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Boulware LE, Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, Lewis-Boyer L, Levine DM, Greer RC, Crews DC, Gudzune KA, Albert MC, Ramamurthi HC, Ameling JM, Davenport CA, Lee HJ, Pendergast JF, Wang NY, Carson KA, Sneed V, Gayles DJ, Flynn SJ, Monroe D, Hickman D, Purnell L, Simmons M, Fisher A, DePasquale N, Charleston J, Aboutamar HJ, Cabacungan AN, Cooper LA. Hypertension Self-management in Socially Disadvantaged African Americans: the Achieving Blood Pressure Control Together (ACT) Randomized Comparative Effectiveness Trial. J Gen Intern Med 2020; 35:142-152. [PMID: 31705466 PMCID: PMC6957583 DOI: 10.1007/s11606-019-05396-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 05/15/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Effective hypertension self-management interventions are needed for socially disadvantaged African Americans, who have poorer blood pressure (BP) control compared to others. OBJECTIVE We studied the incremental effectiveness of contextually adapted hypertension self-management interventions among socially disadvantaged African Americans. DESIGN Randomized comparative effectiveness trial. PARTICIPANTS One hundred fifty-nine African Americans at an urban primary care clinic. INTERVENTIONS Participants were randomly assigned to receive (1) a community health worker ("CHW") intervention, including the provision of a home BP monitor; (2) the CHW plus additional training in shared decision-making skills ("DoMyPART"); or (3) the CHW plus additional training in self-management problem-solving ("Problem Solving"). MAIN MEASURES We assessed group differences in BP control (systolic BP (SBP) < 140 mm Hg and diastolic BP (DBP) < 90 mmHg), over 12 months using generalized linear mixed models. We also assessed changes in SBP and DBP and participants' BP self-monitoring frequency, clinic visit patient-centeredness (i.e., extent of patient-physician discussions focused on patient emotional and psychosocial concerns), hypertension self-management behaviors, and self-efficacy. KEY RESULTS BP control improved in all groups from baseline (36%) to 12 months (52%) with significant declines in SBP (estimated mean [95% CI] - 9.1 [- 15.1, - 3.1], - 7.4 [- 13.4, - 1.4], and - 11.3 [- 17.2, - 5.3] mmHg) and DBP (- 4.8 [- 8.3, - 1.3], - 4.0 [- 7.5, - 0.5], and - 5.4 [- 8.8, - 1.9] mmHg) for CHW, DoMyPART, and Problem Solving, respectively). There were no group differences in BP outcomes, BP self-monitor use, or clinic visit patient-centeredness. The Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 18.7 [4.0, 87.3]) and self-efficacy scores (OR [95% CI] 4.7 [1.5, 14.9]) at 12 months compared to baseline, while other groups did not. Compared to DoMyPART, the Problem Solving group had higher odds of high hypertension self-care behaviors (OR [95% CI] 5.7 [1.3, 25.5]) at 12 months. CONCLUSION A context-adapted CHW intervention was correlated with improvements in BP control among socially disadvantaged African Americans. However, it is not clear whether improvements were the result of this intervention. Neither the addition of shared decision-making nor problem-solving self-management training to the CHW intervention further improved BP control. TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT01902719.
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Affiliation(s)
- L Ebony Boulware
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA.
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lee R Bone
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - LaPricia Lewis-Boyer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David M Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kimberly A Gudzune
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Albert
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Community Physicians, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hema C Ramamurthi
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica M Ameling
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jane F Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Nae-Yuh Wang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
| | - Valerie Sneed
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Debra J Gayles
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah J Flynn
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Dwyan Monroe
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Institute for Public Health Innovation, Washington, DC, USA
| | - Debra Hickman
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Sisters together and Reaching, Inc., Baltimore, MD, USA
| | - Leon Purnell
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- Men and Families Center, Inc., Baltimore, MD, USA
| | - Michelle Simmons
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
| | - Annette Fisher
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA
- American Heart Association, Baltimore, MD, USA
| | - Nicole DePasquale
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Hanan J Aboutamar
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Ashley N Cabacungan
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, 200 Morris Street, 3rd Floor, Durham, NC, 27701, USA
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, MD, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Ibe CA, Bowie J, Carson KA, Bone L, Monroe D, Roter D, Cooper LA. Patient-level Predictors of Extent of Exposure to a Community Health Worker Intervention in a Randomized Controlled Trial. Ethn Dis 2019; 29:261-266. [PMID: 31057311 DOI: 10.18865/ed.29.2.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Community health worker (CHW) interventions have been cited as a best practice for reducing health disparities, but patient-level attributes may contribute to differential uptake. We examined patient characteristics associated with the extent of exposure to a CHW coaching intervention among a predominantly low-income, African American population participating in a randomized controlled trial of hypertension interventions. Design We conducted a within-group longitudinal analysis of those receiving a CHW intervention from a study conducted between September 2003 and August 2005. We employed mixed effects models to ascertain relationships between patients' characteristics, length of time spent with the CHW, and the number of topics discussed during the intervention. Setting Baltimore, MD. Participants 140 patients with a diagnosis of hypertension in the CHW intervention arm. Results Marital status, stress, depression symptomology, and having multiple comorbid conditions were each independently and positively related to the length of time patients spent with CHWs. An indirect relationship between higher perceived physical health and time spent with the CHW was observed. Patients with multiple comorbid conditions discussed more intervention-related topics, while patients who perceived themselves as being healthier discussed fewer topics. Marital status and extreme poverty were the strongest predictors of the length of time spent with the CHW, while having multiple comorbid conditions was the strongest predictor of the number of coaching topics discussed. Conclusions Differential exposure to a CHW intervention is influenced by patients' physical, psychosocial, and sociodemographic characteristics.
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Affiliation(s)
- Chidinma A Ibe
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Janice Bowie
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lee Bone
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Dwyan Monroe
- Institute for Public Health Innovation, Washington, DC
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa A Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Bar-Ilan A, Livnat T, Hoffmann M, Binder L, Zakar M, Guy R, Felikman Y, Moschcovich L, Shenkman B, Monroe D, Hershkovitz O, Kenet G, Hart G. In vitro characterization of MOD-5014, a novel long-acting carboxy-terminal peptide (CTP)-modified activated FVII. Haemophilia 2018. [DOI: 10.1111/hae.13428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - T. Livnat
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- National Hemophilia Center; Sheba Medical Center; Tel Hashomer, Ramat Gan Israel
| | | | | | - M. Zakar
- OPKO Biologics; Kiryat Gat Israel
| | - R. Guy
- OPKO Biologics; Kiryat Gat Israel
| | | | | | - B. Shenkman
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- National Hemophilia Center; Sheba Medical Center; Tel Hashomer, Ramat Gan Israel
| | - D. Monroe
- University of North Carolina; NC USA
| | | | - G. Kenet
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- National Hemophilia Center; Sheba Medical Center; Tel Hashomer, Ramat Gan Israel
| | - G. Hart
- OPKO Biologics; Kiryat Gat Israel
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Ibe C, Bowie J, Roter D, Carson KA, Lee B, Monroe D, Cooper LA. Intensity of exposure to a patient activation intervention and patient engagement in medical visit communication. Patient Educ Couns 2017; 100:1258-1267. [PMID: 28162812 DOI: 10.1016/j.pec.2016.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 11/17/2016] [Accepted: 12/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We examined associations between intensity of exposure to a community health worker (CHW) delivered communication activation intervention targeting low-income patients with hypertension. METHODS We analyzed question-asking behaviors of patients assigned to the intervention arms (n=140) in a randomized controlled trial. Intensity of exposure to the intervention was operationalized as the duration of face-to-face coaching and number of protocol-specified topics discussed. Mixed effects models characterized the relationship between intensity of exposure and patients' communication in a subsequent medical visit. RESULTS The number of topics discussed during the coaching session was positively associated with patients' asking psychosocial-related questions during their visit. The duration of the coaching session was positively associated with patients' use of communication engagement strategies to facilitate their participation in the visit dialogue. Exposure to a physician trained in patient-centered communication did not influence these relationships. CONCLUSIONS A dose-response relationship was observed between exposure to a CHW- delivered communication activation intervention and patient-provider communication. PRACTICE IMPLICATIONS This study supports the use of CHWs in activating patients toward greater communication in the therapeutic exchange.
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Affiliation(s)
- Chidinma Ibe
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Janice Bowie
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Bone Lee
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Dwyan Monroe
- Institute for Public Health Innovation, Washington, D.C., USA
| | - Lisa A Cooper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Tunik MG, Powell EC, Mahajan P, Schunk JE, Jacobs E, Miskin M, Zuspan SJ, Wootton-Gorges S, Atabaki SM, Hoyle JD, Holmes JF, Dayan PS, Kuppermann N, Gerardi M, Tunik M, Tsung J, Melville K, Lee L, Mahajan P, Dayan P, Nadel F, Powell E, Atabaki S, Brown K, Glass T, Hoyle J, Cooper A, Jacobs E, Monroe D, Borgialli D, Gorelick M, Bandyopadhyay S, Bachman M, Schamban N, Callahan J, Kuppermann N, Holmes J, Lichenstein R, Stanley R, Badawy M, Babcock-Cimpello L, Schunk J, Quayle K, Jaffe D, Lillis K, Kuppermann N, Alpern E, Chamberlain J, Dean J, Gerardi M, Goepp J, Gorelick M, Hoyle J, Jaffe D, Johns C, Levick N, Mahajan P, Maio R, Melville K, Miller S, Monroe D, Ruddy R, Stanley R, Treloar D, Tunik M, Walker A, Kavanaugh D, Park H, Dean M, Holubkov R, Knight S, Donaldson A, Chamberlain J, Brown M, Corneli H, Goepp J, Holubkov R, Mahajan P, Melville K, Stremski E, Tunik M, Gorelick M, Alpern E, Dean J, Foltin G, Joseph J, Miller S, Moler F, Stanley R, Teach S, Jaffe D, Brown K, Cooper A, Dean J, Johns C, Maio R, Mann N, Monroe D, Shaw K, Teitelbaum D, Treloar D, Stanley R, Alexander D, Brown J, Gerardi M, Gregor M, Holubkov R, Lillis K, Nordberg B, Ruddy R, Shults M, Walker A, Levick N, Brennan J, Brown J, Dean J, Hoyle J, Maio R, Ruddy R, Schalick W, Singh T, Wright J. Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma. Ann Emerg Med 2016; 68:431-440.e1. [DOI: 10.1016/j.annemergmed.2016.04.058] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/18/2016] [Accepted: 04/27/2016] [Indexed: 12/17/2022]
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Ellison AM, Quayle KS, Bonsu B, Garcia M, Blumberg S, Rogers A, Wootton-Gorges SL, Kerrey BT, Cook LJ, Cooper A, Kuppermann N, Holmes JF, Kuppermann N, Alpern E, Borgialli D, Callahan J, Chamberlain J, Dayan P, Dean J, Gerardi M, Gorelick M, Hoyle J, Jacobs E, Jaffe D, Lichenstein R, Lillis K, Mahajan P, Maio R, Monroe D, Ruddy R, Stanley R, Tunik M, Walker A, Kavanaugh D, Park H. Use of Oral Contrast for Abdominal Computed Tomography in Children With Blunt Torso Trauma. Ann Emerg Med 2015; 66:107-114.e4. [DOI: 10.1016/j.annemergmed.2015.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/08/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
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Getz TM, Piatt R, Petrich BG, Monroe D, Mackman N, Bergmeier W. Novel mouse hemostasis model for real-time determination of bleeding time and hemostatic plug composition. J Thromb Haemost 2015; 13:417-25. [PMID: 25442192 PMCID: PMC4414118 DOI: 10.1111/jth.12802] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/20/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Hemostasis is a rapid response by the body to stop bleeding at sites of vessel injury. Both platelets and fibrin are important for the formation of a hemostatic plug. Mice have been used to uncover the molecular mechanisms that regulate the activation of platelets and coagulation under physiologic conditions. However, measurements of hemostasis in mice are quite variable, and current methods do not quantify platelet adhesion or fibrin formation at the site of injury. METHODS We describe a novel hemostasis model that uses intravital fluorescence microscopy to quantify platelet adhesion, fibrin formation and time to hemostatic plug formation in real time. Repeated vessel injuries of ~ 50-100 μm in diameter were induced with laser ablation technology in the saphenous vein of mice. RESULTS Hemostasis in this model was strongly impaired in mice deficient in glycoprotein Ibα or talin-1, which are important regulators of platelet adhesiveness. In contrast, the time to hemostatic plug formation was only minimally affected in mice deficient in the extrinsic tissue factor (TF(low)) or the intrinsic factor IX coagulation pathways, even though platelet adhesion was significantly reduced. A partial reduction in platelet adhesiveness obtained with clopidogrel led to instability within the hemostatic plug, especially when combined with impaired coagulation in TF(low) mice. CONCLUSIONS In summary, we present a novel, highly sensitive method to quantify hemostatic plug formation in mice. On the basis of its sensitivity to platelet adhesion defects and its real-time imaging capability, we propose this model as an ideal tool with which to study the efficacy and safety of antiplatelet agents.
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Affiliation(s)
- T M Getz
- McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA
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Johnson W, Ezeugwu C, Monroe D, Breunig IM, Shaya F. A Pilot study Evaluating a Community-based Intervention Focused on the ISHIB IMPACT Cardiovascular Risk Reduction Toolkit in African American Patients with Uncontrolled Hypertension. Ethn Dis 2015; 25:162-167. [PMID: 26118143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To evaluate blood pressure (BP) control utilizing the International Society on Hypertension in Blacks (ISHIB) cardiovascular risk reduction toolkit in an African American community with uncontrolled hypertension. METHODS This is a randomized controlled pilot study conducted in two Baltimore community-based physicians' offices assigned adults (18-64 years) with uncontrolled hypertension (systolic blood pressure [SBP] ≤ 169 mm Hg; diastolic blood pressure [DBP] ≤ 109 mm Hg). The study compares usual care to a community-based intervention. In the usual care group, the patients' BP was managed by the treating physician based on their normal office patient care protocol. In the intervention group, usual care was provided but, a community health worker also gave comprehensive education and assessment to the patients based on the ISHIB IMPACT cardiovascular toolkit during study initiation and follow-up visits. The main outcome of study was change in BP from baseline to six months. A secondary outcome was the proportion of patients achieving BP < 135/< 85 mm Hg at six months. RESULTS Fifty-four African American patients were enrolled; 37 completed six months of follow-up (usual care, n = 25; intervention, n = 12). At six months the mean (95% CI) change from baseline in SBP was significantly greater in the intervention group vs the usual care group: -34.75 (-46.55 to -22.95) mm Hg vs -5.65 (-12.84 to 1.54) mm Hg (P < .001). Mean (95% CI) change in DBP from baseline to six months was significantly greater for the intervention group vs the usual care group: -16.19 (-24.00 to -8.39) mm Hg vs -4.36 (-8.26 to -0.46) mm Hg (P = .009). Median change in BP was significantly greater for SBP in the intervention group compared with the usual care group (P = .007), but not for DBP (P = .197). The proportion of patients achieving BP < 135/ <85 at six months was 83% (10/12) in the intervention group vs 60% (15/25) in the usual care group (P = .263). CONCLUSIONS This pilot study on the ISHIB IMPACT toolkit in managing uncontrolled hypertension in the African American community suggests better control of systolic BP and a tendency to better hypertension control with the community-based intervention. The findings support further studies in clinical settings serving African American hypertensive patients to assess effectiveness of approaches for improving BP control and related outcomes.
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Ephraim PL, Hill-Briggs F, Roter DL, Bone LR, Wolff JL, Lewis-Boyer L, Levine DM, Aboumatar HJ, Cooper LA, Fitzpatrick SJ, Gudzune KA, Albert MC, Monroe D, Simmons M, Hickman D, Purnell L, Fisher A, Matens R, Noronha GJ, Fagan PJ, Ramamurthi HC, Ameling JM, Charlston J, Sam TS, Carson KA, Wang NY, Crews DC, Greer RC, Sneed V, Flynn SJ, DePasquale N, Boulware LE. Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial. Contemp Clin Trials 2014; 38:370-82. [PMID: 24956323 PMCID: PMC4169070 DOI: 10.1016/j.cct.2014.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given their high rates of uncontrolled blood pressure, urban African Americans comprise a particularly vulnerable subgroup of persons with hypertension. Substantial evidence has demonstrated the important role of family and community support in improving patients' management of a variety of chronic illnesses. However, studies of multi-level interventions designed specifically to improve urban African American patients' blood pressure self-management by simultaneously leveraging patient, family, and community strengths are lacking. METHODS/DESIGN We report the protocol of the Achieving Blood Pressure Control Together (ACT) study, a randomized controlled trial designed to study the effectiveness of interventions that engage patient, family, and community-level resources to facilitate urban African American hypertensive patients' improved hypertension self-management and subsequent hypertension control. African American patients with uncontrolled hypertension receiving health care in an urban primary care clinic will be randomly assigned to receive 1) an educational intervention led by a community health worker alone, 2) the community health worker intervention plus a patient and family communication activation intervention, or 3) the community health worker intervention plus a problem-solving intervention. All participants enrolled in the study will receive and be trained to use a digital home blood pressure machine. The primary outcome of the randomized controlled trial will be patients' blood pressure control at 12months. DISCUSSION Results from the ACT study will provide needed evidence on the effectiveness of comprehensive multi-level interventions to improve urban African American patients' hypertension control.
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Affiliation(s)
- Patti L Ephraim
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA.
| | - Debra L Roter
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Lee R Bone
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - LaPricia Lewis-Boyer
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - David M Levine
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hanan J Aboumatar
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute for Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA.
| | - Lisa A Cooper
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Michael C Albert
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Community Physicians, Johns Hopkins University, Baltimore, MD, USA.
| | - Dwyan Monroe
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Institute for Public Health Innovation, Washington, DC, USA.
| | - Michelle Simmons
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA.
| | - Debra Hickman
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; Sisters Together and Reaching, Baltimore, MD, USA.
| | - Leon Purnell
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; The Men's Center, Baltimore, MD, USA.
| | - Annette Fisher
- Community Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD, USA; American Heart Association, Baltimore, MD, USA.
| | | | - Gary J Noronha
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
| | - Peter J Fagan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Hema C Ramamurthi
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jessica M Ameling
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jeanne Charlston
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | | | - Kathryn A Carson
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Deidra C Crews
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Nephrology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Raquel C Greer
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Valerie Sneed
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sarah J Flynn
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nicole DePasquale
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - L Ebony Boulware
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA; Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
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Xie YH, Fitzgerald EA, Mii YJ, Monroe D, Thiel FA, Weir BE, Feldman LC. Molecular Beam Epitaxial Growth of Very High Mobility Two-Dimensional Electron Gases in Si/GeSi Heterostructures. ACTA ACUST UNITED AC 2011. [DOI: 10.1557/proc-220-413] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACTWe report the fabrication of modulation doped Si/Gex Si1−x heterostructures by molecular beam epitaxy. The samples are characterized by Rutherford backscattering spectrometry, cross-sectional transmission electron microscopy, electron beam induced current, Hall measurement, and the magnetoresistance (Shubnikov-de Haas) measurements. Threading dislocation densities of = 106cm−2 are observed for relaxed Ge0.3Si0.7 films on Si (100). The modulation doped structures fabricated on these Ge0.3 Si0.7 films contain two-dimensional electron gases with mobilities ranging from 60,000 to 96,000 cm2/V - s at 4.2 K.
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Abstract
AbstractWe have observed fluctuations in the tunneling current through 3.5 nm gate oxides with a 1/f power spectrum where f is the frequency. For voltages in the direct tunneling regime we lind an anomalous current dependence of the noise relative to previous observations of noise in thin oxides. We present a simplified model for the current noise in terms of fluctuations in a trap assisted tunneling current that exists in the oxide in addition to the direct tunneling current. Current noise appears to be a very sensitive probe of trap assisted tunneling and degradation in oxides.
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Vieira S, Monroe D. Is Rituximab Infusion Getting Easier? (Is it Safe to Give Rituximab Faster?). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vieira S, Monroe D. Palonosetron Versus Ondansetron in Chemotherapy Induced Nausea and Vomitting. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.619] [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: 11/16/2022]
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Vieira S, Monroe D. Is It Magic? Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gui T, Reheman A, Ni H, Gross PL, Yin F, Monroe D, Monahan PE, Stafford DW. Abnormal hemostasis in a knock-in mouse carrying a variant of factor IX with impaired binding to collagen type IV. J Thromb Haemost 2009; 7:1843-51. [PMID: 19583826 DOI: 10.1111/j.1538-7836.2009.03545.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Factor IX binds to collagen type IV, but this binding has no known consequence. OBJECTIVES To determine the effect of reduced binding of FIX to collagen IV. METHODS We constructed and characterized 'knock-in' mice containing the mutation lysine 5 to alanine (K5A) in the Gla domain of their FIX. The K5A mutation dramatically reduced the affinity of FIX for collagen type IV, but had no measurable effect on platelet binding, phospholipid binding, or in vitro clotting activity. However, K5AFIX mice had a mild bleeding tendency, despite their in vitro clotting activity being normal. Hemostatic protection from delayed rebleeding was intermediate between wild-type and hemophilia B mice (which had no detectable clotting activity); moreover, survival of K5A FIX mice after nascent clot removal was dramatically improved as compared with hemophilia B mice. Importantly, there was no detectable difference between K5AFIX and wild-type mice in either a laser-induced thrombosis model or the chromogenic FIX activity assay. In contrast, after ferric chloride injury, which exposes collagen IV as well as other basement membrane proteins, intravital microscopy revealed that vessel occlusion was significantly slower in K5AFIX mice than in wild-type mice. CONCLUSIONS Our results indicate that the FIX molecule with decreased affinity for collagen IV has altered hemostatic properties in vivo and that the binding of FIX to collagen IV probably plays a significant functional role in hemostasis.
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Affiliation(s)
- T Gui
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Gorelick M, Atabaki S, Hoyle J, Dayan P, Holmes J, Holubkov R, Monroe D, Callahan J, Kuppermann N. Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.962] [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: 11/10/2022]
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Affiliation(s)
- D. Monroe
- a Department of Physics and Center for Materials Science and Engineering , Massachusetts Institute of Technology , Cambridge , Massachusetts , 02139 , U.S.A
| | - M. A. Kastner
- a Department of Physics and Center for Materials Science and Engineering , Massachusetts Institute of Technology , Cambridge , Massachusetts , 02139 , U.S.A
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Lea-Currie YR, Monroe D, Mcintosh MK. Dehydroepiandrosterone and related steroids alter 3T3-L1 preadipocyte proliferation and differentiation. Comp Biochem Physiol C Pharmacol Toxicol Endocrinol 1999; 123:17-25. [PMID: 10390052 DOI: 10.1016/s0742-8413(99)00003-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to determine if the anti-adipogenic effects of dehydroepiandrosterone (DHEA) are mediated solely by DHEA or by one or more of its downstream metabolites. In Experiment 1, preconfluent proliferating cultures of 3T3-L1 preadipocytes were incubated for either 24 or 72 h with 0, 1, 5 or 25 microM DHEA, DHEA sulfate (DHEAS), testosterone, estrone and 17beta-estradiol. Pregnenolone, a precursor of DHEA(S), was also tested at these concentrations. After 24 h of incubation, DHEAS, 17beta-estradiol and estrone at the 1 microM level stimulated preadipocyte proliferation. In contrast, DHEA and 17beta-estradiol at the 25 microM level attenuated proliferation to a greater extent than all other steroids. After 72 h of incubation, DHEA and 17beta-estradiol at the 25 microM level attenuated proliferation to a greater extent than all other steroids. In Experiment 2, post-confluent cultures of differentiating 3T3-L1 preadipocytes were incubated for 6 days with 0, 5, 30, or 60 microM levels of these steroids. Preadipocyte differentiation, as assessed by lipid content and glycerol-3-phosphate dehydrogenase activity, decreased markedly when treated with 30 and 60 microM DHEA, 17beta-estradiol, estrone and pregnenolone. In contrast, DHEAS had no impact on preadipocyte proliferation or differentiation. These results suggest that the anti-adipogenic actions of DHEA in adipose tissue may be mediated, in part, by one or more of its distal metabolites, including 17beta-estradiol.
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Affiliation(s)
- Y R Lea-Currie
- Department of Nutrition, and Food Service Systems, School of Human Environmental Sciences, University of North Carolina at Greensboro, 27402-6170, USA
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Hoffman M, Romp K, Monroe D. Platelets contain releasable coagulation factor IX antigen: response. Blood Coagul Fibrinolysis 1994; 5:657-8. [PMID: 7841326] [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: 01/27/2023]
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Radermacher K, Monroe D, White AE, Short KT, Jebasinski R. Quantum transport of buried single-crystalline CoSi2 layers in (111)Si and (100)Si substrates. Phys Rev B Condens Matter 1993; 48:8002-8015. [PMID: 10006989 DOI: 10.1103/physrevb.48.8002] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Monroe D, Xie YH, Fitzgerald EA, Silverman PJ. Quantized Hall effects in high-electron-mobility Si/Ge structures. Phys Rev B Condens Matter 1992; 46:7935-7937. [PMID: 10002542 DOI: 10.1103/physrevb.46.7935] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Monroe D. Patient teaching for X-ray and other diagnostics. Intravenous pyelogram. RN 1990; 53:42-4. [PMID: 2267536] [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: 12/31/2022]
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Monroe D. Patient teaching for x-ray and other diagnostics. RN 1990; 53:52-6. [PMID: 2320856] [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: 12/31/2022]
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Flowers ME, Pepe MS, Longton G, Doney KC, Monroe D, Witherspoon RP, Sullivan KM, Storb R. Previous donor pregnancy as a risk factor for acute graft-versus-host disease in patients with aplastic anaemia treated by allogeneic marrow transplantation. Br J Haematol 1990; 74:492-6. [PMID: 2346728 DOI: 10.1111/j.1365-2141.1990.tb06340.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To determine if previous donor pregnancies influence the development of acute graft-versus-host disease (GVHD) we evaluated data from 136 patients with aplastic anaemia greater than 15 years of age and given marrow grafts from HLA-identical sibling donors. Of the 136 marrow donors, 30 were parous females (previous history of pregnancy), 30 were nulliparous females (no history of pregnancy or abortions), and 76 were males. The cumulative incidence of grade II-IV GVHD was 57%, 21% and 46% for patients with parous, nulliparous and male donors, respectively. A multivariate analysis of the data confirmed that the risk of grade II-IV acute GVHD was significantly increased among patients receiving marrow from parous females as compared to those from nulliparous females (relative risk = 2.5, P = 0.02). There was no statistically significant difference in the incidence of acute GVHD, however, between patients with parous donors and male donors (relative risk = 1.3, P = 0.26). Male patients given grafts from parous donors showed a higher incidence of acute GVHD (63%) than female patients (45%), though this difference was not statistically significant. The 5-year probability of survival was 47% for patients with parous donors, 68% for patients with nulliparous donors and 70% for those with male donors. We confirm that prior donor pregnancy represents an important factor in selecting marrow donors or designing clinical protocols for GVHD prophylaxis.
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Affiliation(s)
- M E Flowers
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98104
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Abstract
An exciting new analytical technique based on amperometric devices used to measure immunoassays is reviewed in this article. The utility, ease, speed, simplicity, and many other advantages of performing amperometric immunoassays (AIAs) are discussed throughout the review. Limitations are also described, with electrochemical comparisons being made between AIAs and other conventional analytical methods, including potentiometric immunoassays. The review essentially consists of a general AIA overview, followed by sections devoted to amperometric electrode types, assay design, basic principles, automation, application, and future use. Operational features of oxygen gas selective electrodes and oxidoreductase probes are discussed for a better understanding of AIA principles. Characteristics, limits, advantages, and disadvantages of these different devices are presented. A variety of homogeneous and heterogeneous AIAs are described, together with many applications of the different assay formats available. AIAs are classified according to the electrode type employed, enzyme labels required, or electrochemical components involved. Important related AIAs discussed include pulse agglutination reactions and bioaffinity or displacement assays.
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Affiliation(s)
- D Monroe
- Department of Medicine, VAMC, Memphis, Tennessee
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Monroe D. Patient teaching for x-ray and other diagnostics. RN 1989; 52:36-40. [PMID: 2602817] [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: 01/01/2023]
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Monroe D. Patient teaching for X-ray and other diagnostics. RN 1989; 52:50-6. [PMID: 2772533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Many patients scheduled for diagnostic tests want to know in detail what they will experience. Here are the first in a new series of patient guides to X-ray exams.
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Monroe D. Will your patient survive that trip to x-ray? RN 1989; 52:40-4. [PMID: 2928695] [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: 01/03/2023]
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Monroe D. Coming of age: a retrospective. J Qual Assur 1989; 10:20-1. [PMID: 10303193 DOI: 10.1111/j.1945-1474.1988.tb00311.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Numerous potentiometric assays utilizing bioselective electrodes are fast revolutionizing many areas of biotechnology. Adequately discussing the utility and limitations of these electrochemical systems is the purpose of this review. A general overview introduces bioselective potentiometry by presenting basic concepts, historical background, and current developments. Essentially, the review consists of several sections describing electrode architecture, operational concepts, different biosensors, assay systems, applications, and future trends. Advantages and disadvantages of the different bioselective assay systems discussed are included throughout each section. Electrode design discussion covers conventional liquid probes and the newer solid-state transitor biosensors. Limitations and advantages of different chemoreceptors, biocatalysts, and potentiometric transducers are presented. Operational characteristics include: linear behavior, sensitivity, stability, specificity, response, recovery, and the influence of interfering factors. Enzyme, organelle, tissue, and microbial biocatalytic sensors are discussed. Bioligand systems include: affinity, immunoselective enzyme, and liposome sensors. Potentiometric bioselective drug, microbial, and immunoassay systems are also included.
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Affiliation(s)
- D Monroe
- Department of Medicine, University of Tennessee, Memphis
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Brocklesby WS, Monroe D, Hong M, Liou SH, Kwo J, Fisanick GJ, Mankiewich PM, Howard RE. Tunneling characteristics of internal Josephson junctions in YBa2Cu3O7- delta thin films. Phys Rev B Condens Matter 1988; 38:11805-11808. [PMID: 9946070 DOI: 10.1103/physrevb.38.11805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Monroe D, Gossard AC, English JH, Golding B, Haemmerle WH, Kastner MA. Long-lived Coulomb gap in a compensated semiconductor-the electron glass. Phys Rev Lett 1987; 59:1148-1151. [PMID: 10035152 DOI: 10.1103/physrevlett.59.1148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Doney K, Dahlberg SJ, Monroe D, Storb R, Buckner CD, Thomas ED. Therapy of severe aplastic anemia with anti-human thymocyte globulin and androgens: the effect of HLA-haploidentical marrow infusion. Blood 1984; 63:342-8. [PMID: 6362750] [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] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fifty-four patients with severe aplastic anemia were treated with horse anti-human thymocyte globulin (ATG) and androgens. Thirty of these patients also received an infusion of HLA-haploidentical marrow cells. Only those patients having evidence of hematologic recovery within 3 mo after ATG therapy were considered responders to the immunosuppressive regimen. Of 53 patients evaluable for response, 21 had complete or partial responses and 7 had minimal improvement by defined criteria. The remaining patients did not respond or died. Factors correlated with response to therapy included a short duration of aplasia and a high admission granulocyte count. Thirty-six patients (66.7%) are surviving between 18 and 43 mo, and 18 have died. Deaths were due to hemorrhage and/or infection. Short duration of aplasia and high granulocyte counts also correlated with survival, as did younger age. Four patients with complete or partial responses had a recurrence of severe aplasia 6-17 mo after their first course of ATG. Three of these patients were retreated with ATG (and oxymetholone in two cases). All three had second responses to therapy, but two of the three have had second relapses. The fourth patient responded to oxymetholone alone, but died after a second relapse. Mismatched marrow infusion had no effect on the incidence of response or survival.
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Monroe D. Iron metabolism. Am Sci 1983; 71:118; author reply 118. [PMID: 17726835] [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: 05/17/2023]
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Monroe D. Letters. Hazardous waste landfills. Environ Sci Technol 1981; 15:852. [PMID: 22283988 DOI: 10.1021/es00090a607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Monroe D. The Family Physician. Tex Med J (Austin) 1907; 22:263-266. [PMID: 36956108 PMCID: PMC9622170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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