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Bai X, Wei J, Starr D, Zhang X, Wu X, Guo Y, Liu Y, Ma X, Wei Y, Li C, Zilla ML, Zhang W, Zeng X, Zhao C. Assessment of Efficacy and Accuracy of Cervical Cytology Screening With Artificial Intelligence Assistive System. Mod Pathol 2024; 37:100486. [PMID: 38588882 DOI: 10.1016/j.modpat.2024.100486] [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: 11/25/2023] [Revised: 03/02/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
The role of artificial intelligence (AI) in pathology offers many exciting new possibilities for improving patient care. This study contributes to this development by identifying the viability of the AICyte assistive system for cervical screening, and investigating the utility of the system in assisting with workflow and diagnostic capability. In this study, a novel scanner was developed using a Ruiqian WSI-2400, trademarked AICyte assistive system, to create an AI-generated gallery of the most diagnostically relevant images, objects of interest (OOI), and provide categorical assessment, according to Bethesda category, for cervical ThinPrep Pap slides. For validation purposes, 2 pathologists reviewed OOIs from 32,451 cases of ThinPrep Paps independently, and their interpretations were correlated with the original ThinPrep interpretations (OTPI). The analysis was focused on the comparison of reporting rates, correlation between cytological results and histologic follow-up findings, and the assessment of independent AICyte screening utility. Pathologists using the AICyte system had a mean reading time of 55.14 seconds for the first 3000 cases trending down to 12.90 seconds in the last 6000 cases. Overall average reading time was 22.23 seconds per case compared with a manual reading time approximation of 180 seconds. Usage of AICyte compared with OTPI had similar sensitivity (97.89% vs 97.89%) and a statistically significant increase in specificity (16.19% vs 6.77%) for the detection of cervical intraepithelial neoplsia 2 and above lesions. When AICyte was run alone at a 50% negative cutoff value, it was able to read slides with a sensitivity of 99.30% and a specificity of 9.87%. When AICyte was run independently at this cutoff value, no sole case of high-grade squamous intraepithelial lesions/squamous cell carcinoma squamous lesion was missed. AICyte can provide a potential tool to help pathologists in both diagnostic capability and efficiency, which remained reliable compared with the baseline standard. Also unique for AICyte is the development of a negative cutoff value for which AICyte can categorize cases as "not needed for review" to triage cases and lower pathologist workload. This is the largest case number study that pathologists reviewed OOI with an AI-assistive system. The study demonstrates that AI-assistive system can be broadly applied for cervical cancer screening.
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Affiliation(s)
- Xinru Bai
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Jingjing Wei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - David Starr
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xin Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | | | - Yongzhen Guo
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Yixuan Liu
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Xiaotian Ma
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Yuan Wei
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | | | - Megan L Zilla
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Zhang
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China
| | - Xianxu Zeng
- Department of Pathology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Zhengzhou Key Laboratory of Gynecological Disease's Early Diagnosis, Zhengzhou, China.
| | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Tilden EL, Holmes LR, Vasquez Guzman CE, Orzech CP, Seghete KM, Eyo V, Supahan N, Rogers GR, Caughey AB, Starr D, DiPietro JL, Fisher PA, Graham AM. Adapting Mindfulness-Based Cognitive Therapy for Perinatal Depression to Improve Access and Appeal of Preventive Care. J Midwifery Womens Health 2022; 67:707-713. [PMID: 36527394 PMCID: PMC10015792 DOI: 10.1111/jmwh.13444] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022]
Abstract
Existing and emerging evidence indicates that perinatal depression is a key contributor to preventable morbidity and mortality during and after childbearing. Despite this, there are few effective options for prevention and treatment that are readily accessible for and appealing to pregnant people. Aspects of routine health care systems contribute to this situation. Furthermore, societal and health care systems factors create additional barriers for people of color, people living in rural regions, and people living in poverty. Our interprofessional team of perinatal care providers, mental health providers, community partners, health services scientists, health equity scientists, and business leaders developed and are piloting a perinatal mental health preventive intervention designed to increase access and appeal of a program incorporating mindfulness cognitive behavioral therapy with proven efficacy in preventing perinatal depression. In this article, we briefly summarize key systems barriers to delivering preventive care for perinatal depression in standard prenatal care clinics. We then describe Mindfulness-Based Cognitive Therapy for Perinatal Depression and outline our adaptation of this intervention, Center M. Finally, we identify next steps, challenges, and opportunities for this recent innovation.
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Affiliation(s)
- Ellen L Tilden
- Nurse-Midwifery Department, School of Nursing, Oregon Health & Science University, Portland, Oregon.,Department of Obstetrics and Gynecology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Leah R Holmes
- Nurse-Midwifery Department, School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Cirila Estela Vasquez Guzman
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.,Zapotec/Mayan, Mexico
| | - Catherine Polan Orzech
- Mental Health Division, Center for Women's Health, Oregon Health & Science University, Portland, Oregon
| | | | | | - Nisha Supahan
- Karuk Tribal Leader, Karuk Tribal Land, California.,Small Business Owner, Tattoo 34, Portland, Oregon
| | - Ginger R Rogers
- Hupa Culture and Language Specialist, Hoopa Tribal Reservation, California
| | - Aaron B Caughey
- Nurse-Midwifery Department, School of Nursing, Oregon Health & Science University, Portland, Oregon.,Department of Obstetrics and Gynecology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - David Starr
- Biomedical Innovation Program Consultant, Oregon Health & Science University, Portland, Oregon
| | - Jennifer L DiPietro
- School of Medicine, Oregon Health & Science University, Portland, Oregon.,School of Public Health, Portland State University and Oregon Health & Science University, Portland, Oregon
| | - Philip A Fisher
- Graduate School of Education, Stanford University, Stanford, USA, California
| | - Alice M Graham
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, Oregon
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3
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Beaumont JD, Smith NC, Starr D, Davis D, Dalton M, Nowicky A, Russell M, Barwood MJ. Modulating eating behavior with transcranial direct current stimulation (tDCS): A systematic literature review on the impact of eating behavior traits. Obes Rev 2022; 23:e13364. [PMID: 34786811 DOI: 10.1111/obr.13364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 12/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) is becoming an increasingly popular technique for altering eating behaviors. Recent research suggests a possible eating behavior trait-dependent effect of tDCS. However, studies recruit participant populations with heterogeneous trait characteristics, including "healthy" individuals who do not present with eating behavior traits suggesting susceptibility to overconsumption. The present review considers the effects of tDCS across eating-related measures and explores whether a trait-dependent effect is evident across the literature. A literature search identified 28 articles using sham-controlled tDCS to modify eating-related measures. Random effects meta-analyses were performed, with subgroup analyses to identify differences between "healthy" and trait groups. Trivial overall effects (g = -0.12 to 0.09) of active versus sham tDCS were found. Subgroup analyses showed a more consistent effect for trait groups, with small and moderate effect size (g = -1.03 to 0.60), suggesting tDCS is dependent on participants' eating behavior traits. Larger effect sizes were found for those displaying traits associated with study outcomes (e.g., heightened food cravings). "Healthy" individuals appear to be unresponsive to stimulation. Based on this meta data, future work should recruit those with eating behavior trait susceptibilities to overconsumption, focusing on those who present with traits associated with the outcome of interest.
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Affiliation(s)
- Jordan D Beaumont
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Natalie C Smith
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - David Starr
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Danielle Davis
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Michelle Dalton
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Alexander Nowicky
- Centre for Cognitive Neuroscience, Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Mark Russell
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
| | - Martin J Barwood
- School of Social and Health Sciences, Leeds Trinity University, Leeds, UK
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Badru F, Osei H, Munoz-Abraham AS, Saxena S, Breeden R, Piening N, Starr D, Xu P, Greenspon J, Fitzpatrick CM, Villalona GA, Chatoorgoon K. Screening Laboratory Testing in Asymptomatic Minor Pediatric Blunt Trauma Leads to Unnecessary Needle Sticks. Pediatr Emerg Care 2021; 37:e821-e824. [PMID: 30973496 DOI: 10.1097/pec.0000000000001810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Screening blood work after minor injuries is common in pediatric trauma. The risk of missed injuries versus diagnostic necessity in an asymptomatic patient remains an ongoing debate. We evaluated the clinical utility of screening blood work in carefully selected asymptomatic children after minor trauma. METHODS Patients seen at a level 1 pediatric center with "minor trauma" for blunt trauma between 2010 and 2015 were retrospectively reviewed. Exclusion criteria were age <4 of >18 years, a Glasgow Coma Scale score of <15, penetrating trauma, nonaccidental trauma, hemodynamic instability, abdominal findings (pain, distension, bruising, tenderness), hematuria, pelvic/femur fracture, multiple fractures, and operative intervention. Data abstraction included demographics, blood work, interventions, and disposition. RESULT A total of 1308 patients were treated during the study period. Four hundred thirty-three (33%) met inclusion criteria. Mean ± SD age was 12.7 ± 4 years (range, 4-18 years), and 59% were male. Seventy-eight percent were discharged home from the emergency department. All patients had blood work. Twenty-eight percent had at least one abnormal laboratory value. The most common abnormal blood work was leukocytosis (16%). Thirty percent had an intervention, and none prompted by abnormal blood work. One patient had an intra-abdominal finding (psoas hematoma). CONCLUSION When appropriately selected, screening laboratory testing in asymptomatic minor pediatric blunt trauma patients leads to unnecessary needle sticks without significant advantage.
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Affiliation(s)
| | | | | | | | | | | | | | - Perry Xu
- Saint Louis School of Medicine, St. Louis
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5
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Whittemore K, Ali M, Schroeder A, Vora NM, Starr D, Daskalakis D, Lucero DE. Walking distance for vulnerable populations to public health emergency response points of dispensing in New York City. J Emerg Manag 2021; 19:519-529. [PMID: 34878162 DOI: 10.5055/jem.0574] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
During certain public health emergencies, points of dispensing (PODs) may be used to rapidly distribute medical countermeasures such as antibiotics to the general public to prevent disease. Jurisdictions across the country have identified sites for PODs in preparation for such an emergency; in New York City (NYC), the sites are identified based largely on population density. Vulnerable populations, defined for this analysis as persons with income below the federal poverty level, persons with less than a high school diploma, foreign-born persons, persons of color, persons aged ≥65 years, physically disabled persons, and unemployed persons, often experience a wide range of health inequities. In NYC, these populations are often concentrated in certain geographic areas and rely heavily on public transportation. Because public transportation will almost certainly be affected during large-scale public health emergencies that would require the rapid mass dispensing of medical countermeasures, we evaluated walking distances to PODs. We used an ordinary least squares (OLS) model and a geographically weighted regression (GWR) model to determine if certain characteristics that increase health inequities in the population are associated with longer distances to the nearest POD relative to the general NYC population. Our OLS model identified shorter walking distances to PODs in neighborhoods with a higher percentage of persons with income below the federal poverty level, higher percentage of foreign-born persons, or higher percentage of persons of color, and identified longer walking distances to PODs in neighborhoods with a higher percentage of persons with less than a high school diploma. Our GWR model confirmed the findings from the OLS model and further illustrated these patterns by certain neighborhoods. Our analysis shows that currently identified locations for PODs in NYC are generally serving vulnerable populations equitably-particularly those defined by race or income status-at least in terms of walking distance.
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Affiliation(s)
- Kate Whittemore
- New York City Department of Health and Mental Hygiene, New York, New York. ORCID: https://orcid.org/0000-0002-5321-6521
| | - Mustafa Ali
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Andrew Schroeder
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Neil M Vora
- New York City Department of Health and Mental Hygiene, New York, New York; Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Starr
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Demetre Daskalakis
- MPH, New York City Department of Health and Mental Hygiene, New York, New York
| | - David E Lucero
- New York City Department of Health and Mental Hygiene, New York, New York
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Starr D, Hermelin D, Blackall D. Hyperhemolysis Syndrome Following Red Cell Exchange in a Newly Diagnosed Sickle Cell Disease Patient With Spinal Cord Infarction. J Med Cases 2021; 11:263-266. [PMID: 34434408 PMCID: PMC8383669 DOI: 10.14740/jmc3541] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
Hyperhemolysis syndrome (HS) is a rare red blood cell (RBC) transfusion reaction that shares similarities with other hemolytic transfusion reactions. Because of this, it is important to recognize key presenting clinical and laboratory features in order to guide therapy. In this case report, a patient with a sickling hemoglobinopathy who developed HS is presented. The atypical nature of this case resides in the clinical presentation of paraplegia secondary to spinal cord infarction, increasingly complex blood group serological findings, and multiple RBC exchanges prior to the HS reaction. Once the patient was diagnosed with probable HS, approximately 4 weeks into her clinical course, RBC transfusion (including exchange transfusion) was withheld. Instead, corticosteroids and erythropoietin were initiated without complication. The patient remained stable with this treatment modality until her care was transferred to a hospital with a comprehensive sickle cell center. This case highlights the need to withhold transfusion in HS patients, barring exceptional circumstances, and the efficacy of initiating immunomodulatory and erythropoiesis stimulating therapies.
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Affiliation(s)
- David Starr
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA
| | - Daniela Hermelin
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA
| | - Douglas Blackall
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, MO 63104, USA
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7
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Guo J, Starr D, Guo H. Classification and review of free PCR primer design software. Bioinformatics 2021; 36:5263-5268. [PMID: 33104196 DOI: 10.1093/bioinformatics/btaa910] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 01/31/2023] Open
Abstract
MOTIVATION Polymerase chain reaction (PCR) has been a revolutionary biomedical advancement. However, for PCR to be appropriately used, one must spend a significant amount of effort on PCR primer design. Carefully designed PCR primers not only increase sensitivity and specificity, but also decrease effort spent on experimental optimization. Computer software removes the human element by performing and automating the complex and rigorous calculations required in PCR primer design. Classification and review of the available software options and their capabilities should be a valuable resource for any PCR application. RESULTS This article focuses on currently available free PCR primer design software and their major functions (https://pcrprimerdesign.github.io/). The software are classified according to their PCR applications, such as Sanger sequencing, reverse transcription quantitative PCR, single nucleotide polymorphism detection, splicing variant detection, methylation detection, microsatellite detection, multiplex PCR and targeted next generation sequencing, and conserved/degenerate primers to clone orthologous genes from related species, new gene family members in the same species, or to detect a group of related pathogens. Each software is summarized to provide a technical review of their capabilities and utilities.
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Affiliation(s)
- Jingwen Guo
- Department of Computer Science, Princeton University, Princeton, NJ 08544, USA
| | - David Starr
- Department of Pathology, Saint Louis University, St. Louis, MO 63104, USA
| | - Huazhang Guo
- Department of Pathology, Saint Louis University, St. Louis, MO 63104, USA
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Clark R, Shah K, Brown A, Israr M, Starr D, Stassen L. Is eminectomy effective in the management of closed lock? Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.523] [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: 10/26/2022]
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9
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Talbot J, Starr D. Chronic temporomandibular joint pain: A localised benign osteoma and review of the literature. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.320] [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: 10/28/2022]
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Saffa A, Tate A, Ezeoke I, Jacobs-Wingo J, Iqbal M, Baumgartner J, Fine A, Perri BR, McIntosh N, Levy Stennis N, Lee K, Peterson E, Jones L, Helburn L, Heindrichs C, Guthartz S, Chamany S, Starr D, Scaccia A, Raphael M, Varma JK, Vora NM. Active Monitoring of Travelers for Ebola Virus Disease-New York City, October 25, 2014-December 29, 2015. Health Secur 2018; 16:8-13. [PMID: 29406796 DOI: 10.1089/hs.2017.0077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The CDC recommended active monitoring of travelers potentially exposed to Ebola virus during the 2014 West African Ebola virus disease outbreak, which involved daily contact between travelers and health authorities to ascertain the presence of fever or symptoms for 21 days after the travelers' last potential Ebola virus exposure. From October 25, 2014, to December 29, 2015, the New York City Department of Health and Mental Hygiene (DOHMH) monitored 5,359 persons for Ebola virus disease, corresponding to 5,793 active monitoring events. Most active monitoring events were in travelers classified as low (but not zero) risk (n = 5,778; 99%). There were no gaps in contact with DOHMH of ≥2 days during 95% of active monitoring events. Instances of not making any contact with travelers decreased after CDC began distributing mobile telephones at the airport. Ebola virus disease-like symptoms or a temperature ≥100.0°F were reported in 122 (2%) active monitoring events. In the final month of active monitoring, an optional health insurance enrollment referral was offered for interested travelers, through which 8 travelers are known to have received coverage. Because it is possible that active monitoring will be used again for an infectious threat, the experience we describe might help to inform future such efforts.
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Arya V, Medina E, Scaccia A, Mathew C, Starr D. Impact of Hurricane Sandy on community pharmacies in severely affected areas of New York City: A qualitative assessment. Am J Disaster Med 2017; 11:21-30. [PMID: 27649748 DOI: 10.5055/ajdm.2016.0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hurricane Sandy was one of the most severe natural disasters to hit the Mid-Atlantic States in recent history. Community pharmacies were among the businesses affected, with flooding and power outages significantly reducing services offered by many pharmacies. The objectives of our study were to assess the impact of Hurricane Sandy on community pharmacies, both independently owned and chain, in the severely affected areas of New York City (NYC), including Coney Island, Staten Island, and the Rockaways, using qualitative methods, and propose strategies to mitigate the impact of future storms and disasters. Of the total 52 solicited pharmacies, 35 (67 percent) responded and were included in our analysis. Only 10 (29 percent) of the pharmacies surveyed reported having a generator during Hurricane Sandy; 37 percent reported being equipped with a generator at the time of the survey approximately 1 year later. Our findings suggest that issues other than power outages contributed more toward a pharmacy remaining operational after the storm. Of those surveyed, 26 (74 percent) suffered from structural damage (most commonly in Coney Island). Most pharmacies (71 percent) were able to reopen within 1 month. Despite staffing challenges, most pharmacies (88 percent) had enough pharmacists/staff to resume normal operations. Overall, 91 percent were aware of law changes for emergency medication access, and 81 percent found the information easy to obtain. This survey helped inform our work toward improved community resiliency. Our findings have helped us recognize community pharmacists as important stakeholders and refocus our energy toward developing sustained partnerships with them in NYC as part of our ongoing preparedness strategy.
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Affiliation(s)
- Vibhuti Arya
- Associate Clinical Professor, St. John's University College of Pharmacy and Health Sciences, Queens, New York; Clinical Advisor, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Eric Medina
- Countermeasures Special Projects, Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, Queens, New York
| | - Allison Scaccia
- Countermeasures Special Projects Manager, Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, Queens, New York
| | | | - David Starr
- Director, Countermeasures Response Unit, Emergency Preparedness and Response, New York City Department of Health and Mental Hygiene, Queens, New York
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Millman AJ, Chamany S, Guthartz S, Thihalolipavan S, Porter M, Schroeder A, Vora NM, Varma JK, Starr D. Active Monitoring of Travelers Arriving from Ebola-Affected Countries - New York City, October 2014-April 2015. MMWR Morb Mortal Wkly Rep 2016; 65:51-4. [PMID: 26820056 DOI: 10.15585/mmwr.mm6503a3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The Ebola virus disease (Ebola) outbreak in West Africa has claimed approximately 11,300 lives (1), and the magnitude and course of the epidemic prompted many nonaffected countries to prepare for Ebola cases imported from affected countries. In October 2014, CDC and the Department of Homeland Security (DHS) implemented enhanced entry risk assessment and management at five U.S. airports: John F. Kennedy (JFK) International Airport in New York City (NYC), O'Hare International Airport in Chicago, Newark Liberty International Airport in New Jersey, Hartsfield-Jackson International Airport in Atlanta, and Dulles International Airport in Virginia (2). Enhanced entry risk assessment began at JFK on October 11, 2014, and at the remaining airports on October 16 (3). On October 21, DHS exercised its authority to direct all travelers flying into the United States from an Ebola-affected country to arrive at one of the five participating airports. At the time, the Ebola-affected countries included Guinea, Liberia, Mali, and Sierra Leone. On October 27, CDC issued updated guidance for monitoring persons with potential Ebola virus exposure (4), including recommending daily monitoring of such persons to ascertain the presence of fever or symptoms for a period of 21 days (the maximum incubation period of Ebola virus) after the last potential exposure; this was termed "active monitoring." CDC also recommended "direct active monitoring" of persons with a higher risk for Ebola virus exposure, including health care workers who had provided direct patient care in Ebola-affected countries. Direct active monitoring required direct observation of the person being monitored by the local health authority at least once daily (5). This report describes the operational structure of the NYC Department of Health and Mental Hygiene's (DOHMH) active monitoring program during its first 6 months (October 2014-April 2015) of operation. Data collected on persons who required direct active monitoring are not included in this report.
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Yacisin K, Balter S, Fine A, Weiss D, Ackelsberg J, Prezant D, Wilson R, Starr D, Rakeman J, Raphael M, Quinn C, Toprani A, Clark N, Link N, Daskalakis D, Maybank A, Layton M, Varma JK. Ebola virus disease in a humanitarian aid worker - New York City, October 2014. MMWR Morb Mortal Wkly Rep 2015; 64:321-3. [PMID: 25837242 PMCID: PMC4584529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In late October 2014, Ebola virus disease (Ebola) was diagnosed in a humanitarian aid worker who recently returned from West Africa to New York City (NYC). The NYC Department of Health and Mental Hygiene (DOHMH) actively monitored three close contacts of the patient and 114 health care personnel. No secondary cases of Ebola were detected. In collaboration with local and state partners, DOHMH had developed protocols to respond to such an event beginning in July 2014. These protocols included safely transporting a person at the first report of symptoms to a local hospital prepared to treat a patient with Ebola, laboratory testing for Ebola, and monitoring of contacts. In response to this single case of Ebola, initial health care worker active monitoring protocols needed modification to improve clarity about what types of exposure should be monitored. The response costs were high in both human resources and money: DOHMH alone spent $4.3 million. However, preparedness activities that include planning and practice in effectively monitoring the health of workers involved in Ebola patient care can help prevent transmission of Ebola.
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Affiliation(s)
- Kari Yacisin
- Epidemic Intelligence Service, CDC,New York City Department of Health and Mental Hygiene,Corresponding author: Kari Yacisin, , 347-396-4070
| | - Sharon Balter
- New York City Department of Health and Mental Hygiene
| | - Annie Fine
- New York City Department of Health and Mental Hygiene
| | - Don Weiss
- New York City Department of Health and Mental Hygiene
| | | | | | - Ross Wilson
- New York City Health and Hospitals Corporation
| | - David Starr
- New York City Department of Health and Mental Hygiene
| | | | | | - Celia Quinn
- New York City Department of Health and Mental Hygiene,Division of State and Local Readiness, Office of Public Health Preparedness and Response, CDC
| | - Amita Toprani
- New York City Department of Health and Mental Hygiene
| | - Nancy Clark
- New York City Department of Health and Mental Hygiene
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- New York City Department of Health and Mental Hygiene
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Park JB, Zong K, Jeon IC, Hahn JR, Stacchiola D, Starr D, Müller K, Noh J. Adsorption and thermal decomposition of 2-octylthieno[3,4-b]thiophene on Au(111). J Colloid Interface Sci 2012; 384:143-8. [PMID: 22818203 DOI: 10.1016/j.jcis.2012.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/10/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
Abstract
The adsorption and thermal stability of 2-octylthieno[3,4-b]thiophene (OTTP) on the Au(111) surfaces have been studied using scanning tunneling microscopy (STM), temperature programmed desorption (TPD), and X-ray photoelectron spectroscopy (XPS). UHV-STM studies revealed that the vapor-deposited OTTP on Au(111) generated disordered adlayers with monolayer thickness even at saturation coverage. XPS and TPD studies indicated that OTTP molecules on Au(111) are stable up to 450 K and further heating of the sample resulted in thermal decomposition to produce H(2) and H(2)S via C-S bond scission in the thieno-thiophene rings. Dehydrogenation continues to occur above 600 K and the molecules were ultimately transformed to carbon clusters at 900 K. Highly resolved air-STM images showed that OTTP adlayers on Au(111) prepared from solution are composed of a well-ordered and low-coverage phase where the molecules lie flat on the surface, which can be assigned as a (9×2√33)R5° structure. Finally, based on analysis of STM, TPD, and XPS results, we propose a thermal decomposition mechanism of OTTP on Au(111) as a function of annealing temperature.
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Affiliation(s)
- Joon B Park
- Institute of Fusion Science, Department of Chemistry Education, Chonbuk National University, Jeonbuk 560-756, Republic of Korea.
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Starr D. Blood safety in the new millenium--scientific purity and political reality--can they be synthesised for the public good ? Dev Biol (Basel) 2007; 127:259-65. [PMID: 17486899] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- D Starr
- Boston University Department of Journalism, College of Communication Boston University, Boston, MA 02115, USA.
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Abstract
Broken dental needles are a rare event. They are difficult to find and remove. We report two cases in which broken needles were located using a simple stereotactic method with the aid of an image intensifier.
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Affiliation(s)
- M Thompson
- Department of Maxillofacial Surgery, Middlesbrough General Hospital, Aryesome Green Lane, Middlesbrough, TS5 5AZ, UK.
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Fogden M, Whitehorn K, Starr D, Persaud R, Hannaford R, Barbara J, Love E, Robinson A, Ferguson E, Turner G, Wallington T, Klein H, Franklin I, Fry R. Panel Discussion. Millennium Festival of Medicine--Transfusion 2020--18 October 2000. Transfus Med 2001; 11:136-45. [PMID: 11583001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Affiliation(s)
- D Starr
- Center for Science and Medical Journalism at Boston University, College of Communication, MA 02215, USA
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Worrall SF, Corrigan M, High A, Starr D, Matthias C, Wolf CR, Jones PW, Hand P, Gilford J, Farrell WE, Hoban P, Fryer AA, Strange RC. Susceptibility and outcome in oral cancer: preliminary data showing an association with polymorphism in cytochrome P450 CYP2D6. Pharmacogenetics 1998; 8:433-9. [PMID: 9825835 DOI: 10.1097/00008571-199810000-00008] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Members of the cytochrome P450 and glutathione S-transferase supergene families are candidates for susceptibility and outcome in oral squamous cell cancer. We determined GSTM1, GSTM3, GSTT1, CYP1A1 and CYP2D6 genotypes in 100 Caucasian cases and 467 control individuals. The frequency of homozygosity for mutant CYP2D6 alleles was higher in the cases (P = 0.001, OR = 3.2, 95% CI = 1.6-6.5) than control individuals. In the cases, the frequency of homozygosity for mutant alleles was greater and that of homozygosity for wild-type CYP2D6 alleles was lower in those diagnosed at > or = 65 years (P = 0.009) than in those diagnosed at < or = 64 years. The older cases included relatively more women and patients who did not consume tobacco or alcohol. The association of CYP2D6 with outcome was assessed using the Cox's proportional hazards model. The time to first cervical node metastasis was shorter in heterozygotes and homozygotes for mutant CYP2D6 alleles compared with homozygotes for wild-type alleles after correction for age at diagnosis, gender, alcohol and tobacco consumption and tumour differentiation (P = 0.04, hazard ratio 3.6, 95% CI 1.1-12.5). The mechanism for the association of CYP2D6 alleles with susceptibility and outcome is unclear though the data are compatible with the view that homozygosity for mutant alleles confers impaired detoxication of an unknown carcinogen. No associations between GSTM1, GSTM3, GSTT1 or CYP1A1 genotypes and susceptibility or, time to node metastases were identified. We previously showed that CYP2D6 genotypes were not associated with susceptibility to squamous cell cancer in the pharynx or larynx. Therefore, the data presented suggest that susceptibility to squamous cell cancer in the various parts of the upper aerodigestive tract is associated with different genes and allelic variants.
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Affiliation(s)
- S F Worrall
- Department of Oral Maxillofacial Surgery, North Staffordshire Hospital, Stoke-on-Trent, UK
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Starr D. Orbital tumours. Br J Oral Maxillofac Surg 1995. [DOI: 10.1016/0266-4356(95)90219-8] [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: 10/26/2022]
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Louie C, Starr D, Sexton K. Move it! Solving patient transportation problems. Mater Manag Health Care 1995; 4:18, 20-1. [PMID: 10141751] [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: 02/11/2023]
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Abstract
Although carnitine palmitoyltransferase (CPT) has received considerable attention, particularly its regulation by malonyl CoA, most studies have monitored the forward reaction, ie, the formation of acylcarnitine. We examined the opposite or reverse reaction, in which palmitoyl CoA is generated, in osmotically-disrupted rat hepatic mitochondria. Specifically, the effects of pH, fasting, and untreated recent-onset diabetes were investigated. As with the forward (f) reaction, the CPT reverse (r) velocity v pH curve was somewhat parabolic with a pH maximum at approximately 7.2 (except the CPT that was from the diabetic rats). However, as the pH rose, the CPT reverse and forward curves diverged due to a precipitous decline in the forward reaction. This discordance in rates in the alkaline range was apparent in all three groups of CPT but was most prominent in the diabetic preparation (for example, as the pH increased from 7.3 to 8.8, the respective declines in the f and r velocities were 74% and 2%). In addition, under our assay conditions the CPTr from diabetic rats not only had a higher velocity (55.4 +/- 1.4 nmol/min/mg protein) than that from the fed (32.1 +/- 3.1) or fasted (43.1 +/- 3.4) animals, but also the Vmax was found to be twofold greater, even though there was no difference in the Km for palmitoylcarnitine. In summary, diabetes affects the kinetics of the reverse reaction and, regardless of the animal's premortem condition, but more so in the diabetes, this reaction is less attenuated than the forward one as the pH rises.
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Korner PI, Langsford G, Starr D, Uther JB, Ward W, White SW. The effects of chloralose-urethane and sodium pentobarbitone anaesthesia on the local and autonomic components of the circulatory response to arterial hypoxia. J Physiol 1968; 199:283-302. [PMID: 5723513 PMCID: PMC1365381 DOI: 10.1113/jphysiol.1968.sp008654] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
1. The circulatory and respiratory responses to severe arterial hypoxia were studied in normal rabbits, ;de-efferented' rabbits without functioning autonomic effectors, and atropinized animals before anaesthesia and during chloralose-urethane and sodium pentobarbitone anaesthesia. Net systemic autonomic activity and autonomic activity to the heart was assessed from a comparison of the responses of the various preparations.2. In the normal spontaneously breathing animal each anaesthetic had a similar mode of action, and modified qualitatively the circulatory response present before anaesthesia. In the ;de-efferented' animal the circulatory response was determined by the local effects of hypoxia, and was altered only quantitatively during anaesthesia.3. In the normal unanaesthetized animal the reflex changes in autonomic activity during hypoxia consisted of a large increase in vagal efferent activity, a decrease in cardiac sympatho-adrenal activity, and an increase in total sympatho-adrenal constrictor activity.4 In hypoxia during anaesthesia the vagal efferent activity no longer increased, but the change in sympatho-adrenal activity to heart and systemic circulation was the same as before anaesthesia in the spontaneously breathing animal. During anaesthesia with controlled ventilation systemic sympatho-adrenal activity increased further, and bradycardia again developed. The bradycardia was now due exclusively to reduction in cardiac sympathetic activity and not to an increase in vagal efferent activity.
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Elder AV, Starr D. SODIUM NITRITE IN SEA-SICKNESS. West J Med 1928. [DOI: 10.1136/bmj.2.3537.727-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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