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Abstract
Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U.S. Department of Defense to establish a 90-day Independent Review Commission on Sexual Assault in the Military (IRC) to assess the department's efforts and make actionable recommendations. As servicemembers discharge from the military, effects of military sexual trauma (MST) are often seen in the Veterans Health Administration (VA). In response to an IRC inquiry about VA MST research, we organized an overview on prevalence, adverse consequences, and evidence-based treatments targeting the sequelae of MST. Women are significantly more likely to experience MST than their male counterparts. Other groups with low societal and institutional power (e.g., lower rank) are also at increased risk. Although not all MST survivors experience long-term adverse consequences, for many, they can be significant, chronic, and enduring and span mental and physical health outcomes, as well as cumulative impairments in functioning. Adverse consequences of MST come with commonalities shared with sexual trauma in other settings (e.g., interpersonal betrayal, victim-blaming) as well as unique aspects of the military context, where experiences of interpersonal betrayal may be compounded by perceptions of institutional betrayal (e.g., fear of reprisal or ostracism, having to work/live alongside a perpetrator). MST's most common mental health impact is posttraumatic stress disorder, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.
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Affiliation(s)
- Tara E Galovski
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Amy E Street
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Street, Boston, MA, 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Suzannah Creech
- VA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas VA, Waco, TX, USA
- Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Keren Lehavot
- VA HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ursula A Kelly
- Atlanta VA Health Care System, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Haputhantri SSK, Bandaranayake KHK, Rathnasuriya MIG, Nirbadha KGS, Weerasekera SJWWMMP, Athukoorala AASH, Jayathilaka RAM, Perera HACC, Creech S. Reproductive Biology and Feeding Ecology of The Blue Swimming Crab (Portunus pelagicus) in Northern Coastal Waters, Sri Lanka. Trop Life Sci Res 2022; 33:155-178. [PMID: 35966266 PMCID: PMC9354908 DOI: 10.21315/tlsr2022.33.2.8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Blue swimming crab (Portunus pelagicus) fishery has emerged to become an important export-oriented fishery in Sri Lanka over a decade and recently resulted in a rapid increase in the exploitation. The present study attempts to understand the reproductive biology and feeding ecology of blue swimming crab which will be vital in the management of capture fishery. Five major landing sites in the Jaffna district in Northern Sri Lanka, where blue swimming crab is frequently landed throughout the year were selected for the study. Biological parameters relating to sex, carapace width, body weight, maturity, and egg sac colour with egg sac weight were recorded at the field from November 2014 to October 2015. Randomly selected crab samples were brought to the laboratory and analysed for their maturity stages, length at first maturity, Gonadosomatic Index, fecundity, and gut contents. The study revealed that male crabs mature at a smaller size than females. The sex ratio varied greatly with time and males were always dominant in the catch. The blue swimming crabs in the Northern waters of Sri Lanka spawn throughout the year, with two spawning peaks in February and May. The total fecundity of ovigerous blue swimming crab increased with increased carapace width and body weight and it ranged from 123,482 to 3,179,928 eggs, with an average of 884,982 ± 676,420. A remarkably higher percentage of empty stomachs were observed under the present study in both mature and immature crabs and this could be due to lack of food availability in the environment and different digestibility rates of food items. The diet of blue swimming crab is highly variable reflecting the ability to adopt to different modes of feeding.
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Claborn K, Creech S, Conway FN, Clinton NM, Brinkley KT, Lippard E, Ramos T, Samora J, Miri A, Benzer J. Development of a digital platform to improve community response to overdose and prevention among harm reduction organizations. Harm Reduct J 2022; 19:62. [PMID: 35658871 PMCID: PMC9164184 DOI: 10.1186/s12954-022-00636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/16/2022] [Indexed: 11/12/2022] Open
Abstract
The overdose crisis in the USA remains a growing and urgent public health concern. Over 108,000 people died due to overdose during 2021. Fatal and non-fatal overdoses are under-reported in the USA due to current surveillance methods. Systemic gaps in overdose data limit the opportunity for data-driven prevention efforts and resource allocation. This study aims to improve overdose surveillance and community response through developing a digital platform for overdose reporting and response among harm reduction organizations. We used a community-engaged, user-center design research approach. We conducted qualitative interviews with N = 44 overdose stakeholders including people who use drugs and harm reductionists. Results highlighted the need for a unified, multilingual reporting system uniquely tailored for harm reduction organizations. Anonymity, data transparency, protection from legal repercussions, data accuracy, and community-branded marketing emerged as key themes for the overdose platform. Emergent themes included the need for real-time data in a dashboard designed for community response and tailored to first responders and harm reduction organizations. This formative study provides the groundwork for improving overdose surveillance and data-driven response through the development of an innovative overdose digital platform.
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Affiliation(s)
| | | | | | | | | | | | | | - Jake Samora
- The University of Texas at Austin, Austin, TX, USA
| | - Aaron Miri
- Baptist Health, Jacksonville, Florida, USA
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Claborn KR, Creech S, Whittfield Q, Parra-Cardona R, Daugherty A, Benzer J. Ethical by Design: Engaging the Community to Co-design a Digital Health Ecosystem to Improve Overdose Prevention Efforts Among Highly Vulnerable People Who Use Drugs. Front Digit Health 2022; 4:880849. [PMID: 35712228 PMCID: PMC9192346 DOI: 10.3389/fdgth.2022.880849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The COVID-19 pandemic highlighted significant structural barriers that exacerbated health inequities among people at-risk for overdose. Digital health technologies have the potential to overcome some of these barriers; however, development of these technologies often fails to include people who use drugs and community key stakeholders in the development and dissemination process. Consequently, this may exacerbate health inequities and the digital divide among underserved, highly vulnerable people who use drugs. Methods The current study employed community-engaged research methods to develop and implement a digital platform to improve overdose surveillance among harm reductionists in Texas. We used a co-design process with four community advisory boards (CABs) and conducted qualitative interviews among N = 74 key stakeholders (n = 24 people who use drugs; n = 20 first responders, n = 20 harm reductionists, n = 10 overdose prevention and response experts) to inform initial design and development. Results Several key themes emerged through the qualitative data pertaining to technical features and human factors applications. In regards to technical features, participants highlighted the importance of developing a unified system of overdose reporting and data sharing among community organizations within a county or region to better inform overdose surveillance and community outreach efforts. This system should include flexible data entry methods, have offline usage capability, be user friendly, and allow for tracking of overdose-related supply distribution. Key human factor themes included the need to use person-centered language, to preserve the established trust of the community organizations among people who use drugs, to be tailored to specific target user groups (e.g., harm reduction workers, people who use drugs, first responders), and maintain transparency of data usage. Further, participants noted the importance of developing a platform that will facilitate client conversations about overdose when doing outreach in the field. These themes were reviewed by our CABs, academic, and industry partners to design an overdose digital platform uniquely tailored to community-based organizations providing harm reduction and overdose response efforts. Discussion Community engagement throughout the development process is critical toward developing digital health tools for underserved people who use drugs. Dismantling the power structure among academic and industry partners is critical toward creating equity in engagement of community-based partners, particularly among persons with lived experience in addiction, a history of incarceration, or financial challenges. Our study highlights a multisectoral co-design process across community-academic-industry partners to develop a digital health tool tailored to the unique needs of community-based harm reduction organizations serving highly vulnerable people who use drugs. These partnerships are essential toward creating impact and reducing health disparities among highly vulnerable people who use drugs.
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Affiliation(s)
- Kasey R. Claborn
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
- Addiction Research Institute, The University of Texas at Austin, Austin, TX, United States
- *Correspondence: Kasey R. Claborn
| | - Suzannah Creech
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Quanisha Whittfield
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Ruben Parra-Cardona
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, United States
| | - Andrea Daugherty
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Justin Benzer
- Department of Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
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Brown EK, Guthrie KM, Stange M, Creech S. "A Woman in A Man's World": A Pilot Qualitative Study of Challenges Faced by Women Veterans During and After Deployment. J Trauma Dissociation 2021; 22:202-219. [PMID: 33470907 PMCID: PMC7933094 DOI: 10.1080/15299732.2020.1869068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Women Veterans face gender-specific challenges to military life and post-deployment readjustment, including gender-based discrimination and military sexual trauma. Despite recent military initiatives to address these issues, women still experience unique challenges during military service. This study examines spontaneous comments about gender-specific challenges to military life that were made by participants in a qualitative study of women's transitions to civilian life after deployment to Iraq or Afghanistan. METHODS Women Veterans who were enrolled at a New England VA hospital and who had deployed to the U.S. conflicts in Iraq and Afghanistan participated in this qualitative study (N = 22). Interview queries and initial coding structure were developed through an extensive literature review. An iterative coding process generated additional themes identified in the data. For this project, codes regarding self-initiated reports of gender-specific challenges that fell outside the scope of the study's initial interview agenda were reviewed for thematic analysis. RESULTS The following three self-initiated themes emerged among 12 respondents: 1) gender-based scrutiny and discrimination; 2) the military's inadequate position and response to military sexual trauma; and 3) disadvantages to women service members living in a male-dominated environment. Across all three themes emerged a sub-theme in which women perceived their unique needs to be inconvenient and/or disregarded. Respondents described how these challenges disrupted their lives during and after military service. CONCLUSION Results imply gender-specific challenges and military sexual trauma remain critical concerns for women Veterans well after deployment had ended, and that improved policy may have long-term health implications.
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Affiliation(s)
- Elaine K Brown
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.,Epidemiology Program, Louisiana State University School of Public Health, New Orleans, LA, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Mia Stange
- Johns Hopkins Bloomberg School of Public Health
| | - Suzannah Creech
- VISN17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA.,Dell Medical School of the University of Texas at Austin
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Rodriguez-Paras C, Tippey K, Brown E, Sasangohar F, Creech S, Kum HC, Lawley M, Benzer JK. Posttraumatic Stress Disorder and Mobile Health: App Investigation and Scoping Literature Review. JMIR Mhealth Uhealth 2017; 5:e156. [PMID: 29074470 PMCID: PMC5680516 DOI: 10.2196/mhealth.7318] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/05/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a prevalent mental health issue among veterans. Access to PTSD treatment is influenced by geographic (ie, travel distance to facilities), temporal (ie, time delay between services), financial (ie, eligibility and cost of services), and cultural (ie, social stigma) barriers. OBJECTIVE The emergence of mobile health (mHealth) apps has the potential to bridge many of these access gaps by providing remote resources and monitoring that can offer discrete assistance to trauma survivors with PTSD and enhance patient-clinician relationships. In this study, we investigate the current mHealth capabilities relevant to PTSD. METHODS This study consists of two parts: (1) a review of publicly available PTSD apps designed to determine the availability of PTSD apps, which includes more detailed information about three dominant apps and (2) a scoping literature review performed using a systematic method to determine app usage and efforts toward validation of such mHealth apps. App usage relates to how the end users (eg, clinicians and patients) are interacting with the app, whereas validation is testing performed to ensure the app's purpose and specifications are met. RESULTS The results suggest that though numerous apps have been developed to aid in the diagnosis and treatment of PTSD symptoms, few apps were designed to be integrated with clinical PTSD treatment, and minimal efforts have been made toward enhancing the usability and validation of PTSD apps. CONCLUSIONS These findings expose the need for studies relating to the human factors evaluation of such tools, with the ultimate goal of increasing access to treatment and widening the app adoption rate for patients with PTSD.
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Affiliation(s)
- Carolina Rodriguez-Paras
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Kathryn Tippey
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Brown
- Health Science Center, School of Public Health, Louisiana State University, New Orleans, LA, United States
| | - Farzan Sasangohar
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Suzannah Creech
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Mark Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, United States
| | - Justin K Benzer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System, Waco, TX, United States
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, United States
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Creech S, Davis K, Howard M, Pearlstein T, Zlotnick C. Psychological/verbal abuse and utilization of mental health care in perinatal women seeking treatment for depression. Arch Womens Ment Health 2012; 15:361-5. [PMID: 22767033 DOI: 10.1007/s00737-012-0294-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/23/2012] [Indexed: 12/21/2022]
Abstract
Research on psychological violence has suggested it is common among perinatal women and is predictive of later physical violence. Psychological violence is also a strong correlate of negative mental and physical health outcomes and may influence engagement in health services. Both physical and mental health care are of critical importance for perinatal women who may be especially vulnerable to psychological violence and its deleterious effects. This study examined the clinical records of 299 perinatal patients who received treatment in a psychiatric partial hospital program to determine whether there were differences in utilization of care between those women with and without current interpersonal psychological abuse. More women than expected who reported current psychological abuse left treatment early compared to those without such reports.
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Affiliation(s)
- Suzannah Creech
- Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Albuquerque KV, Singla R, Potkul RK, Smith DM, Creech S, Lo S, Emami B. Impact of tumor volume-directed involved field radiation therapy integrated in the management of recurrent ovarian cancer. Gynecol Oncol 2005; 96:701-4. [PMID: 15721414 DOI: 10.1016/j.ygyno.2004.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Assess the role of involved field radiation therapy (IFRT) in recurrent ovarian cancer. METHODS Thirty-five patients with a diagnosis of epithelial ovarian cancer received radiation therapy at LUMC between 1991 and 2001. Of these, 20 received tumor volume-directed IFRT for localized extraperitoneal recurrences (either as consolidation following debulking surgery or as attempted salvage if unresectable) and form the basis of this report. All patients were heavily pretreated with multiple chemotherapy regimens. Eleven patients had optimal debulking of their recurrences prior to radiation. IFRT was primarily with external beam (median dose 50.4 Gy). Appropriate statistical analyses evaluated association among disease-free (DFS), overall survival (OS), local recurrence-free (LRFS), and various prognostic factors. LRFS was defined as freedom from in-field recurrences and was considered as a measure of effectiveness of radiotherapy. RESULTS Of 20 patients, 17 had a complete response after RT. The actuarial LRFS, OS, and DFS at 5 years from date of radiation were 66%, 34%, and 34%, respectively. The LRFS at 3 years was 89% for those with optimal resection vs. 42% for those with gross residual/unresectable tumor, which was significantly better (P = 0.04). The corresponding 3-year DFS was 72% vs. 22% and 5-year OS was 50% vs. 19%, respectively. Acute complication of RT was mild, half had Grade 1-2 gastrointestinal (GI) toxicity, three patients had Grade 3-4 late GI effects. CONCLUSION IFRT is effective in controlling localized recurrences of ovarian cancer, especially after they are optimally debulked (89% local control and 50% 5-year overall survival in this subgroup), and is relatively well tolerated in these heavily pretreated patients.
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Affiliation(s)
- K V Albuquerque
- Department of Radiation Oncology, Loyola University Medical Center, 2160 S. First Avenue, Maguire Center, Ste. 2944, Maywood, IL 60153, USA.
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Boeve S, Strupeck J, Creech S, Stiff PJ. Analysis of remobilization success in patients undergoing autologous stem cell transplants who fail an initial mobilization: risk factors, cytokine use and cost. Bone Marrow Transplant 2004; 33:997-1003. [PMID: 15064690 DOI: 10.1038/sj.bmt.1704486] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Inadequate stem cell mobilization is seen in approximately 25% of patients undergoing autotransplantation for hematologic malignancies. Remobilization strategies include chemotherapy/cytokine combinations or high-dose cytokines alone or in combination. From 1/1997 to 7/2002, we remobilized 86 patients who failed an initial mobilization (median total CD34=0.72 x 10(6)/kg) in sequential cohorts using high-dose G-CSF (32 microg/kg/day) or G-CSF(10 microg/kg/day)+GM-CSF (5 microg/kg/day). No difference in CD34/kg yields were seen (G-CSF alone: 2.2 x 10(6) and G-CSF+GM-CSF 1.6 x 10(6)) in the median 3 aphereses performed (P=0.333). Of the 86, 23 (27%) failed the second mobilization; 14 were remobilized again (yield=1.5 x 10(6) CD34/kg; three aphereses). Of the 86, 93% went to transplant: three progressed, and three had inadequate stem cells. Significant risk factors for a failed remobilization were: number of stem-cell-damaging regimens (P=0.015), time between last chemotherapy and first mobilization (P=0.028), and higher WBC at initiation of first mobilization (P=0.04). High-dose G-CSF (32 microg/kg/day) was more costly @ USD $9,016, vs $5,907 for the G-CSF+GM-CSF combination (P<0.001). Most patients failing an initial mobilization benefit from a cytokine only remobilization. Lower cost G-CSF+GM-CSF is as effective as high-dose G-CSF.
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Affiliation(s)
- S Boeve
- BMT Program, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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Preisler HD, Li B, Chen H, Fisher L, Nayini J, Raza A, Creech S, Venugopal P. P15INK4B gene methylation and expression in normal, myelodysplastic, and acute myelogenous leukemia cells and in the marrow cells of cured lymphoma patients. Leukemia 2001; 15:1589-95. [PMID: 11587217 DOI: 10.1038/sj.leu.2402211] [Citation(s) in RCA: 30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
P15INK4B methylation and expression was studied in bone marrow cells obtained from normal individuals, from patients who had been cured of lymphoma, and from patients with either MDS or AML. The level of p15 methylation was very low in normal BM cells and in CD34+ and CD34- subpopulations (0-6.5%; med, = 2.5%). P15INK4B transcripts were present in each of these cell populations. In contrast, methylation was the usual situation in MDS and AML marrows. The presence of methylation of the p15INK4B gene did not always indicate an absence of expression nor was expression always present if methylation was absent. P15INK4B methylation was studied in the marrows of nine patients (one studied twice) who had been cured of lymphoma and in whom hemopoiesis was believed to be normal. Increased methylaton was present in all 10 marrows. These data indicate that p15INK4B methylation is likely to be a very early event in the development of the secondary hematologic disorders.
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Affiliation(s)
- H D Preisler
- Rush Cancer Institute, Chicago, Illinois 60612, USA
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11
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Devemy E, Li B, Tao M, Horvath E, Chopra H, Fisher L, Nayini J, Creech S, Venugopal P, Yang J, Kaspar C, Hsu W, Preisler HD. Poor prognosis acute myelogenous leukemia: 3--biological and molecular biological changes during remission induction therapy. Leuk Res 2001; 25:783-91. [PMID: 11489472 DOI: 10.1016/s0145-2126(01)00032-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This is the third paper in a series which describes a new remission induction regimen for patients with 'poor prognosis' acute myelogenous leukemia (AML). Twenty-four patients were treated with two one day pulses of chemotherapy separated by 96 h. Each pulse consisted of two doses of cytarabine and a single dose of mitoxantrone. Amifostine was administered three times a week after the second pulse of chemotherapy until treatment outcome became known. The first paper described the outcome of treatment while the second described the relationship of treatment outcome to the pretherapy characteristics of the leukemia. This paper describes the changes in the leukemia cells which occur during remission induction therapy. While only a limited number of specimens were available for each post treatment study, the studies demonstrated a profound fall in blood counts, BM cellularity, and telomerase activity in leukemia cells after pulse #1 of treatment. This fall was usually accompanied by a coordinate rise in IL6, TNFalpha, and IL1beta transcripts within the AML cells which survived chemotherapy. High levels of telomerase activity in the day 5 marrow was correlated with high levels of IL1beta transcripts which in turn were associated with treatment failure ascribable to resistant disease.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Apoptosis
- Biomarkers, Tumor/metabolism
- Bone Marrow/drug effects
- Bone Marrow/enzymology
- Bone Marrow/pathology
- Cytokines/drug effects
- Cytokines/genetics
- Cytokines/metabolism
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Leukocyte Count
- Prognosis
- RNA, Messenger/drug effects
- RNA, Messenger/metabolism
- Remission Induction
- S Phase/drug effects
- Telomerase/metabolism
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Affiliation(s)
- E Devemy
- Rush Cancer Institute, 1725 West Harrison Street, Suite 809, Chicago, IL 60612, USA
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Preisler HD, Perambakam S, Li B, Hsu WT, Venugopal P, Creech S, Sivaraman S, Tanaka N. Alterations in IRF1/IRF2 expression in acute myelogenous leukemia. Am J Hematol 2001; 68:23-31. [PMID: 11559933 DOI: 10.1002/ajh.1144] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The interferon response genes 1 and 2 have been shown to be involved in the regulation of differentiation and proliferation of cells of the myeloid series, with the former functioning as an anti-oncogene and the latter as an oncogene. In the study described here, the levels of expression of these two genes and the ratio of their expression were compared in AML and normal marrow. The ratio of gene expression was significantly less in AML marrow cells as compared to normal marrow cells [med ratio = 1.33 vs. 2.97, P = 0.003]. While the expression ratio was unaffected by the presence or absence of either ras or fms mutations, p53 mutations were associated with higher IRF1:IRF2 expression ratios that wt p53 genes [med = 1.701 vs. 1.135, P = 0.014]. Given the functional characteristics and the competitive nature of these two genes, it is possible that leukemic transformation is associated with a fall in IRF1:IRF2 ratios. Finally, the administration of IL4 can result in the normalization of the IRF1:IRF2 ratio in the marrow cells of some patients with AML.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bone Marrow Cells/metabolism
- Cytogenetic Analysis
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Genes, ras
- Humans
- Interferon Regulatory Factor-1
- Interferon Regulatory Factor-2
- Interleukin-4/therapeutic use
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Middle Aged
- Phosphoproteins/genetics
- Phosphoproteins/metabolism
- RNA, Messenger/metabolism
- Receptor, Macrophage Colony-Stimulating Factor/genetics
- Reference Values
- Repressor Proteins
- Transcription Factors
- Treatment Outcome
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- H D Preisler
- Rush Cancer Institute, Rush Presbyterian St. Luke's Medical Center, Chicago, Illinois 60612, USA.
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13
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Preisler HD, Venugopal P, Gregory SA, Hsu W, Loew J, Adler S, Gezer S, Creech S, Galvez A, Slivnick D, Andric T, Larson RA, Jajeh A. Poor prognosis acute myelogenous leukemia: 1 - response to treatment with high dose cytarabine/mitoxantrone/ethyol @ (Amifostine). Leuk Res 2000; 24:671-80. [PMID: 10936421 DOI: 10.1016/s0145-2126(00)00037-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twenty patients with poor prognosis AML and four patients in the blastic phase of a myeloproliferative disorder were treated with two 'pulses' of therapy each consisting of two doses of high dose araC (separated by 12 h) followed by a single dose of mitoxantrone. The pulses were separated by 96 h. Amifostine was then administered tiw. The median age of the population was 68 years with 88% of patients having had either a prior MDS, MPD or toxic exposure. The acute leukemia of 58% of patients either entered a CR or reverted to preleukemic state. For patients under 70 years of age, treatment produced 62% CRs with a leukemia free decision marrow in 77%. For patients over 70 years the CR rate was 27% with 36% of patients having a leukemia free decision marrow.
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Affiliation(s)
- H D Preisler
- Rush Cancer Institute, 1725 W. Harrison Street, Suite 809 PB I, Chicago, IL 60612, USA
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14
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Preisler H, Venugopla P, Sivaraman S, Larson R, Tricot G, Goldberg J, Miller K, Galvez A, Gregory S, Adler S, Creech S, Raza A. Selection of optimal remission consolidation therapy for individual patients with acute myelogenous leukemia. Exp Hematol 2000. [DOI: 10.1016/s0301-472x(00)00418-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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15
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