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Messier SP, Callahan LF, Losina E, Mihalko SL, Guermazi A, Ip E, Miller GD, Katz JN, Loeser RF, Pietrosimone BG, Soto S, Cook JL, Newman JJ, DeVita P, Spindler KP, Runhaar J, Armitano-Lago C, Duong V, Selzer F, Hill R, Love M, Beavers DP, Saldana S, Stoker AM, Rice PE, Hunter DJ. The osteoarthritis prevention study (TOPS) - A randomized controlled trial of diet and exercise to prevent Knee Osteoarthritis: Design and rationale. Osteoarthr Cartil Open 2024; 6:100418. [PMID: 38144515 PMCID: PMC10746515 DOI: 10.1016/j.ocarto.2023.100418] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/19/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Background Osteoarthritis (OA), the leading cause of disability among adults, has no cure and is associated with significant comorbidities. The premise of this randomized clinical trial is that, in a population at risk, a 48-month program of dietary weight loss and exercise will result in less incident structural knee OA compared to control. Methods/design The Osteoarthritis Prevention Study (TOPS) is a Phase III, assessor-blinded, 48-month, parallel 2 arm, multicenter randomized clinical trial designed to reduce the incidence of structural knee OA. The study objective is to assess the effects of a dietary weight loss, exercise, and weight-loss maintenance program in preventing the development of structural knee OA in females at risk for the disease. TOPS will recruit 1230 ambulatory, community dwelling females with obesity (Body Mass Index (BMI) ≥ 30 kg/m2) and aged ≥50 years with no radiographic (Kellgren-Lawrence grade ≤1) and no magnetic resonance imaging (MRI) evidence of OA in the eligible knee, with no or infrequent knee pain. Incident structural knee OA (defined as tibiofemoral and/or patellofemoral OA on MRI) assessed at 48-months from intervention initiation using the MRI Osteoarthritis Knee Score (MOAKS) is the primary outcome. Secondary outcomes include knee pain, 6-min walk distance, health-related quality of life, knee joint loading during gait, inflammatory biomarkers, and self-efficacy. Cost effectiveness and budgetary impact analyses will determine the value and affordability of this intervention. Discussion This study will assess the efficacy and cost effectiveness of a dietary weight loss, exercise, and weight-loss maintenance program designed to reduce incident knee OA. Trial registration ClinicalTrials.gov Identifier: NCT05946044.
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Affiliation(s)
- Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shannon L. Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Ali Guermazi
- Boston University School of Medicine, Boston, MA, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gary D. Miller
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brian G. Pietrosimone
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sandra Soto
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James L. Cook
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jovita J. Newman
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Kurt P. Spindler
- Clinical Research and Outcomes, Cleveland Clinic Florida, Weston, FL, USA
| | - Jos Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands
| | - Cortney Armitano-Lago
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vicky Duong
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia
| | - Faith Selzer
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ryan Hill
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Monica Love
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Aaron M. Stoker
- Department of Orthopaedic Surgery, Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri School of Medicine, Columbia, MO, USA
| | - Paige E. Rice
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia
- Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
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Caldarera T, Ponir C, Seals A, Penmetsa M, Ip E, German CA, Virani SS, Saha A, Bosworth HB, Moore JB, Shapiro MD, Pokharel Y. Clinicians' self-reported efficacy in cardiovascular prevention practice in the southeastern United States. Future Cardiol 2023; 19:593-604. [PMID: 37916575 DOI: 10.2217/fca-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Aim: We assessed self-reported efficacy in cardiovascular prevention practice among internal medicine, family medicine, endocrinology and cardiology clinicians. Patients & methods: We emailed a 21-item questionnaire to 956 physicians, nurse practitioners, physician assistants and pharmacists. Results: 264 clinicians responded (median age: 39 years, 55% women, 47.9% specialists). Most expressed high self-efficacy in lifestyle counselling, prescribing statins, metformin, and aspirin in primary prevention, but low self-efficacy in managing specialized conditions like elevated lipoprotein(a). Compared with specialists, PCPs expressed lower self-efficacy in managing advanced lipid disorders and higher self-efficacy in prescribing sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Conclusion: Self-efficacy in cardiovascular prevention varied across specialties. Future research should explore relevant provider, clinic and system level factors to optimize cardiovascular prevention.
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Affiliation(s)
- Trevor Caldarera
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Cynthia Ponir
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Austin Seals
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
| | - Megha Penmetsa
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA 24014, USA
| | - Edward Ip
- Department of Biostatistics & Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Charles A German
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Salim S Virani
- Department of Medicine, The Aga Khan University, Karachi, 74800, Pakistan
- Department of Internal Medicine, Division of Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Animita Saha
- Department of Internal Medicine, Atrium Health, Charlotte, NC 28207, USA
| | - Hayden B Bosworth
- Department of Population Health Science, Duke University School of Medicine, Durham, NC 27710, USA
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Michael D Shapiro
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
| | - Yashashwi Pokharel
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27101
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Siembida EJ, Fladeboe KM, Ip E, Zebrack B, Snyder MA, Salsman JM. A Developmental Science Approach to Informing Age Subgroups in Adolescent and Young Adult Cancer Research. J Adolesc Health 2023; 73:543-552. [PMID: 37294255 PMCID: PMC10524106 DOI: 10.1016/j.jadohealth.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Adolescent and young adult (AYA; diagnosed ages 15-39) cancer survivors are developmentally heterogenous, and this population consists of at least three distinct theoretically informed subgroups, as follows: adolescents, emerging adults, and young adults. However, there are limited evidence-based recommendations for delineating the validity of these subgroups in cancer-specific research. We sought to inform recommended chronological age ranges for each subgroup based on developmental processes. METHODS The data were collected using a 2x3 stratified sampling design (on-vs. off-treatment; ages 15-17, 18-25, 26-39) and a cross-sectional survey. AYAs (N = 572) completed three subscales of the Inventory of Dimensions of Emerging Adulthood (identity exploration, experimentation/possibilities, and other-focused), and we used regression tree analyses to identify distinct shifts in mean subscale scores that would indicate unique subgroups. Models included (a) chronological age, (b) chronological age + cancer-related variables, and (c) chronological age + sociodemographic/psychosocial variables as predictors of each developmental measure. RESULTS The recommended age ranges for AYA survivors receiving active treatment were consistent with prior research as follows: adolescents ages 15-17, emerging adults ages 18-24, and young adults ages 25-39. Models for off-treatment survivors suggested four distinct subgroups: adolescents ages 15-17, emerging adults ages 18-23, and 'younger' (ages 24-32) and 'older' young adults (ages 33-39). No sociodemographic or psychosocial variables meaningfully shifted these recommendations. DISCUSSION Our results suggest that three developmental subgroups remain appropriate for on-treatment survivors, but a second young adult subgroup (ages 33-39) emerged for off-treatment survivors. Therefore, development disruptions may be more likely to occur or manifest in post-treatment survivorship.
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Affiliation(s)
- Elizabeth J Siembida
- Institute of Health System Science, Northwell Health, Manhasset, New York; Northwell Health Cancer Institute, Northwell Health, Manhasset, New York.
| | - Kaitlyn M Fladeboe
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington
| | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina; Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan; University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Mallory A Snyder
- Office of Research, The University of Chicago, Chicago, Illinois
| | - John M Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina; Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Fladeboe KM, Siembida EJ, Ip E, Rosenberg AR, Snyder MA, Salsman JM. Indicators of developmental status among adolescents and young adults with cancer: Perceived adult status, social milestones, and health-related quality of life. Psychooncology 2023; 32:1363-1371. [PMID: 37381114 DOI: 10.1002/pon.6186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Developmental disruption contributes to poor psychosocial outcomes among adolescents and young adults (AYAs) with cancer, though indicators of AYAs' developmental status are not well understood. In this study, we describe perceived adult status as a novel developmental indicator and examine its associations with social milestones achievements and health-related quality of life (HRQoL). METHODS For this secondary analysis, AYAs with cancer were recruited using a 2 (on/off treatment) × 2 [emerging adults (EAs) 18-25 years-old, young adults (YAs) 26-39 years-old] stratified sampling design through an online research panel. Surveys assessed perceived adult status (i.e., self-perception of the extent to which one has reached adulthood), social milestones (marital, child-rearing, employment, educational status), demographic and treatment characteristics, and HRQoL. Generalized linear models tested associations between perceived adult status, social milestones, and HRQoL. RESULTS AYAs (N = 383; Mage = 27.2, SD = 6.0) were majority male (56%) and treated with radiation without chemotherapy (37%). Most EAs (60%) perceived they had reached adulthood in some ways; most YAs (65%) perceived they had reached adulthood. EAs who perceived they had reached adulthood were more likely to be married, raising a child, and working than EAs who did not perceive they had reached adulthood. Among EAs, lower perceived adult status was associated with lower HRQoL when accounting for social milestones. Among YAs, perceived adult status was not associated with social milestones and neither perceived adult status nor social milestones were associated with HRQoL. CONCLUSIONS Perceived adult status may be a useful developmental indicator for EAs with cancer. Findings highlight unique developmental needs of EAs and utility of patient perspectives for understanding developmental outcomes.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Cambia Palliative Care Center of Excellence at the University of Washington, Seattle, Washington, USA
| | | | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mallory A Snyder
- Office of Research, The University of Chicago, Chicago, Illinois, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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Peipert JD, Shaunfield S, Kaiser K, Moreno PI, Fox RS, Kircher S, Mohindra N, Ip E, Zhao F, Wagner L, Cella D. Correction to: How do patients interpret and respond to a single‑item global indicator of cancer treatment tolerability? Support Care Cancer 2023; 31:489. [PMID: 37486453 PMCID: PMC10366021 DOI: 10.1007/s00520-023-07953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Affiliation(s)
- John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA.
| | - Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rina S Fox
- University of Arizona College of Nursing, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Nisha Mohindra
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fengmin Zhao
- ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Lynne Wagner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
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Peipert JD, Shaunfield S, Kaiser K, Moreno PI, Fox RS, Kircher S, Mohindra N, Ip E, Zhao F, Wagner L, Cella D. How do patients interpret and respond to a single-item global indicator of cancer treatment tolerability? Support Care Cancer 2023; 31:37. [PMID: 36525100 PMCID: PMC10356672 DOI: 10.1007/s00520-022-07484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is increasing interest in patient-reported measures of cancer treatment tolerability. A global measure of bother, the FACT GP5 item ("I am bothered by side effects of treatment") is potentially useful for regulatory, research, and clinical use. To understand this item's appropriateness for capturing treatment tolerability, we conducted cognitive interviews on this item with 3 samples of cancer patients. METHODS Patients with ovarian cancer (Study 1: N = 21; on treatment), lymphoma (Study 2: N = 14; on treatment), and colorectal or lung cancer (Study 3: N = 16; treatment naïve) were interviewed about GP5's understandability and relevance to their treatment side effects. What patients think about when answering GP5 was also assessed. In all studies, the interview included both structured and open-ended questions. Qualitative data were coded to extract themes and responses to structured questions were tallied. RESULTS Most patients on treatment (Studies 1 and 2) reported that the GP5 item wording is appropriate (88%) and its meaning is clear (97%). They were very confident or confident in their response (97%) and stated that GP5 was relevant to their cancer experience (97%). When answering GP5, patients considered their treatment and specific side effects. A large proportion (40%) of the treatment-naïve (Study 3) patients reported that GP5 was not relevant to their cancer treatment, and the largest proportion responded to GP5 thinking of negative side effect expectancies. CONCLUSION This study provides assurance that GP5 is a useful indicator of treatment tolerability, and is meaningful to people with cancer, especially once they have started treatment.
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Zhao F, Peipert J, Stearns V, Chang VTS, Jegede O, Ip E, Lee JW, O'Connell NS, Graham N, Henry NL, Loprinzi CL, Flynn PJ, Fisch MJ, Gareen IF, Carlos RC, Smith ML, Cella D, Sparano JA, Gray RJ, Wagner LI. Predictive value of baseline patient-rated treatment bother for early anastrozole discontinuation in a racially diverse cohort: Results from ECOG-ACRIN E1Z11. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12094 Background: The Functional Assessment of Cancer Therapy patient-reported outcomes (PRO) item GP5 (“I am bothered by side effects of treatment”) estimates treatment tolerability. We aimed to extend our previous finding that GP5 predicts early aromatase inhibitor (AI) discontinuation (E1Z03, 96% White) in the racially diverse E1Z11 trial cohort. Methods: E1Z11 was coordinated by the ECOG-ACRIN NCI Community Oncology Research Program (NCORP) Research Base. Postmenopausal women initiating anastrozole per clinical care for ER+ stage I-III breast cancer with a pain score 0-3/10 and no rheumatologic comorbidities were eligible. Accrual of a racially diverse cohort of 1,000 women, including Black and Asian women, was planned. GP5 was administered prior to initiating anastrozole (trial baseline) and at 3, 6, 9 and 12 months. GP5 was scored on a 5-point Likert scale from 0 (not at all) to 4 (very much) and dichotomized as no/little treatment bother (0/1) or moderate/high treatment bother (2-4), consistent with previous analyses. A univariate Cox proportional hazards model estimated baseline GP5’s association with treatment duration via hazard ratio (HR). Early treatment discontinuation status was defined as treatment duration < 12 months with discontinuation not attributed to disease progression or death (n = 4), consistent with previous analyses. Results: 1,046 women enrolled from 6/2013-10/2018 (640 White, 201 Black, 205 Asian), including 590 (56%) from NCORP Community or Minority/Underserved Sites. Approximately 10% (100/987 with GP5 data) reported moderate/high treatment bother prior to initiating anastrozole. Anastrozole discontinuation rate at 1-year was 26.2% overall; it was lower among women with no/little treatment bother (25.7%, GP5 = 0-1) compared to moderate/high treatment bother prior to initiating anastrozole (34.7%, GP5 = 2-4; HR = 1.50, 95% confidence interval [CI]:1.04-2.15, p = 0.027). Subgroup analyses by racial cohort showed a similar predictive effect of GP5 in the White (n = 606, HR = 1.76, 95% CI: 1.12-2.77, p = 0.014) and Black (n = 184, HR = 1.85, 95% CI: 0.92-3.71, p = 0.079) cohorts, but not in the Asian cohort (n = 197, HR = 0.40, 95% CI: 0.10-1.62, p = 0.20). Conclusions: Moderate/high treatment bother prior to starting anastrozole was observed in 10% of patients and associated with a higher risk of early discontinuation, except in Asian patients. Our findings support the presence of a treatment tolerability threshold which can be compromised by pre-treatment burden. Treatment tolerability may also be influenced by cultural and genetic factors, which will be explored in further analysis of genetic and PRO data. Clinical trial information: NCT01824836.
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Affiliation(s)
| | - John Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Victor Tsu-Shih Chang
- Section of Hematology/Oncology, Veterans Administration New Jersey Health Care System, East Orange, NJ
| | | | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | | | | | | | - Patrick J. Flynn
- NSABP/NRG Oncology, and Metro-Minnesota Community Oncology Research Consotrium (MMCORC), Minneapolis, MN
| | | | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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Hugenschmidt C, Thumuluri D, Soriano C, Barnstaple R, Fanning J, Laurita-Spanglet J, Ip E. The Virtualization of a Movement and Social Group-Activity Intervention for Older Adults and Their Caregivers. Innov Aging 2021. [PMCID: PMC8679398 DOI: 10.1093/geroni/igab046.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
COVID-related safety concerns mandated suspension of our ongoing trial testing the effects of movement and social engagement in older adults with early-stage dementia and their caregivers (dyads). Participant vulnerability and the requirement for group social interaction complicated intervention resumption. We present results from a successful pilot to rapidly and iteratively optimize study interventions for remote delivery targeting intervention mediators (social connection, movement) based on participant feedback. Three-dyad groups (n=6 individuals) completed cycles of intervention via Zoom immediately followed by an interview with open-ended and quantitative feedback. Cycles were repeated until no new information was solicited, then repeated with new participants. Optimization revealed needs for technological support, more intensive movement, and social connection. Specifically, the inability to make eye contact, see others’ full body, and technology-associated timing asynchronies impeded social connection in the movement group. We will present practical tips for crafting remote group interventions for caregiver/person living with dementia dyads.
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Affiliation(s)
| | - Deepthi Thumuluri
- Wake Forest School of Medicine, winston-Salem, North Carolina, United States
| | - Christina Soriano
- Wake Forest University, Winston-Salem, North Carolina, United States
| | | | - Jason Fanning
- Wake Forest University, Winston Salem, North Carolina, United States
| | | | - Edward Ip
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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Speiser J, Callahan K, Ip E, Miller M, Tooze J, Krtichevsky S, Houston D. Machine Learning Prediction Models for Mobility Limitation Over Time in Older Adults: The Health ABC Study. Innov Aging 2021. [PMCID: PMC8679294 DOI: 10.1093/geroni/igab046.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mobility limitation in older adults is common and associated with poor health outcomes and loss of independence. Identification of at-risk individuals remains challenging because of time-consuming clinical assessments and limitations of statistical models for dynamic outcomes over time. Therefore, we aimed to develop machine learning models for predicting mobility limitation in older adults using repeated measures and variable selection. We used nine years of follow-up data from the Health, Aging, and Body Composition study to model mobility limitation, defined as self-report of any difficulty walking ¼ mile or up a flight of stairs, assessed annually. We considered 46 predictors for modeling, including demographic, lifestyle, chronic condition and physical function variables. We developed three models with Binary Mixed Model Forest, using: 1) all 46 predictors, 2) an automated variable selection algorithm, and 3) the top five most important predictors. Area under the receiver operating curve ranged from 0.78 to 0.84 for the models for two validation datasets (with and without previous annual visit data for participants). Across the three models, the most important predictors of mobility limitation were ease of getting up from chair, gait speed, self-reported health status, body mass index and depression. Longitudinal, machine learning models predicting mobility limitation had good performance for identifying at-risk older adults based on current and previous annual visit data. Future studies should evaluate the utility and efficiency of the prediction models as a tool in a clinical setting for identifying at-risk older adults who may benefit from interventions aimed to prevent mobility limitation.
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Affiliation(s)
- Jaime Speiser
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Kathryn Callahan
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Edward Ip
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Michael Miller
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Janet Tooze
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Stephen Krtichevsky
- Wake Forest School of Medicine, Wake Forest School of Medicine, North Carolina, United States
| | - Denise Houston
- Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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Berry DC, Rhodes ET, Hampl S, Young CB, Cohen G, Eneli I, Fleischman A, Ip E, Sweeney B, Houle TT, Skelton J. Stay in treatment: Predicting dropout from pediatric weight management study protocol. Contemp Clin Trials Commun 2021; 22:100799. [PMID: 34169176 PMCID: PMC8209185 DOI: 10.1016/j.conctc.2021.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 05/18/2021] [Accepted: 06/06/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Childhood obesity is a serious public health concern. Multidisciplinary pediatric weight management programs have been deemed effective. However, effectiveness of these programs is impacted by attrition, limiting health benefits to children, and inefficiently utilizing scarce resources. Methods We have developed a model (the Outcomes Forecasting System, OFS) that isolates variables associated with attrition from pediatric weight management, with the potential to forecast participant dropout. In Aim 1, we will increase the power and precision of the OFS and then validate the model through the consistent acquisition of key patient, family, and treatment data, from three different weight management sites. In Aim 2, external validity will be established through the application of the OFS at a fourth pediatric weight management program. Aim 3 will be a pilot clinical trial, incorporating an intervention built on the results of Aims 1 and 2 and utilizing the OFS to reduce attrition. Discussion A greater understanding of the patient, family, and disease-specific factors that predict dropout from pediatric weight management can be utilized to prevent attrition. The goal of the current study is to refine the OFS to a level of precision and efficiency to be a valuable tool to any weight management program. By identifying the most pertinent factors driving attrition across weight management sites, new avenues for treatment will be identified. This study will result in a valuable forecasting tool that will be applicable for diverse programs and populations, decrease program costs, and improve patient retention, adherence, and outcomes. Clinicaltrials.gov identifier NCT04364282.
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Affiliation(s)
- Diane C Berry
- The University of North Carolina, School of Nursing, Chapel Hill, NC, USA
| | - Erinn T Rhodes
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Sarah Hampl
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Caroline Blackwell Young
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gail Cohen
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ihuoma Eneli
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Amy Fleischman
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Edward Ip
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brooke Sweeney
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joseph Skelton
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
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11
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Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Cella D, Zhao F, Ip E, O'Connell N, Hong F, Peipert J, Gareen IF, Gray RJ, Wagner LI, Carlos R. Association between allostatic load, symptom burden and mortality in E1A11 trial for myeloma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12102 Background: Allostatic load (AL) conceptualizes the effects of chronic psychosocial adversity on physiologic dysregulation. To date, studies have shown an association between elevated AL and higher disease-specific and overall mortality among cancer patients; however, none have focused on multiple myeloma (MM) patients. We aim to understand the relationship between baseline AL, symptom burden, and mortality among patients enrolled in the E1A11 therapeutic trial in MM. Methods: ECOG-ACRIN E1A11 was a phase III RCT comparing induction with Bortezomib (Arm A) versus Carfilzomib (Arm B) in conjunction with Lenalidomide +Dexamethasone. AL included 7 biomarkers: BMI, alkaline phosphatase, creatinine, C-reactive protein, white blood cell count, albumin and creatinine clearance. AL7 was a composite summary score with a point was assigned for each biomarker value in the highest quartile, except for albumin and creatinine clearance, where a point was assigned for values in the lowest quartile. Endpoints included symptom burden at baseline and ̃1 month, non-completion of induction therapy, and overall survival (OS). Functional Assessment of Cancer Therapy Multiple Myeloma (FACT-MM) items assessed patient-reported symptom burden, including fatigue (item HI7), pain (GP4), and bother by side effects of treatment (GP5) on a 5-point Likert scale. Multivariable logistic regressions assessed the effect of AL7 (ranging 0-7) on high-pain, -fatigue, and -bother (QOL score > = 3 vs < 3), and non-completion of induction therapy. The effect of AL7 on OS was assessed using multivariable Cox regression. Regression covariates included study arm, age, sex, race, ECOG performance status, and the target symptom burden score at baseline. Results: The study cohort included 1087 patients. Mean baseline AL7 was 1.8 (±1.4). In adjusted analysis, a unit increase in AL7 was associated with a greater odds of high pain (OR 1.15, 95%CI [1.04-1.27]) and high fatigue (OR 1.19, 95%CI [1.07-1.32]) at baseline, which did not persist at ̃1 month (pain OR 0.96, 95%CI [0.84-1.10]; fatigue OR 1.03, 95%CI [0.91-1.16]). There was no association between AL7 and high side effect bother at baseline (OR 1.06, 95% CI [0.83-1.35]) or at ̃1 month (OR 1.06, 95%CI [0.90-1.24]). There was no association between AL7 and induction non-completion (OR 1.07, 95%CI [0.96-1.18]). Notably, each unit increase in AL7 was associated with higher mortality (HR 1.26, 95%CI [1.14-1.39]). Conclusions: Despite its association with fatigue and pain at baseline, AL7 was not associated with these symptoms at ̃1 month nor induction non-completion. However, elevated baseline AL7 was associated with poorer OS. AL composite score at baseline, which we interpret as a measure of physiological dysregulation associated with adverse social factors, may have implications on clinical outcomes within clinical trials despite presumed equal treatment access.
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Affiliation(s)
| | | | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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12
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Welti LM, Beavers KM, Mampieri A, Rapp SR, Ip E, Shumaker SA, Beavers DP. Patterns of Home Environmental Modification Use and Functional Health: The Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2021; 75:2119-2124. [PMID: 31837269 DOI: 10.1093/gerona/glz290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined common patterns of home environmental modification (HEM) use and associated major (including disability-, cardiovascular-, and cancer-related) health conditions and events among older women. METHODS Women, aged 78.6 ± 6.3 years (n = 71,257), self-reported utilization of nine types of HEMs (hand rails, grab bars, ramps, nonslip surfaces, tacking carpets/rugs, decreasing clutter, increasing lighting, raised sink/counter heights, other). Concurrent history of major health conditions and events was collected. Odds ratios (ORs) were estimated based on overall HEM use and four latent classes (low HEM use [56%], rails/grab bars [20%], lighting/decluttering [18%], high HEM use [5%]), adjusted for age, marital status, race/ethnicity, education, depression, and obesity. RESULTS Fifty-five percent of women reported using any HEM (overall), with strongest associations among disability-related conditions. Activities of daily living limitations were strongly associated with high HEM use (OR = 8.16, 95% confidence interval [CI] = 6.62-10.05), railing/grab bar use (OR = 4.02, 95% CI = 3.26-4.95), and lighting/declutter use (OR = 1.87, 95% CI = 1.40-2.50) versus low HEM use. Recent falls were positively associated with overall HEM use (OR = 1.79, 95% CI = 1.72-1.87); high HEM use (OR = 2.89, 95% CI = 2.64-3.16), railings/grab bars use (OR = 2.32, 95% CI = 2.18-2.48), and lighting/declutter use (OR = 1.93, 95% CI = 1.79-2.08) were positively associated with recent falls. Modest associations were observed between HEM use and select (ie, atrial fibrillation, heart valve disease, stroke) cardiovascular outcomes. CONCLUSIONS Among older women, disability-related conditions, including functional limitations and recent falls, were strongly associated with overall HEM use, high HEM use, and railings/grab bar use.
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Affiliation(s)
- Laura M Welti
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Annie Mampieri
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sally A Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Daniel P Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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13
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Fanning J, Brooks AK, Ip E, Nicklas BJ, Rejeski WJ, Nesbit B, Ford S. A Mobile Health Behavior Intervention to Reduce Pain and Improve Health in Older Adults With Obesity and Chronic Pain: The MORPH Pilot Trial. Front Digit Health 2020; 2. [PMID: 33817686 PMCID: PMC8018691 DOI: 10.3389/fdgth.2020.598456] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chronic, multisite pain is a common phenomenon in aging and is associated with a host of negative health outcomes. It is a complex and multifaceted condition that may be exacerbated by weight gain and long periods of inactivity. Unfortunately, older adults suffering from chronic pain have unique barriers limiting access to center-based behavior change interventions. The MORPH study first adapted and iteratively refined an evidence-based group-mediated intervention for delivery in the home via mHealth tools (a smartphone app, teleconferencing software, wearable activity monitor, smart weight scale). This was followed by a pilot randomized controlled trial (RCT) meant to assess feasibility of the MORPH intervention, and to examine initial effects on physical function, pain, weight, and sedentary behavior. We recruited low-active and obese older adults with multisite pain to partake in a series of N-of-1 refinement studies (N = 5 total) or a 12-week pilot RCT delivered largely in the home (N = 28 assigned to active intervention or wait-list control). The refinement phase identified several key technological (e.g., selection of a new smart weight scale) and user interface (e.g., clarification of in-app phrasing) modifications that were made before initiating the RCT phase. Analyses of covariance, controlling for baseline values, sex, and age indicated effects favoring the intervention across all domains of interest: there was a substantially clinically meaningful difference in short physical performance battery scores (0.63 points, η2 = 0.08), a moderate-to-large difference in PROMIS pain intensity scores (5.52 points, η2 = 0.12), a large difference in body weight (2.90 kg, η2 = 0.207), and a moderate effect on adjusted ActivPAL-assessed sedentary time (64.90 min, η2 = 0.07) with a small effect on steps (297.7 steps, η2 = 0.01). These results suggest a largely-home delivered movement and weight loss program for older adults with pain is feasible and recommendations are provided for future programs of this nature. Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT03377634.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Amber K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Beverly Nesbit
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
| | - Sherri Ford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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14
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Cramer C, Page B, Wefel JS, Dressler E, Ip E, Rapp S, Shaw E, Weaver K, Lesser G, Chan M. NCOG-24. WAKE FOREST NCORP RESEARCH BASE FEASIBILITY STUDY OF RAMIPRIL FOR PREVENTING COGNITIVE DECLINE IN GLIOBLASTOMA PATIENTS RECEIVING BRAIN RADIOTHERAPY (WF-1801). Neuro Oncol 2020. [PMCID: PMC7651320 DOI: 10.1093/neuonc/noaa215.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Chronic neuro-inflammation after brain radiotherapy (RT) contributes to radiation-induced cognitive decline (RICD). The renin angiotensin system (RAS) may mediate this inflammatory cascade after RT. Ramipril is an angiotensin-converting enzyme inhibitor used to treat hypertension and has good blood-brain barrier penetration. By blocking RAS activation, ramipril reduces neuro-inflammation and preclinical data show that ramipril administration during RT can prevent RICD. METHODS WF-1801 is an ongoing feasibility study that will enroll a total of 75 patients. Patients ≥ 18 with newly diagnosed and pathologically confirmed GBM who will receive chemoradiation are eligible. All participants take ramipril daily during RT and for 4 months thereafter. Ramipril is titrated from 1.25mg to 5mg daily over 3 weeks. A cognitive battery that includes the Hopkins Verbal Learning Test-Revised (HVLT-R), Trail Making Test (TMT), and Controlled Oral Word Association test (COWA) is administered at baseline, end of RT, and 1-month and 4-months post-RT. The co-primary endpoints are retention rate (with retention defined as compliance with > 75% of drug therapy doses) and neurocognitive function at 1-month post-RT. To estimate the effect of ramipril on cognitive function, performance on the cognitive battery will be compared to a historical control (cognitive data from the control arm of RTOG 0825). ApoE genotyping is being performed as a correlative study. RESULTS 31 of a planned 75 participants have been enrolled over 14 months. 20 of 31 (64.5%) are male. 21 (67.7%) are between the age of 40-64. 20 (95.6%) are white and 29 (93.6%) are not Hispanic or Latino. CONCLUSION Despite a pause in accrual due to COVID-19, we are easily meeting planned accrual goals. Community oncology-based clinical trials of interventions to prevent cognitive toxicity appear to be feasible. GBM patients seem eager to enroll in studies seeking to prevent cognitive decline. Supported by NCI grant UG1CA189824.
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Affiliation(s)
| | - Brandi Page
- Johns Hopkins University School of Medicine, Bethesda, MD, USA
| | | | | | - Edward Ip
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steve Rapp
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Edward Shaw
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Glenn Lesser
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Michael Chan
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Koehler AN, Sudano LE, Ip E, Davis SW, Marion GS, Kirk JK. Patient experience of an integrated care model in a family practice clinic & FQHC. Int J Psychiatry Med 2020; 55:357-365. [PMID: 32883139 DOI: 10.1177/0091217420951059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In order to investigate the patient experience of integrated behavioral health care in primary care settings, we implemented a patient cohort model from a combined site sample (N = 727) consisting of a family practice clinic and a Federally Qualified Health Center. Patient experience was measured using 12 questions from a validated measure, the Agency for Healthcare Research and Quality's Consumer Assessment of Health Care Providers and Systems (CAHPS®), Home and Community Based Services version, and six additional questions about interactions with an integrated behavioral health care team. We assessed bivariate relationships between satisfaction with integration and the clinic practice and self-reported physical health or self-reported mental/emotional health. We also utilized multiple regression to evaluate this relationship. Our analyses showed a statistically significant and small to moderate direct correlation between patients' self-reported health (both physical and mental/emotional health) and their ratings of the practice as a whole (p = .0003), such that patients who rated their physical and/or mental/emotional health as better were more likely to rate their overall satisfaction with the practice higher. The results of this study suggest that primary care patients with only mild to moderate health conditions (physical and/or mental/emotional) may experience greater satisfaction with integrated behavioral health care than patients with multiple and/or severe health conditions. In contrast, patients with multiple and/or severe health conditions may experience lower satisfaction with integrated behavioral health care and may be better served through higher levels of care.
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Affiliation(s)
- Aubry N Koehler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura E Sudano
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Edward Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen W Davis
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gail S Marion
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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16
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Corriere MA, Barnard R, Saldana S, Guzman RJ, Boone D, Easterling D, Burke G, Ip E. Characterizing Treatment Preference “Phenotypes” Among Patients With Symptomatic Peripheral Artery Disease to Support Identification of Concordant Treatment and Communication Strategies. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.144] [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: 11/30/2022]
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17
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Strachan T, Ip E, Fu Y, Ackerman T, Chen SH, Willse J. Robustness of Projective IRT to Misspecification of the Underlying Multidimensional Model. Appl Psychol Meas 2020; 44:362-375. [PMID: 32879536 PMCID: PMC7433385 DOI: 10.1177/0146621620909894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
As a method to derive a "purified" measure along a dimension of interest from response data that are potentially multidimensional in nature, the projective item response theory (PIRT) approach requires first fitting a multidimensional item response theory (MIRT) model to the data before projecting onto a dimension of interest. This study aims to explore how accurate the PIRT results are when the estimated MIRT model is misspecified. Specifically, we focus on using a (potentially misspecified) two-dimensional (2D)-MIRT for projection because of its advantages, including interpretability, identifiability, and computational stability, over higher dimensional models. Two large simulation studies (I and II) were conducted. Both studies examined whether the fitting of a 2D-MIRT is sufficient to recover the PIRT parameters when multiple nuisance dimensions exist in the test items, which were generated, respectively, under compensatory MIRT and bifactor models. Various factors were manipulated, including sample size, test length, latent factor correlation, and number of nuisance dimensions. The results from simulation studies I and II showed that the PIRT was overall robust to a misspecified 2D-MIRT. Smaller third and fourth simulation studies were done to evaluate recovery of the PIRT model parameters when the correctly specified higher dimensional MIRT or bifactor model was fitted with the response data. In addition, a real data set was used to illustrate the robustness of PIRT.
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Affiliation(s)
| | - Edward Ip
- Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - Yanyan Fu
- Graduate Management Admission Council,
Reston, VA, USA
| | | | | | - John Willse
- The University of North Carolina at
Greensboro, USA
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18
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Zhao F, Peipert J, Lee JW, Hong F, Ip E, Gareen IF, O'Connell N, Carlos R, Mayer IA, Miller K, Partridge AH, Shanafelt TD, Stewart AK, Tarhini AA, Thomas ML, Weiss M, Sparano JA, Cella D, Gray RJ, Wagner LI. Predictive value of bother by side effects of treatment prior to protocol therapy for early treatment discontinuation in clinical trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19132 Background: The Functional Assessment of Cancer Therapy–General has an item about patient tolerability of treatment: “I am bothered by side effects of treatment” (GP5). We examined the predictive value of this single item for early treatment discontinuation in clinical trials. Methods: GP5 level prior to protocol therapy (rated using a 5-point Likert scale) and treatment start/end dates and off treatment reason data at each treatment phase were drawn from five phase III clinical trials conducted by ECOG-ACRIN. In the present analysis, GP5 was dichotomized as 0 = “Not at all”/“A little bit” and 1 = “Somewhat”/“Quite a bit”/“Very Much”. Early treatment discontinuation was defined either as receiving less than protocol specified cycles of treatment when maximum cycles specified in the protocol (E1A06 induction, E1912 induction, E1609 induction, E1105 induction, E5103 adjuvant), analyzed using logistic regression via odds ratio [OR]), or treatment cessation for reasons other than progressive disease or death when treatment continued until progression or intolerability (E1A06 maintenance, E1912 maintenance, E1609 maintenance, E1105 maintenance), analyzed using Cox proportional hazard model via hazard ratio [HR]. Results: GP5 prior to treatment was significantly associated with early discontinuation of E1A06 maintenance, E1609 maintenance, E1912 maintenance, and E1912 induction. No significant association was found for other therapies examined in the study. Conclusions: High GP5 level prior to treatment is associated with higher likelihood of early treatment discontinuation in patients who have received previous treatment. The limited predictive value of GP5 for treatment naïve patients is more limited, serial on-treatment assessment should be considered in this setting. Clinical trial information: NCT00602641 . [Table: see text]
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Affiliation(s)
| | - John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ilana F Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | - Kathy Miller
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| | | | | | | | - Ahmad A. Tarhini
- H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, FL
| | | | | | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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19
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Peipert J, Zhao F, Lee JW, Hong F, Ip E, Gareen IF, O'Connell N, Carlos R, Stewart AK, Weiss M, Sparano JA, Cella D, Gray RJ, Wagner LI. Increase in side effect bother was associated with early treatment discontinuation in a clinical trial among multiple myeloma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19136] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19136 Background: Patient reported side effect bother is needed to understand tolerability of cancer drugs. We examined whether increase in side effect bother from baseline to cycle 7 as measured by a single item (GP5) from the FACT-G, “I am bothered by side effects of treatment”, was associated with early treatment discontinuation (ETD) in a multiple myeloma (MM) trial. Methods: Data were drawn from the induction phase of ECOG ACRIN E1A06, a two arm, phase 3 trial conducted in patients with untreated MM. The induction phase occurred over twelve, 28-day cycles. GP5 was assessed at registration and cycle 7. ETD was defined as completion of less than 12 cycles of treatment. We tested whether increase in side effect bother on the GP5 from baseline to cycle 7 was associated with months to ETD in two ways. At each timepoint, GP5 was rated with these response options: “Not at all”, “A little bit”, “Somewhat”, “Quite a bit”, “Very Much”. First, we stratified Kaplan Meier curves by patients with versus without substantially increased side effect burden from registration to cycle 7 on the GP5, defined as an increase of > 2 response categories; Cox regression was used to calculate a hazard ratio. Second, we fit a joint model of the GP5 change trajectory on months to ETD that substituted the estimated slope of a longitudinal logistic regression model into the hazard function of a Cox model. In this model, GP5 was dichotomized as 0 = “Not at all/”A little bit”; 1 = “Somewhat”/ “Quite a bit”/ “Very Much”. Results: 159 patients were followed during induction for a median of 11 months (range: 0.2-16.0). 10 patients (6%) reported a substantial increase on GP5 from registration to cycle 7. After 16 months, these patients had a significantly higher hazard of ETD as estimated by Kaplan Meier methods: 40% experienced ETD vs. 24% of patients without substantial GP5 increase [hazard ratio (HR): 3.08 (95% CI: 1.18-8.02)]. In the joint model, the effect of GP5 on hazard of ETD was larger [HR: 9.56 (95% CI: 2.41-37.82)]. Conclusions: This study found initial evidence that increase in side effect bother as measured by the GP5 predicts ETD and may therefore reflect treatment intolerability in cancer drug trials. The effects found in this study will be tested for replication in additional ECOG-ACRIN trials with diverse designs, treatments, and cancer types. Clinical trial information: NCT00602641 .
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Affiliation(s)
- John Peipert
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ju-Whei Lee
- Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Edward Ip
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Ilana F Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
| | | | | | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | - Robert James Gray
- Dana-Farber Cancer Institute-ECOG-ACRIN Biostatistics Center, Boston, MA
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Speiser JL, Miller ME, Tooze J, Ip E. A Comparison of Random Forest Variable Selection Methods for Classification Prediction Modeling. Expert Syst Appl 2019; 134:93-101. [PMID: 32968335 PMCID: PMC7508310 DOI: 10.1016/j.eswa.2019.05.028] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Random forest classification is a popular machine learning method for developing prediction models in many research settings. Often in prediction modeling, a goal is to reduce the number of variables needed to obtain a prediction in order to reduce the burden of data collection and improve efficiency. Several variable selection methods exist for the setting of random forest classification; however, there is a paucity of literature to guide users as to which method may be preferable for different types of datasets. Using 311 classification datasets freely available online, we evaluate the prediction error rates, number of variables, computation times and area under the receiver operating curve for many random forest variable selection methods. We compare random forest variable selection methods for different types of datasets (datasets with binary outcomes, datasets with many predictors, and datasets with imbalanced outcomes) and for different types of methods (standard random forest versus conditional random forest methods and test based versus performance based methods). Based on our study, the best variable selection methods for most datasets are Jiang's method and the method implemented in the VSURF R package. For datasets with many predictors, the methods implemented in the R packages varSelRF and Boruta are preferable due to computational efficiency. A significant contribution of this study is the ability to assess different variable selection techniques in the setting of random forest classification in order to identify preferable methods based on applications in expert and intelligent systems.
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Affiliation(s)
- Jaime Lynn Speiser
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Michael E. Miller
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Janet Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Oussedik E, Cline A, Su JJ, Masicampo EJ, Kammrath LK, Ip E, Feldman SR. Accountability in patient adherence. Patient Prefer Adherence 2019; 13:1511-1517. [PMID: 31564838 PMCID: PMC6732501 DOI: 10.2147/ppa.s213113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/27/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The accountability inherent in the social interaction between a patient and healthcare provider affects patients' motivation to adhere to treatment. To characterize the role of accountability as a tool to improve self-efficacy and self-management and thereby promote patients' adherence to treatment, a measure of accountability is needed. AIMS To develop and test the validity, reliability, and sensitivity of a new outcome measure designed to assess accountability. METHODS The accountability measurement tool was developed from the literature, expert consultation, and focus groups. A focus group and three pilot studies were performed both in clinic and through an online crowdsourcing platform. Principal Component Analysis evaluated constructs, and Cronbach's alpha measured internal consistency. Validity was established using convergent and divergent correlations to other validated scales. RESULTS A total of 292 participants took part in this study. The 12-item accountability scale demonstrated very good internal consistency (Cronbach's α=0.92). Components of the accountability measurement tool correlated with predicted validated measures, including the Treatment Self-Regulation Questionnaire. Divergent validity was established with no significant difference noted between age, sex, race, and education level. CONCLUSION Future use of this questionnaire will allow for the assessment of the interaction between accountability and adherence to treatment and lead to the development of new interventions to promote better adherence.
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Affiliation(s)
- Elias Oussedik
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Abigail Cline
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Correspondence: Abigail ClineCenter for Dermatology Resarch, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC27157-1071, USATel +1 336 716 7740Fax +1 336 716 7732Email
| | - Jennifer J Su
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - EJ Masicampo
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Lara K Kammrath
- Department of Psychology, Wake Forest University, Winston-Salem, NC, USA
| | - Edward Ip
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Messier SP, Martin DF, Mihalko SL, Ip E, DeVita P, Cannon DW, Love M, Beringer D, Saldana S, Fellin RE, Seay JF. A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS). Am J Sports Med 2018; 46:2211-2221. [PMID: 29791183 DOI: 10.1177/0363546518773755] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The National Center for Injury Prevention and Control, noting flaws in previous running injury research, called for more rigorous prospective designs and comprehensive analyses to define the origin of running injuries. PURPOSE To determine the risk factors that differentiate recreational runners who remain uninjured from those diagnosed with an overuse running injury during a 2-year observational period. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Inclusion criteria were running a minimum of 5 miles per week and being injury free for at least the past 6 months. Data were collected at baseline on training, medical and injury histories, demographics, anthropometrics, strength, gait biomechanics, and psychosocial variables. Injuries occurring over the 2-year observation period were diagnosed by an orthopaedic surgeon on the basis of predetermined definitions. RESULTS Of the 300 runners who entered the study, 199 (66%) sustained at least 1 injury, including 73% of women and 62% of men. Of the injured runners, 111 (56%) sustained injuries more than once. In bivariate analyses, significant ( P ≤ .05) factors at baseline that predicted injury were as follows: Short Form Health Survey-12 mental component score (lower mental health-related quality of life), Positive and Negative Affect Scale negative affect score (more negative emotions), sex (higher percentage of women were injured), and knee stiffness (greater stiffness was associated with injury); subsequently, knee stiffness was the lone significant predictor of injury (odds ratio = 1.18) in a multivariable analysis. Flexibility, quadriceps angle, arch height, rearfoot motion, strength, footwear, and previous injury were not significant risk factors for injury. CONCLUSION The results of this study indicate the following: (1) among recreational runners, women sustain injuries at a higher rate than men; (2) greater knee stiffness, more common in runners with higher body weights (≥80 kg), significantly increases the odds of sustaining an overuse running injury; and (3) contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury are not significant etiologic factors across all overuse running injuries.
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Affiliation(s)
- Stephen P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - David F Martin
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Shannon L Mihalko
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, North Carolina, USA
| | - D Wayne Cannon
- Wayne Cannon Physical Therapy and Associates, Winston-Salem, North Carolina, USA
| | - Monica Love
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Danielle Beringer
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca E Fellin
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
| | - Joseph F Seay
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA
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Fanning J, Brooks AK, Ip E, Nicklas BJ, Rejeski WJ. A Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) in Older Adults With Obesity: Protocol for the MORPH Trial. JMIR Res Protoc 2018; 7:e128. [PMID: 29759957 PMCID: PMC5972205 DOI: 10.2196/resprot.9712] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chronic pain is a complex, age-related health issue that affects both physical functioning and quality of life. Because the impact of chronic pain is worsened by obesity and inactivity, nonpharmacological interventions that promote movement, reduce sitting, and aid in weight loss are needed to help manage pain symptoms among older adults with chronic pain. OBJECTIVE The Mobile Intervention to Reduce Pain and Improve Health (MORPH) pilot trial aims to develop and test the feasibility and acceptability of a novel, patient-centered intervention to reduce chronic pain and improve physical functioning in older adults, leveraging the combination of telecoaching and individually adaptive mHealth tools to decrease both body mass and sedentary behavior. METHODS MORPH comprises 2 phases, including a 1-year iterative development phase, and a 1-year pilot randomized controlled trial (RCT). During the development phase, representative participants will engage in one-on-one structured interviews and a 1-week field test. The resulting feedback will be used to guide the development of the finalized MORPH intervention package. During the second phase, the finalized intervention will be tested in a pilot RCT (N=30) in which older adult participants with chronic pain and obesity will be assigned to receive the 12-week MORPH intervention or to a waitlist control. Primary outcomes include self-reported pain symptoms and physical function. RESULTS Phase 1 recruitment is ongoing as of December 2017. CONCLUSIONS The MORPH intervention brings together a strong body of evidence using group-based behavioral intervention designs with contemporary mHealth principles, allowing for intervention when and where it matters the most. Given the ubiquity of smartphone devices and the popularity of consumer activity and weight monitors, the results of this study may serve to inform the development of scalable, socially driven behavioral pain management interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03377634; https://clinicaltrials.gov/ct2/show/NCT03377634 (Archived by WebCite at http://www.webcitation.org/6yj0J5Pan). REGISTERED REPORT IDENTIFIER RR1-10.2196/9712.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Amber K Brooks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Barbara J Nicklas
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States
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Abstract
OBJECTIVE The current study explores whether a well-known model (i.e., Ryff's, 1989, conceptualization of psychological functioning) can be used to examine patterns of eudaimonic well-being among Asian Americans, who are rarely the focus of systematic investigations in positive psychology. METHOD Hidden Markov modeling, a form of latent transition analysis, was used to analyze longitudinal data from adolescents (N = 180; 49% female; 75% U.S.-born). RESULTS After establishing measurement validity, analyses revealed 4 profiles of well-being: Flourishing (consistently high on all well-being dimensions), Functioning (consistently moderate), Hindered (consistently low), and Self-Driven Success (high on most dimensions, but moderate levels of positive relationships). The Functioning profile was the most prevalent, followed by relatively even distributions of the remaining profiles. Profiles substantially shifted from year to year, with the Functioning and Hindered groups exhibiting the most stability. Profiles reflecting more positive well-being (i.e., Flourishing, Self-Driven) were associated with ethnic and American centrality and regard, and interactive effects suggest compounding benefits of these identities. CONCLUSIONS Psychological models of well-being appear malleable, and cultural identity can contribute to such fluctuations. Results also support the utility of a profile approach to continue examining qualities of positive well-being among Asian American youth. (PsycINFO Database Record
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Affiliation(s)
- Lisa Kiang
- Department of Psychology, Wake Forest University
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine
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Rejeski W, Marsh A, Barnard R, Fanning J, Ip E. ANIMATED VIDEO TECHNOLOGY: ADVANCING THE ASSESSMENT OF MOBILITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- W. Rejeski
- Wake Forest University, Winston-Salen, North Carolina
| | - A. Marsh
- Wake Forest University, Winston-Salen, North Carolina
| | - R. Barnard
- Wake Forest University, Winston-Salen, North Carolina
| | - J. Fanning
- Wake Forest University, Winston-Salen, North Carolina
| | - E. Ip
- Wake Forest University, Winston-Salen, North Carolina
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Rapp SR, Barnard R, Sink KM, Chamberlain D, Wilson VM, Lu L, Ip E. [P1–325]: COMPUTER SIMULATIONS FOR ASSESSING EVERYDAY COGNITIVE FUNCTIONING IN OLDER ADULTS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ryan Barnard
- Wake Forest School of MedicineWinston‐SalemNCUSA
| | | | | | | | - Lingyi Lu
- Wake Forest School of MedicineWinston‐SalemNCUSA
| | - Edward Ip
- Wake Forest School of MedicineWinston‐SalemNCUSA
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27
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Affiliation(s)
- William B Applegate
- Department of Internal Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Edward Ip
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Crandall S, Bushardt R, Ip E. Key Sampling Issues in Quantitative Research in Health Professions Education. Acad Med 2016; 91:e6. [PMID: 27655053 DOI: 10.1097/acm.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Sonia Crandall
- professor and director, Research and Scholarship, Department of Physician Assistant Studies professor and chair, Department of Physician Assistant Studies, and professor, Department of Biostatistics, Wake Forest School of Medicine
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Ip E, Pokorny AMJ, Della-Fiorentina S, Beale P, Bray V, Kiely BE, Blinman P. Use of palliative chemotherapy in patients aged 80 years and over with incurable cancer: experience at three Sydney cancer centres. Intern Med J 2016; 47:75-81. [PMID: 27749003 DOI: 10.1111/imj.13296] [Citation(s) in RCA: 4] [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: 07/10/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM To describe the use of palliative first-line chemotherapy in patients 80 years and over and factors associated with its use. METHODS We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013. Patient, disease and treatment details were summarised and factors associated with chemotherapy use explored. RESULTS Of 420 eligible patients, 100 (24%) started first-line chemotherapy. Younger age at diagnosis was the only factor associated with receiving chemotherapy (median 82.9 vs 84.1 years, P = 0.002). A total of 78% of patients had single-agent chemotherapy, and 41% received a full dose for the first cycle. During treatment, 54% experienced toxicity, necessitating dose reduction, delay or omission, and 32% were hospitalised. These events were associated with receipt of combination chemotherapy (OR 5.1; P = 0.04) and full-dose chemotherapy for cycle 1 (OR 3.5; P = 0.02). Radiological disease control was achieved in 60%. Chemotherapy was stopped because of progressive disease (48%), toxicity (37%) or completion of planned course (17%). CONCLUSION A quarter of patients 80 years and older received first-line palliative chemotherapy. Despite most receiving a modified dose, one third were hospitalised during treatment. These findings highlight the need for careful clinical assessment and selection of older cancer patients for chemotherapy.
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Affiliation(s)
- E Ip
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - A M J Pokorny
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Della-Fiorentina
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Beale
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - V Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - B E Kiely
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Blinman
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Corriere MA, Avise JA, Peterson LA, Stafford JM, Easterling D, Boone DS, Ip E, Hyde AS, Burke GL. Exploring patient involvement in decision making for vascular procedures. J Vasc Surg 2015; 62:1032-1039.e2. [DOI: 10.1016/j.jvs.2015.04.443] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
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DeVita P, Seay JF, Fellin RE, Ip E, Stavro N, Messier S. The Relationships Between Age and Running Biomechanics. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478659.49575.13] [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: 11/21/2022]
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Kirk JK, Arcury TA, Ip E, Bell RA, Saldana S, Nguyen HT, Quandt SA. Diabetes symptoms and self-management behaviors in rural older adults. Diabetes Res Clin Pract 2015; 107:54-60. [PMID: 25467626 PMCID: PMC4309740 DOI: 10.1016/j.diabres.2014.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 01/07/2014] [Revised: 09/23/2014] [Accepted: 10/17/2014] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the demographic and health correlates of reporting diabetes symptoms, and the relationship between diabetes symptoms and self-management behaviors in rural older adults. METHODS Cross-sectional interviews were conducted with 489 African American, American Indian, and white female and male adults 60 years and older. Participants with diabetes were recruited from eight North Carolina counties. Participants completed the 34-item Diabetes Symptom Checklist (DSC). Associations of demographic and health characteristics with reported symptoms were evaluated. Multivariate linear regression models were used to examine the associations of DSC scores and diabetes self-management. RESULTS Participants had low scores on the DSC. They largely practiced appropriate diabetes self-management behaviors (self-foot checks, fruit and vegetable consumption, and self-monitoring blood glucose). Correlates of DSC included women having higher scores for hypoglycemia, psychological total, and fatigue dimensions. Neuropathic pain and vision dimensions were significantly associated with educational attainment. Most DSC dimensions were associated with ethnicity or economic status. Taking oral diabetes medicine was correlated with hyperglycemia; insulin use was associated with most DSC dimensions. HbA1c was not associated with any DSC dimension; diabetes duration >10 years was correlated with all dimensions except neuropathic pain and vision. Higher levels of psychological fatigue were significantly associated with fewer self-management behaviors. DISCUSSION/CONCLUSIONS Demographic and health characteristics are associated with reported symptoms. Fatigue is a symptom negatively associated with diabetes self-management behavior in older adults. Health care providers are uniquely positioned to assess patient symptoms and potential relationships with successful diabetes management.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America.
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Edward Ip
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Santiago Saldana
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Ha T Nguyen
- Department of Family and Community Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America
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Rapp S, Sink KM, Wilson V, Barnard R, Ip E. P4‐090: COGNITIVE ASSESSMENT WITH THE SIMULATED BEHAVIORAL ASSESSMENT OF COGNITION SYSTEM: COMPARISON OF OLDER ADULTS WITH NORMAL COGNITION, MILD COGNITIVE IMPAIRMENT AND DEMENTIA. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephen Rapp
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUnited States
| | - Kaycee M. Sink
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUnited States
| | - Valerie Wilson
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUnited States
| | - Ryan Barnard
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUnited States
| | - Edward Ip
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUnited States
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Abstract
OBJECTIVES To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes. METHODS 563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale. RESULTS Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders. CONCLUSIONS Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
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Affiliation(s)
- Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Shashi V, Veerapandiyan A, Schoch K, Kwapil T, Keshavan M, Ip E, Hooper S. Social skills and associated psychopathology in children with chromosome 22q11.2 deletion syndrome: implications for interventions. J intellect Disabil Res 2012; 56:865-78. [PMID: 21883601 DOI: 10.1111/j.1365-2788.2011.01477.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Although distinctive neuropsychological impairments have been delineated in children with chromosome 22q11 deletion syndrome (22q11DS), social skills and social cognition remain less well-characterised. OBJECTIVE To examine social skills and social cognition and their relationship with neuropsychological function/behaviour and psychiatric diagnoses in children with 22q11DS. METHODS Sixty-six children with 22q11DS and 54 control participants underwent neuropsychological testing and were administered the Diagnostic Analysis of Non-Verbal Accuracy (DANVA) for face and auditory emotion recognition, a measure of social cognition: their parents/guardians were administered the Social Skills Rating System (SSRS) - parent version, Child Behavior Checklist (CBCL) - parent version and the Computerised Diagnostic Interview Schedule for Children (C-DISC). RESULTS The 22q11DS group exhibited significantly lower social skills total score and more problem social behaviours, lower neurocognitive functioning, higher rates of anxiety disorders and more internalising symptoms than the control group. Participants with 22q11DS also exhibited significant deficits in their ability to read facial expressions compared with the control group, but performed no differently than the control participants in the processing of emotions by tone of voice. Within the 22q11DS group, higher social competency was correlated with higher global assessment of functioning and parental socio-economic status. Social competency was worse in those with anxiety disorders, attention deficit hyperactivity disorder, more than two psychiatric diagnoses on the C-DISC and higher internalising symptoms. No significant correlations of SSRS scores were seen with IQ, executive functions, attention, or verbal learning and memory. No correlations were found between social cognition and social skill scores. CONCLUSION Our results indicate that social skills in children with 22q11DS are associated with behaviour/emotional functioning and not with neurocognition. Thus, treating the behaviour or emotional problems such as attention deficit hyperactivity disorder and anxiety disorders may provide a pathway for improving social skills in these children.
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Affiliation(s)
- V Shashi
- Pediatric Genetics, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Choi SJ, Shively CA, Register TC, Feng X, Stehle J, High K, Ip E, Kritchevsky SB, Nicklas B, Delbono O. Force-generation capacity of single vastus lateralis muscle fibers and physical function decline with age in African green vervet monkeys. J Gerontol A Biol Sci Med Sci 2012; 68:258-67. [PMID: 22923428 DOI: 10.1093/gerona/gls143] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Previous studies on the contractile properties of human myofibrils reported increase, decrease, or no change with aging, perhaps due to the differences in physical activity, diet, and other factors. This study examined physical performance and contractile characteristics of myofibrils of vastus lateralis (VL) muscle in young adult and old African green vervet monkeys. Animals were offered the same diet and lived in the same enclosures during development, so we were able to examine skeletal muscle function in vivo and in vitro with fewer potential confounding factors than are typical in human research studies. Fiber atrophy alone did not account for the age-related differences in specific force and maximal power output. Regression modeling used to identify factors contributing to lower fiber force revealed that age is the strongest predictor. Our results support a detrimental effect of aging on the intrinsic force and power generation of myofilament lattice and physical performance in vervet monkeys.
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Affiliation(s)
- Seung Jun Choi
- Department of Internal Medicine, Gerontology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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Abstract
The "dual effects" hypothesis argues that social control can be effective in promoting positive health-related behavior change, but it can also jeopardize the targeted individual's well-being. This hypothesis is tested using hemoglobin A1C as an objective indicator of behavioral compliance with diabetes self-management behavior and depressive symptoms. Differences in the effects of social control on A1C and depressive symptoms by sex and ethnicity are tested. Cross-sectional data were obtained from a multi-ethnic sample of older adults with diabetes (N = 593). Greater social control was associated with poorer rather than better odds of achieving glucose control, and with greater depressive symptoms. There was no evidence that social control has differential effects on either glucose control or depressive symptoms by sex or ethnicity. Active use of social control attempts by family members and friends, especially if they are coercive or punitive in nature, are likely counterproductive for maintaining the physical and mental health of older adults with diabetes.
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Affiliation(s)
- Joseph G. Grzywacz
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of Medicine
| | - Julienne K. Kirk
- Department of Family and Community Medicine, Wake Forest School of Medicine
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine
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Abstract
BACKGROUND: Pediatric weight management clinics experience significant dropout, and few studies have investigated this problem. The objective of this study was to identify family and clinic characteristics associated with attrition from a tertiary care pediatric weight management clinic. METHODS: This was a prospective and retrospective clinical database study of a multidisciplinary clinic for obese children 2-18 years with a weight-related co-morbidity. All patients seen between November, 2007, and July, 2009, were included. Characteristics of Active and Inactive families were compared using chi-squared and t-tests, and logistic regression was used to identify independent correlates of program status. A one-page survey was mailed to all Inactive families. RESULTS: A total of 133 patients were seen during the study period. Their mean age was 12 years old, mean BMI was 38 kg/m(2), 53% were female, 52% represented racial/ethnic minorities, and 50% were Medicaid recipients. In all, 32% dropped out of treatment. Inactive children had significantly lower BMI z-scores, were older, and were more likely to have poor school performance than active children. Similar results were found on regression analysis: Children with higher BMI z-scores, commercial insurance, average school performance, and a major weight-related co-morbidity were less likely to be inactive. The most common parent-reported reasons for dropping out were: Child not wanting to make changes, weight not improving, child desired to leave program, and program not meeting parent or child's expectations. CONCLUSIONS: Attrition from pediatric weight management treatment is high, with age, weight, school performance, and health associated with dropout. Parents mostly reported child-related issues, including lack of weight loss, as reasons for dropout.
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Affiliation(s)
- Joseph A. Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.,Brenner FIT (Families In Training) Program, Brenner Children's Hospital, North Carolina Baptist Hospital, Winston-Salem, NC
| | - David C. Goff
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Edward Ip
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Bettina M. Beech
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC.,Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
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Veerapandiyan A, Blalock D, Ghosh S, Ip E, Barnes C, Shashi V. The role of cephalometry in assessing velopharyngeal dysfunction in velocardiofacial syndrome. Laryngoscope 2011; 121:732-7. [DOI: 10.1002/lary.21449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2010] [Indexed: 11/07/2022]
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Marsh AP, Haakonssen EH, Wrights AP, Pecorella A, Ip E, Rejeski WJ. A Self-Report Measure of Physical Function in Older Adults using Computer Animation: The Virtual Short Physical Performance Battery (vSPPB). Med Sci Sports Exerc 2010. [DOI: 10.1249/01.mss.0000385476.67038.a3] [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: 11/21/2022]
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Gleason JF, Case D, Rapp SR, Ip E, Naughton M, Butler JM, McMullen K, Stieber V, Saconn P, Shaw EG. Symptom clusters in patients with newly-diagnosed brain tumors. J Support Oncol 2007; 5:427-436. [PMID: 18019850] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A symptom cluster comprises three or more concurrent symptoms. There is a paucity of symptom cluster research in cancer patients. Data from a previously conducted clinical trial were analyzed to search for symptom clusters. This phase III, placebo-controlled, double-blind, prospective, randomized clinical trial of 66 patients assessed the effect of prophylactic d-threo-methylphenidate (d-MPH) on quality of life (QOL) in newly diagnosed brain tumor patients receiving brain radiation therapy. Patients received 5-15 mg of d-MPH or placebo twice daily starting on week 1 of radiation therapy and continuing for 8 weeks post radiotherapy. QOL data were collected at baseline; the end of radiation therapy; and 4, 8, and 12 weeks following radiation therapy using the Functional Assessment of Cancer Therapy (FACT), the FACT-Brain subscale, and the Center for Epidemiologic Studies Depression Scale. Exploratory factor analysis, multidimensional scaling (MDS), and cluster analysis were used to search for symptom clusters. The trial failed to show a treatment effect; patients receiving d-MPH or placebo were analyzed together to search for clusters. Two symptom clusters were identified using exploratory factor analysis--a language cluster including difficulty reading, writing, and finding the right words and a mood cluster including feelings of sadness, anxiety, and depressed mood; these clusters were supported by MDS and cluster analysis. Our results suggest that interventions that target both cognitive function and mood should be considered in this patient population. Further research on symptom clusters in brain tumor patients is needed.
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Affiliation(s)
- John F Gleason
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Brenes GA, Williamson JD, Messier SP, Rejeski WJ, Pahor M, Ip E, Penninx BWJH. Treatment of minor depression in older adults: a pilot study comparing sertraline and exercise. Aging Ment Health 2007; 11:61-8. [PMID: 17164159 PMCID: PMC2885010 DOI: 10.1080/13607860600736372] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to conduct a pilot clinical trial to test the feasibility and efficacy of an exercise program and anti-depressant treatment compared with usual care in improving the emotional and physical functioning of older adults with minor depression. Participants were 37 older adults with minor depression who were randomized to exercise, sertraline, or usual care; 32 participants completed the 16-week study. Outcomes included measures of both emotional (clinician and self-report) and physical (observed and self-report) functioning. There were trends for the superiority of the exercise and sertraline conditions over usual care in improving SF-36 mental health scores and clinician-rated depression scores. Individuals in the exercise condition showed greater improvements in physical functioning than individuals in the usual care condition. Both sertraline and exercise show promise as treatments for late-life minor depression. However, exercise has the added benefit of improving physical functioning as well.
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Affiliation(s)
- G A Brenes
- Department of Social Sciences and Health Policy, Winston-Salem, NC 25157, USA.
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Avis NE, Ip E, Foley KL. Evaluation of the Quality of Life in Adult Cancer Survivors (QLACS) scale for long-term cancer survivors in a sample of breast cancer survivors. Health Qual Life Outcomes 2006; 4:92. [PMID: 17140438 PMCID: PMC1697806 DOI: 10.1186/1477-7525-4-92] [Citation(s) in RCA: 53] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 12/01/2006] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This paper evaluates psychometric properties of a recently developed measure focusing on the health-related quality of life (HRQL) of long-term cancer survivors, the Quality of Life in Adult Survivors scale (QLACS), in a sample of breast cancer survivors. This represents an important area of study, given the large number of breast cancer patients surviving many years post diagnosis. METHODS Analyses are based on an 8-year follow-up of a sample of breast cancer survivors who participated in an earlier study conducted in 1995. Participants were re-contacted in 2003 and those who were reachable and agreed to participate (n = 94) were surveyed using a variety of measures including the QLACS. Additional follow-up surveys were conducted 2 weeks and one year later. Psychometric tests of the QLACS included test-retest reliability, concurrent and retrospective validity, and responsiveness. RESULTS The QLACS domain and summary scores showed good test-retest reliability (all test-retest correlations were above .7) and high internal consistency. The Generic Summary Score showed convergent validity with other measures designed to assess generic HRQL. The Cancer-Specific Summary score exhibited divergent validity with generic HRQL measures, but not a cancer-related specific measure. The QLACS Cancer-Specific Summary Score demonstrated satisfactory predictive validity for factors that were previously shown to be correlated with HRQL. The QLACS generally demonstrated a high level of responsiveness to life changes. CONCLUSION The QLACS may serve as a useful measure for assessing HRQL among long-term breast cancer survivors that are not otherwise captured by generic measures or those specifically designed for newly diagnosed patients.
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Affiliation(s)
- Nancy E Avis
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Edward Ip
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristie Long Foley
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Abstract
8581 Background: Symptom clusters, whereby ≥2 symptoms coexist within patients, occur with cancer and its treatment. Identification and treatment of symptom clusters may improve functional status and health-related quality of life (HRQL). We report the characterization of symptom clusters occurring in irradiated brain tumor survivors. Materials/Methods: 34 adult survivors of primary or metastatic brain tumors following partial or whole brain irradiation ≥6 months prior were enrolled in an open-label Phase II study of donepezil, an acetylcholinesterase inhibitor (Rapp et al and Shaw et al, Neuro-Oncology 6:357 and 358, 2004). Eligibility criteria included life expectancy ≥30 weeks, no imaging evidence of progressive brain disease ≥3 months, stable/decreasing steroid dose, Karnofsky Performance Status (KPS) ≥70, and no brain tumor therapy during the study period. Patients received donepezil 5mg/day for 6 weeks, then 10mg/day for 18 weeks, followed by 6 weeks observation off drug. Symptoms were assessed at baseline, 6, 12, 24, and 30 weeks with the Functional Assessment of Cancer Therapy - Brain (FACT-Br) and Profile of Mood States (POMS). Factor analysis, multidimensional scaling and multivariate cluster analysis were used to characterize symptom clustering. Results: Of 34 patients enrolled, 24 remained on study for 24 weeks and 21 remained for the entire 30 weeks. Utilizing the HRQL data, all three methods of analysis demonstrated 3 distinct symptom clusters: mood, cognition and energy. The factor analysis table below illustrates such findings. Conclusions: Three symptom clusters with symptoms related to mood, cognitive function and energy were identified in this group of irradiated brain tumor survivors. Further research should focus on therapeutic interventions for symptom clusters rather than the traditional emphasis on single-symptom therapy. This study was supported by NCI grant 1 U10 CA81851. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
| | - E. Ip
- Wake Forest University, Winston Salem, NC
| | - S. Rapp
- Wake Forest University, Winston Salem, NC
| | | | | | - J. Gleason
- Wake Forest University, Winston Salem, NC
| | - E. G. Shaw
- Wake Forest University, Winston Salem, NC
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Gleason J, Case D, Rapp S, Ip E, Naughton M, Butler J, McMullen K, Stieber V, Saconn P, Shaw E. Symptom clusters in newly-diagnosed brain tumor patients. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.8587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8587 Background: A symptom cluster is 2 or more co-occurring symptoms. Patients with brain tumors experience disease and treatment-related symptoms that impact their health-related quality of life (QOL). Identifying symptom clusters will facilitate treatment and improve QOL outcomes. Methods: 66 patients were enrolled in a phase III, placebo-controlled, double-blind, prospective randomized clinical trial assessing the effect of prophylactic d-methylphenidate (d-MPH) on QOL in newly diagnosed brain tumor patients receiving brain radiation therapy (RT). Inclusion criteria were: age ≥ 13 years, primary or metastatic brain tumor, partial or whole brain RT with a total dose of ≥ 2,500 cGy in ≥ 10 fractions, KPS ≥ 70, and life expectancy ≥ 3 months. Patients received d-MPH 5–15 mg BID (or placebo) starting week 1 of RT and continuing for 8 weeks post-RT. QOL data were collected at baseline, the end of RT, and 4, 8, and 12 weeks following RT using the Functional Assessment of Cancer Therapy-Brain (FACT-Br) and the Center for Epidemiologic Studies Depression Scale (CES-D). Symptom data were analyzed using exploratory factor analysis, multi-dimensional scaling (MDS), and cluster analysis. Results: The study failed to show a treatment effect for d-MPH (Butler J et al, Int J Radiat Oncol Biol Physics 63 [Supp1]:80, 2005).Thus, both d-MPH and placebo patients were analyzed together. 58 and 48 patients were analyzed at baseline and the end of RT, respectively. Two symptom clusters were identified using exploratory factor analysis and supported by MDS and cluster analysis: an expressive language cluster including difficulty reading, writing, and finding the right words, and a mood cluster including feeling sad, anxious, and having depressed mood. Conclusions: Two symptom clusters were identified in patients undergoing brain RT: an expressive language cluster and a mood cluster. This suggests that interventions that target both cognitive function and mood should be utilized. Further research on symptom clusters in cancer patients is needed. This study was supported by NCI grant 1 U10 CA81851. No significant financial relationships to disclose.
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Affiliation(s)
- J. Gleason
- Wake Forest University School of Medicine, Winston Salem, NC
| | - D. Case
- Wake Forest University School of Medicine, Winston Salem, NC
| | - S. Rapp
- Wake Forest University School of Medicine, Winston Salem, NC
| | - E. Ip
- Wake Forest University School of Medicine, Winston Salem, NC
| | - M. Naughton
- Wake Forest University School of Medicine, Winston Salem, NC
| | - J. Butler
- Wake Forest University School of Medicine, Winston Salem, NC
| | - K. McMullen
- Wake Forest University School of Medicine, Winston Salem, NC
| | - V. Stieber
- Wake Forest University School of Medicine, Winston Salem, NC
| | - P. Saconn
- Wake Forest University School of Medicine, Winston Salem, NC
| | - E. Shaw
- Wake Forest University School of Medicine, Winston Salem, NC
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Abstract
BACKGROUND Studies indicate that children use media (television, video, and computer) more than the recommended limit of 2 h/d, but little is known about parents' role in mediating their children's media use. DESIGN Office-based survey. Data were collected on demographics, reported media behaviors, parental awareness about media effects, television in the bedroom, and parental concern. We developed logistic regression models to examine factors associated with the following 3 mediation approaches: restrictive, instructive, and unlimited. SETTING Pediatric Research in Office Settings practices. PARTICIPANTS Parents with children aged 2 to 11 years (n = 1831) presenting for a well-child visit. RESULTS Almost half of parents reported a single mediation approach, including restrictive for 23%, instructive for 11%, and unlimited for 7%, with 59% reporting the use of multiple strategies. Restrictive (odds ratio [OR], 1.16; P<.001) and instructive (OR, 1.06; P = .02) approaches were associated with increased awareness about negative media effects, whereas a decreased awareness existed for those who used an unlimited approach (OR, 0.87; P<.001). A restrictive strategy also occurred with increased parental concern (OR, 1.77; P<.001) and 2 adults in the home (OR, 1.64; P<.01). The only strategy associated with the child's age was instructive mediation, noted more often with younger children (OR, 1.41; P<.001). Allowing unlimited media use occurred when parents permitted a television in the child's bedroom (OR, 2.13; P<.001) and were Latino (OR, 2.03; P<.01) or African American (OR, 2.20; P<.001). Mother as primary decision maker and maternal education were not statistically significant. CONCLUSIONS Pediatric health care providers should identify parental practices and reinforce active media mediation strategies.
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Affiliation(s)
- Shari Barkin
- Department of Pediatrics, Wake Forest University Baptist Medical Center,Wake Forest University, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Abstract
OBJECTIVE Anticipatory guidance is a cornerstone of primary care pediatrics. Despite the fact that retention of information is essential for later action, data are lacking on what parents recall immediately after the visit and 1 month later and how the total number of topics discussed affects this outcome. METHODS Parents and practitioners completed postvisit surveys of anticipatory guidance topics discussed during health-maintenance visits for children ages 2-11. Postvisit and 1 month later, parental recall was compared with provider report of topics discussed. We examined the relationship between parental recall and the total number of topics discussed. RESULTS Families with children ages 2-11 years from across the United States participated in this study (N = 861). Providers reported discussing the topics of nutrition, car restraints, dental care, and reading aloud most often (72%- 93%). Concordance between parent and provider was high for all topics (72%-90%). Immediately postvisit, parents reported 6.33 (SD 2.9) as the mean number of topics discussed while providers reported 6.9 (SD 2.7) as the mean number of topics discussed. However, parental recall decreased significantly with more topics (> or =9) discussed. The same trend existed 1 month later. CONCLUSIONS Providers and parents have good agreement about topics discussed or not discussed during a well-child visit; however, parental recall dwindles with increasing numbers of topics discussed. Rethinking well-child care to limit the total number of topics discussed is warranted.
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Affiliation(s)
- Shari L Barkin
- Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Marsh AP, Rejeski WJ, Hutton SL, Brown CL, Ip E, Guralnik JM. Development of a Lateral Mobility Task to Identify Individuals at Risk for Mobility Disability and Functional Decline. J Aging Phys Act 2005; 13:363-81. [PMID: 16301751 DOI: 10.1123/japa.13.4.363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 11/18/2022]
Abstract
Lateral mobility is integral to many activities of daily living involving transfer from one position to another. The objective of this study was to develop and evaluate the validity and test–retest reliability of a lateral-mobility (LATMOB) task for older adults. Measurements of lateral mobility, balance, and strength and self-reported and performance-based physical functioning were obtained in 63 women and 77 men ≥50 years of age. The LATMOB task was significantly correlated with age, knee-extensor strength, grip strength, functional reach, and one-leg-stance time. Test–retest reliability of the task was excellent. The LATMOB task was highly correlated with the car task. Balance was significantly correlated with time to get into and out of a car and performance on the LATMOB task. The LATMOB task was significantly correlated with the Short Physical Performance Battery score. The LATMOB task is valid and reliable, but additional work is needed to assess its sensitivity to change and predictive validity.
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Affiliation(s)
- Anthony P Marsh
- Dept. of Health and Exercise Sciences, Wake Forest University, Winston-Salem, NC 27109-7868, USA
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Affiliation(s)
- M. J. Naughton
- Wake Forest Univ Sch of Medicine, Winston-Salem, NC; Memorial Sloan-Kettering Cancer Ctr, New York, NY; Ohio State Univ, Columbus, OH; Univ of Texas - Southwestern, Dallas, TX
| | - J. A. Petrek
- Wake Forest Univ Sch of Medicine, Winston-Salem, NC; Memorial Sloan-Kettering Cancer Ctr, New York, NY; Ohio State Univ, Columbus, OH; Univ of Texas - Southwestern, Dallas, TX
| | - E. Ip
- Wake Forest Univ Sch of Medicine, Winston-Salem, NC; Memorial Sloan-Kettering Cancer Ctr, New York, NY; Ohio State Univ, Columbus, OH; Univ of Texas - Southwestern, Dallas, TX
| | - E. D. Paskett
- Wake Forest Univ Sch of Medicine, Winston-Salem, NC; Memorial Sloan-Kettering Cancer Ctr, New York, NY; Ohio State Univ, Columbus, OH; Univ of Texas - Southwestern, Dallas, TX
| | - E. Naftalis
- Wake Forest Univ Sch of Medicine, Winston-Salem, NC; Memorial Sloan-Kettering Cancer Ctr, New York, NY; Ohio State Univ, Columbus, OH; Univ of Texas - Southwestern, Dallas, TX
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