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Abstract
Chronic absenteeism is associated with poor health and educational outcomes. School nurses have great potential to address the health and educational needs that contribute to absenteeism. Through qualitative analysis of interviews with school nurses, we characterize their current role in reducing absenteeism and identify barriers 3 that limit their capacity to meet this goal, organized by the Framework for 21st Century School Nursing Practice. Interviewees (n = 23) identified actions perceived to reduce absenteeism aligned with domains of care coordination, leadership, quality improvement, and community and public health. Barriers perceived to limit the capacity of school nurses to address absenteeism were identified within these domains and ranged from student- and family-level to federal-level barriers. Specific healthcare system-level barriers included insufficient communication with community-based healthcare teams and the need for coordinated approaches across health and education sectors to address absenteeism. Strategic opportunities exist to address barriers to comprehensive school nursing practice and reduce absenteeism.
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Affiliation(s)
- Jacquelin Rankine
- Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Goldberg
- Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lori Kelley
- Pennsylvania Association of School Nurses and Practitioners, Sewickley, Pennsylvania, USA
| | - Kristin N. Ray
- Pediatrics, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
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Lokken EM, Taylor GG, Huebner EM, Vanderhoeven J, Hendrickson S, Coler B, Sheng JS, Walker CL, McCartney SA, Kretzer NM, Resnick R, Kachikis A, Barnhart N, Schulte V, Bergam B, Ma KK, Albright C, Larios V, Kelley L, Larios V, Emhoff S, Rah J, Retzlaff K, Thomas C, Paek BW, Hsu RJ, Erickson A, Chang A, Mitchell T, Hwang JK, Gourley R, Erickson S, Delaney S, Kline CR, Archabald K, Blain M, LaCourse SM, Adams Waldorf KM. Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients. Am J Obstet Gynecol 2021; 225:75.e1-75.e16. [PMID: 33607103 PMCID: PMC7884918 DOI: 10.1016/j.ajog.2021.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood. OBJECTIVE This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State. STUDY DESIGN Pregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State. RESULTS A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3-23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2-7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3-2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3-20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96-1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%). CONCLUSION The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
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Lokken EM, Huebner EM, Taylor GG, Hendrickson S, Vanderhoeven J, Kachikis A, Coler B, Walker CL, Sheng JS, al-Haddad BJ, McCartney SA, Kretzer NM, Resnick R, Barnhart N, Schulte V, Bergam B, Ma KK, Albright C, Larios V, Kelley L, Larios V, Emhoff S, Rah J, Retzlaff K, Thomas C, Paek BW, Hsu RJ, Erickson A, Chang A, Mitchell T, Hwang JK, Erickson S, Delaney S, Archabald K, Kline CR, LaCourse SM, Adams Waldorf KM. Disease severity, pregnancy outcomes, and maternal deaths among pregnant patients with severe acute respiratory syndrome coronavirus 2 infection in Washington State. Am J Obstet Gynecol 2021; 225:77.e1-77.e14. [PMID: 33515516 PMCID: PMC7838012 DOI: 10.1016/j.ajog.2020.12.1221] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence is accumulating that coronavirus disease 2019 increases the risk of hospitalization and mechanical ventilation in pregnant patients and for preterm delivery. However, the impact on maternal mortality and whether morbidity is differentially affected by disease severity at delivery and trimester of infection are unknown. OBJECTIVE This study aimed to describe disease severity and outcomes of severe acute respiratory syndrome coronavirus 2 infections in pregnancy across the Washington State, including pregnancy complications and outcomes, hospitalization, and case fatality. STUDY DESIGN Pregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 1, 2020, and June 30, 2020, were identified in a multicenter retrospective cohort study from 35 sites in Washington State. Sites captured 61% of annual state deliveries. Case-fatality rates in pregnancy were compared with coronavirus disease 2019 fatality rates in similarly aged adults in Washington State using rate ratios and rate differences. Maternal and neonatal outcomes were compared by trimester of infection and disease severity at the time of delivery. RESULTS The principal study findings were as follows: (1) among 240 pregnant patients in Washington State with severe acute respiratory syndrome coronavirus 2 infections, 1 in 11 developed severe or critical disease, 1 in 10 were hospitalized for coronavirus disease 2019, and 1 in 80 died; (2) the coronavirus disease 2019-associated hospitalization rate was 3.5-fold higher than in similarly aged adults in Washington State (10.0% vs 2.8%; rate ratio, 3.5; 95% confidence interval, 2.3-5.3); (3) pregnant patients hospitalized for a respiratory concern were more likely to have a comorbidity or underlying conditions including asthma, hypertension, type 2 diabetes mellitus, autoimmune disease, and class III obesity; (4) 3 maternal deaths (1.3%) were attributed to coronavirus disease 2019 for a maternal mortality rate of 1250 of 100,000 pregnancies (95% confidence interval, 257-3653); (5) the coronavirus disease 2019 case fatality in pregnancy was a significant 13.6-fold (95% confidence interval, 2.7-43.6) higher in pregnant patients than in similarly aged individuals in Washington State with an absolute difference in mortality rate of 1.2% (95% confidence interval, -0.3 to 2.6); and (6) preterm birth was significantly higher among women with severe or critical coronavirus disease 2019 at delivery than for women who had recovered from coronavirus disease 2019 (45.4% severe or critical coronavirus disease 2019 vs 5.2% mild coronavirus disease 2019; P<.001). CONCLUSION Coronavirus disease 2019 hospitalization and case-fatality rates in pregnant patients were significantly higher than in similarly aged adults in Washington State. These data indicate that pregnant patients are at risk of severe or critical disease and mortality compared to nonpregnant adults, and also at risk for preterm birth.
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Affiliation(s)
- Erica M. Lokken
- Department of Global Health, University of Washington, Seattle, WA,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - G. Gray Taylor
- Department of Epidemiology, University of Washington, Seattle, WA
| | | | - Jeroen Vanderhoeven
- Swedish Maternal and Fetal Specialty Center—First Hill, Seattle, WA,Obstetrix Medical Group of Washington, Seattle, WA
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Brahm Coler
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | | | | | | | - Nicole M. Kretzer
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Nena Barnhart
- Department of Obstetrics and Gynecology, PeaceHealth St. Joseph Medical Center, Bellingham, WA
| | - Vera Schulte
- University of Washington School of Medicine, Seattle, WA
| | | | - Kimberly K. Ma
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Catherine Albright
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Lori Kelley
- Yakima Valley Farm Workers Clinic, Yakima, WA
| | | | | | - Jasmine Rah
- University of Washington School of Medicine, Seattle, WA
| | - Kristin Retzlaff
- Quality Department, EvergreenHealth Medical Center Kirkland, Kirkland, WA
| | - Chad Thomas
- Department of Obstetrics and Gynecology, PeaceHealth St. Joseph Medical Center, Bellingham, WA
| | - Bettina W. Paek
- Eastside Maternal-Fetal Medicine, EvergreenHealth Medical Center Kirkland, Kirkland, WA,Obstetrix Medical Group of Washington, Bellevue, WA
| | - Rita J. Hsu
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA,Women’s and Children’s Health, Confluence Health, Wenatchee, WA
| | - Anne Erickson
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | | | - Timothy Mitchell
- Department of Obstetrics and Gynecology, Vancouver Clinic, Vancouver, WA
| | - Joseph K. Hwang
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Stephen Erickson
- University of Washington School of Medicine, Seattle, WA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA,Jefferson Healthcare, Port Townsend, WA
| | - Shani Delaney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Karen Archabald
- Legacy Medical Group—Maternal-Fetal Medicine, Legacy Health, Vancouver, WA
| | - Carolyn R. Kline
- Eastside Maternal-Fetal Medicine, EvergreenHealth Medical Center Kirkland, Kirkland, WA,Obstetrix Medical Group of Washington, Bellevue, WA
| | - Sylvia M. LaCourse
- Department of Global Health, University of Washington, Seattle, WA,Department of Medicine, University of Washington, Seattle, WA
| | - Kristina M. Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA,Department of Obstetrics and Gynecology, University of Washington, Seattle, WA,Corresponding author: Kristina M. Adams Waldorf, MD
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Creelan B, Teer J, Toloza E, Mullinax J, Landin A, Gray J, Tanvetyanon T, Taddeo M, Noyes D, Kelley L, Fang B, Koomen J, Sarnaik A, Kim S, Haura E, Antonia S. OA05.03 Safety and Clinical Activity of Adoptive Cell Transfer Using Tumor Infiltrating Lymphocytes (TIL) Combined with Nivolumab in NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ribickas A, Thigpen S, Janssen W, Kelley L. An automated method of enrichment of lymphocytes from apheresis products for cellular engineering. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.197] [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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Davis K, Alloush L, Hale J, Ribickas A, Kelley L, Janssen W. Haemonetics cell saver as a laboratory cell processing instrument: Fine tuning buffy coat processing. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.182] [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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Kelley L, Schlegel M, Hecker-Nolting S, Rössig C, Reichardt P, Kager L, Kühne T, Gosheger G, Windhager R, Specht K, Kevric M, Nathrath M, Tunn P, Baumhoer D, Werner M, Von Kalle T, Burdach S, Bielack S, Von Luettichau I. Pathological fracture and prognosis of high-grade osteosarcoma of the extremities. An analysis of 2,847 consecutive cooperative osteosarcoma study group (COSS) patients. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kelley L, Sanders AFP, Beaton EA. Vitamin D deficiency, behavioral atypicality, anxiety and depression in children with chromosome 22q11.2 deletion syndrome. J Dev Orig Health Dis 2016; 7:616-625. [PMID: 27827293 PMCID: PMC5922262 DOI: 10.1017/s2040174416000428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a complex developmental disorder with serious medical, cognitive and emotional symptoms across the lifespan. This genetic deletion also imparts a lifetime risk for developing schizophrenia that is 25-30 times that of the general population. The origin of this risk is multifactorial and may include dysregulation of the stress response and immunological systems in relation to brain development. Vitamin D is involved in brain development and neuroprotection, gene transcription, immunological regulation and influences neuronal signal transduction. Low levels of vitamin D are associated with schizophrenia, depression and anxiety in the general population. Yet, little is known about how vitamin D levels in children with 22q11.2DS could mediate risk of psychosis in adulthood. Blood plasma levels of vitamin D were measured in children aged 7-16 years with (n=11) and without (n=16) 22q11.2DS in relation to parent reports of children's anxiety and atypicality. Anxiety and atypicality in childhood are risk indicators for the development of schizophrenia in those with 22q11.2DS and the general population. Children with 22q11.2DS had lower vitamin D levels, as well as elevated anxiety and atypicality compared with typical peers. Higher levels of anxiety, depression and internalizing problems but not atypicality were associated with lower levels of vitamin D. Vitamin D insufficiency may relate to higher levels of anxiety and depression, in turn contributing to the elevated risk of psychosis in this population. Further study is required to determine casual linkages between anxiety, stress, mood and vitamin D in children with 22q11.2DS.
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Affiliation(s)
- L. Kelley
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - A. F. P. Sanders
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
| | - E. A. Beaton
- Department of Psychology, University of New Orleans, New Orleans, LA, USA
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Kelley L, Neimeyer R, Rusch T. SU-G-TeP2-02: Characterization of An Improved X-Ray Source for Use with the Xoft Surface Applicator. Med Phys 2016. [DOI: 10.1118/1.4957037] [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: 11/07/2022] Open
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Buzzi A, Kelley L, Gregory M, Skinner M, Kalnins W. Improving comprehensive care in the haemophilia community: building on the HERO Study. Haemophilia 2016; 22:e320-2. [PMID: 27170451 DOI: 10.1111/hae.12945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- A Buzzi
- Fondazione Paracelso, Milan, Italy
| | - L Kelley
- LA Kelley Communications, Inc., Georgetown, MA, USA
| | | | - M Skinner
- World Federation of Hemophilia, Washington, DC, USA
| | - W Kalnins
- German Haemophilia Society, Hamburg, Germany
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Kelley L, Holt R, Rusch T. SU-E-T-301: Spectral Comparison of the Xoft and Zeiss 50 KVp X-Ray Systems. Med Phys 2014. [DOI: 10.1118/1.4888633] [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: 11/07/2022] Open
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Kelley L, Swan N, Hughes DJ. An analysis of the duplicate testing strategy of an Irish immunochemical faecal occult blood test colorectal cancer screening programme. Colorectal Dis 2013; 15:e512-21. [PMID: 23746062 DOI: 10.1111/codi.12310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/05/2012] [Accepted: 01/22/2013] [Indexed: 02/08/2023]
Abstract
AIM This study examined the relevance of using a two-sample quantitative immunochemical faecal occult blood test (FIT) at a high cut-off stringency by the first population-based colorectal cancer (CRC) pilot screening programme in Ireland. METHOD Approximately 10,000 individuals between the ages of 50 and 74 years were invited to perform two consecutive FITs. These were analysed in tandem using the OC Sensor and participants with at least one positive result with a haemoglobin cut-off for positivity at 100 ng/ml were offered colonoscopy. RESULTS A total of 5023 (52%) [2177 (43%) male, 2846 (57%) female] individuals with a median age of 64 years participated. At least one positive FIT was detected from 514 (10%) individuals. From the 419 (82%) patients who proceeded to colonoscopy 17 (4%) had CRC and 132 (33%) had an advanced adenoma. The detection rate for these screen-relevant lesions was 3% (95% CI 2.5-3.5) and the FIT-positive colonoscopy detection rate was 36% (95% CI 31-40). The number needed to undergo colonoscopy to find an advanced lesion was 2.8. The two-test system detected four (23.5%) additional patients with CRC and 37 (28%) with an advanced adenoma compared with a single test. CONCLUSION The CRC miss rate estimated for a single test (23.5%) was unacceptably high when the goal was to maximize the discovery of advanced lesions in the initial screening round. We conclude that the two-test protocol at a high cut-off threshold is suitable for optimizing FIT screening in Ireland.
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Affiliation(s)
- L Kelley
- Department of Gastroenterology, Adelaide and Meath Hospital, Dublin, Ireland
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Holt R, Kelley L, Rusch T, Hausen H. SU-E-T-454: Comparative Dosimetry of the Xoft Cervical Applicator and HDR Ir-192 Henschke Applicator. Med Phys 2013. [DOI: 10.1118/1.4814887] [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: 11/07/2022] Open
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Kelley L, Holt R, Rusch T, Walawalkar A, Lum A. WE-A-BRB-02: Characterization of a New Cervical Applicator for Use with the Axxent 50kVp EBx Source. Med Phys 2012. [DOI: 10.1118/1.4736043] [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: 11/07/2022] Open
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Carr W, Meltzer E, Finn A, Dorinsky P, Kelley L, Dunbar S, Tantry S. Effective Nasal Symptom Relief and Improvement in Health-Related Quality of Life in Subjects with Perennial Allergic Rhinitis Following 6-Week Once-Daily Treatment with Beclomethasone Dipropionate Hydrofluoroalkane Nasal Aerosol. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.266] [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: 10/14/2022]
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Segall N, Mansfield L, Amar N, Dorinsky P, Kelley L, Ding Y, Tantry S. Once Daily Treatment with Beclomethasone Dipropionate Hydrofluoroalkane Nasal Aerosol Is Safe and Effective in Children (6-11 Years of Age) With Seasonal Allergic Rhinitis. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.268] [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: 10/14/2022]
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Kelley L, Rusch T. SU-E-T-373: Treatment Plan Validation of the XPS (Interstitial) Applicator for Use with the Xoft Axxent 50kVp X-Ray Source. Med Phys 2011. [DOI: 10.1118/1.3612327] [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: 11/07/2022] Open
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Hughes D, O'Morain C, Lee N, Kelley L, McMurray H, Latten M, Ebert M. 128 Use of a biochip assaying 28 mutations in the KRAS, BRAF, TP53, and APC genes for detection of colorectal neoplasia. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70936-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Holt R, Kelley L, Rusch T. SU-GG-T-46: An Equivalent Path Length TG-43(U) Model for Heterogeneity Corrections of HAM Applicator Treatments Using Low Energy Electronic Brachytherapy. Med Phys 2010. [DOI: 10.1118/1.3468432] [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: 11/07/2022] Open
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Axelrod S, Kelley L, Walawalkar A, Yao S, Rusch T. SU-FF-T-58: Dosimetric Study of a New Surface Applicator for the Xoft Axxent System. Med Phys 2009. [DOI: 10.1118/1.3181530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kelley L, Axelrod S, Rusch T. SU-FF-T-311: Calibration of Lot 47207-01I GAFCHROMIC EBT Film Using the Xoft Axxent X-Ray Source. Med Phys 2009. [DOI: 10.1118/1.3181791] [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: 11/07/2022] Open
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Petrella JR, Prince SE, Krishnan S, Husn H, Kelley L, Doraiswamy PM. Effects of donepezil on cortical activation in mild cognitive impairment: a pilot double-blind placebo-controlled trial using functional MR imaging. AJNR Am J Neuroradiol 2008; 30:411-6. [PMID: 19001543 DOI: 10.3174/ajnr.a1359] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cholinesterase-inhibitor therapy is approved for treatment of Alzheimer disease; however, application in patients with mild cognitive impairment (MCI) is still under active investigation. The purpose of this study was to determine the effect of such therapy on the neural substrates underlying memory processing in subjects with MCI by using functional MR imaging (fMRI). MATERIALS AND METHODS Thirteen subjects with MCI (mean age, 68 +/- 6.9 years) enrolled in a multicenter double-blind placebo-controlled trial testing the clinical efficacy of the cholinesterase-inhibitor, donepezil, were studied with fMRI at baseline and following 12 or 24 weeks of therapy (single-site pilot study). The cognitive paradigm was delayed-response visual memory for novel faces. Within-group 1-sample t tests were performed on the donepezil and placebo groups at baseline and at follow-up. A repeated-measures analysis of variance design was used to look for a Treatment Group x Time interaction showing a significant donepezil- but not placebo-related change in blood oxygen level-dependent response during the course of the study. RESULTS At baseline, both groups showed multiple areas of activation, including the bilateral dorsolateral prefrontal cortex, fusiform gyrus, and anterior cingulate cortex. On follow-up, the placebo group demonstrated a decreased extent of dorsolateral prefrontal activation, whereas the donepezil group demonstrated an increased extent of activation in the ventrolateral prefrontal cortex. Interaction demonstrated significant donepezil- but not placebo-related change in the left inferior frontal gyrus. CONCLUSIONS Despite the limitations inherent to a pilot study of a small sample, our results point to specific cortical substrates underlying the actions of donepezil, which can be tested in future studies.
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Affiliation(s)
- J R Petrella
- Department of Radiology, Alzheimer's Disease Imaging Research Laboratory and Brain Imaging and Analysis Center, Duke University Medical Center, Duke University, Durham, NC 27710, USA.
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Axelrod S, Kelley L, Mantese L, Rusch T. SU-GG-T-36: Film Based Treatment Plan Validation for a New Vaginal Applicator Using the Xoft Axxent™ 50 KVp Miniature X-Ray Source. Med Phys 2008. [DOI: 10.1118/1.2961786] [Citation(s) in RCA: 2] [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: 11/07/2022] Open
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Hausen H, Kelley L, Lovoi T, Mantese L, Rusch T. SU-GG-T-43: X-Ray Transmission of Vaginal Cylinders for Use with the Axxent® Electronic Brachytherapy System. Med Phys 2008. [DOI: 10.1118/1.2961793] [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: 11/07/2022] Open
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Kelley L, Axelrod S, Dutta A. SU-DD-A2-03: Measurement of Skin Dose When Using FlexiShield® with the Axxent® Electronic Brachytherapy System. Med Phys 2008. [DOI: 10.1118/1.2961358] [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: 11/07/2022] Open
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Kelley L, Axelrod S, Powell M. TH-D-352-09: A High Precision, High Throughput Fixture for Routine Spatial Characterization of the Xoft Axxent™ Miniature X-Ray Source. Med Phys 2008. [DOI: 10.1118/1.2962952] [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: 11/07/2022] Open
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Rusch T, Klein E, Kelley L, Myerson R, Axelrod S. SU-GG-T-549: Dosimetry of An X-Ray Endocavitary Proctoscope Adapted for Use with the Axxent® Electronic Brachytherapy System. Med Phys 2008. [DOI: 10.1118/1.2962298] [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: 11/07/2022] Open
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Kao G, Kim H, Gatzo L, Madison H, Daley H, Perzepiorka D, Burger S, Kelley L, Vierra-Green C, Flesch S, Spellman S, Miller J, Confer D. 251: Impact of Storage Conditions on Marrow and Peripheral Blood Stem Cell Products Stored Over 72 Hours. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.260] [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: 10/22/2022]
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Kelley L, Baloh RW, Jen J. 363 VERTIGO, SENSORY COMPLAINTS, VISUAL AURA, AND MIGRAINE HEADACHES IN A LARGE FAMILY. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.362] [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: 11/18/2022]
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Kelley L. Commentary on 2003-808: infusion of unwashed umbilical cord blood stem cells after thawing for allogeneic transplantation. Bone Marrow Transplant 2004; 34:741. [PMID: 15334051 DOI: 10.1038/sj.bmt.1704652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kelley L. The role and activities of the ISCT Regulatory Affairs Committee. Cytotherapy 2004; 5:279-83. [PMID: 12944232 DOI: 10.1080/14653240310002199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The following article is written as part of a series of reviews addressing regulatory issues relevant to the field of cellular therapy. The first in the series describes the activities and mission of the Legal and Regulatory Affairs Committee of ISCT.
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Affiliation(s)
- L Kelley
- Hematopoietic Stem Cell Laboratory, University of Utah, Salt Lake City, UT 84103, USA
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Behling-Kelly E, Schultz-Cherry S, Koci M, Kelley L, Larsen D, Brown C. Localization of astrovirus in experimentally infected turkeys as determined by in situ hybridization. Vet Pathol 2003; 39:595-8. [PMID: 12243474 DOI: 10.1354/vp.39-5-595] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Twenty-one 3-day-old turkey poults from British United Turkeys of America were orally inoculated with a recently characterized astrovirus, TAstV-2, isolated from turkeys with poult enteritis and mortality syndrome. At 1, 2, 3, 4, 5, 7, and 9 days postinfection (dpi), three inoculated birds were euthanatized, and tissues (intestines, spleen, bursa, and thymus) were collected immediately into 10% neutral buffered formalin. Inoculated birds were diarrheic by 3 dpi, and frothy feces persisted throughout the experimental period. Histologically, there was only slight evidence of enteric damage, which was characterized by mild epithelial necrosis, lamina propria infiltrates, minimal villus atrophy, and mild crypt hyperplasia. In situ hybridization, using a negative sense digoxigenin-labeled riboprobe to the capsid gene of TAstV-2, revealed viral RNA in intestinal epithelial cells at the basal margins of the villi, in distal small intestine, and in cecum at 2 dpi, with subsequent extension to epithelium of the large intestine and proximal small intestine (3-5 dpi). Minimal virus remained by 9 dpi.
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Abstract
Optimal collections of mobilized CD34+ cells are important in terms of both patient toxicity and cost. The factors that determine CD34+ collection efficiency (CD34eff) of cell separators have not been well studied. In addition, because several cell separators are available, the type of collection device may also be a significant variable. Previous studies comparing the Baxter-Fenwal CS3000 and the COBE Spectra have not yielded consistent conclusions. Therefore, we retrospectively analyzed the collection outcomes of 163 consecutive donors with a peripheral CD34+ cell concentration (pCD34) of > or =5 cells/microl on the first collection that had been harvested on one or the other device. The CS3000 was found to yield a significantly higher CD34eff (50% vs. 39%, P = 0.006). However, donors were not balanced for several prognostic factors, which may contribute to CD34eff including mobilization with G-CSF vs. chemotherapy+G-CSF, average flow rate, and total volume of peripheral blood processed. When appropriate variables were included in a stepwise multiple variable analysis, cell separator type emerged as a significant independent predictive factor for CD34eff (P = 0.018). Our data indicates that the CS3000 will, on average, show a higher absolute CDeff of 8%. Furthermore, since the two devices differ in mechanism, prognostic factors may also differ. Comparisons suggest that peripheral blood WBC and hematocrit may be more important predictors for the CS3000.
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Affiliation(s)
- C D Ford
- Utah Blood and Marrow Transplant Program, LDS Hospital, Eighth Avenue and C Street, Salt Lake City, UT 84143, USA.
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Mitas M, Mikhitarian K, Hoover L, Lockett MA, Kelley L, Hill A, Gillanders WE, Cole DJ. Prostate-Specific Ets (PSE) factor: a novel marker for detection of metastatic breast cancer in axillary lymph nodes. Br J Cancer 2002; 86:899-904. [PMID: 11953821 PMCID: PMC2364139 DOI: 10.1038/sj.bjc.6600190] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2001] [Revised: 01/07/2002] [Accepted: 01/09/2002] [Indexed: 11/09/2022] Open
Abstract
Prostate Specific Ets factor is a recently identified transcriptional activator that is overexpressed in prostate cancer. To determine whether this gene is overexpressed in breast cancer, we performed a virtual Northern blot using data available online at the Cancer Genome Anatomy Project website. Ninety-five SAGE libraries were probed with a unique sequence tag to the Prostate Specific Ets gene. The results indicate that Prostate Specific Ets is expressed in 14 out of 15 breast cancer libraries (93%), nine out of 10 prostate cancer libraries (90%), three out of 40 libraries from other cancers (7.5%), and four out of 30 normal tissue libraries (13%). To determine the possibility that the Prostate Specific Ets gene is a novel marker for detection of metastatic breast cancer in axillary lymph nodes, quantitative real-time RT-PCR analyses were performed. The mean level of Prostate Specific Ets expression in lymph nodes containing metastatic breast cancer (n=22) was 410-fold higher than in normal lymph node (n=51). A receiver operator characteristic curve analysis indicated that Prostate Specific Ets was overexpressed in 18 out of 22 lymph nodes containing metastatic breast cancer (82%). The receiver operator characteristic curve analysis also indicated that the diagnostic accuracy of the Prostate Specific Ets gene for detection of metastatic breast cancer in axillary lymph nodes was 0.949. These results provide evidence that Prostate Specific Ets is a potentially informative novel marker for detection of metastatic breast cancer in axillary lymph nodes, and should be included in any study that involves molecular profiling of breast cancer.
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Affiliation(s)
- M Mitas
- Department of Surgery, Suite 420, Medical University of South Carolina, Charleston, SC 29425, USA.
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Abstract
Self-rated scales allow the comparison of subjective mood across the spectrum of manic, depressive, and euthymic states. This study examined the self-reported mood of manic, depressed, and normal subjects using a 23-item research instrument based on the Carroll-Klein model of bipolar disorder. The Multiple Visual Analog Scale (MVAS) measures the following dimensions: consummatory reward (seven items), incentive reward (two items), psychomotor speed (seven items), and central pain (seven items). The MVAS was completed by 31 manic inpatients, 43 depressed inpatients, and 29 normal volunteer subjects. Total scores, average item scores, and total dimension scores were obtained. Subjects also completed a global mood VAS and the Carroll Depression Scale (CDS). Groups were compared by analysis of variance (ANOVA) and post hoc Bonferroni-Dunn methods. In a separate post hoc analysis, the group of manic patients was divided at the median CDS score into "pure" and "dysphoric" manic subgroups. We found excellent congruence of average 23-item total MVAS scores with global VAS and CDS scores. Dimension scores on the MVAS conformed to the predictions of the Carroll-Klein model. Depressed patients differed significantly from both manic and normal subjects on each dimension. MVAS dimension scores of normal subjects did not differ significantly from those of manic patients. On the dimension of central pain, normal subjects had significantly less inhibited scores than the "pure" subgroup of manics. The results confirmed that the dimensions of the Carroll-Klein model are bipolar and orthogonal. By the MVAS technique, the self-reported mood of normal subjects is similar to the self-reported mood of manic patients on all dimensions of the Carroll-Klein model of bipolar disorder. The positive scores of both groups are clearly distinguished from the negative scores of depressed patients. Average MVAS scores of normal subjects approximated the conventional zero score only on the dimension of central pain. Normal subjects exhibit megalothymic (hyperthymia) on most dimensions of subjective mood. The negative MVAS scores of depressed patients are even more deviant from normal than the conventional scoring system would suggest.
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Affiliation(s)
- E P Ahearn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Qin G, Takenaka T, Telsch K, Kelley L, Howard T, Levade T, Deans R, Howard BH, Malech HL, Brady RO, Medin JA. Preselective gene therapy for Fabry disease. Proc Natl Acad Sci U S A 2001; 98:3428-33. [PMID: 11248095 PMCID: PMC30670 DOI: 10.1073/pnas.061020598] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fabry disease is a lipid storage disorder resulting from mutations in the gene encoding the enzyme alpha-galactosidase A (alpha-gal A; EC ). We previously have demonstrated long-term alpha-gal A enzyme correction and lipid reduction mediated by therapeutic ex vivo transduction and transplantation of hematopoietic cells in a mouse model of Fabry disease. We now report marked improvement in the efficiency of this gene-therapy approach. For this study we used a novel bicistronic retroviral vector that engineers expression of both the therapeutic alpha-gal A gene and the human IL-2Ralpha chain (huCD25) gene as a selectable marker. Coexpression of huCD25 allowed selective immunoenrichment (preselection) of a variety of transduced human and murine cells, resulting in enhanced intracellular and secreted alpha-gal A enzyme activities. Of particular significance for clinical applicability, mobilized CD34(+) peripheral blood hematopoietic stem/progenitor cells from Fabry patients have low-background huCD25 expression and could be enriched effectively after ex vivo transduction, resulting in increased alpha-gal A activity. We evaluated effects of preselection in the mouse model of Fabry disease. Preselection of transduced Fabry mouse bone marrow cells elevated the level of multilineage gene-corrected hematopoietic cells in the circulation of transplanted animals and improved in vivo enzymatic activity levels in plasma and organs for more than 6 months after both primary and secondary transplantation. These studies demonstrate the potential of using a huCD25-based preselection strategy to enhance the clinical utility of ex vivo hematopoietic stem/progenitor cell gene therapy of Fabry disease and other disorders.
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Affiliation(s)
- G Qin
- Department of Medicine, University of Illinois, Chicago, IL 60607, USA
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Elsner A, Miura M, Burns S, Beausencourt E, Kunze C, Kelley L, Walker J, Wing G, Raskauskas P, Fletcher D, Zhou Q, Dreher A. Multiply scattered light tomography and confocal imaging: detecting neovascularization in age-related macular degeneration. Opt Express 2000; 7:95-106. [PMID: 19404374 DOI: 10.1364/oe.7.000095] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A novel technique, Multiply Scattered Light Tomography (MSLT), and confocal Infrared Imaging are used to provide diagnostic information using a comfortable, rapid, and noninvasive method. We investigated these techniques in detecting neovascularization in age-related macular degeneration. The MSLT used a Vertical Cavity Surface Emitting Laser (VCSEL) at 850 nm, while the confocal imaging technique used either the VCSEL or a 790 nm laser diode. Both were implemented into the topographical scanning system (TopSS, Laser Diagnostic Technologies, Inc.) Confocal imaging with both lasers provided different information about neovascularization as a function of focal plane, and different also from MSLT.
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Elsner A, Moraes L, Beausencourt E, Remky A, Weiter J, Walker J, Wing G, Burns S, Raskauskas P, Kelley L. Scanning laser reflectometry of retinal and subretinal tissues. Opt Express 2000; 6:243-250. [PMID: 19404357 DOI: 10.1364/oe.6.000243] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Measurements of the human ocular fundus that make use of the light returning through the pupil are called reflectometry. Early reflectometry studies were limited by poor light return from the retina and strong reflections from the anterior surface of the eye. Artifacts produced misleading results in diseases like age-related macular degeneration. Novel laser sources, scanning, confocal optics, and digital imaging provide improved sampling of the signal from the tissues of interest: photoreceptors and retinal pigment epithelial cells. A wider range of wavelengths is now compared, including the near infrared. Reflectometry now provides functional mapping, even in severe pathology.
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Ingardia CJ, Kelley L, Lerer T, Wax JR, Steinfeld JD. Correlation of maternal and fetal hepatitis B antibody titers following maternal vaccination in pregnancy. Am J Perinatol 1999; 16:129-32. [PMID: 10438194 DOI: 10.1055/s-2007-993846] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to compare the levels of hepatitis B antibody in maternal and cord blood following maternal vaccination in pregnancy and to determine the level of maternal hepatitis B surface antibody (HbsAb) associated with a seroprotective level in cord blood. Thirty-seven (37) healthy gravidas who were identified as seronegative for hepatitis B surface antigen (HbsAg) and antibody (HbsAb) on initial prenatal assessment and subsequently began a series of three vaccinations in the pregnancy with hepatitis B recombinant DNA vaccine (Engerix-B, SmithKline Beecham) were studied. These mothers represented the first group of gravidas delivering between 6/1/97 and 8/1/97 following the iniatiation of a new protocol of offering hepatitis B vaccination to all patients testing seronegative to HbsAg and HbsAb. All gravidas were given a dose of 20 microg into the deltoid muscle utilizing a 1 1/2-inch needle at a schedule of 0, 1, and 6 months. At the time of delivery specimens were obtained for maternal serum levels and paired cord blood levels of HbsAb. Levels were determined utilizing a quantitative enzyme-linked immunoadsorbent assay (ELISA) analysis (AUSAB-EIA Abbott Lab; Abbott Park, IL). A serum titer of > or =10 mLU/mL was considered seroprotective. Maternal and cord blood groups identified by seroprotection status were then sudivided by number of maternal vaccines received. Data were compared using the Student's t-test and Chi-square or Fisher's exact test. Eighteen gravidas (49%) had seroprotective titers at the time of delivery. Of these, 16 (88%) had seroprotective cord blood levels. All maternal specimens with a HbsAb titer > or =35 mLU/mL were associated with cord blood tiers > or =10 mLU/mL. When maternal titers achieved seroprotective levels of HbsAb, there was no difference in the frequency of cord blood seroprotection comparing groups by number of maternal vaccine doses received. When maternal titers of HbsAb achieve seroprotective levels following vaccination, cord blood seroprotection was achieved in 88% of studied patients. Maternal HbsAb titers > or =35 mLU/mL were associated with cord blood seroprotective levels in all cases.
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Affiliation(s)
- C J Ingardia
- Department of Obstetrics and Gynecology, Hartford Hospital, Connecticut 06106, USA
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Abstract
OBJECTIVE To determine seroprotective antibody response after hepatitis B vaccination during pregnancy and to assess factors influencing the rate of maternal seroprotection. METHODS Records of 80 healthy gravidas who elected hepatitis B vaccination during pregnancy, after being identified as hepatitis B surface antigen (HbsAg) and antibody (HbsAb) negative on initial prenatal screen, were analyzed retrospectively. Each gravida was begun on a series of three recombinant hepatitis B vaccines at 0, 1, and 6 months. At 36-40 weeks' gestation, all gravidas were rescreened for seroprotective levels of HbsAb using qualitative enzyme-linked immunosorbent assay analysis. The women were grouped by maternal age (less than 25 years or at least 25 years), smoking history, maternal weight, body mass index (BMI) (less than 30, at least 30, less than 34, or at least 34), number of vaccinations received, race-ethnicity, gestational age at vaccination, and vaccination-to-rescreening interval. Data were compared by t test, chi2 test, or Fisher exact test. Stepwise logistic regression analysis was done. RESULTS At rescreening, 39 (49%) of the 80 women had seroprotective HbsAb conversion. After two vaccinations, obese women (BMI at least 30) (P = .04), women at least 25 years old (P = .04), and women with smoking histories (P = .005) were significantly less likely to respond to the vaccine. Logistic regression analysis for predicting failure of seroprotective response after two vaccinations showed significantly increased odds for severe obesity with BMI at least 34 (odds ratio [OR] 16.2; 95% confidence interval [CI] 1.7, 154.7), smoking history (OR 7.5; 95% CI 2.0, 27.7), and age at least 25 years (OR 3.9; 95% CI 1.1, 14.4). CONCLUSION Maternal obesity, advancing age, and smoking have negative influences on the efficacy of hepatitis B vaccination in pregnant women.
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Affiliation(s)
- C J Ingardia
- Department of Obstetrics and Gynecology, Hartford Hospital, Connecticut 06102, USA.
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Abstract
Diagnosis of von Willebrand disease Type 2N (vWD 2N), which mimics hemophilia A and its carrier state, is important for accurate genetic counseling and appropriate therapy. To make testing for the disorder more clinically applicable, we developed a simplified method for measurement of factor VIII (FVIII) binding to von Willebrand factor (vWF) using commercially available reagents and standard clinical assays. FVIII binding to vWF was measured by capture of patient vWF by polyclonal antibodies on cyanogen bromide-activated Sepharose beads, reaction with recombinant FVIII, and assay of unbound FVIII by clotting methods. Unbound vWF was measured in patient plasma after capture by the Laurell method. The ratio of bound FVIII/bound vWF was normal in hemophilia A, vWD Type 1, and vWD Type 3 patients, and abnormal in 5 subjects from two families, all of whom had vWD 2N mutations. Patient 1, with FVIII 8 U/dl, vWF: Ag 61 U/dl, vWF:RC 74 U/dl, and FVIII binding nil, was homozygous for the Arg91 Gln mutation. She was followed during pregnancy and delivered an unaffected heterozygous son. Patient 2 had FVIII 8 U/dl, vWF:Ag 73 U/dl, and vWF:RC 71 U/dl, and very low FVIII binding. She was heterozygous for Arg91Gln, as were her mother and sister; no second vWD 2N mutation was found. Her brother, with FVIII 14 U/dl, vWF:Ag 113 U/dl, and vWF:RC 72 U/dl, has no evidence of vWD 2N. With an X-linked inheritance pattern of bleeding tendency, this family is the first reported with combined hemophilia A and vWD 2N.
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Affiliation(s)
- C H Miller
- Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA.
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Kelley L, Sklar DP, Johnson DR, Tandberg D. Women's perception of pain and distress during intravenous catheterization and urethral mini-catheterization. Am J Emerg Med 1997; 15:570-2. [PMID: 9337363 DOI: 10.1016/s0735-6757(97)90159-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented "no pain" or "no distress" and the right "the worst pain imaginable" or "extreme distress." Distress was defined to include embarrassment, anxiety, or fear. A convenience sample of 40 adult women who presented to a university emergency department and were undergoing both procedures as part of their management appraised pain and distress after IV placement and urethral MC. The mean IV pain score was 4.2 cm, whereas the mean MC score was only 2.6 cm (P = .02). The IV and MC distress score means were similar (2.3 v 2.6 cm, P = .55). These results suggest that patients perceive urethral MC as less painful than IV placement. The distress scores of these two procedures did not differ and were low in both instances.
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Affiliation(s)
- L Kelley
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque 87131-5246, USA
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Brown TP, Garcia A, Kelley L. Spiking mortality of turkey poults: 1. Experimental reproduction in isolation facilities. Avian Dis 1997; 41:604-9. [PMID: 9356706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Spiking mortality of turkeys (SMT) is an infectious disease of 5-to-25-day-old turkey poults characterized by acute enteritis and bursal and thymic atrophy. Brooding 1-day-old poults on litter taken from naturally occurring cases successfully reproduced SMT 5 days postexposure. Oral exposure to an organ homogenate made of tissue samples from naturally occurring cases successfully reproduced SMT 5 days postinoculation. Coronaviruses were present in intestinal and bursal contents taken from poults with naturally occurring SMT. They were also present 5 days after exposure in the experimentally reproduced disease. Severe intestinal villus atrophy, bursal follicular lymphoid depletion, and thymic cortical atrophy were present histologically in naturally occurring SMT and in SMT reproduced by either experimental method.
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Affiliation(s)
- T P Brown
- Department of Avian Medicine, College of Veterinary Medicine, University of Georgia, Athens 30602, USA
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Miller AE, Morgante LA, Buchwald LY, Nutile SM, Coyle PK, Krupp LB, Doscher CA, Lublin FD, Knobler RL, Trantas F, Kelley L, Smith CR, La Rocca N, Lopez S. A multicenter, randomized, double-blind, placebo-controlled trial of influenza immunization in multiple sclerosis. Neurology 1997; 48:312-4. [PMID: 9040712 DOI: 10.1212/wnl.48.2.312] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We determined the effect of influenza vaccine in patients with relapsing/remitting MS. Considerable controversy surrounds the question of whether to administer influenza vaccines to MS patients. Prevention of a febrile viral illness is clearly desirable in MS, and previous studies suggest that immunization is safe. Despite this, many clinicians avoid vaccination because they fear precipitating an MS exacerbation. We conducted a multicenter, prospective, randomized, double-blind trial of influenza immunization in patients with relapsing/remitting MS. In the autumn of 1993, 104 patients at five MS centers received either standard influenza vaccine or placebo. Patients were followed for 6 months for evaluation of neurologic status and the occurrence of influenza. Influenza was operationally defined as fever > or = 38 degrees C in the presence of coryza, cough, or sore throat at a time when the disease was present in the community. Attacks were defined in the standard manner, requiring objective change in the examination. Patients were examined at 4 weeks and 6 months after inoculation and were contacted by telephone at 1 week and 3 months. They were also examined at times of possible attacks but not when they were sick with flu-like illness. Three vaccine patients and two placebo patients experienced attacks within 28 days of vaccine (no significant difference). Exacerbation rates in the first month for both groups were equal to or less than expected from published series. The two groups showed no difference in attack rate or disease progression over 6 months. Influenza immunization in MS patients is neither associated with an increased exacerbation rate in the postvaccination period nor a change in disease course over the subsequent 6 months.
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Affiliation(s)
- A E Miller
- Division of Neurology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Abstract
The Beck Depression Inventory was administered, along with measures of anxiety, locus of control, and self-concept, to 211 undergraduates at a major southern institution to test for concurrent validity. Correlations of scores on Beck's scale with other scores provide additional support for Beck's scale as a valid measure of depression.
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Affiliation(s)
- B E Robinson
- Department of Counseling, Special Education, and Child Development, University of North Carolina, Charlotte 28223, USA
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Affiliation(s)
- J Boyd
- Oxford Health Plans, Norwalk, Connecticut, USA
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Hodges R, Kelley L, Wilkes A. Benchmarking and networking through collaborative groups. J Healthc Qual 1996; 18:26-31. [PMID: 10153769 DOI: 10.1111/j.1945-1474.1996.tb00820.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The search for better ways to deliver healthcare services at lower cost led a group of hospitals in the Carolinas, 2 years ago, to pioneer a new concept, the collaborative group. A collaborative group typically is composed of five or six similar (but not competing) hospitals that work together closely to help each other make the changes necessary to survive in an increasingly competitive marketplace. Hospital staff members at all levels are able to work together to discover improvement opportunities through benchmarking teams and networking efforts. This article describes their experiences, achievements, and lessons learned.
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Affiliation(s)
- R Hodges
- SunHealth Alliance, Inc., Charlotte, NC, USA
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Alexandreas DE, Allen GE, Berley D, Biller S, Burman RL, Cavalli-Sforza M, Chang CY, Chen ML, Chumney P, Coyne D, Dion C, Dion GM, Dorfan D, Ellsworth RW, Goodman JA, Haines TJ, Harmon M, Hoffman CM, Kelley L, Klein S, Nagle DE, Schmidt DM, Schnee R, Sinnis C, Shoup A, Stark MJ, Weeks DD, Williams DA, Wu JP, Yang T, Yodh GB, Zhang WP. New limit on the rate-density of evaporating black holes. Phys Rev Lett 1993; 71:2524-2527. [PMID: 10054704 DOI: 10.1103/physrevlett.71.2524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Affiliation(s)
- L Kelley
- USDA, FSIS, Eastern Laboratory, Russell Research Center, Athens, GA 30604
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Songer JG, Beckenbach K, Marshall MM, Olson GB, Kelley L. Biochemical and genetic characterization of Corynebacterium pseudotuberculosis. Am J Vet Res 1988; 49:223-6. [PMID: 2831763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Isolates (n = 94) of Corynebacterium pseudotuberculosis were obtained from sheep, goats, horses, and cattle from various parts of the world. The isolates were characterized biochemically and by restriction endonuclease analysis of DNA. We found near homogeneity in the ability of isolates to ferment carbohydrates and to produce urease. All isolates produced phospholipase D and catalase. The ability of isolates from horses to reduce nitrate, the inability of isolates from sheep and goats to do so, and the correlation of this characteristic with results of restriction endonuclease analyses confirmed the existence of 2 biovars of C pseudotuberculosis. We propose that these biovars be referred to as biovar equi for isolates that reduce nitrate and biovar ovis for isolates that fail to do so.
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Affiliation(s)
- J G Songer
- Department of Veterinary Science, College of Agriculture, University of Arizona, Tucson 85721
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