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Epstein M, Syed K, Danella J, Ginzburg S, Belkoff L, Tomaszewski J, Trabulsi E, Singer EA, Jacobs BL, Raman JD, Guzzo TJ, Uzzo R, Reese AC. Model risk scores may underestimate rate of biochemical recurrence in African American men with localized prostate cancer: a cohort analysis of over 3000 men. Prostate Cancer Prostatic Dis 2024; 27:257-263. [PMID: 37821578 DOI: 10.1038/s41391-023-00727-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/09/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION This study aims to determine if there is a difference in prostate cancer nomogram-adjusted risk of biochemical recurrence (BCR) and/or adverse pathology (AP) between African American (AAM) and Caucasian men (CM) undergoing radical prostatectomy (RP). METHODS A retrospective review was performed of men undergoing RP in the Pennsylvania Urologic Regional Collaborative between 2015 and 2021. Cox proportional hazard regression models were used to compare the rate of BCR after RP, and logistic regression models were used to compare rates of AP after RP between CM and AAM, adjusting for the CAPRA, CAPRA-S, and MSKCC pre- and post-operative nomogram scores. RESULTS Rates of BCR and AP after RP were analyzed from 3190 and 5029 men meeting inclusion criteria, respectively. The 2-year BCR-free survival was lower in AAM (72.5%) compared to CM (79.0%), with a hazard ratio (HR) of 1.38 (95% CI 1.16-1.63, p < 0.001). The rate of BCR was significantly greater in AAM compared to CM after adjustment for MSKCC pre-op (HR 1.29; 95% CI 1.08-1.53; p = 0.004), and post-op nomograms (HR 1.26; 95% CI 1.05-1.49; p < 0.001). There was a trend toward higher BCR rates among AAM after adjustment for CAPRA (HR 1.13; 95% CI 0.95-1.35; p = 0.17) and CAPRA-S nomograms (HR 1.11; 95% 0.93-1.32; p = 0.25), which did not reach statistical significance. The rate of AP was significantly greater in AAM compared to CM after adjusting for CAPRA (OR 1.28; 95% CI 1.10-1.50; p = 0.001) and MSKCC nomograms (OR 1.23; 95% CI 1.06-1.43; p = 0.007). CONCLUSION This analysis of a large multicenter cohort provides further evidence that AAM may have higher rates of BCR and AP after RP than is predicted by CAPRA and MSKCC nomograms. Accordingly, AAM may benefit with closer post-operative surveillance and may be more likely to require salvage therapies.
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Affiliation(s)
- Matthew Epstein
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Kaynaat Syed
- Health Care Improvement Foundation, Philadelphia, PA, USA
| | | | | | | | | | | | - Eric A Singer
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | | - Jay D Raman
- Department of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Robert Uzzo
- Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Adam C Reese
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
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Epstein M, Helstrom E, Correa A. Balancing Patient Safety and Early Postoperative Discharge: An American College of Surgeons National Surgical Quality Improvement Program Analysis of Postoperative Complications After Minimally Invasive Urologic Surgery. J Urol 2024; 211:174-176. [PMID: 37788014 DOI: 10.1097/ju.0000000000003724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Matthew Epstein
- Department of Urology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
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Lecolant S, Khelifi D, Neukirch C, Taillé C, Chabane H, Giboury Lafarge S, Sève E, Pham Thi N, Epstein M, Chollet Martin S, Nicaise Roland P. Comparaison des performances diagnostiques de deux biopuces IgE : ISAC® et ALEX2®. Revue Française d'Allergologie 2023. [DOI: 10.1016/j.reval.2023.103289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Chey W, Cash B, Lacy B, Cohen S, Zeitzoff L, Cekola P, Araujo Torres K, Epstein M. Peppermint Oil is Highly Effective for the Treatment of Adults with IBS: Results from a Self-Reported Survey. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Strother MC, Kutikov A, Epstein M, Bochner E, Deng M, Handorf E, Lewis B, Ghatalia P, Greenberg RE, Chen D, Viterbo R, Anari F, Smaldone MC, Zibelman MR, Uzzo RG, Plimack ER, Geynisman DM. Safety of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer and malignant ureteric obstruction. BJU Int 2022; 129:364-372. [PMID: 33780097 PMCID: PMC9659478 DOI: 10.1111/bju.15410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether patients with carcinoma invading bladder muscle (MIBC) and ureteric obstruction can safely receive cisplatin-based neoadjuvant chemotherapy (C-NAC), and to determine whether such patients require relief of obstruction with a ureteric stent or percutaneous nephrostomy prior to beginning C-NAC. PATIENTS AND METHODS We performed a single-institution retrospective analysis of MIBC patients receiving C-NAC and falling into three groups: no ureteric obstruction (NO); relieved ureteric obstruction (RO); and unrelieved ureteric obstruction (URO). To address whether patients with obstruction can safely receive C-NAC, we compared patients with NO to those with RO, with the primary outcome of premature chemotherapy discontinuation. To investigate whether patients with obstruction should have the obstruction relieved prior to NAC, we compared RO to URO patients using a primary composite outcome of grade ≥ 3 adverse events, premature chemotherapy discontinuation, dose reduction, or dose interruption. The primary outcomes were compared using multivariable logistic regression. Sensitivity analyses were performed for the RO vs URO comparison, in which patients with only mild degrees of obstruction were excluded from the URO group. RESULTS A total of 193 patients with NO, 49 with RO, and 35 with URO were analysed. There were no statistically significant differences between those with NO and those with RO in chemotherapy discontinuation (15% vs 22%; P = 0.3) or any secondary outcome. There was no statistically significant difference between those with RO and URO in the primary composite outcome (51% vs 53%; P = 1) or any secondary outcome. CONCLUSION Patients with ureteric obstruction can safely receive C-NAC. Relief of obstruction was not associated with increased safety of C-NAC delivery.
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Affiliation(s)
- Marshall C. Strother
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | - Alexander Kutikov
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | - Matthew Epstein
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA. Department of Urology
| | - Emily Bochner
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Mengying Deng
- Fox Chase Cancer Center, Philadelphia, PA. Department of Biostatistics and Bioinformatics
| | - Elizabeth Handorf
- Fox Chase Cancer Center, Philadelphia, PA. Department of Biostatistics and Bioinformatics
| | - Bianca Lewis
- Fox Chase Cancer Center, Philadelphia, PA. Department of Medical Oncology
| | - Pooja Ghatalia
- Fox Chase Cancer Center, Philadelphia, PA. Department of Medical Oncology
| | - Richard E. Greenberg
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | - David Chen
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | - Rosalia Viterbo
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | - Fern Anari
- Fox Chase Cancer Center, Philadelphia, PA. Department of Medical Oncology
| | - Marc C. Smaldone
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
| | | | - Robert G Uzzo
- Fox Chase Cancer Center, Philadelphia, PA. Division of Urology, Department of Surgery
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Thomas HM, Runions KC, Lester L, Lombardi K, Epstein M, Mandzufas J, Barrow T, Ang S, Leahy A, Mullane M, Whelan A, Coffin J, Mitrou F, Zubrick SR, Bowen AC, Gething PW, Cross D. Western Australian adolescent emotional wellbeing during the COVID-19 pandemic in 2020. Child Adolesc Psychiatry Ment Health 2022; 16:4. [PMID: 35027061 PMCID: PMC8756750 DOI: 10.1186/s13034-021-00433-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/13/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The impacts of the COVID-19 pandemic have been vast and are not limited to physical health. Many adolescents have experienced disruptions to daily life, including changes in their school routine and family's financial or emotional security, potentially impacting their emotional wellbeing. In low COVID-19 prevalence settings, the impact of isolation has been mitigated for most young people through continued face-to-face schooling, yet there may still be significant impacts on their wellbeing that could be attributed to the pandemic. METHODS We report on data from 32,849 surveys from Year 7-12 students in 40 schools over two 2020 survey cycles (June/July: 19,240; October: 13,609), drawn from a study of 79 primary and secondary schools across Western Australia, Australia. The Child Health Utility Index (CHU9D) was used to measure difficulties and distress in responding secondary school students only. Using comparable Australian data collected six years prior to the pandemic, the CHU9D was calibrated against the Kessler-10 to establish a reliable threshold for CHU9D-rated distress. RESULTS Compared to 14% of responding 12-18-year-olds in 2013/2014, in both 2020 survey cycles almost 40% of secondary students returned a CHU9D score above a threshold indicative of elevated difficulties and distress. Student distress increased significantly between June and October 2020. Female students, those in older Grades, those with few friendships or perceived poor quality friendships, and those with poor connectedness to school were more likely to score above the threshold. CONCLUSIONS In a large dataset collected during the first year of the COVID-19 pandemic, the proportion of secondary school students with scores indicative of difficulties and distress was substantially higher than a 2013/2014 benchmark, and distress increased as the pandemic progressed, despite the low local prevalence of COVID-19. This may indicate a general decline in social and emotional wellbeing exacerbated by the events of the pandemic. TRIAL REGISTRATION ANZCTRN (ACTRN12620000922976). Retrospectively registered 17/08/2020. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380429&isReview=true .
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Affiliation(s)
- H. M. Thomas
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - K. C. Runions
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - L. Lester
- grid.1012.20000 0004 1936 7910University of Western Australia, Perth, Australia
| | - K. Lombardi
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia ,grid.1038.a0000 0004 0389 4302Edith Cowan University, Perth, Australia
| | - M. Epstein
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - J. Mandzufas
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - T. Barrow
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - S. Ang
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - A. Leahy
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - M. Mullane
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - A. Whelan
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - J. Coffin
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia ,grid.1012.20000 0004 1936 7910University of Western Australia, Perth, Australia
| | - F. Mitrou
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - S. R. Zubrick
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia
| | - A. C. Bowen
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia ,grid.1012.20000 0004 1936 7910University of Western Australia, Perth, Australia ,grid.410667.20000 0004 0625 8600Perth Children’s Hospital, Perth, Australia
| | - P. W. Gething
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia ,grid.1032.00000 0004 0375 4078Curtin University, Perth, Australia
| | - D. Cross
- grid.414659.b0000 0000 8828 1230Telethon Kids Institute, Perth, Australia ,grid.1012.20000 0004 1936 7910University of Western Australia, Perth, Australia
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Kidd LC, Lee M, Lee Z, Epstein M, Liu S, Rangel E, Ahmed N, Sotelo R, Hemal A, Eun DD. A Multi-Institutional Experience with Robotic Vesicovaginal and Ureterovaginal Fistula Repair After Iatrogenic Injury. J Endourol 2021; 35:1659-1664. [PMID: 33787314 DOI: 10.1089/end.2020.0993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To describe our multi-institutional experience with robotic repair of iatrogenic urogynecologic fistulae (UGF), including vesicovaginal fistulae (VVF) and ureterovaginal fistulae (UVF). Methods: We performed a retrospective review identifying patients who underwent robotic repair of VVF and UVF between January 2010 and May 2019. All patients failed conservative management with Foley catheter or upper tract drainage (ureteral stent and/or nephrostomy tube), respectively. Patient demographics and perioperative outcomes were analyzed. Success was defined as no vaginal leakage of urine postoperatively, in the absence of drains, catheters, or stents. Results: Of 34 patients, 22/34 (65%) had VVF and 12/34 (35%) had UVF repair. VVF etiology included radiation (1/22, 4.5%) and surgery (21/22, 95.5%). Four of 22 (18%) had undergone prior repair attempt. Median console time was 187 minutes (interquartile range [IQR]: 151-219), estimated blood loss (EBL) was 50 mL (IQR: 50-93), and median length of stay (LOS) was 1 day (IQR: 1-2). Two of 22 (9%) patients had a postoperative complication. At mean follow-up of 28.9 months, 20/22 (91%) VVF cases were clinically effective. UVF etiology was gynecologic surgery in all cases; 8/12 (67%) were left-sided, 4/12 (33%) were right-sided. None was repeat repairs. Two of 12 (17%) underwent ureteroureterostomy, and 10/12 (83%) had reimplant. Median console time was 160 minutes (IQR: 133-196), EBL was 50 mL (IQR: 50-112), and LOS was 1 day (IQR: 1-1). No complications were encountered. At mean follow-up of 29.3 months, 100% of UVF repairs were effective. Conclusions: Robotic repair of iatrogenic UGF may be effectively performed with low complication rates by experienced urologic surgeons.
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Affiliation(s)
- Laura C Kidd
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ziho Lee
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Matthew Epstein
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Shuo Liu
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Enanyeli Rangel
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nahrin Ahmed
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Rene Sotelo
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ashok Hemal
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel D Eun
- Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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Epstein M, Musa T, Chiu S, Costanzo J, Dunne C, Cerrone F, Capone R. Use of the WatchPAT to detect occult residual sleep-disordered breathing in patients on CPAP for obstructive sleep apnea. J Clin Sleep Med 2020; 16:1073-1080. [PMID: 32118574 DOI: 10.5664/jcsm.8406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES To determine the accuracy of the apnea-hypopnea index (AHI) as measured by continuous positive airway pressure (CPAP) machines by simultaneously employing a home sleep apnea testing device (WatchPAT 200, Itamar Medical, Israel [WPAT]) in patients suspected of having residual sleep-disordered breathing (SDB). METHODS Patients with new, recurrent, or worsening signs, symptoms, or comorbidities associated with obstructive sleep apnea underwent home sleep apnea testing using WPAT while simultaneously using CPAP at their usual prescribed settings. CPAP AHI and WPAT AHI, respiratory disturbance index, and oximetry readings were then compared. RESULTS We identified an elevated AHI with WPAT testing in nearly half of patients with clinically suspected residual SDB and a normal CPAP AHI. WPAT detected additional respiratory events as well, including rapid eye movement-related apneas, respiratory effort-related arousals, and hypoxemia. CONCLUSIONS WPAT AHI was significantly higher than simultaneous CPAP AHI in nearly half of those patients with clinically suspected residual SDB being treated with CPAP. Additional respiratory disturbances, including rapid eye movement-related respiratory events, respiratory effort-related arousals, and hypoxemia, were elucidated only with the use of the WPAT. Residual SDB may have potential clinical consequences, including reduced CPAP adherence, ongoing hypersomnolence, and other health-related sequelae. Simultaneous WPAT testing of patients with a normal CPAP AHI may represent a valuable tool to detect clinically suspected residual SDB or to ensure adequate treatment in high-risk patients with obstructive sleep apnea in general.
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Affiliation(s)
- Matthew Epstein
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey.,New Jersey Medical School, Newark, New Jersey
| | - Tariq Musa
- Atlantic Health System, Morristown, New Jersey
| | | | | | - Christine Dunne
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Federico Cerrone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
| | - Robert Capone
- Atlantic Health Sleep Centers, Livingston, New Jersey.,Atlantic Health System, Morristown, New Jersey
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Rotulo A, Epstein M, Kondilis E. Fiscal federalism vs fiscal decentralization in healthcare: a conceptual framework. Hippokratia 2020; 24:107-113. [PMID: 34239287 PMCID: PMC8256788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Fiscal federalism and fiscal decentralization are distinct policy options in public services in general and healthcare in particular, with possibly opposed effects on equity, effectiveness, and efficiency. However, the pertinent discourse often reflects confusion between the concepts or conflation thereof. METHODS This paper performs a narrative review of theoretical literature on decentralization. The study offers clear definitions of the concepts of fiscal federalism and fiscal decentralization and provides an overview of the potential implications of each policy for healthcare systems. RESULTS The interpretation of the literature identified three different dimensions of decentralization: political, administrative, economic. Economic decentralization can be further implemented through two different policy options: fiscal federalism and fiscal decentralization. Fiscal federalism is the transfer of spending authority of a centrally pooled public health budget to local governments or authorities. Countries like the UK, Cuba, Denmark, and Brazil mostly rely on fiscal federalism mechanisms for healthcare financing. Fiscal decentralization consists of transferring both pooling and spending responsibilities from the central government to local authorities. Contrarily to fiscal federalism, the implementation of fiscal decentralization requires as a precondition the fragmentation of the national pool into many local pools. The restructuring of the pooling system may limit the cross-subsidization effect between high- and low-income groups and areas that a central pool guarantees; thus, severely affecting local equality and equity. With the limited availability of local public resources in poorer regions, the quality of services drops, increasing the disparity gap between areas. Evidence from Italy, Spain, China, and Ivory Coast -countries with a strong fiscal decentralization element in their healthcare services- suggests that fiscal decentralization has positive effects on the infant mortality rate. However, it decreases healthcare resources as well as access to services, fostering spatial inequities. CONCLUSION If public resources are and remain adequate, allocation follows equitable criteria, and local communities are involved in the decision-making debate, fiscal federalism -rather than fiscal decentralization- appear to be an adequate policy option to improve the healthcare services and population's health nationwide and achieve health sector economic decentralization. HIPPOKRATIA 2020, 24(3): 107-113.
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Affiliation(s)
- A Rotulo
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Greece
- Institute of Population Health Science, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - M Epstein
- Institute of Population Health Science, School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - E Kondilis
- Laboratory of Primary Health Care, General Medicine and Health Services Research, School of Medicine, Aristotle University of Thessaloniki, Greece
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Trinh QD, Hong F, Halpenny B, Epstein M, Berry DL. Racial/ethnicity differences in endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials. Urol Oncol 2020; 38:78.e7-78.e13. [DOI: 10.1016/j.urolonc.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/12/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022]
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Strother M, Kutikov A, Lewis B, Deng M, Handorf EA, Epstein M, Ghatalia P, Greenberg RE, Chen D, Viterbo R, Anari F, Smaldone MC, Zibelman MR, Uzzo RG, Plimack ER, Geynisman DM. Neoadjuvant cisplatin-based chemotherapy in patients with ureteral obstruction secondary to muscle invasive bladder cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.523] [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: 11/20/2022] Open
Abstract
523 Background: Neoadjuvant cisplatin-based chemotherapy (NAC) followed by cystectomy is the standard of care for muscle-invasive urothelial bladder cancer (MIBC). 15-35% of MIBC patients present with ureteral obstruction. Poor renal function increases cisplatin toxicity. It is unknown whether patients with ureteral obstruction which has been relieved (whether by nephrostomy tube or nephroureteral stent) have the same risk of toxicity as patients without ureteral obstruction. Methods: We retrospectively reviewed an institutional database of all patients undergoing NAC for MIBC with either dose dense MVAC (ddMVAC) or gemcitabine and cisplatin (GC) from January 2004 through May 2017. Patients without ureteral obstruction prior to initiation of NAC (Group A) were compared to those who had ureteral obstruction which was relieved prior to undergoing NAC (Group B). Continuous variables were compared using the Wilcoxon rank-sum test and categorical variables were compared using Fisher’s exact test. The primary outcome was premature discontinuation of NAC, which was defined as failure to complete all planned cycles. Logistic regression was used to test for differences between the groups in this outcome adjusting for age, ECOG performance status, and baseline glomerular filtration rate (GFR). Results: 160 patients in Group A and 59 patients in Group B were identified. Baseline age, Charlson Comorbidity Index, race, smoking status, and ECOG performance status were similar. Patients in Group B had lower GFR (99.2% vs 78.8% p <0.001) and were more likely to be female (21.9% vs 27.3% p <0.025) and to receive ddMVAC (65.0% vs. 83.1% p =0.012). There was no significant difference between groups in rates of premature NAC discontinuation (15.8% vs 22.0% p = 0.284) or grade ≥3 adverse events (23.4% vs 30.5% p = 0.285). Adjusted analysis showed no significant difference between the groups in frequency of premature NAC discontinuation (OR 1.96, 95% CI 0.84-4.57 p=0.12). Conclusions: We detected no difference in frequency of premature discontinuation of NAC in patients with relieved malignant ureteral obstruction relative to patients without obstruction. NAC for MIBC is likely safe in this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | - David Chen
- Fox Chase Cancer Center, Philadelphia, PA
| | | | - Fern Anari
- Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - Robert Guy Uzzo
- Fox Chase Cancer Center – Temple University Health System, Philadelphia, PA
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Berry DL, Hong F, Halpenny B, Epstein M, Trinh QD. Racial/ethnicity differences when endorsing influential factors for prostate cancer treatment choice: An analysis of data from the personal patient profile-prostate (P3P) I and II trials. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.351] [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: 11/20/2022] Open
Abstract
351 Background: Race and ethnicity impact the type of treatment received for localized prostate cancer in American men. We hypothesized that there may be differences in men’s influential values and preferences related to treatment decisions. Methods: We analyzed samples from two multicenter, randomized trials of the Patient Profile-Prostate (P3P) decision aid, first comparing the trial groups on demographic and decisional variables using Chi-square tests. Stratified (P3P I vs II) logistic regression was then used to assess the univariate association between race/ethnicity and endorsement of moderate-or-strong influence of 14 lifestyle factors, current or future symptoms, or important others on the decision. A multivariable stratified logistic regression with backward variable selection was used to further estimate the association between influential factors and race/ethnicity. Results: Data from 494 and 392 participants in P3PI and P3PII, respectively, were analyzed for 40 Hispanic, 168 non-Hispanic black, 637 non-Hispanic white, 19 others and 6 missing. Age (p=.0001), education (p<.0001), marital status (p<.0001), income (p<.0001), Internet use for information (p<.0001) and decisional control preference were significantly different across racial/ethnic groups. In adjusted analyses, racial/ethnic differences existed for influence of age (Non Hispanic Black (NHB) vs. Non Hispanic White (NHW) OR: 0.56 95%CI 0.38-0.85p=.002), religion/spirituality (NHB vs. NHW OR: 3.2095%CI1.95-5.26, p<.0001), future bladder function (NHB vs. NHW OR: 0.5795%CI0.35-0.90, p=.04), future ability to engage in recreation (NHB vs. NHW OR: 0.5495%CI 0.34-0.86, p=0.02), and a story of a famous person with prostate cancer (NHB vs. NHW OR: 2,11 95%CI1.30-3.43, p=.007). Conclusions: Our results suggest racial/ethnic differences for influences underlying treatment choice. Better understanding these influences may help us present salient information about treatment options to patients and address disparities.
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Affiliation(s)
| | - Fangxin Hong
- Biostatistical Core, Harvard University, Boston, MA
| | - Barbara Halpenny
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
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Hervé F, Abrams P, Bower W, Wachter S, Epstein M, Lombardo R, Robinson D, Tubaro A, Wein A, Weiss JP, Everaert K. Is our current understanding and management of nocturia allowing improved care? International Consultation on Incontinence‐Research Society 2018. Neurourol Urodyn 2019; 38 Suppl 5:S127-S133. [DOI: 10.1002/nau.23961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Francois Hervé
- Department of UrologyGhent University HospitalGhent Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead HospitalBristol UK
| | - Wendy Bower
- Department of Medicine and Community CareFaculty of Medicine, Dentistry and Health Science, Melbourne Health, University of MelbourneMelbourne Australia
| | - Stefan Wachter
- Department of UrologyAntwerp University HospitalEdegem Belgium
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerp Belgium
| | - Matthew Epstein
- Department of UrologySUNY Downstate College of MedicineBrooklyn Newyork
| | - Riccardo Lombardo
- Department of UrologySant'Andrea Hospital, School of Health Sciences, Sapienza University of RomeRome Italy
| | | | - Andrea Tubaro
- Department of UrologySant'Andrea Hospital, School of Health Sciences, Sapienza University of RomeRome Italy
| | - Alan Wein
- Department of UrologyPerelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Jeffrey P. Weiss
- Department of UrologySUNY Downstate College of MedicineBrooklyn Newyork
| | - Karel Everaert
- Department of UrologyGhent University HospitalGhent Belgium
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Abstract
OBJECTIVES To review systematically the literature on genomic tests for prostate cancer (PCa) and to evaluate the current state of the evidence on their use in patients with newly diagnosed PCa. METHODS We conducted a systematic review by searching PubMed, Embase, Cochrane Central and conference abstracts from the American Urological Association, published between 2010 and 2018. Studies evaluating Prolaris, Oncotype Dx and Decipher assays were assessed for inclusion by two authors. Studies were excluded if the results were derived from surgical specimens rather than biopsy specimens. A meta-analysis was not performed owing to significant variations in methodologies, definitions and outcome measures. RESULTS A total of 729 articles were retrieved in our initial search. After removing duplicates (270) and excluding articles deemed not relevant (432), 21 full-text articles were deemed suitable for inclusion in the present analysis. The full-text articles comprised eight studies on Prolaris, eight studies on Oncotype Dx and five studies on Decipher. For each genomic test we extracted data regarding the risks of adverse pathology, biochemical recurrence, metastasis and PCa-specific mortality. CONCLUSION The results of genomic tests that use biomarkers derived from prostate biopsy can be used in conjunction with clinicopathological variables to improve our ability to risk-stratify patients with newly diagnosed PCa. Additional data are needed on the impact of using these tests on long-term patient outcomes and their cost-effectiveness.
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Affiliation(s)
| | - Fred LaPolla
- NYU Health Sciences Library, New York University, New York, NY, USA
| | | | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan VA, New York, NY, USA
| | - Hasan Dani
- James Buchanan Brady Urological Institute, Johns Hopkins, University School of Medicine, Baltimore, MD, USA
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15
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Mack D, Epstein M, Dube C, Clark R, Lapane K. LESS IS MORE: POTENTIAL OVERSCREENING FOR BREAST CANCER IN U.S. NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Mack
- University of Massachusetts Medical School
| | - M Epstein
- University of Massachusetts Medical School
| | - C Dube
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - R Clark
- University of Massachusetts Medical School
| | - K Lapane
- University of Massachusetts Medical School
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16
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Affiliation(s)
- M. Epstein
- The Nephrology Section Veterans Administration Medical Center and the Department of Medicine, University of Miami, School of Medicine, Miami, Florida, USA
| | - G. O. Perez
- The Nephrology Section Veterans Administration Medical Center and the Department of Medicine, University of Miami, School of Medicine, Miami, Florida, USA
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17
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Fribbens C, Garcia Murillas I, Beaney M, Hrebien S, O'Leary B, Kilburn L, Howarth K, Epstein M, Green E, Rosenfeld N, Ring A, Johnston S, Turner N. Tracking evolution of aromatase inhibitor resistance with circulating tumour DNA analysis in metastatic breast cancer. Ann Oncol 2018; 29:145-153. [PMID: 29045530 PMCID: PMC6264798 DOI: 10.1093/annonc/mdx483] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Selection of resistance mutations may play a major role in the development of endocrine resistance. ESR1 mutations are rare in primary breast cancer but have high prevalence in patients treated with aromatase inhibitors (AI) for advanced breast cancer. We investigated the evolution of genetic resistance to the first-line AI therapy using sequential ctDNA sampling in patients with advanced breast cancer. Patients and methods Eighty-three patients on the first-line AI therapy for metastatic breast cancer were enrolled in a prospective study. Plasma samples were collected every 3 months to disease progression and ctDNA analysed by digital droplet PCR and enhanced tagged-amplicon sequencing (eTAm-Seq). Mutations identified in progression samples by sequencing were tracked back through samples before progression to study the evolution of mutations on therapy. The frequency of novel mutations was validated in an independent cohort of available baseline plasma samples in the Study of Faslodex versus Exemestane with or without Arimidex (SoFEA) trial, which enrolled patients with prior sensitivity to AI. Results Of the 39 patients who progressed on the first-line AI, 56.4% (22/39) had ESR1 mutations detectable at progression, which were polyclonal in 40.9% (9/22) patients. In serial tracking, ESR1 mutations were detectable median 6.7 months (95% confidence interval 3.7-NA) before clinical progression. Utilising eTAm-Seq ctDNA sequencing of progression plasma, ESR1 mutations were demonstrated to be sub-clonal in 72.2% (13/18) patients. Mutations in RAS genes were identified in 15.4% (6/39) of progressing patients (4 KRAS, 1 HRAS, 1 NRAS). In SoFEA, KRAS mutations were detected in 21.2% (24/113) patients although there was no evidence that KRAS mutation status was prognostic for progression free or overall survival. Conclusions Cancers progressing on the first-line AI show high levels of genetic heterogeneity, with frequent sub-clonal mutations. Sub-clonal KRAS mutations are found at high frequency. The genetic diversity of AI resistant cancers may limit subsequent targeted therapy approaches.
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Affiliation(s)
- C Fribbens
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
- Breast Unit, Royal Marsden Hospital, London, UK
| | - I Garcia Murillas
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
| | - M Beaney
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
| | - S Hrebien
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
| | - B O'Leary
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
| | - L Kilburn
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, UK
| | - K Howarth
- Inivata Ltd., The Portway, Granta Park, Great Abington, UK
| | - M Epstein
- Inivata Ltd., The Portway, Granta Park, Great Abington, UK
| | - E Green
- Inivata Ltd., The Portway, Granta Park, Great Abington, UK
| | - N Rosenfeld
- Inivata Ltd., The Portway, Granta Park, Great Abington, UK
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK
- Cancer Research UK Major Centre, Robinson Way, Cambridge, UK
| | - A Ring
- Breast Unit, Royal Marsden Hospital, London, UK
| | - S Johnston
- Breast Unit, Royal Marsden Hospital, London, UK
| | - N Turner
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK
- Breast Unit, Royal Marsden Hospital, London, UK
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18
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Dahlgren A, Epstein M, Söderström M, Tucker P. Nurses' strategies for managing sleep when starting shift work – implications for interventions targeting sleep behaviours in a shift work population. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Zivi SM, Epstein M, Wright RW, Barghusen JJ, Cho DH, Testa FJ, Goldfuss GT, Mouring RW. An In-Pile Study of Thermal Interactions Between . High-Energy Molten UO2 Fuel and Liquid Sodium. NUCL SCI ENG 2017. [DOI: 10.13182/nse75-a26737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. M. Zivi
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - M. Epstein
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - R. W. Wright
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - J. J. Barghusen
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - D. H. Cho
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - F. J. Testa
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - G. T. Goldfuss
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
| | - R. W. Mouring
- Argonne National Laboratory, Reactor Analysis and Safety Division, Argonne, Illinois 60439
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20
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Epstein M, Blaivas J, Wein AJ, Weiss JP. Nocturia treatment outcomes: Analysis of contributory frequency volume chart parameters. Neurourol Urodyn 2017; 37:186-191. [DOI: 10.1002/nau.23272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/24/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew Epstein
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
| | - Jerry Blaivas
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
- Department of UrologyWeill Cornell Medical CollegeNew YorkNew York
| | - Alan J. Wein
- Department of UrologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | - Jeffrey P. Weiss
- Department of UrologySUNY Downstate College of MedicineBrooklynNew York
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21
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Forde JC, Davila JL, Marks BK, Epstein M, Tsui JF, Weiss JP, Blaivas JG. Urogynecological conditions associated with overactive bladder symptoms in women. Can Urol Assoc J 2017; 11:E83-E87. [PMID: 28360952 DOI: 10.5489/cuaj.3962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Overactive bladder symptoms (OAB) affect 9-43% of women and are associated with underlying disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI). The aim of this study is to identify urogynecological conditions associated with OAB symptoms. METHODS This prospective, institutional review board-approved study included women referred to a tertiary centre with lower urinary tract symptoms (LUTS). All women completed the self-administered OAB questionnaire (OABSS). Those with an OABSS ≥8, the cutoff, were considered to have OAB symptoms. Patients underwent a history and physical examination (including Baden-Walker prolapse grading and stress test), 24-hour voiding diary, pad test (for urinary incontinence), urinalysis, and uroflow with post-void residual volume. Patients were classified clinically into the following: idiopathic OAB, SUI, POP, bladder outlet obstruction (BOO) neurogenic bladder (NGB), recurrent urinary tract infection (UTI), and miscellaneous. RESULTS In total, 148 women met the inclusion criteria with a mean age of 67 years. Only 27% had no comorbid conditions and were considered idiopathic OAB. Associated urogynecological conditions included SUI in 37%, POP in 26%, miscellaneous conditions in 18%, recurrent UTI in 11%, NGB in 9%, and BOO in 8%. Some patients met criteria for more than one category, thus the total is greater than 100%. CONCLUSIONS In a tertiary care setting, a significant proportion of women with OAB symptoms have underlying conditions that may cause or contribute to their symptoms. Appropriate evaluation is desirable to enhance our understanding of the relationship of these conditions to the diagnosis, treatment, outcomes, and pathophysiology of OAB.
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Affiliation(s)
- James C Forde
- Deptartment of Urology, Weill Medical College of Cornell University, New York, NY, United States
| | - Jonathan L Davila
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States
| | - Brian K Marks
- Institute for Bladder and Prostate Research, New York, NY, United States
| | - Matthew Epstein
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States
| | - Johnson F Tsui
- Institute for Bladder and Prostate Research, New York, NY, United States
| | - Jeffrey P Weiss
- Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States; Institute for Bladder and Prostate Research, New York, NY, United States
| | - Jerry G Blaivas
- Deptartment of Urology, Weill Medical College of Cornell University, New York, NY, United States; Deptartment of Urology, SUNY Downstate Medical School, Brooklyn, NY, United States; Institute for Bladder and Prostate Research, New York, NY, United States
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22
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Redline S, Baker-Goodwin S, Bakker JP, Epstein M, Hanes S, Hanson M, Harrington Z, Johnston JC, Kapur VK, Keepnews D, Kontos E, Lowe A, Owens J, Page K, Rothstein N. Patient Partnerships Transforming Sleep Medicine Research and Clinical Care: Perspectives from the Sleep Apnea Patient-Centered Outcomes Network. J Clin Sleep Med 2016; 12:1053-8. [PMID: 27166300 DOI: 10.5664/jcsm.5948] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient "researchers" are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the "customer." To date, however, the "patient voice" largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care.
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Affiliation(s)
- Susan Redline
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Sleep Apnea Patient-Centered Outcomes Network
| | | | | | | | | | - Mark Hanson
- Sleep Apnea Patient-Centered Outcomes Network
| | - Zinta Harrington
- Department of Respiratory and Sleep Medicine, Liverpool Hospital, Sydney, Australia
| | | | - Vishesh K Kapur
- Sleep Apnea Patient-Centered Outcomes Network.,University of Washington Medicine Sleep Center, Seattle, WA
| | - David Keepnews
- Sleep Apnea Patient-Centered Outcomes Network.,Hunter-Bellevue School of Nursing, Hunter College/CUNY, New York, NY
| | - Emily Kontos
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Sleep Apnea Patient-Centered Outcomes Network
| | - Andy Lowe
- Sleep Apnea Patient-Centered Outcomes Network
| | - Judith Owens
- Sleep Apnea Patient-Centered Outcomes Network.,Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kathy Page
- Sleep Apnea Patient-Centered Outcomes Network
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Epstein M, Costanzo J, Dunne C, Cerrone F, Capone R. Inaccuracy of Apnea-Hypopnea Index Determination by CPAP Machines in Patients With Incompletely Treated Obstructive Sleep Apnea. Chest 2015. [DOI: 10.1378/chest.2275291] [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: 11/01/2022] Open
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24
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Geronemus RP, Schneider NS, Epstein M. Survival in patients treated with continuous arteriovenous hemodialysis for acute renal failure and chronic renal failure. Preliminary observations. Contrib Nephrol 2015; 93:29-31. [PMID: 1802596 DOI: 10.1159/000420180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Bailey JA, Samek DR, Keyes MA, Hill KG, Hicks BM, McGue M, Iacono WG, Epstein M, Catalano RF, Haggerty KP, Hawkins JD. General and substance-specific predictors of young adult nicotine dependence, alcohol use disorder, and problem behavior: replication in two samples. Drug Alcohol Depend 2014; 138:161-8. [PMID: 24631001 PMCID: PMC4000557 DOI: 10.1016/j.drugalcdep.2014.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 09/16/2013] [Revised: 12/24/2013] [Accepted: 02/16/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND This paper presents two replications of a heuristic model for measuring environment in studies of gene-environment interplay in the etiology of young adult problem behaviors. METHODS Data were drawn from two longitudinal, U.S. studies of the etiology of substance use and related behaviors: the Raising Healthy Children study (RHC; N=1040, 47% female) and the Minnesota Twin Family Study (MTFS; N=1512, 50% female). RHC included a Pacific Northwest, school-based, community sample. MTFS included twins identified from state birth records in Minnesota. Both studies included commensurate measures of general family environment and family substance-specific environments in adolescence (RHC ages 10-18; MTFS age 18), as well as young adult nicotine dependence, alcohol and illicit drug use disorders, HIV sexual risk behavior, and antisocial behavior (RHC ages 24, 25; MTFS age 25). RESULTS Results from the two samples were highly consistent and largely supported the heuristic model proposed by Bailey et al. (2011). Adolescent general family environment, family smoking environment, and family drinking environment predicted shared variance in problem behaviors in young adulthood. Family smoking environment predicted unique variance in young adult nicotine dependence. Family drinking environment did not appear to predict unique variance in young adult alcohol use disorder. CONCLUSIONS Organizing environmental predictors and outcomes into general and substance-specific measures provides a useful way forward in modeling complex environments and phenotypes. Results suggest that programs aimed at preventing young adult problem behaviors should target general family environment and family smoking and drinking environments in adolescence.
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Affiliation(s)
- J A Bailey
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States.
| | - D R Samek
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, United States
| | - M A Keyes
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, United States
| | - K G Hill
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States
| | - B M Hicks
- Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Ann Arbor, MI 48109, United States
| | - M McGue
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, United States
| | - W G Iacono
- Department of Psychology, University of Minnesota, 75 E River Road, Minneapolis, MN 55455, United States
| | - M Epstein
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States
| | - R F Catalano
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States
| | - K P Haggerty
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States
| | - J D Hawkins
- Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Avenue NE, Suite 401, Seattle, WA 98115, United States
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Bayer JD, Epstein M, Beaumont J. Fitting C² continuous parametric surfaces to frontiers delimiting physiologic structures. Comput Math Methods Med 2014; 2014:278479. [PMID: 24782911 PMCID: PMC3982317 DOI: 10.1155/2014/278479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/16/2014] [Accepted: 01/23/2014] [Indexed: 11/17/2022]
Abstract
We present a technique to fit C(2) continuous parametric surfaces to scattered geometric data points forming frontiers delimiting physiologic structures in segmented images. Such mathematical representation is interesting because it facilitates a large number of operations in modeling. While the fitting of C(2) continuous parametric curves to scattered geometric data points is quite trivial, the fitting of C(2) continuous parametric surfaces is not. The difficulty comes from the fact that each scattered data point should be assigned a unique parametric coordinate, and the fit is quite sensitive to their distribution on the parametric plane. We present a new approach where a polygonal (quadrilateral or triangular) surface is extracted from the segmented image. This surface is subsequently projected onto a parametric plane in a manner to ensure a one-to-one mapping. The resulting polygonal mesh is then regularized for area and edge length. Finally, from this point, surface fitting is relatively trivial. The novelty of our approach lies in the regularization of the polygonal mesh. Process performance is assessed with the reconstruction of a geometric model of mouse heart ventricles from a computerized tomography scan. Our results show an excellent reproduction of the geometric data with surfaces that are C(2) continuous.
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Affiliation(s)
- Jason D Bayer
- L'Institut de Rythmologie et Modélisation Cardiaque, Université de Bordeaux, 166 Cours de l'Argonne, 33000 Bordeaux, France
| | - Matthew Epstein
- Department of Bioengineering, Binghamton University, P.O. Box 6000, Binghamton, NY 13902, USA
| | - Jacques Beaumont
- Department of Pharmacology, SUNY Upstate Medical University, 3135 Weiskotten Hall, 750 East Adams Street, Syracuse, NY 13210, USA
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Schraibman V, Kaufmann O, Epstein M, Maccapani G, Okazaki S, Neme R. Robotic Assisted Colorectal Resection of Intestinal Endometriosis. Single Center Experience with 11 Cases. J Minim Invasive Gynecol 2013. [DOI: 10.1016/j.jmig.2013.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Raber-Durlacher J, Laheij A, Epstein J, Epstein M, Geerligs G, Wolffe G, Donnelly J, Blijlevens N. Periodontal Status and Bacteremia In Allogeneic Hematopoietic Stem Cell Recipients. Oral Surg Oral Med Oral Pathol Oral Radiol 2013. [DOI: 10.1016/j.oooo.2013.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lange S, Rehm J, Bekmuradov D, Mihic A, Popova S, Perumal N, Al Mahmud A, Baqui A, Raqib R, Roth D, Billard M, Bowers S, Gomes J, Ste-Marie N, Venners S, Webster G, Li H, Moraros J, Szafron M, Muhajarine N, Bowen A, Gowan-Moody D, Leis A, Epstein M, Premkumar K, Abonyi S, Nicolau I, Xie X, Dendukuri N, Aglipay M, Jolly AM, Wylie J, Ramsay T, Katapally T, Muhajarine N, Marwa N, Muhajarine N, Winquist B, Muhajarine N, Niruban S, Alagiakrishnan K, Beach J, Senthilselvan A. The Canadian Society for Epidemiology and Biostatics 2012 National Student Conference. Am J Epidemiol 2012. [DOI: 10.1093/aje/kws292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Catalano R, Goodman J, Margerison-Zilko CE, Saxton KB, Anderson E, Epstein M. Selection against small males in utero: a test of the Wells hypothesis. Hum Reprod 2012; 27:1202-8. [PMID: 22298840 DOI: 10.1093/humrep/der480] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The argument that women in stressful environments spontaneously abort their least fit fetuses enjoys wide dissemination despite the fact that several of its most intuitive predictions remain untested. The literature includes no tests, for example, of the hypothesis that these mechanisms select against small for gestational age (SGA) males. METHODS We apply time-series modeling to 4.9 million California male term births to test the hypothesis that the rate of SGA infants in 1096 weekly birth cohorts varies inversely with labor market contraction, a known stressor of contemporary populations. RESULTS We find support for the hypothesis that small size becomes less frequent among term male infants when the labor market contracts. CONCLUSIONS Our findings contribute to the evidence supporting selection in utero. They also suggest that research into the association between maternal stress and adverse birth outcomes should acknowledge the possibility that fetal loss may affect findings and their interpretation. Strengths of our analyses include the large number and size of our birth cohorts and our control for autocorrelation. Weaknesses include that we, like nearly all researchers in the field, have no direct measure of fetal loss.
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Affiliation(s)
- R Catalano
- School of Public Health, University of California, Berkeley, CA 94720, USA.
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Boeglin WU, Coman L, Ambrozewicz P, Aniol K, Arrington J, Batigne G, Bosted P, Camsonne A, Chang G, Chen JP, Choi S, Deur A, Epstein M, Finn JM, Frullani S, Furget C, Garibaldi F, Gayou O, Gilman R, Hansen O, Hayes D, Higinbotham DW, Hinton W, Hyde C, Ibrahim H, de Jager CW, Jiang X, Jones MK, Kaufman LJ, Klein A, Kox S, Kramer L, Kumbartzki G, Laget JM, LeRose J, Lindgren R, Margaziotis DJ, Markowitz P, McCormick K, Meziani Z, Michaels R, Milbrath B, Mitchell J, Monaghan P, Moteabbed M, Moussiegt P, Nasseripour R, Paschke K, Perdrisat C, Piasetzky E, Punjabi V, Qattan IA, Quéméner G, Ransome RD, Raue B, Réal JS, Reinhold J, Reitz B, Roché R, Roedelbronn M, Saha A, Slifer K, Solvignon P, Sulkosky V, Ulmer PE, Voutier E, Weinstein LB, Wojtsekhowski B, Zeier M. Probing the high momentum component of the deuteron at high Q2. Phys Rev Lett 2011; 107:262501. [PMID: 22243152 DOI: 10.1103/physrevlett.107.262501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Indexed: 05/31/2023]
Abstract
The (2)H(e,e'p)n cross section at a momentum transfer of 3.5 (GeV/c)(2) was measured over a kinematical range that made it possible to study this reaction for a set of fixed missing momenta as a function of the neutron recoil angle θ(nq) and to extract missing momentum distributions for fixed values of θ(nq) up to 0.55 GeV/c. In the region of 35°≤θ(nq)≤45° recent calculations, which predict that final-state interactions are small, agree reasonably well with the experimental data. Therefore, these experimental reduced cross sections provide direct access to the high momentum component of the deuteron momentum distribution in exclusive deuteron electrodisintegration.
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Affiliation(s)
- W U Boeglin
- Florida International University, University Park, Florida 33199, USA
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Ceacareanu AC, Hong C, Brennan JJ, Epstein M, Kossoff E, Nimako GK, Patel K, Forrest A. Statin treatment use in diabetic patients with breast cancer: A potential C-reactive protein mediated benefit. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
173 Background: Statin treatment has not yet been evaluated in relation to breast cancer (BC) prognosis in diabetes mellitus (DM) patients. Reported decreased survival following BC in women with metabolic syndrome, led us to investigate whether specific statin therapy may lead to improved BC survival. Reported associations between elevated C-reactive protein (CRP) levels at the time of diagnosis with worse cancer prognosis, and CRP-lowering properties of statin treatment in non-cancer patients, led us to investigate whether statin use is associated with lower CRP levels at the time of BC diagnosis and with improved BC outcomes. Methods: All DM patients newly diagnosed with BC between 2003 and 2007 (Roswell Park Cancer Institute) were retrospectively reviewed (n = 225). BC pathology, outcomes, existing comorbidities and drug therapy were documented. Follow up began at BC diagnosis and ended with first confirmed recurrence and/or death, or last date of follow-up. Hazard ratios (HR) and 95% confidence intervals (CI)s representing the association between statins, BC and a defined event were computed with Cox proportional hazards model. CRP plasma levels were determined by enzyme-linked immunosorbent assay in specimens donated at the time of BC diagnosis. A total of 98 study patients, DM+BC, and their matched controls, BC only (n = 196) were analyzed. Results: After a median follow up of 30 months, patients receiving statins for cholesterol management were found to have better disease-free survival (HR 0.27, 95% CI: 0.10, 0.71, X2 = 7.31, p = 0.06), and lower overall mortality (HR 0.23, 95% CI: 0.08, 0.66, X2 = 7.80, p = 0.05) compared to patients not receiving any cholesterol management medication. CRP levels have ranged between 0.2 and 21 mg/L and clinically relevant levels ( > 3mg/L) were noted in the study group. Conclusions: This study explored for the first time the association between statin therapy and BC prognosis in DM. We observed improved outcomes in statin-treated patients. While we currently analyze statin therapy in relationship with baseline CRP levels and BC prognosis, our existing findings suggest that statins have the potential to improve BC outcomes potentially through lowering overall inflammation.
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Affiliation(s)
- A. C. Ceacareanu
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - C. Hong
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - J. J. Brennan
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - M. Epstein
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - E. Kossoff
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - G. K. Nimako
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - K. Patel
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
| | - A. Forrest
- School of Pharmacy and Pharmaceutical Sciences, State University of New York, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
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Epstein M, Ephros H. Poster 56: Denosumab: A Review of Current Literature and Implications for Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.joms.2011.06.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Dan Brock argues that since the unexploitable rich could sell their kidneys too, exploitation could not be an essential feature of organ vending. This paper takes his claim as the point of departure for a discussion on the locus of organ vending-associated oppression. While it accepts Brock's conclusion, it explores the possibility that such oppression is invariably found rather outside the sphere of exchange. It then analyses the implications of this possibility for the discourse surrounding the ethics of organ vending.
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Affiliation(s)
- M Epstein
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 2 Newark Street, London E1 2AT, UK.
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Isakova T, Gutiérrez O, Smith K, Epstein M, Patel N, Jüppner H, Wolf M. 137: Short-Term Effect of Dietary Phosphorus Restriction and Lanthanum Carbonate on FGF23 in Chronic Kidney Disease Patients. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.144] [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: 11/11/2022]
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Epstein M, Bardack A, Bhandari P, Doggett J, Gagliolo N, Graff S, Li E, Petro E, Sailey M, Salaets N, Tousley B, Turner J, McCombe-Waller S, Whitall J, Abshire P. 285 EMG FEEDBACK VIA VIDEOGAME FOR REHABILITATION OF HEMIPARETIC GAIT. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70286-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barr NB, Ledezma LA, Vasquez JD, Epstein M, Kerr PH, Kinnee S, Sage O, Gilligan TM. Molecular identification of the light brown apple moth (Lepidoptera: Tortricidae) in California using a polymerase chain reaction assay of the internal transcribed spacer 2 locus. J Econ Entomol 2009; 102:2333-2342. [PMID: 20069865 DOI: 10.1603/029.102.0640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A molecular protocol using a hemi-nested polymerase chain reaction (PCR) of the internal transcribed spacer region 2 (ITS2) is reported for the diagnosis of light brown apple moth, Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae), in California. This protocol distinguishes the light brown apple moth from other moths in California based on size differences of PCR amplicons that are visualized on agarose gels. The molecular diagnostic tool generated no false negatives based on analysis of 337 light brown apple moths collected from California, Hawaii, England, New Zealand, and Australia. Analysis of a data set including 424 moths representing other tortricid species generated correct identification for >95% of the samples and only two false positives. Of the 761 moths tested only fourteen produced no PCR amplicons and five generated inconclusive data.
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Affiliation(s)
- N B Barr
- Center for Plant Health Science and Technology, Mission Laboratory, USDA-APHIS, Moore Air Base, Edinburg, TX 78541, USA.
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Suzuki K, Kohlbrenner R, Obajuluwa A, Epstein M, Garg S, Hori M, Baron R. TH-C-304A-10: Computer-Aided Measurement of Liver Volumes in CT by Means of Fast-Marching and Level-Set Segmentation. Med Phys 2009. [DOI: 10.1118/1.3182646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Grelewicz Z, Suzuki K, Kohlbrenner R, Obajuluwa A, Ng E, Tompkins R, Epstein M, Hori M, Baron R. SU-FF-I-03: Computer-Aided Diagnostic Scheme for Detection of Hepatocellular Carcinoma in Contrast-Enhanced Hepatic CT: Preliminary Results. Med Phys 2009. [DOI: 10.1118/1.3181122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
The medical admissions unit (MAU) of the Royal Free Hospital, London, should receive all acute accident and emergency (A&E) medical admissions. The unit aims to discharge 60% of patients and to transfer the remainder to a base ward within 48 hours of admission. This study tracked the patient journey from admission to A&E through the MAU during two parallel weeks, one year apart. Key bottlenecks were identified in the first audit and reforms implemented prior to the second. These reforms included improved transfer to base wards, improved weekend work patterns and improved access to investigation, specialist teams and pharmacy. The reforms served to facilitate the patient journey. A greater proportion of acute medical admissions were managed on the MAU and the number of patients exceeding a 48-hour stay fell from 55% to 10%. Both study periods demonstrated a peak in transfer activity from A&E in the 20 minutes before the four-hour target.
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Affiliation(s)
- M Epstein
- Department of Medicine, Royal Free Hospital, London
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Stone M, Stock G, Bunin K, Kumar K, Epstein M, Kambhamettu C, Li M, Parthasarathy V, Prince J. Comparison of speech production in upright and supine position. J Acoust Soc Am 2007; 122:532-41. [PMID: 17614510 DOI: 10.1121/1.2715659] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Speech is usually produced in an upright sitting or standing posture. Measurements and judgments of speech may be made in conditions requiring a supine position, however. These conditions include MRI recordings, and oral procedures, such as, adjustments to dental appliances, medical and surgical procedures. It is of interest, therefore, to see whether gravity has strong or systematic effects on tongue behavior. In the present study, 13 subjects repeated several words, which contained extreme consonant and vowel tongue positions, during upright and supine condition. Ultrasound imaging provided midsagittal tongue contours, in each condition, for comparison. A neck brace was used to stabilize transducer placement and the palate was used as a physiological reference to register the data sets. Results showed a significant subject effect. In supine position the tongue was more posterior than upright for seven subjects, more anterior for two subjects and varied by phoneme for four subjects. However, there was no significant phoneme effect. The direction of change and the amount of change were not directly related. Most subjects had small upright-supine differences. The largest differences, less than 3 mm on average, were in the posterior tongue.
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Affiliation(s)
- M Stone
- Department of Biomedical Sciences, University of Maryland, Baltimore, Maryland 21201, USA.
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Epstein M, Wingate DL. Is the NHS research ethics committees system to be outsourced to a low-cost offshore call centre? Reflections on human research ethics after the Warner Report. J Med Ethics 2007; 33:45-7. [PMID: 17209111 PMCID: PMC2598083 DOI: 10.1136/jme.2005.015479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The recently published Report of the AHAG on the Operation of NHS Research Ethics Committees (the Warner Report) advocates major reforms of the NHS research ethics committees system. The main implications of the proposed changes and their probable effects on the major stakeholders are described.
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Affiliation(s)
- M Epstein
- Institute of Health Sciences Education, Centre for Health Sciences, Academic Unit for Human Science and Medical Ethics, Barts and The London, Queen Mary's School of Medicine and Dentistry, 40 New Road, London E1 2AX, UK.
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Warner JV, Nyholt DR, Busfield F, Epstein M, Burgess J, Stranks S, Hill P, Perry-Keene D, Learoyd D, Robinson B, Teh BT, Prins JB, Cardinal JW. Familial isolated hyperparathyroidism is linked to a 1.7 Mb region on chromosome 2p13.3-14. J Med Genet 2006; 43:e12. [PMID: 16525030 PMCID: PMC2563254 DOI: 10.1136/jmg.2005.035766] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Familial isolated hyperparathyroidism (FIHP) is an autosomal dominantly inherited form of primary hyperparathyroidism. Although comprising only about 1% of cases of primary hyperparathyroidism, identification and functional analysis of a causative gene for FIHP is likely to advance our understanding of parathyroid physiology and pathophysiology. METHODS A genome-wide screen of DNA from seven pedigrees with FIHP was undertaken in order to identify a region of genetic linkage with the disorder. RESULTS Multipoint linkage analysis identified a region of suggestive linkage (LOD score 2.68) on chromosome 2. Fine mapping with the addition of three other families revealed significant linkage adjacent to D2S2368 (maximum multipoint LOD score 3.43). Recombination events defined a 1.7 Mb region of linkage between D2S2368 and D2S358 in nine pedigrees. Sequencing of the two most likely candidate genes in this region, however, did not identify a gene for FIHP. CONCLUSIONS We conclude that a causative gene for FIHP lies within this interval on chromosome 2. This is a major step towards eventual precise identification of a gene for FIHP, likely to be a key component in the genetic regulation of calcium homeostasis.
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Abstract
Effective consent is indeed a legal fiction
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Affiliation(s)
- M Epstein
- Queen Mary University of London, School of Medicine and Dentistry, Institute for Health Sciences, Unit for Human Science and Medical Ethics, 40 New Road, London E1 2AX, UK.
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Cardinal JW, Bergman L, Hayward N, Sweet A, Warner J, Marks L, Learoyd D, Dwight T, Robinson B, Epstein M, Smith M, Teh BT, Cameron DP, Prins JB. A report of a national mutation testing service for the MEN1 gene: clinical presentations and implications for mutation testing. J Med Genet 2006; 42:69-74. [PMID: 15635078 PMCID: PMC1735899 DOI: 10.1136/jmg.2003.017319] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/03/2022]
Abstract
INTRODUCTION Mutation testing for the MEN1 gene is a useful method to diagnose and predict individuals who either have or will develop multiple endocrine neoplasia type 1 (MEN 1). Clinical selection criteria to identify patients who should be tested are needed, as mutation analysis is costly and time consuming. This study is a report of an Australian national mutation testing service for the MEN1 gene from referred patients with classical MEN 1 and various MEN 1-like conditions. RESULTS All 55 MEN1 mutation positive patients had a family history of hyperparathyroidism, had hyperparathyroidism with one other MEN1 related tumour, or had hyperparathyroidism with multiglandular hyperplasia at a young age. We found 42 separate mutations and six recurring mutations from unrelated families, and evidence for a founder effect in five families with the same mutation. DISCUSSION Our results indicate that mutations in genes other than MEN1 may cause familial isolated hyperparathyroidism and familial isolated pituitary tumours. CONCLUSIONS We therefore suggest that routine germline MEN1 mutation testing of all cases of "classical" MEN1, familial hyperparathyroidism, and sporadic hyperparathyroidism with one other MEN1 related condition is justified by national testing services. We do not recommend routine sequencing of the promoter region between nucleotides 1234 and 1758 (Genbank accession no. U93237) as we could not detect any sequence variations within this region in any familial or sporadic cases of MEN1 related conditions lacking a MEN1 mutation. We also suggest that testing be considered for patients <30 years old with sporadic hyperparathyroidism and multigland hyperplasia.
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Affiliation(s)
- J W Cardinal
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Brisbane 4102, Australia.
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Herzog W, Han SK, Federico S, Epstein M. Reply to letter to the editor by Dr. Robert W. Mann. J Biomech 2005. [DOI: 10.1016/j.jbiomech.2005.01.014] [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: 11/29/2022]
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Abstract
The aim of this study is to present a detailed continuum mechanics formulation, and the corresponding algorithms, to predict the deformation of skeletal muscle at different structural levels, starting from the muscle fiber level. The model is used to investigate force production and structural changes during isometric and dynamic contractions of the cat medial gastrocnemius. From a comparison with experimental data obtained in our own laboratories, we conclude that the model faithfully predicts all of the observations pertaining to force production, fascicle length and angle of pennation under various test conditions.
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Affiliation(s)
- R R Lemos
- Department of Computer Science, The University of Calgary, Calgary, Alta., Canada
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Karagiannidis C, Hense G, Martin C, Epstein M, Rückert B, Mantel PY, Uhlig S, Blaser K, Schmidt-Weber C, Menz G. Die Rolle von TGF-beta1 und Activin A beim Asthma bronchiale. Pneumologie 2005. [DOI: 10.1055/s-2005-864487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Warner J, Epstein M, Sweet A, Singh D, Burgess J, Stranks S, Hill P, Perry-Keene D, Learoyd D, Robinson B, Birdsey P, Mackenzie E, Teh BT, Prins JB, Cardinal J. Genetic testing in familial isolated hyperparathyroidism: unexpected results and their implications. J Med Genet 2004; 41:155-60. [PMID: 14985373 PMCID: PMC1735699 DOI: 10.1136/jmg.2003.016725] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [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: 11/04/2022]
Abstract
Familial hyperparathyroidism is not uncommon in clinical endocrine practice. It encompasses a spectrum of disorders including multiple endocrine neoplasia types 1 (MEN1) and 2A, hyperparathyroidism-jaw tumour syndrome (HPT-JT), familial hypocalciuric hypercalcaemia (FHH), and familial isolated hyperparathyroidism (FIHP). Distinguishing among the five syndromes is often difficult but has profound implications for the management of patient and family. The availability of specific genetic testing for four of the syndromes has improved diagnostic accuracy and simplified family monitoring in many cases but its current cost and limited accessibility require rationalisation of its use. No gene has yet been associated exclusively with FIHP. FIHP phenotypes have been associated with mutant MEN1 and calcium-sensing receptor (CASR) genotypes and, very recently, with mutation in the newly identified HRPT2 gene. The relative proportions of these are not yet clear. We report results of MEN1, CASR, and HRPT2 genotyping of 22 unrelated subjects with FIHP phenotypes. We found 5 (23%) with MEN1 mutations, four (18%) with CASR mutations, and none with an HRPT2 mutation. All those with mutations had multiglandular hyperparathyroidism. Of the subjects with CASR mutations, none were of the typical FHH phenotype. These findings strongly favour a recommendation for MEN1 and CASR genotyping of patients with multiglandular FIHP, irrespective of urinary calcium excretion. However, it appears that HRPT2 genotyping should be reserved for cases in which other features of the HPT-JT phenotype have occurred in the kindred. Also apparent is the need for further investigation to identify additional genes associated with FIHP.
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Affiliation(s)
- J Warner
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba 4102, Qld, Australia
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