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Rhodes RL, Cummings-Vaughn LA, Lundebjerg NE, Hardi A, Obrusniak EE, Yeo G. Diversity in research on aging: A new series. J Am Geriatr Soc 2024. [PMID: 38594955 DOI: 10.1111/jgs.18880] [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] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
This editorial comments on the article by Gilmore et al.
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Affiliation(s)
- Ramona L Rhodes
- Division of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Angela Hardi
- School of Medicine, Washington University, Saint Louis, Missouri, USA
| | | | - Gwen Yeo
- Stanford University School of Medicine, Stanford, California, USA
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Affiliation(s)
- Gwen Yeo
- Stanford University School of Medicine, Stanford, California
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Ta Park VM, Ton V, Yeo G, Tiet QQ, Vuong Q, Gallagher-Thompson D. Vietnamese American Dementia Caregivers' Perceptions and Experiences of a Culturally Tailored, Evidence-Based Program to Reduce Stress and Depression. J Gerontol Nurs 2020; 45:39-50. [PMID: 31437289 DOI: 10.3928/00989134-20190813-05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
Abstract
Vietnamese American dementia caregivers are at increased risk for adverse mental health compared to the general U.S. population given their sociodemographic and immigration experiences, yet programs that address their needs are lacking. The current article describes Vietnamese American dementia caregivers' perceptions and experiences of a culturally tailored, evidence-based intervention to reduce stress and depression. A convenience sample of caregivers was recruited from the San Francisco Bay area and randomly assigned to intervention ("Our Family Journey"; OFJ) (n = 30) or control (written dementia caregiving information) (n = 30) groups. All intervention and 76.7% of control caregivers reported that the OFJ or educational materials, respectively, were very/somewhat helpful. Three or more skills were refined/learned by 96.7% of OFJ and 36.6% of control participants. Qualitative findings indicated that the intervention had positive effects on well-being and taught new caregiving skills. This first U.S. study to address the mental health needs of Vietnamese American dementia caregivers shows positive perceptions/experiences and demonstrates a model to address a significant need in the community. [Journal of Gerontological Nursing, 45(9), 39-50.].
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Ta Park VM, Ton V, Tiet QQ, Vuong Q, Yeo G, Gallagher-Thompson D. Promising results from a pilot study to reduce distress in Vietnamese American dementia and memory loss caregivers. Alzheimers Dement (N Y) 2019; 5:319-327. [PMID: 31384663 PMCID: PMC6661409 DOI: 10.1016/j.trci.2019.05.006] [Citation(s) in RCA: 9] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study developed and examined the feasibility of a culturally tailored, evidence-based skill-building program to reduce stress and depression of Vietnamese American dementia caregivers. METHODS This pilot randomized controlled trial included pretest and posttest measures using the Center for Epidemiologic Studies-Depression Scale and the Revised Memory and Behavior Problems Checklist. The intervention (n = 30) group participated in a culturally tailored, 4-week Vietnamese-language cognitive-behavioral skills evidenced-based program (Our Family Journey); caregivers in the control condition (n = 30) received dementia-related educational materials (education control condition). RESULTS Our Family Journey caregivers showed significantly lower somatic scores on the Center for Epidemiologic Studies-Depression Scale and reported lower frequency of care recipients' disruptive behaviors. However, they also reported being more stressed by their care recipients' depressive symptoms on the Revised Memory and Behavior Problems Checklist compared to caregivers in the education control condition. DISCUSSION These promising results suggest that a culturally adapted program can benefit Vietnamese dementia caregivers. Additional research is needed to develop and evaluate stronger, more impactful interventions for this underserved group.
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Affiliation(s)
- Van M. Ta Park
- Department of Community Health Systems, University of California at San Francisco, School of Nursing, San Francisco, CA, USA
| | - Vy Ton
- Department of Health Science and Recreation, San Jose State University, One Washington Square, San Jose, CA
| | - Quyen Q. Tiet
- California School of Professional Psychology at Alliant International University, San Francisco, CA, USA
- National Center for PTSD, VA Palo Alto HCS, Menlo Park, CA, USA
| | - Quyen Vuong
- International Children Assistance Network, Milpitas, CA, USA
| | - Gwen Yeo
- Department of Psychiatry and Behavioral Science, Stanford University, School of Medicine, Stanford, CA, USA
| | - Dolores Gallagher-Thompson
- Department of Psychiatry and Behavioral Science, Stanford University, School of Medicine, Stanford, CA, USA
- University of California at Davis, Betty Irene Moore School of Nursing, Family Caregiving Institute, Sacramento, CA, USA
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Salomon LJ, Alfirevic Z, Da Silva Costa F, Deter RL, Figueras F, Ghi T, Glanc P, Khalil A, Lee W, Napolitano R, Papageorghiou A, Sotiriadis A, Stirnemann J, Toi A, Yeo G. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol 2019; 53:715-723. [PMID: 31169958 DOI: 10.1002/uog.20272] [Citation(s) in RCA: 253] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 05/09/2023]
Abstract
INTRODUCTION These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1. It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating2–4. HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age1. Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.
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Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - F Figueras
- Hospital Clinic, Obstetrics and Gynecology, Barcelona, Spain
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Stirnemann
- Obstetrics, University Paris Descartes, Hôpital Necker Enfants Malades, Paris, France
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
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Yeo G, Yoshikawa T. To the Future of Ethnogeriatric Research and Publication. J Am Geriatr Soc 2019; 67:1120-1122. [DOI: 10.1111/jgs.15875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Gwen Yeo
- Stanford Geriatric Education CenterStanford University School of Medicine Stanford California
| | - Thomas Yoshikawa
- Geriatric and Extended Care Service, VA Greater Los Angeles Healthcare SystemDavid Geffen School of Medicine at University of California at Los Angeles Los Angeles California
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Ta Park V, Nguyen K, Tran Y, Yeo G, Tiet Q, Suen J, Gallagher-Thompson D. Perspectives and Insights from Vietnamese American Mental Health Professionals on How to Culturally Tailor a Vietnamese Dementia Caregiving Program. Clin Gerontol 2018; 41:184-199. [PMID: 29419364 DOI: 10.1080/07317115.2018.1432734] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Little is known about dementia and caregiving among the rapidly growing Vietnamese American population. This qualitative study elicited insights on culturally tailoring an intervention to address mental health needs in Vietnamese American dementia caregivers from Vietnamese American mental health professionals. METHODS Eight Vietnamese American mental health professionals were interviewed to explore: experiences working with and needs of the community; Vietnamese attitudes toward treatment; and acculturation in Vietnamese caregiving. Participants provided recommendations on tailoring a program for Vietnamese dementia caregivers. Content analysis of their responses was conducted. RESULTS Themes included: a) caregivers' unique needs and experiences; b) different waves of immigration and acculturation levels affect views on mental health, treatment, and caregiving; c); traditions and beliefs on caregiving; d) mental health, help-seeking and health services; e) how to culturally tailor a program for Vietnamese dementia caregivers; and f) cultural acceptance of the program. CONCLUSIONS An intervention to reduce stress and depression among Vietnamese American dementia caregivers should recognize the special risks of the experiences of war and immigration of the caregivers as well as the pressure of the expectations of the Vietnamese culture on family care. For the program to be acceptable and effective, it needs to consider all aspects of caregivers' health, and incorporate Vietnamese cultural values/beliefs. CLINICAL IMPLICATIONS A successful Vietnamese dementia caregiver intervention should include traditional Vietnamese values/beliefs, holistic experiences, spirituality, and background/immigration experiences. Evidence-based programs may be used with this population if they are culturally tailored.
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Affiliation(s)
- Van Ta Park
- a Department of Community Health Systems, School of Nursing , University of California at San Francisco , San Francisco , California , USA
| | - Khue Nguyen
- b Department of Health Science & Recreation, San Jose State University , San Jose , California , USA
| | - Yvonne Tran
- b Department of Health Science & Recreation, San Jose State University , San Jose , California , USA
| | - Gwen Yeo
- c Stanford Geriatric Education Center , Stanford , California , USA
| | - Quyen Tiet
- d California School of Professional Psychology , Alliant International University , San Francisco , California , USA
| | - Joyce Suen
- b Department of Health Science & Recreation, San Jose State University , San Jose , California , USA
| | - Dolores Gallagher-Thompson
- e Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine , Stanford , California , USA.,f Clinical Gerontologist Office , Los Altos , California , USA
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Cruz-Oliver DM, Malmstrom TK, Roegner M, Yeo G. Evaluation of a Video-Based Seminar to Raise Health Care Professionals' Awareness of Culturally Sensitive End-of-Life Care. J Pain Symptom Manage 2017; 54:546-554. [PMID: 28716618 DOI: 10.1016/j.jpainsymman.2017.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 03/15/2017] [Revised: 06/26/2017] [Accepted: 07/07/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Health care workers serve diverse communities and face challenges in delivering culturally responsive EOL care, especially when caring for Latino elders. OBJECTIVE The objective of this study was to investigate the effect of a newly developed telenovela, or video soap opera, on health care professionals (HCPs)' awareness of caregivers' stress and patients' cultural approaches to end-of-life (EOL) care decisions. METHODS A multicenter cross-sectional study among three communities in New York, Miami, and Missouri. Participants from a convenience sample of multidisciplinary HCPs were randomly assigned to view power point presentation with either a control video or an intervention-telenovela about caregiving as part of a one-hour audiovisual seminar and completed a pre- and post-test questionnaire to evaluate reaction and learning. RESULTS Participants (N = 142) were mostly female (80%) nurses (54%) with a mean age of 44.5 ± 12.4 years and from non-Hispanic white (41%) or Hispanics (37%) ethnicity. In both control and intervention groups, post-test responses demonstrated a high level (87%) of satisfaction with seminar and an increase in openness to discuss EOL issues with culturally diverse patients (P < 0.001). Although both groups reported post-test improvement in awareness of health literacy, cultural competency skills, cultural differences about EOL attitudes, family caregiver stress, and possible interventions, this improvement was significantly higher in the intervention group (P < 0.05) compared with the control group. CONCLUSION The telenovela was effective in increasing health care workers' awareness of caregivers stress and cultural approach to EOL decisions. There is need for ongoing efforts to educate HCPs on cultural sensitivity to help ethnically diverse caregivers and their patients benefit from EOL care.
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Affiliation(s)
- Dulce M Cruz-Oliver
- Internal Medicine, Palliative Medicine Program, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Theodore K Malmstrom
- Department of Psychiatry and Behavioral Sciences, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Michael Roegner
- Department of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical Center/Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Gwen Yeo
- Stanford University School of Medicine, Stanford, California, USA
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Yeo G, Hikoyeda N, McBride M, Tzuang M, Grudzen M, Mehta K. FACULTY DEVELOPMENT IN ETHNOGERIATRICS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G. Yeo
- Stanford University, Stanford, California,
| | | | | | - M. Tzuang
- Stanford University, Stanford, California,
- Johns Hopkins University, Baltimore, Maryland
| | | | - K. Mehta
- Stanford University, Stanford, California,
- University of California, San Francisco, San Francisco, California,
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Ta Park V, Nguyen K, Tran Y, Yeo G, Tiet Q, Suen J, Gallagher‐Thompson D. [P2–507]: VIETNAMESE AMERICAN MENTAL HEALTH COMMUNITY's PERSPECTIVES ON A CULTURALLY TAILORED PROGRAM FOR VIETNAMESE AMERICAN DEMENTIA CAREGIVERS. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - Gwen Yeo
- Stanford University School of MedicineStanfordCAUSA
| | - Quyen Tiet
- VA Palo Alto Health Care SystemMenlo ParkCAUSA
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Tzuang M, Downey J, Yeo G, Mehta K, McBride M, Grudzen M, Gallagher-Thompson D. WEBINARS AS A TOOL FOR GERIATRIC EDUCATION: OUTCOMES OF A WEBINAR SERIES ON DEMENTIA CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M. Tzuang
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,
- Stanford Geriatric Education Center, Stanford, California,
| | - J. Downey
- Stanford Geriatric Education Center, Stanford, California,
| | - G. Yeo
- Stanford Geriatric Education Center, Stanford, California,
| | - K.M. Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Stanford Geriatric Education Center, Stanford, California,
| | - M.R. McBride
- Stanford Geriatric Education Center, Stanford, California,
| | - M.R. Grudzen
- Stanford Geriatric Education Center, Stanford, California,
| | - D. Gallagher-Thompson
- Stanford Geriatric Education Center, Stanford, California,
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California,
- Stanford Alzheimer’s Disease Research Center, Stanford, California,
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Salomon LJ, Alfirevic Z, Audibert F, Kagan KO, Paladini D, Yeo G, Raine-Fenning N. ISUOG updated consensus statement on the impact of cfDNA aneuploidy testing on screening policies and prenatal ultrasound practice. Ultrasound Obstet Gynecol 2017; 49:815-816. [PMID: 28573775 DOI: 10.1002/uog.17483] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France, and SFAPE (Société Française d'Amélioration des Pratiques Echographique)
| | - Z Alfirevic
- Department for Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Audibert
- Department of Obstetrics and Gynaecology, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - D Paladini
- Fetal Medicine and Surgery Unit, Giannina Gaslini Institute, Genoa, Italy
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
| | - N Raine-Fenning
- Division of Obstetrics & Gynaecology, School of Clinical Sciences, University of Nottingham, Nottingham, UK
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Abstract
In this paper we present a method for obtaining explicit results for some two-sided boundary problems involving sums of independent random variables with alternating distributions. We apply the method to finding the first passage time to either one of two finite barriers, and to some situations arising in queueing and dam theory. The results can be expressed in terms of a finite sum of simple repeated integrals (or sums) of known functions (cf. formulae (3.6)– (3.11)).
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Bilek M, Kosobrodova E, Wakelin E, Kondyurin A, Yeo G, Martin L, McKenzie D, Hutmacher D, Weiss A. Cost-Effective Creation of Biofunctionalised Scaffolds, Tailored to Function as Stem Cell Niches for Expansion, Transport and Delivery. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Yeo G, Gupta A, Ding G, Skerman H, Khatun M, Melsom D. Pain Levels after Local Anaesthetic with or without Hyaluronidase in Carpal Tunnel Release: A Randomised Controlled Trial. Adv Orthop 2015; 2015:784329. [PMID: 26587288 PMCID: PMC4637433 DOI: 10.1155/2015/784329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/15/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose. Hyaluronidase is an enzyme that temporarily liquefies the interstitial barrier, allowing easy dispersal of local anaesthetic through cleavage of tissue planes. This prospective, blinded, randomised controlled study investigates the utility of adding hyaluronidase to local anaesthetic in the setting of carpal tunnel release. Methods. 70 consecutive carpal tunnel release patients were recruited and randomised into a control group only receiving local anaesthetic and a hyaluronidase group receiving both hyaluronidase and local anaesthetic. Pain scores were rated using the visual analogue scale (VAS) by patients immediately after local anaesthetic injection and again immediately after the carpal tunnel release. Results. Preoperative VAS scores, taken after local anaesthetic injection, were greater than postoperative VAS scores. Postoperative VAS scores were significantly lower in the hyaluronidase group and tourniquet times were significantly shorter in the hyaluronidase group. Conclusion. Hyaluronidase addition to local anaesthetic in carpal tunnel release resulted in significant reductions in operative time and pain immediately after operation.
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Affiliation(s)
- G. Yeo
- Royal Brisbane Hospital, Australia
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Salomon LJ, Alfirevic Z, Audibert F, Kagan KO, Paladini D, Yeo G, Raine-Fenning N. ISUOG consensus statement on the impact of non-invasive prenatal testing (NIPT) on prenatal ultrasound practice. Z Geburtshilfe Neonatol 2014; 218:242-3. [PMID: 25518828 DOI: 10.1055/s-0034-1395670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Evans KH, Bereknyei S, Yeo G, Hikoyeda N, Tzuang M, Braddock CH. The impact of a faculty development program in health literacy and ethnogeriatrics. Acad Med 2014; 89:1640-1644. [PMID: 25006703 DOI: 10.1097/acm.0000000000000411] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PROBLEM A faculty development curriculum aimed at increasing health literacy and awareness of patient care issues in ethnogeriatrics is essential to address serious deficiencies in faculty and health professionals' training and to prepare future health care professionals to care for older adults. APPROACH Authors from the Stanford Geriatric Education Center developed and implemented a faculty development program in Health Literacy and Ethnogeriatrics (HLE). The goal was to enhance faculty and health professionals' knowledge, skills, and attitudes in HLE-related areas (e.g., health disparities, low health literacy, quality of care for ethnically diverse elders, patient/provider communication). The curriculum was implemented during an intensive weeklong program over a three-year period (2008-2010). The eight-module core curriculum was presented in a train-the-trainer format, supplemented by daily resource sessions. OUTCOMES Thirty-four faculty participants from 11 disciplines, including medicine, came from 19 institutions in 12 states. The curriculum positively affected participants' knowledge, skills, and attitudes related to topics in HLE. Participants rated the curriculum's usefulness highly, and they reported that over 57% of the content was new. The HLE curriculum provided a mechanism to increase the self-assessed knowledge, skills, and attitudes of participants. It also fostered local curricular change: Over 91% of the participants have either disseminated the HLE curriculum through seminars conducted at their home sites or implemented HLE-related projects in their local communities, reaching diverse patient populations. NEXT STEPS Next steps include measuring the impact on the participants' teaching skills and at their home sites through their trainees and patients.
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Affiliation(s)
- Kambria H Evans
- Mrs. Evans is program officer, Quality and Organizational Improvement, Department of Medicine, Stanford University, Stanford, California. Dr. Bereknyei is research associate, Stanford Center for Medical Education Research and Innovation, Department of Medicine, Stanford University, Stanford, California. Dr. Yeo is senior research scholar and director emerita, Stanford Geriatric Education Center, Department of Medicine, Stanford University, Stanford, California. Dr. Hikoyeda is associate director, Stanford Geriatric Education Center, Department of Medicine, Stanford University, Stanford, California. Mrs. Tzuang is program coordinator, Stanford Geriatric Education Center, Department of Medicine, Stanford University, Stanford, California. Dr. Braddock is vice dean for medical education, Department of the Dean, University of California, Los Angeles, Los Angeles, California
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Salomon LJ, Alfirevic Z, Audibert F, Kagan KO, Paladini D, Yeo G, Raine-Fenning N. ISUOG consensus statement on the impact of non-invasive prenatal testing (NIPT) on prenatal ultrasound practice. Ultrasound Obstet Gynecol 2014; 44:122-123. [PMID: 24895295 DOI: 10.1002/uog.13393] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France and, SFAPE (Société Française d'Amélioration des Pratiques Echographique)
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Salomon LJ, Alfirevic Z, Bilardo CM, Chalouhi GE, Ghi T, Kagan KO, Lau TK, Papageorghiou AT, Raine-Fenning NJ, Stirnemann J, Suresh S, Tabor A, Timor-Tritsch IE, Toi A, Yeo G. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41:102-13. [PMID: 23280739 DOI: 10.1002/uog.12342] [Citation(s) in RCA: 344] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Yeo G, Villalobos F, Robinson G. Outcomes and Challenges of <I>Familias Saludables</I>: A Rural Latino Chronic Disease Screening and Management Project. Hisp Hlth Care Int 2011. [DOI: 10.1891/1540-4153.9.3.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
To better understand conceptualizations of dementia, this study explored causal attributions of dementia among 209 Korean Americans, using a self-administered questionnaire in Korean. Findings show that Korean Americans endorsed various causal attributions. Factor analysis yielded 3 dimensions of their attributions including psychological, physical/environmental, and cognitive/social. Bivariate analyses showed that younger age and higher education were related to more physical/environmental attributions, and younger age was related to more cognitive/social attributions. The study provides an understanding of causal attributions of dementia that practitioners need to understand to provide culturally competent practice and highlights a need to customize public education messages by specific ethnic groups.
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Affiliation(s)
- Sang E Lee
- School of Social Work, San Jose State University, San Jose, California 95192–0124, USA.
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Dreja T, Jovanovic Z, Rasche A, Kluge R, Kleinjung F, Herwig R, Joost HG, Yeo G, Al-Hasani H. Identifizierung von Suszeptibilitätsgenen für Adipositas und Diabetes durch Analysen der Expressionsprofile von Fett- und Inselzellen bei einem polygenen Mausmodell für das Metabolische Syndrom. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221807] [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: 10/20/2022]
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24
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Yeo G. Grandfather’s Story Cloth. J Gerontol Nurs 2008. [DOI: 10.3928/00989134-20080901-07] [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: 11/20/2022]
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Dreja T, Jovanovic Z, Rasche A, Kluge R, Herwig R, Joost HG, Yeo G, Al-Hasani H. Diet-induced gene expression of isolated pancreatic islets from a polygenic mouse model for the metabolic syndrome. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gray J, Yeo G, Hung C, Keogh J, Clayton P, Banerjee K, McAulay A, O'Rahilly S, Farooqi IS. Functional characterization of human NTRK2 mutations identified in patients with severe early-onset obesity. Int J Obes (Lond) 2006; 31:359-64. [PMID: 16702999 DOI: 10.1038/sj.ijo.0803390] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The neurotrophin receptor TrkB has been implicated in the regulation of energy homeostasis in rodents. We have previously identified four rare missense mutations in the gene encoding TrkB, NTRK2, in 198 severely obese children with developmental delay. We have now undertaken a more detailed analysis of the in vitro functional consequences of the mutations identified: I98V, P660L, T821A and Y722C. DESIGN Wild-type and mutant TrkB receptor constructs were stably transfected into PC12 cells and the signaling responses to the endogenous ligand, brain-derived neurotrophic factor (BDNF), were examined by Western blotting of cell lysates. In the case of Y722C, PC12 cells stably expressing this mutant were studied for their ability to respond to BDNF by promoting neurite outgrowth and cell survival. RESULTS Further functional characterization of the previously reported Y722C TrkB mutation reveals impaired activation of mitogen-activated protein kinase, phospholipase C-gamma and Akt, as well as reduced BDNF-induced neurite outgrowth and cell survival in stably transfected PC12 cell lines. However, the signaling properties of I98V, P660L and T821A were all indistinguishable from wild type. CONCLUSION We provide further evidence for the impairment in signaling by Y722C and show that as well as a loss of signaling, this mutation affects the ability of TrkB to promote neurite outgrowth in response to BDNF. Thus, impaired hypothalamic neurogenesis may contribute to the severe hyperphagia and obesity seen in the individual harboring the Y722C variant. The other three rare TrkB variants do not show reduced autophosphorylation or impaired downstream signaling in vitro and, as yet, it is unclear whether these variants contribute to obesity in these patients.
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Affiliation(s)
- J Gray
- Department of Clinical Biochemistry, Cambridge Institute for Medical Research, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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Abstract
Geriatric Education Center (GEC) faculty and staff are committed to teaching health professionals about the impact of culture on the health and health care of elders from ethnically diverse backgrounds. Ethnogeriatrics was highlighted as an important issue in the National Agenda for Geriatric Education during the 1990s. Between 1999 and 2001, the GEC Collaborative on Ethnogeriatric Education developed a Core Curriculum on Ethnogeriatrics and Ethnic Specific Modules. Faculty from 34 GECs wrote, reviewed, revised, expanded, and disseminated the Curriculum in Ethnogeriatrics. The 16-module, web-based Curriculum provides detailed information and teaching resources about important historical and cultural influences on the health care experience of the diverse U.S. population of elders. The Stanford GEC has tracked usage of the ethnogeriatric curriculum and reports favorable responses regarding its effectiveness. Many GECs have used the modules in their continuing education programs. GEC faculty share their teaching methods with others at professional meetings and present training sessions in their own geographical areas.
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Affiliation(s)
- Janet S Severance
- Midwestern Geriatric Education Center, Midwestern University, 555 31st Street, Downers Grove, IL 60515, USA.
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Yeo G. Role of Community Health Workers in Dementia Case Finding. J Am Geriatr Soc 2005; 53:1829-30. [PMID: 16181187 DOI: 10.1111/j.1532-5415.2005.53559.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Understanding variability in conceptions of dementia in multiethnic populations is important to improve care and guide research. The objectives of this study were to describe caregiver conceptions of dementia using a previously developed typology and to examine the correlates of conceptions of dementia in a multiethnic sample. This is a cross-sectional study conducted in Boston and the San Francisco Bay area. Participants were a convenience sample of 92 family dementia caregivers from four ethnic/racial groups: African-American, Anglo European-American, Asian-American, and Latino. In-depth, qualitative interviews explored the caregivers' ideas about the nature and cause of dementia (i.e., explanatory models). Explanatory models of caregivers were categorized as biomedical, folk, or mixed (folk/biomedical). Quantitative analyses examined the association between ethnicity and other caregiver characteristics, and explanatory model type. Overall, 54% of caregivers, including 41% of Anglo European Americans, held explanatory models that combined folk and biomedical elements (i.e., mixed models). For example, many families attributed Alzheimer's disease and related dementias to psychosocial stress or normal aging. Ethnicity, lower education, and sex were associated with explanatory model type in bivariate analyses. In multiple logistic regression analysis, minority caregivers (P<.02) and those with less formal education (P<.02) were more likely to hold mixed or folk models of dementia. Although minority and nonminority caregivers often incorporated folk models into their understanding of dementia, this was more common in minority caregivers and those with less formal education. Further research on cross-ethnic differences in a larger, more-representative sample is needed.
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Affiliation(s)
- Ladson Hinton
- Department of Psychiatry, University of California at Davis, Davis, California 95817, USA.
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Bisits A, Madsen G, Knox M, Gill A, Smith R, Yeo G, Kwek K, Daniel M, Leung TN, Cheung K, Chung T, Jones I, Toohill J, Tudehope D, Giles W. The Randomized Nitric Oxide Tocolysis Trial (RNOTT) for the treatment of preterm labor. Am J Obstet Gynecol 2004; 191:683-90. [PMID: 15467526 DOI: 10.1016/j.ajog.2004.02.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study was undertaken to assess the effectiveness of glyceryl trinitrate (GTN) patches in comparison with beta2 sympathomimetics (beta2) for the treatment of preterm labor. STUDY DESIGN A multicenter, multinational, randomized controlled trial was conducted in tertiary referral teaching hospitals. Women in threatened preterm labor with positive fetal fibronectin or ruptured membranes between 24 and 35 weeks' gestation were recruited and randomly assigned to either beta2 or GTN with rescue beta2 tocolysis if moderate-to-strong contractions persisted at 2 hours. Obstetric and neonatal outcomes were assessed. RESULTS Two hundred thirty-eight women were recruited and randomly assigned, 117 to beta2 and 121 to GTN. On a strict intention-to-treat basis, there was no significant difference in the time to delivery using Kaplan-Meier curves (P = .451). At 2 hours, 27% of women receiving beta2 had moderate or stronger contractions compared with 53% in the GTN group (P < .001). This led to 35% of women in the GTN group receiving rescue treatment. If delivery or requirement for beta2 rescue are regarded as treatment failure, then a significant difference was observed between the 2 arms (P = .0032). There were no significant differences in neonatal outcomes. CONCLUSION GTN is a less efficacious tocolytic compared with ss2 sympathomimetics.
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Affiliation(s)
- A Bisits
- The Mothers and Babies Research Centre, Faculty of Medicine and Health Sciences, The University of Newcastle, Australia
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Abstract
OBJECTIVES To increase the information available for clinicians and educators to care for, and educate others to care for, elders from Afghan backgrounds more effectively. DESIGN Focus group methodology. SETTING Community senior center in Fremont, CA, United States. PARTICIPANTS Nine leaders of an Afghan elders group. MEASUREMENTS Content analysis of translated proceedings of focus group. RESULTS The two most important themes were: 1) Participants identified their health status and effective treatments with their faith in, and practice of, Islam. 2) They also emphasized the importance of care given by same-sex providers. CONCLUSION Clinicians providing care for older Afghan refugees need to be aware of the importance of respecting the practices of Islam, especially using same sex providers. Allowing for Muslim practices in the hospital is also important, such as washing before daily prayers, not serving pork products (e.g. gelatin), and having the bed face Mecca (Southeast) for prayers, especially for a dying patient.
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Affiliation(s)
- Nancy Morioka-Douglas
- Co-Director, Stanford Geriatric Education Center, Stanford University School of Medicine, Stanford, California, USA
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Xakellis G, Brangman SA, Hinton WL, Jones VY, Masterman D, Pan CX, Rivero J, Wallhagen M, Yeo G. Curricular Framework: Core Competencies in Multicultural Geriatric Care. J Am Geriatr Soc 2004; 52:137-42. [PMID: 14687329 DOI: 10.1111/j.1532-5415.2004.52024.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Strategies to reduce the documented disparities in health and health care for the rapidly growing numbers of older patients from diverse ethnic populations include increased cultural competence of providers. To assist geriatric faculty in medical and other health professional schools develop cultural competence training for their ethnogeriatric programs, the University of California Academic Geriatric Resource Program partnered with the Ethnogeriatric Committee of the American Geriatrics Society to develop a curricular framework. The framework includes core competencies based on the format of the Core Competencies for the Care of Older Patients developed by the Education Committee of the American Geriatrics Society. Competencies in attitudes, knowledge, and skills for medical providers caring for elders from diverse populations are specified. Also included are recommended teaching strategies and resources for faculty to pursue the development of full curricula.
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Affiliation(s)
- Gwen Yeo
- Stanford Geriatric Education Center, Stanford University School of Medicine VAPAHCS, Building 4 (182B-SGEC), Palo Alto, CA 94304, USA.
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Berger D, Barroso I, Soos M, Yeo G, Schafer AJ, O'Rahilly S, Whitehead JP. Genetic variants of insulin receptor substrate-1 (IRS-1) in syndromes of severe insulin resistance. Functional analysis of Ala513Pro and Gly1158Glu IRS-1. Diabet Med 2002; 19:804-9. [PMID: 12358865 DOI: 10.1046/j.1464-5491.2002.00779.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/20/2022]
Abstract
AIMS To define further the role of IRS-1 mutations in human syndromes of severe insulin resistance. METHODS The IRS-1 gene was scanned for mutations in 83 unrelated affected subjects and 47 unaffected individuals using fluorescent single-strand conformation polymorphism (fSSCP) analysis. A novel heterozygous mutation, Gly1158Glu, was found in one affected subject. Four and two subjects were heterozygous for the previously reported variants Gly972Arg and Ala513Pro, respectively. The previously identified variant Gly819Arg was found in one affected and one unaffected subject. While Gly972Arg has been described to alter the signalling properties of IRS-1, no functional studies of Ala513Pro or Gly1158Glu have been reported. RESULTS Chinese hamster ovary (CHO) cells stably over-expressing the insulin receptor were transiently transfected with vectors expressing either wild-type, Glu1158 or Pro513 IRS-1. A modest increase in insulin-stimulated tyrosine phosphorylation of Glu1158 IRS-1 was observed. However, this did not result in any significant change in the association of Grb2 or the p85 alpha subunit of PI3-kinase or of PI3-kinase activity. In parallel studies, the Pro513 IRS-1 variant was indistinguishable from wild-type IRS-1. CONCLUSIONS While subtle effects of these variants cannot be excluded in this system, it is unlikely that these variants are responsible for the extreme insulin resistance seen in the subjects harbouring them. Although IRS proteins play a central role in insulin signalling, functionally significant mutations in the IRS-1 gene are a rare cause of human syndromes of severe insulin resistance.
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Affiliation(s)
- D Berger
- University of Cambridge, Department of Medicine and Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
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Chan EC, Fraser S, Yin S, Yeo G, Kwek K, Fairclough RJ, Smith R. Human myometrial genes are differentially expressed in labor: a suppression subtractive hybridization study. J Clin Endocrinol Metab 2002; 87:2435-41. [PMID: 12050195 DOI: 10.1210/jcem.87.6.8439] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [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: 11/19/2022]
Abstract
Human parturition is effected by a cascade of factors, of which many are unknown. We aim to identify the genes that are changed by labor in the human myometrium by suppression subtractive hybridization. We also seek to ascertain whether these genes are differentially expressed in the myometrium at the upper or fundal and lower segments of the uterus. Term myometrial tissues were obtained from laboring and nonlaboring women undergoing cesarean section after obtaining informed consent. Total RNA was used in suppression subtractive hybridization (CLONTECH PCR Select) to produce two subtracted cDNA libraries enriched for genes expressed during or before labor, labor and not-in-labor libraries, respectively. Dot blot screening of 400 positive clones, constituting 20% of the two subtracted libraries, revealed 30 differentially expressed clones, 14 of which were up-regulated by labor. Among the 10 known genes that were up-regulated in labor, 6 had apparent immune regulatory and inflammatory roles. Three are well-known inflammatory mediators and modulators that were previously linked with parturition: IL-8, manganese superoxide dismutase (MnSOD), and metalloproteinase-9. Three others, interferon-inducible 1-8d gene, elongation factor 1alpha, and nucleophosmin, have not been previously linked with labor. Constitutively expressed genes, including cyclophilin and alpha-actin, were found to be altered by labor. Quantitative real-time RT-PCR using Taqman probes further confirmed the up-regulation of some of these genes. The amounts of the specific genes assayed were standardized to 18S ribosomal RNA and are expressed as mean +/- SEM. Quantitative real-time RT-PCR showed that IL-8 mRNA rose from 0.003 +/- 0.002 in nonlaboring samples (n = 38) to 0.24 +/- 0.11 (n = 20) in gestational-age-matched spontaneously laboring women (P = 0.035). Similarly, MnSOD rose from 0.11 +/- 0.02 (n = 24) to 1.23 +/- 0.56 (n = 24) in gestational-age-matched women (P = 0.047). Additionally, cyclophilin, often used as a constitutive or housekeeping gene marker, increased from 0.0008 +/- 0.0002 (n = 6) to 0.002 +/- 0.0004 (n = 6; P = 0.008) during labor. Notably, MnSOD mRNA was differentially distributed between the upper (0.63 +/- 0.18) and lower (0.15 +/- 0.05; n = 15; P = 0.022) segments of the uterus, but IL-8 was not (n = 17; P = 0.97). Induced labor further showed significantly higher levels of IL-8 (0.63 +/- 0.21; n = 14) than spontaneous labor (0.22 +/- 0.11; n = 20; P = 0.046), but not MnSOD (P = 0.1). This work identifies novel as well as known genes that were not previously associated with parturition. It extends previous data indicating that there is differential expression of some, but not all genes within the gravid human uterus. Inflammatory genes constitute a major proportion of the known genes found to be up-regulated in labor, lending support to the hypothesis of an inflammatory mechanism for human parturition. This work further indicates that many factors associated with human labor and their complex interactions remain to be elucidated.
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Affiliation(s)
- E Cheng Chan
- Mothers and Babies Research Centre, Endocrine Unit, John Hunter Hospital, Hunter Region Mail Centre, Newcastle, New South Wales 2310, Australia.
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Abstract
Identification of the immunogenic proteins that induce Chlamydia trachomatis (CT)-specific T cell responses is crucial to the development of protective vaccines and understanding the mechanisms of chlamydia-induced pathology. To characterize the targets of the human T cell response we have used chlamydia-reactive human T cell clones as cellular probes to screen a CT genomic library expressed in Escherichia coli using peripheral blood mononuclear cells to present antigens. The library was screened with three chlamydia-reactive T cell clones of unknown specificity and three novel stimulatory chlamydia antigens were identified. These E. coli recombinants were shown to express the chlamydia proteins, enolase, pmpD and CT579. Enolase and pmpD proteins were purified and shown to induce the proliferation of synovial fluid mononuclear cells isolated from the knee joints of patients suffering from chlamydia-associated reactive arthritis. We suggest that these stimulatory antigens are common targets of the T cell response in this group of patients. A greater understanding of T cell-mediated immunity in uncomplicated CT infection, and in patients with CT-induced chronic inflammatory disease (trachoma, salpingitis, arthritis) may identify the principal immune responses associated with immunopathology.
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Affiliation(s)
- J C Goodall
- Department of Medicine, University of Cambridge, GB.
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De Angelis E, MacFarlane J, Du JS, Yeo G, Hicks R, Rathjen FG, Kenwrick S, Brümmendorf T. Pathological missense mutations of neural cell adhesion molecule L1 affect homophilic and heterophilic binding activities. EMBO J 1999; 18:4744-53. [PMID: 10469653 PMCID: PMC1171547 DOI: 10.1093/emboj/18.17.4744] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mutations in the gene for neural cell adhesion molecule L1 (L1CAM) result in a debilitating X-linked congenital disorder of brain development. At the neuronal cell surface L1 may interact with a variety of different molecules including itself and two other CAMs of the immunoglobulin superfamily, axonin-1 and F11. However, whether all of these interactions are relevant to normal or abnormal development has not been determined. Over one-third of patient mutations are single amino acid changes distributed across 10 extracellular L1 domains. We have studied the effects of 12 missense mutations on binding to L1, axonin-1 and F11 and shown for the first time that whereas many mutations affect all three interactions, others affect homophilic or heterophilic binding alone. Patient pathology is therefore due to different types of L1 malfunction. The nature and functional consequence of mutation is also reflected in the severity of the resultant phenotype with structural mutations likely to affect more than one binding activity and result in early mortality. Moreover, the data indicate that several extracellular domains of L1 are required for homophilic and heterophilic interactions.
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Affiliation(s)
- E De Angelis
- Cambridge Institute for Medical Research, University of Cambridge Clinical School, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2XY, UK
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Handelman L, Yeo G. Using explanatory models to understand chronic symptoms of Cambodian refugees. Fam Med 1996; 28:271-6. [PMID: 8728521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Case reports indicate that understanding patients' "explanatory models" can improve diagnosis, patient compliance, and satisfaction. However, few studies have examined explanatory models within specific cultural groups to understand their symptoms. METHODS Seventy-six older Cambodian refugees were interviewed using measures of symptom frequency, explanatory models, help-seeking patterns, and use of traditional Cambodian remedies. Psychiatric patients were compared with non-patients. RESULTS Headache was the most common symptom, reported by 58% of those interviewed, and also the most frequent chief complaint (41%). Headache was reported in both groups but was reported by significantly more psychiatric patients. Headache was positively associated with the diagnosis of depression. More than half explained their headaches as a result of sadness, grief, and anxiety. Explanatory models did not differ significantly between groups. All participants maintained Cambodian medical beliefs, and 83% used traditional Cambodian remedies. CONCLUSIONS Results suggest a high prevalence of headache among older Cambodian refugees, for whom it may be a manifestation of depression. Emphasis on this somatic complaint does not preclude patients' recognition of psychological factors. Addressing explanatory models can help clinicians determine underlying etiology and understand challenging patients.
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Affiliation(s)
- L Handelman
- Division of Family and Community Medicine, Stanford University School of Medicine, Calif, USA
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Thom D, Yeo G, LeBaron S. Structured student interviews of elders at home during a family practice clerkship. Acad Med 1995; 70:446-447. [PMID: 7748416 DOI: 10.1097/00001888-199505000-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- D Thom
- Stanford University School of Medicine, USA
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41
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Yeo G. Ethical considerations in Asian and Pacific Island elders. Clin Geriatr Med 1995; 11:139-52. [PMID: 7720017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A brief overview of the demographic and psychosocial characteristics and medical problems of African Americans age 65 and older provide the context for a discussion of the mental health issues of older African Americans. With this background, specific concerns regarding diagnostic bias are reviewed. Existing epidemiologic data on the prevalence of psychiatric symptoms and disorders are summarized and the specific mental health issues affecting older African Americans are described. Specific research strategies are suggested to address the areas of absent data.
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Affiliation(s)
- G Yeo
- Stanford Geriatric Education Center, California, USA
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Abstract
The Stanford Geriatric Education Center cosponsored a conference to train service providers to work more effectively with a culturally diverse population of elders. At the end of the conference, participants identified specific new strategies their agencies should implement to increase their effectiveness with ethnic elders. A telephone follow-up 6 months later reached 44 of the 55 participants. They reported an average of 6 implemented strategies from an average of 10 originally identified; 86% reported 2 or more strategies implemented. Over half of the respondents reported successfully recruiting and promoting new ethnic staff and volunteers.
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Affiliation(s)
| | - Gwen Yeo
- Stanford University School of Medicine
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Abstract
Using a prospective, randomized design, the effects on self-reported functional health and well being of 18 months of primary outpatient care in a geriatric clinic staffed by a multidisciplinary team with geriatric training were compared with traditional Veterans Administration care for 205 elders. Significantly less decline in functional health was found for the geriatric clinic participants on the total Sickness Impact Profile (SIP) (M = .18 vs. 3.12, p = .029) and its physical dimension (M = .28 vs. 4.39, p = .011), but not for the psychosocial dimension of the SIP, life satisfaction, depression, self-rated health, or affect balance. In addition, twice as many geriatrics clinic patients died (p = .10) during the study. Further clarification of the impact of a multidisciplinary geriatrics clinic on health outcomes and cost in VA and other settings are needed prior to recommending that this model of geriatric health care be adopted.
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Shepard K, Yeo G, McGann L. Successful components of interdisciplinary education. J Allied Health 1985; 14:297-303. [PMID: 4044401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Although interdisciplinary education of health care professionals for more effective health care provision has been widely recommended, barriers such as specialization and lack of recognition and support for interdisciplinary teaching remain. This paper presents ten ideas for developing successful interdisciplinary curricula as suggested in the allied health literature. Implementation of the ideas is illustrated by examples from a clinical geriatric course involving physical therapy, physician assistant, nurse practitioner, and medical students.
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Stark R, Yeo G, Fordyce M, Grudzen M, Hopkins J, McGann L, Shepard K. An interdisciplinary teaching program in geriatrics for physician's assistants. J Allied Health 1984; 13:280-7. [PMID: 6150927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
An interdisciplinary curriculum committee within the Division of Family Medicine, Stanford University Medical Center, developed and taught a beginning course in clinical geriatrics for medical students and student physician's assistants, physical therapists, and nurse practitioners. Through a series of Saturday classes held in community facilities serving seniors, physician's assistant students had the opportunity to learn clinical geriatrics from a faculty team including a physician's assistant, physician, nurse, physical therapist, social worker, gerontologist, and health educator. Local seniors served as consumer consultants and models of health and vigor. This interdisciplinary approach was modeled by the faculty to demonstrate the need for a team approach to deliver quality care to seniors. In this well-received course, the role of the physician's assistant in health care was made evident to their future physician employers and physical therapy co-workers through faculty modeling as well as through informal contacts and patient conferences. Older people constitute a growing and increasingly medically underserved population. Team training may serve to stimulate physician's assistant students to include geriatrics in their career plans while educating their future physician employers about their role.
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Yeo G. Multidisciplinary geriatric training, using elders as consultants and community senior resources as classrooms. Gerontol Geriatr Educ 1982; 2:227-232. [PMID: 7173621 DOI: 10.1300/j021v02n03_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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