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Zhang H, Tarabanis C, Jethani N, Goldstein M, Smith S, Chinitz L, Ranganath R, Aphinyanaphongs Y, Jankelson L. QTNet: Predicting Drug-Induced QT Prolongation With Artificial Intelligence-Enabled Electrocardiograms. JACC Clin Electrophysiol 2024:S2405-500X(24)00166-X. [PMID: 38703162 DOI: 10.1016/j.jacep.2024.01.022] [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: 08/24/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Prediction of drug-induced long QT syndrome (diLQTS) is of critical importance given its association with torsades de pointes. There is no reliable method for the outpatient prediction of diLQTS. OBJECTIVES This study sought to evaluate the use of a convolutional neural network (CNN) applied to electrocardiograms (ECGs) to predict diLQTS in an outpatient population. METHODS We identified all adult outpatients newly prescribed a QT-prolonging medication between January 1, 2003, and March 31, 2022, who had a 12-lead sinus ECG in the preceding 6 months. Using risk factor data and the ECG signal as inputs, the CNN QTNet was implemented in TensorFlow to predict diLQTS. RESULTS Models were evaluated in a held-out test dataset of 44,386 patients (57% female) with a median age of 62 years. Compared with 3 other models relying on risk factors or ECG signal or baseline QTc alone, QTNet achieved the best (P < 0.001) performance with a mean area under the curve of 0.802 (95% CI: 0.786-0.818). In a survival analysis, QTNet also had the highest inverse probability of censorship-weighted area under the receiver-operating characteristic curve at day 2 (0.875; 95% CI: 0.848-0.904) and up to 6 months. In a subgroup analysis, QTNet performed best among males and patients ≤50 years or with baseline QTc <450 ms. In an external validation cohort of solely suburban outpatient practices, QTNet similarly maintained the highest predictive performance. CONCLUSIONS An ECG-based CNN can accurately predict diLQTS in the outpatient setting while maintaining its predictive performance over time. In the outpatient setting, our model could identify higher-risk individuals who would benefit from closer monitoring.
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Affiliation(s)
- Hao Zhang
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
| | - Constantine Tarabanis
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Neil Jethani
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Mark Goldstein
- Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Silas Smith
- Ronald O. Perelman Department of Emergency Medicine, NYU Langone Health, New York, New York, USA
| | - Larry Chinitz
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Rajesh Ranganath
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA; Courant Institute of Mathematical Sciences, New York University, New York, New York, USA
| | - Yindalon Aphinyanaphongs
- Department of Population Health, NYU Langone Health, New York University School of Medicine, New York, New York, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, Cardiac Electrophysiology, NYU Langone Health, New York University School of Medicine, New York, New York, USA.
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Tuvia G, Burshtein A, Silber I, Aharony A, Entin-Wohlman O, Goldstein M, Dagan Y. Enhanced Nonlinear Response by Manipulating the Dirac Point at the (111) LaTiO_{3}/SrTiO_{3} Interface. Phys Rev Lett 2024; 132:146301. [PMID: 38640380 DOI: 10.1103/physrevlett.132.146301] [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] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
Tunable spin-orbit interaction (SOI) is an important feature for future spin-based devices. In the presence of a magnetic field, SOI induces an asymmetry in the energy bands, which can produce nonlinear transport effects (V∼I^{2}). Here, we focus on such effects to study the role of SOI in the (111) LaTiO_{3}/SrTiO_{3} interface. This system is a convenient platform for understanding the role of SOI since it exhibits a single-band Hall response through the entire gate-voltage range studied. We report a pronounced rise in the nonlinear longitudinal resistance at a critical in-plane field H_{cr}. This rise disappears when a small out-of-plane field component is present. We explain these results by considering the location of the Dirac point formed at the crossing of the spin-split energy bands. An in-plane magnetic field pushes this point outside of the Fermi contour, and consequently changes the symmetry of the Fermi contours and intensifies the nonlinear transport. An out-of-plane magnetic field opens a gap at the Dirac point, thereby significantly diminishing the nonlinear effects. We propose that magnetoresistance effects previously reported in interfaces with SOI could be comprehended within our suggested scenario.
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Affiliation(s)
- G Tuvia
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - A Burshtein
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - I Silber
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - A Aharony
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - O Entin-Wohlman
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel-Aviv University, Tel Aviv 6997801, Israel
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Hu Y, Lui A, Goldstein M, Sudarshan M, Tinsay A, Tsui C, Maidman SD, Medamana J, Jethani N, Puli A, Nguy V, Aphinyanaphongs Y, Kiefer N, Smilowitz NR, Horowitz J, Ahuja T, Fishman GI, Hochman J, Katz S, Bernard S, Ranganath R. Development and external validation of a dynamic risk score for early prediction of cardiogenic shock in cardiac intensive care units using machine learning. Eur Heart J Acute Cardiovasc Care 2024:zuae037. [PMID: 38518758 DOI: 10.1093/ehjacc/zuae037] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Myocardial infarction and heart failure are major cardiovascular diseases that affect millions of people in the US with the morbidity and mortality being highest among patients who develop cardiogenic shock. Early recognition of cardiogenic shock allows prompt implementation of treatment measures. Our objective is to develop a new dynamic risk score, called CShock, to improve early detection of cardiogenic shock in cardiac intensive care unit (ICU). METHODS We developed and externally validated a deep learning-based risk stratification tool, called CShock, for patients admitted into the cardiac ICU with acute decompensated heart failure and/or myocardial infarction to predict onset of cardiogenic shock. We prepared a cardiac ICU dataset using MIMIC-III database by annotating with physician adjudicated outcomes. This dataset that consisted of 1500 patients with 204 having cardiogenic/mixed shock was then used to train CShock. The features used to train the model for CShock included patient demographics, cardiac ICU admission diagnoses, routinely measured laboratory values and vital signs, and relevant features manually extracted from echocardiogram and left heart catheterization reports. We externally validated the risk model on the New York University (NYU) Langone Health cardiac ICU database that was also annotated with physician adjudicated outcomes. The external validation cohort consisted of 131 patients with 25 patients experiencing cardiogenic/mixed shock. RESULTS CShock achieved an area under the receiver operator characteristic curve (AUROC) of 0.821 (95% CI 0.792-0.850). CShock was externally validated in the more contemporary NYU cohort and achieved an AUROC of 0.800 (95% CI 0.717-0.884), demonstrating its generalizability in other cardiac ICUs. Having an elevated heart rate is most predictive of cardiogenic shock development based on Shapley values. The other top ten predictors are having an admission diagnosis of myocardial infarction with ST-segment elevation, having an admission diagnosis of acute decompensated heart failure, Braden Scale, Glasgow Coma Scale, Blood urea nitrogen, Systolic blood pressure, Serum chloride, Serum sodium, and Arterial blood pH. CONCLUSIONS The novel CShock score has the potential to provide automated detection and early warning for cardiogenic shock and improve the outcomes for the millions of patients who suffer from myocardial infarction and heart failure.
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Affiliation(s)
- Yuxuan Hu
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | | | | | | | | | - Cindy Tsui
- Department of Medicine, NYU Langone Health
| | | | | | - Neil Jethani
- NYU Grossman School of Medicine
- Courant Institute of Mathematics, New York University
| | - Aahlad Puli
- Courant Institute of Mathematics, New York University
| | - Vuthy Nguy
- Department of Population Health, NYU Langone Health
| | | | | | | | - James Horowitz
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | | | | | - Judith Hochman
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Stuart Katz
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Samuel Bernard
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Rajesh Ranganath
- Courant Institute of Mathematics, New York University
- Department of Population Health, NYU Langone Health
- Center for Data Science, New York University
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Silber I, Mathimalar S, Mangel I, Nayak AK, Green O, Avraham N, Beidenkopf H, Feldman I, Kanigel A, Klein A, Goldstein M, Banerjee A, Sela E, Dagan Y. Two-component nematic superconductivity in 4Hb-TaS 2. Nat Commun 2024; 15:824. [PMID: 38280890 PMCID: PMC10821864 DOI: 10.1038/s41467-024-45169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
Most superconductors have an isotropic, single component order parameter and are well described by the standard (BCS) theory for superconductivity. Unconventional, multiple-component superconductors are exceptionally rare and are much less understood. Here, we combine scanning tunneling microscopy and angle-resolved macroscopic transport for studying the candidate chiral superconductor, 4Hb-TaS2. We reveal quasi-periodic one-dimensional modulations in the tunneling conductance accompanied by two-fold symmetric superconducting critical field. The strong modulation of the in-plane critical field, Hc2, points to a nematic, unconventional order parameter. However, the imaged vortex core is isotropic at low temperatures. We suggest a model that reconciles this apparent discrepancy and takes into account previously observed spontaneous time-reversal symmetry breaking at low temperatures. The model describes a competition between a dominating chiral superconducting order parameter and a nematic one. The latter emerges close to the normal phase. Our results strongly support the existence of two-component superconductivity in 4Hb-TaS2 and can provide valuable insights into other systems with coexistent charge order and superconductivity.
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Affiliation(s)
- I Silber
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - S Mathimalar
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Mangel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A K Nayak
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - O Green
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - N Avraham
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - H Beidenkopf
- Department of Condensed Matter Physics, Weizmann Institute of Science, Rehovot, Israel
| | - I Feldman
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Kanigel
- Physics Department, Technion-Israel Institute of Technology, Haifa, 32000, Israel
| | - A Klein
- Department of Physics, Faculty of Natural Sciences, Ariel University, Ariel, 40700, Israel
- Department of Chemical Physics, The Weizmann Institute of Science, Rehovot, 76100, Israel
| | - M Goldstein
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - A Banerjee
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | - E Sela
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel
| | - Y Dagan
- School of Physics and Astronomy, Tel - Aviv University, Tel Aviv, 69978, Israel.
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LeCompte MC, Chen H, Shaaban S, Goldstein M, Lubelski D, Kleinberg LR, Hooker T, Li H, Redmond KJ. RBE Model Based Proton Planning of Stereotactic Body Radiotherapy for Spine Metastasis: A Dosimetric Analysis. Int J Radiat Oncol Biol Phys 2023; 117:e124-e125. [PMID: 37784677 DOI: 10.1016/j.ijrobp.2023.06.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Study of proton stereotactic body radiotherapy (SBRT) for spine metastasis is limited, largely due to theorized increased risk of spinal cord injury with higher end of range RBE. Though the 1.1 RBE constant for proton beam is clinically used, data indicate that proton RBE is variable and dependent on technical-, tissue-, and patient-factors. To better understand safety of proton SBRT for spine metastasis, we performed a dosimetric analysis comparing plans delivered by photon robotic technique versus intensity modulated proton therapy (IMPT) and accounting for RBE weighted dose. MATERIALS/METHODS A total of 9 patients with spine metastasis (3 cervical, 3 thoracic, 3 lumbar) previously treated with a frameless robotic radiosurgery system (Sunnyvale, CA) were identified. Each level contained a case with paraspinal extension, a reirradiation case, and a case with epidural extension (Bilsky grade ≥1c) as such cases in current practice often require planning target volume (PTV) under-coverage in order to meet organ at risk (OAR) dose constraints. Given these challenges, selected cases were clinically treated with 30 Gy in 5 fractions despite an institutional preference of further dose escalation. Comparative IMPT plans were generated using 30 GyE in 5 fractions and 1.1 RBE constant. IMPT plans were then made using 1.1 RBE and 45 GyE in 5 fractions: a prescription dose associated with a 2-yr local control rate of 95% on prior tumor control probability modelling. A treatment planning system was used to separately generate and optimize RBE weighted plans based on Carabe-, McNamara-, or Wedenberg models for prescription doses of 30 GyE and 45 GyE. IMPT plans used robust optimization parameters of ± 3.5% range and 2-mm setup uncertainties. PTV coverage and OAR sparing were compared using Wilcoxon signed-rank tests. RESULTS PTV coverage (PTV volume receiving prescription dose) was significantly improved with IMPT at 30 GyE / 1.1 RBE (median PTV V30: 93%) compared to CK at 30 Gy (median: 88.5%, p = .02). PTV coverage was similar when comparing CK at 30 Gy with IMPT at 45 GyE / 1.1 RBE (median PTV V45: 90%, p = .23). When comparing maximum spinal cord dose (cord Dmax), there was improved OAR sparing with IMPT at 30 GyE / 1.1 RBE (median: 17.6 GyE, p = .04) and IMPT at 45 GyE / 1.1 RBE (median: 16.1 GyE, p = .04) when respectively compared to CK at 30 Gy (median: 18 Gy). No difference was seen in cord Dmax when comparing CK at 30 Gy to RBE weighted plans at 30 GyE using Carabe- (median: 17.3 GyE, p = .22), McNamara- (median: 17.4 GyE, p = .22), or Wedenberg (median: 17.0 GyE, p = .08) model. Median cord Dmax values for RBE weighted plans at 45 GyE were numerically equivalent. The average increase in variable RBE plans' maximum dose compared to fixed RBE plans was 105.3% +/- 3.5%. CONCLUSION We report the first dosimetric analysis of proton SBRT for spine metastasis using variable RBE dose models. IMPT may provide improved target coverage and better sparing of adjacent OARs compared to CK though fixed RBE computation may underestimate maximum dose to adjacent OARs.
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Affiliation(s)
- M C LeCompte
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Shaaban
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - M Goldstein
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - L R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - T Hooker
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - H Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - K J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Goldstein M, Gabriel N, Buchser W, Sentmanat M, Markovina S, Schwarz JK, Cui X. HPV Infection Causes Dependence on Alternative DNA Damage Response Pathways Providing Cancer Specific Targets for Radiosensitization. Int J Radiat Oncol Biol Phys 2023; 117:e231-e232. [PMID: 37784926 DOI: 10.1016/j.ijrobp.2023.06.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Cancer-specific radiosensitization is an attractive approach to improving the efficacy of radiotherapy. However, drugs targeting ubiquitous DNA damage response pathways are not cancer specific and can increase radiation related side effects. Thus, there is an unmet need for tumor specific molecular targets. This approach requires an identification of DNA damage signaling pathways that are unique to cancer cells. We hypothesized that by expressing its genome in the host cells HPV infection can rewire DNA damage signaling making HPV-positive tumor cells dependent on alternative pathways to survive radiation, which can be exploited for radiosensitization of HPV-induced cancers. MATERIALS/METHODS We have performed a CRISPR/Cas9 screen in HPV-positive SiHa cells that either express HPV16 proteins E6 and E7 or contain a selective knock-out of E6 or E7. We used next-generation sequencing to determine the abundance of gRNA in cells that were mock-treated or irradiated. We identified genes that were required for survival of radiation specifically in the context of E6 or E7 expression. Results of the screen were validated by generating knock-outs of the discovered genes using CRISPR/Cas9. By applying an array of molecular tools to analyze cell survival, cell cycle progression and mitotic progression we assessed the role of these genes in radiation response in HPV-positive cancer cells. RESULTS We have identified genes that are required for survival of radiation-induced DNA damage in the context of either E6 or E7 expression. We demonstrate that targeting these genes results in hypersensitization of cervical cancer cells to radiation specifically in the presence of E6 or E7. We show that the gene product required for survival in E6-expressing cells is critical for mitotic progression after radiation exposure serving as a member of a protein complex stabilizing the attachment of mitotic spindle to centromeres. CONCLUSION We have uncovered specific genes that are critical for DNA damage response and cell survival after radiation exposure in HPV-positive cells. Our findings suggest that expression of the HPV proteins E6 and E7 rewires DNA damage signaling causing dependence on alternative response pathways. We propose that these pathways can be targeted for a tumor-specific radiosensitization of HPV-induced cancers.
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Affiliation(s)
- M Goldstein
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - N Gabriel
- Washington University, Department of Radiation Oncology, St. Louis, MO
| | - W Buchser
- Washington University in St. Louis, St. Louis, MO
| | - M Sentmanat
- Washington University in St. Louis, St. Louis, MO
| | - S Markovina
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - J K Schwarz
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - X Cui
- Washington University in St. Louis, St. Louis, MO
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Isaacson SH, Goldstein M, Pahwa R, Singer C, Klos K, Pucci M, Zhang Y, Crandall D, Koblan KS, Navia B. Ulotaront, a Trace Amine-Associated Receptor 1/Serotonin 5-HT 1A Agonist, in Patients With Parkinson Disease Psychosis: A Pilot Study. Neurol Clin Pract 2023; 13:e200175. [PMID: 37273942 PMCID: PMC10238151 DOI: 10.1212/cpj.0000000000200175] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
Background and Objectives Ulotaront (SEP-363856) is a trace amine-associated receptor 1 agonist with 5-HT1A receptor agonist activity currently in phase 3 clinical development for the treatment of schizophrenia. In this exploratory, flexibly dosed study, ulotaront was evaluated for the treatment of Parkinson disease psychosis (PDP). Methods Patients with PDP requiring antipsychotic therapy were randomized, double-blind to ulotaront (25, 50, or 75 mg/d) or placebo. Mixed Model for Repeated Measures was used to assess change from baseline in the Scale for the Assessment of Positive Symptoms for Parkinson Disease (SAPS-PD) at 6 weeks (primary end point). Results The efficacy analysis sample comprised 38 patients (ulotaront, n = 24; placebo, n = 14). SAPS-PD total scores were numerically reduced in ulotaront-treated vs placebo-treated patients from week 1 to week 6: Least squares mean (95% confidence interval) difference in change from baseline at week 6 was -1.1 (-6.5, 4.3, p = 0.681). PDP symptom complete remission (≥100% improvement [reduction] from baseline in SAPS-PD total score) was observed in 25% of ulotaront-treated vs 0% of placebo-treated patients. SAPS-PD and Neuropsychiatric Inventory hallucinations subscales were numerically reduced vs placebo, and SAPS-PD total scores were reduced in patients with greater cognitive impairment (baseline Mini-Mental State Examination [MMSE] scores ≤24). Ulotaront improved Scales for Outcomes in Parkinson Disease Sleep Scale - Daytime Sleepiness scores (p = 0.022). There was no worsening of Unified Parkinson Disease Rating Scale Part III motor score, MMSE, or vital signs. Adverse events (≥10%) with ulotaront vs placebo included hallucinations (24% vs 14%), confusional state (20% vs 14%), dizziness (16% vs 7%), nausea (12% vs 7%), and falls (12% vs 21%). Discussion In this exploratory pilot study, ulotaront may decrease PDP symptoms without worsening motor function, particularly in patients with cognitive impairment. Trial Registration Information ClinicalTrials.gov identifier: NCT02969369; submitted: November 17, 2016; study start date: December 31, 2016. Classification of Evidence This Class II study was an exploratory pilot study that was underpowered to detect a statistically significant difference between ulotaront and placebo in the treatment of patients with Parkinson disease psychosis without worsening motor function.
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Affiliation(s)
- Stuart H Isaacson
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Mark Goldstein
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Rajesh Pahwa
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Carlos Singer
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Kevin Klos
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Michael Pucci
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Yi Zhang
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - David Crandall
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Kenneth S Koblan
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
| | - Bradford Navia
- Parkinson's Disease and Movement Disorders Center of Boca Raton (SHI), FL; JEM Research Institute (MG), Lake Worth, FL; University of Kansas (RP), Kansas City; University of Miami Health System (CS), FL; The Movement Disorder Clinic of Oklahoma (KK), Tulsa; The Lockwood Group (MP), Stamford, CT; and Sunovion Pharmaceuticals Inc. (YZ, DC, KSK, BN), Marlborough, MA
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Camilleri M, Subramanian T, Pagan F, Isaacson S, Gil R, Hauser RA, Feldman M, Goldstein M, Kumar R, Truong D, Chhabria N, Walter BL, Eskenazi J, Riesenberg R, Burdick D, Tse W, Molho E, Robottom B, Bhatia P, Kadimi S, Klos K, Shprecher D, Marquez-Mendoza O, Hidalgo G, Grill S, Li G, Mandell H, Hughes M, Stephenson S, Vandersluis J, Pfeffer M, Duker A, Shivkumar V, Kinney W, MacDougall J, Zasloff M, Barbut D. Oral ENT-01 Targets Enteric Neurons to Treat Constipation in Parkinson Disease : A Randomized Controlled Trial. Ann Intern Med 2022; 175:1666-1674. [PMID: 36343348 DOI: 10.7326/m22-1438] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/09/2022] Open
Abstract
BACKGROUND Parkinson disease (PD) is associated with α-synuclein (αS) aggregation within enteric neurons. ENT-01 inhibits the formation of αS aggregates and improved constipation in an open-label study in patients with PD. OBJECTIVE To evaluate the safety and efficacy of oral ENT-01 for constipation and neurologic symptoms in patients with PD and constipation. DESIGN Randomized, placebo-controlled phase 2b study. (ClinicalTrials.gov: NCT03781791). SETTING Outpatient. PATIENTS 150 patients with PD and constipation. INTERVENTION ENT-01 or placebo daily for up to 25 days. After baseline assessment of constipation severity, daily dosing was escalated to the prokinetic dose, the maximum dose (250 mg), or the tolerability limit, followed by a washout period. MEASUREMENTS The primary efficacy end point was the number of complete spontaneous bowel movements (CSBMs) per week. Neurologic end points included dementia (assessed using the Mini-Mental State Examination [MMSE]) and psychosis (assessed using the Scale for the Assessment of Positive Symptoms adapted for PD [SAPS-PD]). RESULTS The weekly CSBM rate increased from 0.7 to 3.2 in the ENT-01 group versus 0.7 to 1.2 in the placebo group (P < 0.001). Improvement in secondary end points included SBMs (P = 0.002), stool consistency (P < 0.001), ease of passage (P = 0.006), and laxative use (P = 0.041). In patients with dementia, MMSE scores improved by 3.4 points 6 weeks after treatment in the ENT-01 group (n = 14) versus 2.0 points in the placebo group (n = 14). Among patients with psychosis, SAPS-PD scores improved from 6.5 to 1.7 six weeks after treatment in the ENT-01 group (n = 5) and from 6.3 to 4.4 in the placebo group (n = 6). ENT-01 was well tolerated, with no deaths or drug-related serious adverse events. Adverse events were predominantly gastrointestinal, including nausea (34.4% [ENT-01] vs. 5.3% [placebo]; P < 0.001) and diarrhea (19.4% [ENT-01] vs. 5.3% [placebo]; P = 0.016). LIMITATION Longer treatment periods need to be investigated in future studies. CONCLUSION ENT-01 was safe and significantly improved constipation. PRIMARY FUNDING SOURCE Enterin, Inc.
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Affiliation(s)
| | | | - Fernando Pagan
- Department of Neurology, Georgetown University Hospital, Washington, DC (F.P.)
| | - Stuart Isaacson
- Parkinson's Disease and Movement Disorder Center of Boca Raton, Boca Raton, Florida (S.I.)
| | - Ramon Gil
- Parkinson's Disease Treatment Center of SW Florida, Port Charlotte, Florida (R.G.)
| | - Robert A Hauser
- USF Parkinson's Disease and Movement Disorder Center, Tampa, Florida (R.A.H.)
| | - Mary Feldman
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (M.F.)
| | - Mark Goldstein
- JEM Headlands Research Institute, Atlantis, Florida (M.G.)
| | - Rajeev Kumar
- Rocky Mountain Movement Disorder Center, Englewood, Colorado (R.K.)
| | - Daniel Truong
- The Parkinson's and Movement Disorder Institute, Fountain Valley, California (D.T.)
| | - Nisha Chhabria
- Palm Beach Neurology and Premiere Research Institute, West Palm Beach, Florida (N.C.)
| | - Benjamin L Walter
- Parkinson's and Movement Disorders Center, Cleveland Clinic, Cleveland, Ohio (B.L.W.)
| | | | | | - Daniel Burdick
- Booth Gardner Parkinson's Care Center, EvergreenHealth, Kirkland, Washington (D.B.)
| | - Winona Tse
- Parkinson's and Movement Disorders Center, Icahn School of Medicine at Mount Sinai, New York, New York (W.T.)
| | - Eric Molho
- Parkinson's Disease and Movement Center, Albany Medical College, Albany, New York (E.M.)
| | | | | | - Srinath Kadimi
- Associated Neurologists of Southern Connecticut, Fairfield, Connecticut (S.K.)
| | - Kevin Klos
- The Movement Disorder Clinic of Oklahoma, Tulsa, Oklahoma (K.K.)
| | - David Shprecher
- Banner Sun Health Research Institute, Sun City, Arizona (D.S.)
| | | | - Gonzalo Hidalgo
- The Neuromedical Clinic of Central Louisiana, Alexandria, Louisiana (G.H.)
| | - Stephen Grill
- Parkinson's and Movement Disorders Center of Maryland, Elkridge, Maryland (S.G.)
| | - George Li
- MEDSOL Clinical Research, Port Charlotte, Florida (G.L.)
| | - Howard Mandell
- Metrolina Neurological Associates, Indian Land, South Carolina (H.M.)
| | - Mary Hughes
- Premier Neurology, Greer, South Carolina (M.H.)
| | | | - Joel Vandersluis
- Elias Research, Neurology Diagnostics, Inc., Dayton, Ohio (J.V.)
| | - Michael Pfeffer
- Allied Biomedical Neurologic Research Institute, Miami, Florida (M.P.)
| | - Andrew Duker
- University of Cincinnati, Cincinnati, Ohio (A.D.)
| | - Vikram Shivkumar
- University Physicians and Surgeons, Inc., Marshall Health, Huntington, West Virginia (V.S.)
| | | | - James MacDougall
- MacDougall Statistical Institute, Haverhill, Massachusetts (J.M.)
| | - Michael Zasloff
- Medstar-Georgetown Transplant Institute, Washington, DC, and Enterin Research Institute and Enterin, Inc., Philadelphia, Pennsylvania (M.Z.)
| | - Denise Barbut
- Enterin Research Institute and Enterin, Inc., Philadelphia, Pennsylvania (D.B.)
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Han X, Goldstein M, Ranganath R. Survival Mixture Density Networks. Proc Mach Learn Res 2022; 182:224-248. [PMID: 37706207 PMCID: PMC10498417] [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] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Survival analysis, the art of time-to-event modeling, plays an important role in clinical treatment decisions. Recently, continuous time models built from neural ODEs have been proposed for survival analysis. However, the training of neural ODEs is slow due to the high computational complexity of neural ODE solvers. Here, we propose an efficient alternative for flexible continuous time models, called Survival Mixture Density Networks (Survival MDNs). Survival MDN applies an invertible positive function to the output of Mixture Density Networks (MDNs). While MDNs produce flexible real-valued distributions, the invertible positive function maps the model into the time-domain while preserving a tractable density. Using four datasets, we show that Survival MDN performs better than, or similarly to continuous and discrete time baselines on concordance, integrated Brier score and integrated binomial log-likelihood. Meanwhile, Survival MDNs are also faster than ODE-based models and circumvent binning issues in discrete models.
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10
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Goldstein M. Improving emergency care for patients with behavioral health disorders. Nursing 2022; 52:51-54. [PMID: 35609079 DOI: 10.1097/01.nurse.0000833180.26442.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mark Goldstein
- Mark Goldstein is a clinical nurse at Denver Health Emergency Department
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11
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Goldstein M, Puli A, Ranganath R, Jacobsen JH, Chau O, Saporta A, Miller AC. Learning Invariant Representations with Missing Data. Proc Mach Learn Res 2022; 177:290-301. [PMID: 37646010 PMCID: PMC10465015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Spurious correlations allow flexible models to predict well during training but poorly on related test populations. Recent work has shown that models that satisfy particular independencies involving correlation-inducing nuisance variables have guarantees on their test performance. Enforcing such independencies requires nuisances to be observed during training. However, nuisances, such as demographics or image background labels, are often missing. Enforcing independence on just the observed data does not imply independence on the entire population. Here we derive MMD estimators used for invariance objectives under missing nuisances. On simulations and clinical data, optimizing through these estimates achieves test performance similar to using estimators that make use of the full data.
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12
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Han X, Goldstein M, Puli A, Wies T, Perotte AJ, Ranganath R. Inverse-Weighted Survival Games. Adv Neural Inf Process Syst 2021; 34:2160-2172. [PMID: 35859987 PMCID: PMC9295257] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Deep models trained through maximum likelihood have achieved state-of-the-art results for survival analysis. Despite this training scheme, practitioners evaluate models under other criteria, such as binary classification losses at a chosen set of time horizons, e.g. Brier score (BS) and Bernoulli log likelihood (BLL). Models trained with maximum likelihood may have poor BS or BLL since maximum likelihood does not directly optimize these criteria. Directly optimizing criteria like BS requires inverse-weighting by the censoring distribution. However, estimating the censoring model under these metrics requires inverse-weighting by the failure distribution. The objective for each model requires the other, but neither are known. To resolve this dilemma, we introduce Inverse-Weighted Survival Games. In these games, objectives for each model are built from re-weighted estimates featuring the other model, where the latter is held fixed during training. When the loss is proper, we show that the games always have the true failure and censoring distributions as a stationary point. This means models in the game do not leave the correct distributions once reached. We construct one case where this stationary point is unique. We show that these games optimize BS on simulations and then apply these principles on real world cancer and critically-ill patient data.
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J Silla KE, S Brigham K, Goldstein M, Misra M, Singhal V. Clinical, biochemical, and hematological characteristics of community-dwelling adolescent and young adult males with anorexia nervosa. Int J Eat Disord 2021; 54:2213-2217. [PMID: 34617624 DOI: 10.1002/eat.23622] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/11/2021] [Accepted: 09/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Data regarding clinical characteristics in males with AN are limited. We aimed to delineate clinical, biochemical, and hematological features in community-dwelling adolescent and young adult males with AN. METHOD A retrospective chart review of electronic medical records from 2000 to 2016 was conducted for 53 males aged 10-23 years old; AN (n = 36) and healthy controls (n = 17) were similar for Tanner stage. RESULTS Adolescent and young adult males with AN were diagnosed at a mean age of 15.9 ± 3.0 years. The most prevalent strategy for weight loss (following calorie restriction) was over-exercising. Labs demonstrated polycythemia, leukopenia, and thrombocytopenia, but no electrolyte abnormalities. Compared with healthy controls of similar Tanner stage, males with AN had lower total testosterone levels. A significant proportion of males with AN had traumatic bone fractures. DISCUSSION Over-exercising is a common secondary weight loss strategy in males with AN. Testosterone levels are lower than in controls, but electrolyte abnormalities are rare. With enhanced provider awareness, diagnostic delays may be prevented.
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Affiliation(s)
| | - Kathryn S Brigham
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Goldstein
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Goldstein M, Saxena S. M285 EXERCISE-INDUCED LARYNGOPHARYNGEAL REFLUX (EILPR). Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.393] [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: 11/16/2022]
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15
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Page SJ, Kasner SE, Bockbrader M, Goldstein M, Finklestein SP, Ning M, El-Feky WH, Wilson CA, Roberts H. A double-blind, randomized, controlled study of two dose strengths of dalfampridine extended release on walking deficits in ischemic stroke. Restor Neurol Neurosci 2021; 38:301-309. [PMID: 32651338 PMCID: PMC7592666 DOI: 10.3233/rnn-201009] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stroke-induced ischemia affects both cortex and underlying white matter. Dalfampridine extended release tablets (D-ER) enhance action potential conduction in demyelinated axons, which may positively affect post-stroke recovery. OBJECTIVE Based on promising preliminary data, we compared efficacy of D-ER administered at 7.5 mg or 10 mg with placebo on post-stroke ambulation. Primary study outcome (response) was a ≥20% increase on the 2-minute walk test (2 MinWT) at 12 weeks after first drug administration. METHODS This was a multicenter, randomized, placebo-controlled, 3-arm, parallel-group, safety and efficacy trial. After obtaining baseline measures of 2 MinWT, Walk-12, and Timed Up and Go, subjects entered a 2-week, single-blind placebo run-in period and were randomized 1:1:1 to receive 7.5 mg D-ER, 10 mg D-ER, or placebo, dosed twice-daily for 12 weeks. Follow-up evaluations occurred at weeks 14 and 16 when subjects were off study drug. RESULTS The study was terminated early with 377 of planned 540 patients enrolled, due to no treatment effect. At week 12, mean increase in distances walked in 2 minutes were similar among the 3 study groups (14.9±40.0 feet; 19.4±39.6 feet; and 20.4±38.3 feet for placebo, 7.5 mg D-ER, and 10 mg D-ER, respectively). The proportion of subjects who showed ≥20% improvement on 2 MinWT at week 12 was 13.5%, 14.0%, and 19.0%, for placebo, 7.5 mg D-ER, and 10 mg D-ER, respectively; these were nonsignificant changes from baseline for all groups. CONCLUSIONS D-ER at either a 7.5-mg or 10-mg dose did not significantly increase performance on the 2 MinWT in stroke survivors with gait impairment, although this study was terminated early before full enrollment. (Clinical Trial # NCT02271217).
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Affiliation(s)
| | | | | | | | | | - MingMing Ning
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Holly Roberts
- Acorda Therapeutics, Inc., Ardsley, NY, USA,Correspondence to: Holly Roberts, MD, Acorda Therapeutics, Inc., 420 Saw Mill River Road, Ardsley, NY 10502, USA.
Tel.: (914) 326 5224; E-mail:
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16
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Zhang LH, Goldstein M, Ranganath R. Understanding Failures in Out-of-Distribution Detection with Deep Generative Models. Proc Mach Learn Res 2021; 139:12427-12436. [PMID: 35860036 PMCID: PMC9295254] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Deep generative models (dgms) seem a natural fit for detecting out-of-distribution (ood) inputs, but such models have been shown to assign higher probabilities or densities to ood images than images from the training distribution. In this work, we explain why this behavior should be attributed to model misestimation. We first prove that no method can guarantee performance beyond random chance without assumptions on which out-distributions are relevant. We then interrogate the typical set hypothesis, the claim that relevant out-distributions can lie in high likelihood regions of the data distribution, and that ood detection should be defined based on the data distribution's typical set. We highlight the consequences implied by assuming support overlap between in- and out-distributions, as well as the arbitrariness of the typical set for ood detection. Our results suggest that estimation error is a more plausible explanation than the misalignment between likelihood-based ood detection and out-distributions of interest, and we illustrate how even minimal estimation error can lead to ood detection failures, yielding implications for future work in deep generative modeling and ood detection.
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Nang Q, Basourakos S, Punjani N, Al Hussein O, Barone M, Goldstein M, Li P, Lee R. Listening to the parents as key to early infant male circumcision efforts in fight against HIV: Perspectives of a contemporary cohort of legal adult representatives of infants enrolled in the ShangRing vs. mogen clamp trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01455-x] [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: 11/16/2022]
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Kuzmin R, Grabon N, Mehta N, Burshtein A, Goldstein M, Houzet M, Glazman LI, Manucharyan VE. Inelastic Scattering of a Photon by a Quantum Phase Slip. Phys Rev Lett 2021; 126:197701. [PMID: 34047614 DOI: 10.1103/physrevlett.126.197701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Spontaneous decay of a single photon is a notoriously inefficient process in nature irrespective of the frequency range. We report that a quantum phase-slip fluctuation in high-impedance superconducting waveguides can split a single incident microwave photon into a large number of lower-energy photons with a near unit probability. The underlying inelastic photon-photon interaction has no analogs in nonlinear optics. Instead, the measured decay rates are explained without adjustable parameters in the framework of a new model of a quantum impurity in a Luttinger liquid. Our result connects circuit quantum electrodynamics to critical phenomena in two-dimensional boundary quantum field theories, important in the physics of strongly correlated systems. The photon lifetime data represent a rare example of verified and useful quantum many-body simulation.
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Affiliation(s)
- R Kuzmin
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - N Grabon
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - N Mehta
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
| | - A Burshtein
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - M Goldstein
- Raymond and Beverly Sackler School of Physics and Astronomy, Tel Aviv University, Tel Aviv 6997801, Israel
| | - M Houzet
- Univ. Grenoble Alpes, CEA, Grenoble INP, IRIG, PHELIQS, 38000 Grenoble, France
| | - L I Glazman
- Departments of Physics and Applied Physics, Yale University, New Haven, Connecticut 06520, USA
| | - V E Manucharyan
- Department of Physics, Joint Quantum Institute, and Quantum Materials Center, University of Maryland, College Park, Maryland 20742, USA
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Chan AJ, O'Donnell D, Kaasa B, Mathers A, Papaioannou A, Brazil K, Paraschiv N, Goldstein M, Sadowski CA, Dolovich L. Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility. Can Pharm J (Ott) 2021; 154:100-109. [PMID: 33868521 DOI: 10.1177/1715163521989756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fifty percent of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm. Most studies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused antimicrobial stewardship (AS) intervention at a LTCF, with the secondary objective of exploring the pharmacist's potential roles. Methods The study used a qualitative descriptive design. Participants attended either a focus group or one-on-one interview. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barrier and facilitator themes were mapped using the capability, opportunity, motivation and behaviour (COM-B) model. Similarly, themes were identified from the transcripts regarding the pharmacist's roles. Results Sixteen participants were interviewed. Most barriers and facilitators mapped to the opportunities domain of the COM-B model. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors, while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist's role, the barrier themes were ineffective collaboration and communication. Conclusion This study supports the importance of tailoring interventions to target factors underlying barriers to behaviour change. At this LTCF, an effective antimicrobial stewardship intervention should incorporate strategies to improve access, knowledge, communication and collaboration in its design, having sufficient resources and addressing external factors to optimize its success and long-term sustainability. Can Pharm J (Ott) 2021;154:xx-xx.
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Goldstein M, Han X, Puli A, Perotte AJ, Ranganath R. X-CAL: Explicit Calibration for Survival Analysis. Adv Neural Inf Process Syst 2020; 33:18296-18307. [PMID: 34017160 PMCID: PMC8132615] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Survival analysis models the distribution of time until an event of interest, such as discharge from the hospital or admission to the ICU. When a model's predicted number of events within any time interval is similar to the observed number, it is called well-calibrated. A survival model's calibration can be measured using, for instance, distributional calibration (D-CALIBRATION) [Haider et al., 2020] which computes the squared difference between the observed and predicted number of events within different time intervals. Classically, calibration is addressed in post-training analysis. We develop explicit calibration (X-CAL), which turns D-CALIBRATION into a differentiable objective that can be used in survival modeling alongside maximum likelihood estimation and other objectives. X-CAL allows practitioners to directly optimize calibration and strike a desired balance between predictive power and calibration. In our experiments, we fit a variety of shallow and deep models on simulated data, a survival dataset based on MNIST, on length-of-stay prediction using MIMIC-III data, and on brain cancer data from The Cancer Genome Atlas. We show that the models we study can be miscalibrated. We give experimental evidence on these datasets that X-CAL improves D-CALIBRATION without a large decrease in concordance or likelihood.
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Goldstein M, Mindel R. M150 KOUNIS SYNDROME (KS) AND MAST CELL ACTIVATION TREATED WITH OMALIZUMAB. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.222] [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: 11/28/2022]
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22
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Goldstein M, Gabriel N, Wang X, Wong N, Dahiya S. SETD2 Histone Methyltransferase Mutation Status Predicts Treatment Response In Glioblastoma: Strategies To Overcome Chemoresistance. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1712] [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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Wilf-Yarkoni A, Elkayam O, Aizenstein O, Oron Y, Furer V, Zur D, Goldstein M, Barequet D, Hallevi H, Karni A, Habot-Wilner Z, Regev K. Increased incidence of Susac syndrome: a case series study. BMC Neurol 2020; 20:332. [PMID: 32878610 PMCID: PMC7465403 DOI: 10.1186/s12883-020-01892-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 05/25/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Susac syndrome (SuS) is a rare condition characterized by a clinical triad of sensorineural hearing loss, branch artery occlusion and encephalopathy. This study reports an increased incidence of SuS in Israel. We describe the clinical characteristics of these patients, diagnostic procedures and the use and subsequent outcomes of newly published treatment guidelines. METHODS This is a single center retrospective study. Patients who were diagnosed with SuS between July 2017 and August 2018 were enrolled in this study. RESULTS Seven patients were diagnosed with SuS according to the diagnostic criteria in a time period of 13 months. The annual incidence was recently evaluated in Austria to be 0.024/100000, therefore, our case series represent at least a 5.4- fold increase in the annual incidence of SuS expected in Israel and a 7-fold increase in the annual incidence expected in our medical center. Mean time from the onset of the symptoms to diagnosis was three weeks and follow-up time was twenty four months. Recent exposure to cytomegalovirus was serologically evident in three patients and one patient had high titer of anti-streptolysin antibody. All patients underwent brain MRI, fluorescein angiography and audiometry. All patients were treated according to the newly recommended guidelines. All patients achieved clinical and radiological stability. CONCLUSIONS We report of an increased incidence of SuS in Israel. Infectious serological findings may imply a post infectious mechanism. The use of the recommended diagnostic procedures reduced the time to diagnosis. Newly published treatment guidelines led to favorable clinical outcomes.
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Affiliation(s)
- A Wilf-Yarkoni
- Neuro-Immunology Service and Department of Neurology Rabin Medical Center, 4941492, Petach Tikva, Israel.
| | - O Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Aizenstein
- Neuroradiology unit, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Oron
- Department of ENT, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - V Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Zur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - M Goldstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Barequet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H Hallevi
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Karni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience Tel Aviv University, Tel Aviv, Israel
| | - Z Habot-Wilner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Al Hussein Alawamlh O, Punjani N, Barone M, Awori Q, Goldstein M, Li P, Lee R. Acceptability of no-flip ShangRing male circumcision in a WHO mandated population for HIV prevention. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33470-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Al Hussein Alawamlh O, Punjani N, Chen H, Barone M, Awori Q, Goldstein M, Lee R, Li P. Feasibility of no-flip ShangRing male circumcision in adolescent boys with phimosis. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33999-9] [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] Open
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Daveson AJM, Popp A, Taavela J, Goldstein KE, Isola J, Truitt KE, Mäki M, Anderson RP, Adams A, Andrews J, Behrend C, Brown G, Chen Yi Mei S, Coates A, Daveson A, DiMarino A, Elliott D, Epstein R, Feyen B, Fogel R, Friedenberg K, Gearry R, Gerdis M, Goldstein M, Gupta V, Holmes R, Holtmann G, Idarraga S, James G, King T, Klein T, Kupfer S, Lebwohl B, Lowe J, Murray J, Newton E, Quinn D, Radin D, Ritter T, Stacey H, Strout C, Stubbs R, Thackwray S, Trivedi V, Tye‐Din J, Weber J, Wilson S. Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ygh2.380] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Alina Popp
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- University of Medicine and Pharmacy "Carol Davila" and National Institute for Mother and Child Health "Alessandrescu‐Rusescu" Bucharest Romania
| | - Juha Taavela
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
- Department of Internal Medicine Central Finland Central Hospital Jyväskylä Finland
| | | | - Jorma Isola
- Laboratory of Cancer Biology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Jilab Inc. Tampere Finland
| | | | - Markku Mäki
- Tampere Centre for Child Health Research Faculty of Medicine and Health Technology Tampere University and Tampere University Hospital Tampere Finland
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Goh HL, Hawkins L, Kamarajah SK, Karandikar S, Goldstein M. Is water-soluble contrast enema examination for integrity of rectal anastomosis necessary prior to ileostomy reversal? JGH Open 2019; 4:417-421. [PMID: 32514447 PMCID: PMC7273697 DOI: 10.1002/jgh3.12267] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/15/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
Abstract
Background and Aim Routine use of water-soluble contrast enema (WSCE) to assess anastomotic integrity is debated. This study aimed to evaluate the role of WSCE to assess anastomotic integrity following anterior resections (AR) with defunctioning stoma prior to reversal and identify factors to limit its selective use. Methods This retrospective study evaluated all WSCE performed over a 7-year period at a high-volume colorectal unit. Risk factors for radiological abnormality/leak, including malignancy, chemoradiotherapy, and immediate postoperative complications, were recorded. A gastrointestinal specialist radiologist and surgeon validated all WSCEs reported as abnormal. Results Of the 486 WSCE studies identified, 92 were excluded (repeat studies (n = 51), pediatric cases [n = 2], no AR [n = 39]). A total of 394 WSCE studies were evaluated (260 cancer; 134 noncancer patients); 14% (37/260) of cancer patients and 8% (10/134) of noncancer patients had abnormal studies (P = 0.072). Of the 37 abnormal studies in cancer patients, 73% (27/37) radiological leaks were found, and 41% (n = 11/27) of these patients had postoperative complications. Of the 10 abnormal studies in noncancer patients, 20% (2/10) radiological leaks were found, but none of these patients had postoperative complications. Overall leak rates were 7% (29/394), and rates were significantly higher in cancer patients than noncancer patients (10 vs 2%, P = 0.005). Conclusion Routine use of WSCE may not be necessary prior to reversal. WSCE should be selectively used in event of postoperative leak or complications. Noncancer resections are less likely demonstrate a leak.
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Affiliation(s)
- Hui Lu Goh
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Lauren Hawkins
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Sivesh K Kamarajah
- Department of HPB and Transplant Surgery The Freeman Hospital Newcastle upon Tyne UK.,Institute of Cellular Medicine University of Newcastle Newcastle upon Tyne UK
| | - Sharad Karandikar
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
| | - Mark Goldstein
- Heartlands Hospital University Hospitals Birmingham Foundation NHS Trust Birmingham UK
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Goldstein M, Vadaketh K. M151 IGG4-RELATED DISEASE PRESENTING AS PERIORBITAL SWELLING. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.151] [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: 10/25/2022]
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Mascitelli L, Goldstein M. Should we continue to consider serum cholesterol as an exogenous poisoning? Br J Sports Med 2019. [DOI: 10.1136/bjsports-2018-099134] [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: 11/03/2022]
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Singhal V, Reyes KC, Pfister B, Ackerman K, Slattery M, Cooper K, Toth A, Gupta N, Goldstein M, Eddy K, Misra M. Bone accrual in oligo-amenorrheic athletes, eumenorrheic athletes and non-athletes. Bone 2019; 120:305-313. [PMID: 29758361 PMCID: PMC6636860 DOI: 10.1016/j.bone.2018.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/11/2017] [Revised: 04/26/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanical loading improves bone mineral density (BMD) and strength while decreasing fracture risk. Cross-sectional studies show that exercise advantage is lost in oligo-amenorrheic athletes (OA). Longitudinal studies examining the opposing effects of exercise and hypogonadism on bone are lacking in adolescents/young adults. OBJECTIVE Evaluate differences in bone accrual over 12 months in OA, eumenorrheic athletes (EA) and non-athletes (NA). We hypothesized that bone accrual would be lower in OA than EA and NA, with differences most pronounced at non-weight bearing trabecular sites. METHODS 27 OA, 29 EA, and 22 NA, 14-25 years old, completed 12-months of the prospective study. Athletes were weight-bearing endurance athletes. Subjects were assessed for areal BMD and bone mineral content (BMC) using DXA at the femoral neck, total hip, lumbar spine and whole body (WB). Failure load (a strength estimate) at the distal radius and tibia was assessed using microfinite element analysis of data obtained via high resolution peripheral quantitative computed tomography (HRpQCT). The primary analysis was a comparison of changes in areal BMD, BMC, and failure load across groups over 12-months at the respective sites. RESULTS Groups did not differ for baseline age, height or BMI. Percent body fat was lower in both OA and EA compared to NA. OA attained menarche later than EA and NA. Over the follow-up period, OA gained 1.9 ± 2.7 kg of weight compared to 0.5 ± 2.4 kg and 0.8 ± 2.3 kg in EA and NA respectively (p = 0.09); 39% of OA resumed menses. Changes in BMD, BMD Z-scores, and tibial failure load over 12-months did not differ among groups. At follow up, EA had higher femoral neck, hip and WB BMD Z-scores than NA, and higher hip BMD Z-scores than OA (p < 0.05) after adjusting for covariates. At follow-up, radial failure load was lower in OA vs. NA, and tibial failure load lower in OA and NA vs. EA (p ≤ 0.04 for all). Change in weight and fat mass were associated with changes in BMD measures at multiple sites. CONCLUSION Despite weight gain and menses recovery in many OA during follow-up, residual deficits persist without catch-up raising concerns for suboptimal peak bone mass acquisition.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States; Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States.
| | - Karen Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
| | - Brooke Pfister
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
| | - Kathryn Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States; Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, United States
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
| | - Katherine Cooper
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
| | - Alexander Toth
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
| | - Nupur Gupta
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital, Harvard Medical School, United States
| | - Mark Goldstein
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital, Harvard Medical School, United States
| | - Kamryn Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, United States
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States; Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States
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Plumb AA, Eason D, Goldstein M, Lowe A, Morrin M, Rudralingam V, Tolan D, Thrower A. Computed tomographic colonography for diagnosis of early cancer and polyps? Colorectal Dis 2019; 21 Suppl 1:23-28. [PMID: 30809907 DOI: 10.1111/codi.14490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/08/2018] [Indexed: 02/08/2023]
Affiliation(s)
- A A Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - D Eason
- Department of Radiology, Raigmore Hospital, Inverness, UK
| | - M Goldstein
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - A Lowe
- Department of Radiology, Musgrove Park Hospital, Taunton, UK
| | - M Morrin
- Department of Radiology, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - V Rudralingam
- Department of Radiology, Wythenshawe Hospital, Manchester Foundation Trust, Manchester, UK
| | - D Tolan
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Thrower
- Department of Radiology, Basingstoke Hospital, Basingstoke, UK
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Wang R, Singh J, Sterlin V, Goldstein M, Lake D, Wong S, Baselga J, Norton L, Dang C. Abstract P6-18-30: Phase Ib/II study of capecitabine 7/7 schedule with neratinib in patients with HER2-positive metastatic breast cancer (MBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neratinib (N) is a potent irreversible inhibitor of HER1, HER2, and HER4 and has been shown to have antitumor activity in patients (pts) with human epidermal growth factor receptor 2 (HER2) - positive breast cancer. A previous study of combination of neratinib with capecitabine (X) was associated with > G 3 diarrhea in > 20% of patients. Currently, the NALA study is evaluating this combination of N with X at standard schedule against control. X at 7 day on and 7 day off schedule (7/7) has been shown to be well-tolerated with less ≥G3 toxicities. We are conducting a phase Ib/II study of N with X (7/7) in pts with pretreated HER2+ MBC (NCT03377387). Methods: Eligible pts had HER2+ MBC, normal left ventricular ejection fraction (LVEF ≥ 50%); pts can have any and up to 4 prior chemotherapy-based treatments in phase Ib and II portions, respectively. Primary endpoints are to define maximum tolerated dose and efficacy in phase I and phase II portions, respectively. Secondary endpoints include safety and tolerability; exploratory endpoint is to quantify cell-free DNA to correlate with response for phase II portion. There were 4 cohorts for phase Ib with dose level 1 with starting dose of X at 1500 mg BID at 7/7 schedule with N at 240 mg daily. Results: As of July 1, 2018 8 pts have been enrolled in 2 cohorts. The median age is 63y (range: 57-79), and median ECOG is 0 (range: 0-1). 4 patients were treated at dose level 1 and 2 of 4 patients experienced dose-limiting toxicity with G3 diarrhea during cycle 1. Other significant toxicities included G3 hand foot syndrome (n=1), G3 fatigue (n=1) and G3 nausea (n=1). Three pts have now been treated at dose level -1 (X at 1000 mg twice daily 7/7 and N at 240 mg daily) and no ≥ G3 toxicities has been noted. Once MTD is reached, the phase II portion will occur to assess the efficacy and to further establish the safety and tolerability of capecitabine and neratinib at the MTD. Conclusions: The phase Ib/II study combining neratinib and capecitabine 7/7 is ongoing and updated result will be presented.
Citation Format: Wang R, Singh J, Sterlin V, Goldstein M, Lake D, Wong S, Baselga J, Norton L, Dang C. Phase Ib/II study of capecitabine 7/7 schedule with neratinib in patients with HER2-positive metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-30.
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Affiliation(s)
- R Wang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Singh
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - V Sterlin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - M Goldstein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - D Lake
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - S Wong
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - L Norton
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
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Goldstein M, Freeman C, Belecanech N, Belecanech L, Dvorin D. LATE SUMMER/FALL GRASS POLLEN SEASON: RETROSPECTIVE ANALYSIS OVER A 6 YEAR PERIOD. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.077] [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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Kandemir N, Slattery M, Ackerman KE, Tulsiani S, Bose A, Singhal V, Baskaran C, Ebrahimi S, Goldstein M, Eddy K, Klibanski A, Misra M. Bone Parameters in Anorexia Nervosa and Athletic Amenorrhea: Comparison of Two Hypothalamic Amenorrhea States. J Clin Endocrinol Metab 2018; 103:2392-2402. [PMID: 29659886 PMCID: PMC6456997 DOI: 10.1210/jc.2018-00338] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We have reported low bone mineral density (BMD), impaired bone structure, and increased fracture risk in participants with anorexia nervosa (AN) and normal-weight oligoamenorrheic athletes (OAs). However, data directly comparing compartment-specific bone parameters in participants with AN, OAs, and controls are lacking. DESIGN A total of 468 female participants 14 to 21.9 years old were included: 269 with AN, 104 OAs, and 95 normal-weight eumenorrheic controls. Dual-energy x-ray absorptiometry was used to assess areal BMD (aBMD) of the whole body less head (WBLH), spine, and hip. High-resolution peripheral quantitative computed tomography was used to assess volumetric BMD (vBMD), bone geometry, and structure at the non-weight-bearing distal radius and weight-bearing distal tibia. RESULTS Participants with AN had lower WBLH and hip aBMD z scores than OAs and controls (P < 0.0001). Participants with AN and OAs had lower spine aBMD z scores than controls (P < 0.01). At the radius, total and cortical vBMD, percentage cortical area, and thickness were lower in the AN and OA groups than in controls (P ≤ 0.04); trabecular vBMD was lower in participants with AN than controls. At the tibia, participants with AN had lower measures for most parameters compared with OAs and controls (P < 0.05); OAs had lower cortical vBMD than controls (P = 0.002). Participants with AN and OAs had higher fracture rates than controls. Stress fracture prevalence was highest in OAs (P < 0.0001); nonstress fracture prevalence was highest in participants with AN (P < 0.05). CONCLUSION AN is deleterious to bone at all sites and both bone compartments. A high stress fracture rate in OAs, who have comparable WBLH and hip aBMD measures to controls, indicates that BMD in these women may need to be even higher to avoid fractures.
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Affiliation(s)
- Nurgun Kandemir
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Divisions of Sports Medicine and Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Shreya Tulsiani
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charumathi Baskaran
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Seda Ebrahimi
- Center of Eating Disorders Management, Cambridge, Massachusetts
| | - Mark Goldstein
- Division of Adolescent Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kamryn Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Madhusmita Misra, MD, MPH, Massachusetts General Hospital, BUL 457 B, 55 Fruit Street, Boston, Massachusetts 02114. E-mail:
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Goldstein M, Leibovitch I, Varssano D, Rothkoff L, Feitt N, Loewenstein A. Axial Length, Refractive Error, and Keratometry in Patients with Branch Retinal Vein Occlusion. Eur J Ophthalmol 2018; 14:37-9. [PMID: 15005583 DOI: 10.1177/112067210401400106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
Purpose To evaluate ocular parameters that may predispose to the development of branch retinal vein occlusion (BRVO). METHODS This prospective study included patients with unilateral BRVO evaluated in the authors' clinic. The mean period from the acute phase was 2.29 ±1.57 years (range 1–6 years). All patients underwent a complete ophthalmologic examination including subjective refraction, axial length measurements, and keratometry readings. The fellow eye served as a control in each patient. The variables of interest were compared between the affected eye and the fellow eye using the parametric t-test and the nonparametric Wilcoxon test. Results Twenty-four consecutive patients (14 women, 10 men, mean age 62.4 years) were included in the study. The mean axial length in the affected eye was significantly shorter compared to the mean fellow eye length. No difference was found between the two eyes in mean subjective refraction or mean keratometry readings. CONCLUSIONS The authors found that eyes with BRVO have a shorter axial length compared to the fellow eye in the same patient.
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Affiliation(s)
- M Goldstein
- Department of Ophthalmology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Amitay M, Goldstein M. Evaluating the peptide structure prediction capabilities of a purely ab-initio method. Protein Eng Des Sel 2017; 30:723-727. [PMID: 29040794 DOI: 10.1093/protein/gzx052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/02/2017] [Accepted: 09/08/2017] [Indexed: 01/25/2023] Open
Abstract
DEEPSAM is a relatively new global optimization algorithm aimed to predict the structure of bio-molecules from sequence, without any additional preliminary assumption. It is an evolutionary algorithm whose mutation operators are built by hybridizing the diffusion equation method, molecular dynamics simulated annealing, and a quasi-Newton local minimization method. The goal of this study was to evaluate the structure prediction capabilities of DEEPSAM by running it upon NMR structures of linear peptides (10-20 residues). The results indicate that DEEPSAM successfully predicted the conformations of these peptides, using modest computing resources.
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Affiliation(s)
- M Amitay
- Department of Bioinformatics, Jerusalem College of Technology, Havaad Haleumi 21, Jerusalem 9372115, Israel
| | - M Goldstein
- Department of Computer Science, Jerusalem College of Technology, Havaad Haleumi 21, Jerusalem 9372115, Israel
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Goldstein M, Vadaketh K, Dvorin D, Belecanech G. P214 Mepolizumab induction therapy for eosinophilic granulomatosis with polyangiitis (EGPA). Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.252] [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: 10/18/2022]
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Dvorin D, Vadaketh K, Goldstein M, Belecanech G. P256 Hypogammaglobulinemia as presenting sign of nephrotic syndrome. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.263] [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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Ong P, Wald R, Goldstein M, Leipsic J, Kiaii M, Deva D, Connelly K, Kirpalani A, Jimenez-Juan L, Bello O, Azizi P, Wald R, Yan A. LEFT VENTRICULAR STRAIN ANALYSIS USING CARDIAC MRI IN PATIENTS UNDERGOING IN-CENTRE NOCTURNAL HEMODIALYSIS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.060] [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: 11/16/2022] Open
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Parrella A, O'Neill C, Chow S, Goldstein M, Rosenwaks Z, Palermo G. Sperm source influences the extent of DNA fragmentation and shapes reproductive outcome. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.914] [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: 11/28/2022]
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Flannigan R, Bach P, Goldstein M. Microsurgical varicocele repair induces spermatogenesis among men with non obstructive azoospermia: a 25 year experience. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.918] [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: 10/18/2022]
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Ng P, McGowan M, Goldstein M, Kassardjian CD, Steinhart BD. The impact of CT head scans on ED management and length of stay in bizarre behavior patients. Am J Emerg Med 2017; 36:213-217. [PMID: 28789887 DOI: 10.1016/j.ajem.2017.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/30/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 12/21/2022] Open
Abstract
METHODS A 5-year retrospective chart review was conducted at 3 EDs. Inclusion criteria were patients ≥18years old triaged as "mental health - bizarre behavior" (deviation from normal cognitive behaviour with no obvious cause) with a CT head scan ordered in the ED. Exclusion criteria were focal neurologic deficits on exam, alternative medical etiology (i.e. delirium, trauma) and/or pre-existing CNS disease. Clinical, demographic and administrative data were extracted with 10% of charts independently reviewed by an Emergency Physician for inter-rater reliability. RESULTS 266 cases met study criteria. Population demographics: 49% percent female, average age 51years old, 28% homeless, 58% arrived by police or ambulance. CT head results: 1 (0.4%) case with possible acute findings, 105 (39%) with incidental findings (i.e. cerebral atrophy) that did not impact clinical management. Average time to physician assessment was 1:48 (hour:min) (sd 1:11), time to CT completion was 5:05 (sd 7:28) and an average delay of 3:17 awaiting results. Subgroup analysis revealed a net increase in ED length of stay (ED LOS) of 5:02 from obtaining neuroimaging. 85% of patients were referred to a consultant, 92% were to psychiatry. CONCLUSIONS CT head results prolonged ED LOS, delayed patient disposition and did not change the patient's clinical management. A prospective trial for ordering CT head scans in these patients is warranted.
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Affiliation(s)
- P Ng
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Canada.
| | - M McGowan
- Emergency Medicine, St. Michael's Hospital, Canada
| | - M Goldstein
- Department of Psychiatry, University of Toronto, Canada
| | - C D Kassardjian
- Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - B D Steinhart
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Canada; Emergency Medicine, St. Michael's Hospital, Canada
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Zafar A, Seretis C, Feretis M, Karandikar S, Williams SC, Goldstein M, Chapman M. Comparative study of magnetic resonance defaecography and evacuation proctography in the evaluation of obstructed defaecation. Colorectal Dis 2017; 19:O204-O209. [PMID: 28304122 DOI: 10.1111/codi.13657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/13/2017] [Indexed: 12/13/2022]
Abstract
AIM Obstructed defaecation syndrome is a common condition of multifactorial aetiology and requires specialized evaluation. Accurate and reproducible pelvic floor imaging is imperative for multidisciplinary decision-making. Evacuation proctography (EP) and magnetic resonance defaecography (MRD) are the main imaging modalities used to assess dynamic pelvic floor function. The aim of this prospective study was to compare the findings and acceptability of MRD and EP in the same cohort of patients. METHOD This was a prospective comparative study of MRD vs EP in 55 patients with obstructed defaecation syndrome in a single National Health Service Foundation Trust. RESULTS Fifty-five patients were recruited and underwent both EP and MRD. Detection rates for rectocoele were similar (82% vs 73%, P = 0.227), but EP revealed a significantly higher number of trapping rectocoeles compared to MRD (75% vs 31%, P < 0.001). EP detected more rectal intussusceptions than MRD (56% vs 35%, P = 0.023). MRD appeared to underestimate the size of the identified rectocoele, although it detected a significant number of anatomical abnormalities in the middle and anterior pelvic compartment not seen on EP (1.8% enterocoele, 9% peritoneocoele and 20% cystocoele). Patients achieved higher rates of expulsion of rectal contrast during EP compared to MRD, but this difference was not significant (76% vs 64% in MRD, P = 0.092). Of the two studies, patients preferred MRD. CONCLUSIONS MRD provides a global assessment of pelvic floor function and anatomical abnormality. MRD is better tolerated by patients but it is not as sensitive as EP in detecting trapping rectocoeles and intussusceptions.
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Affiliation(s)
- A Zafar
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - C Seretis
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - M Feretis
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - S Karandikar
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - S C Williams
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - M Goldstein
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - M Chapman
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
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Affiliation(s)
- M. Goldstein
- Israel Atomic Energy Commission, Nuclear Research Center-Negev P.O. Box 9001, Beer Sheva, Israel
| | - E. Greenspan
- Ben-Gurion University of the Negev Department of Nuclear Engineering, Beer Sheva, Israel
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Ma S, Goldstein M, Pitman AJ, Haghdadi N, MacGill I. Pricing the urban cooling benefits of solar panel deployment in Sydney, Australia. Sci Rep 2017; 7:43938. [PMID: 28262843 PMCID: PMC5338272 DOI: 10.1038/srep43938] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/31/2017] [Indexed: 11/09/2022] Open
Abstract
Cities import energy, which in combination with their typically high solar absorption and low moisture availability generates the urban heat island effect (UHI). The UHI, combined with human-induced warming, makes our densely populated cities particularly vulnerable to climate change. We examine the utility of solar photovoltaic (PV) system deployment on urban rooftops to reduce the UHI, and we price one potential value of this impact. The installation of PV systems over Sydney, Australia reduces summer maximum temperatures by up to 1 °C because the need to import energy is offset by local generation. This offset has a direct environmental benefit, cooling local maximum temperatures, but also a direct economic value in the energy generated. The indirect benefit associated with the temperature changes is between net AUD$230,000 and $3,380,000 depending on the intensity of PV systems deployment. Therefore, even very large PV installations will not offset global warming, but could generate enough energy to negate the need to import energy, and thereby reduce air temperatures. The energy produced, and the benefits of cooling beyond local PV installation sites, would reduce the vulnerability of urban populations and infrastructure to temperature extremes.
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Affiliation(s)
- S Ma
- ARC Centre of Excellence for Climate System Science and Climate Change Research Centre, University of New South Wales, Sydney, Australia
| | | | - A J Pitman
- ARC Centre of Excellence for Climate System Science and Climate Change Research Centre, University of New South Wales, Sydney, Australia
| | - N Haghdadi
- School of PV and Renewable Energy Engineering and Centre for Energy and Environmental Markets, University of New South Wales, Sydney Australia
| | - I MacGill
- Centre for Energy and Environmental Markets and School of Electrical Engineering and Telecommunications, University of New South Wales, Sydney, Australia
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Ibrahim U, Saqib A, Nalluri N, Raza MR, Goldstein M. IgG4-related Disease Presenting as a Pancreatic Mass and Bilateral Lacrimal Gland Swelling. Cureus 2017; 9:e1054. [PMID: 28367391 PMCID: PMC5364085 DOI: 10.7759/cureus.1054] [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] [Indexed: 11/10/2022] Open
Abstract
IgG4-related disease is characterized by multi-system inflammation and possible elevation in serum immunoglobulin-G4 level. Treatment regimens include glucocorticoids, disease-modifying anti-rheumatic agents and recently, rituximab infusions have been reported to be effective in treatment-refractory disease. We present a case of a 64-year-old male presenting with acute abdominal pain and scleral icterus. An abdominal ultrasound demonstrated extensive biliary ductal dilatation. A computed tomography (CT) scan and a magnetic resonance cholangiopancreatography (MRCP) revealed a 4.8 cm pancreatic head mass. He underwent an exploratory laparotomy, and a pathologic examination of the mass revealed a dense lymphoplasmacytic infiltrate. The patient’s IgG subclass 2 level was elevated. A review of the patient’s medical records revealed that, in 1992, he presented with bilateral periorbital discomfort not severe enough to require intervention. In 2006, he presented with bilateral periorbital swelling and discomfort. A magnetic resonance imaging (MRI) scan showed gross enlargement of the lacrimal glands, and a biopsy revealed a dense lymphoplasmacytic infiltrate. He was treated with corticosteroids, cyclosporine and methotrexate. The regimen was repeated in 2009 for recurrent symptoms. Hence, on our encounter, a diagnosis of IgG4-related disease was made and he was treated with rituximab that resulted in complete remission.
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Affiliation(s)
- Uroosa Ibrahim
- Department of Hematology/Oncology, Staten Island University Hospital
| | - Amina Saqib
- Pulmonary/Critical Care, Staten Island University Hospital
| | - Nikhil Nalluri
- Department of Internal Medicine, Staten Island University Hospital
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Tiosano L, Segal O, Mathalone N, Pollack A, Ehrlich R, Klemperer I, Barak Y, Moroz I, Chowers I, Goldstein M. Aflibercept as a Second Line Therapy for Neovascular Age Related Macular Degeneration in Israel (ASLI) study. Eye (Lond) 2017; 31:890-898. [PMID: 28211882 DOI: 10.1038/eye.2017.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 12/05/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeThe purpose of this study is to evaluate an early switch to aflibecept in eyes with neovascular age-related macular degeneration (nvAMD) showing partial or lack of response for initial therapy with bevacizumab.MethodsThe Aflibercept as a Second Line Therapy for Neovascular Age Related Macular Degeneration in Israel (ASLI) was a prospective, multicenter, single-arm clinical trial. Eyes with nvAMD having incomplete response to 3-9 prior bevacizumab injections were recruited. Three monthly intravitreal aflibercept (2 mg) injections were administered, followed by two bi-monthly injections and a final examination at week 28. An optional injection was allowed at week 20.ResultsForty-seven eyes of 46 patients (mean±SD age 76±8 years) were recruited. The mean number of prior bevacizumab injections was 5.5±2.9. The mean visual acuity improved from 60.3±10 ETDRS letters at baseline to 63.1±15 letters at week 28 (P=0.02, paired t-test). The central subfield thickness (CST) reduced from 409±127 micron at baseline to 330±110 microns at week 4 (P=0.0002; paired t-test), and 277±70 microns at week 28 (P=0.00002; paired t-test). Twenty-two eyes had three to five prior bevacizumab injections (mean 5.1±0.7), and 25 eyes had six to nine prior injections (7.32±1.2). Both groups had reduced CST from baseline to week 28 (P=0.0004 and P=0.0007; paired t-test, respectively). Thirty-five (75%) eyes required the optional additional aflibercept injection at week 20.ConclusionsThe ASLI study demonstrated improved BCVA and reduced CST following an early switch to aflibercept therapy in eyes with prior incomplete response to initial therapy with three to nine bevacizumab injections.
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Affiliation(s)
- L Tiosano
- Department of Ophthalmology Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - O Segal
- Meir Medical Center, Kfar Sava, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | | | - A Pollack
- Kaplan Medical Center, Rehovot, Israel
| | - R Ehrlich
- Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - I Klemperer
- Soroka University Medical Center, Beer Sheva, Israel
| | - Y Barak
- Rambam Medical Center, Haifa, Israel
| | - I Moroz
- Sheba Medical Center, Tel Hashomer, Israel
| | - I Chowers
- Department of Ophthalmology Hadassah, Hebrew University Medical Center, Jerusalem, Israel
| | - M Goldstein
- Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Bale SD, Goetz K, Harvey PR, Turin P, Bonnell JW, de Wit TD, Ergun RE, MacDowall RJ, Pulupa M, Andre M, Bolton M, Bougeret JL, Bowen TA, Burgess D, Cattell CA, Chandran BDG, Chaston CC, Chen CHK, Choi MK, Connerney JE, Cranmer S, Diaz-Aguado M, Donakowski W, Drake JF, Farrell WM, Fergeau P, Fermin J, Fischer J, Fox N, Glaser D, Goldstein M, Gordon D, Hanson E, Harris SE, Hayes LM, Hinze JJ, Hollweg JV, Horbury TS, Howard RA, Hoxie V, Jannet G, Karlsson M, Kasper JC, Kellogg PJ, Kien M, Klimchuk JA, Krasnoselskikh VV, Krucker S, Lynch JJ, Maksimovic M, Malaspina DM, Marker S, Martin P, Martinez-Oliveros J, McCauley J, McComas DJ, McDonald T, Meyer-Vernet N, Moncuquet M, Monson SJ, Mozer FS, Murphy SD, Odom J, Oliverson R, Olson J, Parker EN, Pankow D, Phan T, Quataert E, Quinn T, Ruplin SW, Salem C, Seitz D, Sheppard DA, Siy A, Stevens K, Summers D, Szabo A, Timofeeva M, Vaivads A, Velli M, Yehle A, Werthimer D, Wygant JR. The FIELDS Instrument Suite for Solar Probe Plus: Measuring the Coronal Plasma and Magnetic Field, Plasma Waves and Turbulence, and Radio Signatures of Solar Transients. Space Sci Rev 2016; 204:49-82. [PMID: 29755144 PMCID: PMC5942226 DOI: 10.1007/s11214-016-0244-5] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
NASA's Solar Probe Plus (SPP) mission will make the first in situ measurements of the solar corona and the birthplace of the solar wind. The FIELDS instrument suite on SPP will make direct measurements of electric and magnetic fields, the properties of in situ plasma waves, electron density and temperature profiles, and interplanetary radio emissions, amongst other things. Here, we describe the scientific objectives targeted by the SPP/FIELDS instrument, the instrument design itself, and the instrument concept of operations and planned data products.
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Affiliation(s)
- S D Bale
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - K Goetz
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - P R Harvey
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Turin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J W Bonnell
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Dudok de Wit
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - R E Ergun
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - R J MacDowall
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Pulupa
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Andre
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Bolton
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | | | - T A Bowen
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - D Burgess
- Astronomy Unit, Queen Mary, University of London, London, UK
| | - C A Cattell
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - B D G Chandran
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - C C Chaston
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - C H K Chen
- Department of Physics, Imperial College, London, UK
| | - M K Choi
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J E Connerney
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - S Cranmer
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - M Diaz-Aguado
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - W Donakowski
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J F Drake
- Department of Physics, University of Maryland, College Park, MD, USA
| | - W M Farrell
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - P Fergeau
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - J Fermin
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J Fischer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - N Fox
- Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
| | - D Glaser
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - M Goldstein
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - D Gordon
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Hanson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
- Physics Department, University of California, Berkeley, CA, USA
| | - S E Harris
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - L M Hayes
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Hinze
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - J V Hollweg
- Department of Physics, University of New Hampshire, Durham, NH, USA
| | - T S Horbury
- Department of Physics, Imperial College, London, UK
| | - R A Howard
- Space Science Division, Naval Research Laboratory, Washington, DC, USA
| | - V Hoxie
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - G Jannet
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - M Karlsson
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J C Kasper
- University of Michigan, Ann Arbor, MI, USA
| | - P J Kellogg
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - M Kien
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - J A Klimchuk
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | | | - S Krucker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J J Lynch
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | | | - D M Malaspina
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - S Marker
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - P Martin
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | | | - J McCauley
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D J McComas
- Southwest Research Institute, San Antonio, TX, USA
| | - T McDonald
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - M Moncuquet
- LESIA, Observatoire de Paris, Meudon, France
| | - S J Monson
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
| | - F S Mozer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - S D Murphy
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Odom
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - R Oliverson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Olson
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E N Parker
- Department of Astronomy and Astrophysics, University of Chicago, Chicago, IL, USA
| | - D Pankow
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - T Phan
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - E Quataert
- Astronomy Department, University of California, Berkeley, CA, USA
| | - T Quinn
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | | | - C Salem
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D Seitz
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - D A Sheppard
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - A Siy
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - K Stevens
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Summers
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - A Szabo
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M Timofeeva
- LPC2E, CNRS, 3A avenue de la Recherche Scientifique, Orléans, France
| | - A Vaivads
- Swedish Institute of Space Physics (IRF), Uppsala, Sweden
| | - M Velli
- Earth, Planetary, and Space Sciences, UCLA, Los Angelos, CA, USA
| | - A Yehle
- Laboratory for Atmospheric and Space Physics, University of Colorado, Boulder, CO, USA
| | - D Werthimer
- Space Sciences Laboratory, University of California, Berkeley, CA, USA
| | - J R Wygant
- School of Physics and Astronomy, University of Minnesota, Minneapolis, MN, USA
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Andrianakis I, Vernon I, McCreesh N, McKinley TJ, Oakley JE, Nsubuga RN, Goldstein M, White RG. History matching of a complex epidemiological model of human immunodeficiency virus transmission by using variance emulation. J R Stat Soc Ser C Appl Stat 2016; 66:717-740. [PMID: 28781386 PMCID: PMC5516248 DOI: 10.1111/rssc.12198] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Complex stochastic models are commonplace in epidemiology, but their utility depends on their calibration to empirical data. History matching is a (pre)calibration method that has been applied successfully to complex deterministic models. In this work, we adapt history matching to stochastic models, by emulating the variance in the model outputs, and therefore accounting for its dependence on the model's input values. The method proposed is applied to a real complex epidemiological model of human immunodeficiency virus in Uganda with 22 inputs and 18 outputs, and is found to increase the efficiency of history matching, requiring 70% of the time and 43% fewer simulator evaluations compared with a previous variant of the method. The insight gained into the structure of the human immunodeficiency virus model, and the constraints placed on it, are then discussed.
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Affiliation(s)
| | | | - N McCreesh
- London School of Hygiene and Tropical Medicine UK
| | | | | | - R N Nsubuga
- Medical Research Council Uganda Kampala Uganda
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Hedge A, Goldstein M, Hettinger L, Varner C, Silva D, Malafronte J, Goodyear C. Longitudinal Study of the Effects of an Adjustable Ergonomic Keyboard on Upper Body Musculoskeletal Symptoms. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120204600501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A longitudinal study assessed the differential impact of standard and adjustable ergonomic keyboards on musculoskeletal symptoms among 71 computer users over a six month period. A total of 73 subjects participated: 34 subjects used a standard, flat keyboard and 37 used an adjustable, ergonomic keyboard. Subjects completed weekly surveys of perceived keyboard comfort, and body discomfort, along with other items. The ergonomic keyboard was rated favorably and for users there were significantly improvements neck, shoulder and arm comfort.
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Affiliation(s)
- Alan Hedge
- Cornell University, Dept. of Design and Environmental Analysis, Ithaca, NY 14853
| | - Mark Goldstein
- Goldtouch Technologies, Inc., 17300 Red Hill Avenue, Suite 100, Irvine, CA 92614
| | - Lawrence Hettinger
- Northrop Grumman Information Technology, 57 Myrick Lane, Harvard, MA, 01451
| | - Can Varner
- Cornell University, Dept. of Design and Environmental Analysis, Ithaca, NY 14853
| | - Don Silva
- Blue Cross Blue Shield of Rhode Island, 444 Westminster Street, Providence, RI 02903
| | - Jean Malafronte
- Blue Cross Blue Shield of Rhode Island, 444 Westminster Street, Providence, RI 02903
| | - Chuck Goodyear
- Goodyear Statistics, Inc., 5536 Corwin Road, Waynesville, OH 45068
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