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Chakravorty S, Drasar E, Kaya B, Kesse-Adu R, Velangi M, Wright J, Howard J. UK Haemoglobin Disorders Peer Review: A Quality Standards-based review programme for sickle cell disease and thalassaemia. Br J Haematol 2024; 204:668-676. [PMID: 37786398 DOI: 10.1111/bjh.19114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/04/2023]
Abstract
We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)-based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease-group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review-driven improvement initiatives within different disease groups.
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Affiliation(s)
| | - E Drasar
- Whittington Hospital NHS Trust, London, UK
| | - B Kaya
- Barts Health NHS Trust, London, UK
| | - R Kesse-Adu
- Guy's and St Thomas's Hospital NHS Trust, London, UK
| | - M Velangi
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - J Wright
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - J Howard
- Guy's and St Thomas's Hospital NHS Trust, London, UK
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2
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Krouse RA, Morales KH, Kampman KM, Chakravorty S. The role of baseline insomnia in moderating the hypnotic properties of quetiapine. Addict Behav 2023; 140:107622. [PMID: 36701905 PMCID: PMC10082592 DOI: 10.1016/j.addbeh.2023.107622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The primary aim of this study was to investigate the effect of quetiapine on insomnia and alcohol craving (craving) in subjects with co-occurring insomnia and AUD. METHODS Insomnia was assessed with the Insomnia Severity Index (ISI) and craving with the Penn Alcohol Craving Scale (PACS, primary) and Obsessive-Compulsive Drinking Scale (OCDS, secondary). A multivariable model adjusted for covariates (N = 123) evaluated the relationship between craving (PACS and OCDS total scores) and insomnia (ISI total score). To simultaneously assess the effects of treatment arm allocation and insomnia status, subjects (N = 115) were stratified into 4 groups, quetiapine-insomnia(N = 38), quetiapine-No insomnia(N = 19), placebo-insomnia(N = 38), and placebo-No insomnia(N = 20). Linear mixed-effects regression models adjusted for covariates compared the trajectories of ISI, PACS, and OCDS total scores across 12 weeks of treatment and at post-treatment follow-up at week 24, between the four groups. RESULTS The ISI total score was positively associated with the PACS (p = 0.006) and OCDS (p = 0.001) total scores in the multivariable models. In the longitudinal analysis, when compared to the three other groups, subjects with insomnia treated with quetiapine showed a marked reduction in their insomnia scores with a return of insomnia after stopping treatment. There was no significant difference between the groups for the PACS and OCDS total score trajectories. DISCUSSION Although craving is associated with insomnia, treatment with quetiapine may improve insomnia but not craving in patients with co-occurring AUD and insomnia.
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Affiliation(s)
- R A Krouse
- Coatesville Veterans Affairs Medical Center, Coatesville, PA 19320, USA; School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA.
| | - K H Morales
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - K M Kampman
- Department of Psychiatry, Cpl. Michael J. Crescenz VA Medical Center, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA 19104, USA.
| | - S Chakravorty
- Department of Psychiatry, Cpl. Michael J. Crescenz VA Medical Center, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA 19104, USA.
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3
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Agarwal A, Hassanandani T, Das A, Panda M, Chakravorty S. 'Mask tinea': tinea faciei possibly potentiated by prolonged mask usage during the COVID-19 pandemic. Clin Exp Dermatol 2020; 46:190-193. [PMID: 33098693 PMCID: PMC9213933 DOI: 10.1111/ced.14491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Agarwal
- Department of Dermatology, IMS & SUM Hospital, Bhubaneshwar, India
| | - T Hassanandani
- Department of Dermatology, IMS & SUM Hospital, Bhubaneshwar, India
| | - A Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, India
| | - M Panda
- Department of Dermatology, IMS & SUM Hospital, Bhubaneshwar, India
| | - S Chakravorty
- Department of Microbiology, Bhagirathi Neotia Woman and Child Care Centre, Kolkata, India
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4
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Wills CC, Rosenberg EA, Perlis ML, Parthasarathy S, Chakravorty S, Grandner MA. 0120 Association Between Sleep Duration and Daytime Memory and Cognition Depends on Sleep Quality: Data from the 2017 Israel Social Survey. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.118] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
This study examines the relationship between sleep duration, sleep disturbance, and cognitive problems in a representative sample of the Israeli population.
Methods
7,230 Israelis responded to an Israeli Bureau of Statistics population-based survey of households from the year 2017. All variables were self-reported. Outcome of interest was difficulty with memory/concentration (none, mild, or severe). Predictors included previous month sleep duration (<=5hrs, 6hrs, 7hrs [reference], 8hrs, or >=9hrs) and sleep disturbance (none [reference], mild [1/week], moderate [2–3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Multinomial logistic regressions evaluated the relationships between variables, and post-hoc testing identified relationships within specific subgroups.
Results
72.9% denied cognitive problems, 22.2% reported mild problems, and 4.9% severe problems. In adjusted analyses, Sleep <=5hrs and >=9hrs were associated with mild (RRR=1.39, p<0.0005), (RRR=1.46, p=0.004) and severe (RRR=2.75, p<0.0005), (RRR=3.24, p<0.0005) cognitive problems, respectively. Mild, moderate, and severe sleep difficulties were associated with mild cognitive problems (RRR=2.09, p<0.0005), (RRR=2.22, p<0.0005), (RRR=2.44, p<0.0005), and severe cognitive problems (RRR=1.77, p=0.001), (RRR=3.04, p<0.0005), (RRR=4.22, p<0.0005), respectively. There was an interaction between sleep duration and sleep difficulties (p<0.05). Among those denying sleep difficulties, only >=9hrs of sleep was associated with cognitive problems. Among those with mild, moderate, and severe sleep difficulties, both short and long sleep were associated with cognitive problems.
Conclusion
In an Israeli population sample, both sleep duration and quality were associated with cognitive problems. Among those with sleep difficulties, short and long sleep duration were associated with cognitive problems, but among those denying sleep difficulties, only long sleep was associated with cognitive problems. These results suggest that the impact of sleep loss on real-world cognition may also rely on the presence of poor sleep quality.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
| | | | - M L Perlis
- University of Pennsylvania, Philadelphia, PA
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5
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Tubbs A, Khader WS, Fernandez F, Perlis ML, Chakravorty S, Grandner MA. 1096 Morning Wakefulness is Associated with Reduced Suicidal Ideation in a Nationally-Representative US Sample. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1091] [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: 11/15/2022] Open
Abstract
Abstract
Introduction
Nocturnal wakefulness is a unique risk factor for suicidal ideation in clinical as well as community samples. Preliminary data suggest that morning wakefulness may also be a protective factor against such thinking. However, these associations have not been explored in a nationally-representative dataset.
Methods
Data were collected from the 2015-2016 wave of the National Health and Nutrition Examination Survey. Participants reported typical bedtimes and waketimes. From these values, wakefulness during the night (00:00 to 05:59), morning (06:00 to 11:59), afternoon (12:00 to 17:59), and evening (18:00 to 23:59) was determined. Suicidal ideation was assessed by a question about “thoughts that you would be better off dead, or thoughts of hurting yourself in some way.” Ordinal logistic regression estimated the association between the number of hours awake at particular times of day and the frequency of suicidal ideation. Additional analyses adjusted for demographic factors and depressed mood.
Results
Out of 5133 respondents with available data, 125 reported suicidal ideation several days a week, 36 reported suicidal ideation more than half the days, and 29 reported suicidal ideation nearly every day. When controlling for demographics, morning wakefulness was associated with reduced frequency of suicidal ideation (OR: 0.69, 95% CI: [0.59,0.8]). Controlling for depressed mood attenuated, but did not eliminate, this association. Nocturnal wakefulness was not associated with suicidal ideation in this sample.
Conclusion
Using data from a nationally representative sample, morning wakefulness was associated with less frequent suicidal ideation. However, previous findings regarding nocturnal wakefulness were not replicated. The limited number of individuals in the sample endorsing both suicidal ideation and nighttime wakefulness may have insufficient power to detect an association.
Support
Dr. Grandner is supported by R01MD011600.
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Affiliation(s)
- A Tubbs
- University of Arizona, Tucson, AZ
| | | | | | - M L Perlis
- University of Pennsylvania, Philadelphia, PA
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6
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Rosenberg E, Perlis ML, Parthasarathy S, Jean-Louis G, Chakravorty S, Grandner MA. 0404 Jewish-Arab Disparities in Sleep Behaviors and Differential Ethnic Impact on Daytime Functioning, Driving Safety, and Health in Israel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.401] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In Israel, those with Arabic as compared to Jewish ethnicity, exhibit poorer health and motor vehicle safety behaviors. Their ethnic differences in sleep duration and quality may modulate their vulnerabilities to these behaviors.
Methods
7,230 Israeli individuals (N=5,880 Jewish and N=1350 Arabic) responded to the 2017 Israeli Bureau of Statistics population-based survey of households. Variables were self-reported. Outcomes included sleepiness, sleep medications, functional impairment, drowsy driving, overall health, 1-year health change, and obesity. Predictors included categorical sleep duration (<=5, 6, 7, 8 [reference], or >=9 hours) and sleep disturbance in the past month (none [reference], mild [1/week], moderate [2-3/week], or severe [>3/week]). Covariates included age, sex, and financial status. Ethnicity (Jewish/Arabic) was treated as a predictor of sleep and behavioral outcomes.
Results
When compared to normal (8-hour) sleepers, Jewish as compared to Arabic individuals were more likely to to sleep <=5h (RRR=3.99, p<0.0005), 6h (RRR=4.65, p<0.0005), and 7h (RRR=3.34, p<0.0005), and were more likely to report severe sleep difficulties (RRR=1.49, p<0.0005) and sleepiness (oOR=1.52, p< 0.0005). Yet, they were less likely to report functional impairment (oOR=0.65, p<0.0005), drowsy driving (OR=0.58, p<0.0005), worse health (oOR=0.51, p<0005), worsening health (oOR=0.70, p<0.0005), or obesity (OR=0.64, p<0.0005). Significant ethnicity by sleep duration interactions (p<0.05) characterized sleepiness, sleep medications, functional impairment, health, and health change. Moreover, significant ethnicity by sleep disturbance interactions (p<0.05) characterized the same outcomes, in addition to drowsy driving. Overall, the impact of sleep duration and sleep difficulties was generally greater among Arabs for all variables.
Conclusion
Despite Jewish individuals endorsing relatively shorter sleep and more severe sleep difficulties, Arabs seem to be more vulnerable to the health and functional outcomes. This finding may explain some of the discrepancies in the health and safety outcomes between these ethnic groups.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
| | - M L Perlis
- University of Pennsylvania, Philadelphia, PA
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7
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Khader WS, Tubbs A, Fernandez F, Chakravorty S, Hale L, Branas C, Barrett M, Killgore WD, Wills CC, Grandner MA. 0243 Community-Level Daytime Sleepiness and Substance Use: Implications of Sleep Time and Mental Health. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.241] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Daytime sleepiness is associated with impaired functioning and well-being. Those with more sleepiness may turn to illicit substances to overcome these problems. The present study examined whether community-level daytime sleepiness is associated with the likelihood of drug use.
Methods
Data were pulled from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 community adults (age 22–60). Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Use of different substances was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). The present analyses examined use within the past month of alcohol, tobacco, cannabis, cocaine, amphetamines, inhalants, sedatives, hallucinogens, and illicit opioids. A separate item assessed caffeine. Ordinal logistic regression analyzed ESS score as a predictor of frequency of substance use adjusted for age, sex, education, and race/ethnicity. Additional models included habitual sleep duration and score on the PHQ9 depression scale.
Results
In sociodemographically-adjusted analyses, ESS score was associated with an increased risk of using tobacco (OR=1.04, p=0.015), cannabis (OR=1.04, p=0.014), cocaine (OR=1.07, p=0.009), amphetamines (OR=1.06, p=0.025), inhalants (OR=1.13, p=0.002), sedatives (OR=1.07, p=0.003), hallucinogens (OR=1.12, p=0.001), and opioids (OR=1.12, p=0.0001). Controlling for sleep duration did not significantly affect these relationships, while controlling for depression made every association non-significant except hallucinogens (OR=1.09, p=0.040).
Conclusion
Daytime sleepiness was associated with increased use of nearly all drug categories, but not alcohol or caffeine. Public consumption of alcohol and caffeine might be sufficiently common that the presence of their use cannot be adequately associated with sleepiness. Moreover, the increased frequency of drug use with sleepiness is not linked to sleep deprivation but may reflect emotional distress.
Support
This work was supported by a grant from Jazz Pharmaceuticals
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
| | - A Tubbs
- University of Arizona, Tucson, AZ
| | | | | | - L Hale
- Stony Brook University, Stony Brook, NY
| | - C Branas
- Columbia University, New York, NY
| | - M Barrett
- University of Pennsylvania, Philadelphia, PA
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8
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Khader WS, Tubbs A, Fernandez F, Jean-Louis G, Seixas AA, Williams NJ, Chakravorty S, Killgore WD, Wills CC, Grandner MA. 0232 Impact of Mental Health on 10-Year Trends in Habitual Sleep Duration. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.230] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Public health efforts aimed at reducing the decline in habitual sleep duration have not been successful. It is possible that this decline is differentially experienced relative to individuals’ mental health status. This would further support the need to focus on mental health as a strategy for improving sleep in the general population.
Methods
We examined 10 years of the National Health Interview Survey data (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height and weight (used to compute body mass index) were recorded in the same way. In addition, depressed mood in the past 30 days was evaluated (coded as none, mild, moderate, or severe). Weighted regression analyses examined sleep duration as an outcome, year and depressed mood as predictors, and sociodemographics as covariates. A year-by-depressed mood interaction was computed, and analyses were stratified by group.
Results
There was a significant year-by-depression interaction on linear change in sleep duration over the 10 year period (p=0.0001). Analyses were then stratified by depressed mood. In adjusted analyses, individuals with no depressed mood lost an average of 0.68 minutes of sleep per year (95%CI -0.82,-0.55; p<0.0001). Among those with mild depression, this was 7% higher, at 0.73 minutes (95%CI -1.13,-0.33; p<0.0001). Among those with moderate depressed mood, this was 154% higher, at 1.73 minutes lost per year (95%CI -2.31,-1.16; p<0.0001). Among those with severe depressed mood, this was 351% higher, at 3.07 minutes per year (95%CI -4.22,-1.92; p<0.0001).
Conclusion
The 10-year linear decline in habitual sleep duration seems to depend on mental health status. Individuals with better mental health lose less sleep over time, relative to those with worse mental health. This highlights the importance of mental health as a possible avenue for improving sleep health in the population.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
| | - A Tubbs
- University of Arizona, Tucson, AZ
| | | | - G Jean-Louis
- New York University School of Medicine, New York City, NY
| | - A A Seixas
- New York University School of Medicine, New York City, NY
| | - N J Williams
- New York University School of Medicine, New York City, NY
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9
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Rosenberg E, Perlis ML, Parthasarathy S, Chakravorty S, Grandner MA. 0405 Sleep Duration and Sleep Disturbance Related to Obesity, Health, Motor Vehicle Safety, and Daytime Functioning in Israel: Data From the 2017 Israel Social Survey. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.402] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Previous studies suggest the Israeli population exhibits relatively short sleep duration and experiences sleep difficulties. This analysis evaluates the relationships between habitual sleep and outcomes of interest in this population.
Methods
Data were obtained from 7,230 Israeli individuals. The sample consisted a 2017 population-based survey of households, conducted by the Israeli Bureau of Statistics. All variables were self-reported. Outcomes of interest included drowsy driving, sleep medication use, functional impairment, sleepiness, overall health, 1-year health change, and obesity. Predictors included categories of sleep duration (<=5, 6, 7, 8 [reference], or >=9 hours) and sleep disturbance in the past month (none [reference], mild [1/week], moderate [2-3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Binary and ordinal logistic regressions were employed to evaluate the relationship between them and post-hoc analyses evaluated the relationships between subgroups.
Results
Drowsy driving was associated with <=5h, 6h, and 7h sleep duration categories, and severe sleep disturbance. The use of sleep medication use was associated with <=5h and >=9h, and all levels of sleep disturbance. Functional impairment and sleepiness were both associated with <=5h, 6h, 7h, and >=9h, and all levels of sleep disturbance. Their reported overall health was linked to sleep duration of <=5h and >=9h, and all levels of sleep disturbance. Worsening health was associated with <=5h and all levels of sleep disturbance. Obesity was associated with <=5h and severe sleep disturbance. In post-hoc analyses restricted to individuals with no sleep disturbance, habitual sleep duration was still statistically significantly related to drowsy driving, sleep medications, sleepiness, and health change.
Conclusion
Short sleep duration and sleep disturbance are associated with worse motor vehicle safety, health, and functioning in the Israeli population. Effects of sleep duration were generally maintained even for those without sleep disturbance. These results may help focus public health efforts on improving sleep health.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
| | - M L Perlis
- University of Pennsylvania, Philadelphia, PA
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10
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Jajoo A, Tubbs A, Perlis ML, Chakravorty S, Seixas A, Killgore WD, Wills CC, Grandner MA. 1093 Population-level Suicide Ideation: Impact Of Combined Roles Of Sleep Duration, Sleep Disturbance, And Daytime Sleepiness. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1088] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Poor sleep has been shown to be related to suicide ideation and depressed mood, but population-level studies have not been done to explore the specific issues within sleep that effect mood, specifically leading to suicide ideation.
Methods
Data from adults 18 and older in the 2015-2016 National Health and Nutrition Examination Survey (NHANES) who provided complete data were used (N=5,123). Suicide ideation was recorded as the presence of thinking that “you would be better off dead” in the past 2 weeks. Sleep duration was recorded in half-hour increments and transformed to represent absolute distance from 7 hours (to model u-shaped association). Sleep disturbance was recorded as presence of “difficulty falling asleep, staying asleep, or sleeping too much” non, several days, or more than half the days of the past 2 weeks. Sleepiness was frequency feeling “overly sleepy during the day” in the past 12 months. Covariates included age, sex, race/ethnicity, and presence of depressed mood in the past 2 weeks. Additional impact of difficulty thinking/concentrating in the past 2 weeks was explored. NHANES sample weights were used in analyses.
Results
In adjusted analyses, increase likelihood of suicide ideation was associated with distance from 7hrs (OR=1.24/hr, p=0.008), sleep difficulties most of the time (OR=2.46, p=0.001), but not sleepiness. When both sleep variables were adjusted for each other, results remained significant for U-shaped sleep duration (OR=1.21/hr, p=0.02) and sleep disturbance (OR=2.31, p=0.003). These were attenuated but remained significant when difficulty thinking/concentrating was introduced; a significant sobel test (p<0.0001) suggested partial mediation, with this variable accounting for approximately 13% of the variance of the relationship to sleep.
Conclusion
In the population, improper and poor sleep was associated with a greater risk of suicide ideation.
Support
Dr. Grandner is supported by R01MD011600
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Affiliation(s)
- A Jajoo
- University of Arizona, Tucson, AZ
| | - A Tubbs
- University of Arizona, Tucson, AZ
| | - M L Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - A Seixas
- New York University, New York, NY
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Balhara YPS, Kalra S, Bajaj S, Kuppili PP, Himanshu D, Atam V, Usman K, Singh V, Usman K, Singh V, Chaudhary SC, Chakravorty S, Wakhlu A, Fatma J, Tandon S, Maheshwari A, Gupta A, Parvez A, Chakravarty J, Chaudhary RR, Singh AK, Sawlani KK, Mathur M, Soni NK, Gupta OK, Gupta M, Agarwal S. Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes. J Assoc Physicians India 2018; 66:11-12. [PMID: 31315339] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Associate Professor of Psychiatry, National Drug Dependence Treatment Center and Department of Psychiatry, AIIMS, Delhi
| | - Sanjay Kalra
- Consultant, Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
| | - Sarita Bajaj
- Consultant Endocrinologist, Director-Professor and Head, Dept of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - D Himanshu
- Senior Resident, Department of Psychiatry, JIPMER, Puducherry
| | - Veerendra Atam
- Professor and Head, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Singh
- Professor and Head, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Singh
- Professor and Head, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | | | - S Chakravorty
- Additional Professor, Dept of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Anupam Wakhlu
- Sr. Consultant Physician and Unit Head, Department of Internal Medicine, Diabetology and Critical Care, Metro Multispeciality Hospital, Noida, Uttar Pradesh
| | - Jalees Fatma
- Professor, Department of Rheumatology, KGMU, Lucknow, Uttar Pradesh
| | - Sanjay Tandon
- Professor and Head, Depatment of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh
| | - Anuj Maheshwari
- Diabetologist and Metabolic Physician, Professor and Head in Internal Medicine, BBDCODS, BBD University, Lucknow, Uttar Pradesh
| | - Abha Gupta
- Consultant Physician, Former Associate Prof and Head, Dept. of Medicine, AIODS, Lucknow, Uttar Pradesh
| | - Anjum Parvez
- Professor, Dept. of Medicine, LLRM Medical College, Meerut, Uttar Pradesh
| | - Jaya Chakravarty
- Professor, Dept. of Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh
| | - R R Chaudhary
- Professor, Dept of Medicine, IMS, BHU, Varanasi, Uttar Pradesh
| | - A K Singh
- Senior Consultant Physician & Geriatrician, S.S.P.G Divisional District Hospital, Varanasi, Uttar Pradesh
| | - K K Sawlani
- Associate Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Manoj Mathur
- Senior Consultant Physician and Geriatrician, S.S.P.G. Divisional District Hospital, Varanasi, Uttar Pradesh
| | - N K Soni
- Associate Professor, Dept. of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - Madhukar Gupta
- Sr. Consultant and Clinical Hematologist, Metro Heart and Research Institute, Noida, Uttar Pradesh
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He S, Kampman K, Chakravorty S. 0977 The Association Between Alcohol Craving And Insomnia Symptoms In Alcohol Dependent Individuals. Sleep 2018. [DOI: 10.1093/sleep/zsy061.976] [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: 11/14/2022] Open
Affiliation(s)
- S He
- Cpl Michael J Crescenz VA Medical Center, Philadelphia, PA
| | - K Kampman
- Perelman School of Medicine;, Philadelphia, PA
| | - S Chakravorty
- Cpl Michael J Crescenz VA Medical Center, Philadelphia, PA
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Tubbs A, Perlis M, Chakravorty S, Basner M, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0988 Seasonal Changes in Nocturnal Suicide Risk. Sleep 2018. [DOI: 10.1093/sleep/zsy061.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tubbs
- University of Arizona, Tucson, AZ
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - M Basner
- University of Pennsylvania, Philadelphia, PA
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Kolla B, Foroughi M, Saeidifard F, Chakravorty S, Wang Z, Mansukhani M. 1001 The Impact Of Alcohol On Sleep Disordered Breathing: A Systematic Review And Meta-analysis. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1000] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - Z Wang
- Mayo Clinic, Rochester, MN
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Tubbs A, Perlis M, Chakravorty S, Basner M, Killgore W, Gehrels J, Alfonso-Miller P, Grandner M. 0978 Does Increased Risk of Suicide at Night Favor One Method of Suicide Over Another? Sleep 2018. [DOI: 10.1093/sleep/zsy061.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Tubbs
- University of Arizona, Tucson, AZ
| | - M Perlis
- University of Pennsylvania, Philadelphia, PA
| | | | - M Basner
- University of Pennsylvania, Philadelphia, PA
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Foroughi M, Saeidifard F, Kolla B, Chakravorty S, Mansukhani MP. 0472 Effect Of Alcohol On Sleep-disordered Breathing In Snorers Versus Non-snorers:a Systematic Review And Meta-analysis. Sleep 2018. [DOI: 10.1093/sleep/zsy061.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Foroughi
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - F Saeidifard
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - B Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - S Chakravorty
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Bastien C, Ellis J, Athey A, Chakravorty S, Robbins R, Knowlden A, Charest J, Grandner M. Driving after alcohol consumption is associated with insufficient sleep and insomnia among student athletes and non-athletes. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.073] [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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Balhara YPS, Kalra S, Bajaj S, Kuppili PP, Himanshu D, Atam V, Usman K, Singh V, Chaudhary SC, Chakravorty S, Wakhlu A, Fatma J, Tandon S, Maheshwari A, Gupta A, Parvez A, Chakravarty J, Chaudhary RR, Singh AK, Sawlani KK, Mathur M, Soni NK, Gupta OK, Rai M, Agarwal S. Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome. J Assoc Physicians India 2017; 65:66-72. [PMID: 29327524] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Associate Professor of Psychiatry, National Drug Dependence Treatment Center and Department of Psychiatry, AIIMS, Delhi
| | - Sanjay Kalra
- Consultant, Department of Endocrinology, Bharti Hospital & BRIDE, Karnal, Haryana
| | - Sarita Bajaj
- Consultant Endocrinologist, Director-Professor and Head, Dept of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - D Himanshu
- Associate Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Atam
- Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | | | | | - S Chakravorty
- Sr. Consultant Physician & Unit Head, Department of Internal Medicine, Diabetology & Critical Care, Metro Multispeciality Hospital, Noida, Uttar Pradesh
| | - Anupam Wakhlu
- Professor, Department of Rheumatology, KGMU, Lucknow, Uttar Pradesh
| | - Jalees Fatma
- Professor and Head, Depatment of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh
| | - Sanjay Tandon
- Consultant Physician, Former Associate Prof and Head, Dept. of Medicine, AIODS, Lucknow, Uttar Pradesh
| | - Anuj Maheshwari
- Diabetologist & Metabolic Physician, Professor & Head in Internal Medicine, BBDCODS, BBD University, Lucknow, Uttar Pradesh
| | - Abha Gupta
- Professor, Dept. of Medicine, LLRM Medical College, Meerut, Uttar Pradesh
| | - Anjum Parvez
- Professor, Dept. of Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh
| | | | - R R Chaudhary
- Professor and Head, Dept of Medicine, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh
| | - A K Singh
- Senior Consultant Physician & Geriatrician, S.S.P.G. Divisional District Hospital, Varanasi, Uttar Pradesh
| | - K K Sawlani
- Associate Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Manoj Mathur
- Associate Professor, Dept. of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - N K Soni
- Consultant Physician, Ghaziabad, Uttar Pradesh
| | - Om Kumari Gupta
- Sr. Consultant and Clinical Hematologist, Metro Heart and Research Institute, Noida, Uttar Pradesh
| | - Madhukar Rai
- Professor, Dept of Medicine, IMS, BHU, Varanasi, Uttar Pradesh
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Till K, Athey A, Chakravorty S, Killgore WD, Alfonso-Miller P, Gehrels J, Grandner MA. 1134 INSOMNIA AND DAYTIME TIREDNESS IN STUDENT ATHLETES ASSOCIATED WITH RISKY BEHAVIORS AND POOR DECISION MAKING WHEN UNDER THE INFLUENCE OF ALCOHOL. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1133] [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: 11/13/2022] Open
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Warlick C, Hall C, Athey A, Chakravorty S, Killgore WD, Alfonso-Miller P, Gehrels J, Grandner MA. 1135 DIFFICULTY SLEEPING ASSOCIATED WITH SUBSTANCE USE AMONG STUDENT ATHLETES. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1134] [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: 11/14/2022] Open
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Akthar M, Ruiz G, Chakravorty S, Bossley C, Rees D, Gupta A. P177 High prevalence of unrecognised asthma in children with sickle cell disease. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.320] [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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Chakravorty S, Tallett A, Sathyamoorthy G, James J. ISQUA16-1920USING A NEW PATIENT FEEDBACK SURVEY TO EXPLORE EXPERIENCES OF LIVING WITH SICKLE CELL DISEASE IN THE UK. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.95] [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: 11/13/2022] Open
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Chakravorty S, Sarkar S, Gachhui R. [Identification of new conserved and variable regions in the 16S rRNA gene of acetic acid bacteria and acetobacteraceae family]. Mol Biol (Mosk) 2015; 49:749-59. [PMID: 26510592 DOI: 10.7868/s0026898415050055] [Citation(s) in RCA: 3] [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: 08/20/2014] [Accepted: 01/27/2015] [Indexed: 11/23/2022]
Abstract
The Acetobacteraceae family of the class Alpha Proteobacteria is comprised of high sugar and acid tolerant bacteria. The Acetic Acid Bacteria are the economically most significant group of this family because of its association with food products like vinegar, wine etc. Acetobacteraceae are often hard to culture in laboratory conditions and they also maintain very low abundances in their natural habitats. Thus identification of the organisms in such environments is greatly dependent on modern tools of molecular biology which require a thorough knowledge of specific conserved gene sequences that may act as primers and or probes. Moreover unconserved domains in genes also become markers for differentiating closely related genera. In bacteria, the 16S rRNA gene is an ideal candidate for such conserved and variable domains. In order to study the conserved and variable domains of the 16S rRNA gene of Acetic Acid Bacteria and the Acetobacteraceae family, sequences from publicly available databases were aligned and compared. Near complete sequences of the gene were also obtained from Kombucha tea biofilm, a known Acetobacteraceae family habitat, in order to corroborate the domains obtained from the alignment studies. The study indicated that the degree of conservation in the gene is significantly higher among the Acetic Acid Bacteria than the whole Acetobacteraceae family. Moreover it was also observed that the previously described hypervariable regions V1, V3, V5, V6 and V7 were more or less conserved in the family and the spans of the variable regions are quite distinct as well.
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Affiliation(s)
- S Chakravorty
- Department of Life Science and Biotechnology, Jadavpur University, Kolkata-700032, West Bengal, India
| | - S Sarkar
- Department of Life Science and Biotechnology, Jadavpur University, Kolkata-700032, West Bengal, India
| | - R Gachhui
- Department of Life Science and Biotechnology, Jadavpur University, Kolkata-700032, West Bengal, India.,
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Chakravorty S, Sarkar S, Gachhui R. Identification of new conserved and variable regions in the 16S rRNA gene of acetic acid bacteria and acetobacteraceae family. Mol Biol 2015. [DOI: 10.1134/s0026893315050052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sunberg Z, Chakravorty S, Scott Erwin R. Information space receding horizon control. IEEE Trans Cybern 2013; 43:2255-2260. [PMID: 23757584 DOI: 10.1109/tsmcb.2012.2236313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this paper, we present a receding horizon solution to the optimal sensor scheduling problem. The optimal sensor scheduling problem can be posed as a partially observed Markov decision problem whose solution is given by an information space (I-space) dynamic programming (DP) problem. We present a simulation-based stochastic optimization technique that, combined with a receding horizon approach, obviates the need to solve the computationally intractable I-space DP problem. The technique is tested on a sensor scheduling problem, in which a sensor must choose among the measurements of N dynamical systems in a manner that maximizes information regarding the aggregate system over an infinite horizon. While simple, such problems nonetheless lead to very high dimensional DP problems to which the receding horizon approach is well suited.
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Chakravorty S, King MJ, Bain BJ. An unexpectedly bizarre blood film in hemoglobin H disease. Am J Hematol 2012; 87:1104. [PMID: 22573537 DOI: 10.1002/ajh.23240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 11/05/2022]
Affiliation(s)
- S Chakravorty
- Department of Hematology, St Mary's Hospital campus of Imperial College, St Mary's Hospital, Praed Street, London W2 1NY, UK.
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Khadilkar UN, Khadilkar NP, Rao PS, Chakravorty S, Goel G. Superficial angiomyxoma of the external ear not associated with Carney's complex: a case report. Kathmandu Univ Med J (KUMJ) 2007; 5:546-549. [PMID: 18604093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Superficial angiomyxomas are rare tumours and multiple tumours occurring in the external ear are invariably associated with Carney's complex. In the present study, a solitary superficial angiomyxoma was found in a 20 year old lady; and there was no evidence of any of the components of Carney's complex at the time of presentation or at the end of 2 years of follow-up, after the surgical excision of the tumour.
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Affiliation(s)
- U N Khadilkar
- Department of Pathology, Kasturba Medical College, Mangalore, Karnataka State, India.
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Duggal P, Chakravorty S, Azad RK, Mohan C. An epidemiological study on patients undergoing dacryocystorhinostomy. Indian J Otolaryngol Head Neck Surg 2006; 58:349-51. [PMID: 23120343 DOI: 10.1007/bf03049589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/25/2022] Open
Abstract
Dacryocystorhinostomy is performed in patients with naso-lacrimal duct obstruction to bypass the site of obstruction so as to relieve the patient of the irritating and socially embarrassing symptoms of epiphora. We discuss the various epidemiological aspects especially the vast difference by which the females out-number the males in patients undergoing DCR and the likely explanations for this difference in our study on 74 patients which underwent DCR in our institute.
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Affiliation(s)
- Prahlad Duggal
- Department of ENT, Dr. Rajinder Prasad Govt. Medical College, Tanda, Kangra, Himachal Pradesh
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Bain BJ, Murray JA, Patterson KG, Chakravorty S, Ancliff P, Wong CC, Hann I, Wong C, Philpott N, Bolam S, Thomas W. Slide session, British Society for Haematology, 45th Annual Scientific Meeting, Manchester, 2005. ACTA ACUST UNITED AC 2005; 27:363-9. [PMID: 16307536 DOI: 10.1111/j.1365-2257.2005.00732.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Each year at the Annual Scientific Meeting of the British Society for Haematology, there is a slide session in which microscopic slides of six patients with haematological disorders are discussed by two experts. Further data and the final diagnosis are then provided. The slide session is presented here, as it occurred at the meeting.
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Affiliation(s)
- B J Bain
- Department of Haematology, St Mary's Hospital, London, UK.
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Bliwise DL, Freeman A, Ingram CD, Rye DB, Chakravorty S, Watts RL. Randomized, double-blind, placebo-controlled, short-term trial of ropinirole in restless legs syndrome. Sleep Med 2005; 6:141-7. [PMID: 15716217 DOI: 10.1016/j.sleep.2004.12.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Revised: 10/20/2004] [Accepted: 12/01/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Restless legs syndrome (RLS) is a condition characterized by an urge to move the legs, usually accompanied by lower limb paresthesias. These symptoms worsen at rest, are relieved by activity, and are worse at night. Previous studies have suggested that dopaminergic drugs such as L-dopa and dopamine agonists, as well as benzodiazepines and opioids, can treat RLS successfully. The purpose of this study was to test the clinical efficacy of ropinirole, a D2/D3 agonist, in the treatment of RLS in a double-blind, short-term, placebo-controlled clinical trial. PATIENTS AND METHODS After undergoing successful open-label titration and dose adjustments with ropinirole for RLS symptoms over a period of 4 weeks, 22 RLS patients (mean age=50.8; mean duration of symptoms=26.1 years) were randomized to receive either placebo (n=13) or ropinirole (n=9) for 2 additional weeks. Outcome measures included assessment of periodic leg movements in sleep (PLMS) recorded with nocturnal polysomnography and RLS symptoms as assessed with the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale. Secondary outcomes included sleep macroarchitecture. RESULTS Results indicated that relative to placebo, ropinirole, at a mean dose of 1.4mg HS significantly decreased PLMS and RLS symptoms. Sleep macroarchitecture did not change. Side effects were typical of all dopamine agonists and were dose related. The majority of patients elected to continue treatment with ropinirole upon study completion. CONCLUSIONS Ropinirole successfully treated long-standing RLS and can be considered a viable short-term treatment for this condition.
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Affiliation(s)
- D L Bliwise
- Department of Neurology, Emory University Medical School, WMRB, Suite 6000, 1639 Pierce Drive, Atlanta, GA 30322, USA.
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Abstract
Nucleic acid amplification technologies offer great promise for the rapid, sensitive and specific diagnosis of tuberculosis. However, the isolation of inhibitor-free DNA from biological specimens is a bottleneck of the PCR assay. Here we describe a simple method for the isolation of PCR-amplifiable DNA of Mycobacterium tuberculosis from all types of samples of pulmonary and extrapulmonary origin tested. Briefly, it involves concentration of the bacilli by high-speed centrifugation, removal of PCR inhibitors by a wash solution containing guanidinium isothiocyanate and the release of bacterial DNA by heating in the presence of detergents and Chelex-100 resin. The entire process is accomplished within approximately 3 h. The method has been validated on 780 samples of human, bovine and guinea pig origin including sputum, cerebrospinal fluid, pulmonary fluids, pus, fine needle aspirate, tissue, blood and milk.
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Affiliation(s)
- S Chakravorty
- Department of Biotechnology, All India Institute of Medical Sciences, New Delhi-110029, India
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Reynolds CH, Tropsha A, Pfahler LB, Druker R, Chakravorty S, Ethiraj G, Zheng W. Diversity and coverage of structural sublibraries selected using the SAGE and SCA algorithms. J Chem Inf Comput Sci 2001; 41:1470-7. [PMID: 11749571 DOI: 10.1021/ci010041u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
It is often impractical to synthesize and test all compounds in a large exhaustive chemical library. Herein, we discuss rational approaches to selecting representative subsets of virtual libraries that help direct experimental synthetic efforts for diverse library design. We compare the performance of two stochastic sampling algorithms, Simulating Annealing Guided Evaluation (SAGE; Zheng, W.; Cho, S. J.; Waller, C. L.; Tropsha, A. J. Chem. Inf. Comput. Sci. 1999, 39, 738-746.) and Stochastic Cluster Analysis (SCA; Reynolds, C. H.; Druker, R.; Pfahler, L. B. Lead Discovery Using Stochastic Cluster Analysis (SCA): A New Method for Clustering Structurally Similar Compounds J. Chem. Inf. Comput. Sci. 1998, 38, 305-312.) for their ability to select both diverse and representative subsets of the entire chemical library space. The SAGE and SCA algorithms were compared using u- and s-optimal metrics as an independent assessment of diversity and coverage. This comparison showed that both algorithms were capable of generating sublibraries in descriptor space that are diverse and give reasonable coverage (i.e. are representative) of the original full library. Tests were carried out using simulated two-dimensional data sets and a 27 000 compound proprietary structural library as represented by computed Molconn-Z descriptors. One of the key observations from this work is that the algorithmically simple SCA method is capable of selecting subsets that are comparable to the more computationally intensive SAGE method.
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Affiliation(s)
- C H Reynolds
- The R. W. Johnson Pharmaceutical Research Institute, Welsh and McKean Roads, Spring House, PA 19477, USA.
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Duncan EJ, Madonick SH, Parwani A, Angrist B, Rajan R, Chakravorty S, Efferen TR, Szilagyi S, Stephanides M, Chappell PB, Gonzenbach S, Ko GN, Rotrosen JP. Clinical and sensorimotor gating effects of ketamine in normals. Neuropsychopharmacology 2001; 25:72-83. [PMID: 11377920 DOI: 10.1016/s0893-133x(00)00240-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical similarities between PCP psychosis and schizophrenia have contributed importantly to the development of the glutamate hypothesis of schizophrenia. Sensory gating, as measured by prepulse inhibition of the acoustic startle reflex (PPI), is impaired in patients with schizophrenia. In animals, the noncompetitive NMDA antagonists PCP and ketamine disrupt PPI in a way that resembles the defect seen in schizophrenia. The purpose of this work is to investigate the modulation of sensory gating in humans by subanaesthetic doses of ketamine. 16 healthy male subjects received a 60-min infusion of ketamine (0.5 mg/kg) or normal saline on two separate days in a randomized double-blind crossover design. Clinical ratings and PPI were done during the infusion on both days. Ketamine produced robust clinical effects. Dissociative symptoms as measured by the CADSS increased from 0 +/- 0.0 to 29.3 +/- 14.3; negative symptoms (Affect Rating Scale) increased from 17.2 +/- 0.8 to 24.8 +/- 3.1; and total BPRS scores increased from 18.3 +/- 0.8 to 26.4 +/- 5.1. ANOVAs for these ratings were all significant at the p <.000 level, although BPRS increases were not in the range seen in decompensated schizophrenic patients. The amplitudes of the startle responses to pulse-alone stimuli were not significantly different on ketamine and placebo days. Ketamine did not cause disruption in PPI as expected. On the contrary, in the first block of the PPI session ketamine significantly enhanced PPI (ANOVA; F=6.15, p =.026). These results indicate that the clinical effects of ketamine are not coupled with schizophrenic-like disruption of PPI in normal controls.
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Affiliation(s)
- E J Duncan
- Veterans Affairs New York Harbor Health Care System/New York Campus, New York, NY, USA.
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Duncan E, Madonick S, Chakravorty S, Parwani A, Szilagyi S, Efferen T, Gonzenbach S, Angrist B, Rotrosen J. Effects of smoking on acoustic startle and prepulse inhibition in humans. Psychopharmacology (Berl) 2001; 156:266-72. [PMID: 11549228 DOI: 10.1007/s002130100719] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
RATIONALE Prepulse inhibition of the acoustic startle response (PPI) is a paradigm in which a startle response to an auditory stimulus is reduced when that stimulus is preceded by a lower intensity, non-startling stimulus (prepulse). PPI is used as an operational measure of sensorimotor gating in both humans and other mammals. Acute administration of nicotine enhances PPI in rats, an effect that has been recently demonstrated in humans. OBJECTIVES We compared PPI in 12 male smokers and 14 male non-smokers tested in four repeat startle sessions across 2 test days in order to examine further the effects of smoking and smoking withdrawal on acoustic startle and PPI. METHODS In a crossover design, the smokers smoked ad lib or abstained from smoking overnight prior to 9 a.m. testing. These 2 test days were in randomized order. On both days, smokers were immediately retested after smoking three cigarettes. Non-smokers were tested twice on each of 2 separate days. RESULTS Across sessions, the smokers had reduced startle to pulse alone stimuli in the first block of each session when compared to the non-smokers. The non-smokers had no change in gating across their four test sessions. For the smokers, the abstinence condition produced a non-significant reduction in PPI compared to that of the ad lib smoking day. During the smoking abstinence session, smokers had comparable gating to non-smokers. Smoking immediately after washout produced a significant improvement in PPI such that gating in the smokers exceeded that of the non-smokers. CONCLUSION Smoking after overnight washout from cigarettes enhanced sensorimotor gating compared to pre-smoking values and compared to gating in non-smokers.
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Affiliation(s)
- E Duncan
- Psychiatry Service, New York Harbor Veterans Affairs Medical Center, NY 10010, USA.
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Chanda S, Chakravorty S. Host-mediated juvenoids affect development and metamorphosis of endoparasitic wasp, Chelonus blackburni (Hymenoptera: Braconidae) and consequent morphogenetic derangements in its reproductive system. Indian J Exp Biol 2001; 39:143-7. [PMID: 11480210] [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] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Juvenoids, applied topically on larvae of Corcyra cephalonica harbouring the larvae of the parasitoid, produce various types of developmental derangements in parasitoid C. blackburni. The deformed morphs, e.g., apparently normal adults, adultoids and prolonged larvae were developed at different rates by different doses of juvenoids. Larval and pupal mortality rates of the parasite were 6-13 and 4-8% respectively in different treatments. Deformities in reproductive system of the parasitoid were increased or decreased ovariole number, development of compound egg chamber and ill-developed ovariole.
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Affiliation(s)
- S Chanda
- Department of Zoology, University of Kalyani, Kalyani 741 235, India
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40
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Ray R, Chakravorty S, Tyagi JS, Airan B, Talwar KK, Venugopal P, Chopra P. Fatal atypical mycobacterial infection in a cardiac transplant recipient. Indian Heart J 2001; 53:100-3. [PMID: 11456134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
A 37-year-old female underwent heart transplantation for giant cell myocarditis. The patient died within three-and-a-half months of cardiac transplantation. Postmortem specimens from the heart and lung showed multiple necrotizing granulomas with numerous acid-fast bacilli. Polymerase chain reaction done on both the postmortem samples confirmed the presence of atypical mycobacterial infection. This fatal case of atypical mycobacteriosis in a cardiac transplant patient is reported for its rarity.
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Affiliation(s)
- R Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi
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41
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Chanda S, Chakravorty S. Morphogenetic derangements in the reproductive system of Bracon hebetor, a beneficial parasitoid, bred on juvenoid treated host (Corcyra cephalonica) larvae. Indian J Exp Biol 2000; 38:700-4. [PMID: 11215314] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Effect of juvenoids (hydroprene and methoprene) on the ecto-parasite B. hebetor was investigated by rearing them upon the juvenoid treated ultimate instar host larvae of C. cephalonica. Emerged adultoid wasps of either sexes obtained from treated series showed anatomical deformities in the reproductive systems. Ill-developed ovaries with reduced length, terminally free ovarioles and abnormal testicular growth showing non-fusion of lobes were the important abnormal features. Data on measurements of male reproductive system, e.g., width (transverse axis) of testis, length of common vas deferens plus ejaculatory duct and length of accessory gland showed significant difference (P < 0.05) from control.
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Affiliation(s)
- S Chanda
- Department of Zoology, University of Kalyani, Kalyani 741235, India
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Abstract
Substance abuse has been associated with attempted suicide and suicide. Few studies have examined the prevalence and associations of combined depression and substance abuse in suicide attempters. A chart review study of 1136 adult general hospital patients referred for psychiatric consultation between 1995 and 1998 was conducted to assess this further. Among 371 cases with self-harm, 311 (84%) attempted suicide. Suicide attempters were younger and diagnosed more often with comorbid substance abuse than patients without self-harm. Depressive disorders were found in 59% and substance abuse disorders in 46%. Comorbid depression and substance abuse was the most frequent category in suicide attempters, i.e., in 37%. Self-reported suicide intent was associated with increasing age, male gender, and comorbid depression and substance abuse. The suicide rate in suicide attempters was 322 per 100,000 patient-years, and 131 per 100,000 in consultation patients without self-harm. It is concluded that comorbid depression and substance abuse is associated with attempted suicide in psychiatric consultation patients. Suicide attempters should be thoroughly assessed for substance abuse. The increased suicide rate in psychiatric consultation patients with and without suicide attempts warrants further research.
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Affiliation(s)
- D M Dhossche
- Department of Psychiatry, University of South Alabama College of Medicine, Mobile, Alabama, USA
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Parwani A, Duncan EJ, Bartlett E, Madonick SH, Efferen TR, Rajan R, Sanfilipo M, Chappell PB, Chakravorty S, Gonzenbach S, Ko GN, Rotrosen JP. Impaired prepulse inhibition of acoustic startle in schizophrenia. Biol Psychiatry 2000; 47:662-9. [PMID: 10745060 DOI: 10.1016/s0006-3223(99)00148-1] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Schizophrenics show deficits in sensorimotor gating, as measured by prepulse inhibition of acoustic startle (PPI). The goal of this investigation is to further characterize PPI and habituation deficits in schizophrenia, and to examine whether differing subgroups of schizophrenics would show comparable PPI deficits. METHODS PPI was measured in 24 male schizophrenic subjects (9 acutely decompensated inpatients and 15 stable outpatients) and in 20 age-matched normal control subjects. Schizophrenic subjects were rated for positive and negative symptoms at the time of testing. RESULTS Schizophrenic subjects showed deficits in prepulse inhibition and habituation as compared to normal subjects. Similar latency facilitation was produced by the prepulse in both groups. Acutely decompensated inpatients and stable outpatients did not differ in percent PPI. PPI did not correlate with severity of positive or negative symptoms. CONCLUSIONS These results suggest that schizophrenic subjects have impaired central inhibitory mechanisms as measured by PPI, and support the hypothesis that periods of relative clinical remission are not accompanied by normalization of sensorimotor gating.
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Affiliation(s)
- A Parwani
- New York Veterans Affairs Medical Center, Psychiatric Service, New York, NY 10010, USA
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Efferen TR, Duncan EJ, Szilagyi S, Chakravorty S, Adams JU, Gonzenbach S, Angrist B, Butler PD, Rotrosen J. Diminished acoustic startle in chronic cocaine users. Neuropsychopharmacology 2000; 22:89-96. [PMID: 10633494 DOI: 10.1016/s0893-133x(99)00089-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- T R Efferen
- School of Medicine, New York University, NY, USA
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45
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Devi K, Patnaik L, Chakravorty S, Mishra K, Mohanty GN. Bone marrow necrosis in paediatric patients. INDIAN J PATHOL MICR 2000; 43:47-50. [PMID: 12583419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Necrosis of bone marrow is a very rare condition with a prevalence ranging from 0.15 to 7 percent. It is mostly not compatible with life. We diagnosed four cases of necrotic marrow out of 830 bone marrow aspirations done in last five years of time. All were paediatric patients having peripheral pancytopenia. Three out of four patients expired within one month of diagnosis.
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Affiliation(s)
- K Devi
- Division of Haematology, Department of Pathology, S.C.B. Medical College, Cuttack
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46
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Abstract
The structure and rotational barrier for substituted diacylhydrazines are of significant interest given the role this functionality plays in peptidomimetics and ecdysone agonists, the latter of which have application as extremely selective insecticides. Ab initio calculations show that the lowest energy conformations are typically nonplanar with essentially perpendicular nitrogen lone pairs. Molecular mechanics calculations using the AMBER force field in MacroModel yield minima and rotational barriers that are both quantitatively and qualitatively inconsistent with the ab initio results. In this work the AMBER N-N rotational barriers for all configurations of the parent, methyl and di-methyl substituted diformylhydrazines have been fitted to MP2/6-31 + G relative energies. The resulting AMBER torsional parameters have been validated by calculating the rotational barriers for N-t-butyl substituted diformylhydrazine, dibenzoylhydrazine and an azadipeptide. In each case the new AMBER rotational barriers compare favorably with the corresponding MP2 calculated rotational barriers.
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Affiliation(s)
- S Chakravorty
- Rohm and Haas Company, Spring House, PA 19477-0904, USA
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47
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Silkoff PE, Chatkin J, Qian W, Chakravorty S, Gutierrez C, Furlott H, McClean P, Rai S, Zamel N, Haight J. Nasal nitric oxide: a comparison of measurement techniques. Am J Rhinol 1999; 13:169-78. [PMID: 10392234 DOI: 10.2500/105065899781389803] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nasal nitric oxide measurement may be a surrogate marker of upper airway inflammation. There is, however, no standardized measurement technique; and this led us to examine measurement techniques for acceptability and reproducibility. In five subjects we examined the flow dependence of nasal NO. In 13 healthy volunteers, nasal NO was measured on-line by five methods: 1) Tidal nasal and oral breathing: NO sampling during exclusive nasal followed by exclusive oral tidal breathing; 2) Fixed flow exhalation: NO sampling during exclusive nasal followed by exclusive oral exhalation at 100 mL/second from total lung capacity; 3) Nasal-oral aspiration: air aspirated from the mouth via both nares at 100 mL/second with glottis closure; 4) Aspiration from one nares: air aspirated from one nares at 3.3 mL/second using nitric oxide analyzer sample line with velum closure; 5) Nasal Insufflation: NO sampled at one nares as air insufflated into the other nares at a flow of 100 mL/second with velum closure. Acceptability of all methods was assessed by subjects and technicians. Nasal NO concentration showed a significant inverse correlation with transnasal flow rate. All methods showed excellent reproducibility as assessed by the intraclass correlation coefficient except tidal breathing, which showed highly variable breath-to-breath NO levels, although mean breath values were reproducible. Mean nasal NO concentrations with methods 1, 2, 3, 4, and 5 were 32.1, 50.2, 62.8, 1381, and 60.0 ppb, respectively. Velum closure was not always achieved in methods 4 and 5, whereas methods 1 and 2 required separate nasal and oral procedures. Method 5 had reduced acceptability. NO concentrations were similar with methods that used the same airflow (2, 3, and 5). Nasal NO can be sampled in different ways with excellent reproducibility. In view of the flow dependence of nasal NO, it is vital to use a constant flow rate, and lower airway NO contribution must be excluded or subtracted. The fixed flow exhalation appears to be the preferred method as it is highly reproducible and acceptable.
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Affiliation(s)
- P E Silkoff
- Division of Respiratory Medicine, University of Toronto, Canada
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Abstract
The reproducibility of nasal patency measurements was assessed by acoustic rhinometry and active rhinomanometry using previously described Toronto methodologies. Six subjects with normal upper airways were tested with both procedures on six separate occasions within a 2-month period. Topical decongestant was applied to minimize the effects of mucosal variation on the nasal airway. The mean coefficients of variation (mean +/- s.d; %) over time of the measurements were 8.1 +/- 4.1 and 9.7 +/- 5.2 for minimal unilateral cross-sectional area and 4.8 +/- 1.8 and 5.5 +/- 3.5 for nasal volume (0-5 cm) of the right and left sides, respectively. For active rhinomanometry, the mean coefficients of variation (mean +/- s.d.; %) over time of the measurements were 15.9 +/- 7.3, 12.9 +/- 4.6, and 8.5 +/- 2.8 for right, left and combined nasal airflow resistance. The intraclass correlation coefficient was 0.76, 0.70, and 0.96 for right, left, and combined nasal resistance, 0.91 and 0.87 for right and left minimal cross sectional area, and 0.86 and 0.69 for right and left nasal volumes, respectively, also confirming a high level of reproducibility for both methods. In conclusion, performed by an experienced operator under controlled circumstances, the reproducibility of both methods of nasal patency assessment compared favorably with many widely accepted clinical tests.
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Affiliation(s)
- P E Silkoff
- Department of Otolaryngology and Medicine, Mt. Sinai Hospital, University of Toronto, Canada
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Chowdhury A, Chakravorty S, Sinha I, Chowdhury S. Cirrhosis of the liver presenting with galactorrhea. J Clin Gastroenterol 1997; 25:716-7. [PMID: 9451707 DOI: 10.1097/00004836-199712000-00046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Chowdhury
- Department of Gastroenterology, Institute of Post Graduate Medical Education and Research, Calcutta, India
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Abstract
Four hundred fourteen former and 73 current users of smokeless tobacco were questioned about their experiences in giving up smokeless tobacco. Their responses were compared with those of 463 ex-smokers to determine whether former smokeless tobacco users differed from former smokers in using specific cessation techniques. Of the smokeless tobacco users, 77% were interested in quitting, but only 7% wanted to quit "now." Seven percent of the daily users reported that a college-based health or fitness professional had advised them to quit. Former smokeless tobacco users were significantly more likely than former smokers to report that smoking cigarettes was related to their efforts to give up smokeless tobacco than former smokers were to report using smokeless tobacco as a strategy to stop smoking, Former smokeless tobacco users were also significantly more likely than former smokers to report current tobacco use. Smokeless tobacco cessation programs based on the transtheoretical approach to behavior change are recommended.
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Affiliation(s)
- B Chakravorty
- Department of Community Health, University of Illinois, Urbana-Champaign, USA
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