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Smith JG, Anderson K, Clarke G, Crowe C, Goldsmith LP, Jarman H, Johnson S, Lomani J, McDaid D, Park A, Turner K, Gillard S. The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England - CORRIGENDUM. Epidemiol Psychiatr Sci 2024; 33:e24. [PMID: 38605576 PMCID: PMC11022248 DOI: 10.1017/s2045796024000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
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Yakovchenko V, Lamorte C, Chinman MJ, Goodrich DE, Gibson S, Park A, Bajaj JS, McCurdy H, Morgan TR, Rogal SS. Comparing the CFIR-ERIC matching tool recommendations to real-world strategy effectiveness data: a mixed-methods study in the Veterans Health Administration. Implement Sci 2023; 18:49. [PMID: 37828539 PMCID: PMC10571268 DOI: 10.1186/s13012-023-01307-x] [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: 12/06/2022] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Practical and feasible methods for matching implementation strategies to diagnosed barriers of evidence-based interventions in real-world contexts are lacking. This evaluation compared actual implementation strategies applied with those recommended by an expert opinion-based tool to improve guideline-concordant cirrhosis care in a Veterans Health Administration national learning collaborative effort. METHODS This convergent parallel mixed-methods study aimed to (1) identify pre-implementation Consolidated Framework for Implementation Research (CFIR) barriers to cirrhosis care through focus groups with frontline providers, (2) generate 20 recommended strategies using focus group identified barriers entered into the CFIR-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool, (3) survey providers over two consecutive years on the actual use of 73 ERIC strategies and determine strategy effectiveness, (4) compare actual versus recommended strategy use, and (5) compare actual versus expected barriers by reverse applying the CFIR-ERIC Matching Tool. RESULTS Eighteen semi-structured focus groups were conducted with 197 providers representing 95 VA sites to identify barriers to quality improvement, including cirrhosis care complexity, clarity of national goals, and local leadership support. The CFIR-ERIC Matching Tool recommended strategies such as assessing for readiness and needs, promoting adaptability, building local groups, preparing champions, and working with opinion leaders and early adopters. Subsequent strategy surveys found that sites used the top 20 "recommended" strategies no more frequently than other strategies. However, 14 (70%) of the top recommended strategies were significantly positively associated with cirrhosis care compared to 48% of actual strategies. Reverse CFIR-ERIC matching found that the strategies most used in the first year corresponded to the following barriers: opinion leaders, access to knowledge and information, and resources. The strategies most frequently employed in the second year addressed barriers such as champions, cosmopolitanism, readiness for implementation, relative priority, and patient needs and resources. Strategies used in both years were those that addressed adaptability, trialability, and compatibility. CONCLUSIONS This study is among the first to empirically evaluate the relationship between CFIR-ERIC Matching Tool recommended strategies and actual strategy selection and effectiveness in the real world. We found closer connections between recommended strategies and strategy effectiveness compared to strategy frequency, suggesting validity of barrier identification, and application of the expert-informed tool.
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Affiliation(s)
- Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
- Mental Health Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - David E Goodrich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology and Hepatology, Central Virginia VA Health Care System, Richmond, VA, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
- Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive C (151C), Building 30, Pittsburgh, PA, 15240-1001, USA.
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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White J, Park A, Ryjewski C, Schwartz L, Miller C. A Simple Method To Reduce the Risk of Venous Stent Migration After Endovascular Treatment of Nutcracker Or May-Thurner Syndromes. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.037] [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: 04/09/2023] Open
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Pokhilenko I, Kast T, Janssen LMM, Evers SMAA, Paulus ATG, Simon J, Mayer S, Berger M, Konnopka A, Muntendorf L, Brodszky V, García-Pérez L, Park A, Salvador-Carulla L, Drost RMWA. International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project). Expert Rev Pharmacoecon Outcomes Res 2023; 23:135-141. [PMID: 36472303 DOI: 10.1080/14737167.2023.2152331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. METHODS The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. RESULTS The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. DISCUSSION The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.
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Affiliation(s)
- I Pokhilenko
- Centre for Economics of Obesity, Health Economics Unit, Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, The United Kingdom
| | - T Kast
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - L M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,Centre of Economic Evaluation & Machine Learning, Trimbos Institute, National Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - A T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - J Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Mayer
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - M Berger
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Muntendorf
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - L García-Pérez
- Servicio de Evaluación, Servicio Canario de la Salud (SESCS), Santa Cruz de Tenerife, Spain
| | - A Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - L Salvador-Carulla
- Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, Australia
| | - R M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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5
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Elder K, Matheson J, Nickson C, Box G, Ellis J, Mou A, Shadbolt C, Park A, Tay J, Rose A, Mann G. Contrast Enhanced Mammography in Breast Cancer Surveillance. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01364-8] [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: 11/19/2022]
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Mann B, Rose A, Hughes J, Skandarajah A, Murugasu A, Spillane A, Chua B, Zdenkowski N, Badger H, Braggett H, Gebski V, Eggins R, Park A, Collins J. Primary results of ANZ 1002 : Post-operative Radiotherapy Omission in Selected Patients with Early breast Cancer Trial (PROSPECT) following pre-operative breast MRI. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01476-9] [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: 11/19/2022]
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Taskesen T, Ahsan M, Putz J, Park A, De Santis T, Latif A, Ugwu J, Ellerman M, Shivapour D, Chawla A, McAllister D, Sigurdsson G, Martin E. Predictive Role of Aortic Valve Calcium score on post-procedural outcomes and mortality after Transcatheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Extent of aortic valve (AV) calcium increases as degenerative aortic valve stenosis progresses. Initial studies postulated AV calcium (AVC) score to be a predictor of complications such as need for pacemaker implantation, paravalvular regurgitation and mortality after Trans-catheter Aortic valve Replacement (TAVR). However, evidence regarding the impact of AVC score as a predictor of post-procedural complications and mortality has been conflicting.
Objective
This study aimed to determine the prognostic impact of AVC as predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.
Methods
We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was obtained retrospectively. Patients were divided into two groups: 1) Non-severe AVC score group [women <1200 Agatston unit (AU) and men <2000 AU]; 2) Severe AV Calcium Score group [women >1200 AU and men >2000 AU]. Primary outcome was 1-year mortality.
Results
Among 466 patients included in the analysis, 352 patients were included severe AVC group while 114 patients were in the non-severe AVC group. Patients in the severe AVC group were older (81±8 vs 79±8 years), were predominantly males (79% vs 71%), and had less diabetes mellitus (31% vs 42%, p=0.02). Post-TAVR AV dimensionless index (0.58±0.13 vs 0.58±0.12, p=0.8) and AV mean gradient (9.5±4.9 vs 9.2±5.4 mmHg) were not statistically different between both groups. There was no statistical difference in the need for PPM (12% vs 7%, p=0.16), post-TAVR stroke (1.5% vs 0%), post-TAVR major complications (17.4% vs 10%, p=0.07), 30 day (3.7% vs 4.4%), and 1-year mortality (13.6 vs 11.4, p=0.6) between both groups.
Conclusion
Our study report that the severity of AVC score does not have a prognostic impact on major post-procedural outcomes and mortality after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Taskesen
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - M Ahsan
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - J Putz
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - A Park
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - T De Santis
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - A Latif
- Creighton University Medical Centre, Internal Medicine , Omaha , United States of America
| | - J Ugwu
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - M Ellerman
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D Shivapour
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - A Chawla
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D McAllister
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - G Sigurdsson
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - E Martin
- Iowa Heart Center Inc , West Des Moines , United States of America
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Ahsan M, Taskesen T, Putz J, Ugwu J, Latif A, Park A, De Santis T, Sigurdsson G, Shivapour D, McAllister D, Chawla A, Bhatt D, Mamas M, Velagapudi P, Martin E. Sex-based differences of the impact of aortic valve calcium score on mortality and post-procedural outcomes after trans-catheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sex based differences exist in the presentation, outcomes, and management of cardiovascular diseases. Although aortic valve calcium (AVC) score has been postulated to be associated with post-procedural outcomes after transcatheter aortic valve replacement (TAVR), data on the impact of AVC score on procedural outcomes after TAVR based on sex have been scarce.
Objective
The aim of the present study was to elucidate sex related differences in the prognostic impact of AVC score as a predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.
Methods
We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was calculated retrospectively. Primary outcome was 1-year mortality. Patients were divided into two groups: 1) Non-severe AVC score group [women <1200 Agatston unit (AU) and men <2000 AU]; 2) Severe AVC Score group [women >1200 AU and men >2000 AU]. Cox-regression model was used to predict effect of variables on 1-year mortality in male and female patients.
Results
Among 466 patients included, 268 patients were male and 198 were female (57.5% vs 42.5%). When compared with males, female patients had significantly lower AVC score (p<0.001), aortic valve area (AVA) (p<0.001), obstructive CAD (p<0.001), and history of previous PCI (p<0.004), and CABG (<0.001) but had a significantly higher STS score (6.7±3.2 vs 5.8±3.3 P=0.01). There was no difference between need for permanent pacemaker (PPM) implantation (11% vs 9.6%, p=0.4), major complications (16% vs 15%, p=0.9), stroke (0.8% vs 1.6%, p=0.7), 30-day (3.7% vs 4%, p=0.9), and 1-year mortality (14% vs 12%, p=0.6) between males and females, respectively. Female patients required smaller bio-prosthetic valves compared with males (26±3.2 vs 30±3, p<0.001). Cox regression analysis for female patients showed BMI, hemoglobin level, and AVA independently predicted 1-year mortality, while there was no impact of severe AVC score (>1200 AU) on 1-year mortality in females. Similarly, Cox regression analysis for male patients showed there was no impact of severe AVC score (>2000 AU) on 1-year mortality in males. When males in the severe AVC group were compared with female patients in the severe AVC group, there was no difference in 30 day (4.3% vs 3.3%, p=0.82) and 1-year mortality (14.2% vs 13.3%, p=0.77). Similarly, in the severe AVC group there was no difference between need for PPM implantation (12.8% vs 12.1%, p=0.9), major complications (19.7% vs 15.8%, p=0.4), and stroke (2.2% vs 1%, p=0.6) between males and females, respectively.
Conclusion
There were no sex differences in the impact of AVC score on mortality and post-procedural outcomes after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ahsan
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - T Taskesen
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - J Putz
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - J Ugwu
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - A Latif
- Creighton University Medical Centre, Internal Medicine , Omaha , United States of America
| | - A Park
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - T De Santis
- Mercy Medical Center, Internal Medicine , Des Moines , United States of America
| | - G Sigurdsson
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D Shivapour
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D McAllister
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - A Chawla
- Iowa Heart Center Inc , West Des Moines , United States of America
| | - D Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center, Cardiovascular Diseases , Boston , United States of America
| | - M Mamas
- Keele University, Cardiovascular Diseases , Keele , United Kingdom
| | - P Velagapudi
- University of Nebraska Medical Center, Cardiovascular Diseases , Omaha , United States of America
| | - E Martin
- Iowa Heart Center Inc , West Des Moines , United States of America
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Park A, Stewart J, Morisak P, Gustafson S, Meihls S, Black P, Ameel K, Asfour F. 110 Inadequacy of targeted hearing screening for children with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00801-3] [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: 11/06/2022]
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Jung KL, Choi UY, Park A, Foo SS, Kim S, Lee SA, Jung JU. Single-cell analysis of Kaposi’s sarcoma-associated herpesvirus infection in three-dimensional air-liquid interface culture model. PLoS Pathog 2022; 18:e1010775. [PMID: 35976902 PMCID: PMC9385030 DOI: 10.1371/journal.ppat.1010775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022] Open
Abstract
The oral cavity is the major site for transmission of Kaposi’s sarcoma-associated herpesvirus (KSHV), but how KSHV establishes infection and replication in the oral epithelia remains unclear. Here, we report a KSHV spontaneous lytic replication model using fully differentiated, three-dimensional (3D) oral epithelial organoids at an air-liquid interface (ALI). This model revealed that KSHV infected the oral epithelia when the basal epithelial cells were exposed by damage. Unlike two-dimensional (2D) cell culture, 3D oral epithelial organoid ALI culture allowed high levels of spontaneous KSHV lytic replication, where lytically replicating cells were enriched at the superficial layer of epithelial organoid. Single cell RNA sequencing (scRNAseq) showed that KSHV infection induced drastic changes of host gene expression in infected as well as uninfected cells at the different epithelial layers, resulting in altered keratinocyte differentiation and cell death. Moreover, we identified a unique population of infected cells containing lytic gene expression at the KSHV K2-K5 gene locus and distinct host gene expression compared to latent or lytic infected cells. This study demonstrates an in vitro 3D epithelial organoid ALI culture model that recapitulates KSHV infection in the oral cavity, where KSHV undergoes the epithelial differentiation-dependent spontaneous lytic replication with a unique cell population carrying distinct viral gene expression.
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Affiliation(s)
- Kyle L. Jung
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Un Yung Choi
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Angela Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Suan-Sin Foo
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Stephanie Kim
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Shin-Ae Lee
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Jae U. Jung
- Department of Cancer Biology and Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- * E-mail:
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Choi UY, Lee JJ, Park A, Jung KL, Lee SA, Choi YJ, Lee HR, Lai CJ, Eoh H, Jung JU. Herpesvirus-induced spermidine synthesis and eIF5A hypusination for viral episomal maintenance. Cell Rep 2022; 40:111234. [PMID: 35977517 DOI: 10.1016/j.celrep.2022.111234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/16/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022] Open
Abstract
Spermidine is essential for cellular growth and acts as a prerequisite of hypusination, a post-translational modification of eukaryotic initiation factor 5A (eIF5A), allowing the translation of polyproline-containing proteins. Here, we show that oncogenic Kaposi's sarcoma-associated herpesvirus (KSHV) increases spermidine synthesis and eIF5A hypusination to enhance expression of polyproline-containing latency-associated nuclear antigen (LANA) for viral episomal maintenance. KSHV upregulates intracellular spermidine levels by dysregulating polyamine metabolic pathways in three-dimensional (3D) culture and 2D de novo infection conditions. Increased intracellular spermidine leads to increased eIF5A hypusination, ultimately enhancing LANA expression. In contrast, inhibition of spermidine synthesis or eIF5A hypusination alleviates LANA expression, decreasing viral episomal maintenance and KSHV-infected cell proliferation in vitro and in vivo, which is reversed by spermidine supplement. This demonstrates that KSHV hijacks spermidine synthesis and eIF5A hypusination pathways to enhance LANA expression for viral episomal maintenance, suggesting polyamine metabolism and eIF5A hypusination as therapeutic targets for KSHV-induced tumorigenesis.
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Affiliation(s)
- Un Yung Choi
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Jae Jin Lee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Angela Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Kyle L Jung
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Shin-Ae Lee
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Youn Jung Choi
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hye-Ra Lee
- Department of Biotechnology and Bioinformatics, College of Science and Technology, Korea University, Sejong 30019, Republic of Korea
| | - Chih-Jen Lai
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Hyungjin Eoh
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jae U Jung
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Hwang J, Na Y, Park A, Kim H, Park W. 698 Retinol: A better solution for skin anti-aging than retinyl palmitate. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Yakovchenko V, Morgan TR, Miech EJ, Neely B, Lamorte C, Gibson S, Beste LA, McCurdy H, Scott D, Gonzalez R, Park A, Powell BJ, Bajaj JS, Dominitz JA, Chartier M, Ross D, Chinman MJ, Rogal SS. Core implementation strategies for improving cirrhosis care in the Veterans Health Administration. Hepatology 2022; 76:404-417. [PMID: 35124820 PMCID: PMC9288973 DOI: 10.1002/hep.32395] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 10/26/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention. APPROACH AND RESULTS VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18, n = 63; FY19, n = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews. CONCLUSIONS In a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA,Division of Gastroenterology, Department of Medicine, University of California, Irvine, CA
| | - Edward J. Miech
- Department of Veterans Affairs, Roudebush VA Medical Center, HSR&D Center for Health Information & Communication, VA PRIS-M QUERI, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Brittney Neely
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren A. Beste
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA,General Medicine Service, VA Puget Sound Health Care System, Seattle, WA
| | | | - Dawn Scott
- Department of Medicine, Central Texas Veterans Healthcare System, Temple, TX
| | - Rachel Gonzalez
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA
| | - Angela Park
- Office of Healthcare Transformation, Department of Veterans Affairs, Washington, DC
| | - Byron J. Powell
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA,Division of Gastroenterology, Central Virginia Veterans Affairs Healthcare System, Richmond, VA
| | - Jason A. Dominitz
- Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA,Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC
| | - David Ross
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC
| | - Matthew J. Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,RAND Corporation, Pittsburgh, PA
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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14
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Lin E, Chandra V, Haskal Z, Sheeran D, Park A. Abstract No. 6 “UnpleASAnt” outcomes: can the American Society of Anesthesiologists (ASA) Physical Status Classification predict post–interventional radiology procedure complication severity? J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Dwyer D, Lee Y, Sheeran D, Park A. Abstract No. 74 Endovascular treatment of pancreaticoduodenal artery aneurysms associated with median arcuate ligament compression of the celiac artery. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Labonté C, Zhand N, Park A, Harvey PD. Complete blood count inflammatory markers in treatment-resistant schizophrenia: Evidence of association between treatment responsiveness and levels of inflammation. Psychiatry Res 2022; 308:114382. [PMID: 34995832 DOI: 10.1016/j.psychres.2021.114382] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
Accumulating evidence suggests that the variable response to antipsychotic treatment in schizophrenia reflects distinct biological subtypes. The pathophysiology of schizophrenia is associated with alteration in the immune system which can be measured with complete blood count (CBC) markers of systemic inflammation, including the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR). While previous research suggested a decrease in CBC inflammatory markers following treatment, it is unknown if treatment or response to treatment is associated with CBC markers in treatment-resistant schizophrenia. Here, we retrospectively analyzed the CBC at admission and discharge in schizophrenia inpatients classified as treatment-responsive, treatment-resistant, and ultra-treatment-resistant. Despite similar NLR at admission, the subtypes manifested different changes in NLR during treatment resulting in significant differences at discharge. Only the treatment-responsive group presented a significant decrease in inflammatory markers after treatment. Additionally, we found that the responsive group had a higher PLR at admission and was the only subgroup to demonstrate a significant reduction following treatment. In sum, our results support the idea that persistent inflammation is a biological trait marker of treatment resistance in schizophrenia.
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Affiliation(s)
- Caleb Labonté
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Naista Zhand
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Angela Park
- The Royal Ottawa Mental Health Center, Schizophrenia and Recovery Program, 1145 Carling Ave, Ottawa, Ontario K1Z 7K4, Canada
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, United States
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17
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Yakovchenko V, Morgan TR, Chinman MJ, Powell BJ, Gonzalez R, Park A, Malone PS, Chartier M, Ross D, Rogal SS. Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the veterans health administration. BMC Health Serv Res 2021; 21:1348. [PMID: 34922538 PMCID: PMC8684191 DOI: 10.1186/s12913-021-07312-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND While few countries and healthcare systems are on track to meet the World Health Organization's hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. We aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA. METHODS We conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019. Participants from 130 VHA medical centers treating HCV were sent annual electronic surveys about their use of 73 implementation strategies, organized into nine clusters as described by the Expert Recommendations for Implementing Change taxonomy. Descriptive and nonparametric analyses assessed strategy use over time, strategy attribution to the HIT, and strategy associations with site HCV treatment volume and rate of adoption, following the Theory of Diffusion of Innovations. RESULTS Between 58 and 109 medical centers provided responses in each year, including 127 (98%) responding at least once, and 54 (42%) responding in all four implementation years. A median of 13-27 strategies were endorsed per year, and 8-36 individual strategies were significantly associated with treatment volume per year. Data warehousing, tailoring, and patient-facing strategies were most commonly endorsed. One strategy-"identify early adopters to learn from their experiences"-was significantly associated with HCV treatment volume in each year. Peak implementation year was associated with revising professional roles, providing local technical assistance, using data warehousing (i.e., dashboard population management), and identifying and preparing champions. Many of the strategies were driven by a national learning collaborative, which was instrumental in successful HCV elimination. CONCLUSIONS VHA's tremendous success in rapidly treating nearly all Veterans with HCV can provide a roadmap for other HCV elimination initiatives.
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Gonzalez
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA, USA
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, USA
| | - Patrick S Malone
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - David Ross
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
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18
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Hutchison DM, Duffens A, Yale K, Park A, Cardenas K, Mesinkovska NA. Eyelash trichomegaly: a systematic review of acquired and congenital aetiologies of lengthened lashes. J Eur Acad Dermatol Venereol 2021; 36:536-546. [PMID: 34919300 DOI: 10.1111/jdv.17877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/05/2021] [Accepted: 11/10/2021] [Indexed: 02/01/2023]
Abstract
Long eyelashes have been popularized and many commercially available products exist to achieve eyelash growth as a desired cosmetic effect. Eyelash trichomegaly may be induced by medications, procedures, or be related to medical conditions; however, the exact mechanisms that govern eyelash growth are not well elucidated. This study aims to identify and summarize aetiologies associated with eyelash trichomegaly. We report a systematic review of 148 clinical trials, prospective and retrospective studies, and case reports describing all evidence-based potential aetiologies of eyelash trichomegaly obtained from the Medline/PubMed and Cochrane Library through January 2021. Inclusion criteria were defined as (i) human studies involving congenital and acquired diseases in which eyelash trichomegaly is a characteristic or (ii) assessment of trichomegaly as an adverse or desired effect of a medication or procedure. Exclusion criteria included: animal studies, articles not available in English, outcomes unrelated to eyelash trichomegaly, and secondary review articles. Pharmacologic agents associated with eyelash trichomegaly included prostaglandin analogues (15-keto fluprostenol isopropyl ester, bimatoprost, latanoprost, and travoprost), epidermal growth factor receptor inhibitors (cetuximab, erlotinib, and panitumumab), interferon-alpha, and calcineurin inhibitors (tacrolimus and cyclosporine). Surgical procedures of the eyelid, as well as allergic rhinitis, atopic dermatitis, HIV, ichthyosis vulgaris (IV), uveitis, and vernal keratoconjunctivitis were also associated with increased eyelash growth. Congenital disorders associated with lengthened eyelashes included Cantú syndrome, CHOPS syndrome, Coffin-Siris syndrome, congenital heart disease, Cornelia de Lange syndrome, Costello syndrome, familial trichomegaly, Floating Harbor syndrome, Hermansky-Pudlak syndrome, Kabuki-Makeup syndrome, KBG syndrome, Oliver-McFarlane syndrome, Rubinstein-Taybi syndrome, and Smith-Magenis syndrome. While the most common cause of eyelash trichomegaly is topical bimatoprost use, better understanding of pathways implicated in eyelash trichomegaly may lead to the discovery of additional medications to stimulate eyelash growth and create avenues for future therapeutic interventions.
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Affiliation(s)
- D M Hutchison
- Department of Dermatology, University of California Irvine, Irvine, CA, USA.,Beckman Laser Institute, University of California Irvine, Irvine, CA, USA
| | - A Duffens
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - K Yale
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - A Park
- Beckman Laser Institute, University of California Irvine, Irvine, CA, USA
| | - K Cardenas
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - N A Mesinkovska
- Department of Dermatology, University of California Irvine, Irvine, CA, USA.,Beckman Laser Institute, University of California Irvine, Irvine, CA, USA
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19
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Yun P, DeLuca S, Robinson D, Park A, Rosenberg C, Kohler M, Tenforde A. Radial versus Combined Shockwave Therapy in the Management of Proximal Hamstring Tendinopathy: Similar Functional Outcomes in Running Cohort. Muscles Ligaments Tendons J 2021. [DOI: 10.32098/mltj.04.2021.18] [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: 11/05/2022]
Affiliation(s)
- P.H. Yun
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston (MA), U.S.A
| | - S. DeLuca
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown (MA) U.S.A
| | - D. Robinson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown (MA) U.S.A
| | - A. Park
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown (MA) U.S.A
| | | | - M.J. Kohler
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital/Harvard Medical School, Boston (MA), U.S.A
| | - A.S. Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown (MA) U.S.A
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20
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Gonzalez R, Park A, Yakovchenko V, Rogal S, Chartier M, Morgan TR, Ross D. HCV Elimination in the US Department of Veterans Affairs. Clin Liver Dis (Hoboken) 2021; 18:1-6. [PMID: 34484696 PMCID: PMC8405054 DOI: 10.1002/cld.1150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Rachel Gonzalez
- Department of Veterans AffairsSierra Pacific Veterans Integrated Service NetworkPharmacy Benefits ManagementMatherCA
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare TransformationWashingtonDC
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation ResearchEdith Norse Rogers Memorial VA HospitalBedfordMA
| | - Shari Rogal
- Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPA,Departments of Medicine and Surgery and Center for Clinical and Translational Science InstituteUniversity of PittsburghPittsburghPA
| | - Maggie Chartier
- Veterans Health AdministrationHIV, Hepatitis, and Related Conditions ProgramsOffice of Specialty Care ServicesWashingtonDC
| | - Timothy R. Morgan
- Gastroenterology SectionVA Long Beach Healthcare SystemLong BeachCA,Department of MedicineDivision of GastroenterologyUniversity of CaliforniaIrvineCA
| | - David Ross
- Veterans Health AdministrationHIV, Hepatitis, and Related Conditions ProgramsOffice of Specialty Care ServicesWashingtonDC
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21
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Liu C, Schönke M, Zhou E, Larsson M, Wallenius K, Park A, Oldham S, Ikeda Y, Peng XR, Boon M, Wang Y, Rensen P. Hepatic fibroblast growth factor 21 overexpression attenuates diet-induced hepatic steatosis and inflammation. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Bettany-Saltikov J, Park A, Ling J. The experiences and effectiveness of the Spinecor brace on older adults with degenerative scoliosis: a mixed methods pilot study. Stud Health Technol Inform 2021; 280:294-295. [PMID: 34190122 DOI: 10.3233/shti210508] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - A Park
- School of Health Sciences and Wellbeing, University of Sunderland, UK
| | - J Ling
- School of Health Sciences and Wellbeing, University of Sunderland, UK
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23
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Rogal SS, Yakovchenko V, Gonzalez R, Park A, Beste LA, Rozenberg-Ben-Dror K, Bajaj JS, Scott D, McCurdy H, Comstock E, Sidorovic M, Gibson S, Lamorte C, Nobbe A, Chartier M, Ross D, Dominitz JA, Morgan TR. The Hepatic Innovation Team Collaborative: A Successful Population-Based Approach to Hepatocellular Carcinoma Surveillance. Cancers (Basel) 2021; 13:cancers13092251. [PMID: 34067177 PMCID: PMC8125814 DOI: 10.3390/cancers13092251] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Liver cancer is a growing problem that largely impacts people with cirrhosis. This article describes the Veterans Health Administration’s national cirrhosis quality improvement program and its focus on early detection of liver cancer. Abstract After implementing a successful hepatitis C elimination program, the Veterans Health Administration’s (VHA) Hepatic Innovation Team (HIT) Collaborative pivoted to focus on improving cirrhosis care. This national program developed teams of providers across the country and engaged them in using systems redesign methods and population health approaches to improve care. The HIT Collaborative developed an Advanced Liver Disease (ALD) Dashboard to identify Veterans with cirrhosis who were due for surveillance for hepatocellular carcinoma (HCC) and other liver care, promoted the use of an HCC Clinical Reminder in the electronic health record, and provided training and networking opportunities. This evaluation aimed to describe the VHA’s approach to improving cirrhosis care and identify the facility factors and HIT activities associated with HCC surveillance rates, using a quasi-experimental design. Across all VHA facilities, as the HIT focused on cirrhosis between 2018–2019, HCC surveillance rates increased from 46% (IQR 37–53%) to 51% (IQR 42–60%, p < 0.001). The median HCC surveillance rate was 57% in facilities with high ALD Dashboard utilization compared with 45% in facilities with lower utilization (p < 0.001) and 58% in facilities using the HCC Clinical Reminder compared with 47% in facilities not using this tool (p < 0.001) in FY19. Increased use of the ALD Dashboard and adoption of the HCC Clinical Reminder were independently, significantly associated with HCC surveillance rates in multivariate models, controlling for other facility characteristics. In conclusion, the VHA’s HIT Collaborative is a national healthcare initiative associated with significant improvement in HCC surveillance rates.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
- Departments of Medicine and Surgery, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15240, USA
- Correspondence: ; Tel.: +1-412-360-6177
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA 01730, USA;
| | - Rachel Gonzalez
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA 94523, USA;
| | - Angela Park
- Office of Healthcare Transformation, Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA;
| | - Lauren A. Beste
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA;
- General Medicine Service, VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA
| | - Karine Rozenberg-Ben-Dror
- Veteran Affairs Great Lakes Health Care System, VISN 12 PBM, 11301 W Cermak Road, Ste 810, Westchester, IL 60154, USA;
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, 1200 E Broad Street, West Hospital, 14th Floor, Box 980341, Richmond, VA 23298, USA;
- Division of Gastroenterology, Central Virginia Veterans Affairs Healthcare System, 1201 Broad Rock Blvd, Richmond, VA 23249, USA
| | - Dawn Scott
- Department of Medicine, Central Texas Veterans Healthcare System, 1901 Veterans Memorial Drive, Temple, TX 76504, USA;
| | - Heather McCurdy
- VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA;
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore VA Medical Center, 10 N Greene Street, Baltimore, MD 21201, USA;
| | - Michael Sidorovic
- Salisbury VA Medical Center, 1601 Brenner Avenue, Salisbury, NC 28144, USA;
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA; (S.G.); (C.L.)
| | - Anna Nobbe
- Digestive Disease Section, Cincinnati VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA;
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA; (M.C.); (D.R.)
| | - David Ross
- HIV, Hepatitis, and Related Conditions, Office of Specialty Care Services (10P11I), Department of Veterans Affairs, 810 Vermont Avenue, Washington, DC 20420, USA; (M.C.); (D.R.)
| | - Jason A. Dominitz
- Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA;
- Division of Gastroenterology, Department of Medicine, RR-512, Health Sciences Building, University of Washington School of Medicine, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, 5901 E 7th Street, Long Beach, CA 90822, USA;
- Division of Gastroenterology, Department of Medicine, University of California, 333 City Blvd. West, Suite 400, Orange, CA 92868, USA
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24
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Kumar A, Bantilan KS, Jacob AP, Park A, Schoninger SF, Sauter C, Ulaner GA, Casulo C, Faham M, Kong KA, Grewal RK, Gerecitano J, Hamilton A, Hamlin P, Matasar M, Moskowitz CH, Noy A, Palomba ML, Portlock CS, Younes A, Willis T, Zelenetz AD. Noninvasive Monitoring of Mantle Cell Lymphoma by Immunoglobulin Gene Next-Generation Sequencing in a Phase 2 Study of Sequential Chemoradioimmunotherapy Followed by Autologous Stem-Cell Rescue. Clin Lymphoma Myeloma Leuk 2021; 21:230-237.e12. [PMID: 33558202 PMCID: PMC9476895 DOI: 10.1016/j.clml.2020.09.007] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/20/2020] [Indexed: 11/28/2022]
Abstract
Limited information exists in mantle cell lymphoma (MCL) on the performance of next-generation sequencing–based assay of immunoglobulin gene rearrangements for minimal residual disease (MRD) assessment. Posttreatment peripheral blood samples were collected from 16 MCL patients and analyzed with the Adaptive Biotechnologies MRD assay, which identified early molecular relapse. We observed more sensitivity in the cellular versus acellular compartment.
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MESH Headings
- Aged
- Chemoradiotherapy
- DNA, Neoplasm/blood
- Female
- Gene Rearrangement
- High-Throughput Nucleotide Sequencing
- Humans
- Immunoglobulins/genetics
- Immunotherapy
- Induction Chemotherapy
- Lymphoma, Mantle-Cell/blood
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local/blood
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/genetics
- Neoplasm, Residual
- Neoplastic Cells, Circulating
- Prospective Studies
- Remission Induction
- Stem Cell Transplantation
- Transplantation, Autologous
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Affiliation(s)
- Anita Kumar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - K S Bantilan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A P Jacob
- Adaptive Biotechnologies, Seattle, WA
| | - A Park
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S F Schoninger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Sauter
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G A Ulaner
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Casulo
- Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY
| | - M Faham
- Adaptive Biotechnologies, Seattle, WA
| | - K A Kong
- Adaptive Biotechnologies, Seattle, WA
| | - R K Grewal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Gerecitano
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Hamilton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - P Hamlin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Matasar
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C H Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Noy
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M L Palomba
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C S Portlock
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Younes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Willis
- Adaptive Biotechnologies, Seattle, WA
| | - A D Zelenetz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Bai G, Park A, Wang Y, Overton HN, Bruhn WE, Makary MA. The Commissions Paid to Brokers for Fully Insured Health Insurance Plans. Med Care Res Rev 2020; 79:133-140. [PMID: 33327861 DOI: 10.1177/1077558720980561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Insurance agents and brokers play an important role in facilitating the contracting of fully insured health insurance and pharmacy benefit plans for U.S. employers. They are primarily compensated with a commission charged back to the plan. Using a national sample that covered 11.7 million employees enrolled in 33,689 health plans in 2017, we found that a plan's commission (median: $178) was positively associated with a plan's premium (coefficient: 0.01 for the full sample and 0.03 for small plans, p < .001) after controlling for the number of enrollees. The commission-to-premium ratio was greater for smaller plans and plans offered by nonmajor insurance companies, and varied by geographic region. Policy makers should consider improving transparency of the commission to facilitate employers making efficient broker contracting and plan purchasing decisions. The fee-based brokerage model has the potential to help employers and workers contain health care spending.
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Affiliation(s)
- Ge Bai
- Johns Hopkins Carey Business School, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela Park
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi N Overton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William E Bruhn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin A Makary
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Rogal SS, Yakovchenko V, Morgan T, Bajaj JS, Gonzalez R, Park A, Beste L, Miech EJ, Lamorte C, Neely B, Gibson S, Malone PS, Chartier M, Taddei T, Garcia-Tsao G, Powell BJ, Dominitz JA, Ross D, Chinman MJ. Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans. Implement Sci 2020; 15:92. [PMID: 33087156 PMCID: PMC7579930 DOI: 10.1186/s13012-020-01050-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/05/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cirrhosis is a rapidly increasing cause of global mortality. To improve cirrhosis care, the Veterans Health Administration (VHA) developed the Hepatic Innovation Team (HIT) Collaborative to support VA Medical Centers (VAMCs) to deliver evidence-based cirrhosis care. This randomized HIT program evaluation aims to develop and assess a novel approach for choosing and applying implementation strategies to improve the quality of cirrhosis care. METHODS Evaluation aims are to (1) empirically determine which combinations of implementation strategies are associated with successful implementation of evidence-based practices (EBPs) for Veterans with cirrhosis, (2) manualize these "data-driven" implementation strategies, and (3) assess the effectiveness of data-driven implementation strategies in increasing cirrhosis EBP uptake. Aim 1 will include an online survey of all VAMCs' use of 73 implementations strategies to improve cirrhosis care, as defined by the Expert Recommendations for Implementing Change taxonomy. Traditional statistical as well as configurational comparative methods will both be employed to determine which combinations of implementation strategies are associated with site-level adherence to EBPs for cirrhosis. In aim 2, semi-structured interviews with high-performing VAMCs will be conducted to operationalize successful implementation strategies for cirrhosis care. These data will be used to inform the creation of a step-by-step guide to tailoring and applying the implementation strategies identified in aim 1. In aim 3, this manualized implementation intervention will be assessed using a hybrid type III stepped-wedge cluster randomized design. This evaluation will be conducted in 12 VAMCs, with four VAMCs crossing from control to intervention every 6 months, in order to assess the effectiveness of using data-driven implementation strategies to improve guideline-concordant cirrhosis care. DISCUSSION Successful completion of this innovative evaluation will establish the feasibility of using early evaluation data to inform a manualized, user-friendly implementation intervention for VAMCs with opportunities to improve care. This evaluation will provide implementation support tools that can be applied to enhance the implementation of other evidence-based practices. TRIAL REGISTRATION This project was registered at ClinicalTrials.Gov ( NCT04178096 ) on 4/29/20.
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Affiliation(s)
- Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA. .,Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Timothy Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA.,Division of Gastroenterology, Department of Medicine, University of California, Irvine, CA, USA
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.,Division of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Rachel Gonzalez
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA, USA
| | - Angela Park
- Office of Healthcare Transformation, Veterans Engineering Resource Center, Washington, DC, USA
| | - Lauren Beste
- Division of General Internal Medicine, Department of Medicine, VA Puget Sound Healthcare System, Seattle, WA, USA.,Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Edward J Miech
- Department of Veterans Affairs, Roudebush VA Medical Center, HSR&D Center for Health Information & Communication, VA PRIS-M QUERI, Indianapolis, IN, USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA
| | - Brittney Neely
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA
| | | | - Maggie Chartier
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Tamar Taddei
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Medicine, Yale University, West Haven, CT, USA
| | - Guadalupe Garcia-Tsao
- VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Medicine, Yale University, West Haven, CT, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Jason A Dominitz
- Gastroenterology Section, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - David Ross
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA.,RAND Corporation, Pittsburgh, PA, USA
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Rogal SS, Yakovchenko V, Gonzalez R, Park A, Lamorte C, Gibson SP, Chartier M, Ross D, Comstock E, Bajaj JS, Morgan TR. Characterizing patient-reported outcomes in veterans with cirrhosis. PLoS One 2020; 15:e0238712. [PMID: 32915828 PMCID: PMC7485762 DOI: 10.1371/journal.pone.0238712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/14/2020] [Accepted: 08/21/2020] [Indexed: 02/08/2023] Open
Abstract
Background and aims The Veterans Health Administration (VA) cares for over 80,000 Veterans with cirrhosis annually. Given the importance of understanding patient reported outcomes in this complex population, we aimed to assess the associations between attitudes towards care, disease knowledge, and health related quality of life (HRQoL) in a national sample. Methods In this cross-sectional study, we mailed paper surveys to a random sample of Veterans with cirrhosis, oversampling those with decompensated disease. Surveys included the Veterans RAND 12-Item Health Survey (measuring HRQoL) and questions about demographics, characteristics of care, satisfaction with care (“attitudes towards care”), and symptoms of cirrhosis. Those who reported being “unsure” about whether they had decompensation events were defined as “unsure about cirrhosis symptoms” (“disease knowledge”). We used multivariable regression models to assess the factors associated with HRQoL. Results Of 1374 surveys, 551 (40%) completed surveys were included for analysis. Most Veterans (63%) were “satisfied” or “very satisfied” with VA liver care. Patients often self-reported being unsure about whether they had experienced hepatic decompensation events (34%). Overall average physical (PCS) and mental (MCS) component scores of HRQoL were 30±11 and 41±12. In multivariable regression models, hepatic decompensation (PCS:β = -3.8, MCS:β = -2.2), medical comorbidities (β = −-2.0, β = -1.7), and being unsure about cirrhosis symptoms (β = -1.9, β = -3.3) were associated with worse HRQoL, while age (β = 0.1, β = 0.2) and satisfaction with care (β = 0.6; β = 1.6) were associated with significantly better HRQoL. Conclusions Hepatic decompensation, lower satisfaction with care, and being unsure about cirrhosis symptoms were associated with reduced QOL scores in this national cohort.
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Affiliation(s)
- Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
- Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: ,
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Edith Norse Rogers Memorial VA Hospital, Bedford, Massachusetts, United States of America
| | - Rachel Gonzalez
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, United States of America
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, United States of America
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
| | - Sandra P. Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States of America
| | - Maggie Chartier
- Veterans Health Administration, HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Washington, DC, United States of America
| | - David Ross
- Veterans Health Administration, HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Washington, DC, United States of America
| | - Emily Comstock
- Department of Infectious Diseases, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, Virginia, United States of America
- Division of Gastroenterology, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, United States of America
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, California, United States of America
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Park A, Oh S, Jung KL, Choi UY, Lee HR, Rosenfeld MG, Jung JU. Global epigenomic analysis of KSHV-infected primary effusion lymphoma identifies functional MYC superenhancers and enhancer RNAs. Proc Natl Acad Sci U S A 2020; 117:21618-21627. [PMID: 32817485 PMCID: PMC7474655 DOI: 10.1073/pnas.1922216117] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Enhancers play indispensable roles in cell proliferation and survival through spatiotemporally regulating gene transcription. Active enhancers and superenhancers often produce noncoding enhancer RNAs (eRNAs) that precisely control RNA polymerase II activity. Kaposi's sarcoma-associated herpesvirus (KSHV) is a human oncogenic gamma-2 herpesvirus that causes Kaposi's sarcoma and primary effusion lymphoma (PEL). It is well characterized that KSHV utilizes host epigenetic machineries to control the switch between two lifecycles, latency and lytic replication. However, how KSHV impacts host epigenome at different stages of viral lifecycle is not well understood. Using global run-on sequencing (GRO-seq) and chromatin-immunoprecipitation sequencing (ChIP-seq), we profiled the dynamics of host transcriptional regulatory elements during latency and lytic replication of KSHV-infected PEL cells. This revealed that a number of critical host genes for KSHV latency, including MYC proto-oncogene, were under the control of superenhancers whose activities were globally repressed upon viral reactivation. The eRNA-expressing MYC superenhancers were located downstream of the MYC gene in KSHV-infected PELs and played a key role in MYC expression. RNAi-mediated depletion or dCas9-KRAB CRISPR inhibition of eRNA expression significantly reduced MYC mRNA level in PELs, as did the treatment of an epigenomic drug that globally blocks superenhancer function. Finally, while cellular IRF4 acted upon eRNA expression and superenhancer function for MYC expression during latency, KSHV viral IRF4 repressed cellular IRF4 expression, decreasing MYC expression and thereby, facilitating lytic replication. These results indicate that KSHV acts as an epigenomic driver that modifies host epigenomic status upon reactivation by effectively regulating host enhancer function.
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Affiliation(s)
- Angela Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Soohwan Oh
- Graduate Program of Biological Sciences, University of California San Diego, La Jolla, CA 92093
- HHMI, University of California San Diego, La Jolla, CA 92093
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92093
| | - Kyle L Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Un Yung Choi
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Hye-Ra Lee
- Department of Biotechnology and Bioinformatics, College of Science and Technology, Korea University, 30019 Sejong, South Korea
| | - Michael G Rosenfeld
- HHMI, University of California San Diego, La Jolla, CA 92093;
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92093
| | - Jae U Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033;
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Choi UY, Lee JJ, Park A, Zhu W, Lee HR, Choi YJ, Yoo JS, Yu C, Feng P, Gao SJ, Chen S, Eoh H, Jung JU. Oncogenic human herpesvirus hijacks proline metabolism for tumorigenesis. Proc Natl Acad Sci U S A 2020; 117:8083-8093. [PMID: 32213586 PMCID: PMC7149499 DOI: 10.1073/pnas.1918607117] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Indexed: 02/05/2023] Open
Abstract
Three-dimensional (3D) cell culture is well documented to regain intrinsic metabolic properties and to better mimic the in vivo situation than two-dimensional (2D) cell culture. Particularly, proline metabolism is critical for tumorigenesis since pyrroline-5-carboxylate (P5C) reductase (PYCR/P5CR) is highly expressed in various tumors and its enzymatic activity is essential for in vitro 3D tumor cell growth and in vivo tumorigenesis. PYCR converts the P5C intermediate to proline as a biosynthesis pathway, whereas proline dehydrogenase (PRODH) breaks down proline to P5C as a degradation pathway. Intriguingly, expressions of proline biosynthesis PYCR gene and proline degradation PRODH gene are up-regulated directly by c-Myc oncoprotein and p53 tumor suppressor, respectively, suggesting that the proline-P5C metabolic axis is a key checkpoint for tumor cell growth. Here, we report a metabolic reprogramming of 3D tumor cell growth by oncogenic Kaposi's sarcoma-associated herpesvirus (KSHV), an etiological agent of Kaposi's sarcoma and primary effusion lymphoma. Metabolomic analyses revealed that KSHV infection increased nonessential amino acid metabolites, specifically proline, in 3D culture, not in 2D culture. Strikingly, the KSHV K1 oncoprotein interacted with and activated PYCR enzyme, increasing intracellular proline concentration. Consequently, the K1-PYCR interaction promoted tumor cell growth in 3D spheroid culture and tumorigenesis in nude mice. In contrast, depletion of PYCR expression markedly abrogated K1-induced tumor cell growth in 3D culture, not in 2D culture. This study demonstrates that an increase of proline biosynthesis induced by K1-PYCR interaction is critical for KSHV-mediated transformation in in vitro 3D culture condition and in vivo tumorigenesis.
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Affiliation(s)
- Un Yung Choi
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Jae Jin Lee
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Angela Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Wei Zhu
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093
| | - Hye-Ra Lee
- Department of Biotechnology and Bioinformatics, College of Science and Technology, Korea University, 30019 Sejong, South Korea
| | - Youn Jung Choi
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Ji-Seung Yoo
- Department of Immunology, Faculty of Medicine, Hokkaido University, 060-8638 Sapporo, Japan
| | - Claire Yu
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093
| | - Pinghui Feng
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
- Section of Infection and Immunity, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089
| | - Shou-Jiang Gao
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
- University of Pittsburgh Medical Center (UPMC), Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15219
- Laboratory of Human Virology and Oncology, Shantou University Medical College, 515041 Shantou, Guangdong, China
| | - Shaochen Chen
- Department of NanoEngineering, University of California San Diego, La Jolla, CA 92093
| | - Hyungjin Eoh
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033;
| | - Jae U Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033;
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Kinariwala D, Khaja M, McCann S, Sheeran D, Park A, Stone J, Wilkins L, Matsumoto A, Redick D. 3:36 PM Abstract No. 169 Preoperative uterine artery embolization before hysterectomy or myomectomy: a case series. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chowdhury S, Sripathy S, Webster AA, Park A, Lao U, Hsu JH, Loe T, Bedalov A, Simon JA. Discovery of Selective SIRT2 Inhibitors as Therapeutic Agents in B-Cell Lymphoma and Other Malignancies. Molecules 2020; 25:molecules25030455. [PMID: 31973227 PMCID: PMC7036909 DOI: 10.3390/molecules25030455] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 11/27/2022] Open
Abstract
Genetic ablation as well as pharmacological inhibition of sirtuin 2 (SIRT2), an NAD+-dependent protein deacylase, have therapeutic effects in various cancers and neurodegenerative diseases. Previously, we described the discovery of a dual SIRT1/SIRT2 inhibitor called cambinol (IC50 56 and 59 µM, respectively), which showed cytotoxic activity against cancer cells in vitro and a marked anti-proliferative effect in a Burkitt lymphoma mouse xenograft model. A number of recent studies have shown a protective effect of SIRT1 and SIRT3 in neurodegenerative and metabolic diseases as well as in certain cancers prompting us to initiate a medicinal chemistry effort to develop cambinol-based SIRT2-specific inhibitors devoid of SIRT1 or SIRT3 modulating activity. Here we describe potent cambinol-based SIRT2 inhibitors, several of which show potency of ~600 nM with >300 to >800-fold selectivity over SIRT1 and 3, respectively. In vitro, these inhibitors are found to be toxic to lymphoma and epithelial cancer cell lines. In particular, compounds 55 (IC50 SIRT2 0.25 µM and <25% inhibition at 50 µM against SIRT1 and SIRT3) and 56 (IC50 SIRT2 0.78 µM and <25% inhibition at 50 µM against SIRT1 and SIRT3) showed apoptotic as well as strong anti-proliferative properties against B-cell lymphoma cells.
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Affiliation(s)
- Sarwat Chowdhury
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Smitha Sripathy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Alyssa A. Webster
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Angela Park
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Uyen Lao
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Joanne H. Hsu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Taylor Loe
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Antonio Bedalov
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
| | - Julian A. Simon
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; (S.C.); (S.S.); (A.A.W.); (A.P.); (U.L.); (J.H.H.); (T.L.); (A.B.)
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Correspondence: ; Tel.: (206)-667-6241
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Park A, Kanowski A, Danda N, Hon M, Thakeria P. 498 Impact of Accelerated Chest Pain Risk Evaluation (ACRE) Pathway on Exercise Stress Test Referrals at the Townsville University Hospital. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Albertini JG, Wang P, Fahim C, Hutfless S, Stasko T, Vidimos AT, Leshin B, Billingsley EM, Coldiron BM, Bennett RG, Marks VJ, Park A, Overton HN, Bruhn WE, Xu T, Krishnan A, Makary MA. Evaluation of a Peer-to-Peer Data Transparency Intervention for Mohs Micrographic Surgery Overuse. JAMA Dermatol 2019; 155:906-913. [PMID: 31055597 DOI: 10.1001/jamadermatol.2019.1259] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Mohs micrographic surgery (MMS) is a skin cancer treatment that uses staged excisions based on margin status. Wide surgeon-level variation exists in the mean number of staged resections used to treat a tumor, resulting in a cost disparity and question of appropriateness. Objective To evaluate the effectiveness of a behavioral intervention aimed at reducing extreme overuse in MMS, as defined by the specialty society, by confidentially sharing stages-per-case performance data with individual surgeons benchmarked to their peers nationally. Design, Setting, and Participants This nonrandomized controlled intervention study included 2329 US surgeons who performed MMS procedures from January 1, 2016, to March 31, 2018. Physicians were identified using a 100% capture of Medicare Part B claims. The intervention group included physicians affiliated with the American College of Mohs Surgery, and the control group included physicians not affiliated with the American College of Mohs Surgery. Interventions Individualized performance reports were delivered to all outlier surgeons, defined by the specialty society as those with mean stages per case 2 SDs above the mean, and inlier surgeons in the intervention group. Main Outcomes and Measures The primary outcome was surgeon-level change in mean stages per case between the prenotification (January 2016 to January 2017) and postnotification (March 2017 to March 2018) periods. A multivariable linear regression model was used to evaluate the association of notification with this surgeon-level outcome. The surgeon-level metric of mean stages per case was not risk adjusted. The mean Medicare cost savings associated with changes in practice patterns were calculated. Results Of the 2329 included surgeons, 1643 (70.5%) were male and 2120 (91.0%) practiced in metropolitan areas. In the intervention group (n = 1045), 53 surgeons (5.1%) were outliers; in the control group (n = 1284), 87 surgeons (6.8%) were outliers. Among the outliers in the intervention group, 44 (83%) demonstrated a reduction in mean stages per case compared with 60 outliers in the control group (69%; difference, 14%; 95% CI of difference, -1 to 27; P = .07). There was a mean stages-per-case reduction of 12.6% among outliers in the intervention group compared with 9.0% among outliers in the control group, and outliers in the intervention group had an adjusted postintervention differential decrease of 0.14 stages per case (95% CI, -0.19 to -0.09; P = .002). The total administrative cost of the intervention program was $150 000, and the estimated reduction in Medicare spending was $11.1 million. Conclusions and Relevance Sharing personalized practice pattern data with physicians benchmarked to their peers can reduce overuse of MMS among outlier physicians.
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Affiliation(s)
- John G Albertini
- The Skin Surgery Center, Winston Salem, North Carolina.,Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Peiqi Wang
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Christine Fahim
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Susan Hutfless
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma, Oklahoma City
| | | | - Barry Leshin
- The Skin Surgery Center, Winston Salem, North Carolina.,Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | | | | | | | | | - Angela Park
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Heidi N Overton
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - William E Bruhn
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Tim Xu
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Aravind Krishnan
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Martin A Makary
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Kamal A, Fain C, Park A, Wang P, Gonzalez-Velez E, Leffler DA, Hutfless SM. Angiotensin II receptor blockers and gastrointestinal adverse events of resembling sprue-like enteropathy: a systematic review. Gastroenterol Rep (Oxf) 2019; 7:162-167. [PMID: 31217979 PMCID: PMC6573796 DOI: 10.1093/gastro/goz019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/10/2019] [Accepted: 03/28/2019] [Indexed: 12/27/2022] Open
Abstract
Background Olmesartan, an angiotensin II receptor blocker (ARB), is associated with gastrointestinal symptoms resembling sprue-like enteropathy. Some have proposed that enteropathy may be a class effect rather than olmesartan-specific. We performed a systematic review to identify literature of sprue-like enteropathy for all ARBs. Methods Case reports, case series and comparative studies of ARBs were searched on PubMed and Embase databases through 21 November 2018 and then assessed. Results A total of 82 case reports and case series as well as 5 comparative studies, including 248 cases, were selected and analysed. The ARBs listed in the case reports were olmesartan (233 users; 94.0%), telmisartan (5 users; 2.0%), irbesartan (4 users; 1.6%), valsartan (3 users; 1.2%), losartan (2 users; 0.8%) and eprosartan (1 user; 0.4%). The periods between ARB initiation and onset of symptoms ranged from 2 weeks to 13 years. Histologic results were reported in 218 cases, in which 201 cases (92.2%) were villous atrophy and 131 cases (60.1%) were intraepithelial lymphocytosis. Human leucocyte antigen (HLA) testing was performed in 147 patients, among whom 105 (71.4%) had HLA-DQ2 or HLA-DQ8 haplotypes. Celiac-associated antibodies were tested in 169 patients, among whom 167 (98.8%) showed negative results. Gluten exclusion from the diet failed to relieve symptoms of enteropathy in 127 (97.7%) of 130 patients with information. Complete remission of symptoms after discontinuation of ARB was reported in 233 (97.4%) of the 239 patients with information. Seven cases (2.8%) reported recurrence of symptoms after restarting olmesartan; rechallenge was not reported for the non-olmesartan ARBs. The retrospective studies conducted worldwide had inconsistent study designs (e.g. differences in periods of study and case definition) and findings. Conclusions Although enteropathy is rare, clinicians should remain vigilant of this potential adverse event even years after medication initiation.
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Affiliation(s)
- Ayesha Kamal
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher Fain
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD, USA
| | - Angela Park
- Johns Hopkins, Department of Surgery and Surgical Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Peiqi Wang
- Johns Hopkins, Department of Surgery and Surgical Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Eduardo Gonzalez-Velez
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel A Leffler
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Susan M Hutfless
- Department of Medicine, Division of Gastroenterology, Johns Hopkins University, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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35
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Rogal SS, Yakovchenko V, Waltz TJ, Powell BJ, Gonzalez R, Park A, Chartier M, Ross D, Morgan TR, Kirchner JE, Proctor EK, Chinman MJ. Longitudinal assessment of the association between implementation strategy use and the uptake of hepatitis C treatment: Year 2. Implement Sci 2019; 14:36. [PMID: 30961615 PMCID: PMC6454775 DOI: 10.1186/s13012-019-0881-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To increase the uptake of evidence-based treatments for hepatitis C (HCV), the Department of Veterans Affairs (VA) established the Hepatitis Innovation Team (HIT) Collaborative. Teams of providers were tasked with choosing implementation strategies to improve HCV care. The aim of the current evaluation was to assess how site-level implementation strategies were associated with HCV treatment initiation and how the use of implementation strategies and their association with HCV treatment changed over time. METHODS A key HCV provider at each VA site (N = 130) was asked in two consecutive fiscal years (FYs) to complete an online survey examining the use of 73 implementation strategies organized into nine clusters as described by the Expert Recommendations for Implementing Change (ERIC) study. The number of Veterans initiating treatment for HCV, or "treatment starts," at each site was captured using national data. Providers reported whether the use of each implementation strategy was due to the HIT Collaborative. RESULTS Of 130 sites, 80 (62%) responded in Year 1 (FY15) and 105 (81%) responded in Year 2 (FY16). Respondents endorsed a median of 27 (IQR19-38) strategies in Year 2. The strategies significantly more likely to be chosen in Year 2 included tailoring strategies to deliver HCV care, promoting adaptability, sharing knowledge between sites, and using mass media. The total number of treatment starts was significantly positively correlated with total number of strategies endorsed in both years. In Years 1 and 2, respectively, 28 and 26 strategies were significantly associated with treatment starts; 12 strategies overlapped both years, 16 were unique to Year 1, and 14 were unique to Year 2. Strategies significantly associated with treatment starts shifted between Years 1 and 2. Pre-implementation strategies in the "training/educating," "interactive assistance," and "building stakeholder interrelationships" clusters were more likely to be significantly associated with treatment starts in Year 1, while strategies in the "evaluative and iterative" and "adapting and tailoring" clusters were more likely to be associated with treatment starts in Year 2. Approximately half of all strategies were attributed to the HIT Collaborative. CONCLUSIONS These results suggest that measuring implementation strategies over time is a useful way to catalog implementation of an evidence-based practice over time and across settings.
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Affiliation(s)
- Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, USA. .,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. .,Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, Edith Norse Rogers Memorial VA Hospital, Bedford, MA, USA
| | - Thomas J Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel Gonzalez
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Angela Park
- Office of Strategic Integration
- Veterans Engineering Resource Center, Washington, DC, USA
| | - Maggie Chartier
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - David Ross
- HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - JoAnn E Kirchner
- Department of Veterans Affairs Medical Center, HSR&D and Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Enola K Proctor
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, USA.,RAND Corporation, Pittsburgh, PA, USA
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36
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Varma S, Hu J, Mehta A, Song Y, Park A, Zhi M, Hutfless S. Initial medical and surgical management of inflammatory bowel disease in the biologic era: A comparison between the United States and China. JGH Open 2019; 3:234-241. [PMID: 31276042 PMCID: PMC6586599 DOI: 10.1002/jgh3.12146] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/21/2018] [Accepted: 12/29/2018] [Indexed: 12/14/2022]
Abstract
Background and Aims We compared the initial medical and surgical management of Crohn's disease (CD) and ulcerative colitis (UC) between the United States and China, with aims to better characterize the global variation in the treatment patterns of inflammatory bowel disease (IBD). Methods Participants from the United States and China completed a questionnaire on demographic and clinical characteristics, medications (biologics, immunomodulators, aminosalicylates, steroids), and IBD‐related surgical history. Patients diagnosed in 2006 and later were eligible. Analysis was restricted to treatment patterns within 1 year of diagnosis. Multivariable logistic regressions examined differences by country. Results We recruited 202 CD (US: 49%, China: 51%) and 133 UC (US: 63%, China: 37%) participants. Median age at survey was 31 years (range: 18–76) and at diagnosis was 28 years (range: 12–70). Biologics were commonly used in the United States for CD (66%) and UC (28%) and less commonly in China for CD (19%) and UC (0%). On regression, US CD participants were more likely to receive biologics (odds ratio [OR] 23.82 [95% confidence interval [CI] 8.98–63.14]), aminosalicylates (OR 4.93 [2.00–12.15]), and steroids (OR 4.36 [1.87–10.16]). US UC participants were more likely to receive immunomodulators (OR 3.45 [1.09–10.90]) and steroids (OR 3.31 [1.55–7.06]). There existed minimal differences regarding undergoing surgery for CD (US: 16%, China: 16%) and UC (US: 5%, China: 2%). A proportion (US: 12%, China: 19%) underwent IBD‐related surgery prior to diagnosis (median: 5 years; range: 1–39). Conclusion US, relative to Chinese, participants were more likely to report early biologic use. There were no differences between countries in undergoing early surgery. Evaluating global practice variation is integral to optimizing early pharmacological therapy and timing of surgery for patients with IBD.
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Affiliation(s)
- Sanskriti Varma
- The Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Jun Hu
- The Sixth Affiliated Hospital of Sun Yat-Sen University Guangzhou Guangdong Providence China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital Guangzhou Guangdong Providence China
| | - Ambar Mehta
- Department of Surgery Columbia University New York New York USA
| | - Yiran Song
- Division of Gastroenterology and Hepatology The Johns Hopkins University Baltimore Maryland USA
| | - Angela Park
- The Johns Hopkins University Baltimore Maryland USA
| | - Min Zhi
- The Sixth Affiliated Hospital of Sun Yat-Sen University Guangzhou Guangdong Providence China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases The Sixth Affiliated Hospital Guangzhou Guangdong Providence China
| | - Susan Hutfless
- Division of Gastroenterology and Hepatology The Johns Hopkins University Baltimore Maryland USA
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Xu T, Mehta A, Park A, Makary MA, Price DW. Association Between Board Certification, Maintenance of Certification, and Surgical Complications in the United States. Am J Med Qual 2019; 34:545-552. [PMID: 30654617 DOI: 10.1177/1062860618822752] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physician credentialing processes aim to improve patient safety and quality, but little research has examined their direct relationship with surgical outcomes. Using national Medicare claims for 2009 to 2013, the authors studied the association between board certification and completion of Maintenance of Certification (MOC) requirements and surgeon rates of complications for 8 elective procedures. Exemplar surgeons were defined as those in the lowest decile of complication rates, and outlier surgeons were those in the highest decile. The analysis included 1.9 million procedures performed by 14 598 surgeons (64% orthopedics, 17% general surgery, 11% urology, 7% neurosurgery). Board-certified surgeons were less likely to be outliers (odds ratio 0.79 [0.66-0.94]). However, completion of MOC was not associated with differences in complication rates in orthopedic surgery or urology. Incorporating additional assessment methods into MOC, such as video evaluation of technical skills, retraining on state-of-the-art care, and peer review, may facilitate further improvements in surgical quality.
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Affiliation(s)
- Tim Xu
- Johns Hopkins University, Baltimore, MD
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38
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Park SJ, Kim YI, Park A, Kwon HI, Kim EH, Si YJ, Song MS, Lee CH, Jung K, Shin WJ, Zeng J, Choi Y, Jung JU, Choi YK. Ferret animal model of severe fever with thrombocytopenia syndrome phlebovirus for human lethal infection and pathogenesis. Nat Microbiol 2018; 4:438-446. [PMID: 30531978 DOI: 10.1038/s41564-018-0317-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023]
Abstract
Severe fever with thrombocytopenia syndrome phlebovirus (SFTSV), listed in the most dangerous pathogens by the World Health Organization, has 12-30% fatality rates with a characteristic thrombocytopenia syndrome. With a majority of clinically diagnosed SFTSV patients older than ~50 years of age, age is a critical risk factor for SFTSV morbidity and mortality. Here, we report an age-dependent ferret model of SFTSV infection and pathogenesis that fully recapitulates the clinical manifestations of human infections. Whereas young adult ferrets (≤2 years of age) did not show any clinical symptoms and mortality, SFTSV-infected aged ferrets (≥4 years of age) demonstrated severe thrombocytopenia, reduced white blood cell counts and high fever with 93% mortality rate. Moreover, a significantly higher viral load was observed in aged ferrets. Transcriptome analysis of SFTSV-infected young ferrets revealed strong interferon-mediated anti-viral signalling, whereas inflammatory immune responses were markedly upregulated and persisted in aged ferrets. Thus, this immunocompetent age-dependent ferret model should be useful for anti-SFTSV therapy and vaccine development.
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Affiliation(s)
- Su-Jin Park
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Young-Il Kim
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Angela Park
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hyeok-Il Kwon
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Eun-Ha Kim
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Young-Jae Si
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Min-Suk Song
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea
| | - Chul-Ho Lee
- Laboratory Animal Center, Korea Research Institute of Bioscience and Biotechnology, University of Science and Technology, Daejeon, Republic of Korea
| | - Kyle Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Woo-Jin Shin
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jianxiong Zeng
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Younho Choi
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jae U Jung
- Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Young Ki Choi
- Department of Microbiology, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea. .,Zoonotic Infectious Diseases Research Center, Chungbuk National University, Cheongju, Republic of Korea.
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Seitz L, Rieger A, Berry W, Ashok D, Direnzo D, Jin L, Lee S, Park A, Piovesan D, Tan J, Walters M, Karakunnel J. Preliminary results from a phase 1 study of AB122, a programmed cell death-1 (PD-1) inhibitor, in patients with advanced solid malignancies. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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40
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Gillespie C, Rose AJ, Petrakis BA, Jones EA, Park A, McCullough MB. Qualitative study of patient experiences of responsibility in warfarin therapy. Am J Health Syst Pharm 2018; 75:1798-1804. [DOI: 10.2146/ajhp170736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Chris Gillespie
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA
| | | | | | - Ellen A. Jones
- Central Western Massachusetts VA Medical Center, Leeds, MA
| | - Angela Park
- Central Western Massachusetts VA Medical Center, Leeds, MA
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41
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Seitz L, Ashok D, Leleti M, Powers J, Rosen B, Miles D, Sharif E, Jin L, Park A, Young S, Rieger A, Schindler U, Karakunnel J, Walters M. Final results of the phase I study in healthy volunteers of AB928, a dual antagonist of the A2aR and A2bR adenosine receptors being studied as an activator of anti-tumor immune response. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Vaughan M, Park A, Sholapurkar A, Esterman A. Medical emergencies in dental practice - management requirements and international practitioner proficiency. A scoping review. Aust Dent J 2018; 63:455-466. [DOI: 10.1111/adj.12649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- M Vaughan
- Faculty of Dentistry; College of Medicine and Dentistry; James Cook University; Smithfield Queensland Australia
| | - A Park
- Faculty of Dentistry; College of Medicine and Dentistry; James Cook University; Smithfield Queensland Australia
| | - A Sholapurkar
- Faculty of Dentistry; College of Medicine and Dentistry; James Cook University; Smithfield Queensland Australia
| | - A Esterman
- School of Nursing and Midwifery; University of South Australia; Adelaide South Australia Australia
- Australian Institute of Tropical Health and Medicine; James Cook University; Smithfield Queensland Australia
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43
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Wang F, Turcheniuk K, Wang B, Song AY, Ren X, Vallamattam A, Park A, Hanley K, Zhu T, Yushin G. Mechanisms of Transformation of Bulk Aluminum–Lithium Alloys to Aluminum Metal–Organic Nanowires. J Am Chem Soc 2018; 140:12493-12500. [DOI: 10.1021/jacs.8b06261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fujia Wang
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
- State Key Laboratory of Chemical Engineering, East China University of Science and Technology, Shanghai 200237, China
| | - Kostiantyn Turcheniuk
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Baolin Wang
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Ah-Young Song
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Xiaolei Ren
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Ashok Vallamattam
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Angela Park
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Kolby Hanley
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Ting Zhu
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Gleb Yushin
- School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
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Park A, Gonzalez R, Chartier M, Rogal S, Yakovchenko V, Ross D, Morgan TR. Screening and Treating Hepatitis C in the VA: Achieving Excellence Using Lean and System Redesign. Fed Pract 2018; 35:24-29. [PMID: 30766371 PMCID: PMC6368013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The national effort to redesign care using Lean management strategies, develop local and regional teams, and centralize support allowed VA to maximize available resources to achieve higher rates of testing and treatment of patients with hepatitis C virus than that of any other health care system in the US.
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Affiliation(s)
- Angela Park
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - Rachel Gonzalez
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - Maggie Chartier
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - Shari Rogal
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - Vera Yakovchenko
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - David Ross
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
| | - Timothy R Morgan
- is a Clinical Pharmacy Specialist and Pharmacy Process Improvement Program Manager at the Office of Strategic Integration and Veterans Engineering Resource Center. is the Program Manager of the National Hepatitis Consortium for Redesigning Care under the Research Service at VA Long Beach Healthcare System in California. is Director and is the Deputy Director at the Veterans Health Administration, Office of Specialty Care Services, HIV, Hepatitis, and Related Conditions Programs. is a Gastroenterologist, Transplant Hepatologist, and an Investigator at the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System Center, and Assistant Professor at University of Pittsburgh in Pennsylvania. is a Health Science Specialist at Center for Healthcare Organization and Implementation Research and Bridging the Care Continuum Quality Enhancement Research Initiative at Bedford VA in Bedford, Massachusetts. is the Chief of Gastroenterology at VA Long Beach Healthcare System in California and Director of the National Hepatitis C Resource Center
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Kim D, Chen R, Kim S, Park A, Evans B, Yu V, Oh E, Miller L, Kang S, Ghiaur G, Yu J, Huang W, Kane M, Garza L. 1410 Non-coding double stranded RNA induces retinoic acid synthesis and retinoid signaling to control regeneration. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Park A, Okhovat J. 880 Divergent trends in acne vulgaris interest and research a decade of lost face value in the United States. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- P A Goodhines
- Syracuse University, Department of Psychology, Syracuse, NY
| | - L A Gellis
- Syracuse University, Department of Psychology, Syracuse, NY
| | - A Park
- Syracuse University, Department of Psychology, Syracuse, NY
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Leko V, Sripathy S, Adrianse RL, Loe T, Park A, Lao U, Foss EJ, Bartolomei MS, Bedalov A. Pooled shRNA Screen for Reactivation of MeCP2 on the Inactive X Chromosome. J Vis Exp 2018. [PMID: 29553562 DOI: 10.3791/56398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Forward genetic screens using reporter genes inserted into the heterochromatin have been extensively used to investigate mechanisms of epigenetic control in model organisms. Technologies including short hairpin RNAs (shRNAs) and clustered regularly interspaced short palindromic repeats (CRISPR) have enabled such screens in diploid mammalian cells. Here we describe a large-scale shRNA screen for regulators of X-chromosome inactivation (XCI), using a murine cell line with firefly luciferase and hygromycin resistance genes knocked in at the C-terminus of the methyl CpG binding protein 2 (MeCP2) gene on the inactive X-chromosome (Xi). Reactivation of the construct in the reporter cell line conferred survival advantage under hygromycin B selection, enabling us to screen a large shRNA library and identify hairpins that reactivated the reporter by measuring their post-selection enrichment using next-generation sequencing. The enriched hairpins were then individually validated by testing their ability to activate the luciferase reporter on Xi.
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Affiliation(s)
- Vid Leko
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health
| | - Smitha Sripathy
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Robin L Adrianse
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Taylor Loe
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Angela Park
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Uyen Lao
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Eric J Foss
- Clinical Research Division, Fred Hutchinson Cancer Research Center
| | - Marisa S Bartolomei
- Epigenetics Program, Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine
| | - Antonio Bedalov
- Clinical Research Division, Fred Hutchinson Cancer Research Center; Departments of Medicine and Biochemistry, University of Washington;
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Elder KJ, Nickson C, Cooke S, Machalek D, Rose A, Mou A, Collins JP, Park A, De Boer R, Phillips C, Pridmore V, Farrugia H, Mann GB. Abstract PD2-13: Benefits to breast screening beyond mortality reduction. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd2-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The value of population-based mammographic screening has been questioned by those who believe that the reduction in mortality from earlier diagnosis is outweighed by harms including overdiagnosis and overtreatment. Much of these commentaries assume that all Early-Stage Breast Cancer (ESBC) is treated the same way after diagnosis; with extensive therapies including surgery, radiotherapy and chemotherapy being standard.
Intensity of treatment received is rarely mentioned in the debate. We hypothesised that those diagnosed through a screening program (Active Screeners (AS)) would receive less extensive surgical treatment and less intense adjuvant therapies than those not recently screened (NRS). If demonstrated, these differences would form an important component of the debate over the role of mammographic screening.
Methods
Retrospective analysis of a consecutive cohort of female patients aged 50-69 and managed for ESBC (invasive or DCIS) during 2007-2013 within a large metropolitan Breast Service, diagnosed either via a population screening program (AS) or outside of the program (NRS). Data on patient characteristics, symptoms, mode of detection, tumour pathology, surgical intervention and adjuvant treatment recommendations were derived from prospectively collected Multi-Disciplinary Meeting (MDM) records. Patients with metastatic disease or prior treatment for breast cancer were excluded.
Results
791 cases were identified (569 with screen-detected cancer, 53 with interval cancers and 169 cancers diagnosed in women not recently screened). Invasive cancers in the AS group were much smaller than in the NRS group – mean 17mm versus 26mm. The AS group had lower grade invasive cancer – grade 1, 2 and 3 were 27%, 42%, 31% - compared with 10%, 39% and 52% in the NRS group. The AS group were more likely to have ER+ve cancers (88% vs 80%) and less likely to have nodal involvement (26% vs 48%). For invasive breast cancer, the NRS group were more than twice as likely to undergo mastectomy than cancers in the AS group (35% vs 16%). Axillary dissections were more common in the NRS than the AS group (43% vs 19%). Adjuvant chemotherapy was recommended more frequently for the NRS group compared to the AS group (65% vs 37%), as was post mastectomy radiotherapy (58% vs 39%). Endocrine therapy was less often recommended to the NRS group (86% versus 77%).
Conclusion
Women diagnosed with early stage breast cancer who are participating in a population based screening program are less likely to receive mastectomy and/or axillary dissection, less likely to receive adjuvant chemotherapy and less likely to receive post-mastectomy radiotherapy. These differences in treatment intensity should be considered in the debate surrounding mammographic screening.
Citation Format: Elder KJ, Nickson C, Cooke S, Machalek D, Rose A, Mou A, Collins JP, Park A, De Boer R, Phillips C, Pridmore V, Farrugia H, Mann GB. Benefits to breast screening beyond mortality reduction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD2-13.
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Affiliation(s)
- KJ Elder
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - C Nickson
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - S Cooke
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - D Machalek
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - A Rose
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - A Mou
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - JP Collins
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - A Park
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - R De Boer
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - C Phillips
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - V Pridmore
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - H Farrugia
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
| | - GB Mann
- Royal Women's Hospital, Melbourne, Victoria, Australia; University of Melbourne; The Royal Melbourne Hospital; BreastScreen Victoria; Victorian Cancer Registry
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Park A, Xu T, Poku M, Taylor J, Makary MA. Variation in markups on outpatient oncology services in the United States. Am J Manag Care 2018; 24:e59-e60. [PMID: 29461852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Price markups are a major cause of healthcare inflation and financial harm to patients, especially those who are self-paying or covered by commercial insurance. STUDY DESIGN Retrospective analysis of publicly-available information on Medicare physician payments, representing 100% of Part B services provided to fee-for-service beneficiaries during calendar year 2014. METHODS Outcomes were markup ratios for oncology services, defined as the ratio of submitted charges to the amount reimbursed by Medicare. For example, the overall cost-to-charge ratio for all Medicare-reimbursed services in 2013 was 3.4, or a 240% charge markup. RESULTS Our analysis included oncology services provided by 3248 hospitals in all 50 states. There was significant variation in markup ratios by hospital across oncology specialty: radiology (median = 3.7; interquartile range [IQR], 3.1-4.5), hematology/oncology (median = 2.3; IQR, 1.8-2.9), medical oncology (median = 2.4; IQR, 1.8-3.0), pathology (median = 4.1; IQR 3.1-5.1), and radiation oncology (median = 3.6; IQR, 2.9-4.5). Higher markups were associated with for-profit status for medical oncology services (coefficient, 0.29; 95% CI, 0.12-0.45) and prestige status for radiology (0.53; 95% CI, 0.15-0.92) and pathology (0.65; 95% CI, 0.20-1.09) services. CONCLUSIONS High markups exist for oncology services, and further legislation is needed to protect patients from highly variable pricing and to address disparities in access to high-quality cancer care.
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Affiliation(s)
| | | | | | | | - Martin A Makary
- Johns Hopkins Department of Surgery, Halsted 610, 600 N Wolfe St, Baltimore, MD 21287.
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