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Lin A, Brown S, Maloy M, Ruiz JD, Devlin S, DeRespiris L, Proli A, Jakubowski AA, Papadopoulos EB, Sauter CS, Tamari R, Castro-Malaspina H, Shaffer B, Barker J, Perales MA, Giralt SA, Gyurkocza B. Impact of omitting post-transplant minidose-methotrexate doses in allogeneic hematopoietic cell transplantation. Leuk Lymphoma 2022; 63:1686-1693. [PMID: 35142567 PMCID: PMC9983694 DOI: 10.1080/10428194.2022.2032036] [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: 10/19/2022]
Abstract
Given prophylactic methotrexate (MTX) is often held in the setting of toxicity we investigated the impact of omitting minidose-MTX dose(s). Outcomes were compared between patients who had 1-3 doses omitted and those who received all four planned doses of minidose-MTX. Of 370 consecutive patients, 50 had MTX dose(s) omitted. When MTX was omitted, initial management was mycophenolate mofetil (MMF; 36/50 patients) with or without corticosteroids (14/50 patients). Rates of grade 3-4 acute GVHD were similar between groups. Omission of minidose-MTX resulted in an increased risk of chronic GVHD (cGVHD; HR 2.27; p = .024) and decreased overall survival (HR 1.61; p = .024). However, other transplant-related outcomes were comparable. In summary, omission of minidose-MTX doses was not associated with an increased risk of acute GVHD when an alternative was added (e.g. MMF ± corticosteroids). This did not abrogate the increased risk of cGVHD or decreased overall survival.
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Affiliation(s)
- A Lin
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Brown
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Maloy
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - JD Ruiz
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - L DeRespiris
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Proli
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY
| | - AA Jakubowski
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - EB Papadopoulos
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - CS Sauter
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - R Tamari
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - H Castro-Malaspina
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Shaffer
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - J Barker
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - MA Perales
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - SA Giralt
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - B Gyurkocza
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY,Department of Medicine, Weill Cornell Medical College, New York, NY
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Shaffer B, Quintero D, Rhodes J. Changing sensitivity to cold weather in Texas power demand. iScience 2022; 25:104173. [PMID: 35434549 PMCID: PMC9010639 DOI: 10.1016/j.isci.2022.104173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 10/29/2022] Open
Abstract
We estimate the effect of heightened temperature sensitivity on electricity demand in Texas during the February 2021 blackout event. Using 20 years of hourly data, we estimate the relationship between temperature and electricity demand; finding demand has become more responsive to cold temperatures over time. This is consistent with the fact electric heating has similarly increased over the past 20 years in Texas. We find during the February 2021 event, average electricity demand was 8% higher, and approximately 10,000 MW higher during the peak hour, than it would have been had temperature sensitivity remained unchanged at early 2000s levels. Our results highlight that Texas's increased sensitivity to cold weather extremes is not limited to the supply side, but the demand side as well. These findings have implications to other regions that are seeking to reduce carbon emissions through the electrification of heating.
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Affiliation(s)
- Blake Shaffer
- Department of Economics, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Daniel Quintero
- Department of Economics, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Joshua Rhodes
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX 78712, USA
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Benham JL, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, Boucher JC, Constantinescu C, Parsons Leigh J, Ivers NM, Ratzan SC, Fullerton MM, Tang T, Manns BJ, Marshall DA, Hu J, Lang R. COVID-19 Vaccine-Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis. JMIR Public Health Surveill 2021; 7:e30424. [PMID: 34779784 PMCID: PMC8709417 DOI: 10.2196/30424] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations.
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Affiliation(s)
- Jamie L Benham
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Omid Atabati
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Robert J Oxoby
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | - Blake Shaffer
- Department of Economics, University of Calgary, Calgary, AB, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean-Christophe Boucher
- School of Public Policy and Department of Political Sciences, University of Calgary, Calgary, AB, Canada
| | - Cora Constantinescu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Noah M Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Scott C Ratzan
- School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Madison M Fullerton
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Theresa Tang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jia Hu
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Lin R, Ritter E, Flynn J, Ho C, Ruiz J, Jakubowski A, Papadopoulos E, Shaffer B, Castro-Malaspina H, Cho C, Ponce D, Barker J, Tamari R, Sauter C, Gyurkocza B, van den Brink M, Young J, Perales M, Devlin S, Wong P, Giralt S. Aging-related, Senescence-associated Secretory Phenotype and Allogeneic Hematopoietic Cell Transplantation Outcomes in Older Adults. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Lang R, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, Fullerton MM, Tang T, Leigh JP, Manns BJ, Marshall DA, Ivers NM, Ratzan SC, Hu J, Benham JL. Characterization of non-adopters of COVID-19 non-pharmaceutical interventions through a national cross-sectional survey to assess attitudes and behaviours. Sci Rep 2021; 11:21751. [PMID: 34741109 PMCID: PMC8571421 DOI: 10.1038/s41598-021-01279-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/25/2021] [Indexed: 01/27/2023] Open
Abstract
Adoption of non-pharmaceutical interventions (NPIs) remains critical to curtail the spread of COVID-19. Using self-reported adherence to NPIs in Canada, assessed through a national cross-sectional survey of 4498 respondents, we aimed to identify and characterize non-adopters of NPIs, evaluating their attitudes and behaviours to understand barriers and facilitators of adoption. A cluster analysis was used to group adopters separately from non-adopters of NPIs. Associations with sociodemographic factors, attitudes towards COVID-19 and the public health response were assessed using logistic regression models comparing non-adopters to adopters. Of the 4498 respondents, 994 (22%) were clustered as non-adopters. Sociodemographic factors significantly associated with the non-adoption cluster were: (1) being male, (2) age 18–34 years, (3) Albertans, (4) lower education level and (5) higher conservative political leaning. Participants who expressed low concern for COVID-19 and distrust towards several institutions had greater odds of being non-adopters. This information characterizes individuals at greatest odds for non-adoption of NPIs to inform targeted marketing interventions.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Omid Atabati
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Robert J Oxoby
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | - Blake Shaffer
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Madison M Fullerton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theresa Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah M Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Scott C Ratzan
- City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Jia Hu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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7
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Lang R, Benham JL, Atabati O, Hollis A, Tombe T, Shaffer B, Burns KK, MacKean G, Léveillé T, McCormack B, Sheikh H, Fullerton MM, Tang T, Boucher JC, Constantinescu C, Mourali M, Manns BJ, Marshall DA, Hu J, Oxoby RJ. Attitudes, behaviours and barriers to public health measures for COVID-19: a survey to inform public health messaging. BMC Public Health 2021; 21:765. [PMID: 33882896 PMCID: PMC8058588 DOI: 10.1186/s12889-021-10790-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 12/07/2020] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background Public support of public health measures including physical distancing, masking, staying home while sick, avoiding crowded indoor spaces and contact tracing/exposure notification applications remains critical for reducing spread of COVID-19. The aim of our work was to understand current behaviours and attitudes towards public health measures as well as barriers individuals face in following public health measures. We also sought to identify attitudes persons have regarding a COVID-19 vaccine and reasons why they may not accept a vaccine. Methods A cross-sectional online survey was conducted in August 2020, in Alberta, Canada in persons 18 years and older. This survey evaluated current behaviours, barriers and attitudes towards public health measures and a COVID-19 vaccine. Cluster analysis was used to identify key patterns that summarize data variations among observations. Results Of the 60 total respondents, the majority of persons were always or often physically distancing (73%), masking (65%) and staying home while sick (67%). Bars/pubs/lounges or nightclubs were visited rarely or never by 63% of respondents. Persons identified staying home while sick to provide the highest benefit (83%) in reducing spread of COVID-19. There were a large proportion of persons who had not downloaded or used a contact tracing/exposure notification app (77%) and who would not receive a COVID-19 vaccine when available (20%) or were unsure (12%). Reporting health authorities as most trusted sources of health information was associated with greater percentage of potential uptake of vaccine but not related to contact tracing app download and use. Individuals with lower concern of getting and spreading COVID-19 showed the least uptake of public health measures except for avoiding public places such as bars. Lower concern regarding COVID-19 was also associated with more negative responses to taking a potential COVID-19 vaccine. Conclusion These results suggest informational frames and themes focusing on individual risks, highlighting concern for COVID-19 and targeting improving trust for health authorities may be most effective in increasing public health measures. With the ultimate goal of preventing spread of COVID-19, understanding persons’ attitudes towards both public health measures and a COVID-19 vaccine remains critical to addressing barriers and implementing targeted interventions and messaging to improve uptake. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10790-0.
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Affiliation(s)
- Raynell Lang
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jamie L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Omid Atabati
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Aidan Hollis
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Trevor Tombe
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Blake Shaffer
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Katharina Kovacs Burns
- Primary Data Support, Data & Analytics, Alberta Health Services, Calgary, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tova Léveillé
- Primary Data Support, Data & Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Brandi McCormack
- Primary Data Support, Data & Analytics, Alberta Health Services, Calgary, AB, Canada
| | - Hasan Sheikh
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Madison M Fullerton
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Theresa Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean-Christophe Boucher
- School of Public Policy and Department of Political Science, University of Calgary, Calgary, AB, Canada
| | - Cora Constantinescu
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mehdi Mourali
- Haskayne School of Business, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jia Hu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Robert J Oxoby
- Department of Economics, Faculty of Arts, University of Calgary, Calgary, AB, Canada
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Epperly M, Chaillet J, Goff J, Kalash R, Shaffer B, Franicola D, Houghton F, Cao S, Zhang X, Greenberger J. Induction of MnSOD Expression in MnSOD Tet On -/- Murine Bone Marrow Stromal Cell Lines Correlates With Temporal Radiation Resistance. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1811] [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: 10/27/2022]
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Abstract
The purpose of this study was to determine the accuracy of radiographic and magnetic resonance imaging techniques in preoperative sizing for allograft meniscus transplantation. Twelve cadaveric knee specimens underwent sequential radiographs, magnetic resonance imaging scans, and arthrotomy. Meniscus dimensions were measured in multiple planes for the purpose of determining accuracy of imaging studies in comparison with actual meniscus dimensions. Overall, magnetic resonance imaging proved only slightly more accurate than conventional radiography. The mean difference between magnetic resonance imaging measurements and actual meniscus dimensions was 2.25 +/- 2.04 mm. The mean difference between radiographic measurements and actual meniscus dimensions was 2.35 +/- 1.79 mm. Neither imaging technique was accurate for measuring individual meniscus dimensions, with only 35% of images measuring within 2 mm of actual meniscus dimensions. Using less stringent criteria for accuracy (within 5 mm), radiography and magnetic resonance imaging were 79% and 83% reliable, respectively. Failure to obtain true anteroposterior or lateral images (15 degrees of external and internal rotation) increased measurement inaccuracy. Intraobserver agreement was significantly higher for magnetic resonance imaging than for radiography. Further research into the development of alternative techniques for more reliable meniscus sizing and better understanding of the tolerance for meniscus size mismatch is necessary.
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Affiliation(s)
- B Shaffer
- Department of Orthopaedic Surgery Georgetown University Medical Center, Washington, District of Columbia, USA
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Abstract
This article describes strategies to build and enhance mentor/protégé relationships, expand nurses' experience, and help new nurses develop.
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Affiliation(s)
- B Shaffer
- Middletown (Ohio) Regional Hospital, USA
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11
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Shaffer B, Tallarica B, Walsh J. Win-win mentoring. Nurs Manag (Harrow) 2000; 31:32-4. [PMID: 10818938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Learn strategies to build and enhance mentor-protégé relationships, expand your experience, and help new nurses develop.
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Affiliation(s)
- B Shaffer
- Middletown Regional Hospital, Ohio, USA
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Shaffer B, Wiesel S, Lauerman W. Spondylolisthesis in the elite football player: an epidemiologic study in the NCAA and NFL. J Spinal Disord 1997; 10:365-70. [PMID: 9355050] [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: 02/05/2023]
Abstract
Although spondylolisthesis in and of itself is not a contraindication to participation or successful performance in football, having spondylolisthesis may well predispose to symptoms and be associated with a worse prognosis. The purpose of this study was to determine the reported prevalence, treatment approach, outcomes, and perceptions regarding prognosis of elite football players with spondylolisthesis by their National Collegiate Athletic Association (NCAA) and National Football League (NFL) team physicians. A questionnaire regarding the prevalence, treatment, results, and perceptions regarding prognosis related to spondylolisthesis in football players was submitted to each team orthopaedic surgeon of the 28 NFL and the Final Associated Press ranked top-25 NCAA Division I teams at the conclusion of the 1993-1994 season. All questionnaires were returned for review. The prevalence of players with known spondylolisthesis currently participating in elite football was 1% in both the NCAA and NFL. Fifty-two percent of NCAA and 43% of NFL team physicians were aware of at least one athlete with spondylolisthesis currently playing. Only six college and two NFL team physicians were aware of athletes surgically treated for spondylolisthesis. Sixty-four percent of NFL team physicians and 36% of college team physicians believed that the presence of spondylolisthesis implies a poor prognosis. Ninety-six percent of professional team physicians downgraded the rating of players with known spondylolisthesis before the NFL draft.
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Affiliation(s)
- B Shaffer
- Department of Orthopaedics, Georgetown University Medical Center, Washington, D.C. 20007, USA
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Abstract
The purpose of this study was to examine the anatomy and ability to reattach the coracoacromial ligament (CAL) after acromioplasty. Twenty-eight fresh cadaveric shoulder specimens were dissected, and the CAL dimensions and pattern of attachment were examined. The ability to reattach the CAL to the anterior acromion after acromioplasty was investigated, comparing release along the anterior acromion (traditional anterior acromioplasty) versus subperiosteal elevation from the acromial undersurface. The influence of CAL length, acromial "type," and amount of acromioplasty on reattachment were examined. In 96% of the specimens (27 of 28) confluent medial and lateral bands of the CAL insertion along the acromion precluded "selective" release. The ability to anatomically reattach the CAL was directly related to the method of ligament release (anterior release versus subperiosteal elevation) (p < 0.0001). When directly released from along the anterior acromion, the CAL could not be anatomically reattached in any specimen. Nonanatomic reattachment to a more medial anterior acromial insertion site, however, was possible in 22 (79%) of 28 specimens. Reattachment required an average medial positioning of 60% (range 16% to 88%) along the anterior acromion from the anterolateral tip. Six (21%) specimens could not be reattached despite attempted medial positioning. In contrast, when subperiosteally elevated from the anterior inferior acromion, the CAL was reattachable in all specimens, anatomically in 26 (93%) of 28. The two nonanatomic reattachments required medially reattaching the ligament's normal acromial insertion by an average of 30%. There was no relationship between specimen sex, age, presence of rotator cuff tear, type of acromion, and CAL reattachment. The confluent anatomy of the CAL does not permit "selective" release of discretely identifiable portions of the CAL (i.e., the lateral band). In cases in which CAL restoration is important, careful subperiosteal elevation from the acromial undersurface will facilitate anatomic reattachment. Standard release of the CAL from the anterior acromion precludes anatomic, and in some cases any, reattachment of the CAL.
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Affiliation(s)
- B Shaffer
- Department of Orthopaedics, Georgetown University Medical Center, Washington, DC 20007, USA
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14
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Shaffer B, Bradley JP, Bogumill GP. Unusual problems of the athlete's elbow, forearm, and wrist. Clin Sports Med 1996; 15:425-38. [PMID: 8726323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Early in their medical training physicians often are told, "When you hear hoofbeats, don't think of zebras." Such sage advice is helpful when facing the formidable challenges of information acquisition early on. Later, however, we must be familiar and consider these uncommon conditions when entrusted with the responsibility of properly caring for our patient athletes. This is particularly true in the athlete presenting with symptoms or findings disproportionate to his or her injury, or when symptoms persist despite seemingly appropriate treatment. A high index of suspicion and attention to radiographs and further appropriate work-ups result in detection of most occult unexpected lesions.
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Affiliation(s)
- B Shaffer
- Department of Orthopaedics, Georgetown University, Washington, DC, USA
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Hassell JT, Games AD, Shaffer B, Harkins LE. Nutrition support team management of enterally fed patients in a community hospital is cost-beneficial. J Am Diet Assoc 1994; 94:993-8. [PMID: 8071497 DOI: 10.1016/0002-8223(94)92192-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine whether nutrition support team (NST) management of enterally fed patients is cost-beneficial and to compare primary outcomes of care between team and nonteam management. DESIGN A quasi-experimental study was conducted over a 7-month period. SETTING A 400-bed community hospital. SUBJECTS A convenience sample of 136 subjects who had received enteral nutrition support for at least 24 hours. Forty-two patients died; only their mortality data were used. Ninety-six patients completed the study. INTERVENTION Outcomes, including cost, for enterally fed patients in two treatment groups--those managed by the nutrition support team and those managed by nonteam staff--were compared. MAIN OUTCOME MEASURES Severity of illness level was determined for patients managed by the nutrition support team and those managed by nonteam staff. For each group, the following measures were adjusted to reflect a significant difference in average severity of illness and then compared: length of hospital stay, readmission rates, and mortality rates. Complication rates between the groups were also compared. The cost benefit was determined based on savings from the reduction in adjusted length of hospital stay. STATISTICAL ANALYSES PERFORMED Parametric and nonparametric statistics were used to evaluate outcomes between the two groups. RESULTS Differences were statistically significant for both severity of illness, which was at a higher level in the nutrition support team group (P < .001), and complication rate, which was greater in the nonteam group (P < .001). In the nutrition support team-managed group, there was a 23% reduction in adjusted mortality rate, an 11.6% reduction in the adjusted length of hospital stay, and a 43% reduction in adjusted readmission rate. Cost-benefit analysis revealed that for every $1 invested in nutrition support team management, a benefit of $4.20 was realized. APPLICATIONS Financial and humanitarian benefits are associated with nutrition support team management of enterally fed hospitalized patients.
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Affiliation(s)
- J T Hassell
- Trumbull Memorial Hospital, Warren, OH 44482
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Shaffer B, Gow W, Tibone JE. Graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction: a new technique of intraarticular measurement and modified graft harvesting. Arthroscopy 1993; 9:633-46. [PMID: 8305099 DOI: 10.1016/s0749-8063(05)80499-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to determine the incidence of bitunnel interference fixation and accurate femoral insertion site targeting using a modified technique of endoscopic anterior cruciate ligament (ACL) reconstruction. Thirty-four consecutive central-third bone-patellar tendon-bone autograft modified endoscopic ACL reconstructions were prospectively studied. A new technique was used intraoperatively to directly measure (a) intraarticular (graft) distance (IAD) and (b) patellar tendon graft length, thereby allowing calculation of optimal tibial tunnel length for each case. Accuracy of guide pin placement through this tibial tunnel into the proposed femoral insertion site was assessed, as was the ability to achieve interference fixation in both tunnels (minimum of 20 mm bone interference fixation within the tibial tunnel). A new technique for patellar tendon-bone harvesting and proximal graft fixation to address graft mismatch is described. The average IAD from tibial origin to femoral ACL insertion measured 26.3 +/- 3.0 mm (range 21-33). The average patellar tendon length (LP) was 48.4 +/- 6.0 mm (range 40-63). The average calculated tibial tunnel length (TT) necessary to achieve bitunnel fixation (TT > or = LP + 20 - IAD) was 42.1 +/- 5.3 mm (range 36-57). Establishment of the calculated tibial tunnel length was achieved in 25 cases (74%) (no graft-tunnel mismatch). Graft-tunnel mismatch, in which the tibial tunnel could not be established to the length calculated necessary to accommodate a minimum of 20 mm of bone graft, occurred in nine cases (26%). Graft-tunnel mismatch occurred more frequently in patients whose patellar lengths were > or = 50 mm (p < 0.005), but was not found to correlate specifically to IAD. Recession of the graft up into the femoral tunnel allowed accommodation of the mismatched graft (bitunnel interference screw fixation) in these nine cases, averaging 22.0 +/- 2.98 mm (range 16-29 mm) of available distal bone block fixation. Tibial tunnel fixation of > or = 20 mm was achieved in 30 patients (88%), 18 mm in two, 17 mm in one, and 16 mm in one. Measurement error resulted in inadequate distal graft accommodation in four patients in whom error averaged 3 mm. Targeting of the femoral insertion site guide pin was achieved without requiring any knee manipulation for all cases. Patellar tendon graft protrusion through the tibial tunnel and potentially suboptimal graft fixation poses a frequent problem during endoscopic ACL reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- B Shaffer
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC 20007
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Shaffer B, Jobe FW, Pink M, Perry J. Baseball batting. An electromyographic study. Clin Orthop Relat Res 1993:285-93. [PMID: 8519123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The muscle firing pattern in 12 muscles throughout the lower extremity, trunk, and upper extremity during the batting swing is described in this study. The two hamstring muscles studied and the gluteal muscle had a similar pattern of high muscle activity during pre-swing and early swing, and then rapidly diminished. The vastus medialis demonstrated peak activity between 95 and 110% maximum muscle test (MMT) throughout the swing phases and follow-through. The erector spinae demonstrated activity from 85 to 185% MMT during the swing phases. The abdominal obliques showed greater than 100% MMT during the swing phases and follow-through. The supraspinatus and serratus anterior showed relatively low muscle activity (less than 40% MMT). These results show that batting is a sequence of coordinated muscle activity, beginning with the hip, followed by the trunk, and terminating with the arms. Power in the swing is initiated in the hip, and therefore exercises that emphasize such strength development are indicated. The maintained, high muscle activity in the trunk muscles indicates a need for back and abdominal stabilization and rotation exercises. The relatively low level of activity in the four scapulohumeral muscles tested indicated that emphasis should be placed on the trunk and hip muscles for a batter's strengthening program.
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Affiliation(s)
- B Shaffer
- Department of Orthopaedics, Georgetown Medical Center, Washington, D.C
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Abstract
Sixty-two patients (sixty-eight shoulders) who had been treated non-operatively for idiopathic frozen shoulder were evaluated subjectively and objectively at two years and two months to eleven years and nine months of follow-up (average, seven years). Thirty-one (50 per cent) of these patients still had either mild pain or stiffness of the shoulder, or both. The range of motion averaged 161 degrees of forward flexion, 157 degrees of forward elevation, 149 degrees of abduction, 65 degrees of external rotation, and internal rotation to the level of the fifth thoracic spinous process. Thirty-seven (60 per cent) of the sixty-two patients still demonstrated some restriction of motion as compared with study-generated control values (calculated as the average motion, in each plane, for the thirty-seven unaffected shoulders of the patients who had unilateral disease). Ten patients had restriction of forward flexion; eight, of forward elevation; seventeen, of abduction; twenty-nine, of external rotation; and ten, of internal rotation. However, when the motion of each affected shoulder of thirty-seven patients who had unilateral involvement was compared with that of the unaffected contralateral shoulder, eleven (30 per cent) demonstrated some restriction. None of these patients had restriction of forward flexion; two had restriction of forward elevation; two, of abduction; seven, of external rotation; and seven, of internal rotation. The patients who had substantial restriction in three planes or more were thirteen times more likely to be men (p greater than 0.05). Marked restriction, when it was present, was most commonly in external rotation. Only seven patients (11 per cent) reported mild functional limitation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Shaffer
- Kerlan-Jobe Orthopaedic Clinic, Inglewood, California 90301
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Parisien JS, Shaffer B. Arthroscopic management of pyarthrosis. Clin Orthop Relat Res 1992:243-7. [PMID: 1735221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Sixteen patients (average age, 38 years; range, 20-63 years) with pyarthrosis were treated during a ten-year period by arthroscopic techniques consisting of joint debridement and application of suction drains, combined with appropriate antibiotics. There were 13 knees, two shoulders, and one ankle in the series. At the first visit to the authors' institution, patients typically had fever, leukocytosis, elevated sedimentation rate, and localized joint findings, such as generalized tenderness, swelling, effusion, and painful, limited range of motion in almost every joint involved. Most patients were seen two to five days after the onset of symptoms. After the initial culture and sensitivity were obtained and broad-spectrum antibiotics were administered, all patients were taken to the operating room on an emergency basis. At an average follow-up evaluation of 36 months (range, 14-48 months), the results have been excellent to good, without evidence of recurrence.
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Affiliation(s)
- J S Parisien
- Hospital for Joint Diseases Orthopaedic Institute, New York, New York
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Present DA, Meislin R, Shaffer B. Gas gangrene. A review. Orthop Rev 1990; 19:333-41. [PMID: 2185454] [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: 12/30/2022]
Abstract
Gas gangrene continues to cause significant morbidity and mortality. This monograph reviews the entire spectrum of clostridial infection, including its etiology, pathophysiology, diagnosis, current recommended treatment, and prophylaxis. The early diagnosis of gas gangrene is paramount, as delay in aggressive combined treatment may result in death.
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Affiliation(s)
- D A Present
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, New York
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Present D, Shaffer B. Disease-associated fractures: detection and management in the elderly. Geriatrics (Basel) 1990; 45:48-54, 59. [PMID: 2407621] [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: 12/31/2022] Open
Abstract
Pathologic fractures in the elderly result from a variety of conditions, including malignancies and Paget's disease. Comprehensive laboratory and radiological evaluation is essential to analyze both the underlying etiology and the extent of the disease. Surgical intervention is critical in stabilizing these fractures so that pain is relieved and function is improved.
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Affiliation(s)
- D Present
- Department of Orthopedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, New York
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Abstract
Cytogenetic analysis of a synovial sarcoma of the base of the tongue showed a reciprocal translocation involving chromosomes X and 18 [t(X;18)(p11.2;q11.2)]. This is a translocation recently reported to be characteristic of synovial sarcomas of the extremities. The histogenesis of synovial sarcoma is controversial. Our discovery of this translocation in an oral synovial sarcoma confirms the unity of origin of this neoplasm with the far more common synovial sarcomas of the extremity. Karyotypic analysis may prove useful in confirming the diagnosis of this uncommon neoplasm.
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Affiliation(s)
- J A Bridge
- Department of Pathology and Oncology, University of Kansas Medical Center, Kansas City 66103
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Bridge JA, Shaffer B, Neff JR, Sanger WG, Moran J. A complex translocation involving chromosomes 12 and 16 in a metastatic myxoid liposarcoma. Cancer Genet Cytogenet 1988; 34:119-20. [PMID: 3395986 DOI: 10.1016/0165-4608(88)90177-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
The cytogenetic findings of two malignant fibrous histiocytomas from two unrelated patients are discussed. Both tumors were characterized by trisomy 7.
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Affiliation(s)
- J A Bridge
- Department of Pathology and Oncology, University of Kansas Medical Center, Kansas City 66103
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Abstract
Studied severity of thought disorder related to putative, exaggerated tendency of schizophrenics to respond to associative intrusions. Three groups of patients, paranoid schizophrenics, nonparanoid schizophrenics, and manics, participated in the investigation. The findings were: vulnerability to associative distractors is not specific to schizophrenia; performance deficit is more related to severity of thought disorder than to a specific diagnosis; degree of cognitive impairment was found to negatively influence verbal performance; the three groups of patients manifested equivalent levels of cognitive impairment.
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Abstract
Tested the ability of the Whitaker Index of Schizophrenic Thinking (WIST): (1) to distinguish schizophrenics from nonschizophrenics (N = 30); (2) to agree with clinically rated severity of thought disorder; and (3) to correlate with a measure of generalized cognitive deficit. The WIST was not found to discriminate accurately schizophrenics from nonschizophrenics, but was found to agree strongly with the Shipley Institute of Living Scale, a measure of generalized cognitive dysfunction. Finally, clinically rated estimates of schizophrenic thinking (i.e., conceptual disorganization, unusual thought content) failed to predict WIST Index. The WIST appears to be primarily a measure of generalized deficit.
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Suaudeau J, Shaffer B, Daggett WM, Austen WG, Erdmann AJ. Role of procaine and washed red cells in the isolated dog heart perfused at 5 degrees C. J Thorac Cardiovasc Surg 1982; 84:886-96. [PMID: 7144221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Isolated dog hearts were perfused for 24 hours at 5 degrees C with one of three solutions: plain Krebs solution, Krebs solution containing 167 mg/L of procaine hydrochloride, or Krebs-procaine solution with washed red cells (hematocrit 2%). Coronary vascular resistance (CVR) of hearts perfused with Krebs solution alone increased sharply between the eighth and the twelfth hours of perfusion and then stabilized. Increase of myocardial firmness paralleled the increase of CVR. The addition of procaine to Krebs perfusate kept the heart flaccid and suppressed the steplike increase in CVR but failed to improve significantly the preservation of the hearts. The addition of washed red cells to Krebs perfusate kept CVR near baseline level, improved coronary perfusion flow, doubled myocardial oxygen consumption, reduced edema formation, and improved left ventricular stroke work (LVSW) of the preserved heart. This improvement seems mostly related to a mechanical effect of red blood cells on capillary flow distribution of the heart.
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Abstract
The his4 region of yeast contains the information necessary for the catalysis of three steps in the histidine biosynthetic pathway. The three activities specified by this region remain physically associated during gel filtration and ultracentrifugation and after extensive purification. Nonsense mutations in the "operator distal" his4C region lower the molecular weight of the two proximal activities. The proximal activities can, therefore, function without the his4C portion of the protein(s). These observations are compatible with the following three possibilities. The his4 region codes for: (1) an aggregate of three proteins forming a multiprotein complex; (2) a single protein with three catalytic activities; and (3) a single protein which is cleaved to form three proteins which remain associated.
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Hoyos N, Shaffer B, Beerman H. Liquefying nodular panniculitis. Arch Dermatol 1966; 94:436-9. [PMID: 5920773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Beerman H, Shaffer B. Reactions to Tryparsamide: A Review of Ten Years' Experience. Sex Transm Infect 1940; 16:145-65. [PMID: 21773299 DOI: 10.1136/sti.16.3-4.145] [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: 11/04/2022] Open
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