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Fruchter E, Goldenthal N, Adler LA, Gross R, Harel EV, Deutsch L, Nacasch N, Grinapol S, Amital D, Voigt JD, Marmar CR. Amygdala-derived-EEG-fMRI-pattern neurofeedback for the treatment of chronic post-traumatic stress disorder. A prospective, multicenter, multinational study evaluating clinical efficacy. Psychiatry Res 2024; 333:115711. [PMID: 38325159 DOI: 10.1016/j.psychres.2023.115711] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 02/09/2024]
Abstract
We conducted a prospective, single arm, multisite, multinational, open label trial assessing the safety and efficacy of a novel amygdala derived neurofeedback treatment, designated Amygdala-Derived-EFP, for chronic PTSD. Participants, including veterans and civilians, underwent screening, training, 15 neurofeedback sessions over 8 weeks and; baseline, termination (8 weeks) and 3 month post treatment assessments with validated measures. The primary endpoint was more than 50 % of the participants demonstrating a Minimally Clinically Important Difference (MCID) defined as a 6-point reduction, on the Clinician Administered PTSD Scale (CAPS-5) total score at 3 months. Secondary measures included the PCL-5, ERQ, PHQ-9, and CGI. Statistical analyses were performed using SAS®V9.4. The primary endpoint was met, with a CAPS-5 MCID response rate of 66.7 %. The average reduction in CAPS-5 total scores at 3 month follow up was 13.5 points, more than twice the MCID. Changes from baseline in CAPS-5, PCL-5, PHQ-9 scores at 8 weeks and the 3 month follow-up demonstrated statistically significant improvements in response and; demonstrated effect sizes ranging from 0.46 to 1.07. Adverse events were mild and resolved after treatment. This study builds on prior research demonstrating similar outcomes using amygdala-derived neurofeedback. Positive attributes of this therapy include monitoring by non-physician personnel, affordability, accessibility, and tolerability.
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Affiliation(s)
- Eyal Fruchter
- Rambam Medical Center, Bruss Rapaport Faculty of Medicine - Technicon - Haifa, Haifa, Israel
| | - Nadav Goldenthal
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Lenard A Adler
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
| | - Raz Gross
- Department of Epidemiology, School of Public Health and Department of Psychiatry, School of Medicine, Tel Aviv University, Sheba Medical Center, Tel Aviv, Isreal
| | - Eiran V Harel
- Be'er Ya'akov Mental Health Center, Tel Aviv, Israel
| | | | - Nitsa Nacasch
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Shulamit Grinapol
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Daniela Amital
- Division of Psychology, Barzilai Medical Center, Ashkelon, Israel
| | | | - Charles R Marmar
- Department Psychiatry, New York University Grossman School of Medicine, NY, NY, United States
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Zur O, Ben-Rubi Shimron H, Deutsch L, Carmeli E. Reliability, validity and normal ranges of the Zur Balance Scale for detecting mild postural control differences: introducing the modified, short version mZBS. Front Hum Neurosci 2023; 17:1131478. [PMID: 37305365 PMCID: PMC10250721 DOI: 10.3389/fnhum.2023.1131478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Balance is achieved through interactions between the vestibular, somatosensory, and visual systems. There are several clinical tests to measure postural stability. However, most of them do not assess postural stability with head movements, which is the main function of the vestibular system, and those that do, require the use of sizeable, expensive equipment. Therefore, an applicable, easy-to-perform test that challenges the function of the visual, somatosensory and vestibular systems, using head movements, is needed. The Zur Balance Scale (ZBS) contains ten conditions, which are a combination of surfaces (floor or Styrofoam with subject standing on its width in Romberg position or its length in tandem position), stances (Romberg or tandem), tasks (no head movement with eyes open or closed and horizontal or vertical head movements with eyes open). The purpose of this study was to determine the validity, inter- and intra-examiner reliability, and normal performance values of the ZBS among individuals 29-70-years of age and to introduce the modified version: the mZBS, using kinetic measurements. Methods Healthy participants ages 29-70 years were evaluated for inter- and intra-tester reliability (n = 65), kinetic measurements on a force plate, and validity compared to the modified clinical test of sensory interaction and balance (mCTSIB) (n = 44) and characterization of normal values (n = 251). Results Zur Balance Scale head movements, duration of each condition (up to 10 s) and the total ZBS score agreed across examiners (ICC > 0.8). Normal ZBS scores were negatively correlated with age (r = -0.34; P < 0.0001). Older subjects (60-70 years) had a median score of 95.5 compared with younger subjects, where medians ranged from 97.6 to 98.9. Kinetic parameters showed positive correlations between ZBS and the mCTSIB scores, with the highest correlation between the five Romberg tasks (modified ZBS). Conclusion Zur Balance Scale is a valid and reliable test. Its advantages include using head movements and the ability to detect minimal differences in postural control, even in healthy populations. Kinetic evaluation of the ZBS enables the use of a modified, shorter version of the ZBS (mZBS).
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Affiliation(s)
- Oz Zur
- The Israeli Center for Dizziness and Balance Disorders, Ra’anana, Israel
- Department of Physical Therapy, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Lisa Deutsch
- BioStats Statistical Consulting, Ltd., Modi’in-Maccabim-Re’ut, Israel
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa, Israel
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Deutsch L, Cloutier A, Leahy G, Teubner A, Abraham A, Taylor M, Paine P, Lal S. Factors Associated With Strong Opioid Use For Non-Cancer Pain In Patients With Chronic Intestinal Failure. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.289] [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: 03/28/2023]
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Mare SD, Nishri Y, Shai A, Efrati M, Deutsch L, Den RB, Kelson I, Keisari Y, Domankevich V. Diffusing Alpha-Emitters Radiation Therapy Promotes a Proimmunogenic Tumor Microenvironment and Synergizes With Programmed Cell Death Protein 1 Blockade. Int J Radiat Oncol Biol Phys 2023; 115:707-718. [PMID: 36031029 DOI: 10.1016/j.ijrobp.2022.08.043] [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: 06/27/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Diffusing alpha-emitters Radiation Therapy (DaRT) releases alpha-emitting atoms into the tumor microenvironment. The treatment effectively ablates human and mice xenografts and shows 100% response rates in skin or head and neck squamous cell carcinoma patients. DaRT induces specific and systemic antitumor immune activation and synergizes with immune stimulation and modulation in mice. Here, the transcriptional profile activated by DaRT, and its potential to enhance responsiveness to immune checkpoint inhibition by programmed cell death protein 1 (PD-1) blockade were studied. METHODS AND MATERIALS Squamous cell carcinoma tumor- bearing BALB/C mice were treated with DaRT or inert seeds in combination with anti-PD-1 (aPD-1) or IgG control antibody. Sixteen days after seed insertion, tumors and spleens were subjected to immunophenotyping and immunohistochemical staining. Combination of DaRT and aPD-1 was tested for efficacy. Gene expression analysis was performed on mRNA extracted from tumors 7 days after DaRT or inert insertion using Nanostring PanCancer-IO-360 panel, and tumors and spleens were subjected to flow cytometry analysis. RESULTS DaRT in combination with aPD-1 delayed tumor development, induced CD3 and CD8 lymphocytes infiltration more efficiently than either monotherapy. The combined treatment reduced splenic polymorphonuclear myeloid derived suppressor cells more than aPD-1 therapy or control. Granzyme B release in the tumor was increased only in the combinational treatment and was correlated with T-lymphocyte infiltration. Gene expression and gene set enrichment analysis of mRNA levels 7 days after DaRT insertion indicated that DaRT upregulated apoptosis, p53 signaling, G1/S-related arrest, interferon signaling and myeloid related transcription, while downregulating DNA repair, cell proliferation, and notch-related transcription. Flow cytometry showed that DaRT increased dendritic cells activation and led to changes in MDSCs distribution. CONCLUSIONS DaRT promotes a "hot" tumor microenvironment and changes in immune suppression that lead to a potentiation of aPD-1 blockade induced effector T cell function and improved treatment efficacy. This study provides rationale for investigating DaRT and aPD-1 combination in patients with squamous cell carcinoma.
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Affiliation(s)
- Sara Del Mare
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel
| | - Yossi Nishri
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel
| | - Amit Shai
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel
| | - Margalit Efrati
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd., Maccabim, Israel
| | - Robert B Den
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Itzhak Kelson
- Sackler Faculty of Exact Sciences, School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - Yona Keisari
- Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Domankevich
- Translational Research Laboratory, Alpha Tau Medical Ltd., Jerusalem, Israel.
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Bahar-Shany K, Barnabas GD, Deutsch L, Deutsch N, Glick-Saar E, Dominissini D, Sapoznik S, Helpman L, Perri T, Blecher A, Katz G, Yagel I, Rosenblatt O, Shai D, Brandt B, Meyer R, Mohr-Sasson A, Volodarsky-Perel A, Zilberman I, Armon S, Jakobson-Setton A, Eitan R, Kadan Y, Beiner M, Josephy D, Brodsky M, Friedman E, Anafi L, Molchanov Y, Korach J, Geiger T, Levanon K. Proteomic signature for detection of high-grade ovarian cancer in germline BRCA mutation carriers. Int J Cancer 2023; 152:781-793. [PMID: 36214786 DOI: 10.1002/ijc.34318] [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] [Received: 03/15/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
No current screening methods for high-grade ovarian cancer (HGOC) guarantee effective early detection for high-risk women such as germline BRCA mutation carriers. Therefore, the standard-of-care remains risk-reducing salpingo-oophorectomy (RRSO) around age 40. Proximal liquid biopsy is a promising source of biomarkers, but sensitivity has not yet qualified for clinical implementation. We aimed to develop a proteomic assay based on proximal liquid biopsy, as a decision support tool for monitoring high-risk population. Ninety Israeli BRCA1 or BRCA2 mutation carriers were included in the training set (17 HGOC patients and 73 asymptomatic women), (BEDOCA trial; ClinicalTrials.gov Identifier: NCT03150121). The proteome of the microvesicle fraction of the samples was profiled by mass spectrometry and a classifier was developed using logistic regression. An independent cohort of 98 BRCA mutation carriers was used for validation. Safety information was collected for all women who opted for uterine lavage in a clinic setting. We present a 7-protein diagnostic signature, with AUC >0.97 and a negative predictive value (NPV) of 100% for detecting HGOC. The AUC of the biomarker in the independent validation set was >0.94 and the NPV >99%. The sampling procedure was clinically acceptable, with favorable pain scores and safety. We conclude that the acquisition of Müllerian tract proximal liquid biopsies in women at high-risk for HGOC and the application of the BRCA-specific diagnostic assay demonstrates high sensitivity, specificity, technical feasibility and safety. Similar classifier for an average-risk population is warranted.
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Affiliation(s)
- Keren Bahar-Shany
- Sheba Cancer Research Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Georgina D Barnabas
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Lisa Deutsch
- BioStats, Statistical Consulting Ltd, Modiin, Israel
| | | | - Efrat Glick-Saar
- Sheba Cancer Research Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Dan Dominissini
- Sheba Cancer Research Center, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Stav Sapoznik
- Sheba Cancer Research Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Limor Helpman
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Perri
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Anna Blecher
- Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Guy Katz
- Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Itai Yagel
- Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Orgad Rosenblatt
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Shai
- Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Benny Brandt
- Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Raanan Meyer
- Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Aya Mohr-Sasson
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Itamar Zilberman
- Division of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shunit Armon
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ariella Jakobson-Setton
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Ram Eitan
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Rabin Medical Center, Petah Tikva, Israel
| | - Yfat Kadan
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Mario Beiner
- Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Dana Josephy
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Division of Gynecologic Oncology, Meir Medical Center, Kfar Saba, Israel
| | - Malka Brodsky
- Meirav Breast Health Center, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Eitan Friedman
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,The Susanne-Levy Gertner Oncogenetics Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Liat Anafi
- Department of Pathology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yossef Molchanov
- Department of Pathology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Korach
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.,Department of Gynecologic Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Geiger
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Keren Levanon
- Sheba Cancer Research Center, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Ehrlich A, Ioannidis K, Nasar M, Abu Alkian I, Daskal Y, Atari N, Kliker L, Rainy N, Hofree M, Shafran Tikva S, Houri I, Cicero A, Pavanello C, Sirtori CR, Cohen JB, Chirinos JA, Deutsch L, Cohen M, Gottlieb A, Bar-Chaim A, Shibolet O, Mandelboim M, Maayan SL, Nahmias Y. Efficacy and safety of metabolic interventions for the treatment of severe COVID-19: in vitro, observational, and non-randomized open-label interventional study. eLife 2023; 12:79946. [PMID: 36705566 PMCID: PMC9937660 DOI: 10.7554/elife.79946] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/26/2023] [Indexed: 01/28/2023] Open
Abstract
Background Viral infection is associated with a significant rewire of the host metabolic pathways, presenting attractive metabolic targets for intervention. Methods We chart the metabolic response of lung epithelial cells to SARS-CoV-2 infection in primary cultures and COVID-19 patient samples and perform in vitro metabolism-focused drug screen on primary lung epithelial cells infected with different strains of the virus. We perform observational analysis of Israeli patients hospitalized due to COVID-19 and comparative epidemiological analysis from cohorts in Italy and the Veteran's Health Administration in the United States. In addition, we perform a prospective non-randomized interventional open-label study in which 15 patients hospitalized with severe COVID-19 were given 145 mg/day of nanocrystallized fenofibrate added to the standard of care. Results SARS-CoV-2 infection produced transcriptional changes associated with increased glycolysis and lipid accumulation. Metabolism-focused drug screen showed that fenofibrate reversed lipid accumulation and blocked SARS-CoV-2 replication through a PPARα-dependent mechanism in both alpha and delta variants. Analysis of 3233 Israeli patients hospitalized due to COVID-19 supported in vitro findings. Patients taking fibrates showed significantly lower markers of immunoinflammation and faster recovery. Additional corroboration was received by comparative epidemiological analysis from cohorts in Europe and the United States. A subsequent prospective non-randomized interventional open-label study was carried out on 15 patients hospitalized with severe COVID-19. The patients were treated with 145 mg/day of nanocrystallized fenofibrate in addition to standard-of-care. Patients receiving fenofibrate demonstrated a rapid reduction in inflammation and a significantly faster recovery compared to patients admitted during the same period. Conclusions Taken together, our data suggest that pharmacological modulation of PPARα should be strongly considered as a potential therapeutic approach for SARS-CoV-2 infection and emphasizes the need to complete the study of fenofibrate in large randomized controlled clinical trials. Funding Funding was provided by European Research Council Consolidator Grants OCLD (project no. 681870) and generous gifts from the Nikoh Foundation and the Sam and Rina Frankel Foundation (YN). The interventional study was supported by Abbott (project FENOC0003). Clinical trial number NCT04661930.
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Affiliation(s)
- Avner Ehrlich
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Konstantinos Ioannidis
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Makram Nasar
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | | | - Yuval Daskal
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Nofar Atari
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical CenterTel HashomerIsrael
| | - Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical CenterTel HashomerIsrael
| | - Nir Rainy
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
| | - Matan Hofree
- Klarman Cell Observatory, The Broad Institute of Harvard and MITCambridgeUnited States
| | - Sigal Shafran Tikva
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
- Hadassah Research and Innovation CenterJerusalemIsrael
- Department of Nursing, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology Lev Academic CenterJerusalemIsrael
| | - Inbal Houri
- Department of Gastroenterology, Sourasky Medical CenterTel AvivIsrael
| | - Arrigo Cicero
- IRCSS S.Orsola-Malpighi University HospitalBolognaItaly
| | - Chiara Pavanello
- Centro Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di MilanoMilanoItaly
- Centro Dislipidemie, Niguarda HospitalMilanoItaly
| | | | - Jordana B Cohen
- Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | - Julio A Chirinos
- Perelman School of Medicine, University of PennsylvaniaPhiladelphiaUnited States
| | | | - Merav Cohen
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
| | - Amichai Gottlieb
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | - Adina Bar-Chaim
- Laboratory Division, Shamir (Assaf Harofeh) Medical CenterZerifinItaly
| | - Oren Shibolet
- Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | | | - Shlomo L Maayan
- Division of Infectious Diseases, Barzilai Medical CenterAshkelonIsrael
| | - Yaakov Nahmias
- Grass Center for Bioengineering, Benin School of Computer Science and EngineeringJerusalemIsrael
- Department of Cell and Developmental Biology, Silberman Institute of Life SciencesJerusalemIsrael
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Wood A, Queiroz C, Deutsch L, González-Mon B, Jonell M, Pereira L, Sinare H, Svedin U, Wassénius E. Reframing the local-global food systems debate through a resilience lens. Nat Food 2023; 4:22-29. [PMID: 37118580 DOI: 10.1038/s43016-022-00662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/04/2022] [Indexed: 04/30/2023]
Abstract
Despite the growing knowledge that food system solutions should account for interactions and drivers across scales, broader societal debate on how to solve food system challenges is often focused on two dichotomous perspectives and associated solutions: either more localized food systems or greater global coordination of food systems. The debate has found problematic expressions in contemporary challenges, prompting us to revisit the role that resilience thinking can play when faced with complex crises that increase uncertainty. Here we identify four 'aching points' facing food systems that are central points of tension in the local-global debate. We apply the seven principles of resilience to these aching points to reframe the solution space to one that embeds resilience into food systems' management and governance at all scales, supporting transformative change towards sustainable food systems.
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Affiliation(s)
- Amanda Wood
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.
| | - Cibele Queiroz
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Resilience Partnership, Stockholm, Sweden
| | - Lisa Deutsch
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Nordic Institute of Latin American Studies, Stockholm University, Stockholm, Sweden
| | | | - Malin Jonell
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Stockholm, Sweden
- Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, Stockholm, Sweden
| | - Laura Pereira
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Change Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Hanna Sinare
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Uno Svedin
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Emmy Wassénius
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Global Economic Dynamics and the Biosphere, The Royal Swedish Academy of Sciences, Stockholm, Sweden
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8
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Juri S, Baraibar M, Clark LB, Cheguhem M, Jobbagy E, Marcone J, Mazzeo N, Meerhoff M, Trimble M, Zurbriggen C, Deutsch L. Food systems transformations in South America: Insights from a transdisciplinary process rooted in Uruguay. Front Sustain Food Syst 2022. [DOI: 10.3389/fsufs.2022.887034] [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: 11/13/2022] Open
Abstract
The wicked nature of sustainability challenges facing food systems demands intentional and synergistic actions at multiple scales and sectors. The Southern Cone of Latin America, with its historical legacy of “feeding the world,” presents interesting opportunities for generating insights into potential trajectories and processes for food system transformation. To foster such changes would require the development of collective understanding and agency to effectively realize purposeful and well-informed action toward desirable and sustainable food futures. This in turn demands the transdisciplinary engagement of academia, the private sector, government/policy-makers, community groups, and other institutions, as well as the broader society as food consumers. While the need for contextualized knowledge, priorities and definitions of what sustainable food systems change means is recognized, there is limited literature reporting these differences and critically reflecting on the role of knowledge brokers in knowledge co-production processes. The political nature of these issues requires arenas for dialogue and learning that are cross-sectoral and transcend knowledge generation. This paper presents a case study developed by SARAS Institute, a bridging organization based in Uruguay. This international community of practice co-designed a 3-year multi-stakeholder transdisciplinary process entitled “Knowledges on the Table.” We describe how the process was designed, structured, and facilitated around three phases, two analytical levels and through principles of knowledge co-production. The case study and its insights offer a model that could be useful to inform similar processes led by transdisciplinary communities of practice or bridging institutions in the early stages of transformative work. In itself, it also represents a unique approach to generate a language of collaboration, dialogue, and imagination informed by design skills and methods. While this is part of a longer-term process toward capitalizing on still-unfolding insights and coalitions, we hope that this example helps inspire similar initiatives to imagine, support, and realize contextualized sustainable food system transformations.
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9
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de Smet MD, Haim-Langford D, Neumann R, Kramer M, Cunningham E, Deutsch L, Milman Z. Tarsier Anterior Chamber Cell Grading: Improving the SUN Grading Scheme with a Visual Analog Scale. Ocul Immunol Inflamm 2022; 30:1686-1691. [PMID: 34232824 DOI: 10.1080/09273948.2021.1934036] [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: 12/16/2022]
Abstract
PURPOSE To compare an analog visual scale in grading anterior chamber cells (ACC) to a modified Standardization of Uveitis Nomenclature (SUN) ACC scale. METHOD A graphical representation of anterior chamber cells as a reference and a test set was created and shown to two groups of experienced uveitis experts. Group 1 was given the analog scale in written format, while group two was given the reference images for comparison. Each test subject was asked to provide the best approximation for each grade. RESULTS Eleven graders participated in phase 1. Correct grading occurred in 87.4% of cases. Discrepancies were seen at all grades. Only 3 of 11 graders were able to achieve a perfect score. Seven graders participated in phase 2. Agreement was 95.2% with 4/7 graders achieving a perfect score. Discrepancies were seen at higher grades only. CONCLUSIONS ACC grading is improved by a visual grading scale, and interobserver variability is reduced.
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Affiliation(s)
- Marc D de Smet
- MIOS Sa, Lausanne, Switzerland; Department of Ophthalmology, Leiden Medical Center, University of Leiden, Leiden, The Netherlands
| | | | - Ron Neumann
- Department of Ophthalmology, Maccabi Sherutei Briut, Ramat Hasharon, Israel
| | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmett Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; the Department of Ophthalmology, Stanford University School of Medicine, Stanford, California; the Francis I Proctor Foundation, UCSF School of Medicine, San Francisco, California; and West Coast Retina Medical Group, San Francisco, California, USA
| | - Lisa Deutsch
- BioStats, Statistical Consulting Ltd, Modiin, Israel
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Nishri Y, Vatarescu M, Luz I, Epstein L, Dumančić M, Del Mare S, Shai A, Schmidt M, Deutsch L, Den RB, Kelson I, Keisari Y, Arazi L, Cooks T, Domankevich V. Diffusing alpha-emitters radiation therapy in combination with temozolomide or bevacizumab in human glioblastoma multiforme xenografts. Front Oncol 2022; 12:888100. [PMID: 36237307 PMCID: PMC9552201 DOI: 10.3389/fonc.2022.888100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Glioblastoma multiforme (GBM) is at present an incurable disease with a 5-year survival rate of 5.5%, despite improvements in treatment modalities such as surgery, radiation therapy, chemotherapy [e.g., temozolomide (TMZ)], and targeted therapy [e.g., the antiangiogenic agent bevacizumab (BEV)]. Diffusing alpha-emitters radiation therapy (DaRT) is a new modality that employs radium-224-loaded seeds that disperse alpha-emitting atoms inside the tumor. This treatment was shown to be effective in mice bearing human-derived GBM tumors. Here, the effect of DaRT in combination with standard-of-care therapies such as TMZ or BEV was investigated. In a viability assay, the combination of alpha radiation with TMZ doubled the cytotoxic effect of each of the treatments alone in U87 cultured cells. A colony formation assay demonstrated that the surviving fraction of U87 cells treated by TMZ in combination with alpha irradiation was lower than was achieved by alpha- or x-ray irradiation as monotherapies, or by x-ray combined with TMZ. The treatment of U87-bearing mice with DaRT and TMZ delayed tumor development more than the monotherapies. Unlike other radiation types, alpha radiation did not increase VEGF secretion from U87 cells in culture. BEV treatment introduced several days after DaRT implantation improved tumor control, compared to BEV or DaRT as monotherapies. The combination was also shown to be superior when starting BEV administration prior to DaRT implantation in large tumors relative to the seed size. BEV induced a decrease in CD31 staining under DaRT treatment, increased the diffusive spread of 224Ra progeny atoms in the tumor tissue, and decreased their clearance from the tumor through the blood. Taken together, the combinations of DaRT with standard-of-care chemotherapy or antiangiogenic therapy are promising approaches, which may improve the treatment of GBM patients.
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Affiliation(s)
- Yossi Nishri
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
| | - Maayan Vatarescu
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Ishai Luz
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Lior Epstein
- Unit of Nuclear Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Radiation Protection Department, Soreq Nuclear Research Center, Yavne, Israel
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Mirta Dumančić
- Unit of Nuclear Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sara Del Mare
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
| | - Amit Shai
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
| | | | - Lisa Deutsch
- Biostatistics Department, BioStats Statistical Consulting Ltd., Maccabim, Israel
| | - Robert B. Den
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
- Department of Radiation Oncology, Urology, and Cancer Biology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Itzhak Kelson
- School of Physics and Astronomy, Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yona Keisari
- Department of Clinical Microbiology and Immunology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Arazi
- Unit of Nuclear Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- *Correspondence: Lior Arazi, ; Tomer Cooks, ; Vered Domankevich,
| | - Tomer Cooks
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
- *Correspondence: Lior Arazi, ; Tomer Cooks, ; Vered Domankevich,
| | - Vered Domankevich
- Translational Research Laboratory, Alpha Tau Medical, Jerusalem, Israel
- *Correspondence: Lior Arazi, ; Tomer Cooks, ; Vered Domankevich,
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11
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Daniel O, Tepper SJ, Deutsch L, Sharon R. External Concurrent Occipital and Trigeminal Neurostimulation Relieves Migraine Headache: A Prospective, Randomized, Double-Blind, Sham-Controlled Trial. Pain Ther 2022; 11:907-922. [PMID: 35661128 PMCID: PMC9314547 DOI: 10.1007/s40122-022-00394-w] [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: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Current external peripheral nerve stimulation devices stimulate only one nerve. This prospective, randomized, double-blind, sham-controlled trial assessed efficacy, safety, and tolerability of a novel external combined occipital and trigeminal neurostimulation (eCOT-NS) device as a self-administered home treatment for migraine (Relivion®MG, Neurolief Ltd; Netanya, Israel). METHODS Episodic and chronic migraine subjects (N = 55) were randomized to receive active (n = 27) or sham (n = 28) treatment. Subjects received eCOT-NS devices and performed 60 ± 20-min home treatments within 45 min of migraine episode onset. The primary endpoint was relative (percent) change in mean baseline VAS pain scores 1 h after treatment initiation. Treatment outcomes assessed at 1-, 2-, and 24-h post-treatment initiation were pain reduction and proportion of pain-free subjects and treatment responders, defined as ≥ 50% pain reduction. Categorical pain ratings (none, mild, moderate, and severe pain) were also analyzed. RESULTS Active stimulation was significantly more effective than sham stimulation for decreasing pain intensity at 1 h (53% vs. 10%), 2 h (52% vs. 17%), and 24 h (71% vs. 34%). Pain-free ratings were greater for the active treatment arm at 1 h (29.2% vs. 16%), 2 h (41.7% vs. 20%), and 24 h (65.2% vs. 40%). The number of subjects with baseline moderate or severe migraine pain who were pain-free at 2 h was significantly greater among active treatment subjects (43% vs. 10.5%). The responder rate was significantly higher among the active treatment group at 1 h (67% vs. 20%), 2 h (66.7% vs. 32%,), and 24 h (78.3% vs. 48%). Overall headache relief was significantly higher in the active treatment group at 1 h (67% vs. 26%) and 2 h (76% vs. 31.6%). Mild adverse events, reported by a minority of subjects, resolved spontaneously. CONCLUSIONS eCOT-NS provides superior clinically meaningful relief and freedom from migraine pain, offering an effective and safe therapy for acute treatment of migraine. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03398668.
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Affiliation(s)
- Oved Daniel
- Headache and Facial Pain Clinic, Ramat-Aviv Medical Center, Tel-Aviv, Israel
| | - Stewart J. Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH USA ,Dartmouth Headache Center, Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA
| | - Lisa Deutsch
- BioStats Statistical Consulting, Ltd, Modiin, Israel
| | - Roni Sharon
- Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel ,Department of Neurology, Chaim Sheba (Tel HaShomer) Medical Center, Ramat Gan, Israel
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12
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Tepper SJ, Grosberg B, Daniel O, Kuruvilla DE, Vainstein G, Deutsch L, Sharon R. Migraine treatment with external concurrent occipital and trigeminal neurostimulation—A randomized controlled trial. Headache 2022; 62:989-1001. [DOI: 10.1111/head.14350] [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] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Stewart J. Tepper
- Geisel School of Medicine at Dartmouth Hanover New Hampshire USA
- Dartmouth Headache Center Lebanon New Hampshire USA
| | - Brian Grosberg
- Hartford Healthcare Headache Center Ayer Neuroscience Institute West Hartford Connecticut USA
- Department of Neurology University of Connecticut School of Medicine Farmington Connecticut USA
| | - Oved Daniel
- Headache and Facial Pain Clinic Ramat‐Aviv Medical Center Tel‐Aviv Israel
| | | | - Gabriel Vainstein
- Kahn‐Sagol‐Maccabi Research and Innovation Institute Maccabi Healthcare Services Tel Aviv Israel
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd. Modiin Israel
| | - Roni Sharon
- Tel‐Aviv University Sackler School of Medicine Tel‐Aviv Israel
- Department of Neurology Chaim Sheba (Tel HaShomer) Medical Center Ramat Gan Israel
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13
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Marcus EL, Chigrinskiy P, Deutsch L, Einav S. Age, pre-arrest neurological condition, and functional status as outcome predictors in out-of-hospital cardiac arrest: Secondary analysis of the Jerusalem Cohort Study data. Arch Gerontol Geriatr 2021; 93:104317. [PMID: 33310659 DOI: 10.1016/j.archger.2020.104317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Investigate the relation between age, baseline neurological and functional status, and survival after out-of-hospital cardiac arrest (OHCA). METHODS Data analysis from the Jerusalem District Resuscitation Study. Patients >80 years and those 18-80 years with OHCA from 4/2005-12/2010 were compared. PRIMARY OUTCOME survival at four time points; secondary outcomes: neurological and functional status at hospital discharge, and relationship between survival, age and pre-arrest activities of daily living (ADL) and Cerebral Performance Category (CPC) scores (higher scores indicate worse function in both). RESULTS 3,211 patients (1,259 >80 years, 1952 aged 18-80) with median follow-up 5.9 years (range 0.1-11.1 years) were included. Survival was better for younger patients at all four time points, including 7.8% versus 2.5% at hospital discharge, 4.6% versus 0.2% at late follow-up. Functional status at discharge was also better, 4.8 ± 5.4 versus 9.0 ± 4.7, p<0.001, and more young patients had CPC1/2, 60.7% versus 32.2%, p = 0.004. Older patients who survived to emergency department admission had increased mortality per year of age (2.6%, hazard ratio [HR] 1.026, 95% confidence interval [CI] 1.006-1.048 versus 1.7%, HR 1.017, 95% CI 1.010-1.025), per point in pre-arrest ADL (3.0%, HR 1.030, 95% CI 1.007-1.054 versus 5.8%, HR 1.058, 95% CI 1.036-1.080), and per point in pre-arrest CPC (24%, HR 1.242, 95% CI 1.097-1.406 versus 37%, HR 1.370 95% CI 1.232-1.524). CONCLUSION Patient independence before arrest may be a more crucial determinant of resuscitation outcome than older age alone. Discussion of end-of-life preferences is particularly important for older individuals with functional and cognitive decline.
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Affiliation(s)
- Esther-Lee Marcus
- Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, Israel; School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Pavel Chigrinskiy
- Chronic Ventilator Dependent Division, Herzog Medical Center, Jerusalem, Israel; School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd., Modiin, Israel.
| | - Sharon Einav
- School of Medicine, Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel; Intensive Care Unit, Shaare-Zedek Medical Center, Jerusalem, Israel.
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14
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Cloutier A, Deutsch L, Leahy G, Teubner A, Abraham A, Lal S. Outcomes associated with strong opioid use for non-cancer pain in patients with chronic intestinal failure. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.342] [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: 11/26/2022]
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15
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Cloutier A, Deutsch L, Leahy G, Miller B, Teubner A, Abraham A, Pironi L, Lal S. Factors affecting antidepressant use by patients requiring home parenteral nutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Stemmer A, Shadmi R, Bregman-Amitai O, Chettrit D, Blagev D, Orlovsky M, Deutsch L, Elnekave E. Using machine learning algorithms to review computed tomography scans and assess risk for cardiovascular disease: Retrospective analysis from the National Lung Screening Trial (NLST). PLoS One 2020; 15:e0236021. [PMID: 32745082 PMCID: PMC7398499 DOI: 10.1371/journal.pone.0236021] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The National Lung Screening Trial (NLST) demonstrated that annual screening with low dose CT in high-risk population was associated with reduction in lung cancer mortality. Nonetheless, the leading cause of mortality in the study was from cardiovascular diseases. PURPOSE To determine whether the used machine learning automatic algorithms assessing coronary calcium score (CCS), level of liver steatosis and emphysema percentage in the lungs are good predictors of cardiovascular disease (CVD) mortality and incidence when applied on low dose CT scans. MATERIALS AND METHODS Three fully automated machine learning algorithms were used to assess CCS, level of liver steatosis and emphysema percentage in the lung. The algorithms were used on low-dose computed tomography scans acquired from 12,332 participants in NLST. RESULTS In a multivariate analysis, association between the three algorithm scores and CVD mortality have shown an OR of 1.72 (p = 0.003), 2.62 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively, and an OR of 1.12 (p = 0.044) for level of liver steatosis. Similar results were shown for the incidence of CVD, OR of 1.96 (p < 0.0001), 4.94 (p < 0.0001) for CCS scores of 101-400 and above 400 respectively. Also, emphysema percentage demonstrated an OR of 0.89 (p < 0.0001). Similar results are shown for univariate analyses of the algorithms. CONCLUSION The three automated machine learning algorithms could help physicians to assess the incidence and risk of CVD mortality in this specific population. Application of these algorithms to existing LDCT scans can provide valuable health care information and assist in future research.
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Affiliation(s)
- Amos Stemmer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Shadmi
- Zebra Medical Vision, Ltd, Shfayim, Israel
| | | | | | - Denitza Blagev
- Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, Utah, United States of America
- Pulmonary and Critical Care Division, University of Utah, Salt Lake City, Utah, United States of America
| | | | - Lisa Deutsch
- Zebra Medical Vision, Ltd, Shfayim, Israel
- BioStats Statistical Consulting Ltd, Maccabim, Merkaz Renanim, Israel
| | - Eldad Elnekave
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Zebra Medical Vision, Ltd, Shfayim, Israel
- Department of Diagnostic Radiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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17
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Weiniger CF, Akdagli S, Turvall E, Deutsch L, Carvalho B. Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine. Anesth Analg 2019; 128:513-522. [PMID: 29958217 DOI: 10.1213/ane.0000000000003503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intrathecal morphine provides excellent analgesia after cesarean delivery; however, respiratory events such as apnea, bradypnea, and hypoxemia have been reported. The primary study aim was to estimate the number of apneas per subject, termed "apnea alert events" (AAEs) defined by no breath for 30-120 seconds, using continuous capnography in women who underwent cesarean delivery. METHODS We performed a prospective, observational study with institutional review board approval of women who underwent cesarean delivery with spinal anesthesia containing 150-µg intrathecal morphine. A STOP-Bang obstructive sleep apnea assessment was administered to all women. Women were requested to use continuous capnography and pulse oximetry for 24 hours after cesarean delivery. Nasal sampling cannula measured end-tidal carbon dioxide (EtCO2) and respiratory rate (RR), and oxygen saturation (SpO2) as measured by pulse oximetry. Capnography data were defined as "valid" when EtCO2 >10 mm Hg, RR >5 breaths per minute (bpm), SpO2 >70%, or during apnea (AAE) defined as "no breath" (EtCO2, <5 mm Hg) for 30-120 seconds. Individual respiratory variable alerts were 10-second means of EtCO2 <10 mm Hg, RR <8 bpm, and SpO2 <94%. Nurse observations of RR (hourly and blinded to capnography) are reported. RESULTS We recruited 80 women, mean (standard deviation [SD]) 35 (5) years, 47% body mass index >30 kg/m2/weight >90 kg, and 11% with suspected obstructive sleep apnea (known or STOP-Bang score >3). The duration of normal capnography and pulse oximetry data was mean (SD) (range) 8:28 (7:51) (0:00-22:32) and 15:08 (6:42) (1:31-23:07) hours:minutes, respectively; 6 women did not use the capnography. There were 198 AAEs, mean (SD) duration 57 (27) seconds experienced by 39/74 (53%) women, median (95% confidence interval for median) (range) 1 (0-1) (0-29) per subject. Observation of RR by nurses was ≥14 bpm at all time-points for all women, r = 0.05 between capnography and nurse RR (95% confidence interval, -0.04 to 0.14). There were no clinically relevant adverse events for any woman. Sixty-five women (82%) had complaints with the capnography device, including itchy nose, nausea, interference with nursing baby, and overall inconvenience. CONCLUSIONS We report 198 AAEs detected by capnography among women who underwent cesarean delivery after receiving intrathecal morphine. These apneas were not confirmed by the intermittent hourly nursing observations. Absence of observer verification precludes distinction between real, albeit nonclinically significant alerts with capnography versus false apneas. Discomfort with the nasal sampling cannula and frequent alerts may impact capnography application after cesarean delivery. No clinically relevant adverse events occurred.
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Affiliation(s)
- Carolyn F Weiniger
- From the Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Division of Anesthesia, Critical Care and Pain, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Seden Akdagli
- Department of Anesthesiology, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York
| | | | - Lisa Deutsch
- BioStats Statistical Consulting Ltd, Modiin, Israel
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Popovtzer A, Rosenfeld E, Mizrachi A, Bellia SR, Ben-Hur R, Feliciani G, Sarnelli A, Arazi L, Deutsch L, Kelson I, Keisari Y. Initial Safety and Tumor Control Results From a "First-in-Human" Multicenter Prospective Trial Evaluating a Novel Alpha-Emitting Radionuclide for the Treatment of Locally Advanced Recurrent Squamous Cell Carcinomas of the Skin and Head and Neck. Int J Radiat Oncol Biol Phys 2019; 106:571-578. [PMID: 31759075 DOI: 10.1016/j.ijrobp.2019.10.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Our purpose was to report the feasibility and safety of diffusing alpha-emitter radiation therapy (DaRT), which entails the interstitial implantation of a novel alpha-emitting brachytherapy source, for the treatment of locally advanced and recurrent squamous cancers of the skin and head and neck. METHODS AND MATERIALS This prospective first-in-human, multicenter clinical study evaluated 31 lesions in 28 patients. The primary objective was to determine the feasibility and safety of this approach, and the secondary objectives were to evaluate the initial tumor response and local progression-free survival. Eligibility criteria included all patients with biopsy-proven squamous cancers of the skin and head and neck with either primary tumors or recurrent/previously treated disease by either surgery or prior external beam radiation therapy; 13 of 31 lesions (42%) had received prior radiation therapy. Toxicity was evaluated according to the Common Terminology Criteria for Adverse Events version 4.03. Tumor response was assessed at 30 to 45 days at a follow-up visit using the Response Evaluation Criteria in Solid Tumors, version 1.1. Median follow-up time was 6.7 months. RESULTS Acute toxicity included mostly local pain and erythema at the implantation site followed by swelling and mild skin ulceration. For pain and grade 2 skin ulcerations, 90% of patients had resolution within 3 to 5 weeks. Complete response to the Ra-224 DaRT treatment was observed in 22 lesions (22/28; 78.6%); 6 lesions (6/28, 21.4%) manifested a partial response (>30% tumor reduction). Among the 22 lesions with a complete response, 5 (22%) developed a subsequent local relapse at the site of DaRT implantation at a median time of 4.9 months (range, 2.43-5.52 months). The 1-year local progression-free survival probability at the implanted site was 44% overall (confidence interval [CI], 20.3%-64.3%) and 60% (95% CI, 28.61%-81.35%) for complete responders. Overall survival rates at 12 months post-DaRT implantation were 75% (95% CI, 46.14%-89.99%) among all patients and 93% (95% CI, 59.08%-98.96%) among complete responders. CONCLUSIONS Alpha-emitter brachytherapy using DaRT achieved significant tumor responses without grade 3 or higher toxicities observed. Longer follow-up observations and larger studies are underway to validate these findings.
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Affiliation(s)
- A Popovtzer
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - E Rosenfeld
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel
| | - A Mizrachi
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - S R Bellia
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - R Ben-Hur
- Rabin Medical Center Petah Tiqva, Petah Tiqva, Israel
| | - G Feliciani
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - A Sarnelli
- Instituto Scientifico Romagnolo per Lo Studio e la Cura dei Tumori, (IRST)-IRCCS, Meldola, Italy
| | - L Arazi
- Ben-Gurion University of the Negev, Beersheba, Israel
| | - L Deutsch
- BioStats Statistical Consult, Merkez Renanim, Maccabim Israel
| | - I Kelson
- Tel Aviv University, Tel Aviv, Israel
| | - Y Keisari
- Tel Aviv University, Tel Aviv, Israel
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Abstract
OBJECTIVE To compare the reported accuracy and sensitivity of the various modalities used to diagnose autism spectrum disorders (ASD) in efforts to help focus further biomarker research on the most promising methods for early diagnosis. METHODS The Medline scientific literature database was searched to identify publications assessing potential clinical ASD biomarkers. Reports were categorized by the modality used to assess the putative markers, including protein, genetic, metabolic, or objective imaging methods. The reported sensitivity, specificity, area under the curve, and overall agreement were summarized and analyzed to determine weighted averages for each diagnostic modality. Heterogeneity was measured using the I2 test. RESULTS Of the 71 papers included in this analysis, each belonging to one of five modalities, protein-based followed by metabolite-based markers provided the highest diagnostic accuracy, each with a pooled overall agreement of 83.3% and respective weighted area under the curve (AUC) of 89.5% and 88.3%. Sensitivity provided by protein markers was highest (85.5%), while metabolic (85.9%) and protein markers (84.7%) had the highest specificity. Other modalities showed degrees of sensitivity, specificity, and overall agreements in the range of 73%-80%. CONCLUSIONS Each modality provided for diagnostic accuracy and specificity similar or slightly higher than those reported for the gold-standard Autism Diagnostic Observation Schedule (ADOS) instrument. Further studies are required to identify the most predictive markers within each modality and to evaluate biological pathways or clustering with possible etiological relevance. Analyses will also be necessary to determine the potential of these novel biomarkers in diagnosing pediatric patients, thereby enabling early intervention.
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Affiliation(s)
| | - Yehudit Posen
- Cell-El Therapeutics Ltd, Jerusalem, Israel
- PSW Ltd, Rehovot, Israel
| | - Ronald Ellis
- Cell-El Therapeutics Ltd, Jerusalem, Israel
- Biotech & Biopharma Consulting, Jerusalem, Israel
| | - Lisa Deutsch
- Biostats Statistical Consulting Ltd, Modiin, Israel
| | | | - Benjamin Gesundheit
- Cell-El Therapeutics Ltd, Jerusalem, Israel
- To whom correspondence should be addressed. E-mail:
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20
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Mitelpunkt A, Kramer U, Hausman Kedem M, Zilbershot Fink E, Orbach R, Chernuha V, Fattal-Valevski A, Deutsch L, Heffetz D, Sacks H. The safety, tolerability, and effectiveness of PTL-101, an oral cannabidiol formulation, in pediatric intractable epilepsy: A phase II, open-label, single-center study. Epilepsy Behav 2019; 98:233-237. [PMID: 31394352 DOI: 10.1016/j.yebeh.2019.07.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/27/2019] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Several works have reported on the antiepileptic impact of cannabis-based preparations in patients with treatment-resistant epilepsy (TRE). However, current formulations suffer from low bioavailability and side effects. PTL-101, an oral formulation containing highly purified cannabidiol (CBD) embedded in seamless gelatin matrix beadlets was designed to enhance bioavailability and maintain a constant gastrointestinal transit time. METHODS This phase II, prospective study was open to pediatric patients with TRE on stable antiepileptic drugs' (AEDs) doses, who experienced ≥4 seizures within four weeks of enrolment and with a history of ≥4 AEDs failing to provide seizure control. Following a 4-week observation period, patients began a 2-week dose-titration phase (up to ≤25mg/kg or 450mg, the lower of the two), followed by a 10-week maintenance treatment period. Caregivers recorded seizure frequency, type, and severity and ranked their global impressions after 7 and 12weeks of treatment. Responders were those showing a ≥50% reduction from baseline monthly seizure frequency. Safety assessments monitored vital signs, adverse effects, physical and neurological exams, and laboratory tests. RESULTS Sixteen patients (age: 9.1±3.4) enrolled in the study; 11 completed the full treatment program. The average maintenance dose was 13.6±4.2mg/kg. Patient adherence to treatment regimens was 96.3±9.9%. By the end of the treatment period, 81.9% and 73.4±24.6% (p<0.05) reductions from baseline median seizure count and monthly seizure frequency, respectively, were recorded. Responders' rate was 56%; two patients became fully seizure-free. By study end, 8 (73%) caregivers reported an improved/very much improved condition, and 9 (82%) reported reduced/very much reduced seizure severity. Most commonly reported treatment-related adverse effects were sleep disturbance/insomnia, (4 (25.0%) patients), followed by somnolence, increased seizure frequency, and restlessness (3 patients each (18.8%)). None were serious or severe, and all resolved. CONCLUSIONS PTL-101 was safe and tolerable for use and demonstrated a potent seizure-reducing effect among pediatric patients with TRE.
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Affiliation(s)
- Alexis Mitelpunkt
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Uri Kramer
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Moran Hausman Kedem
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Efrat Zilbershot Fink
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel
| | - Rotem Orbach
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel
| | - Veronika Chernuha
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Center, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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Bar-Shalita T, Livshitz A, Levin-Meltz Y, Rand D, Deutsch L, Vatine JJ. Sensory modulation dysfunction is associated with Complex Regional Pain Syndrome. PLoS One 2018; 13:e0201354. [PMID: 30091986 PMCID: PMC6084887 DOI: 10.1371/journal.pone.0201354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/14/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Complex Regional Pain Syndrome (CRPS), a chronic pain condition, develops mainly after limb trauma and severely inhibits function. While early diagnosis is essential, factors for CRPS onset are elusive. Therefore, identifying those at risk is crucial. Sensory modulation dysfunction (SMD), affects the capacity to regulate responses to sensory input in a graded and adaptive manner and was found associated with hyperalgesia in otherwise healthy individuals, suggestive of altered pain processing. AIM To test SMD as a potential risk factor for CRPS. METHODS In this cross-sectional study, forty-four individuals with CRPS (29.9±11 years, 27 men) and 204 healthy controls (27.4±3.7 years, 105 men) completed the Sensory Responsiveness Questionnaire-Intensity Scale (SRQ-IS). A physician conducted the CRPS Severity Score (CSS), testing individuals with CRPS. RESULTS Thirty-four percent of the individuals with CRPS and twelve percent of the healthy individuals were identified to have SMD (χ2 (1) = 11.95; p<0.001). Logistic regression modeling revealed that the risk of CRPS is 2.68 and 8.21 times higher in individuals with sensory over- and sensory under-responsiveness, respectively, compared to non-SMD individuals (p = 0.03 and p = 0.01, respectively). CONCLUSIONS SMD, particularly sensory under-responsiveness, might serve as a potential risk factor for CRPS and therefore screening for SMD is recommended. This study provides the risk index probability clinical tool a simple evaluation to be applied by clinicians in order to identify those at risk for CRPS immediately after injury. Further research is needed.
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Affiliation(s)
- Tami Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Anatoly Livshitz
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Yulia Levin-Meltz
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Deutsch
- BioStats Statistical Consulting Ltd, Modiin, Israel
| | - Jean-Jacques Vatine
- Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Atsmon J, Heffetz D, Deutsch L, Deutsch F, Sacks H. Single-Dose Pharmacokinetics of Oral Cannabidiol Following Administration of PTL101: A New Formulation Based on Gelatin Matrix Pellets Technology. Clin Pharmacol Drug Dev 2017; 7:751-758. [DOI: 10.1002/cpdd.408] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/24/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jacob Atsmon
- Tel Aviv Sourasky Medical Center; Tel-Aviv; Israel, and Tel Aviv University Sackler Faculty of Medicine; Tel-Aviv Israel
| | | | - Lisa Deutsch
- BioStats Statistical Consulting Ltd.; Modiin Israel
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Ben-Pazi H, Cohen A, Kroyzer N, Lotem- Ophir R, Shvili Y, Winter G, Deutsch L, Pollak Y. Clown-care reduces pain in children with cerebral palsy undergoing recurrent botulinum toxin injections- A quasi-randomized controlled crossover study. PLoS One 2017; 12:e0175028. [PMID: 28414728 PMCID: PMC5393564 DOI: 10.1371/journal.pone.0175028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 07/02/2016] [Accepted: 03/19/2017] [Indexed: 12/04/2022] Open
Abstract
Objective We investigated the impact of clown-care on pain in 45 children with cerebral palsy who underwent recurrent Botulinum-toxin injections (age 7.04± 4.68 years). Participants were randomized to receive either clown (n = 20) or standard (n = 25) -care. Methods Pain Visual-Analogue-Scale (range 1–5) was reported before and after procedures. Pain assessment was lower for children undergoing Botulinum-toxin injections with clown-care (2.89± 1.36) compared to standard-care (3.85± 1.39; p = 0.036) even though pain anticipated prior to procedures was similar (~3). Findings Children who underwent the first procedure with clown-care reported lower pain even after they crossed-over to the following procedure which was standard (p = 0.048). Carryover effect was more prominent in injection-naïve children (p = 0.019) and during multiple procedures (p = 0.009). Prior pain experience correlated with pain in subsequent procedures only when first experience was standard-care (p = 0.001). Conclusions Clown-care alleviated pain sensation during Botulinum-toxin injections and initial clown-care experience reduced pain during subsequent injections even though clowns were not present. Trial registration clinicaltrials.gov ID # NCT01377883.
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Affiliation(s)
- Hilla Ben-Pazi
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- * E-mail:
| | - Avraham Cohen
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Naama Kroyzer
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Yaakov Shvili
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Gidon Winter
- Neuropediatric Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lisa Deutsch
- Biostatistical Consulting (L.D), BioStats, Modien, Israel
| | - Yehuda Pollak
- School of Education, The Hebrew University of Jerusalem, Jerusalem, Israel
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Lindborg R, Gordon LJ, Malinga R, Bengtsson J, Peterson G, Bommarco R, Deutsch L, Gren Å, Rundlöf M, Smith HG. How spatial scale shapes the generation and management of multiple ecosystem services. Ecosphere 2017. [DOI: 10.1002/ecs2.1741] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Regina Lindborg
- Department of Physical Geography Stockholm University 106 91 Stockholm Sweden
- Stellenbosch Institute for Advanced Study (STIAS) Wallenberg Research Centre Stellenbosch University Stellenbosch 7599 South Africa
| | - Line J. Gordon
- Stockholm Resilience Centre Stockholm University 106 91 Stockholm Sweden
| | - Rebecka Malinga
- Stockholm Resilience Centre Stockholm University 106 91 Stockholm Sweden
- Centre for Water Resources Research University of KwaZulu‐Natal Durban 4041 South Africa
| | - Jan Bengtsson
- Stellenbosch Institute for Advanced Study (STIAS) Wallenberg Research Centre Stellenbosch University Stellenbosch 7599 South Africa
- Department of Ecology Swedish University of Agricultural Sciences 750 07 Uppsala Sweden
| | - Garry Peterson
- Stockholm Resilience Centre Stockholm University 106 91 Stockholm Sweden
| | - Riccardo Bommarco
- Department of Ecology Swedish University of Agricultural Sciences 750 07 Uppsala Sweden
| | - Lisa Deutsch
- Stockholm Resilience Centre Stockholm University 106 91 Stockholm Sweden
| | - Åsa Gren
- Beijer Institute 114 18 Stockholm Sweden
| | - Maj Rundlöf
- Department of Biology Lund University 223 62 Lund Sweden
| | - Henrik G. Smith
- Beijer Institute 114 18 Stockholm Sweden
- Department of Biology Lund University 223 62 Lund Sweden
- Centre for Environmental and Climate Research Lund University 223 62 Lund Sweden
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Bar-Shalita T, Deutsch L, Honigman L, Weissman-Fogel I. Ecological aspects of pain in sensory modulation disorder. Res Dev Disabil 2015; 45-46:157-167. [PMID: 26254166 DOI: 10.1016/j.ridd.2015.07.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Sensory Modulation Disorder (SMD) interferes with the daily life participation of otherwise healthy individuals and is characterized by over-, under- or seeking responsiveness to naturally occurring sensory stimuli. Previous laboratory findings indicate pain hyper-sensitivity in SMD individuals suggesting CNS alteration in pain processing and modulation. However, laboratory studies lack ecological validity, and warrant clinical completion in order to elicit a sound understanding of the phenomenon studied. Thus, this study explored the association between sensory modulation and pain in a daily life context in a general population sample. METHODS Daily life context of pain and sensations were measured in 250 adults (aged 23-40 years; 49.6% males) using 4 self-report questionnaires: Pain Sensitivity Questionnaire (PSQ) and Pain Catastrophizing Scale (PCS) to evaluate the sensory and cognitive aspects of pain; the Sensory Responsiveness Questionnaire (SRQ) to appraise SMD; and the Short Form - 36 Health Survey, version 2 (SF36) to assess health related Quality of Life (QoL). RESULTS Thirty two individuals (12.8%) were found with over-responsiveness type of SMD, forming the SOR-SMD group. While no group differences (SOR-SMD vs. Non-SMD) were found, low-to-moderate total sample correlations were demonstrated between the SRQ-Aversive sub-scale and i) PSQ total (r=0.31, p<0.01) and sub-scales scores (r=0.27-0.28, p<0.01), as well as ii) PCS total and the sub-scales of Rumination and Helplessness scores (r=0.15, p<0.05). PSQ total and sub-scale scores were more highly correlated with SRQ-Aversive in the SOR-SMD group (r=0.57-0.68, p=0.03-<0.01) compared to Non-SMD group. The Physical Health - Total score (but not the Mental Health - Total) of the SF36 was lower for the SOR-SMD group (p=0.03), mainly due to the difference in the Body pain sub-scale (p=0.04). CONCLUSIONS Results suggest that SOR-SMD is strongly associated with the sensory aspect of pain but weakly associated with the cognitive aspect. This indicates that SMD co-occurs with daily pain sensitivity, thus reducing QoL, but less with the cognitive-catastrophizing manifestation of pain perception.
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Affiliation(s)
- T Bar-Shalita
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - L Deutsch
- BioStats Statistical Consulting Ltd, Modiin, Israel
| | - L Honigman
- The Laboratory of Clinical Neurophysiology, Faculty of Medicine, Technion, Haifa, Israel
| | - I Weissman-Fogel
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Adini Y, Bonneh YS, Komm S, Deutsch L, Israeli D. The time course and characteristics of procedural learning in schizophrenia patients and healthy individuals. Front Hum Neurosci 2015; 9:475. [PMID: 26379536 PMCID: PMC4555022 DOI: 10.3389/fnhum.2015.00475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 08/14/2015] [Indexed: 11/13/2022] Open
Abstract
Patients with schizophrenia have deficits in some types of procedural learning. Several mechanisms contribute to this learning in healthy individuals, including statistical and sequence-learning. To find preserved and impaired learning mechanisms in schizophrenia, we studied the time course and characteristics of implicitly introduced sequence-learning (SRT task) in 15 schizophrenia patients (seven mild and eight severe) and nine healthy controls, in short sessions over multiple days (5-22). The data show speed gains of similar magnitude for all groups, but the groups differed in overall speed and in the characteristics of the learning. By analyzing the data according to its spatial-position and temporal-order components, we provide evidence for two types of learning that could differentiate the groups: while the learning of the slower, severe group was dominated by statistical learning, the control group moved from a fast learning phase of statistical-related performance to subsequence learning (chunking). Our findings oppose the naïve assumption that a similar gain of speed reflects a similar learning process; they indicate that the slower performance reflects the activation of a different motor plan than does the faster performance; and demonstrate that statistical learning and subsequence learning are two successive stages in implicit sequence learning, with chunks inferred from prior statistical computations. Our results indicate that statistical learning is intact in patients with schizophrenia, but is slower to develop in the severe patients. We suggest that this slow learning rate and the associated slow performance contribute to their deficit in developing sequence-specific learning by setting a temporal constraint on developing higher order associations.
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Affiliation(s)
- Yael Adini
- The Institute for Vision ResearchKiron, Israel
| | - Yoram S. Bonneh
- Department of Human Biology, University of HaifaHaifa, Israel
- Department of Optometry, Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan UniversityRamat-Gan, Israel
| | - Seva Komm
- Day Care Unit and the Laboratory of Imaging and Brain Stimulation, Kfar Shaul hospital, Jerusalem Center for Mental HealthJerusalem, Israel
| | - Lisa Deutsch
- Biostats Statistical Consulting LtdModiin, Israel
| | - David Israeli
- Jerusalem Center for Mental Health, Hebrew UniversityJerusalem, Israel
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Kallmayer M, Tsantilas P, Knappich C, Deutsch L, Haller B, Söllner H, Storck M, Kühnl A, Zimmermann A, Eckstein HH. Trends und Ergebnisse der Karotischirurgie in Deutschland 2003–2013. Gefässchirurgie 2015. [DOI: 10.1007/s00772-015-0040-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Segel R, Ben-Pazi H, Zeligson S, Fatal-Valevski A, Aran A, Gross-Tsur V, Schneebaum-Sender N, Shmueli D, Lev D, Perlberg S, Blumkin L, Deutsch L, Levy-Lahad E. Copy number variations in cryptogenic cerebral palsy. Neurology 2015; 84:1660-8. [DOI: 10.1212/wnl.0000000000001494] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/06/2015] [Indexed: 11/15/2022] Open
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Levkovitz Y, Isserles M, Padberg F, Lisanby SH, Bystritsky A, Xia G, Tendler A, Daskalakis ZJ, Winston JL, Dannon P, Hafez HM, Reti IM, Morales OG, Schlaepfer TE, Hollander E, Berman JA, Husain MM, Sofer U, Stein A, Adler S, Deutsch L, Deutsch F, Roth Y, George MS, Zangen A. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry 2015; 14:64-73. [PMID: 25655160 PMCID: PMC4329899 DOI: 10.1002/wps.20199] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [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: 12/11/2022] Open
Abstract
Major depressive disorder (MDD) is a prevalent and disabling condition, and many patients do not respond to available treatments. Deep transcranial magnetic stimulation (dTMS) is a new technology allowing non-surgical stimulation of relatively deep brain areas. This is the first double-blind randomized controlled multicenter study evaluating the efficacy and safety of dTMS in MDD. We recruited 212 MDD outpatients, aged 22-68 years, who had either failed one to four antidepressant trials or not tolerated at least two antidepressant treatments during the current episode. They were randomly assigned to monotherapy with active or sham dTMS. Twenty sessions of dTMS (18 Hz over the prefrontal cortex) were applied during 4 weeks acutely, and then biweekly for 12 weeks. Primary and secondary efficacy endpoints were the change in the Hamilton Depression Rating Scale (HDRS-21) score and response/remission rates at week 5, respectively. dTMS induced a 6.39 point improvement in HDRS-21 scores, while a 3.28 point improvement was observed in the sham group (p=0.008), resulting in a 0.76 effect size. Response and remission rates were higher in the dTMS than in the sham group (response: 38.4 vs. 21.4%, p=0.013; remission: 32.6 vs. 14.6%, p=0.005). These differences between active and sham treatment were stable during the 12-week maintenance phase. dTMS was associated with few and minor side effects apart from one seizure in a patient where a protocol violation occurred. These results suggest that dTMS constitutes a novel intervention in MDD, which is efficacious and safe in patients not responding to antidepressant medications, and whose effect remains stable over 3 months of maintenance treatment.
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Affiliation(s)
- Yechiel Levkovitz
- Shalvata Mental Health Center, Tel Aviv UniversityHod Hasharon, Israel
| | - Moshe Isserles
- Department of Psychiatry, Hadassah-Hebrew University Medical CenterJerusalem, Israel
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-UniversityMunich, Germany
| | - Sarah H Lisanby
- Department of Psychiatry and Behavioral Sciences and Department of Psychology and Neuroscience, Duke UniversityDurham, NC, USA
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of CaliforniaLos Angeles, CA, USA
| | - Guohua Xia
- UC Davis Center for Mind and Brain and Department of Psychiatry and Behavioral Science, University of CaliforniaDavis, CA, USA
| | - Aron Tendler
- Advanced Mental Health Care Inc.Royal Palm Beach, FL, USA
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, University of TorontoToronto, Ontario, Canada
| | | | - Pinhas Dannon
- Beer Yaakov Mental Health Center, Tel Aviv UniversityBeer Yaakov, Israel
| | | | - Irving M Reti
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of MedicineBaltimore, MD, USA
| | | | - Thomas E Schlaepfer
- Department of Psychiatry and Psychotherapy, University HospitalBonn, Germany
| | - Eric Hollander
- Spectrum Neuroscience and Treatment CenterNew York, NY, USA
| | - Joshua A Berman
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric InstituteNew York, NY, USA
| | - Mustafa M Husain
- Department of Psychiatry, University of Texas Southwestern Medical CenterDallas, TX, USA
| | | | - Ahava Stein
- A. Stein - Regulatory Affairs Consulting Ltd.Kfar Saba, Israel
| | - Shmulik Adler
- A. Stein - Regulatory Affairs Consulting Ltd.Kfar Saba, Israel
| | | | | | - Yiftach Roth
- Department of Life Sciences, Ben-Gurion University of the NegevBe'er Sheva, Israel
| | - Mark S George
- Psychiatry Department, Brain Stimulation Laboratory, Medical University of South Carolina and Ralph H. Johnson VA Medical CenterCharleston, SC, USA
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the NegevBe'er Sheva, Israel
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Rabany L, Deutsch L, Levkovitz Y. Double-blind, randomized sham controlled study of deep-TMS add-on treatment for negative symptoms and cognitive deficits in schizophrenia. J Psychopharmacol 2014; 28:686-90. [PMID: 24829210 DOI: 10.1177/0269881114533600] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Negative symptoms and cognitive deficits are considered core symptoms of schizophrenia, yet treatment for them remains inadequate. Deep-transcranial magnetic stimulation (TMS) is a novel technology that enables non-invasive stimulation of deep layers of the prefrontal cortex. Preliminary evidence suggests that deep-TMS could be effective in the treatment of negative symptoms and cognitive deficits. The current study is the first double-blind, randomized sham-controlled study to examine the feasibility of deep-TMS add-on treatment for negative symptoms and cognitive deficits in schizophrenia. Twenty daily H1 deep-TMS treatments (20Hz, 120% MT) were delivered, in a double-blind, randomized sham-controlled design (n=30). Extensive clinical and cognitive assessments were carried out throughout the study and for an additional one month follow-up period. The results indicate that at the end of the treatment period, negative symptoms (as indicated by the Scale for the Assessment of Negative Symptoms (SANS)) significantly reduced in the TMS group (-7.7), but not in the sham group (-1.9). Differences between the groups were not statistically significant.
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Affiliation(s)
- Liron Rabany
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, which is affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Lisa Deutsch
- Biostatistical Consulting, BioStats, Modiin, Israel
| | - Yechiel Levkovitz
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, which is affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Harel EV, Rabany L, Deutsch L, Bloch Y, Zangen A, Levkovitz Y. H-coil repetitive transcranial magnetic stimulation for treatment resistant major depressive disorder: An 18-week continuation safety and feasibility study. World J Biol Psychiatry 2014; 15:298-306. [PMID: 22313023 DOI: 10.3109/15622975.2011.639802] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Evidence has shown that repetitive transcranial magnetic stimulation (rTMS) can be effective as an acute treatment for major depressive disorder (MDD). However, few studies have examined the safety and feasibility of rTMS as a long-term\continuation treatment. Deep-TMS is a novel tool enabling deeper stimulation than standard coils. The current study examined the safety and feasibility of repetitive deep-TMS continuation treatment for MDD over the course of 18 weeks, following 4 weeks of acute treatment. METHOD A total of 29 MDD patients were enrolled in the study. rTMS sessions (20 Hz) were given for a total of 22 weeks, divided into: 4 weeks of acute daily treatments, followed by 18 weeks of continuation treatments. Clinical evaluations were performed weekly throughout the study. RESULTS A significant decrease from baseline in Hamilton Depression Rating Scale (HDRS) score was found at the end of the acute phase, and maintained throughout the study (P < 0.0001). The Kaplan-Meier estimated probability of response was 46.15% (SE = 9.78%) at the end of the acute phase, and 81.12% (SE = 9.32%) at the end of the study (22 weeks). probability of remission at the end of the acute phase was 26.92% (SE = 8.70%) and 71.45% (SE = 10.99%) at the end of the study. Response in the acute phase was indicative of response in the continuation phases. The procedure was generally well tolerated and no adverse events were reported. CONCLUSION The results suggest that H-coil deep-TMS administered continuation treatment can help maintain an antidepressant effect for 18 weeks, following 4 weeks of acute treatment.
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Affiliation(s)
- Eiran Vadim Harel
- The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Porter JR, Dyball R, Dumaresq D, Deutsch L, Matsuda H. Feeding capitals: Urban food security and self-provisioning in Canberra, Copenhagen and Tokyo. Global Food Security 2014. [DOI: 10.1016/j.gfs.2013.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deutsch L, Haller B, Söllner H, Storck M, Eckstein HH. Trends und Ergebnisse der Karotischirurgie in Deutschland 2003–2011. Gefässchirurgie 2013. [DOI: 10.1007/s00772-013-1229-2] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kapusta L, Mainzer G, Weiner Z, Deutsch L, Khoury A, Haddad S, Lorber A. Changes in Fetal Left and Right Ventricular Strain Mechanics during Normal Pregnancy. J Am Soc Echocardiogr 2013; 26:1193-1200. [DOI: 10.1016/j.echo.2013.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Indexed: 11/26/2022]
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Kapusta L, Mainzer G, Weiner Z, Deutsch L, Khoury A, Haddad S, Lorber A. Second trimester ultrasound: reference values for two-dimensional speckle tracking-derived longitudinal strain, strain rate and time to peak deformation of the fetal heart. J Am Soc Echocardiogr 2013. [PMID: 23200418 DOI: 10.1016/j.echo.2012.09.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data on myocardial deformation during the internationally widely used second-trimester screening are scarce and confusing. Reference values of time to peak strain are missing. The aims of this study were to assess reference values derived from two-dimensional speckle-tracking echocardiography for global and regional longitudinal right ventricular (RV) and left ventricular (LV) strain, strain rate, and time to peak global strain and to determine the influence of heart rate and gender on these strain parameters. METHODS Seventy-five healthy fetuses were enrolled during second-trimester ultrasound (20-24 weeks). Clips with high frame rates (mean, 132 frames/sec) and two-dimensional (B-mode) grayscale images of apical or basal four-chamber views of both ventricles were used for offline analyses. RESULTS There were no statistically significant differences in global strain and strain rate between both ventricles (P = .679 and P = .734, respectively) or among the RV, septal, and LV free walls. Regional measurements, modeled also as an interaction of wall and segment (basal mid and apical), showed only a small, statistically significant difference between the basal RV and LV free walls. Strain and strain rate values were independent of heart rate. The mean time to peak LV global strain adjusted for heart rate was statistically significantly shorter than the RV value (P < .0001]). Strain, strain rate, and time to peak global strain were not found to be associated with gender. CONCLUSIONS The establishment of second-trimester two-dimensional speckle-tracking echocardiographic reference values for global and regional strain, strain rate, and time to peak global strain in a healthy fetal cohort is a mandatory prerequisite for its use in evaluating (pathologic) changes in both ventricular functions during pregnancy.
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Affiliation(s)
- Livia Kapusta
- Children's Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Ran Y, Deutsch L, Lannerstad M, Heinke J. Rapidly Intensified Beef Production in Uruguay: Impacts on Water-related Ecosystem Services. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.aqpro.2013.07.007] [Citation(s) in RCA: 11] [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] [Indexed: 11/25/2022]
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Seitzinger SP, Svedin U, Crumley CL, Steffen W, Abdullah SA, Alfsen C, Broadgate WJ, Biermann F, Bondre NR, Dearing JA, Deutsch L, Dhakal S, Elmqvist T, Farahbakhshazad N, Gaffney O, Haberl H, Lavorel S, Mbow C, McMichael AJ, deMorais JMF, Olsson P, Pinho PF, Seto KC, Sinclair P, Stafford Smith M, Sugar L. Planetary stewardship in an urbanizing world: beyond city limits. Ambio 2012; 41:787-94. [PMID: 23076974 PMCID: PMC3492563 DOI: 10.1007/s13280-012-0353-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/14/2012] [Accepted: 09/13/2012] [Indexed: 05/04/2023]
Abstract
Cities are rapidly increasing in importance as a major factor shaping the Earth system, and therefore, must take corresponding responsibility. With currently over half the world's population, cities are supported by resources originating from primarily rural regions often located around the world far distant from the urban loci of use. The sustainability of a city can no longer be considered in isolation from the sustainability of human and natural resources it uses from proximal or distant regions, or the combined resource use and impacts of cities globally. The world's multiple and complex environmental and social challenges require interconnected solutions and coordinated governance approaches to planetary stewardship. We suggest that a key component of planetary stewardship is a global system of cities that develop sustainable processes and policies in concert with its non-urban areas. The potential for cities to cooperate as a system and with rural connectivity could increase their capacity to effect change and foster stewardship at the planetary scale and also increase their resource security.
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Affiliation(s)
- Sybil P. Seitzinger
- International Geosphere Biosphere Programme, Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
| | - Uno Svedin
- Stockholm Resilience Centre, 106 91 Stockholm, Sweden
| | - Carole L. Crumley
- Department of Archaeology and Ancient History, Uppsala University, 75126 Uppsala, Sweden
- Center for Biodiversity, Swedish Agricultural University, Box 7007, 750 07 Uppsala, Sweden
| | - Will Steffen
- Stockholm Resilience Centre, 106 91 Stockholm, Sweden
- The ANU Climate Change Institute, The College of Asia and the Pacific, Australian National University, Coombs Building, Canberra, ACT 0200 Australia
| | - Saiful Arif Abdullah
- Institute for Environment and Development (LESTARI), Universiti Kebangsaan Malaysia, 43600 Bangi, Selangor Darul Ehsan Malaysia
| | | | - Wendy J. Broadgate
- International Geosphere Biosphere Programme, Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
| | - Frank Biermann
- Institute for Environmental Studies (IVM), VU University Amsterdam, De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands
| | - Ninad R. Bondre
- International Geosphere Biosphere Programme, Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
| | - John A. Dearing
- Geography and Environment, University of Southampton, Southampton, SO17 1BJ UK
| | - Lisa Deutsch
- Stockholm Resilience Centre, 106 91 Stockholm, Sweden
| | - Shobhakar Dhakal
- Energy Field of Study, Asian Institute of Technology, PO Box 4, Klong Luang, Pathumthani, 12120 Thailand
| | | | - Neda Farahbakhshazad
- Swedish Secretariat for Environmental Earth System Sciences, The Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
| | - Owen Gaffney
- International Geosphere Biosphere Programme, Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
| | - Helmut Haberl
- Institute of Social Ecology Vienna, Alpen-Adria Universität Klagenfurt, Schottenfeldgasse 29, 1070 Vienna, Austria
| | - Sandra Lavorel
- Laboratoire d’Ecologie Alpine, CNRS UMR 5553, BP 53, 2233 Rue de la Piscine, 38041 Grenoble Cedex 9, France
| | - Cheikh Mbow
- Institut des Sciences de l’Environment, Laboratoired’Enseignementet de Recherche en Géomatique (LERG), Ecole Supérieure Polytechnique (ESP)/FST, Université Cheikh Anta Diop, Dakar, Senegal
| | - Anthony J. McMichael
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 0200 Australia
| | - Joao M. F. deMorais
- International Geosphere Biosphere Programme, Royal Swedish Academy of Sciences, Box 50005, 104 05 Stockholm, Sweden
- Present Address: FORSK, Swedish International Development Cooperation Agency, Valhallavägen 199, 105 25 Stockholm, Sweden
| | - Per Olsson
- Stockholm Resilience Centre, 106 91 Stockholm, Sweden
| | - Patricia Fernanda Pinho
- IGBP Regional Office Brazil, Brazil Instituto Nacional de Pesquisas Espaciais, São José dos Campos, Brazil
| | - Karen C. Seto
- Yale School of Forestry and Environmental Studies, Yale University, 195 Prospect Street, New Haven, CT 06511 USA
| | - Paul Sinclair
- Department of Archaeology and Ancient History, Uppsala University, 75126 Uppsala, Sweden
| | | | - Lorraine Sugar
- The World Bank Group, 1818 H Street NW, Washington, DC 20433 USA
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Peters S, Deutsch L, Hammer M, Schweitzer D, Dawczynski J. Zwei-Photonen angeregte Fluoreszenz-Mikroskopie zur Interpretation von Fundus-Autofluoreszenz-Analysen in vivo. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1327165] [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: 10/27/2022]
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Jentsch S, Hammer M, Wildner K, Dawczynski J, Deutsch L, Klemm M, Schweitzer D. In vivo Untersuchungen zur zeitaufgelösten Autofluoreszenz bei retinalen Erkrankungen des menschlichen Auges. Klin Monbl Augenheilkd 2012. [DOI: 10.1055/s-0032-1327164] [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: 10/27/2022]
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Abstract
PURPOSE Individuals with sensory modulation disorder (SMD) demonstrate abnormal responses to naturally occurring stimuli in a manner that interferes with daily life activities. This study is the first study applying quantitative sensory testing to characterize the somatosensory sensitivity of adults with SMD. METHOD One hundred and fifty one adults (68 males and 83 females) were tested comparing 91 SMD to 60 SMD-free, control individuals. Group placement (SMD vs. SMD-free) was determined using the Sensory Responsiveness Questionnaire (SRQ). Sensory detection thresholds for skin warming, cooling, punctate dynamic tactile sensation, vibration and thermal pain thresholds for heat and cold stimuli were determined at several body sites. Pinprick pain and prickliness were also assessed, as well as the duration and intensity of the after-sensations of prickliness and pain evoked by the prickly stimuli. RESULTS Compared to control adults, individuals with SMD showed significantly higher pain intensity to prickle stimuli, marginally higher pain intensity to pinprick and hypoesthesia to punctate dynamic tactile sensation at one of two sites tested. CONCLUSIONS These results are in line with our previous study that investigated children with SMD using the same stimuli, and found similar results. We suggest a CNS involvement as the underlying mechanisms in SMD.
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Affiliation(s)
- Tami Bar-Shalita
- School of Occupational Therapy, Faculty of Medicine of Hadassah and the Hebrew University of Jerusalem, Jerusalem, Israel
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Blondheim DS, Friedman Z, Lysyansky P, Kuperstein R, Hay I, Feinberg MS, Beeri R, Vaturi M, Sagie A, Shimoni S, Fehske W, Deutsch L, Leitman M, Gilon D, Agmon Y, Tsadok Y, Rosenmann D, Liel-Cohen N. Use of an automatic application for wall motion classification based on longitudinal strain: is it affected by operator expertise in echocardiography? A multicentre study by the Israeli Echocardiography Research Group. Eur Heart J Cardiovasc Imaging 2011; 13:257-62. [DOI: 10.1093/ejechocard/jer182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Steffen W, Persson A, Deutsch L, Zalasiewicz J, Williams M, Richardson K, Crumley C, Crutzen P, Folke C, Gordon L, Molina M, Ramanathan V, Rockström J, Scheffer M, Schellnhuber HJ, Svedin U. The anthropocene: from global change to planetary stewardship. Ambio 2011; 40:739-61. [PMID: 22338713 PMCID: PMC3357752 DOI: 10.1007/s13280-011-0185-x] [Citation(s) in RCA: 240] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Over the past century, the total material wealth of humanity has been enhanced. However, in the twenty-first century, we face scarcity in critical resources, the degradation of ecosystem services, and the erosion of the planet's capability to absorb our wastes. Equity issues remain stubbornly difficult to solve. This situation is novel in its speed, its global scale and its threat to the resilience of the Earth System. The advent of the Anthropence, the time interval in which human activities now rival global geophysical processes, suggests that we need to fundamentally alter our relationship with the planet we inhabit. Many approaches could be adopted, ranging from geoengineering solutions that purposefully manipulate parts of the Earth System to becoming active stewards of our own life support system. The Anthropocene is a reminder that the Holocene, during which complex human societies have developed, has been a stable, accommodating environment and is the only state of the Earth System that we know for sure can support contemporary society. The need to achieve effective planetary stewardship is urgent. As we go further into the Anthropocene, we risk driving the Earth System onto a trajectory toward more hostile states from which we cannot easily return.
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Affiliation(s)
- Will Steffen
- ANU Climate Change Institute, Australian National University, Canberra, ACT, Australia.
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Shimoni S, Gendelman G, Ayzenberg O, Smirin N, Lysyansky P, Edri O, Deutsch L, Caspi A, Friedman Z. Differential Effects of Coronary Artery Stenosis on Myocardial Function: The Value of Myocardial Strain Analysis for the Detection of Coronary Artery Disease. J Am Soc Echocardiogr 2011; 24:748-57. [DOI: 10.1016/j.echo.2011.03.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Indexed: 10/18/2022]
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Liel-Cohen N, Tsadok Y, Beeri R, Lysyansky P, Agmon Y, Feinberg MS, Fehske W, Gilon D, Hay I, Kuperstein R, Leitman M, Deutsch L, Rosenmann D, Sagie A, Shimoni S, Vaturi M, Friedman Z, Blondheim DS. A New Tool for Automatic Assessment of Segmental Wall Motion Based on Longitudinal 2D Strain. Circ Cardiovasc Imaging 2010; 3:47-53. [DOI: 10.1161/circimaging.108.841874] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [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] [Indexed: 11/16/2022]
Abstract
Background—
Identification and quantification of segmental left ventricular wall motion abnormalities on echocardiograms is of paramount clinical importance but is still performed by a subjective visual method. We constructed an automatic tool for assessment of wall motion based on longitudinal strain.
Methods and Results—
Echocardiograms of 105 patients (3 apical views) were blindly analyzed by 12 experienced readers. Visual segmental scores (VSS) and peak systolic longitudinal strain were assigned to each of 18 segments per patient. Ranges of peak systolic longitudinal strain that best fit VSS (by receiver operating characteristic analysis) were used to generate automatic segmental scores (ASS). Comparisons of ASS and VSS were performed on 1952 analyzable segments. There was agreement of wall motion scores between both methods in 89.6% of normal, 39.5% of hypokinetic, and 69.4% of akinetic segments. Correlation between methods was
r
=0.63 (
P
<0.0001). Interobserver and intraobserver reliability using interclass correlation for scoring segmental wall motion into 3 scores by ASS was 0.82 and 0.83 and by VSS 0.70 and 0.69, respectively. Compared with VSS (majority rule), ASS had a sensitivity, specificity, and accuracy of 87%, 85%, and 86%, respectively. ASS and VSS had similar success rates for correct identification of wall motion abnormalities in territories supplied by culprit arteries. VSS had greater specificity and positive predictive values, whereas ASS had higher sensitivity and negative predictive values for identifying the culprit artery.
Conclusions—
Automatic quantification of wall motion on echocardiograms by this tool performs as well as visual analysis by experienced echocardiographers, with a greater reliability and similar agreement to angiographic findings.
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Affiliation(s)
- Noah Liel-Cohen
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yossi Tsadok
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ronen Beeri
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Peter Lysyansky
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Yoram Agmon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Micha S. Feinberg
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Wolfgang Fehske
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Dan Gilon
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Ilan Hay
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Rafael Kuperstein
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Marina Leitman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Lisa Deutsch
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David Rosenmann
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Alik Sagie
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Sarah Shimoni
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Mordehay Vaturi
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - Zvi Friedman
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
| | - David S. Blondheim
- From the Soroka University Medical Center (N.L.-C.), Beer Sheva, Israel; Ben-Gurion University (Y.T.), Beer Sheva, Israel; Hadassah University Hospital (R.B., D.G.), Jerusalem, Israel; General Electric Healthcare (P.L., L.D., Z.F.), Haifa, Israel; Rambam Medical Center (Y.A.), Haifa, Israel; Sheba Medical Center (M.S.F., I.H., R.K.), Tel Aviv, Israel; St Vinzenz Hospital (W.F.), Cologne, Germany; Asaff Harofeh Medical Center (M.L.), Zerifin, Israel; Shaare Zedek Medical Center (D.R.), Jerusalem,
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Corcoran C, Perrin M, Harlap S, Deutsch L, Fennig S, Manor O, Nahon D, Kimhy D, Malaspina D, Susser E. Incidence of schizophrenia among second-generation immigrants in the jerusalem perinatal cohort. Schizophr Bull 2009; 35:596-602. [PMID: 18648022 PMCID: PMC2669576 DOI: 10.1093/schbul/sbn089] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [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: 11/13/2022]
Abstract
OBJECTIVE Increased incidence of schizophrenia is observed among some immigrant groups in Europe, with the offspring of immigrants, ie "second-generation" immigrants particularly vulnerable. Few contemporary studies have evaluated the risk of schizophrenia among second-generation immigrants in other parts of the world. METHODS We studied the incidence of schizophrenia in relation to parental immigrant status in a population-based cohort of 88 829 offspring born in Jerusalem in 1964-1976. Parental countries of birth were obtained from birth certificates and grouped together as (1) Israel, (2) Other West Asia, (3) North Africa, and (4) Europe and industrialized countries. Cox proportional hazards methods were used in adjusting for sex, parents' ages, maternal education, social class, and birth order. RESULTS Linkage with Israel's Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. Incidence of schizophrenia was not increased among second-generation immigrants in this birth cohort, neither overall nor by specific group. CONCLUSIONS The difference in risk of schizophrenia among second-generation immigrants in Europe and in this Israeli birth cohort suggests that the nature of the immigration experience may be relevant to risk, including reasons for migration, the nature of entry, and subsequent position in the host country for immigrants and their offspring. Minority status may be of importance as, in later studies, immigrants to Israel from Ethiopia had increased risk of schizophrenia.
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Affiliation(s)
- Cheryl Corcoran
- New York State Psychiatric Institute, Unit 2, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Mary Perrin
- Department of Psychiatry, New York University, New York
| | - Susan Harlap
- Department of Psychiatry, New York University, New York,Department of Epidemiology, Mailman School of Public Health, New York
| | - Lisa Deutsch
- Braun School of Public Health, Hebrew University-Hadassah School of Public Health, Jerusalem
| | - Shmuel Fennig
- Department of Psychiatry, Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Ramat Aviv
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah School of Public Health, Jerusalem
| | - Daniella Nahon
- Mental Health Services Section, Israel Ministry of Health, Tel Aviv
| | - David Kimhy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
| | - Dolores Malaspina
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York,Department of Psychiatry, New York University, New York
| | - Ezra Susser
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York,Department of Epidemiology, Mailman School of Public Health, New York
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Corcoran C, Perrin M, Harlap S, Deutsch L, Fennig S, Manor O, Nahon D, Kimhy D, Malaspina D, Susser E. Effect of socioeconomic status and parents' education at birth on risk of schizophrenia in offspring. Soc Psychiatry Psychiatr Epidemiol 2009; 44:265-71. [PMID: 18836884 PMCID: PMC2983097 DOI: 10.1007/s00127-008-0439-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 09/10/2008] [Indexed: 11/25/2022]
Abstract
Although it is known that schizophrenia is associated with social class, controversy exists as to the nature of this association. The authors studied the incidence of schizophrenia in relation to social class at birth in a population-based cohort of 88,829 offspring born in Jerusalem in 1964-1976. They constructed a six-point scale to index social class, based on paternal occupation at the time of birth, with each of 108 occupations being ranked by mean education. Cox proportional hazards methods were used in adjusting for sex, parents' ages, duration of marriage and birth order. Linkage with Israel's Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. There was no gradient of risk for schizophrenia associated with social class at birth; however, offspring of fathers in the lowest social class showed a modest increase in risk (adjusted Relative Risk = 1.4; 95% Confidence interval = 1.1-1.8, P = 0.002). These data suggest that in contrast to many other health outcomes, there is not a continuous gradient for increasing schizophrenia with decreasing social class of origin. Instead, a modest increase in risk for schizophrenia was observed only for those born at the bottom of the social ladder.
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Affiliation(s)
- Cheryl Corcoran
- Dept. of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 2, New York, NY 10032, USA.
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Monsky W, Badawi R, Kim I, Loh S, Dong P, Deutsch L. Abstract No. 183: Semi-Automated Segmentation for Volumetric Analysis of Intra-Tumoral Ethiodol Uptake and Response Following Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.172] [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: 12/01/2022] Open
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Calderon-Margalit R, Friedlander Y, Yanetz R, Deutsch L, Perrin MC, Kleinhaus K, Tiram E, Harlap S, Paltiel O. Preeclampsia and subsequent risk of cancer: update from the Jerusalem Perinatal Study. Am J Obstet Gynecol 2009; 200:63.e1-5. [PMID: 18822400 DOI: 10.1016/j.ajog.2008.06.057] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [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: 01/08/2008] [Revised: 05/15/2008] [Accepted: 06/19/2008] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the association between preeclampsia and cancer incidence. STUDY DESIGN The Jerusalem Perinatal Study is a population-based cohort of all births to 41,206 residents of Western Jerusalem from 1964-76. Cancer incidence to 2004 was assessed by linkage of the cohort with the Israel Cancer Registry. Cox's proportional hazards models were constructed to estimate the hazard ratio for cancer among women who had had preeclampsia. RESULTS Preeclampsia was associated with a 1.23-fold increased risk of cancer at all sites, a 37% increased risk of breast cancer, and more than a doubling of ovarian cancer risk. Analysis by morphologic condition yielded significantly increased risks for malignancies that were classed as cystic mucinous and serous (relative risk, 1.96; 95% CI, 1.00-3.83) and for ductal, lobular, and medullary carcinomas (relative risk, 1.40; 95% CI, 1.07-1.83). No differential association was observed by sex of offspring. CONCLUSION Our study suggests that the previously described protective effect of preeclampsia on cancer is not universal.
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Harlap S, Kleinhaus K, Perrin MC, Calderon-Margalit R, Paltiel O, Deutsch L, Manor O, Tiram E, Yanetz R, Friedlander Y. Consanguinity and birth defects in the jerusalem perinatal study cohort. Hum Hered 2008; 66:180-9. [PMID: 18493143 DOI: 10.1159/000133837] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 10/29/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While parental consanguinity is known to increase the risk of birth defects in offspring, it is hard to quantify this risk in populations where consanguinity is prevalent. METHODS To support ongoing studies of cancer and of psychiatric disease, we studied relationships of consanguinity to 1,053 major birth defects in 29,815 offspring, born in 1964-1976. To adjust for confounding variables (geographic origin, social class and hospital), we constructed logistic regression models, using GEE to take into account correlations between sibs. Odds ratios (ORs) and 95% confidence limits were estimated in comparison to a reference group of offspring with grandfathers born in different countries. RESULTS With 10.1% of offspring having consanguineous parents, the adjusted OR for major birth defect was 1.41 (1.12-1.74). Offspring of marriages between uncles-nieces, first cousins and more distant relatives showed adjusted ORs of 2.36 (0.98-5.68), 1.59 (1.22-2.07) and 1.20 (0.89-1.59) respectively. For descendents of grandfathers born in the same country, but not known to be related, the OR was 1.05 (0.91-1.21); these showed increased risk associated with ancestries in Western Asia (1.27, 1.04-1.55, p < 0.02) or Europe (1.13, 0.79-1.80). CONCLUSIONS A strong association of consanguinity with poverty and low education points to the need to avoid exposure to environmental hazards in these families.
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Affiliation(s)
- S Harlap
- Department of Psychiatry, New York University School of Medicine, New York, NY 10017, USA.
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