement over controls) in all 7 studies. CONCLUSION Our systematic review provides a foundation of encouraging results that support further study of statins in regenerative therapy to augment the number and/or function of MSCs used in cell-based repair and to augment the number and function of EPCs in vivo to repair damaged tissues. Larger studies are needed to ensure safety and confirm clinical benefits.
Collapse
|
66
|
Kuhn H, Park A, Kim B, Lukesh W, Rose A. Proportion of work appropriate for pharmacy technicians in anticoagulation clinics. Am J Health Syst Pharm 2016; 73:322-7. [DOI: 10.2146/ajhp150272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
67
|
Gardner B, Park A, Sabri S, Haskal Z, Angle J, Matsumoto A. Splenic artery embolization provides value at all levels of severity of splenic laceration. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
68
|
Yin H, Song CQ, Dorkin JR, Zhu LJ, Li Y, Wu Q, Park A, Yang J, Suresh S, Bizhanova A, Gupta A, Bolukbasi MF, Walsh S, Bogorad RL, Gao G, Weng Z, Dong Y, Koteliansky V, Wolfe SA, Langer R, Xue W, Anderson DG. Therapeutic genome editing by combined viral and non-viral delivery of CRISPR system components in vivo. Nat Biotechnol 2016; 34:328-33. [PMID: 26829318 PMCID: PMC5423356 DOI: 10.1038/nbt.3471] [Citation(s) in RCA: 621] [Impact Index Per Article: 77.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/05/2016] [Indexed: 12/15/2022]
Abstract
The combination of Cas9, guide RNA and repair template DNA can induce
precise gene editing and the correction of genetic diseases in adult mammals.
However, clinical implementation of this technology requires safe and effective
delivery of all of these components into the nuclei of the target tissue. Here,
we combine lipid nanoparticle–mediated delivery of Cas9 mRNA with
adeno-associated viruses encoding a sgRNA and a repair template to induce repair
of a disease gene in adult animals. We applied our delivery strategy to a mouse
model of human hereditary tyrosinemia and show that the treatment generated
fumarylacetoacetate hydrolase (Fah)-positive hepatocytes by correcting the
causative Fah-splicing mutation. Treatment rescued disease symptoms such as
weight loss and liver damage. The efficiency of correction was
>6% of hepatocytes after a single application, suggesting
potential utility of Cas9-based therapeutic genome editing for a range of
diseases.
Collapse
|
69
|
Hu J, Lomanto D, Dumanian G, Cheesborough J, Ponten J, Hameeteman M, Nienhuijs S, Zahiri H, Benenati M, Sibia U, Sivak B, Park A, Belyansky I, Huang CS, Verhagen T, Loos MJA, Scheltinga MRM, Roumen RMH, Morfesis F, Rose B, Zarrinkhoo E, Towfigh S, Miller J, Campanella AM, Licheri S, Barbarossa M, Porceddu G, Ferraro G, Virdis F, Reccia I, Aresu S, Pisanu A. Rectum Diastasis, Post Partum Floppy Wall & Obscure Groin Pain in Women. Hernia 2015; 19 Suppl 1:S73-6. [PMID: 26518865 DOI: 10.1007/bf03355330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
70
|
Kim J, Choi W, Jeon SM, Kim T, Park A, Kim J, Heo SJ, Oh C, Shim WB, Kang DH. Isolation and characterization of Leptolyngbya
sp. KIOST-1, a basophilic and euryhaline filamentous cyanobacterium from an open paddle-wheel raceway Arthrospira
culture pond in Korea. J Appl Microbiol 2015; 119:1597-612. [DOI: 10.1111/jam.12961] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/25/2015] [Accepted: 09/23/2015] [Indexed: 12/12/2022]
|
71
|
Sim I, Koh JH, Kim DJ, Gu SH, Park A, Lim YH. In vitro assessment of the gastrointestinal tolerance and immunomodulatory function of Bacillus methylotrophicus isolated from a traditional Korean fermented soybean food. J Appl Microbiol 2015; 118:718-26. [PMID: 25494714 DOI: 10.1111/jam.12719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 12/12/2022]
Abstract
AIMS This study aimed to investigate the potential of Bacillus methylotrophicus as a probiotic. METHODS AND RESULTS A Bacillus isolate designated strain C14 was isolated from Korean traditional fermented soybean paste (doenjang). The strain was identified, and its physiological and biochemical properties were characterized. The gastrointestinal tolerance and immunomodulatory function of strain C14 were also investigated. Strain C14 was identified as B. methylotrophicus by analysis of its biochemical properties using the API 50CHB system and by phylogenetic analysis of the 16S rDNA sequence. Strain C14 showed >80% and >75% of survival for artificial gastric juices (pH 2.5 and 1% pepsin) and 0.5% (w/v) bile salt, respectively. Heat-killed B. methylotrophicus C14 inhibited the adhesion of various pathogens and enhanced the adhesion of probiotic bacteria to Caco-2 cells. The heat-killed cells also induced high levels of immune cell proliferation compared with the control and stimulated interleukin-6 and tumour necrosis factor-α production in mouse macrophages. CONCLUSIONS Bacillus methylotrophicus C14 could be used as a probiotic. SIGNIFICANCE AND IMPACT OF THE STUDY Recently identified B. methylotrophicus is a new potential probiotic with high gastrointestinal tolerance.
Collapse
|
72
|
Vardy J, Dhillon HM, Pond GR, Rourke SB, Xu W, Dodd A, Renton C, Park A, Bekele T, Ringash J, Zhang H, Burkes R, Clarke SJ, Tannock IF. Cognitive function and fatigue after diagnosis of colorectal cancer. Ann Oncol 2014; 25:2404-2412. [PMID: 25214544 DOI: 10.1093/annonc/mdu448] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cognitive impairment and fatigue have been associated with cancer and its treatment. We present baseline data from a large longitudinal study that evaluates cognitive function, fatigue, and potential underlying mechanisms following diagnosis of colorectal cancer (CRC). PATIENTS AND METHODS We evaluated CRC patients with stage I-III disease before or after surgery, participants with limited metastatic disease and healthy controls (HC). Neuropsychological evaluation included clinical and computerised tests. Participants completed questionnaires for fatigue and quality of life (QOL)-(FACT-F), anxiety/depression, and cognitive symptoms (FACT-Cog). Ten cytokines, clotting factors, sex hormones, carcinoembryonic antigen (CEA), and apolipoprotein E genotype were evaluated. Primary end points were cognitive function on clinical tests evaluated by a Global Deficit score (GDS) and fatigue. Associations between test results, demographic, and disease related factors were explored. RESULTS We assessed 291 participants with early-stage disease [median age 59 (23-75) years, 63% men], 72 with metastatic disease, and 72 HC. Using GDS, 45% (126/281) of participants with early-stage CRC had cognitive impairment versus 15% (11/72) of HC (odds ratio 4.51, 95% confidence interval 2.28-8.93; P < 0.001), with complex processing speed, attention/working memory, and verbal learning efficiency being most affected. Women with early-stage CRC had greater cognitive impairment than men [55/105 (52%) versus 71/176 (40%), P < 0.050]. Cognitive symptoms were self-reported by 21% (59/286) of early-stage patients versus 17% (12/72) of HC; fatigue by 52% (149/287) of early-stage patients and 26% (19/72) of HC (P < 0.0001). Women reported more fatigue than men (P = 0.003). Fatigue, QOL, anxiety/depression, and cognitive symptoms were associated with each other (r = 0.43-0.71), but not with neuropsychological performance. Most cytokines were elevated in cancer patients. Cognitive function was not associated with cytokines, sex hormones, clotting factors, CEA, or apolipoprotein E genotype. CONCLUSIONS The incidence of cognitive impairment was three to five times higher in CRC patients than HC, with women having higher impairment rates than men. The cognitive impairment profile suggests dysfunction primarily in fronto-subcortical brain systems. TRIAL REGISTRATION NCT00188331.
Collapse
|
73
|
Perry L, Gunderson C, Walter A, Vesely S, Moore K, Park A. The effect of age on completion of prescribed chemoradiation among patients with cervix cancer. Gynecol Oncol 2014. [DOI: 10.1016/j.ygyno.2014.03.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
74
|
Wells S, Rozenblum R, Park A, Dunn M, Bates DW. Personal health records for patients with chronic disease: a major opportunity. Appl Clin Inform 2014; 5:416-29. [PMID: 25024758 DOI: 10.4338/aci-2014-01-ra-0002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/05/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) connected to a physician's electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. OBJECTIVES To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. METHODS A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. RESULTS Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. CONCLUSION This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination.
Collapse
|
75
|
Skillman JM, Venus MR, Nightingale P, Titley OG, Park A. Ligating perforators in abdominoplasty reduces the risk of seroma. Aesthetic Plast Surg 2014; 38:446-50. [PMID: 24488004 DOI: 10.1007/s00266-013-0267-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seroma formation, a common complication of abdominoplasty, can cause patient discomfort and inconvenience. This study aimed to compare seroma rates after ligation and diathermy of large abdominal perforating vessels during abdominoplasty. METHODS Consecutive patients undergoing abdominoplasty with epigastric undermining between 2004 and 2011 were studied. Body mass index (BMI), age at operation, smoking history, preoperative weight loss, operative details, perioperative fluid infiltration, concomitant abdominal liposuction, ligation of perforators by clips, suture or diathermy, use of quilting sutures, weight of tissue removed, postoperative drainage, inpatient stay, and seroma rates were recorded. Statistical analysis was undertaken using the unpaired t test, Fisher's exact test, the Mann-Whitney U test, and Kendall's tau-b test. RESULTS The study included 90 patients. The incidence of seroma was significantly lower among the patients who had perforators ligated (4/60, 6.7%) than among those who had diathermy (10/30, 33%) (p=0.002, Fisher's exact test). Seroma formation was significantly associated with a higher BMI, (27.45 vs. 25.16 kg/m2; p=0.025, t test) but not with preoperative weight loss. Postoperative fluid drainage did not differ significantly between ligated and diathermied perforators (p=0.716 Mann-Whitney U test). CONCLUSIONS Use of ligation by clip or suture rather than by diathermy to ablate large abdominal perforators significantly reduced the incidence of seroma among abdominoplasty patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
76
|
Doster J, Angle J, Stone J, Haskal Z, Park A, Wilkins L, Matsumoto A, Sabri S. Technique and tools needed for successful balloon-occluded retrograde transvenous obliteration (BRTO). J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
77
|
Hendricks N, Angle J, Stone J, Park A, Matsumoto A, Cherry K, Sabri S. Angiographic evaluation of high performance athletes with endofibrosis. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
78
|
Ezzell A, Sokol A, Gutman R, Iglesia C, Park A. Urethral Diverticulectomy and Urinary Incontinence. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
79
|
Doster J, Angle J, Sabri S, Haskal Z, Park A, Wilkins L, Matsumoto A, Stone J. Endovascular treatment options for a Dieulafoy’s lesion. J Vasc Interv Radiol 2014. [DOI: 10.1016/j.jvir.2013.12.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
80
|
Enns JE, Hanke D, Park A, Zahradka P, Taylor CG. Diets high in monounsaturated and polyunsaturated fatty acids decrease fatty acid synthase protein levels in adipose tissue but do not alter other markers of adipose function and inflammation in diet-induced obese rats. Prostaglandins Leukot Essent Fatty Acids 2014; 90:77-84. [PMID: 24411719 DOI: 10.1016/j.plefa.2013.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
This study investigates the effects of monounsaturated and polyunsaturated fatty acids from different fat sources (High Oleic Canola, Canola, Canola-Flaxseed (3:1 blend), Safflower, or Soybean Oil, or a Lard-based diet) on adipose tissue function and markers of inflammation in Obese Prone rats fed high-fat (55% energy) diets for 12 weeks. Adipose tissue fatty acid composition reflected the dietary fatty acid profiles. Protein levels of fatty acid synthase, but not mRNA levels, were lower in adipose tissue of all groups compared to the Lard group. Adiponectin and fatty acid receptors GPR41 and GPR43 protein levels were also altered, but other metabolic and inflammatory mediators in adipose tissue and serum were unchanged among groups. Overall, rats fed vegetable oil- or lard-based high-fat diets appear to be largely resistant to major phenotypic changes when the dietary fat composition is altered, providing little support for the importance of specific fatty acid profiles in the context of a high-fat diet.
Collapse
|
81
|
Mann GB, Pitcher M, Shanahan K, Storer L, Rio I, Bell B, Hookey S, Hickey M, Kennedy L, Curwen-Walker R, Vij S, Park A, Bell C. Abstract P3-08-04: Survivorship care involving a nurse-led survivorship consultation, community support and shared care with primary practitioners. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-08-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Survivorship care (SC) has gained prominence as the number of patients disease free after breast cancer treatment increases, the specific needs of those patients become recognised, and funding to meet these demands is constrained. Involvement of Primary Care Practitioners in SC is seen as a solution, but models of Shared Care have met varying degrees of success. We report on a model that involves Specialist centres, Primary Care Practitioners and organisations, and a community based patient support organisation.
Patients and Methods
A consortium comprising two hospital based breast services – the Royal Melbourne/Royal Women's and Western Hospitals – a regional consortium of Primary Care Physicians, and BreaCan, a non-government peer support organisation for women diagnosed with breast cancer, collaborated to obtain and implement a government-supported Survivorship Care Program. Patients completing definitive treatment for early breast cancer were invited to a Nurse-led consultation where the disease, its pathology, treatment and follow-up were reviewed. Psychosocial and other issues were explored and a personalised SC plan was devised and agreed upon. This plan included Shared Care with the Primary Care Practitioner in the majority of cases. Unmet needs were identified and addressed. The SC plan was signed off by a senior breast cancer clinician and forwarded to the primary care physician for ratification. Evaluation included satisfaction surveys and interviews with patients and primary care physicians. Intensity of use of hospital based services was calculated and compared to a previous cohort of early breast cancer patients.
Results
282 patients completing definitive treatment were offered Nurse-led survivorship consultation. 29 declined, and 28 cancelled. At 31 May 2013, 148 care plans were completed, 38 were in preparation and 39 appointments were booked. Response to this initiative from hospital based specialists was positive. All believed that this program would reduce the amount of routine consultations and increase capacity for new or returning patients requiring specialist care. Primary care doctors overwhelmingly believed the survivorship care plan contained information needed to allow them to manage breast cancer survivors, and gave them confidence to take on this role, although there was some uncertainty regarding role delineation between Primary Care and hospital. Patient evaluation of the Nurse-led clinics was strongly positive. All reported finding out something during the consultation, and 94% said they considered the hospital and GP to be partners in their on-going follow-up care. Modelling suggests that about 5 fewer hospital appointments will be required for each patient managed under this program compared to routine hospital-based care.
Conclusions
Hospital based specialists embrace Survivorship care including shared care and patients expect it, while Primary physicians will participate if offered education, support and specific direction. A model including an end-of –treatment consultation and Shared care with Primary Practitioners appears to address many of the requirements for a successful Survivorship program.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-08-04.
Collapse
|
82
|
Aaberg-Jessen C, Fogh L, Halle B, Jensen V, Brunner N, Kristensen BW, Abe T, Momii Y, Watanabe J, Morisaki I, Natsume A, Wakabayashi T, Fujiki M, Aldaz B, Fabius AWM, Silber J, Harinath G, Chan TA, Huse JT, Anai S, Hide T, Nakamura H, Makino K, Yano S, Kuratsu JI, Balyasnikova IV, Prasol MS, Kanoija DK, Aboody KS, Lesniak MS, Barone T, Burkhart C, Purmal A, Gudkov A, Gurova K, Plunkett R, Barton K, Misuraca K, Cordero F, Dobrikova E, Min H, Gromeier M, Kirsch D, Becher O, Pont LB, Kloezeman J, van den Bent M, Kanaar R, Kremer A, Swagemakers S, French P, Dirven C, Lamfers M, Leenstra S, Pont LB, Balvers R, Kloezeman J, Kleijn A, Lawler S, Leenstra S, Dirven C, Lamfers M, Gong X, Andres A, Hanson J, Delashaw J, Bota D, Chen CC, Yao NW, Chuang WJ, Chang C, Chen PY, Huang CY, Wei KC, Cheng Y, Dai Q, Morshed R, Han Y, Auffinger B, Wainwright D, Zhang L, Tobias A, Rincon E, Thaci B, Ahmed A, He C, Lesniak M, Choi YA, Pandya H, Gibo DM, Fokt I, Priebe W, Debinski W, Chornenkyy Y, Agnihotri S, Buczkowicz P, Rakopoulos P, Morrison A, Barszczyk M, Becher O, Hawkins C, Chung S, Decollogne S, Luk P, Shen H, Ha W, Day B, Stringer B, Hogg P, Dilda P, McDonald K, Moore S, Hayden-Gephart M, Bergen J, Su Y, Rayburn H, Edwards M, Scott M, Cochran J, Das A, Varma AK, Wallace GC, Dixon-Mah YN, Vandergrift WA, Giglio P, Ray SK, Patel SJ, Banik NL, Dasgupta T, Olow A, Yang X, Mueller S, Prados M, James CD, Haas-Kogan D, Dave ND, Desai PB, Gudelsky GA, Chow LML, LaSance K, Qi X, Driscoll J, Driscoll J, Ebsworth K, Walters MJ, Ertl LS, Wang Y, Berahovic RD, McMahon J, Powers JP, Jaen JC, Schall TJ, Eroglu Z, Portnow J, Sacramento A, Garcia E, Raubitschek A, Synold T, Esaki S, Rabkin S, Martuza R, Wakimoto H, Ferluga S, Tome CL, Debinski W, Forde HE, Netland IA, Sleire L, Skeie B, Enger PO, Goplen D, Giladi M, Tichon A, Schneiderman R, Porat Y, Munster M, Dishon M, Weinberg U, Kirson E, Wasserman Y, Palti Y, Giladi M, Porat Y, Schneiderman R, Munster M, Weinberg U, Kirson E, Palti Y, Gramatzki D, Staudinger M, Frei K, Peipp M, Weller M, Grasso C, Liu L, Becher O, Berlow N, Davis L, Fouladi M, Gajjar A, Hawkins C, Huang E, Hulleman E, Hutt M, Keller C, Li XN, Meltzer P, Quezado M, Quist M, Raabe E, Spellman P, Truffaux N, van Vurden D, Wang N, Warren K, Pal R, Grill J, Monje M, Green AL, Ramkissoon S, McCauley D, Jones K, Perry JA, Ramkissoon L, Maire C, Shacham S, Ligon KL, Kung AL, Zielinska-Chomej K, Grozman V, Tu J, Viktorsson K, Lewensohn R, Gupta S, Mladek A, Bakken K, Carlson B, Boakye-Agyeman F, Kizilbash S, Schroeder M, Reid J, Sarkaria J, Hadaczek P, Ozawa T, Soroceanu L, Yoshida Y, Matlaf L, Singer E, Fiallos E, James CD, Cobbs CS, Hashizume R, Tom M, Ihara Y, Ozawa T, Santos R, Torre JDL, Lepe E, Waldman T, Prados M, James D, Hashizume R, Ihara Y, Huang X, Yu-Jen L, Tom M, Mueller S, Gupta N, Solomon D, Waldman T, Zhang Z, James D, Hayashi T, Adachi K, Nagahisa S, Hasegawa M, Hirose Y, Gephart MH, Moore S, Bergen J, Su YS, Rayburn H, Scott M, Cochran J, Hingtgen S, Kasmieh R, Nesterenko I, Figueiredo JL, Dash R, Sarkar D, Fisher P, Shah K, Horne E, Diaz P, Stella N, Huang C, Yang H, Wei K, Huang T, Hlavaty J, Ostertag D, Espinoza FL, Martin B, Petznek H, Rodriguez-Aguirre M, Ibanez C, Kasahara N, Gunzburg W, Gruber H, Pertschuk D, Jolly D, Robbins J, Hurwitz B, Yoo JY, Bolyard C, Yu JG, Wojton J, Zhang J, Bailey Z, Eaves D, Cripe T, Old M, Kaur B, Serwer L, Yoshida Y, Le Moan N, Santos R, Ng S, Butowski N, Krtolica A, Ozawa T, Cary SPL, James CD, Johns T, Greenall S, Donoghue J, Adams T, Karpel-Massler G, Westhoff MA, Kast RE, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Karpel-Massler G, Kast RE, Westhoff MA, Merkur N, Dwucet A, Wirtz CR, Debatin KM, Halatsch ME, Kievit F, Stephen Z, Wang K, Kolstoe D, Silber J, Ellenbogen R, Zhang M, Kitange G, Schroeder M, Sarkaria J, Kleijn A, Haefner E, Leenstra S, Dirven C, Lamfers M, Knubel K, Pernu BM, Sufit A, Pierce AM, Nelson SK, Keating AK, Jensen SS, Kristensen BW, Lachowicz J, Demeule M, Regina A, Tripathy S, Curry JC, Nguyen T, Castaigne JP, Le Moan N, Serwer L, Yoshida Y, Ng S, Davis T, Santos R, Davis A, Tanaka K, Keating T, Getz J, Kapp GT, Romero JM, Ozawa T, James CD, Krtolica A, Cary SPL, Lee S, Ramisetti S, Slagle-Webb B, Sharma A, Connor J, Lee WS, Maire C, Kluk M, Aster JC, Ligon K, Sun S, Lee D, Ho ASW, Pu JKS, Zhang ZQ, Lee NP, Day PJR, Leung GKK, Liu Z, Liu X, Madhankumar AB, Miller P, Webb B, Connor JR, Yang QX, Lobo M, Green S, Schabel M, Gillespie Y, Woltjer R, Pike M, Lu YJ, Torre JDL, Waldman T, Prados M, Ozawa T, James D, Luchman HA, Stechishin O, Nguyen S, Cairncross JG, Weiss S, Lun X, Wells JC, Hao X, Zhang J, Grinshtein N, Kaplan D, Luchman A, Weiss S, Cairncross JG, Senger D, Robbins S, Madhankumar A, Slagle-Webb B, Rizk E, Payne R, Park A, Pang M, Harbaugh K, Connor J, Wilisch-Neumann A, Pachow D, Kirches E, Mawrin C, McDonell S, Liang J, Piao Y, Nguyen N, Yung A, Verhaak R, Sulman E, Stephan C, Lang F, de Groot J, Mizobuchi Y, Okazaki T, Kageji T, Kuwayama K, Kitazato KT, Mure H, Hara K, Morigaki R, Matsuzaki K, Nakajima K, Nagahiro S, Kumala S, Heravi M, Devic S, Muanza T, Nelson SK, Knubel KH, Pernu BM, Pierce AM, Keating AK, Neuwelt A, Nguyen T, Wu YJ, Donson A, Vibhakar R, Venkatamaran S, Amani V, Neuwelt E, Rapkin L, Foreman N, Ibrahim F, New P, Cui K, Zhao H, Chow D, Stephen W, Nozue-Okada K, Nagane M, McDonald KL, Ogawa D, Chiocca E, Godlewski J, Ozawa T, Yoshida Y, Santos R, James D, Pang M, Liu X, Madhankumar AB, Slagle-Webb B, Patel A, Miller P, Connor J, Pasupuleti N, Gorin F, Valenzuela A, Leon L, Carraway K, Ramachandran C, Nair S, Quirrin KW, Khatib Z, Escalon E, Melnick S, Phillips A, Boghaert E, Vaidya K, Ansell P, Shalinsky D, Zhang Y, Voorbach M, Mudd S, Holen K, Humerickhouse R, Reilly E, Huang T, Parab S, Diago O, Espinoza FL, Martin B, Ibanez C, Kasahara N, Gruber H, Pertschuk D, Jolly D, Robbins J, Ryken T, Agarwal S, Al-Keilani M, Alqudah M, Sibenaller Z, Assemolt M, Sai K, Li WY, Li WP, Chen ZP, Saito R, Sonoda Y, Kanamori M, Yamashita Y, Kumabe T, Tominaga T, Sarkar G, Curran G, Jenkins R, Scharnweber R, Kato Y, Lin J, Everson R, Soto H, Kruse C, Kasahara N, Liau L, Prins R, Semenkow S, Chu Q, Eberhart C, Sengupta R, Marassa J, Piwnica-Worms D, Rubin J, Serwer L, Kapp GT, Le Moan N, Yoshida Y, Romero JM, Ng S, Davis A, Ozawa T, Krtolica A, James CD, Cary SPL, Shai R, Pismenyuk T, Moshe I, Fisher T, Freedman S, Simon A, Amariglio N, Rechavi G, Toren A, Yalon M, Shen H, Decollogne S, Dilda P, Chung S, Luk P, Hogg P, McDonald K, Shimazu Y, Kurozumi K, Ichikawa T, Fujii K, Onishi M, Ishida J, Oka T, Watanabe M, Nasu Y, Kumon H, Date I, Sirianni RW, McCall RL, Spoor J, van der Kaaij M, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Stephen Z, Veiseh O, Kievit F, Fang C, Leung M, Ellenbogen R, Silber J, Zhang M, Strohbehn G, Atsina KK, Patel T, Piepmeier J, Zhou J, Saltzman WM, Takahashi M, Valdes G, Inagaki A, Kamijima S, Hiraoka K, Micewicz E, McBride WH, Iwamoto KS, Gruber HE, Robbins JM, Jolly DJ, Kasahara N, Warren K, McCully C, Bacher J, Thomas T, Murphy R, Steffen-Smith E, McAllister R, Pastakia D, Widemann B, Wei K, Yang H, Huang C, Chen P, Hua M, Liu H, Woolf EC, Abdelwahab MG, Fenton KE, Liu Q, Turner G, Preul MC, Scheck AC, Yoshida Y, Ozawa T, Butowski N, Shen W, Brown D, Pedersen H, James D, Zhang J, Hariono S, Yao TW, Sidhu A, Hashizume R, James CD, Weiss WA, Nicolaides TP, Olusanya T. EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2013; 15:iii37-iii61. [PMCID: PMC3823891 DOI: 10.1093/neuonc/not176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
|
83
|
Park A, Zid D, Russell J, Malone A, Rendon A, Wehr A, Li X. Effects of a formal exercise program on Parkinson's disease: a pilot study using a delayed start design. Parkinsonism Relat Disord 2013; 20:106-11. [PMID: 24209458 DOI: 10.1016/j.parkreldis.2013.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/28/2013] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Parkinson's Disease (PD) is a progressive neurodegenerative disease. Increasing evidence shows that physical exercise is beneficial for motor and non-motor symptoms of PD, and animal models suggest that it may help slow progression of disease. METHODS Using a randomized delayed-start design, 31 patients were randomized to an early start group (ESG) or a delayed start group (DSG) exercise program. The ESG underwent a rigorous formal group exercise program for 1 h, three days/week, for 48 weeks (November 2011-October 2012). The DSG participated in this identical exercise program from weeks 24-48. Outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Walking Test (get-up-and-go), Tinetti Mobility Test, PDQ-39 Questionnaire, and the Beck Depression Inventory. RESULTS There was minimal attrition in this study, with only one patient dropping out. Results did not show improvement in total UPDRS scores with early exercise. At week 48, the mean change from baseline total UPDRS score was 6.33 in the ESG versus 5.13 in the DSG (p = 0.58). However, patients randomized to the ESG scored significantly better on the Beck Depression Inventory, with a mean improvement of 1.07 points relative to those in the DSG (p = 0.04). CONCLUSIONS The findings demonstrate that long-term, group exercise programs are feasible in the Parkinson's disease population, with excellent adherence and minimal drop out. While the outcome measures used in our study did not provide strong evidence that exercise has a neuroprotective effect on motor function, earlier participation in a group exercise program had a significant effect on symptoms of depression.
Collapse
|
84
|
Ramage TM, Chang FL, Shih J, Alvi RS, Quitoriano GR, Rau V, Barbour KC, Elphick SA, Kong CL, Tantoco NK, Ben-Tzur D, Kang H, McCreery MS, Huang P, Park A, Uy J, Rossi MJ, Zhao C, Di Geronimo RT, Stratmann G, Sall JW. Distinct long-term neurocognitive outcomes after equipotent sevoflurane or isoflurane anaesthesia in immature rats. Br J Anaesth 2013; 110 Suppl 1:i39-46. [PMID: 23592692 DOI: 10.1093/bja/aet103] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many anaesthetics when given to young animals cause cell death and learning deficits that persist until much later in life. Recent attempts to compare the relative safety or toxicity between different agents have not adequately controlled for the relative dose of anaesthetic given, thereby making direct comparisons difficult. METHODS Isoflurane or sevoflurane were given at 1 minimum alveolar concentration (MAC) for 4 h to postnatal day 7 (P7) rat pups. Beginning at P75 these animals underwent fear conditioning and at P83 Morris water maze testing to assess working memory, short-term memory and early long-term memory using delays of 1 min, 1 h, and 4 h. RESULTS No difference between groups was seen in fear conditioning experiments. Morris water maze learning was equivalent between groups, and no difference was seen in working memory. Sevoflurane-treated animals had a deficit in early long-term memory, and isoflurane-treated animals had a deficit in both short-term and early long-term memory. CONCLUSIONS Both isoflurane and sevoflurane delivered at 1 MAC for 4 h to immature rats caused a deficit in long-term memory. Isoflurane also caused a deficit in short-term memory. Isoflurane might be more detrimental than sevoflurane in very young animals.
Collapse
|
85
|
West J, Park A, Stone J, Rea K, Cage D, Saad W, Sabri S, Matsumoto A. Evaluation of the safety and short-term clinical outcomes in the treatment of uterine fibroids with MR-guided focused ultrasound. J Vasc Interv Radiol 2013. [DOI: 10.1016/j.jvir.2013.01.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
86
|
Carty CL, Spencer KL, Setiawan VW, Fernandez-Rhodes L, Malinowski J, Buyske S, Young A, Jorgensen NW, Cheng I, Carlson CS, Brown-Gentry K, Goodloe R, Park A, Parikh NI, Henderson B, Le Marchand L, Wactawski-Wende J, Fornage M, Matise TC, Hindorff LA, Arnold AM, Haiman CA, Franceschini N, Peters U, Crawford DC. Replication of genetic loci for ages at menarche and menopause in the multi-ethnic Population Architecture using Genomics and Epidemiology (PAGE) study. Hum Reprod 2013; 28:1695-706. [PMID: 23508249 DOI: 10.1093/humrep/det071] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION Do genetic associations identified in genome-wide association studies (GWAS) of age at menarche (AM) and age at natural menopause (ANM) replicate in women of diverse race/ancestry from the Population Architecture using Genomics and Epidemiology (PAGE) Study? SUMMARY ANSWER We replicated GWAS reproductive trait single nucleotide polymorphisms (SNPs) in our European descent population and found that many SNPs were also associated with AM and ANM in populations of diverse ancestry. WHAT IS KNOWN ALREADY Menarche and menopause mark the reproductive lifespan in women and are important risk factors for chronic diseases including obesity, cardiovascular disease and cancer. Both events are believed to be influenced by environmental and genetic factors, and vary in populations differing by genetic ancestry and geography. Most genetic variants associated with these traits have been identified in GWAS of European-descent populations. STUDY DESIGN, SIZE, DURATION A total of 42 251 women of diverse ancestry from PAGE were included in cross-sectional analyses of AM and ANM. MATERIALS, SETTING, METHODS SNPs previously associated with ANM (n = 5 SNPs) and AM (n = 3 SNPs) in GWAS were genotyped in American Indians, African Americans, Asians, European Americans, Hispanics and Native Hawaiians. To test SNP associations with ANM or AM, we used linear regression models stratified by race/ethnicity and PAGE sub-study. Results were then combined in race-specific fixed effect meta-analyses for each outcome. For replication and generalization analyses, significance was defined at P < 0.01 for ANM analyses and P < 0.017 for AM analyses. MAIN RESULTS AND THE ROLE OF CHANCE We replicated findings for AM SNPs in the LIN28B locus and an intergenic region on 9q31 in European Americans. The LIN28B SNPs (rs314277 and rs314280) were also significantly associated with AM in Asians, but not in other race/ethnicity groups. Linkage disequilibrium (LD) patterns at this locus varied widely among the ancestral groups. With the exception of an intergenic SNP at 13q34, all ANM SNPs replicated in European Americans. Three were significantly associated with ANM in other race/ethnicity populations: rs2153157 (6p24.2/SYCP2L), rs365132 (5q35/UIMC1) and rs16991615 (20p12.3/MCM8). While rs1172822 (19q13/BRSK1) was not significant in the populations of non-European descent, effect sizes showed similar trends. LIMITATIONS, REASONS FOR CAUTION Lack of association for the GWAS SNPs in the non-European American groups may be due to differences in locus LD patterns between these groups and the European-descent populations included in the GWAS discovery studies; and in some cases, lower power may also contribute to non-significant findings. WIDER IMPLICATIONS OF THE FINDINGS The discovery of genetic variants associated with the reproductive traits provides an important opportunity to elucidate the biological mechanisms involved with normal variation and disorders of menarche and menopause. In this study we replicated most, but not all reported SNPs in European descent populations and examined the epidemiologic architecture of these early reported variants, describing their generalizability and effect size across differing ancestral populations. Such data will be increasingly important for prioritizing GWAS SNPs for follow-up in fine-mapping and resequencing studies, as well as in translational research.
Collapse
|
87
|
Magraw C, Lam D, Park A, Perrino M, Eisig S. Poster 04: Computer-Simulated Neonatal Mandibular Distraction Osteogenesis. J Oral Maxillofac Surg 2012. [DOI: 10.1016/j.joms.2012.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
88
|
McDaid D, Park A. P04.69. Investing in integrative medicine for mental health and wellbeing: making the economic case. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012. [PMCID: PMC3373874 DOI: 10.1186/1472-6882-12-s1-p339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
89
|
Resendes S, Ramanan T, Park A, Petrisor B, Bhandari M. Send it: study of e-mail etiquette and notions from doctors in training. JOURNAL OF SURGICAL EDUCATION 2012; 69:393-403. [PMID: 22483143 DOI: 10.1016/j.jsurg.2011.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/05/2011] [Accepted: 12/09/2011] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Worldwide, more than 247 billion e-mails are sent each day. Little empiric evidence is available to guide how e-mail presentation style, tone, and content affect e-mail recipients and whether these factors impact opinions about the sender and the rapidity of response. In a study of physicians in training assessing a series of 100 e-mail examples, we examined the following: (1) formatting characteristics most and least endorsed, (2) impression of the sender based on the e-mail itself, and (3) factors associated with the decision to respond. We reasoned that our study would provide empiric data to support recommendations for e-mail etiquette, focusing specifically on doctors in training. DESIGN Cross-sectional survey study. SETTING Division of Orthopaedic Surgery at McMaster University, Hamilton, Ontario, Canada. PARTICIPANTS After each e-mail, the participating surgical residents completed a series of questions focusing on their impression of the e-mail appearance, their perception of the sender, and their motivation to respond to the e-mail. RESULTS Thirty-two residents participated in this study. The responses indicate that the key negatively endorsed features of the e-mails included the use of colored backgrounds (84%), difficult-to-read font (83%), lack of a subject header (55%), opening salutations without recipient names (50%), or no salutation at all (42%). The senders of negatively endorsed e-mails were perceived by participants as inefficient (p = 0.03), unprofessional (p < 0.001), and irritating (p = 0.007). E-mails with overall positive endorsements were significantly more likely to have the participants perceive the e-mail senders as professional (p < 0.001), pleasant (p = 0.048), and kind (p = 0.059). The participants were 2.6-fold more likely to respond immediately when they perceived e-mails as favorable compared with disliking them (42% vs 16% of responses, respectively, p < 0.001). CONCLUSION The e-mails perceived as being disliked overall are likely to result in a negative perception of the sender and delays in response time.
Collapse
|
90
|
Simon P, Saad W, Nicholson D, Bernhard M, Turba U, Davies M, Sabri S, Stone J, Park A, Angle J, Matsumoto A. Abstract No. 143: Balloon-expandable stent-grafts for instent restenosis in atherosclerotic renal artery stenosis with prior clinical response. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
91
|
Lyman S, Turba U, Cage D, Sildiroglu O, Sabri S, Stone J, Park A, Saad W, Angle J, Matsumoto A. Abstract No. 55 Dedicated inferior vena cava filter clinic; evolving clinical practice since 2002. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
92
|
Rueb G, Brady W, Gilliland C, Patrie J, Saad W, Turba U, Sabri S, Park A, Stone J, Angle J. Abstract No. 250: Characterizing cardiopulmonary arrest during interventional radiology procedures. J Vasc Interv Radiol 2012. [DOI: 10.1016/j.jvir.2011.12.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
93
|
Paraiso M, Ridgeway B, Jelovsek J, Park A, Barber M, Falcone T, Einarsson J. Laparoscopic Versus Robotic Hysterectomy: A Randomized Controlled Trial. J Minim Invasive Gynecol 2011. [DOI: 10.1016/j.jmig.2011.08.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
94
|
Pavel H, Ajeawung N, Faure R, Poirier D, Kamnasaran D, Ajeawung N, Joshi H, Kamnasaran D, Poirier D, Ajeawung N, Kamnasaran D, Lun X, Zemp F, Sun B, Stechishin O, Luchman A, Kelly JJ, Weiss S, Hamilton MG, Cairncross G, Senger DL, Bell J, McFadden G, Forsyth PA, Tzeng SY, Guerrero-Cazares H, Martinez EE, Young NP, Sunshine JC, Quinones-Hinojosa A, Green JJ, Lei L, D'Amico R, Sisti J, Leung R, Sonabend AM, Guarnieri P, Rosenfeld SS, Bruce JN, Canoll P, Baichwal VR, Reeves L, Chad BL, Zavitz KH, Beelen AP, Mather GG, Carlson RO, Manton C, Chandra J, Keir ST, Reardon DA, Saling JR, Gray LS, Bigner DD, Friedman HS, Zhang J, Brun J, Ogbomo H, Zemp F, Wang Z, Stojdl DJ, Lun X, Forsyth PA, Kong LY, Hatiboglu MA, Wei J, Wang Y, McEnery KA, Fuller GN, Qiao W, Davies MA, Priebe W, Heimberger AB, Amendolara B, Gil O, Lei L, Ivkovic S, Bruce J, Canoll P, Rosenfeld S, Finniss S, Perlstein B, Miller C, Okhrimenko H, Kazimirsky G, Cazacu S, Lemke N, Brodie S, Rempel SA, Rosenblum M, Mikkelsen T, Margel S, Brodie C, Guvenc H, Demir H, Gupta S, Mazumder S, Ray-Chaundhury A, Li T, Li C, Nakano I, Rahman R, Rahman C, Smith S, Macarthur D, Rose F, Shakesheff K, Grundy RG, Brenner AJ, Goins B, Bao A, Miller J, Trevino A, Zuniga R, Phillips WT, Gilg AG, Bowers KG, Toole BP, Maria BL, Leung GK, Sun S, Wong ST, Zhang XQ, Pu JK, Lui WM, Marino AM, Hussaini IM, Amos S, Simpson K, Redpath GT, Lyons C, Dipierro C, Grant GA, Wilson C, Salami S, Macaroni P, Li S, Park JY, Needham D, Bigner D, Dewhirst M, Ohlfest J, Gallardo J, Argawal S, Mittapalli R, Donelson R, Elmquist WF, Nicolaides T, Hariono S, Barkovich K, Hashizume R, Rowitch D, Weiss W, Sheer D, Baker S, Paugh B, Waldman T, Li H, Jones C, Forshew T, James D, Caroline H, Patrick R, Katrin L, Karl F, Ghazaleh T, Michael W, Albrecht V, Thorsteinsdottir J, Wagner E, Tonn JC, Ogris M, Schichor C, Charest G, Paquette B, Sanche L, Mathieu D, Fortin D, Qi X, Cuttitta F, Chu Z, Celerier J, Pakradouni J, Rixe O, Hashizume R, Gragg A, Muller S, Banerjee A, Phillips J, Prados M, Haas-Kogan D, Gupta N, James D, Florence L, Gwendoline VG, Veronique M, Robert K, Agarwal S, Mittapalli RK, Cen L, Carlson BL, Elmquist WF, Sarkaria JN, Sengupta S, Weeraratne SD, Rallapalli S, Amani V, Pierre-Francois J, Teider N, Rotenberg A, Cook J, Pomeroy SL, Jenses F, Cho YJ, Hjouj M, Last D, Guez D, Daniels D, Lavee J, Rubinsky B, Mardor Y, Serwer LP, Noble CO, Michaud K, Drummond DC, Ozawa T, Zhou Y, Marks JD, Bankiewicz K, Park JW, James D, Wang W, Cho H, Weintraub M, Jhaveri N, Torres S, Petasis N, Schonthal AH, Louie SG, Hofman FM, Chen TC, Grada Z, Hegde M, Schaffer DR, Ghazi A, Byrd T, Dotti G, Wels W, Heslop HE, Gottschalk S, Baker M, Ahmed N, Hamblett KJ, Kozlosky CJ, Liu H, Siu S, Arora T, Retter MW, Matsuda K, Hill JS, Fanslow WC, Diaz RJ, Etame A, Meaghan O, Mainprize T, Smith C, Hynynen K, Rutka J, Pradarelli J, Yoo JY, Kaka A, Alvarez-Breckenridge C, Pan Q, Chiocca EA, Teknos T, Kaur B, Lee SY, Slagle-Webb B, Sheehan JM, Connor JR, Cote J, Lepage M, Gobeil F, Fortin D, Kleijn A, Balvers R, Kloezeman J, Dirven C, Lamfers M, Leenstra S, See W, Tan IL, Nicolaides T, Pieper R, Jiang H, White E, Rios-Vicil CI, Yung WKA, Gomez-Manzano C, Fueyo J, Zemp FJ, McKenzie BA, Lun X, McFadden G, Forsyth PA, Mueller S, Yang X, Hashizume R, Gragg A, Smirnov I, Prados M, James DC, Phillips JJ, Berger MS, Rowitch DH, Gupta N, Haas-Kogan DH, D'Amico R, Lei L, Kennedy B, Rosenfeld SS, Canoll P, Bruce JN, Gopalakrishnan V, Das C, Taylor P, Kommagani R, Su X, Aguilera D, Thomas A, Wolff J, Flores E, Kadakia M, Alkins R, Broderson P, Sodhi R, Hynynen K, Chung SA, McDonald KL, Shen H, Day BW, Stringer BW, Johns T, Decollogne S, Teo C, Hogg PJ, Dilda PJ, Patel TR, Zhou J, Piepmeier JM, Saltzman WM, Vogelbaum MA, Agarwal S, Manchanda P, Ohlfest JR, Elmquist WF, Kitange GJ, Mladek AC, Carlson BL, Schroeder MA, Pokorny JL, Sarkaria JN, Ogbomo H, Lun X, Zhang J, McFadden G, Mody C, Forsyth P, Dasgupta T, Yang X, Hashizume R, Gragg A, Prados M, Nicolaides T, James CD, Haas-Kogan D, Madhankumar AB, Webb BS, Park A, Harbaugh K, Sheehan J, Connor JR. PRECLINICAL EXPERIMENTAL THERAPEUTICS AND PHARMACOLOGY. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
95
|
Muhsen S, Junqueira MJ, Park A, Sung JS, Patil S, Oskar S, Morrogh M, Morrow M, King TA. Patient characteristics associated with the decision to undergo bilateral prophylactic mastectomy for lobular carcinoma in situ. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
148 Background: Women at increased risk for breast cancer due to a diagnosis of lobular carcinoma in situ (LCIS) have three management options: high risk surveillance +/- chemoprevention (CP) or bilateral prophylactic mastectomy (BPM). Among a large cohort of women with LCIS, we previously reported there were no differences between women choosing CP compared to those choosing surveillance alone. The purpose of this study was to identify patient factors associated with the decision to pursue BPM for LCIS. Methods: We reviewed our prospectively maintained LCIS database to identify women choosing BPM (1995-2009). Comparisons were made between patients who chose BPM versus those who chose high risk surveillance +/- CP. Results: Among 995 pts with LCIS, 795 (80%) chose surveillance alone, 149 (15%) chose CP and 51 (5%) chose BPM. Compared to patients electing surveillance +/- CP patients who pursued BPM were younger at age of LCIS diagnosis (48 vs. 52 yrs, p < 0.001), more likely to have bilateral biopsies with LCIS (14% vs. 3%, p = 0.002) and more likely to be premenopausal (82% vs. 57%, p < 0.001). Patients choosing BPM were also more likely to have additional risk factors for breast cancer including: stronger family histories and extremely dense breasts (Table). Occult breast cancer was found in 4 (8%) BPM patients. At a median follow-up of 54 months (range 0-190 mos), 120/944 (13%) patients in the surveillance +/- CP group developed breast cancer. Conclusions: High-risk surveillance alone is the preferred management option for women with LCIS at our institution. Patients electing BPM are younger and more likely to have other associated risk factors for developing breast cancer. Further research to define how the increased risk imparted by LCIS is augmented by these factors may allow for better risk stratification and more informed discussions with patients. [Table: see text]
Collapse
|
96
|
Zanoni P, Fasano T, Deegan P, Park A, Feher M, Gurakan F, Favari E, Bernini F, Calandra S. 186 NOVEL ABCA1 MUTATIONS IN L PATIENTS WITH SEVERE HDL DEFICIENCY WITH OR WITHOUT CLASSIC MANIFESTATIONS OF TANGIER DISEASE. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70187-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
97
|
Seto-Young D, Avtanski D, Varadinova M, Park A, Suwandhi P, Leiser A, Parikh G, Poretsky L. Differential roles of MAPK-Erk1/2 and MAPK-p38 in insulin or insulin-like growth factor-I (IGF-I) signaling pathways for progesterone production in human ovarian cells. Horm Metab Res 2011; 43:386-90. [PMID: 21448845 DOI: 10.1055/s-0031-1273760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Insulin and insulin like-growth factor-I (IGF-I) participate in the regulation of ovarian steroidogenesis. In insulin resistant states ovaries remain sensitive to insulin because insulin can activate alternative signaling pathways, such as phosphatidylinositol-3-kinase (PI-3 kinase) and mitogen-activated protein-kinase (MAPK) pathways, as well as insulin receptors and type 1 IGF receptors. We investigated the roles of MAPK-Erk1/2 and MAPK-p38 in insulin and IGF-I signaling pathways for progesterone production in human ovarian cells. Human ovarian cells were cultured in tissue culture medium in the presence of varying concentrations of insulin or IGF-I, with or without PD98059, a specific MAPK-Erk1/2 inhibitor, with or without SB203580, a specific MAPK-p38 inhibitor or with or without a specific PI-3-kinase inhibitor LY294002. Progesterone concentrations were measured using radioimmunoassay. PD98059 alone stimulated progesterone production in a dose-dependent manner by up to 65% (p<0.001). Similarly, LY294002 alone stimulated progesterone production by 13-18% (p<0.005). However, when used together, PD98059 and LY294002 inhibited progesterone production by 17-20% (p<0.001). SB203580 alone inhibited progesterone production by 20-30% (p<0.001). Insulin or IGF-I alone stimulated progesterone production by 40-60% (p<0.001). In insulin studies, PD98059 had no significant effect on progesterone synthesis while SB203580 abolished insulin-induced progesterone production. Either PD98059 or SB203580 abolished IGF-I-induced progesterone production. Both MAPK-Erk1/2 and MAPK-p38 participate in IGF-I-induced signaling pathways for progesterone production, while insulin-induced progesterone production requires MAPK-p38, but not MAPK-Erk1/2. These studies provide further evidence for divergence of insulin and IGF-I signaling pathways for human ovarian cell steroidogenesis.
Collapse
|
98
|
Kizuka K, Cerviño L, Evans B, Man K, Mushegan S, Park A, Rahimian I, Jiang S. SU-E-T-452: Dynamic Intensity Modulator. Med Phys 2011. [DOI: 10.1118/1.3612406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
99
|
McCrone P, Park A, Knapp M. Cost-effectiveness of early intervention services for psychosis. PSYCHIATRISCHE PRAXIS 2011. [DOI: 10.1055/s-0031-1277798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
100
|
McDaid D, Bonin E, Park A, Hegerl U, Arensman E, Kopp M, Gusmao R. Making the case for investing in suicide prevention interventions: estimating the economic impact of suicide and non-fatal self harm events. Inj Prev 2011. [DOI: 10.1136/ip.2010.029215.916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|