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Wong KYK, Hughes DA, Debski M, Latt N, Assaf O, Abdelrahman A, Taylor R, Allgar V, McNeill L, Howard S, Wong SYS, Jones R, Cassidy CJ, Seed A, Galasko G, Clark A, Wilson D, Davis GK, Montasem A, Lang CC, Kalra PR, Campbell R, Lip GYH, Cleland JGF. Effectiveness of out-patient based acute heart failure care: a pilot randomised controlled trial. Acta Cardiol 2023; 78:828-837. [PMID: 37694719 DOI: 10.1080/00015385.2023.2197834] [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: 05/08/2021] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES Acute heart failure (AHF) hospitalisation is associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM). METHODS We randomised patients with AHF, considered to need IV diuretic treatment for ≥2 days, to IPM or OPM. We recorded all-cause mortality, and the number of days alive and out-of-hospital (DAOH). Quality of life, mental well-being and Hope scores were assessed. Mean NHS cost savings and 95% central range (CR) were calculated from bootstrap analysis. Follow-up: 60 days. RESULTS Eleven patients were randomised to IPM and 13 to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [p = .86]. The OPM group accrued more DAOH {47 [36,51] vs 59 [41,60], p = .13}. Two patients randomised to IPM (vs 6 OPM) were readmitted [p = .31]. Hope scores increased more with OPM within 30 days but dropped to lower levels than IPM by 60 days. More out-patients had increased total well-being scores by 60 days (p = .04). OPM was associated with mean cost savings of £2658 (95% CR 460-4857) per patient. CONCLUSIONS Patients with acute HF randomised to OPM accrued more days alive out of hospital (albeit not statistically significantly in this small pilot study). OPM is favoured by patients and carers and is associated with improved mental well-being and cost savings.
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Affiliation(s)
- K Y K Wong
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - D A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - M Debski
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - N Latt
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - O Assaf
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Abdelrahman
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Taylor
- Research and Development Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - V Allgar
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - L McNeill
- Accountant, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - S Howard
- Financial Information And Costing Manager, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - S Y S Wong
- Department of Care of the Older Person, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - R Jones
- Public Involvement Group, Research and Development Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - C J Cassidy
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Seed
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - G Galasko
- Department of Cardiology, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - A Clark
- Peninsula Clinical Trials Unit, University of Plymouth, Plymouth, UK
| | - D Wilson
- Department of Cardiology, Worcestershire Royal Hospital (Worcestershire Acute Hospital NHS Trust), Worcester, UK
| | - G K Davis
- Cardiorespiratory Research Centre, Edge Hill University Medical School, Ormskirk, UK
| | - A Montasem
- Institute of Life Course and Medical Sciences, School of Dental Sciences, Liverpool University Dental Hospital, University of Liverpool, Liverpool, UK
| | - C C Lang
- Department of Cardiology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - P R Kalra
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - R Campbell
- Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - G Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - J G F Cleland
- Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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2
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Weisse N, Esslinger J, Howard S, Foerster FM, Haberstroh F, Doyle L, Norreys P, Schreiber J, Karsch S, Döpp A. Measuring spatio-temporal couplings using modal spatio-spectral wavefront retrieval. Opt Express 2023; 31:19733-19745. [PMID: 37381382 DOI: 10.1364/oe.483801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/23/2023] [Indexed: 06/30/2023]
Abstract
Knowledge of spatio-temporal couplings such as pulse-front tilt or curvature is important to determine the focused intensity of high-power lasers. Common techniques to diagnose these couplings are either qualitative or require hundreds of measurements. Here we present both a new algorithm for retrieving spatio-temporal couplings, as well as novel experimental implementations. Our method is based on the expression of the spatio-spectral phase in terms of a Zernike-Taylor basis, allowing us to directly quantify the coefficients for common spatio-temporal couplings. We take advantage of this method to perform quantitative measurements using a simple experimental setup, consisting of different bandpass filters in front of a Shack-Hartmann wavefront sensor. This fast acquisition of laser couplings using narrowband filters, abbreviated FALCON, is easy and cheap to implement in existing facilities. To this end, we present a measurement of spatio-temporal couplings at the ATLAS-3000 petawatt laser using our technique.
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3
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Carle PJF, Retière F, Sher A, Underwood R, Starosta K, Hildebrand M, Barsky S, Howard S. Publisher's Note: "Neutron emission spectrometer to measure ion temperature on the Fusion Demonstration Plant" [Rev. Sci. Instrum. 93, 113539 (2022)]. Rev Sci Instrum 2022; 93:129904. [PMID: 36586939 DOI: 10.1063/5.0135254] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Indexed: 06/17/2023]
Affiliation(s)
- P J F Carle
- General Fusion, Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - F Retière
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - A Sher
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - R Underwood
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - K Starosta
- Department of Chemistry, Simon Fraser University, 8888 University Dr., Burnaby, British Columbia V5A 1S6, Canada
| | - M Hildebrand
- General Fusion, Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - S Barsky
- General Fusion, Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - S Howard
- General Fusion, Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
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4
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Carle PJF, Retière F, Sher A, Underwood R, Starosta K, Hildebrand M, Barsky S, Howard S. Neutron emission spectrometer to measure ion temperature on the Fusion Demonstration Plant. Rev Sci Instrum 2022; 93:113539. [PMID: 36461414 DOI: 10.1063/5.0101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
General Fusion is building the Fusion Demonstration Plant to demonstrate a magnetized target fusion scheme in which a deuterium plasma is heated from 200 eV to 10 keV by piston-driven compression of a liquid-lithium liner. The multilayer coaxial time-of-flight neutron emission spectrometer is designed to measure the ion temperature near peak compression at which time the neutron yield will approach 1018 neutrons/s. The neutron energy distribution is expected to be Gaussian since the machine uses no neutral beam or radio-frequency heating. In this case, analysis shows that as few as 500 coincidence events should be sufficient to accurately measure the ion temperature. This enables a fast time resolution of 10 µs, which is required to track the rapid change in temperature approaching peak compression. We overcome the challenges of neutron pile-up and event ambiguity with a compact design having two layers of segmented scintillators. The error in the ion temperature measurement is computed as a function of the neutron spectrometer's geometric parameters and used to optimize the design for the case of reaching 10 keV at peak compression.
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Affiliation(s)
- P J F Carle
- General Fusion Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - F Retière
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - A Sher
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - R Underwood
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - K Starosta
- Department of Chemistry, Simon Fraser University, 8888 University Dr., Burnaby, British Columbia V5A 1S6, Canada
| | - M Hildebrand
- General Fusion Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - S Barsky
- General Fusion Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
| | - S Howard
- General Fusion Inc., 320-3600 Lysander Lane, Richmond, British Columbia V7B 1C3, Canada
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5
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Mills WR, Sender S, Lichtefeld J, Romano N, Reynolds K, Price M, Phipps J, White L, Howard S, Poltavski D, Barnes R. Supporting individuals with intellectual and developmental disability during the first 100 days of the COVID-19 outbreak in the USA. J Intellect Disabil Res 2020; 64:489-496. [PMID: 32490559 PMCID: PMC7300850 DOI: 10.1111/jir.12740] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND It is unknown how the novel Coronavirus SARS-CoV-2, the cause of the current acute respiratory illness COVID-19 pandemic that has infected millions of people, affects people with intellectual and developmental disability (IDD). The aim of this study is to describe how individuals with IDD have been affected in the first 100 days of the COVID-19 pandemic. METHODS Shortly after the first COVID-19 case was reported in the USA, our organisation, which provides continuous support for over 11 000 individuals with IDD, assembled an outbreak committee composed of senior leaders from across the health care organisation. The committee led the development and deployment of a comprehensive COVID-19 prevention and suppression strategy, utilising current evidence-based practice, while surveilling the global and local situation daily. We implemented enhanced infection control procedures across 2400 homes, which were communicated to our employees using multi-faceted channels including an electronic resource library, mobile and web applications, paper postings in locations, live webinars and direct mail. Using custom-built software applications enabling us to track patient, client and employee cases and exposures, we leveraged current public health recommendations to identify cases and to suppress transmission, which included the use of personal protective equipment. A COVID-19 case was defined as a positive nucleic acid test for SARS-CoV-2 RNA. RESULTS In the 100-day period between 20 January 2020 and 30 April 2020, we provided continuous support for 11 540 individuals with IDD. Sixty-four per cent of the individuals were in residential, community settings, and 36% were in intermediate care facilities. The average age of the cohort was 46 ± 12 years, and 60% were male. One hundred twenty-two individuals with IDD were placed in quarantine for exhibiting symptoms and signs of acute infection such as fever or cough. Sixty-six individuals tested positive for SARS-CoV-2, and their average age was 50. The positive individuals were located in 30 different homes (1.3% of total) across 14 states. Fifteen homes have had single cases, and 15 have had more than one case. Fifteen COVID-19-positive individuals were hospitalised. As of 30 April, seven of the individuals hospitalised have been discharged back to home and are recovering. Five remain hospitalised, with three improving and two remaining in intensive care and on mechanical ventilation. There have been three deaths. We found that among COVID-19-positive individuals with IDD, a higher number of chronic medical conditions and male sex were characteristics associated with a greater likelihood of hospitalisation. CONCLUSIONS In the first 100 days of the COVID-19 outbreak in the USA, we observed that people with IDD living in congregate care settings can benefit from a coordinated approach to infection control, case identification and cohorting, as evidenced by the low relative case rate reported. Male individuals with higher numbers of chronic medical conditions were more likely to be hospitalised, while most younger, less chronically ill individuals recovered spontaneously at home.
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Affiliation(s)
| | - S. Sender
- BrightSpring Health ServicesLouisvilleKYUSA
| | | | - N. Romano
- BrightSpring Health ServicesLouisvilleKYUSA
| | | | - M. Price
- BrightSpring Health ServicesLouisvilleKYUSA
| | - J. Phipps
- BrightSpring Health ServicesLouisvilleKYUSA
| | - L. White
- BrightSpring Health ServicesLouisvilleKYUSA
| | - S. Howard
- BrightSpring Health ServicesLouisvilleKYUSA
| | - D. Poltavski
- BrightSpring Health ServicesLouisvilleKYUSA
- University of North DakotaGrand ForksNDUSA
| | - R. Barnes
- BrightSpring Health ServicesLouisvilleKYUSA
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6
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Howard S, Fitzgerald G, Gallagher S. Cardiovascular stress reactions in recent- and long-retired rugby players when watching a game. Physiol Behav 2020; 219:112832. [DOI: 10.1016/j.physbeh.2020.112832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/08/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022]
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7
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O'Reilly P, Kennedy C, Meskell P, Coffey A, Delaunois I, Dore L, Howard S, Ramsay B, Scanlon C, Wilson DM, Whelan B, Ryan S. The psychological impact of Stevens-Johnson syndrome and toxic epidermal necrolysis on patients' lives: a Critically Appraised Topic. Br J Dermatol 2020; 183:452-461. [PMID: 31792924 PMCID: PMC7687230 DOI: 10.1111/bjd.18746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
CLINICAL SCENARIO A 65-year-old man presented with a 12-h history of deteriorating rash. Two weeks previously he had completed a course of neoadjuvant chemotherapy for ductal carcinoma of the breast. On examination there were bullae, widespread atypical targetoid lesions and 15% epidermal detachment. There was no mucosal involvement on presentation, but subsequently it did evolve. Skin biopsy showed subepidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). On transfer to intensive care he was anxious and fearful. MANAGEMENT QUESTION What are the psychological impacts of SJS/TEN on this man's life? BACKGROUND SJS and TEN have devastating outcomes for those affected. OBJECTIVES To conduct a Critically Appraised Topic to (i) analyse existing research related to the psychological impact of SJS and TEN and (ii) apply the results to the clinical scenario. METHODS Seven electronic databases were searched for publications focusing on the psychological impact of SJS/TEN on adults over 18 years of age. RESULTS Six studies met the inclusion criteria. Healthcare practitioners' (HCPs') lack of information around the disorder was highlighted. Patients experienced undue stress and fear. Some patients had symptoms aligned to post-traumatic stress disorder (PTSD), anxiety and depression. DISCUSSION AND RECOMMENDATION The evidence suggests that SJS and TEN impact psychologically on patients' lives. Education of HCPs, to address their lack of awareness and information on SJS/TEN, should facilitate their capacity to provide information and support to patients, thereby reducing patient anxiety. On discharge, a follow-up appointment with relevant HCPs to reduce the possibility of PTSD occurring should be considered.
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Affiliation(s)
- P O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - C Kennedy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,School of Nursing and Midwifery, Robert Gordon University, Aberdeen, U.K
| | - P Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - A Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology (HIST) Research Cluster, University of Limerick, Limerick, Ireland
| | - I Delaunois
- Regional Medical Library, University Hospital Limerick, Limerick, Ireland
| | - L Dore
- Glucksman Library, University of Limerick, Limerick, Ireland
| | - S Howard
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Psychology, University of Limerick, Limerick, Ireland
| | - B Ramsay
- Charles Centre for Dermatology, University Hospital Limerick, Limerick, Ireland
| | | | - D M Wilson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.,Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - B Whelan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - S Ryan
- Charles Centre for Dermatology, University Hospital Limerick, Limerick, Ireland
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8
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Clark S, Shaw C, Padayachee A, Howard S, Hay K, Frakking TT. Frailty and hospital outcomes within a low socioeconomic population. QJM 2019; 112:907-913. [PMID: 31386153 DOI: 10.1093/qjmed/hcz203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clinical frailty scales (CFS) predict hospital-related outcomes. Frailty is more common in areas of higher socioeconomic disadvantage, but no studies exclusively report on the impact of CFS on hospital-related outcomes in areas of known socioeconomic disadvantage. AIMS To evaluate the association of the CFS with hospital-related outcomes. DESIGN Retrospective observational study in a community hospital within a disadvantaged area in Australia (Social Economic Index for Areas = 0.1%). METHODS The CFS was used in the emergency department (ED) for people aged ≥ 75 years. Frailty was defined as a score of ≥4. Associations between the CFS and mortality, admission rates, ED presentations and length of stay (LOS) were analysed using regression analyses. RESULTS Between 11 July 2017 and 31 March 2018, there were 5151 ED presentations involving 3258 patients aged ≥ 75 years. Frail persons were significantly more likely to be older, represent to the ED and have delirium compared with non-frail persons. CFS was independently associated with 28-day mortality, with odds of mortality increasing by 1.5 times per unit increase in CFS (95% CI: 1.3-1.7). Frail persons with CFS 4-6 were more likely to be admitted (OR: 1.2; 95% CI: 1.0-1.5), have higher geometric mean LOS (1.43; 95% CI 1.15-1.77 days) and higher rates of ED presentations (IRR: 1.12; 95% CI 1.04-1.21) compared with non-frail persons. CONCLUSIONS The CFS predicts community hospital-related outcomes in frail persons within a socioeconomic disadvantage area. Future intervention and allocation of resources could consider focusing on CFS 4-6 as a priority for frail persons within a community hospital setting.
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Affiliation(s)
- S Clark
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - C Shaw
- Emergency Department, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - A Padayachee
- Projects and Service Partnerships, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - S Howard
- Nursing Informatics, Caboolture Hospital, Queensland Health, McKean St, Caboolture, Queensland, Australia
| | - K Hay
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - T T Frakking
- Caboolture Hospital, Research Development Unit, Queensland Health, McKean St, Caboolture, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
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Zanaty M, Howard S, Roa J, Alvarez C, Kung D, McCarthy D. Cognitive and Cerebral Hemodynamic Effects of Endovascular Recanalization of Chronically Occluded Cervical Internal Carotid Artery: Single-Center Study and Review of the Literature. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Hughes B, Súilleabháin P, Howard S. Openness to Experience and cardiovascular stress responsivity: A novel examination of hemodynamic trajectories during acute stress exposure. Int J Psychophysiol 2018. [DOI: 10.1016/j.ijpsycho.2018.07.234] [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: 11/15/2022]
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Burr A, Howard S. Abstract P2-11-19: Safety and efficacy of re-irradiation for locoregional breast cancer recurrences using pulsed reduced dose rate technique and concurrent capecitabine. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-11-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Locoregionally recurrent breast cancer presents a tremendous therapeutic challenge, but successful treatment can provide a durable cure. Re-irradiation has been performed infrequently in the recurrent setting due to concern for toxicity. Pulsed reduced dose rate radiation is a technique that can decrease the toxicity of re-irradiation by increasing normal tissue repair. Here, we update our previously published results of chest wall re-irradiation with an additional 16 patients and a focus on outcomes and long term toxicities.
Methods: Patients treated from 11/09/2000 to 04/21/2016 with pulsed reduced dose rate radiation therapy at the University of Wisconsin were identified by query of Aria radiation oncology record software. Patients were retreated to a median dose of 54 Gy (range 37.5-66 Gy) using pulsed reduced does rate technique, delivering radiation at an apparent dose rate of 0.067 Gy/min to allow for normal tissue repair. The median cumulative dose was 109.8 Gy (range 75 to 236 Gy). Eleven patients underwent comprehensive re-irradiation to the chest wall and locoregional lymphatics, while the remainder underwent re-treatment limited to the site of recurrence. Concurrent capecitabine was given to 15 patients, most frequently at 500mg BID (range 1000 mg to 1500mg daily). The Kaplan-Meier method was used for survival analysis.
Results: Thirty-three patients were identified who were treated with pulsed reduced dose rate radiation therapy for locoregionally recurrent invasive breast cancer with a median follow-up of 19.8 months (range 6.8-133.8 months). Sixteen patients were treated with curative intent and 17 patients were treated with palliative intent. Twenty-two patients had gross disease present at the time of treatment, 6 patients had microscopically positive surgical margins, and 5 patients were treated who had negative margins. The 2 year locoregional recurrence free survival was 70.5% by the Kaplan-Meier method for all patients and 81.5% for patients treated with curative intent. Two year overall survival was 43.6% for all patients and 72.2% in patients treated with curative intent. The rate of acute grade 3 skin toxicity was 21.2%. No other acute grade three toxicities occurred. A total of 9 patients (27.2%) developed late grade 3 or greater toxicities, including 4 patients who developed lymphedema, 4 patients who developed non-healing wounds, and one patient who developed both lymphedema and a non-healing wound.
Conclusion: Pulsed reduced dose rate radiation therapy with capecitabine is an effective method for treating patients with recurrent breast cancer. The moderate risk of toxicity is warranted in a subset of patients with high risk of disease recurrence or morbidity from disease progression. Further work, including prospective studies, is needed to determine the patients who who will benefit most from this technique.
Citation Format: Burr A, Howard S. Safety and efficacy of re-irradiation for locoregional breast cancer recurrences using pulsed reduced dose rate technique and concurrent capecitabine [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-11-19.
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Affiliation(s)
- A Burr
- University of Wisconsin, Madison, WI
| | - S Howard
- University of Wisconsin, Madison, WI
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12
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Stilwell JM, Boylan SM, Howard S, Camus AC. Gas gland adenoma in a lined seahorse, Hippocampus erectus, Perry 1810. J Fish Dis 2018; 41:171-174. [PMID: 28677159 DOI: 10.1111/jfd.12677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J M Stilwell
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - S M Boylan
- Department of Husbandry, South Carolina Aquarium, Charleston, SC, USA
| | - S Howard
- Department of Husbandry, South Carolina Aquarium, Charleston, SC, USA
| | - A C Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Paolo FS, Padman L, Fricker HA, Adusumilli S, Howard S, Siegfried MR. Response of Pacific-sector Antarctic ice shelves to the El Niño/Southern Oscillation. Nat Geosci 2018; 11:121-126. [PMID: 29333198 PMCID: PMC5758867 DOI: 10.1038/s41561-017-0033-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Satellite observations over the past two decades have revealed increasing loss of grounded ice in West Antarctica, associated with floating ice shelves that have been thinning. Thinning reduces an ice-shelf's ability to restrain grounded-ice discharge, yet our understanding of the climate processes that drive mass changes is limited. Here, we use ice-shelf height data from four satellite altimeter missions (1994-2017) to show a direct link between ice-shelf-height variability in the Antarctic Pacific sector and changes in regional atmospheric circulation driven by the El Niño-Southern Oscillation. This link is strongest from Dotson to Ross ice shelves and weaker elsewhere. During intense El Niño years, height increase by accumulation exceeds the height decrease by basal melting, but net ice-shelf mass declines as basal ice loss exceeds lower-density snow gain. Our results demonstrate a substantial response of Amundsen Sea ice shelves to global and regional climate variability, with rates of change in height and mass on interannual timescales that can be comparable to the longer-term trend, and with mass changes from surface accumulation offsetting a significant fraction of the changes in basal melting. This implies that ice-shelf height and mass variability will increase as interannual atmospheric variability increases in a warming climate.
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Affiliation(s)
- F S Paolo
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109, USA
| | - L Padman
- Earth & Space Research, Corvallis, OR 97333, USA
| | - H A Fricker
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
| | - S Adusumilli
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
| | - S Howard
- Earth & Space Research, Seattle, WA 98121, USA
| | - M R Siegfried
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
- Department of Geophysics, Stanford University, Palo Alto, CA 94305, USA
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Abgrall N, Arnquist IJ, Avignone FT, Barabash AS, Bertrand FE, Bradley AW, Brudanin V, Busch M, Buuck M, Caldwell TS, Chan YD, Christofferson CD, Chu PH, Cuesta C, Detwiler JA, Dunagan C, Efremenko Y, Ejiri H, Elliott SR, Gilliss T, Giovanetti GK, Goett J, Green MP, Gruszko J, Guinn IS, Guiseppe VE, Haufe CRS, Henning R, Hoppe EW, Howard S, Howe MA, Jasinski BR, Keeter KJ, Kidd MF, Konovalov SI, Kouzes RT, Lopez AM, MacMullin J, Martin RD, Massarczyk R, Meijer SJ, Mertens S, O'Shaughnessy C, Poon AWP, Radford DC, Rager J, Reine AL, Rielage K, Robertson RGH, Shanks B, Shirchenko M, Suriano AM, Tedeschi D, Trimble JE, Varner RL, Vasilyev S, Vetter K, Vorren K, White BR, Wilkerson JF, Wiseman C, Xu W, Yakushev E, Yu CH, Yumatov V, Zhitnikov I, Zhu BX. New Limits on Bosonic Dark Matter, Solar Axions, Pauli Exclusion Principle Violation, and Electron Decay from the Majorana Demonstrator. Phys Rev Lett 2017; 118:161801. [PMID: 28474933 DOI: 10.1103/physrevlett.118.161801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Indexed: 06/07/2023]
Abstract
We present new limits on exotic keV-scale physics based on 478 kg d of Majorana Demonstrator commissioning data. Constraints at the 90% confidence level are derived on bosonic dark matter (DM) and solar axion couplings, Pauli exclusion principle violating (PEPV) decay, and electron decay using monoenergetic peak signal limits above our background. Our most stringent DM constraints are set for 11.8 keV mass particles, limiting g_{Ae}<4.5×10^{-13} for pseudoscalars and (α^{'}/α)<9.7×10^{-28} for vectors. We also report a 14.4 keV solar axion coupling limit of g_{AN}^{eff}×g_{Ae}<3.8×10^{-17}, a 1/2β^{2}<8.5×10^{-48} limit on the strength of PEPV electron transitions, and a lower limit on the electron lifetime of τ_{e}>1.2×10^{24} yr for e^{-}→ invisible.
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Affiliation(s)
- N Abgrall
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - I J Arnquist
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - F T Avignone
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A S Barabash
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow 117218, Russia
| | - F E Bertrand
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A W Bradley
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - V Brudanin
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - M Busch
- Department of Physics, Duke University, Durham, North Carolina 27708, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
| | - M Buuck
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - T S Caldwell
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - Y-D Chan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C D Christofferson
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - P-H Chu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - C Cuesta
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - J A Detwiler
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - C Dunagan
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - Yu Efremenko
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - H Ejiri
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - S R Elliott
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - T Gilliss
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - G K Giovanetti
- Department of Physics, Princeton University, Princeton, New Jersey 08544, USA
| | - J Goett
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M P Green
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - J Gruszko
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - I S Guinn
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - V E Guiseppe
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
| | - C R S Haufe
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - R Henning
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - E W Hoppe
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - S Howard
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - M A Howe
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - B R Jasinski
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - K J Keeter
- Department of Physics, Black Hills State University, Spearfish, South Dakota 57799, USA
| | - M F Kidd
- Tennessee Tech University, Cookeville, Tennessee 38505, USA
| | - S I Konovalov
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow 117218, Russia
| | - R T Kouzes
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - A M Lopez
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - J MacMullin
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - R D Martin
- Department of Physics, Engineering Physics and Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - R Massarczyk
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S J Meijer
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - S Mertens
- Max-Planck-Institut für Physik, München 80805, Germany
- Physik Department and Excellence Cluster Universe, Technische Universität, München 80805, Germany
| | - C O'Shaughnessy
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - A W P Poon
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - D C Radford
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Rager
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - A L Reine
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - K Rielage
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - R G H Robertson
- Center for Experimental Nuclear Physics and Astrophysics, and Department of Physics, University of Washington, Seattle, Washington 98195, USA
| | - B Shanks
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - M Shirchenko
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - A M Suriano
- South Dakota School of Mines and Technology, Rapid City, South Dakota 57701, USA
| | - D Tedeschi
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
| | - J E Trimble
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - R L Varner
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - S Vasilyev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - K Vetter
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - K Vorren
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - B R White
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J F Wilkerson
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27599, USA
| | - C Wiseman
- Department of Physics and Astronomy, University of South Carolina, Columbia, South Carolina 29208, USA
| | - W Xu
- Department of Physics, University of South Dakota, Vermillion, South Dakota 57069, USA
| | - E Yakushev
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - C-H Yu
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - V Yumatov
- National Research Center "Kurchatov Institute" Institute for Theoretical and Experimental Physics, Moscow 117218, Russia
| | - I Zhitnikov
- Joint Institute for Nuclear Research, Dubna 141980, Russia
| | - B X Zhu
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
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Donaghy J, Lopes A, Ali M, Davda R, Mascoll J, Forgenie J, Howard S, McGovern U, Payne H, Mitra A, Linch M. An end of life prognostic score for patients with metastatic prostate cancer receiving palliative radiotherapy. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw384.15] [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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16
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Neba N, Mensah-Brown N, Howlin T, Howard S, Saleh H. SU-F-T-483: An Investigation into the Effect of Varying Temperature On PTP Corrections in TG-51. Med Phys 2016. [DOI: 10.1118/1.4956668] [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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Neilson M, VanOverebeke D, Depue S, Lusk J, Norwood B, Ramanathan R, Howard S, Mafi G. Consumer preference of ground beef patties with varying percentages of finely textured beef. Meat Sci 2016. [DOI: 10.1016/j.meatsci.2015.08.030] [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: 11/27/2022]
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Howard S, Patel M, Lang AR, Youle C, Vyas H, Shaw D, Sharples S. P157 Individual patterns of inhaler use and health outcomes in adolescents with asthma: Abstract P157 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.294] [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: 11/04/2022]
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19
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Hepel J, Leonard K, Howard S, Ng T, Taber A, Khurshid H, Birnbaum A, (BrUOG) B, Wazer D, DiPetrillo T. SBRT Boost Following Concurrent Chemoradiation for Locally Advanced NSCLCa: A Phase 1 Dose-Escalation Study. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Boylan SM, Camus A, Waltzek T, Yarbrough L, Miller SR, Howard S. Liquid nitrogen cryotherapy for fibromas in tarpon, Megalops atlanticus, Valenciennes 1847, and neoplasia in lined sea horse, Hippocampus erectus, Perry 1810. J Fish Dis 2015; 38:681-685. [PMID: 25039679 DOI: 10.1111/jfd.12276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Affiliation(s)
- S M Boylan
- Department of Husbandry, South Carolina Aquarium, Charleston, SC, USA
| | - A Camus
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - T Waltzek
- Department of Infectious Diseases and Pathology, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - L Yarbrough
- Mount Pleasant Dermatology, LLC, Mount Pleasant, SC, USA
| | - S R Miller
- Department of Husbandry, South Carolina Aquarium, Charleston, SC, USA
| | - S Howard
- Department of Husbandry, South Carolina Aquarium, Charleston, SC, USA
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Lago-Hernandez CA, Feldman H, O'Donnell E, Mahal BA, Perez V, Howard S, Rosenthal M, Cheng SC, Nguyen PL, Beard C, D'Amico AV, Sweeney CJ. A refined risk stratification scheme for clinical stage 1 NSGCT based on evaluation of both embryonal predominance and lymphovascular invasion. Ann Oncol 2015; 26:1396-401. [PMID: 25888612 DOI: 10.1093/annonc/mdv180] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 04/07/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Active surveillance is an increasingly accepted approach for managing patients with germ-cell tumors (GCTs) after an orchiectomy. Here we investigate a time-to-relapse stratification scheme for clinical stage 1 (CS1) nonseminoma GCT (NSGCT) patients according to factors associated with relapse and identify a group of patients with a lower frequency and longer time-to-relapse who may require an alternative surveillance strategy. PATIENTS AND METHODS We analyzed 266 CS1 GCT patients from the IRB-approved DFCI GCT database that exclusively underwent surveillance following orchiectomy from 1997 to 2013. We stratified NSGCT patients according to predominance of embryonal carcinoma (EmbP) and lymphovascular invasion (LVI), using a 0, 1, and 2 scoring system. Cox regression and conditional risk analysis were used to compare each NSGCT group to patients in the seminomatous germ-cell tumor (SGCT) category. Median time-to-relapse values were then calculated among those patients who underwent relapse. Relapse-free survival curves were generated using the Kaplan-Meier method. RESULTS Fifty (37%) NSGCT and 20 (15%) SGCT patients relapsed. The median time-to-relapse was 11.5 versus 6.3 months for the SGCT and NSGCT groups, respectively. For NSGCT patients, relapse rates were higher and median time-to-relapse faster with increasing number of risk factors (RFs). Relapse rates (%) and median time-to-relapse (months) were 25%/8.5 months, 41%/6.8 months and 78%/3.8 months for RF0, RF1 and RF2, respectively. We found a statistically significant difference between SGCT and patients with one or two RFs (P < 0.001) but not between SGCT and NSGCT RF0 (P = 0.108). CONCLUSION NSGCT patients grouped by a risk score system based on EmbP and LVI yielded three groups with distinct relapse patterns -and patients with neither EmbP nor LVI appear to behave similar to SGCT.
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Affiliation(s)
- C A Lago-Hernandez
- Harvard Medical School, Boston Department of Medical Oncology-Genitourinary Division, Dana-Farber Cancer Institute, Boston
| | - H Feldman
- Albert Einstein College of Medicine, New York Department of Medical Oncology-Genitourinary Division, Dana-Farber Cancer Institute, Boston
| | - E O'Donnell
- Department of Medical Oncology-Genitourinary Division, Dana-Farber Cancer Institute, Boston
| | - B A Mahal
- Harvard Medical School, Boston Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston
| | - V Perez
- University of Puerto Rico Medical School, San Juan PR
| | - S Howard
- Departments of Imaging, Dana-Farber Cancer Institute, Boston, USA
| | - M Rosenthal
- Departments of Imaging, Dana-Farber Cancer Institute, Boston, USA
| | - S C Cheng
- Biostatistics/Computational Biology, Dana-Farber Cancer Institute, Boston, USA
| | - P L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston
| | - C Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston
| | - A V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston
| | - C J Sweeney
- Department of Medical Oncology-Genitourinary Division, Dana-Farber Cancer Institute, Boston
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Howard S, Speight L, Mills-Bennett R, Lau D, Ketchell R, Duckers J. WS9.6 The All Wales Adult Cystic Fibrosis Centre (AWACFC) Virtual Instruction of Exercise With Technology to Enhance Care – VIEWTEC Programme. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jennings JM, Howard S, Perotte CL. Effects of a school-based sexuality education program on peer educators: the Teen PEP model. Health Educ Res 2014; 29:319-29. [PMID: 24488649 PMCID: PMC3959206 DOI: 10.1093/her/cyt153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 12/17/2013] [Indexed: 05/20/2023]
Abstract
This study evaluated the impact of the Teen Prevention Education Program (Teen PEP), a peer-led sexuality education program designed to prevent unintended pregnancy and sexually transmitted infections (STIs) including HIV among high school students. The study design was a quasi-experimental, nonrandomized design conducted from May 2007 to May 2008. The sample consisted of 96 intervention (i.e. Teen PEP peer educators) and 61 comparison students from five high schools in New Jersey. Baseline and 12-month follow-up surveys were conducted. Summary statistics were generated and multiple regression analyses were conducted. In the primary intent-to-treat analyses, and secondary non-intent-to-treat analyses, Teen PEP peer educators (versus comparison students) reported significantly greater opportunities to practice sexual risk reduction skills and higher intentions to talk with friends, parents, and sex partners about sex and birth control, set boundaries with sex partners, and ask a partner to be tested for STIs including HIV. In addition in the secondary analysis, Teen PEP peer educators (as compared with the comparison students) had significantly higher scores on knowledge of sexual health issues and ability to refuse risky sexual situations. School-based sexuality education programs offering comprehensive training to peer educators may improve sexual risk behavior knowledge, attitudes and behaviors among high school students.
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Affiliation(s)
- J. M. Jennings
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA and Center for Supportive Schools (formerly Princeton Center for Leadership Training), 911 Commons Way, Princeton, NJ 08540, USA
- *Correspondence to: J. M. Jennings. E-mail:
| | - S. Howard
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA and Center for Supportive Schools (formerly Princeton Center for Leadership Training), 911 Commons Way, Princeton, NJ 08540, USA
| | - C. L. Perotte
- Center for Child and Community Health Research (CCHR), Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA and Center for Supportive Schools (formerly Princeton Center for Leadership Training), 911 Commons Way, Princeton, NJ 08540, USA
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Howard S, Metzger M. SIOP PODC Adapted Treatment Regimens for Hodgkin Lymphoma: A Framework for Management of Pediatric Cancer in Low- and Middle-income Countries. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371137] [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: 10/25/2022]
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Anwar M, Lupo J, Molinaro A, Clarke J, Butowski N, Prados M, Chang S, HaasKogan D, Nelson S, Ashman J, Drazkowski J, Zimmerman R, Lidner T, Giannini C, Porter A, Patel N, Atean I, Shin N, Toltz A, Laude C, Freeman C, Seuntjens J, Roberge D, Back M, Kastelan M, Guo L, Wheeler H, Beauchesne P, Faure G, Noel G, Schmitt T, Martin L, Jadaud E, Carnin C, Bowers J, Bennion N, Lomas H, Spencer K, Richardson M, McAllister W, Sheehan J, Schlesinger D, Kersh R, Brower J, Gans S, Hartsell W, Goldman S, Chang JHC, Mohammed N, Siddiqui M, Gondi V, Christensen E, Klawikowski S, Garg A, McAleer M, Rhines L, Yang J, Brown P, Chang E, Settle S, Ghia A, Edson M, Fuller GN, Allen P, Li J, Garsa A, Badiyan S, Simpson J, Dowling J, Rich K, Chicoine M, Leuthardt E, Kim A, Robinson C, Gill B, Peskorski D, Lalonde R, Huq MS, Flickinger J, Graff A, Clerkin P, Smith H, Isaak R, Dinh J, Grosshans D, Allen P, de Groot J, McGovern S, McAleer M, Gilbert M, Brown P, Mahajan A, Gupta T, Mohanty S, Kannan S, Jalali R, Hardie J, Laack N, Kizilbash S, Buckner J, Giannini C, Uhm J, Parney I, Jenkins R, Decker P, Voss J, Hiramatsu R, Kawabata S, Furuse M, Niyatake SI, Kuroiwa T, Suzuki M, Ono K, Hobbs C, Vallow L, Peterson J, Jaeckle K, Heckman M, Bhupendra R, Horowitz D, Wuu CS, Feng W, Drassinower D, Lasala A, Lassman A, Wang T, Indelicato D, Rotondo R, Bradley J, Sandler E, Aldana P, Mendenhall N, Marcus R, Kabarriti R, Mourad WF, Mejia DM, Glanzman J, Patel S, Young R, Bernstein M, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Khatua S, Hou P, Wolff J, Hamilton J, Zaky W, Mahajan A, Ketonen L, Kim SH, Lee SR, Ji, Oh Y, Krishna U, Shah N, Pathak R, Gupta T, Lila A, Menon P, Goel A, Jalali R, Lall R, Lall R, Smith T, Schumacher A, McCaslin A, Kalapurakal J, Chandler J, Magnuson W, Robins HI, Mohindra P, Howard S, Mahajan A, Manfredi D, Rogers CL, Palmer M, Hillebrandt E, Bilton S, Robinson G, Velasco K, Mehta M, McGregor J, Grecula J, Ammirati M, Pelloski C, Lu L, Gupta N, Bell S, Moller S, Law I, Rosenschold PMA, Costa J, Poulsen HS, Engelholm SA, Morrison A, Cuglievan B, Khatib Z, Mourad WF, Kabarriti R, Young R, Santiago T, Blakaj DM, Welch M, Graber J, Patel S, Hong LX, Patel A, Tandon A, Bernstein MB, Shourbaji RA, Glanzman J, Kinon MD, Fox JL, Lasala P, Kalnicki S, Garg MK, Nicholas S, Salvatori R, Lim M, Redmond K, Quinones A, Gallia G, Rigamonti D, Kleinberg L, Patel S, Mourad W, Young R, Kabarriti R, Santiago T, Glanzman J, Bernstein M, Patel A, Yaparpalvi R, Hong L, Fox J, LaSala P, Kalnicki S, Garg M, Redmond K, Mian O, Degaonkar M, Sair H, Terezakis S, Kleinberg L, McNutt T, Wharam M, Mahone M, Horska A, Rezvi U, Melian E, Surucu M, Mescioglu I, Prabhu V, Clark J, Anderson D, Robbins J, Yechieli R, Ryu S, Ruge MI, Suchorska B, Hamisch C, Mahnkopf K, Lehrke R, Treuer H, Sturm V, Voges J, Sahgal A, Al-Omair A, Masucci L, Masson-Cote L, Atenafu E, Letourneau D, Yu E, Rampersaud R, Lewis S, Yee A, Thibault I, Fehlings M, Shi W, Palmer J, Li J, Kenyon L, Glass J, Kim L, Werner-wasik M, Andrews D, Susheela S, Revannasiddaiah S, Muzumder S, Mallarajapatna G, Basavalingaiah A, Gupta M, Kallur K, Hassan M, Bilimagga R, Tamura K, Aoyagi M, Ando N, Ogishima T, Yamamoto M, Ohno K, Maehara T, Xu Z, Vance ML, Schlesinger D, Sheehan J, Young R, Blakaj D, Kinon MD, Mourad W, LaSala PA, Hong L, Kalnicki S, Garg M, Young R, Mourad W, Patel S, Fox J, LaSala PA, Hong L, Graber JJ, Santiago T, Kalnicki S, Garg M, Zimmerman AL, Vogelbaum MA, Barnett GH, Murphy ES, Suh JH, Angelov L, Reddy CA, Chao ST. RADIATION THERAPY. Neuro Oncol 2013; 15:iii178-iii188. [PMCID: PMC3823902 DOI: 10.1093/neuonc/not187] [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: 09/23/2023] Open
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Williams C, Northstone K, Borwick C, Gainsborough M, Roe J, Howard S, Rogers S, Amos J, Woodhouse JM. How to help children with neurodevelopmental and visual problems: a scoping review. Br J Ophthalmol 2013; 98:6-12. [PMID: 24158842 PMCID: PMC4030252 DOI: 10.1136/bjophthalmol-2013-304225] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Children with visual impairment and a condition affecting their neurodevelopment (children with VND) may require extensive and specialised help but evidence on the most effective strategies for visual improvement is lacking. We defined a PICO format (Population, Intervention, Comparator, Outcome) for a scoping review and systematically searched 13 databases. Two reviewers assessed the abstracts for inclusion and a third arbitrated in cases of disagreement. We abstracted data from included studies. We found 4450 abstracts from which we identified 107 papers for inclusion. Of these, 42 related to interventions involving a change in visual input or function: 5 controlled trials, 8 before and after studies and 29 case reports. The strongest evidence supported the provision of spectacles to improve distance or near vision and the use of ultraviolet light as environmental modification for training. Less strong but suggestive evidence supported training/practice routines to improve acuity or oculomotor control. Interventions exist to help children with VND and current recommendations that they are assessed by a vision specialist are supported by the evidence. More information is needed on the effectiveness of training/practice programmes which may promote improved function, and of environmental modifications to facilitate engagement of children with VND with the surroundings.
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Affiliation(s)
- C Williams
- School of Social and Community Medicine, University of Bristol, , Bristol, Somerset, UK
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Packer RJ, Rood BR, Onar-Thomas A, Goldman S, Fisher MJ, Smith C, Boyett J, Kun L, Nelson MB, Compton P, Macey P, Patel S, Jacob E, O'Neil S, Finlay J, Harper R, Legault G, Chhabra A, Allen JC, Si SJ, Flores N, Haley K, Malvar J, Fangusaro J, Dhall G, Sposto R, Davidson TB, Finlay JL, Krieger M, Finlay JL, Zhou T, Miller DC, Geyer JR, Pollack IF, Gajjar A, Cohen BH, Nellan A, Murray JC, Honeycutt J, Gomez A, Head H, Braly E, Puccetti DM, Patel N, Kennedy T, Bradley K, Howard S, Salamat S, Iskandar B, Slavc I, Peyrl A, Chocholous M, Kieran M, Azizi A, Czech T, Dieckmann K, Haberler C, Sadighi ZS, Ellezam B, Khatua S, Ater J, Biswas A, Kakkar A, Goyal S, Mallick S, Sarkar C, Sharma MC, Julka PK, Rath GK, Glass T, Cochrane DD, Rassekh SR, Goddard K, Hukin J, Deopujari CE, Khakoo Y, Hanmantgad S, Forester K, McDonald SA, De Braganca K, Yohay K, Wolff JE, Kwiecien R, Rutkowski S, Pietsch T, Faldum A, Kortmann RD, Kramm C, Fouladi M, Olson J, Stewart C, Kocak M, Onar-Thomas A, Wagner L, Packer R, Goldman S, Gururangan S, Blaney S, Pollack I, Smith C, Demuth T, Kun L, Boyett J, Gilbertson R, Powell MK, Klement GL, Roffidal T, Fonkem E, Wolff JE. CLIN-PEDIATRICS CLINICAL RESEARCH. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos234] [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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Kola S, Walsh J, Hughes B, Howard S. Attention focus, trait anxiety and pain perception in patients undergoing colposcopy. Eur J Pain 2011; 16:890-900. [DOI: 10.1002/j.1532-2149.2011.00068.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2011] [Indexed: 11/10/2022]
Affiliation(s)
- S. Kola
- School of Psychology; National University of Ireland; Galway; Ireland
| | - J.C. Walsh
- School of Psychology; National University of Ireland; Galway; Ireland
| | - B.M. Hughes
- School of Psychology; National University of Ireland; Galway; Ireland
| | - S. Howard
- School of Psychology; National University of Ireland; Galway; Ireland
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Naumov G, Valentine E, Howard S, Seeley A, Jha S, Reilly JF, Bloecher A, Wexler RS, Keihack H, Winter C, Sathyanarayanan S. Development of a novel dalotuzumab/AKT inhibitor combination therapy for the treatment of cetuximab refractory colorectal cancer (CRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13590] [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: 11/20/2022] Open
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Howard S, Mahler P, Tomé W. PULSED REDUCED DOSE-RATE RADIOTHERAPY: AN IRRADIATION STRATEGY MINIMIZING NEUROCOGNITIVE LATE EFFECTS. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Sathyanarayanan S, Watkins D, Sykes K, Howard S, Valentine E, Bloecher A, Clark E, Hsu K, Cunningham D, Winter C. 229 Anti-IGF1R therapy with dalotuzumab is efficacious in a sub-set of KRAS mutant cetuximab refractory CRC models. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Kromrey S, Howard S, Hegde J. Neural Mechanisms of Perception of Depth-Order from Motion: A Human fMRI Study. J Vis 2010. [DOI: 10.1167/10.7.49] [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] Open
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Azam J, Howard S, Macdonald W, Howell SJ. Fit for surgery? A study of self-reported exercise capacity in vascular surgical patients. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2009.06183_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eggen M, Swingen C, Matta P, Bateman M, Rolfes C, Quill J, Richardson E, Howard S, Iaizzo P. Design of a Novel Perfusion System to Perform MR Imaging of an Isolated Beating Heart. J Med Device 2009. [DOI: 10.1115/1.3147496] [Citation(s) in RCA: 5] [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: 11/08/2022] Open
Abstract
Isolated mammalian hearts have been used to study cardiac physiology, pharmacology, and biomedical devices in order to separate myocardial characteristics from the milieu of the intact animal and to allow for increased control over experimental conditions. Considering these benefits and that MRI is the “gold” standard for measuring myocardial function, it was considered desirable to have a system which would allow simultaneous MR imaging of an isolated beating heart. Here we describe a unique portable system, which enables physiologic perfusion of an isolated heart during simultaneous MR imaging. A two unit system was designed to physiologically support a large mammalian isolated heart during MR imaging were a modified Krebs-Henseleit perfusate was used as a blood substitute. The first unit, which resides in an adjacent support room next to the scanner, contains all electronically powered equipment and components (with ferromagnetic materials) which cannot operate safely near the magnet, including (1) a thermal module and custom tube in tube heat exchanger warming the perfusate to 38°C; (2) a carbogen tank (95% O2 5% CO2) and hollow fiber oxygenator; and (3) two centrifugal blood pumps which circulates and pressurizes the left and right atrial filling chambers. The second unit, which resides next to the magnet and is free of ferromagnetic materials, receives warmed, oxygenated perfusate from the first unit via PVC tubing. The isolated hearts were connected to the second unit via four cannulae sutured to the great vessels. A support system placed inside the scanner on the patient bed secured the hearts and cannulae in the correct anatomical position. To date, this system was tested in a 1.5 T Siemens scanner using swine hearts (n=2). The hearts were arrested with St. Thomas cardioplegia and removed via a medial sternotomy. After cannulation of the great vessels, reperfusion, and defibrillation, four-chamber and tagged short-axis cine loops were acquired using standard ECG gating. Tagged short-axis images obtained at the base, mid-ventricle, and apex were used to measure the following functional parameters for one heart: LV end-diastolic volume=38.84 ml, LV end-systolic volume=23.23 ml, LV stroke volume=15.6 ml, LV ejection fraction=40.18%, and peak LV circumferential strain=16%. The feasibility of MR imaging an isolated, four-chamber working large mammalian heart was demonstrated using a custom designed and built portable MRI compatible perfusion system. This system will be useful in studying in vitro cardiac function (including human hearts) and developing MRI safe biomedical devices and MRI guided therapies in a controlled setting.
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Affiliation(s)
- M. Eggen
- University of Minnesota, Minneapolis, USA
| | - C. Swingen
- University of Minnesota, Minneapolis, USA
| | - P. Matta
- University of Minnesota, Minneapolis, USA
| | - M. Bateman
- University of Minnesota, Minneapolis, USA
| | - C. Rolfes
- University of Minnesota, Minneapolis, USA
| | - J. Quill
- University of Minnesota, Minneapolis, USA
| | | | - S. Howard
- University of Minnesota, Minneapolis, USA
| | - P. Iaizzo
- University of Minnesota, Minneapolis, USA
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Rong Y, Howard S, Paliwal B, Welsh J. MO-FF-A2-04: Pulsed Reduced Dose-Rate Radiotherapy On a Helical Tomotherapy Unit. Med Phys 2009. [DOI: 10.1118/1.3182286] [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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Howard S, Wan S, Freeman LJ. Congenital absence of the pulmonary valve. Case Reports 2009; 2009:bcr2006097535. [DOI: 10.1136/bcr.2006.097535] [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: 11/04/2022] Open
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Livingston J, Schmid B, Redemann J, Russell PB, Ramirez SA, Eilers J, Gore W, Howard S, Pommier J, Fetzer EJ, Seemann SW, Borbas E, Wolfe DE, Thompson AM. Comparison of water vapor measurements by airborne Sun photometer and near-coincident in situ and satellite sensors during INTEX/ITCT 2004. ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006jd007733] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Franklin J, Pluetschow A, Paus M, Specht L, Anselmo AP, Aviles A, Biti G, Bogatyreva T, Bonadonna G, Brillant C, Cavalieri E, Diehl V, Eghbali H, Fermé C, Henry-Amar M, Hoppe R, Howard S, Meyer R, Niedzwiecki D, Pavlovsky S, Radford J, Raemaekers J, Ryder D, Schiller P, Shakhtarina S, Valagussa P, Wilimas J, Yahalom J. Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials. Ann Oncol 2006; 17:1749-60. [PMID: 16984979 DOI: 10.1093/annonc/mdl302] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies.
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Affiliation(s)
- J Franklin
- German Hodgkin Study Group, University of Cologne, Germany.
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Abstract
We present a case of esophageal gastrointestinal stromal tumor presenting as gastrointestinal bleeding.
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Affiliation(s)
- N Manu
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK.
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El Saleeby CM, Howard S, Hayden R, McCullers JA. 318 ASSOCATION BETWEEN TEA INGESTION AND INVASIVE BACILLUS CEREUS INFECTION IN CHILDREN WITH CANCER: A CASE CONTROL STUDY. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-871] [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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El Saleeby CM, Howard S, Hayden R, McCullers JA. ASSOCATION BETWEEN TEA INGESTION AND INVASIVE BACILLUS CEREUS INFECTION IN CHILDREN WITH CANCER: A CASE CONTROL STUDY. J Investig Med 2004. [DOI: 10.1097/00042871-200401001-00871] [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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Pilewskie P, Pommier J, Bergstrom R, Gore W, Howard S, Rabbette M, Schmid B, Hobbs PV, Tsay SC. Solar spectral radiative forcing during the Southern African Regional Science Initiative. ACTA ACUST UNITED AC 2003. [DOI: 10.1029/2002jd002411] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- P. Pilewskie
- Earth Science Division; NASA Ames Research Center; Moffett Field California USA
| | - J. Pommier
- Bay Area Environmental Research Institute; Sonoma California USA
| | - R. Bergstrom
- Bay Area Environmental Research Institute; Sonoma California USA
| | - W. Gore
- Earth Science Division; NASA Ames Research Center; Moffett Field California USA
| | - S. Howard
- Bay Area Environmental Research Institute; Sonoma California USA
| | - M. Rabbette
- Bay Area Environmental Research Institute; Sonoma California USA
| | - B. Schmid
- Bay Area Environmental Research Institute; Sonoma California USA
| | - P. V. Hobbs
- Department of Atmospheric Sciences; University of Washington; Seattle Washington USA
| | - S. C. Tsay
- NASA Goddard Space Flight Center; Greenbelt Maryland USA
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Bleecker E, Perez-Perdomo R, Arvizu J, Howard S, Meyers D. Asthma in Puerto Rico. J Allergy Clin Immunol 2003. [DOI: 10.1016/s0091-6749(03)80518-3] [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: 10/24/2022]
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Romano MJ, Hernandez J, Gaylor A, Howard S, Knox R. Improvement in asthma symptoms and quality of life in pediatric patients through specialty care delivered via telemedicine. Telemed J E Health 2002; 7:281-6. [PMID: 11886666 DOI: 10.1089/15305620152814683] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Asthma is the most common chronic disease affecting children. Studies have demonstrated improvements in asthma control when care is delivered by specialists compared with generalists. We postulated that specialist care delivered by telemedicine would result in similar improvements in control of symptoms and quality of life as compared with face-to-face encounters with specialists. Seventeen patients with persistent asthma, who were cared for by pediatricians in a rural school-based health clinic, were treated over a 6-month period in an asthma specialty program. Patients had face-to-face encounters at week zero, and then telemedicine follow-up visits at weeks 4, 12, and 24. Patients maintained a symptom diary and reliever medication use log. Spirometry and patient and caregiver quality-of-life questionnaires were completed at each visit. Mean number of symptom free days increased 83% from 2.35 days at week 0 to 4.31 days at week 24 (p < 0.05). There was a 44% reduction in mean symptom scores, from 2.32 at week 0 to 1.31 at week 24 (p < 0.001). Nine patients reported having 7 symptom-free days or 7 days of symptom scores of zero in the preceding seven days at week 24 compared with one patient at week 0 (p < 0.002). FEV(1) increased by > or = 12% in seven patients during the study period. Significant improvements in quality of life were reported by patients at week 4 (p < 0.02) and week 24 (p < 0.01), and by caregivers at week 24 (p < 0.002). Specialty asthma care delivered via telemedicine resulted in improvements in asthma symptom control and quality of life similar to improvements reported in face-to-face encounters provided by specialists.
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Affiliation(s)
- M J Romano
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
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Etherton JR, Cutlip RG, Harris JR, Ronaghi M, Means KH, Howard S. Dynamic performance of the mechanism of an automatically deployable ROPS. J Agric Saf Health 2002; 8:113-8. [PMID: 12002370 DOI: 10.13031/2013.7222] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The mechanism for an automatically deployable ROPS (AutoROPS) has been designed and tested. This mechanism is part of an innovative project to provide passive protection against rollover fatality to operators of new tractors used in both low-clearance and unrestricted-clearance tasks. The device is a spring-action, telescoping structure that releases on signal to pyrotechnic squibs that actuate release pins. Upper post motion begins when the release pins clear an internal piston. The structure extends until the piston impacts an elastomeric ring and latches at the top position. In lab tests the two-post structure consistently deployed in less than 0.3 s and latched securely. Static load tests of the telescoping structure and field upset tests of the fully functional AutoROPS have been successfully completed.
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Affiliation(s)
- J R Etherton
- National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, USA.
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Abstract
[reaction--see text] The imidazolidine (tetrahydroimidazole) 2, prepared in one step from N-iso-propylethylenediamine, was subjected to asymmetric lithiation and substitution using sec-butyllithium, (-)-sparteine and a range of electrophiles. Substituted imidazolidines were formed with high optical purity and could be hydrolyzed under acidic conditions to chiral, substituted ethylenediamines. Kinetic data indicate that the conformation of the carbonyl group is crucial to the extent of deprotonation, and this has implications for the lithiation of unsymmetrical carbamates and carboxylic amides.
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Affiliation(s)
- I Coldham
- School of Chemistry, University of Exeter, Exeter EX4 4QD, UK.
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