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Mitchell JT, Covington NV, Morrow E, de Riesthal M, Duff MC. Memory and Traumatic Brain Injury: Assessment and Management Practices of Speech-Language Pathologists. Am J Speech Lang Pathol 2024; 33:279-306. [PMID: 38032245 PMCID: PMC10950318 DOI: 10.1044/2023_ajslp-23-00231] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/14/2023] [Accepted: 09/27/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Memory impairments are among the most commonly reported deficits and among the most frequent rehabilitation targets for individuals with traumatic brain injury (TBI). Memory and learning are also critical for rehabilitation success and broader long-term outcomes. Speech-language pathologists (SLPs) play a central role in memory management for individuals with TBI across the continuum of care. Yet, little is known about the current practice patterns of SLPs for post-TBI memory disorders. This study aims to examine the clinical management of memory disorders in adults with TBI by SLPs and identify opportunities to improve post-TBI memory outcomes. METHOD SLPs from across the continuum of care were recruited to complete an online survey. The survey assessed key practice areas specific to memory and memory disorders post-TBI, including education and training, knowledge and confidence, and assessment and treatment patterns. RESULTS Surveys from 155 SLPs were analyzed. Results revealed that TBI-specific training remains low in the field. Respondents varied in their practice patterns in assessing and treating memory disorders. Most SLPs do not appear to have access to appropriate standardized assessments to measure unique forms of memory. Respondents also reported a range of barriers and opportunities to advance memory outcomes following TBI and provided suggestions of areas in which they would like to see more basic and clinical research. CONCLUSIONS These findings establish a baseline of the current practices for clinical management of memory impairment in adults with TBI by SLPs. Improved opportunities for clinician training, the development of a single tool to assess multiple forms of memory, better access to existing memory assessments, and implementation of evidence-based interventions promise to lead to improved memory outcomes for individuals with TBI.
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Affiliation(s)
- Jade T. Mitchell
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Natalie V. Covington
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis
- Courage Kenny Research, Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN
| | - Emily Morrow
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, TN
| | - Michael de Riesthal
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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2
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Ellis SD, Brooks JV, Birken SA, Morrow E, Hilbig ZS, Wulff-Burchfield E, Kinney AY, Ellerbeck EF. Determinants of targeted cancer therapy use in community oncology practice: a qualitative study using the Theoretical Domains Framework and Rummler-Brache process mapping. Implement Sci Commun 2023; 4:66. [PMID: 37308981 PMCID: PMC10259814 DOI: 10.1186/s43058-023-00441-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Precision medicine holds enormous potential to improve outcomes for cancer patients, offering improved rates of cancer control and quality of life. Not all patients who could benefit from targeted cancer therapy receive it, and some who may not benefit do receive targeted therapy. We sought to comprehensively identify determinants of targeted therapy use among community oncology programs, where most cancer patients receive their care. METHODS Guided by the Theoretical Domains Framework, we conducted semi-structured interviews with 24 community cancer care providers and mapped targeted therapy delivery across 11 cancer care delivery teams using a Rummler-Brache diagram. Transcripts were coded to the framework using template analysis, and inductive coding was used to identify key behaviors. Coding was revised until a consensus was reached. RESULTS Intention to deliver precision medicine was high across all participants interviewed, who also reported untenable knowledge demands. We identified distinctly different teams, processes, and determinants for (1) genomic test ordering and (2) delivery of targeted therapies. A key determinant of molecular testing was role alignment. The dominant expectation for oncologists to order and interpret genomic tests is at odds with their role as treatment decision-makers' and pathologists' typical role to stage tumors. Programs in which pathologists considered genomic test ordering as part of their staging responsibilities reported high and timely testing rates. Determinants of treatment delivery were contingent on resources and ability to offset delivery costs, which low- volume programs could not do. Rural programs faced additional treatment delivery challenges. CONCLUSIONS We identified novel determinants of targeted therapy delivery that potentially could be addressed through role re-alignment. Standardized, pathology-initiated genomic testing may prove fruitful in ensuring patients eligible for targeted therapy are identified, even if the care they need cannot be delivered at small and rural sites which may have distinct challenges in treatment delivery. Incorporating behavior specification and Rummler-Brache process mapping with determinant analysis may extend its usefulness beyond the identification of the need for contextual adaptation.
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Affiliation(s)
- Shellie D. Ellis
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Joanna Veazey Brooks
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | - Sarah A. Birken
- Wake Forest University School of Medicine, 525 Vine Street, Winston-Salem, NC 27101 USA
| | - Emily Morrow
- Kansas City Kansas Community College, 7250 State Ave., Kansas City, KS 66112 USA
| | - Zachary S. Hilbig
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
| | | | - Anita Y. Kinney
- Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St., New Brunswick, NJ 08901 USA
| | - Edward F. Ellerbeck
- University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66610 USA
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3
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Clough S, Morrow E, Mutlu B, Turkstra L, Duff MC. Emotion recognition of faces and emoji in individuals with moderate-severe traumatic brain injury. Brain Inj 2023; 37:596-610. [PMID: 36847497 PMCID: PMC10175112 DOI: 10.1080/02699052.2023.2181401] [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: 05/26/2022] [Revised: 01/11/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Facial emotion recognition deficits are common after moderate-severe traumatic brain injury (TBI) and linked to poor social outcomes. We examine whether emotion recognition deficits extend to facial expressions depicted by emoji. METHODS Fifty-one individuals with moderate-severe TBI (25 female) and fifty-one neurotypical peers (26 female) viewed photos of human faces and emoji. Participants selected the best-fitting label from a set of basic emotions (anger, disgust, fear, sadness, neutral, surprise, happy) or social emotions (embarrassed, remorseful, anxious, neutral, flirting, confident, proud). RESULTS We analyzed the likelihood of correctly labeling an emotion by group (neurotypical, TBI), stimulus condition (basic faces, basic emoji, social emoji), sex (female, male), and their interactions. Participants with TBI did not significantly differ from neurotypical peers in overall emotion labeling accuracy. Both groups had poorer labeling accuracy for emoji compared to faces. Participants with TBI (but not neurotypical peers) had poorer accuracy for labeling social emotions depicted by emoji compared to basic emotions depicted by emoji. There were no effects of participant sex. DISCUSSION Because emotion representation is more ambiguous in emoji than human faces, studying emoji use and perception in TBI is an important consideration for understanding functional communication and social participation after brain injury.
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Affiliation(s)
- Sharice Clough
- Department of Hearing and Speech Sciences, Vanderbilt
University Medical Center
| | - Emily Morrow
- Department of Hearing and Speech Sciences, Vanderbilt
University Medical Center
| | - Bilge Mutlu
- Department of Computer Sciences, University of
Wisconsin-Madison
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University
| | - Melissa C. Duff
- Department of Hearing and Speech Sciences, Vanderbilt
University Medical Center
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Bridges KM, LeMaster JW, Parente DJ, Pacheco CM, Schultz C, Morrow E, Corriveau E, Miras Neira T, Greiner KA, Woodward J, Anders- Rumsey J, Cirotski D, Finocchario-Kessler S, Ellerbeck EF. Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers. J Prim Care Community Health 2023; 14:21501319231214513. [PMID: 38041409 PMCID: PMC10693805 DOI: 10.1177/21501319231214513] [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: 09/10/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION Rural and under-resourced urban communities face unique challenges in addressing patients' social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs. METHODS Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics. RESULTS Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers. CONCLUSIONS Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained.
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Affiliation(s)
| | | | | | | | | | - Emily Morrow
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Erin Corriveau
- University of Kansas Medical Center, Kansas City, KS, USA
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5
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Ellis SD, Hwang S, Morrow E, Kimminau KS, Goonan K, Petty L, Ellerbeck E, Thrasher JB. Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists. BMC Cancer 2021; 21:649. [PMID: 34058998 PMCID: PMC8165996 DOI: 10.1186/s12885-021-08386-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists' recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting. METHODS We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention. RESULTS Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient's ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation. CONCLUSIONS Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.
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Affiliation(s)
- Shellie D. Ellis
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Soohyun Hwang
- Department of Health Policy and Management, School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Drive, 1101 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7411 USA
| | - Emily Morrow
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Kim S. Kimminau
- Department of Family Medicine, School of Medicine, University of Kansas, Kansas City, KS USA
| | - Kelly Goonan
- Independent Researcher/Consultant/Scientific Writer, Greensboro, NC USA
| | - Laurie Petty
- Department of Sociology, University of Kansas, Kansas City, KS USA
| | - Edward Ellerbeck
- Department of Population Health, School of Medicine, University of Kansas, Kansas City, KS USA
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Fitzal F, Bolliger M, Dunkler D, Gambone L, Heil J, Riedel F, de Boniface J, André C, Matrai Z, Pukancsik D, Paulinelli R, Ostapenko V, Burneckis A, Ostapenko A, Ostapenko E, Meani F, Harder Y, Bonollo M, Alberti A, Tausch C, Papassotiropoulos B, Helfgott R, Heck D, Fehrer H, Acko M, Schrenk P, Montagna G, Trapp E, Pristauz G, Paliczek C, Blohmer J, Steffen S, Romics L, Morrow E, Lorenz K, Fehr M, Ritter M, Weber W. Retrospective multicenter analysis comparing conventional with oncoplastic breast conservation: oncologic and surgical outcome in women with high risk breast cancer from the OPBC-01/iTOP2 study. Breast 2021. [DOI: 10.1016/s0960-9776(21)00222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Morrow E, Patel N, Duff M. Consequences of COVID-19: A Survey of Individuals with Chronic Traumatic Brain Injury. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Sykes KJ, Morrow E, Smith JB, Holcomb AJ, TenNapel M, Lominska CE, Bur AM, Kakarala K. What is the hold up?—Mixed‐methods analysis of postoperative radiotherapy delay in head and neck cancer. Head Neck 2020; 42:2948-2957. [DOI: 10.1002/hed.26355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/25/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kevin J. Sykes
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Emily Morrow
- Department of Sociology University of Kansas Lawrence Kansas USA
- Department of Social and Behavioral Sciences and Public Services Kansas City Kansas Community College Kansas City Kansas USA
| | - Joshua B. Smith
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Andrew J. Holcomb
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Mindi TenNapel
- Department of Radiation Oncology University of Kansas Medical Center Kansas City Kansas USA
| | | | - Andrés M. Bur
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Kiran Kakarala
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
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9
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Brooks JV, Ellis SD, Morrow E, Kimminau KS, Thrasher JB. Patient Factors That Influence How Physicians Discuss Active Surveillance With Low-Risk Prostate Cancer Patients: A Qualitative Study. Am J Mens Health 2018; 12:1719-1727. [PMID: 29973123 PMCID: PMC6142114 DOI: 10.1177/1557988318785741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/16/2022] Open
Abstract
For men diagnosed with prostate cancer, making treatment decisions can be overwhelming. Navigating treatment options, along with potential treatment side effects, can be difficult, and patients often rely heavily on the advice of their physicians. This study was aimed at understanding more about the way urologists talk with their patients about one treatment option: active surveillance (AS), a recognized management strategy for men with low-risk prostate cancer that includes close observation and monitoring of the cancer. This study reports, through 22 interviews with urologists, that urologists believe patients are hesitant about AS for a number of reasons, including misperceptions about cancer severity, anxiety, aversion to repeated biopsies that accompany AS, or family member preferences. Because urologists play an influential role in educating patients about treatment options, the discussion around AS can be impacted by barriers that physicians believe matter for their patients. Improving awareness among urologists about what factors impact their patient education about low-risk prostate cancer is important. Identifying tools to improve shared decision making in this area could result in treatment decisions that are increasingly concordant with patients' values, concerns, and goals.
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Affiliation(s)
- Joanna Veazey Brooks
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA
| | - Shellie D Ellis
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA
| | - Emily Morrow
- 2 Department of Sociology, University of Kansas, Lawrence, KS, USA
| | - Kim S Kimminau
- 1 Department of Health Policy and Management, University of Kansas Medical Center, Kansas City, KS, USA.,3 Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - J Brantley Thrasher
- 4 Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
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10
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Cubuk ED, Ivancic RJS, Schoenholz SS, Strickland DJ, Basu A, Davidson ZS, Fontaine J, Hor JL, Huang YR, Jiang Y, Keim NC, Koshigan KD, Lefever JA, Liu T, Ma XG, Magagnosc DJ, Morrow E, Ortiz CP, Rieser JM, Shavit A, Still T, Xu Y, Zhang Y, Nordstrom KN, Arratia PE, Carpick RW, Durian DJ, Fakhraai Z, Jerolmack DJ, Lee D, Li J, Riggleman R, Turner KT, Yodh AG, Gianola DS, Liu AJ. Structure-property relationships from universal signatures of plasticity in disordered solids. Science 2018; 358:1033-1037. [PMID: 29170231 DOI: 10.1126/science.aai8830] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 03/15/2017] [Accepted: 10/18/2017] [Indexed: 11/02/2022]
Abstract
When deformed beyond their elastic limits, crystalline solids flow plastically via particle rearrangements localized around structural defects. Disordered solids also flow, but without obvious structural defects. We link structure to plasticity in disordered solids via a microscopic structural quantity, "softness," designed by machine learning to be maximally predictive of rearrangements. Experimental results and computations enabled us to measure the spatial correlations and strain response of softness, as well as two measures of plasticity: the size of rearrangements and the yield strain. All four quantities maintained remarkable commonality in their values for disordered packings of objects ranging from atoms to grains, spanning seven orders of magnitude in diameter and 13 orders of magnitude in elastic modulus. These commonalities link the spatial correlations and strain response of softness to rearrangement size and yield strain, respectively.
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Affiliation(s)
- E D Cubuk
- Google Brain, Mountain View, CA 94043, USA
| | - R J S Ivancic
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S S Schoenholz
- Google Brain, Mountain View, CA 94043, USA.,Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - D J Strickland
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A Basu
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Z S Davidson
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Fontaine
- Laboratoire de Tribologie et Dynamique des Systémes, École Centrale de Lyon, CNRS UMR 5513, Université de Lyon, 69134 Ecully Cedex, France
| | - J L Hor
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Y-R Huang
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Y Jiang
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - N C Keim
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA 19104, USA.,Physics Department, California Polytechnic State University, San Luis Obispo, CA 93407, USA
| | - K D Koshigan
- Laboratoire de Tribologie et Dynamique des Systémes, École Centrale de Lyon, CNRS UMR 5513, Université de Lyon, 69134 Ecully Cedex, France
| | - J A Lefever
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - T Liu
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - X-G Ma
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA.,Complex Assemblies of Soft Matter, CNRS-Solvay-UPenn UMI 3254, Bristol, PA 19007, USA
| | - D J Magagnosc
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - E Morrow
- Department of Physics, Houghton College, Houghton, NY 14744, USA
| | - C P Ortiz
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J M Rieser
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A Shavit
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - T Still
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Y Xu
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Y Zhang
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - K N Nordstrom
- Department of Physics, Mount Holyoke College, South Hadley, MA 01075, USA
| | - P E Arratia
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - R W Carpick
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - D J Durian
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Z Fakhraai
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - D J Jerolmack
- Department of Earth and Environmental Sciences, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daeyeon Lee
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ju Li
- Department of Nuclear Science and Engineering and Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - R Riggleman
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - K T Turner
- Department of Mechanical Engineering and Applied Mechanics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A G Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - D S Gianola
- Materials Department, University of California, Santa Barbara, CA 93106, USA.
| | - Andrea J Liu
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA.
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11
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Morrow E, Lannigan A, Doughty J, Litherland J, Mansell J, Stallard S, Mallon E, Romics L. Population-based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node-positive invasive lobular carcinoma of the breast. Br J Surg 2018; 105:987-995. [PMID: 29623677 DOI: 10.1002/bjs.10791] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/12/2017] [Accepted: 11/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared. METHODS All women diagnosed with pure ILC or IDC in the West of Scotland in 2012-2014 were identified from a database maintained prospectively within the Managed Clinical Network. Pretreatment axillary ultrasound imaging (AUS), core biopsy and fine-needle aspiration cytology (FNAC) results were compared between ILC and IDC. RESULTS Some 602 women with ILC and 4199 with IDC had undergone axillary surgery, of whom 209 and 1402 respectively had nodal metastases. Pretreatment AUS sensitivity was significantly lower in ILC than in IDC (32·1 versus 50·1 per cent respectively, P < 0·001; OR 0·47, 95 per cent c.i. 0·34 to 0·64). Core biopsy had equally high sensitivity of 86 per cent in both subtypes; however, FNAC was significantly less sensitive in both ILC (55 per cent; P = 0·003) and IDC (75·6 per cent; P = 0·006). Multivariable analysis revealed that cT3-4 status and symptomatic presentation were both significant in predicting nodal metastasis in patients with ILC and false-negative AUS findings (OR 3·77, 95 per cent c.i. 1·69 to 8·42, P = 0·001; and OR 1·92, 1·24 to 2·98, P = 0·003, respectively). CONCLUSION AUS is inferior in detecting axillary node metastasis in ILC compared with IDC. Women with cT3-4 lobular carcinoma may benefit from ultrasound-guided axillary biopsy regardless of the ultrasonographic appearance of the nodes.
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Affiliation(s)
- E Morrow
- Department of Academic Surgery, University of Glasgow, Glasgow, UK
| | - A Lannigan
- Department of Surgery, Wishaw General Hospital, Wishaw, UK
| | - J Doughty
- Department of Surgery, Gartnavel General Hospital, Glasgow, UK
| | - J Litherland
- Department of Radiology, West of Scotland Breast Screening Centre, Glasgow, UK
| | - J Mansell
- Department of Surgery, Wishaw General Hospital, Wishaw, UK
| | - S Stallard
- Department of Surgery, Gartnavel General Hospital, Glasgow, UK
| | - E Mallon
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - L Romics
- Department of Academic Surgery, University of Glasgow, Glasgow, UK.,Department of Surgery, New Victoria Hospital, Glasgow, UK
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12
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Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Abstract P4-13-01: Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-13-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: current evidence for oncoplastic breast conservation (OBC) is based on single institutional series. We studied the outcomes of OBC practice in Scotland and compare individual breast units.
Methods: a predefined database of patients treated with OBC was completed retrospectively in 11 breast units in Scotland. Patients were treated with OBC from 2005 onwards were included. For statistical calculations Chi-test, ANOVA and Pearson correlation analysis were used.
Results: Altogether 589 patients were included. Median age was 56 years [21-86]. Patients were diagnosed between September 2005 and March 2017. Number of patients treated with OBC per unit ranged between 4 and 145. High volume units were doing a mean of 19.3 OBCs per year [17.3 – 26.5] vs. low volume units doing 11.1 OBCs per year [7 .7– 14.4] (p=0.012).
23 different oncoplastic surgical techniques were applied. Range of oncoplastic techniques used was associated with case-loads: high volume units used a wider range (8 – 14 different techniques) compared to low volume units (3 – 6) (p=0.004). Volume displacement was done in 515 patients (91.3%), volume replacement in 49 patients (8.7%). OBC was carried out as a joint operation between a breast and a plastic surgeon in 66.3% (389 patients). Immediate contralateral symmetrisation rate was significantly higher when the procedure was carried out as a joint operation (70.7% vs. not joint operations: 29.8%; p<0.001).
Incomplete excision rate was 10.4% (60 of 578). Incomplete excision was significantly higher after invasive lobular carcinoma (18.9%; 10 of 43; p=0.0292). After neoadjuvant chemotherapy incomplete excision rate was significantly lower (3%; 2 of 66 vs. no neoadjuvant chemotherapy: 11%; 35 of 319; p=0.031).
Neodjuvant systemic treatment rate was 28.6% (142 of 496 patients). Of those 68 patients received neoadjuvant chemotherapy (13.7%) and 74 patients had neoadjuvant hormonal treatment (14.9%). Neoadjuvant systemic treatment rate varied amongst the units from 9.7% to 57.2% for patients with invasive carcinoma.
259 patients diagnosed with (non)invasive carcinoma had a median follow-up time of 5 years [35-124]. Of these 7 patients (2.7%) developed isolated local recurrence. 5-year local recurrence rate after DCIS was higher than after pure invasive ductal carcinoma (DCIS: 8.3%; 3 of 36 vs. ductal: 1.6%; 3 of 181; p=0.02567). 5-year disease-free survival of these patients was 91.7%, overall survival was 93.8%, and cancer-specific survival was 96.1%.
145 of 510 patients developed complications, which is 28.4% overall complication rate. 71 patients had major complications (13.9%) and 74 patients had minor complications (14.5%). Overall complication rate was significantly lower after neoadjuvant chemotherapy (15.9%; 11 of 69) compared to patients who did not receive neoadjuvant chemotherapy (27.9%; 127 of 455 patients) (p=0.035).
Conclusion: this national audit demonstrated similar outcomes overall compared to relevant published data. Units should be urged to build stronger collaboration in order to reduce variability in OBC practices.
None of the authors have conflict of interest to declare.
Citation Format: Romics L, Macaskill J, Fernandez T, Morrow E, Simpson L, Pitsinis V, Barber M, Tovey S, Masannat Y, Young O, Mansell J, Stallard S, Doughty J, Dixon M. Oncoplastic breast conservations – The Scottish Audit: Surgical techniques, oncological outcomes, complication rates and variations in practice across the country based on the analysis of 589 patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-01.
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Affiliation(s)
- L Romics
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Macaskill
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - T Fernandez
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - E Morrow
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - L Simpson
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - V Pitsinis
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - M Barber
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - S Tovey
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - Y Masannat
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - O Young
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Mansell
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - S Stallard
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - J Doughty
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
| | - M Dixon
- New Victoria Hospital Glasgow, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; University of Glasgow, United Kingdom; Aberdeen Royal Infirmary, United Kingdom; University Hospital Crosshouse, Ayrshire, United Kingdom; Wishaw General Hospital, Lanarkshire, United Kingdom; Gartnavel General Hospital, Glasgow, United Kingdom; New Stobhill Hospital, Glasgow, United Kingdom
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Morrow E, Griffard A, Murray J, Lannigan A. Abstract P2-10-06: The long term outcomes of female patients treated with primary endocrine therapy for non-metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- E Morrow
- Wishaw General Hospital, Wishaw, Lanarkshire, United Kingdom
| | - A Griffard
- Wishaw General Hospital, Wishaw, Lanarkshire, United Kingdom
| | - J Murray
- Wishaw General Hospital, Wishaw, Lanarkshire, United Kingdom
| | - A Lannigan
- Wishaw General Hospital, Wishaw, Lanarkshire, United Kingdom
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Ahmed S, Morrow E, Morton J. Perioperative considerations when operating on the very obese: tricks of the trade. MINERVA CHIR 2010; 65:667-675. [PMID: 21224800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Obesity is the leading public health concern in the industrialized world with the advent of the very obese or "super obese" increasing exponentially. Bariatric surgery remains the only effective and enduring treatment for morbid obesity and can be safely accomplished in experienced centers. Surgery in the very obese may be considered high-risk: however, this risk may be managed with an experienced bariatric surgery team, appropriate anesthetic consideration, preoperative risk assessment, employment of venothrombotic event prevention, preoperative weight loss, and understanding of particular anatomic considerations. With appropriate preparation, the very obese surgical patient can achieve safe and effective surgical outcomes.
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Affiliation(s)
- S Ahmed
- Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Flaxman D, Rao G, Morrow E, Murrells T, Brearley S, Griffiths P. FP1.2 MRSA origins – a study to identify and determine the role of attributional bias in the control and prevention of MRSA. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Allergy to peanut is a significant health problem. Interestingly, the prevalence of peanut allergy in China is much lower than that in the United States, despite a high rate of peanut consumption in China. In China, peanuts are commonly fried or boiled, whereas in the United States peanuts are typically dry roasted. OBJECTIVE The aim of this study was to examine whether the method of preparing peanuts could be a factor in the disparity of allergy prevalence between the 2 countries. METHODS Two varieties of peanuts grown in the United States were roasted, boiled, or fried. Proteins were analyzed by using SDS-PAGE and immunoblotting. Allergenicity was compared by using immunolabeling with sera from 8 patients with peanut allergy. RESULTS The protein fractions of both varieties of peanuts were altered to a similar degree by frying or boiling. Compared with roasted peanuts, the relative amount of Ara h 1 was reduced in the fried and boiled preparations, resulting in a significant reduction of IgE-binding intensity. In addition, there was significantly less IgE binding to Ara h 2 and Ara h 3 in fried and boiled peanuts compared with that in roasted peanuts, even though the protein amounts were similar in all 3 preparations. CONCLUSION The methods of frying or boiling peanuts, as practiced in China, appear to reduce the allergenicity of peanuts compared with the method of dry roasting practiced widely in the United States. Roasting uses higher temperatures that apparently increase the allergenic property of peanut proteins and may help explain the difference in prevalence of peanut allergy observed in the 2 countries.
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Affiliation(s)
- K Beyer
- The Mount Sinai School of Medicine, Division of Pediatric Allergy & Immunology, One Gustave L. Levy Place, New York, NY 10029-6574, USA
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Morrow E. Attitudes of women from vulnerable populations toward physician-assisted death: a qualitative approach. J Clin Ethics 1998; 8:279-89. [PMID: 9436086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Morrow
- Pacific Institute for Women's Health, Los Angeles, CA, USA
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Abstract
The effects of isoproterenol on brown and white fat were studied by analyzing the total percentage lipid of the tissue and by the fluorescent histochemical method for catecholamines in sympathetic fibers. At dosages which were well below the LD50, isoproterenol selectively emptied brown fat without affecting the white fat at all. It was suggested that the rise in free fatty acids in the blood seen afer injection of isoproterenol is partly due to an emptying of brown fat.
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