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Van Scoy LJ, Scott AM, Higgins J, Wasserman E, Heyland D, Chinchilli V, Green MJ. Feasibility and Acceptability of a Novel Intensive Care Unit Communication Intervention ("Let's Talk") and Initial Assessment Using the Multiple Goals Theory of Communication. Am J Hosp Palliat Care 2024; 41:373-382. [PMID: 37173285 PMCID: PMC10885768 DOI: 10.1177/10499091231176296] [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: 05/15/2023] Open
Abstract
Background: Family members of intensive care unit (ICU) patients often report poor communication, feeling unprepared for ICU family meetings, and poor psychological outcomes after decision-making. The objective of this study was to create a tool to prepare families for ICU family meetings and assess feasibility of using Communication Quality Analysis (CQA) to measure communication quality of family meetings. Methods: This observational study was conducted at an academic tertiary care center in Hershey, PA from March 2019 to 2020. Phase 1a involved conceptual design. Phase 1b entailed acceptability testing of 2 versions of the tool (text-only, comic) with 9 family members of non-capacitated ICU patients; thematic analysis of semi-strucutred interviews was conducted. Phase 1c assessed feasibility of applying CQA to audio-recorded ICU family meetings (n = 17); 3 analysts used CQA to assess 6 domains of communication quality. Wilcoxon Signed Rank tests were used to interpret CQA scores. Results: Four themes emerged from Phase 1b interviews: participants 1) found the tool useful for meeting preparation and organizing thoughts, 2) appreciated emotional content, 3) preferred the comic form (67%), and 4) had indifferent or negative perceptions about specific elements. In Phase 1c, clinicians scored higher on the CQA content and engagement domains; family members scored higher on the emotion domain. CQA scores in the relationship and face domains had the lowest quality ratings. Conclusions: Let's Talk may help families become better prepared for ICU family meetings. CQA provides a feasible approach to assessing communication quality that identifies specific areas of strengths and weaknesses in communication.
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Affiliation(s)
- Lauren J Van Scoy
- Departments of Medicine, Humanities and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Allison M Scott
- Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Jacob Higgins
- Department of Nursing Professional Practice and Development, University of Kentucky College of Nursing and UK Healthcare, Lexington, KY, USA
| | - Emily Wasserman
- Departments of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Daren Heyland
- Department of Critical Care Medicine, Queens University, Kingston, ON, Canada
| | - Vernon Chinchilli
- Departments of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michael J Green
- Departments of Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
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2
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Choe AI, Conaty S, Ha J, Mack J, Aumann EK, Wasserman E, McGillen K. What's in the Shadows? Formal Analysis: Art History Method to Improve Interpretation Skills for Mammography and Chest Radiographs in Resident Education. Acad Radiol 2024; 31:383-389. [PMID: 38401984 DOI: 10.1016/j.acra.2023.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES To assess the feasibility of using an art history tool of formal analysis in resident education for interpretations of mammography and chest radiographs METHODS: In a pre-post study design, residents were shown pre-selected 10 mammograms and 10 chest radiographs for a total of 20 unique anonymized patient cases. After the pretest, residents attended four formal analysis art history lessons. The formal elements included line, light, dark, shade, proportion and balance. The post-tests were administered utilizing the same set of images given during the pre-test. After the completion of the pre- and post-tests, the participants filled out a written survey. RESULTS On average, participants improved their image descriptions for a mean of 30% of the total number of mammographic images they evaluated, and similarly they improved their image diagnoses for a mean of 31% of the mammographic images. On average, participants improved their image descriptions for a mean of 37% of the total number of chest radiographs they evaluated, while improving their image diagnoses for a mean of 52% of the chest X-rays. Of the 20 participants, 14 (70%) completed the post study survey. Almost all of the respondents endorsed agreement in understanding the application of formal analysis to radiologic interpretation. Eight out of 14 (57%) participants self-reported improvement in identifying abnormalities and contriving descriptors. CONCLUSION This pilot study shows that formal art analysis used by art historians may improve radiologic learners' ability to perceive and describe relevant radiologic abnormalities which in turn would lead to a more accurate radiologic differential diagnosis. The formal analysis process trains the eye to detect and categorize the underlying structure of images. This method provides an alternative arts intervention specifically designed to improve fundamental visual skills in radiology education.
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Affiliation(s)
- Angela I Choe
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.).
| | - Siobhan Conaty
- La Salle University, 1900 W. Olney Ave, Philadelphia, Pennsylvania 19141, USA (S.C.)
| | - Jason Ha
- Penn State College of Medicine, 700 HMC Crescent Drive, Hershey, Pennsylvania 17033, USA (J.H.)
| | - Julie Mack
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.)
| | - Emel K Aumann
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.)
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, Pennsylvania 17033, USA (E.W.)
| | - Kathryn McGillen
- Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania 17033, USA (K.M.)
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Lennon RP, Parascando J, Talbot SG, Zhou S, Wasserman E, Mantri S, Day PG, Liu R, Lagerman M, Appiah A, Rabago D, Dean W. Prevalence of Moral Injury, Burnout, Anxiety, and Depression in Healthcare Workers 2 Years in to the COVID-19 Pandemic. J Nerv Ment Dis 2023; 211:981-984. [PMID: 38015191 DOI: 10.1097/nmd.0000000000001705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT COVID-19 has led to marked increases in healthcare worker distress. Studies of these phenomena are often limited to a particular element of distress or a specific subset of healthcare workers. We administered the Moral Injury Symptom Scale for Healthcare Professionals, Copenhagen Burnout Inventory, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 via online survey to 17,000 employees of a large academic medical center between December 2021 and February 2022. A total of 1945 participants completed the survey. Across all roles, the prevalence of moral injury, burnout, depression, and anxiety were 40.9%, 35.3%-60.6%, 25.4%, and 24.8%, respectively. Furthermore, 8.1% had been bothered by thoughts that they would be better off dead or of hurting themselves for "several days" or more frequently. Healthcare workers across all roles and practice settings are experiencing unsustainable levels of distress, with 1 in 12 regularly experiencing thoughts of self-harm.
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Affiliation(s)
- Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jessica Parascando
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Simon G Talbot
- Division of Plastic Surgery, Harvard Medical School Brigham and Women's Hospital, Boston, Massachusetts
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Sneha Mantri
- Department of Neurology and Trent Center for Bioethics, Duke University School of Medicine, Durham, North Carolina
| | - Philip G Day
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Ryan Liu
- Department of Family and Community Medicine, Penn State Health St Joseph Medical Center, Reading, Pennsylvania
| | - Makayla Lagerman
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Annette Appiah
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Wendy Dean
- Moral Injury of Healthcare, Carlisle, Pennsylvania
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Nelson A, Stuckey H, Snyder B, Van Scoy LJ, Daymont C, Irvin C, Wasserman E, Beck M. Provider Perspectives of Transitions of Care at a Tertiary Care Children's Hospital With a Hospitalist-Run Discharge Clinic. Clin Pediatr (Phila) 2023; 62:926-934. [PMID: 36726290 PMCID: PMC10986183 DOI: 10.1177/00099228221149279] [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] [Indexed: 02/03/2023]
Abstract
Children's hospitals are discharging patients to home with increasingly complex outpatient needs, making safe transitions of care (ToCs) of vital importance. Our study involved a survey of both outpatient providers and pediatric hospitalists associated with our medical center to better describe providers' views on the ToC process. The survey included questions assessing views on patient care responsibilities, resource availability, our hospitalist-run postdischarge clinic (PDC), and comfort with telemedicine. Our hospitalists generally believed that primary care providers (PCPs) did not have adequate access to important ToC elements, whereas PCPs felt their access was adequate. Both provider types felt it was the inpatient team's responsibility to manage patient events between discharge and PCP follow-up and that a hospitalist-run PDC may reduce interim emergency room visits. This study challenges perceptions about the ToC process in children and describes a generalizable approach to assessing provider perceptions surrounding the ToC within individual health systems.
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Affiliation(s)
- Abigail Nelson
- Penn State Children’s Hospital, Department of Pediatrics
| | - Heather Stuckey
- Penn State Hershey College of Medicine; Department of Medicine
| | - Bethany Snyder
- Penn State Hershey College of Medicine; Department of Medicine
| | | | - Carrie Daymont
- Penn State Children’s Hospital, Department of Pediatrics
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | | | - Emily Wasserman
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | - Michael Beck
- Penn State Children’s Hospital, Department of Pediatrics
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5
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Heras A, Gomi R, Young M, Chang CL, Wasserman E, Sharma A, Wu W, Gu J, Balaji U, White R, Permaul P, Janahi I, Worgall TS, Worgall S. Dietary long-chain omega 3 fatty acids modify sphingolipid metabolism to facilitate airway hyperreactivity. Sci Rep 2022; 12:19735. [PMID: 36396956 PMCID: PMC9672127 DOI: 10.1038/s41598-022-21083-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are essential nutrients that can affect inflammatory responses. While n-3 PUFAs are generally considered beneficial for cardiovascular disease and obesity, the effects on asthma, the most common inflammatory lung disease are unclear. While prenatal dietary n-3 PUFAs decrease the risk for childhood wheezing, postnatal dietary n-3 PUFAs can worsen allergic airway inflammation. Sphingolipid metabolism is also affected by dietary n-3 PUFAs. Decreased sphingolipid synthesis leads to airway hyperreactivity, besides inflammation, a cardinal feature of asthma, and common genetic asthma risk alleles lead to lower sphingolipid synthesis. We investigated the effect of dietary n-3 PUFAs on sphingolipid metabolism and airway reactivity. Comparing a fish-oil diet with a high n-3 PUFA content (FO) to an isocaloric coconut oil-enriched diet (CO), we found an n-3 PUFA-dependent effect on increased airway reactivity, that was not accompanied by inflammation. Lung and whole blood content of dihydroceramides, ceramides, sphingomyelins, and glucosylceramides were lower in mice fed the n-3 PUFA enriched diet consistent with lower sphingolipid synthesis. In contrast, phosphorylated long chain bases such as sphingosine 1-phosphate were increased. These findings suggest that dietary n-3 PUFAs affect pulmonary sphingolipid composition to favor innate airway hyperreactivity, independent of inflammation, and point to an important role of n-3 PUFAs in sphingolipid metabolism.
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Affiliation(s)
- Andrea Heras
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Rika Gomi
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Madeline Young
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Chuchun L Chang
- Institute of Human Nutrition/Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Emily Wasserman
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
- Weill Cornell Medicine, Drukier Institute for Children's Health, New York, USA
| | - Anurag Sharma
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Wenzhu Wu
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Jinghua Gu
- Weill Cornell Medicine, Drukier Institute for Children's Health, New York, USA
| | - Uthra Balaji
- Weill Cornell Medicine, Drukier Institute for Children's Health, New York, USA
| | - Rachel White
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | - Perdita Permaul
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA
| | | | - Tilla S Worgall
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Stefan Worgall
- Department of Pediatrics, Weill Cornell Medicine, 413 East 69th Street, Room 1200, New York, NY, 10021, USA.
- Weill Cornell Medicine, Drukier Institute for Children's Health, New York, USA.
- Department of Genetic Medicine, Weill Cornell Medicine, New York, USA.
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Foulds J, Veldheer S, Pachas G, Hrabovsky S, Hameed A, Allen SI, Cather C, Azzouz N, Yingst J, Hammett E, Modesto J, Krebs NM, Lester C, Trushin N, Reinhart L, Wasserman E, Zhu J, Liao J, Muscat JE, Richie JP, Evins AE. The effects of reduced nicotine content cigarettes on biomarkers of nicotine and toxicant exposure, smoking behavior and psychiatric symptoms in smokers with mood or anxiety disorders: A double-blind randomized trial. PLoS One 2022; 17:e0275522. [PMID: 36322562 PMCID: PMC9629593 DOI: 10.1371/journal.pone.0275522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 06/10/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The U.S. Food and Drug Administration and the government of New Zealand have proposed a reduction of the nicotine content in cigarettes to very low levels. This study examined the potential effects of this regulation in smokers with affective disorders. METHODS In a randomized controlled parallel group trial conducted at two sites in the USA (Penn State University, Hershey, PA and Massachusetts General Hospital, Boston, MA) 188 adult smokers with a current (n = 118) or lifetime (n = 70) anxiety or unipolar mood disorder, not planning to quit in the next 6 months, were randomly assigned (1:1) to smoke either Usual Nicotine Content (UNC) (11.6 mg nicotine/cigarette) research cigarettes, or Reduced Nicotine Content (RNC) research cigarettes where the nicotine content per cigarette was progressively reduced to 0.2 mg in five steps over 18 weeks. Participants were then offered the choice to either receive assistance to quit smoking, receive free research cigarettes, or resume using their own cigarette brand during a 12-week follow-up period. Main outcomes were biomarkers of nicotine and toxicant exposure, smoking behavior and dependence and severity of psychiatric symptoms. The pre-registered primary outcome was plasma cotinine. RESULTS A total of 143 (76.1%) randomized participants completed the randomized phase of the trial, 69 (73.4%) in the RNC group and 74 (78.8%) in the UNC group. After switching to the lowest nicotine content cigarettes, compared to smokers in the UNC group, at the last randomized visit the RNC group had significantly lower plasma cotinine (metabolite of nicotine): difference between groups, -175.7, 95% CI [-218.3, -133.1] ng/ml. Urine NNAL (metabolite of NNK, a lung carcinogen), exhaled carbon-monoxide, cigarette consumption, and cigarette dependence were also significantly lower in the RNC group than the UNC group. No between-group differences were found on a range of other biomarkers (e.g. 8-isoprostanes) or health indicators (e.g. blood pressure), or on 5 different psychiatric questionnaires, including the Kessler K6 measure of psychological distress. At the end of the subsequent 12-week treatment choice phase, those randomized to the RNC group were more likely to have quit smoking, based on initial intent-to-treat sample, n = 188 (18.1% RNC v 4.3% UNC, p = 0.004). CONCLUSION Reducing nicotine content in cigarettes to very low levels reduces some toxicant exposures and cigarette addiction and increases smoking cessation in smokers with mood and/or anxiety disorders, without worsening mental health. TRIAL REGISTRATION TRN: NCT01928758, registered August 21, 2013.
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Affiliation(s)
- Jonathan Foulds
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- * E-mail:
| | - Susan Veldheer
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States of America
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Shari Hrabovsky
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
- Ross and Carol Nese College of Nursing, Penn State University, State College, PA, United States of America
| | - Ahmad Hameed
- Department of Psychiatry, Pennsylvania State University—College of Medicine, Hershey, PA, United States of America
| | - Sophia I. Allen
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Nour Azzouz
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Jessica Yingst
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Erin Hammett
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jennifer Modesto
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Nicolle M. Krebs
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Courtney Lester
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Neil Trushin
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Lisa Reinhart
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Emily Wasserman
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Junjia Zhu
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Jason Liao
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - Joshua E. Muscat
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - John P. Richie
- Penn State Center for Research on Tobacco and Health, Department of Public Health Sciences, Pennsylvania State University—College of Medicine, University Drive, Hershey, PA, United States of America
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
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Abstract
INTRODUCTION Burnout in healthcare providers begins early, with about half of medical students experiencing symptoms of burnout, and as many as one-quarter experiencing depression. While organizational, systemic-level changes certainly contribute to mitigation, organizationally sponsored individual-level changes may also play a significant role. Although the nature of the burnout epidemic and its impact on trainee wellness is fairly well understood, and interventions have been studied, there remains a gap in the empirical research examining the impact of the arts on medical student well-being. METHODS We designed a convergent mixed methods study to evaluate whether a 9-month course for fourth-year medical students called Art as Self Care (AASC) would help trainees develop habits that supported their well-being. An online survey was used to collect data at the beginning and end of each academic year on two consecutive cohorts of students. A focus group explored students' experience with and perceptions about the course. RESULTS Qualitative results indicated that the AASC course provided positive distraction that is calming and allowed students to shift focus from the stresses of daily medical school life. Our quantitative results suggest that art might provide a slight protective effect in medical students: whereas 22% of the non-AASC students saw a worsening of their psychological distress across the fourth year of medical school, this was observed in only 13% of the AASC students. DISCUSSION Our study presents pilot and feasibility data to better inform future research and practice around the use of art to support medical student well-being. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01604-y.
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Affiliation(s)
- Rebecca L. Volpe
- Department of Humanities, H134, Penn State College of Medicine, 500 University Drive, Hershey, PA 17011 USA
| | - Claire de Boer
- Doctors Kienle Center for Humanistic Medicine and Center Stage Arts in Health, Penn State Health Hershey Medical Center and College of Medicine, Hershey, USA
| | - Emily Wasserman
- Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Lauren Jodi Van Scoy
- Pulmonary and Critical Care Medicine, and Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, USA
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Van Scoy LJ, Levi BH, Bramble C, Calo W, Chinchilli VM, Currin L, Grant D, Hollenbeak C, Katsaros M, Marlin S, Scott AM, Tucci A, VanDyke E, Wasserman E, Witt P, Green MJ. Comparing two advance care planning conversation activities to motivate advance directive completion in underserved communities across the USA: The Project Talk Trial study protocol for a cluster, randomized controlled trial. Trials 2022; 23:829. [PMID: 36180899 PMCID: PMC9523194 DOI: 10.1186/s13063-022-06746-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a process involving conversations between patients, loved ones, and healthcare providers that consider patient preferences for the types of medical therapies received at the end of life. Underserved populations, including Black, Hispanic, rural, and low-income communities are less likely to engage in ACP than other communities, a health inequity that results in lower-quality care and reduced hospice utilization. The purpose of this trial is to compare efficacy of two interventions intended to motivate ACP (particularly advance directive completion) for those living in underserved communities. METHODS This 3-armed cluster, randomized controlled mixed methods design is being conducted in 75 community venues in underserved communities across the USA. The goal of the trial is to compare the efficacy of two interventions at motivating ACP. Arm 1 uses an end-of-life conversation game (Hello); Arm 2 uses a nationally utilized workshop format for ACP conversations (The Conversation Project); and Arm 3 uses an attention control game (TableTopics). Events are held in partnership with 75 local community-based host organizations and will involve 1500 participants (n=20 per event). The primary outcome is completion of a visually verified advance directive at 6 months post-event. Primary analyses compare efficacy of each intervention to each other and the control arm. Secondary mixed methods outcomes include (a) other ACP behaviors and engagement; (b) communication quality; (c) impact of sociocultural environment on ACP (via qualitative interviews); and (d) implementation and sustainability. Subgroup analyses examine outcomes for Black, Hispanic, and rural groups in particular. DISCUSSION This trial will add to the evidence base behind various conversational ACP interventions, examine potential mechanisms of action for such interventions, and provide qualitative data to better understand the sociocultural environment of how community-based ACP interventions are experienced by underserved populations. Results will also provide important data for future researchers to learn whether visual verification of advance directives is necessary or whether reliance on self-reported outcomes is of comparable value. Data from this study will inform ways to effectively motivate underserved communities to participate in advance care planning. TRIAL REGISTRATION ClinicalTrials.gov NCT04612738. Registered on October 12, 2020. All information from the WHO Trial Registration Data Set can be found within the protocol.
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Affiliation(s)
- Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Benjamin H. Levi
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Pediatrics, Penn State College of Medicine, Suite 4400, Mail Code A444, Hershey, PA 17033 USA
| | - Cindy Bramble
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - William Calo
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Lindsey Currin
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Denise Grant
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Christopher Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, 604E Donald H. Ford Bldg., University Park, PA 16802 USA
| | - Maria Katsaros
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Sara Marlin
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, 275 Blazer Dining Hall, University of Kentucky, Lexington, KY 40506 USA
| | - Amy Tucci
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Pamela Witt
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Michael J. Green
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
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9
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Van Scoy LJ, Scott AM, Green MJ, Witt PD, Wasserman E, Chinchilli VM, Levi BH. Communication Quality Analysis: A user-friendly observational measure of patient-clinician communication. Commun Methods Meas 2022; 16:215-235. [PMID: 37063460 PMCID: PMC10104441 DOI: 10.1080/19312458.2022.2099819] [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] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Communication Quality Analysis (CQA) is a rigorous transcript-based coding method for assessing clinical communication quality. We compared the resource-intensive transcript-based version with a streamlined real-time version of the method with respect to feasibility, validity, reliability, and association with traditional measures of communication quality. Simulated conversations between 108 trainees and 12 standardized patients were assessed by 7 coders using the two versions of CQA (transcript and real-time). Participants also completed two traditional communication quality assessment measures. Real-time CQA was feasible and yielded fair to excellent reliability, with some caveats that can be addressed in future work. CQA ratings were moderately correlated with traditional measures of communication quality, suggesting that CQA captures different aspects of communication quality than do traditional measures. Finally, CQA did not exhibit the ceiling effects observed in the traditional measures of communication quality. We conclude that real-time CQA is a user-friendly method for assessing communication quality that has the potential for broad application in training, research, and intervention contexts and may offer improvements to traditional, self-rated communication measures.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Allison M Scott
- Department of Communication; University of Kentucky, Lexington, USA
| | - Michael J. Green
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
- Department of Humanities, Penn State College of Medicine, Hershey, USA
| | - Pamela D. Witt
- Departments of Medicine, Penn State College of Medicine, Hershey, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, USA
- Department of Pediatrics Penn State College of Medicine, Hershey, USA
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10
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Saunders EFH, Mukherjee D, Myers T, Wasserman E, Hameed A, Krishnamurthy VB, MacIntosh B, Domenichiello A, Ramsden CE, Wang M. Adjunctive dietary intervention for bipolar disorder: a randomized, controlled, parallel-group, modified double-blinded trial of a high n-3 plus low n-6 diet. Bipolar Disord 2022; 24:171-184. [PMID: 34218509 PMCID: PMC9157563 DOI: 10.1111/bdi.13112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/29/2022]
Abstract
OBJECTIVE To investigate the preliminary efficacy of a high n-3 plus low n-6 (H3-L6) dietary intervention in improving mood stability in Bipolar Disorder (BD) when compared to dietary intervention with usual U.S. levels of n-6 and n-3 polyunsaturated fatty acid (PUFA) intakes (control diet, CD). METHODS This 2-arm, parallel-group, randomized, modified double-blind, controlled 48-week study of 12-week intensive diet intervention in subjects with BD was conducted at a single suburban-rural site in the mid-Atlantic region. Participants with DSM-IV TR BD I or II with hypomanic or depressive symptoms were randomized, stratified on gender (N = 82). The intervention included the provision of group-specific study foods and dietary counseling. Variability of mood symptoms was measured by a twice-daily, 12-week ecological momentary analysis (EMA) paradigm, and group differences were analyzed using multilevel models. Circulating n-3 and n-6 fatty acids were measured at baseline and after 4, 8, and 12 weeks of diet exposure. RESULTS All 82 randomized participants were included in biochemical analyses. Seventy participants completed at least 2 EMA surveys and were included in primary EMA analyses. Variability in mood, energy, irritability, and pain as measured using EMA was reduced in the H3-L6 group compared to the CD group. No significant differences in mean ratings of mood symptoms, or any other symptom measures, were detected. The dietary intervention effect on target PUFAs significantly differed by the group over time. CONCLUSIONS A dietary intervention adjunctive to usual care showed preliminary efficacy in improving variability in mood symptoms in participants with BD. TRIAL REGISTRATION ClinicalTrials.Gov NCT02272010.
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Affiliation(s)
- Erika F. H. Saunders
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Tiffany Myers
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Ahmad Hameed
- Department of Psychiatry and Behavioral Health, Penn State University College of Medicine, Hershey, PA, USA
| | | | - Beth MacIntosh
- Metabolic and Nutrition Research Core, University of North Carolina, Chapel Hill, NC, USA
| | | | - Christopher E. Ramsden
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA,National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, PA, USA
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11
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Van Scoy LJ, Witt PD, Bramble C, Richardson C, Putzig I, Currin L, Wasserman E, Tucci A, Levi BH, Green MJ. Success of a Community-Based Delivery at Recruiting Individuals from Underserved Communities for an Observational Cohort Study of an Advance Care Planning Intervention. J Pain Symptom Manage 2022; 63:e149-e154. [PMID: 34662724 DOI: 10.1016/j.jpainsymman.2021.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Underserved and minority populations are often reluctant to engage in advance care planning and/or research often due to distrust in healthcare and/or research institutions. AIM To determine if use of a community-based delivery model can facilitate recruitment of individuals from underserved communities in research about advance care planning. DESIGN Recruitment data are presented from a prospective, mixed methods observational cohort study that examined the feasibility and preliminary efficacy of a community-based delivery model involving an end-of-life conversation game to motivate participants to complete advance care planning behaviors. Event attendance and research participation data are reported. SETTING/PARTICIPANTS Game events were held in community venues in 27 states across the US in 2018-2019. The model involved leveraging existing social networks to recruit attendees and research participants to community game day events. Attendees were eligible for research if they were adults who read/spoke English. RESULTS A total of 1,122 individuals attended events at 53 sites. Participants generally reported low income (48% reported $30,000 annual income). At sites with research assistants, there was a 90% consent rate (92% were Black). At community outreach sites, 45% agreed to a follow-up research phone call (49% were Black). CONCLUSIONS Use of the community-based delivery model successfully engaged undeserved communities in a research-based advance care planning related community outreach event. This model may be useful for overcoming underserved and minority populations' skepticism and distrust of healthcare and research that is a common barrier to progress in health agendas, especially advance care planning.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Public Health Sciences (L.J.V.S., E.W.), Penn State College of Medicine, Hershey, Pennsylvania, USA.
| | - Pamela D Witt
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy Bramble
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | | | - Irene Putzig
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Lindsey Currin
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Emily Wasserman
- Department of Public Health Sciences (L.J.V.S., E.W.), Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amy Tucci
- Hospice Foundation of America (C.B., C.R., I.P., L.C., A.T.), Washington, D.C., USA
| | - Benjamin H Levi
- Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Pediatrics, Penn State College of Medicine (B.H.L.), Hershey, Pennsylvania, USA
| | - Michael J Green
- Departments of Medicine (L.J.V.S., P.D.W, M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA; Department of Humanities (L.J.V.S., B.H.L., M.J.G.), Penn State College of Medicine, Hershey, Pennsylvania, USA
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12
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Bruno MA, Fotos JS, Pitot M, Franceschi AM, Neutze JA, Willis MH, Wasserman E, Snyder BL, Cruciata G, Stuckey HL, Wintermark M. Factors Driving Resistance to Clinical Decision Support: Finding Inspiration in Radiology 3.0. J Am Coll Radiol 2022; 19:366-376. [DOI: 10.1016/j.jacr.2021.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 02/02/2023]
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13
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Mukherjee D, Weissenkampen JD, Wasserman E, Krishnamurthy VB, Millett C, Conway S, Saunders EF. Dysregulated Diurnal Cortisol Pattern and Heightened Night-Time Cortisol in Individuals with Bipolar Disorder. Neuropsychobiology 2022; 81:51-59. [PMID: 34320487 PMCID: PMC8795243 DOI: 10.1159/000517343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hypothalamic-pituitary-adrenal (HPA) axis dysregulation may contribute to the symptom burden in bipolar disorder (BD). Further characterization of cortisol secretion is needed to improve understanding of the connection between mood, sleep, and the HPA axis. Here, we observe diurnal cortisol patterns in individuals with BD and healthy controls (HCs) to determine time points where differences may occur. METHODS Salivary cortisol was measured at 6 time points (wake, 15, 30, and 45 min after wake, between 2:00 and 4:00 p.m. and 10:00 p.m.) for 3 consecutive days in individuals with symptomatic BD (N = 27) and HC participants (N = 31). A general linear model with correlated errors was utilized to determine if salivary cortisol changed differently throughout the day between the 2 study groups. RESULTS A significant interaction (F = 2.74, df = 5, and p = 0.02) was observed between the time of day and the study group (BD vs. HC) when modeling salivary cortisol over time, indicating that salivary cortisol levels throughout the day significantly differed between the study groups. Specifically, salivary cortisol in BD was elevated compared to HCs at the 10:00 p.m. time point (p = 0.01). CONCLUSION Significantly higher levels of cortisol in participants with BD in the night-time suggest that the attenuation of cortisol observed in healthy individuals may be impaired in those with BD. Reregulation of cortisol levels may be a target of further study and treatment intervention for individuals with BD.
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Affiliation(s)
- Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - J. Dylan Weissenkampen
- Neural and Behavioral Sciences, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Venkatesh Basappa Krishnamurthy
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Caitlin Millett
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America,Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Stephen Conway
- Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
| | - Erika F.H. Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, United States of America
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14
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Wasserman E, Worgall S. Perinatal origins of chronic lung disease: mechanisms-prevention-therapy-sphingolipid metabolism and the genetic and perinatal origins of childhood asthma. Mol Cell Pediatr 2021; 8:22. [PMID: 34931265 PMCID: PMC8688659 DOI: 10.1186/s40348-021-00130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
Childhood asthma derives from complex host-environment interactions occurring in the perinatal and infant period, a critical time for lung development. Sphingolipids are bioactive molecules consistently implicated in the pathogenesis of childhood asthma. Genome wide association studies (GWAS) initially identified a link between alleles within the 17q21 asthma-susceptibility locus, childhood asthma, and overexpression of the ORMDL sphingolipid biosynthesis regulator 3 (ORMDL3), an inhibitor of de novo sphingolipid synthesis. Subsequent studies of pediatric asthma offer strong evidence that these asthma-risk alleles correlate with early-life aberrancies of sphingolipid homeostasis and asthma. Relationships between sphingolipid metabolism and asthma-related risk factors, including maternal obesity and respiratory viral infections, are currently under investigation. This review will summarize how these perinatal and early life exposures can synergize with 17q21 asthma risk alleles to exacerbate disruptions of sphingolipid homeostasis and drive asthma pathogenesis.
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Affiliation(s)
- Emily Wasserman
- Department of Pediatrics, Weill Cornell Medicine, 525 East 68th Street, Box 225, New York, NY, 10065, USA.,Drukier Institute for Children's Health, Weill Cornell Medicine, 413 East 69th Street, 12th Floor, New York, NY, 10021, USA
| | - Stefan Worgall
- Department of Pediatrics, Weill Cornell Medicine, 525 East 68th Street, Box 225, New York, NY, 10065, USA. .,Drukier Institute for Children's Health, Weill Cornell Medicine, 413 East 69th Street, 12th Floor, New York, NY, 10021, USA. .,Department of Genetic Medicine, Weill Cornell Medicine, 1305 York Avenue, 13th Floor, New York, NY, 10065, USA.
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15
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Wasserman E, Gomi R, Sharma A, Hong S, Bareja R, Gu J, Balaji U, Veerappan A, Kim BI, Wu W, Heras A, Perez-Zoghbi J, Sung B, Gueye-Ndiaye S, Worgall TS, Worgall S. Human Rhinovirus Infection of the Respiratory Tract Affects Sphingolipid Synthesis. Am J Respir Cell Mol Biol 2021; 66:302-311. [PMID: 34851798 DOI: 10.1165/rcmb.2021-0443oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The 17q21 asthma susceptibility locus includes asthma risk alleles associated with decreased sphingolipid synthesis, likely resulting from increased expression of ORMDL3. ORMDL3 inhibits serine-palmitoyl transferase (SPT), the rate limiting enzyme of de novo sphingolipid synthesis. There is evidence that decreased sphingolipid synthesis is critical to asthma pathogenesis. Children with asthma and 17q21 asthma risk alleles display decreased sphingolipid synthesis in blood cells. Reduced SPT activity results in airway hyperreactivity, a hallmark feature of asthma. 17q21 asthma risk alleles are also linked to childhood infections with human rhinovirus (RV). This study evaluates the interaction of RV with the de novo sphingolipid synthesis pathway, and the alterative effects of concurrent SPT inhibition in SPT-deficient mice and human airway epithelial cells. In mice, RV infection shifted lung sphingolipid synthesis gene expression to a pattern that resembles genetic SPT deficiency, including decreased expression of Sptssa, a small SPT subunit. This pattern was pronounced in lung EpCAM+ epithelial cells and reproduced in human bronchial epithelial cells. RV did not affect Sptssa expression in lung CD45+ immune cells. RV increased sphingolipids unique to the de novo synthesis pathway in mouse lung and human airway epithelial cells. Interestingly, these de novo sphingolipid species were reduced in the blood of RV infected, wild-type mice. RV exacerbated SPT-deficiency-associated airway hyperreactivity. Airway inflammation was similar in RV-infected wild-type and SPT deficient mice. This study reveals the effects of RV infection on the de novo sphingolipid synthesis pathway, elucidating a potential mechanistic link between 17q21 asthma risk alleles and rhinoviral infection.
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Affiliation(s)
- Emily Wasserman
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Rika Gomi
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Anurag Sharma
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Seunghee Hong
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Rohan Bareja
- Weill Cornell Medical College, 12295, Precision Medicine, New York, New York, United States
| | - Jinghua Gu
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Uthra Balaji
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Arul Veerappan
- New York University, 5894, Medicine, New York, New York, United States
| | - Benjamin I Kim
- Columbia University, 5798, Pathology, New York, New York, United States
| | - Wenzhu Wu
- Weill Cornell Medical College, 12295, New York, New York, United States
| | - Andrea Heras
- Weill Cornell Medical College, 12295, Pediatrics , New York, New York, United States
| | - Jose Perez-Zoghbi
- Columbia University, 5798, Department of Anesthesiology , New York, New York, United States
| | - Biin Sung
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Seyni Gueye-Ndiaye
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States
| | - Tilla S Worgall
- Columbia University Irving Medical Center, 21611, Dept. of Pathology, New York, New York, United States
| | - Stefan Worgall
- Weill Cornell Medical College, 12295, Pediatrics, New York, New York, United States;
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16
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Van Scoy LJ, Miller EL, Snyder B, Wasserman E, Chinchilli VM, Zgierska AE, Rabago D, Lennon CL, Lipnick D, Toyobo O, Ruffin MT, Lennon RP. Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Central Pennsylvania Adults Early in the Pandemic: A Mixed Methods Cross-Sectional Survey. Ann Fam Med 2021; 19:293-301. [PMID: 33985977 PMCID: PMC8282301 DOI: 10.1370/afm.2674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/27/2020] [Accepted: 10/29/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To explore public knowledge, understanding of public health recommendations, perceptions, and trust in information sources related to COVID-19. METHODS A cross-sectional survey of central Pennsylvanian adults evaluated self-reported knowledge, and a convergent, mixed methods design was used to assess beliefs about recommendations, intended behaviors, perceptions, and concerns related to infectious disease risk, and trust of information sources. RESULTS The survey was completed by 5,948 adults. The estimated probability of correct response for the basic knowledge score, weighted with confidence, was 0.79 (95% CI, 0.79-0.80). Knowledge was significantly higher in patients with higher education and nonminority race. While the majority of respondents reported that they believed following CDC recommendations would decrease the spread of COVID-19 in their community and intended to adhere to them, only 65.2% rated social isolation with the highest level of belief and adherence. The most trusted information source was federal public health websites (42.8%). Qualitative responses aligned with quantitative data and described concerns about illness, epidemiologic issues, economic and societal disruptions, and distrust of the executive branch's messaging. The survey was limited by a lack of minority representation, potential selection bias, and evolving COVID-19 information that may impact generalizability and interpretability. CONCLUSIONS Knowledge about COVID-19 and intended adherence to behavioral recommendations were high. There was substantial distrust of the executive branch of the federal government, however, and concern about mixed messaging and information overload. These findings highlight the importance of consistent messaging from trusted sources that reaches diverse groups.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., B.S.).,Department of Humanities, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S.).,Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., E.W., V.M.C., A.E.Z., D.R.).,Qualitative and Mixed Methods Core, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., B.S., E.W.)
| | - Erin L Miller
- Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.)
| | - Bethany Snyder
- Department of Medicine, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., B.S.).,Qualitative and Mixed Methods Core, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., B.S., E.W.)
| | - Emily Wasserman
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., E.W., V.M.C., A.E.Z., D.R.).,Qualitative and Mixed Methods Core, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., B.S., E.W.)
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., E.W., V.M.C., A.E.Z., D.R.)
| | - Aleksandra E Zgierska
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., E.W., V.M.C., A.E.Z., D.R.).,Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.).,Department of Anesthesiology and Perioperative Medicine, Pennsylvania State University, Hershey, Pennsylvania (A.E.Z.)
| | - David Rabago
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania (L.J.V.S., E.W., V.M.C., A.E.Z., D.R.).,Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.)
| | - Courtney L Lennon
- Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.)
| | - Daniella Lipnick
- Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania (D.L., O.T.)
| | - Olubukola Toyobo
- Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania (D.L., O.T.)
| | - Mack T Ruffin
- Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.)
| | - Robert P Lennon
- Department of Family and Community Medicine, Pennsylvania State University, Hershey, Pennsylvania (E.L.M., A.E.Z., D.R., C.L.L., M.T.R., R.P.L.); .,Penn State Law, Pennsylvania State University, University Park, Pennsylvania (R.P.L.)
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17
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Sakya SM, Scoy LJV, Garman JC, Miller EL, Snyder B, Wasserman E, Chinchilli VM, Lennon RP. The impact of COVID-19-related changes in media consumption on public knowledge: results of a cross-sectional survey of Pennsylvania adults. Curr Med Res Opin 2021; 37:911-915. [PMID: 33840315 DOI: 10.1080/03007995.2021.1901679] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE During the COVID-19 pandemic, Americans have increasingly relied on internet versus television news. The extent to which this change in health news consumption practice impacts health knowledge is not known. This study investigates the relationship between most trusted information source and COVID-19 knowledge. METHODS A cross-sectional online survey was sent to a convenience sample from a list of adults on a central Pennsylvania health system's marketing database 25-31 March 2020. Respondents were grouped by their trusted news sources and comparison of respondent COVID-19 knowledge was made between these groups for 5948 respondents. RESULTS Those who selected government health websites as their most trusted source were more likely to answer COVID-19 questions correctly than those who selected other internet news sources or television news (OR 1.21, p < .05; 1.08, p > .05; and 0.87, p < .05, respectively). Those who used Facebook as an additional source of news in any way were less likely to answer COVID-19 questions correctly than those who did not (OR 0.93, p < .05). CONCLUSIONS COVID-19 knowledge correlates with trusted news source. To increase public knowledge of COVID-19 in order to maximize information dissemination and compliance with COVID-19-related public health recommendations, those who provide health information should consider use of the public's most trusted sources of information, as well as monitoring and correcting misinformation presented by other sources. Independent content review for accuracy in media may be warranted in public health emergencies to improve knowledge.
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Affiliation(s)
- Surav Man Sakya
- School of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Lauren Jodi Van Scoy
- Departments of Medicine, Humanities, Public Health Sciences and the Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA, USA
| | - John C Garman
- School of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Erin L Miller
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Bethany Snyder
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA, USA
| | - Emily Wasserman
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA
- Penn State Law, The Pennsylvania State University, University Park, PA, USA
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18
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Krebs NM, Zhu J, Wasserman E, Kuprewicz R, Martinez DJ, Veldheer S, Livelsberger C, Modesto J, Reinhart L, Trushin N, Reilly SM, Liao J, Fazzi A, Bascom R, Richie JP, Foulds J, Horn K, Muscat JE. Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial. Nicotine Tob Res 2021; 23:992-1001. [PMID: 33249498 PMCID: PMC8150128 DOI: 10.1093/ntr/ntaa247] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Received: 04/17/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC). METHODS A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation. RESULTS The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference -137 ng/mL; 95% CI -172, -102). The RNC group smoked fewer CPD (-4.1; 95% CI -6.44, -1.75) and had lower carbon monoxide levels (-4.0 ppm; 95% CI -7.7, -0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%). CONCLUSIONS This study supports a VLNC standard in cigarettes. IMPLICATIONS Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.
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Affiliation(s)
- Nicolle M Krebs
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Robin Kuprewicz
- Department of Psychiatry, Georgetown University, Washington, DC
| | - Diane J Martinez
- Public Health Division, Arlington County Department of Human Services, Arlington, VA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
- Department of Family and Community Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jennifer Modesto
- Department of Biochemistry and Molecular Biology, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Samantha M Reilly
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Alyse Fazzi
- Department of Pharmacy, Investigational Drug Service Pharmacy, Penn State Health, Hershey, PA
| | - Rebecca Bascom
- Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Roanoke, VA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA
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19
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Van Scoy LJ, Green MJ, Witt PD, Bramble C, Richardson C, Putzig I, Toyobo O, Wasserman E, Chinchilli VM, Tucci A, Levi BH. Low Skepticism and Positive Attitudes About Advance Care Planning Among African Americans: a National, Mixed Methods Cohort Study. J Gen Intern Med 2021; 36:705-712. [PMID: 32948953 PMCID: PMC7947044 DOI: 10.1007/s11606-020-06224-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND African Americans have low engagement in advance care planning (ACP). This has been attributed to healthcare distrust and skepticism about ACP. A better understanding of these attitudes is needed to address health disparities related to end-of-life care. OBJECTIVE To explore the ACP-related values and beliefs of diverse African American communities across the USA and then the perceived value of an inexpensive end-of-life conversational game. DESIGN Prospective, convergent, mixed methods cohort study involving fifteen underserved, African American communities across the USA. PARTICIPANTS Of the 428 who attended events at purposively sampled sites, 90% consented to the research; 37% participated in one of 15 focus groups (n = 141). INTERVENTION An end-of-life conversation game, played in groups of 4-6. MAIN MEASURES The validated, 7-item ACP values and beliefs questionnaire (scaled 7 = least skeptical, 49 = most skeptical) was administered pre-game. Post-game focus groups explored perceptions about ACP and the intervention. KEY RESULTS Participants had positive attitudes (low skepticism) about ACP with a median score of 12.00 (7.00, 20.00). Values and beliefs did not significantly differ by geographical region; however, rural areas were observed to be slightly more skeptical than urban areas (median score 14.00 vs. 11.00, p = 0.002). Themes from focus groups converged with survey data showing participants valued the ACP process and consider further engagement in ACP to be worthwhile. Subthemes emphasized the need for and value of ACP. CONCLUSIONS Skepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism. TRIAL REGISTRATION This study has been registered at clinicaltrials.gov ( NCT03456921 ).
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
| | - Michael J Green
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Pamela D Witt
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Irene Putzig
- Hospice Foundation of America, Washington, DC, USA
| | - Olubukola Toyobo
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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20
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Wasserman E, Toal M, Nellis ME, Traube C, Joyce C, Finkelstein R, Killinger JS, Joashi U, Harrington JS, Torres LK, Greenwald BM, Howell J. Rapid Transition of a PICU Space and Staff to Adult Coronavirus Disease 2019 ICU Care. Pediatr Crit Care Med 2021; 22:50-55. [PMID: 33031350 DOI: 10.1097/pcc.0000000000002597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We describe the process by which a PICU and a PICU care team were incorporated into a hospital-wide ICU care model during the coronavirus disease 2019 pandemic. DESIGN A descriptive, retrospective report from a single-center PICU. SETTING Twenty-three bed, quaternary PICU, within an 862-bed hospital. PATIENTS Critically ill adults, with coronavirus disease 2019-related disease. INTERVENTIONS ICU care provided by pediatric intensivists with training and support from medical intensivists. MEASUREMENTS AND MAIN RESULTS Within the context of the institution's comprehensive effort to centralize and systematize care for adults with severe coronavirus disease 2019 disease, the PICU was transitioned to an adult coronavirus disease 2019 critical care unit. Nurses and physicians underwent just-in-time training over 3 days and 2 weeks, respectively. Medical ICU physicians and nurses provided oversight for care and designated hospital-based teams were available for procedures and common adult emergencies. Over a 7-week period, the PICU cared for 60 adults with coronavirus disease 2019-related critical illness. Fifty-three required intubation and mechanical ventilation for a median of 18 days. Eighteen required renal replacement therapy and 17 died. CONCLUSIONS During the current and potentially in future pandemics, where critical care resources are limited, pediatric intensivists and staff can be readily utilized to meaningfully contribute to the care of critically ill adults.
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Affiliation(s)
- Emily Wasserman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Megan Toal
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Chani Traube
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Christine Joyce
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Robert Finkelstein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Weill Cornell Medicine, New York, NY
| | - James S Killinger
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Umesh Joashi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - John S Harrington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell, New York, NY
| | - Lisa K Torres
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell, New York, NY
| | - Bruce M Greenwald
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Joy Howell
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
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21
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Sathianathan S, Van Scoy LJ, Sakya SM, Miller E, Snyder B, Wasserman E, Chinchilli VM, Garman J, Lennon RP. Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Healthcare Workers: Results of a Cross Sectional Survey. Am J Health Promot 2020; 35:633-636. [PMID: 33353367 DOI: 10.1177/0890117120982416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare COVID-19 related knowledge, perceptions, and preferred information sources between healthcare workers and non-healthcare workers. DESIGN Cross-sectional survey. SETTING Web-based. SUBJECTS Convenience sample of Pennsylvanian adults. MEASURES Primary outcomes were binary responses to 15 COVID-19 knowledge questions weighted by a Likert scale assessing response confidence. ANALYSIS Generalized linear mixed-effects models to assess comparisons between clinical decision makers (CDM), non-clinical decision makers working in healthcare (non-CDM) and non-healthcare workers (non-HCW). RESULTS CDMs (n = 91) had higher overall knowledge than non-CDMs (n = 854; OR 1.81 [1.51, 2.17], p < .05). Overall knowledge scores were not significantly different between non-CDMs (n = 854) and non-HCW (n = 4,966; OR 1.03 [0.97, 1.09], p > .05). CONCLUSION The findings suggest a need for improved education about COVID-19 for healthcare workers who are not clinical decision makers, as they play key roles in patient perceptions and compliance with preventive medicine during primary care visits.
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Affiliation(s)
| | - Lauren Jodi Van Scoy
- Department of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, 12311Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Surav Man Sakya
- School of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Erin Miller
- Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Bethany Snyder
- Department of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA
| | - John Garman
- School of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Penn State Law, The Pennsylvania State University, University Park, PA, USA
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22
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McDonald AC, Wasserman E, Lengerich EJ, Raman JD, Geyer NR, Hohl RJ, Wang M. Prostate Cancer Incidence and Aggressiveness in Appalachia versus Non-Appalachia Populations in Pennsylvania by Urban-Rural Regions, 2004-2014. Cancer Epidemiol Biomarkers Prev 2020; 29:1365-1373. [PMID: 32277006 PMCID: PMC10957111 DOI: 10.1158/1055-9965.epi-19-1232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/04/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have examined prostate cancer incidence and aggressiveness in urban-rural Appalachian populations. We examined these rates in urban-rural Appalachia and non-Appalachia Pennsylvania (PA), and the association between these areas and more aggressive prostate cancer at diagnosis. METHODS Men, ages ≥ 40 years with a primary prostate cancer diagnosis, were identified from the 2004-2014 Pennsylvania Cancer Registry. Age-adjusted incidence rates for prostate cancer and more aggressive prostate cancer at diagnosis were calculated by urban-rural Appalachia status. Multivariable Poisson regressions were conducted. Multiple logistic regressions were used to examine the association between the geographic areas and more aggressive prostate cancer, after adjusting for confounders. RESULTS There were 94,274 cases, ages 40-105 years, included. Urban non-Appalachia had the highest 2004-2014 age-adjusted incidence rates of prostate cancer and more aggressive prostate cancer (293.56 and 96.39 per 100,000 men, respectively) and rural Appalachia had the lowest rates (256.48 and 80.18 per 100,000 men, respectively). Among the cases, urban Appalachia were more likely [OR = 1.12; 95% confidence interval (CI) = 1.08-1.17] and rural Appalachia were less likely (OR = 0.92; 95% CI = 0.87-0.97) to have more aggressive prostate cancer at diagnosis compared with urban non-Appalachia. CONCLUSIONS Lower incidence rates and the proportion of aggressive disease in rural Appalachia may be due to lower prostate cancer screening rates. More aggressive prostate cancer at diagnosis among the cases in urban Appalachia may be due to exposures that are prevalent in the region. IMPACT Identifying geographic prostate cancer disparities will provide information to design programs aimed at reducing risk and closing the disparity gap.
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Affiliation(s)
- Alicia C McDonald
- Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Eugene J Lengerich
- Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jay D Raman
- Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Surgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Nathaniel R Geyer
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Raymond J Hohl
- Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Pharmacology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Ming Wang
- Penn State Cancer Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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23
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Wang M, Wasserman E, Geyer N, Carroll RM, Zhao S, Zhang L, Hohl R, Lengerich EJ, McDonald AC. Spatial patterns in prostate Cancer-specific mortality in Pennsylvania using Pennsylvania Cancer registry data, 2004-2014. BMC Cancer 2020; 20:394. [PMID: 32375682 PMCID: PMC7203834 DOI: 10.1186/s12885-020-06902-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spatial heterogeneity of prostate cancer-specific mortality in Pennsylvania remains unclear. We utilized advanced geospatial survival regressions to examine spatial variation of prostate cancer-specific mortality in PA and evaluate potential effects of individual- and county-level risk factors. METHODS Prostate cancer cases, aged ≥40 years, were identified in the 2004-2014 Pennsylvania Cancer Registry. The 2018 County Health Rankings data and the 2014 U.S. Environmental Protection Agency's Environmental Quality Index were used to extract county-level data. The accelerated failure time models with spatial frailties for geographical correlations were used to assess prostate cancer-specific mortality rates for Pennsylvania and by the Penn State Cancer Institute (PSCI) 28-county catchment area. Secondary assessment based on estimated spatial frailties was conducted to identify potential health and environmental risk factors for mortality. RESULTS There were 94,274 cases included. The 5-year survival rate in PA was 82% (95% confidence interval, CI: 81.1-82.8%), with the catchment area having a lower survival rate 81% (95% CI: 79.5-82.6%) compared to the non-catchment area rate of 82.3% (95% CI: 81.4-83.2%). Black men, uninsured, more aggressive prostate cancer, rural and urban Appalachia, positive lymph nodes, and no definitive treatment were associated with lower survival. Several county-level health (i.e., poor physical activity) and environmental factors in air and land (i.e., defoliate chemical applied) were associated with higher mortality rates. CONCLUSIONS Spatial variations in prostate cancer-specific mortality rates exist in Pennsylvania with a higher risk in the PSCI's catchment area, in particular, rural-Appalachia. County-level health and environmental factors may contribute to spatial heterogeneity in prostate cancer-specific mortality.
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Affiliation(s)
- Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine and Cancer Institute, 90 Hope Drive, Hershey, PA, 17033, USA.
- Penn State Cancer Institute, Hershey, PA, USA.
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine and Cancer Institute, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Nathaniel Geyer
- Department of Public Health Sciences, Penn State College of Medicine and Cancer Institute, 90 Hope Drive, Hershey, PA, 17033, USA
| | - Rachel M Carroll
- Department of Mathematics and Statistics, the University of North Carolina at Wilmington, Wilmington, NC, USA
| | - Shanshan Zhao
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Lijun Zhang
- Penn State Cancer Institute, Hershey, PA, USA
- Penn State Institute of Personalized Medicine, Hershey, PA, USA
| | - Raymond Hohl
- Penn State Cancer Institute, Hershey, PA, USA
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Eugene J Lengerich
- Department of Public Health Sciences, Penn State College of Medicine and Cancer Institute, 90 Hope Drive, Hershey, PA, 17033, USA
- Penn State Cancer Institute, Hershey, PA, USA
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alicia C McDonald
- Department of Public Health Sciences, Penn State College of Medicine and Cancer Institute, 90 Hope Drive, Hershey, PA, 17033, USA
- Penn State Cancer Institute, Hershey, PA, USA
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24
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Van Scoy LJ, Levi BH, Witt P, Bramble C, Richardson C, Putzig I, Levi AR, Wasserman E, Chinchilli V, Tucci A, Green MJ. Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals. JAMA Netw Open 2020; 3:e204315. [PMID: 32383747 PMCID: PMC7210487 DOI: 10.1001/jamanetworkopen.2020.4315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Less than 25% of African American individuals have completed advance directives and are thus vulnerable to poor end-of-life care. Low-cost interventions are needed to increase engagement in advance care planning (ACP). OBJECTIVES To investigate whether an end-of-life conversation game motivates African American attendees to engage in ACP and to assess whether the game is well received and endorsed. EXPOSURES Attendance at an end-of-life conversation game (Hello) played in groups of 4 to 6 participants for 60 minutes. DESIGN, SETTING, AND PARTICIPANTS Prospective, mixed-methods cohort study conducted from 2018 to 2019 with a 3- to 11-month follow-up interview. Game events were held in 53 community venues across the US; 15 were purposively sampled for onsite research procedures. Of 428 attendees at purposively sampled sites, 386 (90%) consented to research procedures (6 attendees were removed from analysis for protocol deviation). Of 367 attendees who provided accurate contact information, 232 (63%) were contacted, and 220 were included in follow-up analyses. MAIN OUTCOMES AND MEASURES The primary outcome was advance directive completion rates after the intervention. Secondary outcomes included rates of other ACP behaviors, ACP engagement, conversation satisfaction and realism, and participants' Net Promoter Score (a measure of endorsement). Follow-up telephone interviews explored the game experience and relevant ACP behaviors of attendees. RESULTS Of 380 individuals who participated (mean [SD] age, 62.2 [13.8] years; 304 were female [80%], and 348 were [92%] African American), none withdrew because of an adverse event. After the intervention, 91 of 220 attendees (41%) completed a new advance directive; 176 of 220 attendees (80%) discussed end-of-life wishes with loved ones, and 214 of 219 attendees (98%) completed at least 1 ACP behavior. There was a moderate increase in the self-efficacy domain on the ACP Engagement Survey (mean [SD] change from before to after the game, 0.54 [0.98]; P < .001). The mean (SD) conversation satisfaction score was 6.21 (0.93) (range, 1-7, with 7 being highest satisfaction), and the overall Net Promoter Score was 57.89 (range, -100 to 100, with 100 being highest endorsement). Interviews revealed 5 themes about the game: (1) it was a useful forum for ACP; (2) it provided new information and perspective; (3) it was emotionally beneficial; (4) it increased appreciation for ACP; and (5) it empowered and motivated participants to perform ACP. Mixed-methods integration showed convergence across data sets. CONCLUSIONS AND RELEVANCE Among a nationwide sample of African American individuals, the end-of-life conversation game appeared to be well received and was associated with high rates of ACP behavior. This low-cost and scalable tool may help reduce health disparities associated with end-of-life care.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Benjamin H. Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Pamela Witt
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | | | - A. Rose Levi
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC
| | - Michael J. Green
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
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25
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Allen SI, Wasserman E, Veldheer S, Yingst J, Hrabovsky S, Liao J, Krebs NM, Horn K, Reinhart L, Modesto J, Putt K, Evins AE, Muscat JE, Richie JP, Foulds J. Characteristics of Adult Cigarette Smokers Who "Relight" and the Effects of Exposure to Tobacco Smoke Constituents. Nicotine Tob Res 2020; 21:1206-1212. [PMID: 29982710 DOI: 10.1093/ntr/nty138] [Citation(s) in RCA: 7] [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] [Received: 03/22/2018] [Accepted: 06/29/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION About half of smokers relight their cigarette, a habit that is a risk factor for chronic bronchitis and possibly lung cancer. Little is known about the characteristics of smokers who relight and their dependence on nicotine. It is unknown whether relighting affects exposure to tobacco smoke constituents. This study examined the characteristics of relighters of usual brand cigarettes and whether relighting affects exposure to selected tobacco smoke constituents. METHODS We explored relighting status and frequency, using baseline data from 248 adult smokers participating in studies of reduced nicotine cigarettes in relation to demographic and cigarette characteristics, smoking behaviors, nicotine dependence, biomarkers of exposure (exhaled carbon monoxide, blood cotinine), and biomarkers of oxidative stress (ratio of oxidized/reduced glutathione). RESULTS 69.4% (n = 172) of subjects reported relighting, and they relit an average of five cigarettes out of 20. Both relighters and non-relighters smoked a mean of 20 cigarettes per day (p = .6). Relighting was significantly associated with higher nicotine dependence, use of longer rod cigarettes, older age, lower income, and unemployment. There were no significant associations between relighting and blood cotinine, exhaled carbon monoxide or measures of oxidized/reduced blood glutathione. CONCLUSIONS The majority of subjects were relighters, who had higher levels of nicotine dependence than non-relighters. Relighters had similar levels of plasma cotinine and exhaled carbon monoxide to non-relighters. IMPLICATIONS No study has compared the cigarette characteristics and biomarkers of exposure of adult cigarette smokers who relight with those who do not. Relighting behavior was common in our sample and was associated with low income, not currently working, higher nicotine dependence, cigarette rod length, daily cigarette use years, and a lifetime history of depressed mood.
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Affiliation(s)
- Sophia I Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jessica Yingst
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Nicolle M Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kimberly Horn
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Kayla Putt
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - John P Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA
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Bluethmann SM, Wang M, Wasserman E, Chen C, Zaorsky NG, Hohl RJ, McDonald AC. Prostate cancer in Pennsylvania: The role of older age at diagnosis, aggressiveness, and environmental risk factors on treatment and mortality using data from the Pennsylvania Cancer Registry. Cancer Med 2020; 9:3623-3633. [PMID: 32212232 PMCID: PMC7221418 DOI: 10.1002/cam4.3003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background To assess: (a) cancer treatment in prostate cancer survivors (PCS) by age at diagnosis (ADx) and prostate cancer (PC) aggressiveness; (b) potential impact on PC mortality; and (c) these results in the context of environmental/behavioral risk factors on PCS in Pennsylvania. Methods Prostate cancer survivors ages ≥40 years were identified from the 2004‐2014 Pennsylvania Cancer Registry (PCR). Demographic/clinical descriptors and PC treatment were extracted from PCR. Prostate cancer aggressiveness was defined by clinical/pathologic Gleason score and tumor stage. Logistic and Cox regression analyses tested associations between treatment received and PC‐specific mortality. County‐level data from the Pennsylvania BRFSS were used to estimate cancer‐related behavioral risk factors (eg, smoking, physical inactivity, fruit/vegetable consumption [FV], alcohol use) and used as covariates. Results There were 90 694 PCS ages 40‐105 years (mean age = 66.19 years, SD = 9.25) included. Most were non‐Hispanic white men (83%). Prostate cancer survivors ≥75 years were least likely to receive any treatment but men ages 65‐74 were more likely to receive combined therapies (OR = 1.47; 95% CI 1.28, 1.69) vs PCS ages 40‐54 years, controlling for covariates. Prostate cancer survivors 55‐75+ with aggressive PC who received any treatment vs no definitive treatment had significantly reduced mortality. Men from counties with high obesity and smoking rates were significantly less likely to receive any treatment than men living in counties with lower rates of these risk factors. Prostate cancer survivors who lived in counties with high rates of physical inactivity and had high rates of sufficient FV consumption were slightly more likely to receive cancer treatment vs no definitive treatment compared to men who lived in counties with high rates of physical activity and lower FV consumption. Conclusions We observed a general age‐related decline in receipt of treatment. Prostate cancer survivors ages ≥75 years were significantly less likely to get any cancer treatment compared to younger PCS. However, most men with more aggressive disease who received any treatment had greatly reduced PC mortality, regardless of age. Considering environmental/behavioral risk factors may attenuate PC risk and inform treatment options.
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Affiliation(s)
- Shirley M Bluethmann
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Ming Wang
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Emily Wasserman
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nicholas G Zaorsky
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Raymond J Hohl
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Alicia C McDonald
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
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27
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Dominic OG, Chinchilli V, Wasserman E, Curry WJ, Kambic DM, Caicedo CH, Ramirez AG, Ochoa JA, Lengerich EJ. Impact of Social Support on Colorectal Cancer Screening among Adult Hispanics/Latinos: A Randomized Community-based Study in Central Pennsylvania. Cancer Prev Res (Phila) 2020; 13:531-542. [PMID: 32127350 DOI: 10.1158/1940-6207.capr-19-0333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/22/2019] [Accepted: 02/27/2020] [Indexed: 11/16/2022]
Abstract
In the United States, the five-year survival rate of colorectal cancer for Latinos is lower than it is for White, non-Latinos. Differences in survival are due, in part, to Latinos being diagnosed at a later stage. An ethnic gap in the use of colorectal cancer screening contributes to the difference in survival. We developed, implemented, and evaluated a targeted colorectal cancer screening intervention to increase colorectal cancer screening uptake by sex, ethnicity, and geography. We measured actual colorectal cancer screening uptake in both arms as a method to determine completion rates. We used a randomized, community-based, participatory design to test the impact of social support (intervention) on completion of a provider-recommended, take-home fecal immunochemical test (FIT) kit screening test among average-risk, urban, and rural Pennsylvania Latino adults age 50 and older not currently adherent to national colorectal cancer screening guidelines (n = 264). Participants in each arm attended a community-based educational program offered at eight sites. Among the 264 participants, 154 (58%) returned a completed usable FIT kit screening test. A higher return rate was observed among participants in the social support arm (66.0%) compared with the control (47.2%). Participants in the social support arm were statistically significant 2.67 times as likely to return a completed FIT kit. Of these, 27 (17.5%) had a positive FIT kit screening test result. The results of this study suggest that social support is an effective method to increase colorectal cancer screening rates among Latinos. Future studies should examine dissemination and implementation of community-based strategies among Latinos that include social support.
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Affiliation(s)
- Oralia G Dominic
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania. .,Department of Biobehavioral Health, The Pennsylvania State University, College of Health and Human Development, University Park, Pennsylvania
| | - Vern Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - William J Curry
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.,Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Daniel M Kambic
- Kambic Family Clinic, Steelton, Pennsylvania.,Pinnacle Health System, Harrisburg, Pennsylvania
| | | | - Amelie G Ramirez
- Institute for Health Promotion Research, Health Disparities Research, UT Health Science Center at San Antonio, San Antonio, Texas
| | - John A Ochoa
- Department of Spanish, Italian and Portuguese, College of Health and Human Development, The Pennsylvania State University, State College, Pennsylvania
| | - Eugene J Lengerich
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.,Department of Biobehavioral Health, The Pennsylvania State University, College of Health and Human Development, University Park, Pennsylvania.,Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Penn State Cancer Institute, The Pennsylvania State University, State College, Pennsylvania
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28
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Schram A, Drilon A, Mercade TM, O’Reilly E, Rodon J, Wolpin B, Ou SHI, Kim DW, Yang JCH, Lam Y, Varga A, de Langen A, Witteveen P, Boni V, Cerea G, Duruisseaux M, Liu S, Wasserman E, Hyman D, Tabernero J. A phase II basket study of MCLA-128, a bispecific antibody targeting the HER3 pathway, in NRG1 fusion-positive advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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McDonald AC, Wasserman E, Lengerich EJ, Raman JD, Geyer N, Hohl R, Wang M. Abstract 4186: Aggressive prostate cancer among men in Pennsylvania: Differences between Appalachian and non-Appalachian counties. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The incidence of prostate cancer (PC) is known to vary within Appalachia, with Northern Appalachia and Southern Appalachia having higher and lower rates, respectively. However, the geographical disparity for aggressive PC has not been investigated. The objective of this study was to determine whether having more aggressive PC was associated with residing in an Appalachian/non-Appalachian county and rural/urban community.
Methods: A cross-sectional study was conducted among men, aged > = 40 years, who had a primary, clinical PC diagnosis identified in the Pennsylvania Cancer Registry between 2004 and 2014. PC aggressiveness was defined as less aggressive (Gleason score 6 or 7 [3+4] and clinical/pathologic tumor stage T1-T2) and more aggressive (Gleason score > = 7 [4+3], clinical/pathologic tumor stage T3-T4, or distant metastasis) PC. Logistic regression analysis was used to examine the association between having aggressive PC (less vs more aggressive PC - dependent variable) and residing in a geographical region (Appalachian versus non-Appalachian county - independent variable), stratified by rural/urban, after adjusting for age, race, ethnicity, insurance status, marital status, serum PSA, positive lymph node status, and cancer treatment.
Results: There were 94,264 PC cases, aged 40 to 105 years, included in the study. The majority of the PC cases were white (83.9%) followed by black race (10.7%). PC cases from urban Appalachian counties (35.42%) had the highest frequency of aggressive PC followed by rural non-Appalachian (34.18%), rural Appalachian (32.12%), and urban non-Appalachian counties (32.08%). In urban areas, Appalachian PC cases were more likely to be aggressive compared to non-Appalachian PC cases, after adjusting for confounders (odds ratio [O.R.] =1.16; 95% confidence interval [C.I.], 1.13-1.21). Conversely, in rural areas, Appalachian PC cases were less likely to be aggressive compared to non-Appalachian PC cases, after adjusting for confounders (O.R. =0.91; 95% C.I., 0.85-0.98).
Conclusion: Differences in having more aggressive PC was observed for Appalachian populations by rural/urban status, with urban Appalachian PC cases more likely and rural Appalachian PC cases less likely to have more aggressive disease, compared to their non-Appalachian counterparts. Further investigation on the underlying mechanisms of aggressive PC in urban Appalachia in PA is warranted.
Citation Format: Alicia C. McDonald, Emily Wasserman, Eugene J. Lengerich, Jay D. Raman, Nathaniel Geyer, Raymond Hohl, Ming Wang. Aggressive prostate cancer among men in Pennsylvania: Differences between Appalachian and non-Appalachian counties [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4186.
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Affiliation(s)
| | | | | | - Jay D. Raman
- 2Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA
| | | | | | - Ming Wang
- 1Penn State Univ. College of Medicine, Hershey, PA
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Thomas NJ, Spear D, Wasserman E, Pon S, Markovitz B, Singh AR, Li S, Gertz SJ, Rowan CM, Kunselman A, Tamburro RF. CALIPSO: A Randomized Controlled Trial of Calfactant for Acute Lung Injury in Pediatric Stem Cell and Oncology Patients. Biol Blood Marrow Transplant 2018; 24:2479-2486. [PMID: 30059785 PMCID: PMC10479933 DOI: 10.1016/j.bbmt.2018.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 05/08/2018] [Accepted: 07/14/2018] [Indexed: 11/23/2022]
Abstract
To assess if calfactant reduces mortality among children with leukemia/lymphoma or after hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS), we conducted a multicenter, randomized, placebo-controlled, double-blinded trial in 17 pediatric intensive care units (PICUs) of tertiary care children's hospitals. Patients ages 18 months to 25 years with leukemia/lymphoma or having undergone HCT who required invasive mechanical ventilation for bilateral lung disease with an oxygenation index (OI) > 10 and <37 were studied. Interventions used were intratracheal instillation of either calfactant or air placebo (1 or 2 doses). Forty-three subjects were enrolled between November 2010 and June 2015: 26 assigned to calfactant and 17 to placebo. There were no significant differences in the primary outcome, which was survival to PICU discharge (adjusted hazard ratio of mortality for calfactant versus placebo, 1.78; 95% confidence interval, .53 to 6.05; P = .35), OI, functional outcomes, or ventilator-free days, adjusting for risk strata and Pediatric Risk of Mortality (PRISM) score. Despite the risk-stratified randomization, more allogeneic HCT patients received calfactant (76% and 39%, respectively) due to low recruitment at various sites. This imbalance is important because independent of treatment arm and while adjusting for PRISM score, those with allogeneic HCT had a nonsignificant higher likelihood of death at PICU discharge (adjusted odds ratio, 3.02; 95% confidence interval, .76 to 12.06; P = .12). Overall, 86% of the patients who survived to PICU discharge also were successfully discharged from the hospital. These data do not support the use of calfactant among this high mortality group of pediatric leukemia/lymphoma and/or HCT patients with PARDS to increase survival. In spite of poor enrollment, allogeneic HCT patients with PARDS appeared to be characterized by higher mortality than even other high-risk immunosuppressed groups. Conducting research among these children is challenging but necessary, because survival to PICU discharge usually results in successful discharge to home.
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Affiliation(s)
- Neal J Thomas
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Debbie Spear
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Steven Pon
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Weill Cornell Medicine, New York, New York
| | - Barry Markovitz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, California
| | - Aalok R Singh
- Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Simon Li
- Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Shira J Gertz
- Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Courtney M Rowan
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Robert F Tamburro
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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31
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Alsina M, Varga A, Amatu A, Schellens J, Witteveen P, Boni V, Moreno V, Bol K, Lourbakos A, Magin Ferrer M, Wasserman E. Phase I/II study of single agent MCLA-128, a full length IgG1 bispecific antibody targeting the HER3 pathway: Overall safety at the recommended phase II dose (R2PD) and preliminary activity in HER2+ metastatic gastric/gastroesophageal junction cancer (GC/GEJ). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
We analyzed data from the 2014-2015 Pennsylvania Youth Tobacco Survey to determine prevalence of tobacco use among middle and high school students. For the first time, questions on current (past 30-day) use of electronic cigarettes (e-cigarettes) were included in the survey. For current use, e-cigarettes were the most commonly used tobacco product among middle school students (2.3%; 95% confidence interval [CI], 1.4%-3.2%), and cigarettes were the most commonly used tobacco product among high school students (11.0%; 95% CI, 8.1%-13.8%). Given the changing landscape of tobacco products, collection of comprehensive data on tobacco use, including frequency, is important for monitoring behaviors among adolescents.
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Affiliation(s)
- Sophia I Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey Medical Center, MC CH69, 500 University Dr, PO Box 850, Hershey, PA 17033.
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Jessica Yingst
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Guodong Liu
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.,Center for Applied Studies in Health Economics, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, Pennsylvania
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33
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Krebs NM, Allen SI, Veldheer S, Martinez DJ, Horn K, Livelsberger C, Modesto J, Kuprewicz R, Wilhelm A, Hrabovsky S, Kazi A, Fazzi A, Liao J, Zhu J, Wasserman E, Reilly SM, Reinhart L, Trushin N, Moyer RE, Bascom R, Foulds J, Richie JP, Muscat JE. Correction to Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial. Trials 2017; 18:598. [PMID: 29246173 PMCID: PMC5732394 DOI: 10.1186/s13063-017-2356-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicolle M Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA.
| | - Sophia I Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Diane J Martinez
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Washington, D.C, 20052, USA
| | - Kimberly Horn
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Washington, D.C, 20052, USA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Robin Kuprewicz
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave, NW, Washington, D.C, 20052, USA
| | - Ashley Wilhelm
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Abid Kazi
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Alyse Fazzi
- Investigational Drug Service, Department of Pharmacy, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Samantha M Reilly
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Robinn E Moyer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
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Liu G, Wasserman E, Kong L, Foulds J. A comparison of nicotine dependence among exclusive E-cigarette and cigarette users in the PATH study. Prev Med 2017; 104:86-91. [PMID: 28389330 PMCID: PMC5868349 DOI: 10.1016/j.ypmed.2017.04.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 12/26/2022]
Abstract
Electronic cigarettes ("e-cigs") have recently gained in popularity, but their health risks, including dependence potential are unclear. This study analyzed the adult database from the Wave 1 Population Assessment of Tobacco and Health (PATH) Study, a nationally representative survey of tobacco use in the United States, to assess the relative level of dependence among adult, exclusive everyday users of e-cigarettes and cigarettes. Of the total 32,320 observations from the Wave 1 PATH adult database, 3586 (5.9%, weighted) were eligible for our analysis population. Among those who met the eligibility criteria, 156 (4.6%) were exclusive e-cig users, and 3430 (95.4%) were exclusive cigarette smokers. Our results show that e-cig users reported a significantly longer time-to-first-use of the day after waking (measured in minutes) compared to cigarette smokers after adjusting for confounders (adjusted geometric mean [95% confidence limits (CL)]: 29.2 [24.4-34.9] vs. 20.0 [18.7, 21.5]). In addition, cigarette smokers were significantly more likely to consider themselves addicted (Adj. Odds Ratio [95% CL]: 6.9 [4.5-10.7]); have strong cravings (2.9 [1.9-4.2]); find it difficult in the past 12months to refrain from using their product in places where it was prohibited (6.4 [2.9-14.3]); and feel like they really needed to use their product (3.9 [2.4-6.4]). These results are consistent with previous studies, in finding that exclusive daily e-cigarette users are less dependent on their respective product than comparable cigarette smokers.
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Affiliation(s)
- Guodong Liu
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States; Penn State Tobacco Center of Regulatory Science, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States; Center for Applied Studies in Health Economics, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States.
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States; Penn State Tobacco Center of Regulatory Science, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States
| | - Lan Kong
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States; Penn State Tobacco Center of Regulatory Science, Penn State University College of Medicine, Hershey Medical Center, Hershey, PA 17033-0850, United States
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35
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Killinger JS, Hurley C, Wasserman E, McArthur J. Complications of Emerging Oncology Therapies Requiring Treatment in the Pediatric Intensive Care Unit. Curr Pediatr Rep 2017. [DOI: 10.1007/s40124-017-0145-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Krebs NM, Allen SI, Veldheer S, Martinez DJ, Horn K, Livelsberger C, Modesto J, Kuprewicz R, Wilhelm A, Hrabovsky S, Kazi A, Fazzi A, Liao J, Zhu J, Wasserman E, Reilly SM, Reinhart L, Trushin N, Moyer RE, Bascom R, Foulds J, Richie JP, Muscat JE. Reduced nicotine content cigarettes in smokers of low socioeconomic status: study protocol for a randomized control trial. Trials 2017; 18:300. [PMID: 28673312 PMCID: PMC5496140 DOI: 10.1186/s13063-017-2038-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/10/2017] [Accepted: 06/01/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The Family Smoking Prevention and Tobacco Control Act gave the Food and Drug Administration jurisdiction over the regulation of all tobacco products, including their nicotine content. Under this act, a major strategy to reduce harm from cigarette tobacco is lowering the nicotine content without causing unintended adverse consequences. Initial research on reduced nicotine content (RNC) cigarettes has shown that smokers of these cigarettes gradually decrease their smoking frequency and biomarkers of exposure. The effectiveness of this strategy needs to be demonstrated in different populations whose response to RNC cigarettes might be substantially mediated by personal or environmental factors, such as low socioeconomic status (SES) populations. This study aims to evaluate the response to a reduced nicotine intervention in low SES smokers, as defined here as those with less than 16 years of education, by switching smokers from high nicotine commercial cigarettes to RNC cigarettes. METHODS/DESIGN Adults (N = 280) who have smoked five cigarettes or more per day for the past year, have not made a quit attempt in the prior month, are not planning to quit, and have less than 16 years of education are recruited into a two-arm, double-blinded randomized controlled trial. First, participants smoke their usual brand of cigarettes for 1 week and SPECTRUM research cigarettes containing a usual amount of nicotine for 2 weeks. During the experimental phase, participants are randomized to continue smoking SPECTRUM research cigarettes that contain either (1) usual nicotine content (UNC) (11.6 mg/cigarette) or (2) RNC (11.6 to 0.2 mg/cigarette) over 18 weeks. During the final phase of the study, all participants are offered the choice to quit smoking with nicotine replacement therapy, continue smoking the research cigarettes, or return to their usual brand of cigarettes. The primary outcomes of the study include retention rates and compliance with using only research cigarettes and no use of other nicotine-containing products. Secondary outcomes are tobacco smoke biomarkers, nicotine dependence measures, smoking topography, stress levels, and adverse health consequences. DISCUSSION Results from this study will provide information on whether low SES smokers can maintain a course of progressive nicotine reduction without increases in incidence of adverse effects. TRIAL REGISTRATION ClinicalTrials.gov, NCT01928719 . Registered on 21 August 2013.
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Affiliation(s)
- Nicolle M. Krebs
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Sophia I. Allen
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Susan Veldheer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Diane J. Martinez
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Kimberly Horn
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Craig Livelsberger
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jennifer Modesto
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robin Kuprewicz
- The Milken School of Public Health, George Washington University, 950 New Hampshire Ave. NW, Washington, D.C, 20052 USA
| | - Ashley Wilhelm
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Shari Hrabovsky
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Abid Kazi
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Alyse Fazzi
- Investigational Drug Service, Department of Pharmacy, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jason Liao
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Samantha M. Reilly
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Lisa Reinhart
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Neil Trushin
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Robinn E. Moyer
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - John P. Richie
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State Tobacco Center of Regulatory Science, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA 17033 USA
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Abstract
Adhering to standard procedures (impartiality), returning favors (reciprocity) or giving based on individuals' needs (charity) may all be considered moral and/or fair ways to allocate resources. However, these allocation behaviors may be perceived as differently motivated, and their moral evaluation may make different demands on theory of mind (ToM) - the capacity to process information about mental states, including motives. In Studies 1 and 2, we examined participants' moral judgments of allocations based on (1) impartiality, (2) reciprocity, (3) charity and (4) unspecified criteria as depicted in vignettes, as well as participants' perceptions of allocators' motivations. In Study 3, we used functional magnetic resonance imaging to investigate how brain regions for ToM were recruited during moral evaluation of the same vignettes. Reciprocity and charity were processed similarly, in that they recruited ToM regions to the same extent, i.e., precuneus, dorsal and ventral medial prefrontal cortex and left temporoparietal junction (LTPJ). In turn, impartiality and the unspecified condition were processed similarly, recruiting the same ToM regions to a lesser extent. Nevertheless, reciprocity elicited greater activity relative to impartiality and unspecified in the ToM regions of interest. Overall, evaluations of different allocation behaviors depend differently on ToM, with charity and reciprocity eliciting greater attention to individuals' unique states and motivations.
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Affiliation(s)
- Laura Niemi
- a Department of Psychology , Harvard University , Cambridge , MA , USA
| | - Emily Wasserman
- b Department of Psychology , Boston College , Chestnut Hill , MA , USA
| | - Liane Young
- b Department of Psychology , Boston College , Chestnut Hill , MA , USA
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Lin J, De A, Figueiredo L, Maxwell R, Wasserman E, Adams K, Weingarten J, Peek G, Miksa M. Pulmonary Alveolar Proteinosis in Association with Secondary Hemophagocytic Lymphohistiocytosis. J Pediatr 2017; 183:191-195. [PMID: 28088396 DOI: 10.1016/j.jpeds.2016.12.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/27/2016] [Accepted: 12/12/2016] [Indexed: 01/06/2023]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare diffuse lung disease in the pediatric population. There are currently few cases documenting hemophagocytic lymphohistiocytosis as a cause for secondary PAP. We describe an ex-preterm child with secondary hemophagocytic lymphohistiocytosis, complicated by PAP and hypoxemic respiratory failure.
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Affiliation(s)
- Jenny Lin
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.
| | - Aliva De
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Lisa Figueiredo
- Division of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Rochelle Maxwell
- Division of Pediatric Hospitalist Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Emily Wasserman
- Division of Pediatric Hospitalist Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Kelly Adams
- Division of Pediatric Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Jacqueline Weingarten
- Division of Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Giles Peek
- Division of Pediatric Cardiothoracic Surgery, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
| | - Michael Miksa
- Division of Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY
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Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Corrigendum. Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: incidence, recurrence, and mechanisms. Am J Sports Med 2016; 44:NP5. [PMID: 26729730 DOI: 10.1177/0363546515623241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: incidence, recurrence, and mechanisms. Am J Sports Med. 2015;43(11):2654-2662. (Original DOI: 10.1177/0363546515599634 )
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Orth H, Dreyer Z, Makgotlho E, Oosthuysen W, Sinha B, Wasserman E. Characterisation of staphylococcus aureus bacteraemia at Tygerberg hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/10158782.2013.11441515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H. Orth
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University; and National Health Laboratory Service
| | - Z.S. Dreyer
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University; and National Health Laboratory Service
| | - E. Makgotlho
- Institute of Hygiene and Microbiology, University of Würzburg
| | - W. Oosthuysen
- Division of Medical Microbiology, Department of Pathology, Stellenbosch University
| | - B. Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - E. Wasserman
- Pathcare Laboratories Extraordinary Professor Department of Pathology, Stellenbosch University
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Affiliation(s)
- E Wasserman
- Division of Medical Microbiology, National Health Laboratory Service and the Centre for Infectious Diseases, Stellenbosch University
| | - J Taljaard
- Division of Infectious Diseases, Department of Medicine, Tygerberg Hospital and the Centre for Infectious Diseases, Stellenbosch University
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Brits H, Adriaanse M, Rall DM, Van Biljon M, Van der Walt A, Wasserman E, Joubert G. Causes of prematurity in the Bloemfontein Academic Complex. S Afr Fam Pract (2004) 2015. [DOI: 10.1080/20786190.2014.976960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Brits H, Adriaanse M, Rall DM, Van Biljon M, Van der Walt A, Wasserman E, Joubert G. Causes of prematurity in the Bloemfontein Academic Complex. S Afr Fam Pract (2004) 2015. [DOI: 10.4102/safp.v57i3.3960] [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] [Indexed: 12/05/2022] Open
Abstract
Background: Prematurity is globally the leading cause of neonatal mortality, morbidity and long-term disability. The Millennium Development Goals (MDG) of the United Nations, and specifically MDG 4, address child mortality. Neonatal mortality rates contribute to 37% of all under-five mortality, with the largest proportion (30%) due to prematurity. The overall purpose of this study was to determine factors associated with prematurity and to identify treatable and preventable causes at the Bloemfontein Academic Complex in order to decrease the morbidity and mortality associated with prematurity in line with MDG.Methods: A case control study design was used including all premature babies referred to the Kangaroo Care Unit of the National District Hospital between December 2010 and March 2011. Each baby was included with his/her mother as a pair. For each premature baby and mother pair a term baby and mother pair was included as a control. Data were collected on a data sheet from the mothers’ antenatal records, and from maternal notes as well as the neonatal follow-up and discharge notes. Data gathered included baseline characteristics, habits, diseases and medication of the mother during the antenatal period and delivery as well as baseline demographics of the babies. Results: A total of 194 mothers and 198 babies were included in the study with 109 case mothers and 85 control mothers . Pre-existing medical conditions were more prevalent in the premature group (69%) compared with the control group (27%) with p 0.0001. These conditions included hypertension, HIV disease and syphilis. Possible causes for prematurity identified in this study included teenage mothers and premature rupture of membranes.Conclusion: Risk factors identified for prematurity were: teenage mothers, pre-existing medical conditions in the mother, and preterm rupture of membranes. Smoking and alcohol consumption during pregnancy could not be identified as risk factors for prematurity. It is recommended that patients with any of the above-mentioned identified risk factors be classified as high risk for the development of prematurity and shorter follow-up intervals and more aggressive management of pre-existing medical conditions should be practised.
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Oosthuysen WF, Orth H, Lombard C, Sinha B, Wasserman E. In vitro characterization of representative clinical South African Staphylococcus aureus isolates from various clonal lineages. New Microbes New Infect 2014; 2:115-22. [PMID: 25356356 PMCID: PMC4184580 DOI: 10.1002/nmi2.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 01/11/2023] Open
Abstract
Data concerning the virulence and pathogenesis of South African strains of Staphylococcus aureus are limited. We investigated host–pathogen interactions of randomly selected clinical S. aureus isolates representing various clones. We characterized the ability of isolates to adhere to fibronectin, fibrinogen, collagens IV and VI, to invade host cells and to induce cell death in vitro. We analysed the possible association of these results with characteristics such as methicillin resistance, Panton–Valentine leucocidin (PVL) positivity and clonality. The S. aureus isolates displayed diversity in their abilities to adhere to various human ligands. All isolates were highly invasive except for ST121. PVL-negative isolates were significantly more invasive than the PVL-positive isolates (p 0.004). Isolates of CC5, CC30 and CC121 were non-cytotoxic, whereas isolates of CC22, CC8, CC15, CC45 and CC88 were very cytotoxic. No statistical association was identified between cell death and methicillin resistance, bacterial PVL status, clonality or patient HIV status. The vast majority of isolates were invasive and induced significant cell death. PVL-negative isolates were more invasive than PVL-positive isolates, while methicillin-resistant isolates were not found to be more invasive or cytotoxic than methicillin-susceptible isolates.
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Affiliation(s)
- W F Oosthuysen
- Division of Medical Microbiology, Stellenbosch University, Tygerberg Hospital Cape Town, South Africa
| | - H Orth
- Division of Medical Microbiology, Stellenbosch University, Tygerberg Hospital Cape Town, South Africa ; National Health Laboratory Services, Microbiology Laboratory, Tygerberg Academic Complex Cape Town, South Africa
| | - C Lombard
- Biostatistics Unit, Medical Research Council Cape Town, South Africa
| | - B Sinha
- University Medical Centre Groningen Groningen, The Netherlands
| | - E Wasserman
- Division of Medical Microbiology, Stellenbosch University, Tygerberg Hospital Cape Town, South Africa ; Pathcare Laboratories Cape Town, South Africa
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Wasserman E, Orth H, Senekal M, Harvey K. High prevalence of mupirocin resistance associated with resistance to other antimicrobial agents in Staphylococcus aureusisolated from patients in private health care, Western Cape. S Afr J Infect Dis 2014. [DOI: 10.1080/23120053.2014.11441586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Oosthuysen WF, Orth H, Lombard CJ, Sinha B, Wasserman E. Population structure analyses of Staphylococcus aureus at Tygerberg Hospital, South Africa, reveals a diverse population, a high prevalence of Panton-Valentine leukocidin genes, and unique local methicillin-resistant S. aureus clones. Clin Microbiol Infect 2013; 20:652-9. [PMID: 24206111 DOI: 10.1111/1469-0691.12452] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 06/14/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 11/29/2022]
Abstract
Studies reporting on the population structure of Staphylococcus aureus in South Africa have focused only on methicillin-resistant S. aureus (MRSA). This study describes the population structure of S. aureus, including methicillin-susceptible S. aureus (MSSA) isolated from patients at Tygerberg Academic Hospital, Western Cape province. Pulsed-field gel electrophoresis (PFGE), detection of Panton-Valentine leukocidin (PVL), spa typing, multilocus sequence typing (MLST), agr typing and SCCmec typing were used to characterize strains. Of 367 non-repetitive S. aureus isolates collected over a period of 1 year, 56 (15.3%) were MRSA. Skin and soft tissue infections were the most frequent source (54.8%), followed by bone and joint (15.3%) and respiratory tract infections (7.7%). For strain typing, PFGE was the most discriminative method, and resulted in 31 pulsotypes (n = 345, 94.0%), as compared with 16 spa clonal complexes (CCs) (n = 344, 93.4%). Four MLST CCs were identified after eBURST of sequence types (STs) of selected isolates. One hundred and sixty isolates (MSSA, n = 155, 42.2%) were PVL-positive, and agr types I-IV and SCCmec types I-V were identified. Our S. aureus population consisted of genotypically diverse strains, with PVL being a common characteristic of MSSA. MSSA and MRSA isolates clustered in different clones. However, the dominant MRSA clone (ST612) also contained an MSSA isolate, and had a unique genotype. Common global epidemic MRSA clones, such as ST239-MRSA-III and ST36-MRSA-II, were identified. A local clone, ST612-MRSA-IV, was found to be the dominant MRSA clone.
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Affiliation(s)
- W F Oosthuysen
- Division of Medical Microbiology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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Heys I, Taljaard J, Prozesky H, Vismer H, Hoffman R, Wasserman E, Orth H. Invasive fungal infections, other than Candida and Cryptococcus, from 2008 to 2011, at Tygerberg Hospital in the Western Cape, South Africa. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Murphy L, Glantz J, Thornburg L, Wasserman E, Stanwood N, Betstadt S. Complications of surgical termination of pregnancy in obese versus nonobese women. Contraception 2012. [DOI: 10.1016/j.contraception.2011.11.053] [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: 11/27/2022]
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Damiano JS, Wasserman E, Rendahl K, Jeffry U, Rediske J, Kakar S, Gardner H, Abraham J. P3-17-09: Neutralizing the Prolactin Receptor with Therapeutic Antibody LFA102: A Novel Approach for the Treatment of Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-17-09] [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
The prolactin receptor (PRLR) is a class I cytokine receptor required for the normal development of the mammary gland and is frequently found to be overexpressed in breast tumors. The polypeptide hormone prolactin (PRL) has been demonstrated to induce PRLR signaling through the Jak/Stat, PI3-kinase/AKT and MAPK pathways, leading to cell proliferation and survival. Mammary gland-specific overexpression of PRL in transgenic mice leads to a higher incidence of ER+ and ER- mammary tumors. In addition, the PRLR locus is the site of frequent viral integrations in MMTV-induced mammary tumors. Elevated serum PRL levels in humans have been correlated with an increased risk for breast cancer, especially for ER+ cases, implicating a role for this hormone in the development of human breast tumors. An analysis of more than 3000 breast tumor specimens indicates that PRLR is expressed with high prevalence (60-70% of tumors) across all breast cancer subtypes, with a trend towards higher expression in ER+ tumors. All of these lines of evidence support the hypothesis that targeting the PRL/PRLR axis may be a new approach for addressing unmet medical need in breast cancer. LFA102 is a Human Engineered™ anti-PRLR antibody of the IgG1 isotype that neutralizes the function of PRLR through a non-ligand competitive binding interaction. LFA102 blocks PRL-induced signaling and proliferation in T47D and MCF7 ER+ human breast cancer cells in vitro, and abolishes PRL-induced phosphorylation of Stat5 in T47D xenograft tumors in vivo. An examination of disaggregated primary human breast tumors ex vivo has indicated that PRL frequently induces signaling through Stat5 in the cells and that LFA102 is capable of completely antagonizing this signaling. LFA102 also neutralizes rat PRLR and the antibody potently regresses PRL-dependent Nb2-C11 pre-T cell lymphoma tumors in vivo. Preliminary data suggests that LFA102 is also capable of inhibiting the growth of carcinogen-induced rat mammary tumors. In vitro studies have shown that LFA102 can also mediate antibody-dependent cellular cytotoxicity (ADCC) and inhibit the PRL-dependent release of the pro-angiogenic factor VEGF from breast cancer cells. Thus, there are multiple potential mechanisms through which LFA102 could show anti-tumor activity in vivo. Preclinical toxicological studies of LFA102 indicate that this therapeutic is well tolerated and exhibits a normal pharmacokinetic profile in relevant animal species. The safety and pharmacokinetics of LFA102 in humans are currently being evaluated in a phase I healthy volunteer trial. At the three dose levels explored so far, no infusion reactions or severe adverse events related to the drug have been reported. Preliminary results suggest that LFA102 has an adequate pharmacokinetic profile for further clinical development. An assessment of LFA102 in a population of metastatic breast cancer patients predicted to have the highest probability of benefit is imminent.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-17-09.
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Affiliation(s)
- JS Damiano
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - E Wasserman
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - K Rendahl
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - U Jeffry
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - J Rediske
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - S Kakar
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - H Gardner
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
| | - J Abraham
- 1Novartis Institutes for BioMedical Research, Emeryville, CA; Novartis Pharmaceuticals, Florham Park, NJ; Novartis Institutes for BioMedical Research, Cambridge, MA
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