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Jeong Y, Crowell T, Devon-Sand A, Sakata T, Sattler A, Shah S, Tsai T, Lin S. Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19. J Med Internet Res 2024; 26:e47667. [PMID: 38393776 PMCID: PMC10924259 DOI: 10.2196/47667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a "postpandemic" landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic. First, clinical workflows must support both in-person and internet-based care delivery. Second, the integration of asynchronous care delivery is critical. Third, planning for the future means planning for everyone, including those with potentially limited access to health care due to barriers in technology and communication. While these lessons are neither unique to primary care settings nor all-encompassing, they establish a grounded foundation on which to construct higher-quality, more resilient, and more equitable health systems.
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Affiliation(s)
- Yejin Jeong
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Trevor Crowell
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Anna Devon-Sand
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Theadora Sakata
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Amelia Sattler
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Shreya Shah
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Timothy Tsai
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
| | - Steven Lin
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Redwood City, CA, United States
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2
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Berry SD, Hecker EJ, McConnell ES, Xue TM, Tsai T, Zullo AR, Colón-Emeric C. Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents. J Am Geriatr Soc 2023; 71:3267-3277. [PMID: 37596877 PMCID: PMC10592133 DOI: 10.1111/jgs.18564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study. METHODS This was a non-randomized trial (pilot study) including NH staff and residents from five facilities. Long-stay residents at high-risk for injurious falls were identified using a validated risk calculator and staff referral. A remote team reviewed the electronic health record (EHR) and provided recommendations as Injury Prevention Plans (IPP). A research nurse served as a care coordinator focused on resident engagement and shared decision-making. Outcomes included implementation measures, as identified in the EHR, and surveys and interviews with staff. RESULTS Across five facilities, 274 residents were screened for eligibility, and 46 residents (16.8%) were enrolled. Most residents were female (73.9%) and had dementia (63.0%). An IPP was completed for 45 residents (97.8%). The nurse made a total of 93 deprescribing recommendations in 36 residents (80% of residents had one or more deprescribing recommendation; mean 2.2 recommendations/resident). Twenty of 45 residents (44.4%) had a recommendation for osteoporosis treatment. Among residents with recommendations, 21/36 (58.3%) had one or more deprescribing orders written and 6/20 (30.0%) had an osteoporosis medication prescribed. At 4 months, most medication changes persisted. Adverse side effects were rare. Staff members identified several areas for program refinement, including aligning recommendations with provider workflow and engaging consultant psychiatrists. CONCLUSIONS A remote injury prevention service is safe and feasible to enhance deprescribing and osteoporosis treatment in long-stay NH residents at risk for injury. Additional investigation is needed to determine if this model could reduce injurious falls when deployed across NH chains.
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Affiliation(s)
- Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, MA
- Beth Israel Deaconess Medical Center, Department of Medicine & Harvard Medical School, Boston, MA
| | - Emily J. Hecker
- Duke University School of Medicine, Department of Medicine, Division of Geriatric Medicine, Durham, NC
| | - Eleanor S. McConnell
- Durham VA Geriatric Research Education and Clinical Center, Durham, NC
- Duke University School of Nursing, Durham, NC
| | - Tingzhong-Michelle Xue
- Durham VA Geriatric Research Education and Clinical Center, Durham, NC
- Duke University School of Nursing, Durham, NC
| | - Timothy Tsai
- Hinda and Arthur Marcus Institute for Aging Research and Department of Medicine, Hebrew SeniorLife, Boston, MA
| | - Andrew R. Zullo
- Brown University School of Public Health, Providence, RI
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Cathleen Colón-Emeric
- Duke University School of Medicine, Department of Medicine, Division of Geriatric Medicine, Durham, NC
- Durham VA Geriatric Research Education and Clinical Center, Durham, NC
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Liu CT, Tsai T, Allaire BT, Bouxsein ML, Hannan MT, Travison TG, Kiel DP. Accumulation in Visceral Adipose Tissue Over 6 Years Is Associated With Lower Paraspinal Muscle Density. J Clin Endocrinol Metab 2023; 108:1348-1354. [PMID: 36546589 PMCID: PMC10368410 DOI: 10.1210/clinem/dgac744] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Visceral adipose tissue (VAT) has been recognized to be a metabolically active fat depot that may have paracrine effects on surrounding tissues, including muscle. Since many adults accumulate VAT as they age, the effect of changes in VAT on muscle is of interest. OBJECTIVE We determined the association between 6-year changes in VAT and paraspinal muscle density, an indicator of fatty infiltration. METHODS This study included 1145 participants from the Framingham Study third-generation cohort who had both quantitative computed tomography scans of the spine at baseline and 6-year's follow-up, on whom muscle density was measured along with VAT. We implemented multiple regression to determine the association of muscle density at follow-up as primary outcome measure with changes in VAT (follow-up minus baseline divided by 100), adjusting for VAT at baseline, age, sex, height, menopausal status, presence of diabetes, and physical activity. Analyses were performed in men and women separately. RESULTS After adjustment for covariates, individuals with the greatest accumulation of VAT over 6 years had significantly lower paraspinal density at the follow-up with an estimated 0.302 (95% CI, -0.380 to -0.224) and 0.476 (95% CI: -0.598 to -0.354) lower muscle density (HU) per 100-cm3 increase in VAT (both P values < .001) in men and women, respectively. CONCLUSION These results highlight that age-related accumulation of VAT in men and women is associated with lower muscle density. VAT may represent a modifiable risk factor for poor musculoskeletal outcomes with aging.
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Affiliation(s)
- Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public
Health, Boston, Massachusetts 02118, USA
| | - Timothy Tsai
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging
Research, Boston, Massachusetts 02131, USA
| | - Brett T Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical
Center, Boston, Massachusetts 02115, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical
Center, Boston, Massachusetts 02115, USA
- Endocrine Unit, Massachusetts General Hospital,
Boston, Massachusetts 02114, USA
- Department of Orthopedic Surgery, Harvard Medical School,
Boston, Massachusetts 02115, USA
| | - Marian T Hannan
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging
Research, Boston, Massachusetts 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts 02115,
USA
| | - Thomas G Travison
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging
Research, Boston, Massachusetts 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts 02115,
USA
| | - Douglas P Kiel
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging
Research, Boston, Massachusetts 02131, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Massachusetts 02115,
USA
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Hwang T, Tsai T, Chou K, Ho C, Chang A. Cadherin-11 blockade activates pyroptosis-mediated anti-tumor immunity in bladder cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00585-7] [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: 02/12/2023]
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De Souza MM, Koltes DA, Beiki H, Sales MA, Tsai T, Maxwell CV, Zhao J, Koltes JE. Early-Life Exposure of Pigs to Topsoil Alters miRNA and mRNA Expression in Peripheral Blood Mononuclear Cells. Front Genet 2022; 13:886875. [PMID: 36081988 PMCID: PMC9445269 DOI: 10.3389/fgene.2022.886875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Exposure to less-hygienic conditions during early childhood has been associated with stimulation and development of the immune system. A recent study indicated that exposure of piglets to soil-borne microbes during lactation was related with modulation of gut microbiota and immune function. To identify the potential molecular mechanisms and pathways impacted by early-life topsoil exposure, we analyzed the messenger RNA (mRNA) and micro-RNA (miRNA) expression in peripheral blood mononuclear cells (PBMCs) from these piglets. Total RNA was extracted from the PBMCs of piglets exposed to topsoil only from d 4–d 21 of life (mRNA n = 6; miRNA n = 5) or unexposed control pigs (mRNA n = 6; miRNA n = 8) at 11, 20, and 56 days of age. Small RNA and mRNA were sequenced with 50-bp single-end reads using Illumina chemistry. Sequence data were quality checked with FASTQC software and aligned to the Sscrofa 11.1 genome with the STAR aligner for mRNA and mirDeep2 for miRNA. Differential expression (DE) analysis was performed using PROC Glimmix of SAS to evaluate changes in expression due to topsoil exposure over time with genes declared DE at a false discovery rate (FDR) of q < 0.10. A total of 138 mRNA and 21 miRNAs were identified as DE for the treatment by age interaction. Ontology enrichment analysis of DE mRNA revealed Gene ontology (GO) terms directly involved in the connection between T-cell and antigen-presenting cells that are associated with T-cell activation. Key regulatory genes identified include PTPRJ, ITGB3, TRBV30, CD3D, mir-143, mir-29, and mir-148a. While these results require validation, this study provides data supporting the hypothesis that less-hygienic environments during early life may contribute to the development of the immune system.
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Affiliation(s)
- M. M. De Souza
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - D. A. Koltes
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - H. Beiki
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - M. A. Sales
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - T. Tsai
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - C. V. Maxwell
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - J. Zhao
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - J. E. Koltes
- Department of Animal Science, Iowa State University, Ames, IA, United States
- *Correspondence: J. E. Koltes,
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Yang J, Tsai T, Chang Y, Chen C, Hung Y, Peng D, Wu C. Mesenchymal Stem/Stromal Cells: STUDY THE MECHANISM OF ACTION OF ELIXCYTE®, AN ALLOGENIC STEM CELL PRODUCT, ON OSTEOARTRITIS. Cytotherapy 2022. [DOI: 10.1016/s1465-3249(22)00216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tsai T, Boazak M, Hinz ERM. Increased Clinician Time Using Electronic Health Records During COVID-19 Pandemic. AMIA Annu Symp Proc 2022; 2021:1159-1168. [PMID: 35308951 PMCID: PMC8861678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic challenged how healthcare systems provided care in socially distanced formats. We hypothesized that the COVID-19 era changes in clinical care delivery models contributed to increased Electronic Health Record (EHR) related work. To evaluate the changes in time and volume metrics of EHR usage, we segregated EHR audit log metric data into PreCOVID2019 March/April/May, initial COVID2020 March/April/May, and late COVID2021 March/April/May for 1262 physician providers. We discovered significant and pragmatically meaningful increases in total average time providers spent in the EHR in minutes mean(SD) PreCOVID2019=1958(1576), Mid-COVID2020=1709(1473), Late-COVID2021=2007(1563). Differences in total time in the EHR were significant Pre-mid:p-value=<0.001, but not Pre-Late:p=0.439. Total number of messages received across all specialties increased significantly mean(SD) PreCOVID=459(389), MidCOVID=400(362), LateCOVID 521(423) Pre-Mid p-value=<0.001 and Pre-Late p-value=<0.001. We additionally found changes in total time to differ significantly across select specialties. Based on these findings we recommend further assessment of physician workload and how new factors such as telehealth are contributing to EHR usage.
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Affiliation(s)
- Timothy Tsai
- Department of Medicine, Authors Duke University School of Medicine, Durham, NC, USA
- Duke Primary Care, Authors Duke University School of Medicine, Durham, NC, USA
- Co-first
| | - Mina Boazak
- Department of Medicine, Authors Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry, Authors Duke University School of Medicine, Durham, NC, USA
- Co-first
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Mitchell SL, D'Agata EMC, Hanson LC, Loizeau AJ, Habtemariam DA, Tsai T, Anderson RA, Shaffer ML. The Trial to Reduce Antimicrobial Use in Nursing Home Residents With Alzheimer Disease and Other Dementias (TRAIN-AD): A Cluster Randomized Clinical Trial. JAMA Intern Med 2021; 181:1174-1182. [PMID: 34251396 PMCID: PMC8276127 DOI: 10.1001/jamainternmed.2021.3098] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Antimicrobials are extensively prescribed to nursing home residents with advanced dementia, often without evidence of infection or consideration of the goals of care. OBJECTIVE To test the effectiveness of a multicomponent intervention to improve the management of suspected urinary tract infections (UTIs) and lower respiratory infections (LRIs) for nursing home residents with advanced dementia. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial of 28 Boston-area nursing homes (14 per arm) and 426 residents with advanced dementia (intervention arm, 199 residents; control arm, 227 residents) was conducted from August 1, 2017, to April 30, 2020. INTERVENTIONS The intervention content integrated best practices from infectious diseases and palliative care for management of suspected UTIs and LRIs in residents with advanced dementia. Components targeting nursing home practitioners (physicians, physician assistants, nurse practitioners, and nurses) included an in-person seminar, an online course, management algorithms (posters, pocket cards), communication tips (pocket cards), and feedback reports on prescribing of antimicrobials. The residents' health care proxies received a booklet about infections in advanced dementia. Nursing homes in the control arm continued routine care. MAIN OUTCOMES AND MEASURES The primary outcome was antimicrobial treatment courses for suspected UTIs or LRIs per person-year. Outcomes were measured for as many as 12 months. Secondary outcomes were antimicrobial courses for suspected UTIs and LRIs when minimal criteria for treatment were absent per person-year and burdensome procedures used to manage these episodes (bladder catherization, chest radiography, venous blood sampling, or hospital transfer) per person-year. RESULTS The intervention arm had 199 residents (mean [SD] age, 87.7 [8.0] years; 163 [81.9%] women; 36 [18.1%] men), of which 163 (81.9%) were White and 27 (13.6%) were Black. The control arm had 227 residents (mean [SD] age, 85.3 [8.6] years; 190 [83.7%] women; 37 [16.3%] men), of which 200 (88.1%) were White and 22 (9.7%) were Black. There was a 33% (nonsignificant) reduction in antimicrobial treatment courses for suspected UTIs or LRIs per person-year in the intervention vs control arm (adjusted marginal rate difference, -0.27 [95% CI, -0.71 to 0.17]). This reduction was primarily attributable to reduced antimicrobial use for LRIs. The following secondary outcomes did not differ significantly between arms: antimicrobials initiated when minimal criteria were absent, bladder catheterizations, venous blood sampling, and hospital transfers. Chest radiography use was significantly lower in the intervention arm (adjusted marginal rate difference, -0.56 [95% CI, -1.10 to -0.03]). In-person or online training was completed by 88% of the targeted nursing home practitioners. CONCLUSIONS AND RELEVANCE This cluster randomized clinical trial found that despite high adherence to the training, a multicomponent intervention promoting goal-directed care for suspected UTIs and LRIs did not significantly reduce antimicrobial use among nursing home residents with advanced dementia. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03244917.
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Affiliation(s)
- Susan L Mitchell
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Erika M C D'Agata
- Division of Infectious Diseases, Brown University, Providence, Rhode Island
| | - Laura C Hanson
- Palliative Care Program, Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Andrea J Loizeau
- Division of Primary Care Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Daniel A Habtemariam
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Timothy Tsai
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill
| | - Michele L Shaffer
- Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey.,Frank Statistical Consulting LLC, Vashon, Washington
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Berning MJ, Palmer E, Tsai T, Mitchell SL, Berry SD. An advance care planning long-term care initiative in response to COVID-19. J Am Geriatr Soc 2021; 69:861-867. [PMID: 33577704 PMCID: PMC8013602 DOI: 10.1111/jgs.17051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/03/2022]
Abstract
Objective Describe a systematic approach to address advance care planning (ACP) during a COVID‐19 outbreak and its impact on the incidence of new do‐not‐hospitalize (DNH) directives among long‐term care (LTC) residents. Design Prospective quality improvement initiative. Setting Two long‐term chronic care campuses within a large academic healthcare organization. Participants LTC residents with activated healthcare proxies who lacked DNH directives based on documentation in the electronic medical record (EMR) as of April 13, 2020. Intervention Using a structured discussion guide, trained healthcare staff from various disciplines contacted the residents' proxies to conduct COVID‐19 focused ACP discussions. Residents without DNH directives with COVID‐19 were prioritized. Preferences ascertained in the discussion were communicated to the residents' primary care teams and directives were updated in the EMR accordingly. Measurements Residents who acquired a new DNH directive during the study initiative were determined using the EMR. Subsequent changes in DNH orders, hospitalizations, and deaths were ascertained by retrospective chart review from the date of new DNH through August 5, 2020. Results At baseline, 315/581 (54%) of LTC residents did not have a DNH directive. Their mean age was 87 (±9) years and 70% were female. Following ACP discussions, 124/315 (39%) of residents acquired a new DNH directive. Among residents with new DNH directives, 65/124 (52%) were diagnosed with COVID‐19 from April 2, 2020 to May 21, 2020. During follow‐up, only 6/124 (4.8%) residents had their DNH order reversed, 2/124 (1.6%) residents were hospitalized with illnesses unrelated to COVID‐19, and 29/124 (23%) died. Conclusions There was substantial opportunity to increase the proportion of LTC residents with DNH orders during the COVID‐19 pandemic through a systematic ACP initiative which utilized real‐time EMR data. New directives to avoid hospitalizations were sustained among the majority of residents beyond the peak of the pandemic.
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Affiliation(s)
| | - Emily Palmer
- Department of Medicine, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Timothy Tsai
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Susan L Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Perloff J, Thomas CP, Macklin E, Gagnon P, Tsai T, Isaza I, Wayne PM, Lipsitz L. The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing. Glob Adv Health Med 2021; 10:2164956120985479. [PMID: 33598365 PMCID: PMC7841657 DOI: 10.1177/2164956120985479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. DESIGN Cluster randomized controlled trial with randomization at the housing site level. SETTING Greater Boston, Massachusetts. PARTICIPANTS The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. INTERVENTION Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. RESULTS The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. CONCLUSION ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.
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Affiliation(s)
- Jennifer Perloff
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Cindy Parks Thomas
- The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Eric Macklin
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Peggy Gagnon
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Timothy Tsai
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Ilean Isaza
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
| | - Peter M Wayne
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lewis Lipsitz
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Beth Israel Deaconess Medical Center Division of Gerontology, Boston, Massachusetts
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11
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Tsai T, Perez-Alvarez I, Woo J, Tran M. Efficacy of HLA-compatible Platelet Transfusion for Patients with Acute Myeloid Leukemia Refractory to Platelet Transfusion. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Acute myeloid leukemia (AML) patients often require transfusion support during induction chemotherapy. Platelet transfusion refractoriness (PTR) may develop due to HLA alloimmunization. Management of immune-refractory patients with HLA-compatible platelet transfusions is labor intensive and associated with increased costs. The purpose of this study is to evaluate the efficacy of HLA-compatible platelet units in AML patients.
Methods
Newly diagnosed AML patients undergoing induction chemotherapy in our institute between 2015 and 2018 were identified. Platelet counts and platelet transfusion data from initiation of chemotherapy until platelet recovery (> 20K/µL and increased consistently) were extracted. A 24-hour posttransfusion corrected count increment (CCI) was calculated to evaluate the efficacy of each platelet transfusion. PTR was declared if a patient had a 24-hour CCI < 4K following two consecutive transfusions. Student’s t-test was used for statistical analysis. Results were presented as mean ± SE, * if p < 0.05.
Results
We identified 39 patients with newly diagnosed AML. PTR developed in 22/39 (56%) patients during induction chemotherapy. The average CCI was higher among those without PTR compared to those with PTR (8,408 ± 585 vs. 2,923 ± 360*), and overall platelet transfusion burden (in number of units) was lower (7.29 ± 1.0 vs. 18.55 ± 1.71*). HLA antibodies were identified in 3/22 (14%) PTR patients, as 6/22 (27%) were tested. The average CCI during HLA matched transfusions for these 3 patients was higher than that with random units (2,059 ± 149 vs. -126 ± 306*). Compared to HLA-negative PTR patients receiving random units, the average CCI for HLA-compatible transfusions was still lower, though not significantly (2,059 ± 149 vs. 3,099 ± 390, p = 0.33), while the number of HLA- compatible units transfused was significantly higher (31.0 ± 3.0 vs. 16.6 ± 1.45*).
Conclusion
In a cohort of newly diagnosed AML patients undergoing induction chemotherapy whose PTR was associated with detectable HLA antibodies, transfusion support with HLA-matched products did not lead to reduced overall platelet transfusion rates and CCI remains in the refractory range. This suggests that use of HLA matched platelets among newly diagnosed AML patients with PTR, even in the setting of detectable HLA antibodies, does not appear to result in reduced overall product utilization.
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Affiliation(s)
- T Tsai
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - I Perez-Alvarez
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - J Woo
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
| | - M Tran
- Pathology, UCI Medical Center, Irvine, California, UNITED STATES
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Kiel D, Tsai T, Liu CT, Hannan M, Travison T, Rosen C, Khosla S, Bouxsein M. Plasma sclerostin is associated with visceral adipose tissue but not subcutaneous adipose tissue in men and women in the Framingham Study. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hwang T, Chen P, Tsai T, Yang S, Chen H, Lin Y, Chou K, Lin J. Cis-platinum induces immunity evasion demonstrated by PD-L1 expression in bladder cancer cells. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Tsai T, Dlugaiczyk J, Bardins S, Huppert D, Brandt T, Wühr M. P83 Ocular-mandibular phenomenon. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.081] [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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15
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Loizeau AJ, D'Agata EMC, Shaffer ML, Hanson LC, Anderson RA, Tsai T, Habtemariam DA, Bergman EH, Carroll RP, Cohen SM, Scott EME, Stevens E, Whyman JD, Bennert EH, Mitchell SL. The trial to reduce antimicrobial use in nursing home residents with Alzheimer's disease and other dementias: study protocol for a cluster randomized controlled trial. Trials 2019; 20:594. [PMID: 31615540 PMCID: PMC6794759 DOI: 10.1186/s13063-019-3675-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infections are common in nursing home (NH) residents with advanced dementia but are often managed inappropriately. Antimicrobials are extensively prescribed, but frequently with insufficient evidence to support a bacterial infection, promoting the emergence of multidrug-resistant organisms. Moreover, the benefits of antimicrobials remain unclear in these seriously ill residents for whom comfort is often the goal of care. Prior NH infection management interventions evaluated in randomized clinical trials (RCTs) did not consider patient preferences and lack evidence to support their effectiveness in 'real-world' practice. METHODS This report presents the rationale and methodology of TRAIN-AD (Trial to reduce antimicrobial use in nursing home residents with Alzheimer's disease and other dementias), a parallel group, cluster RCT evaluating a multicomponent intervention to improve infection management for suspected urinary tract infections (UTIs) and lower respiratory tract infections (LRIs) among NH residents with advanced dementia. TRAIN-AD is being conducted in 28 facilities in the Boston, USA, area randomized in waves using minimization to achieve a balance on key characteristics (N = 14 facilities/arm). The involvement of the facilities includes a 3-month start-up period and a 24-month implementation/data collection phase. Residents are enrolled during the first 12 months of the 24-month implementation period and followed for up to 12 months. Individual consent is waived, thus almost all eligible residents are enrolled (target sample size, N = 410). The intervention integrates infectious disease and palliative care principles and includes provider training delivered through multiple modalities (in-person seminar, online course, management algorithms, and prescribing feedback) and an information booklet for families. Control facilities employ usual care. The primary outcome, abstracted from the residents' charts, is the number of antimicrobial courses prescribed for UTIs and LRIs per person-year alive. DISCUSSION TRAIN-AD is the first cluster RCT testing a multicomponent intervention to improve infection management in NH residents with advanced dementia. Its findings will provide an evidence base to support the benefit of a program addressing the critical clinical and public health problem of antimicrobial misuse in these seriously ill residents. Moreover, its hybrid efficacy-effectiveness design will inform the future conduct of cluster RCTs evaluating nonpharmacological interventions in the complex NH setting in a way that is both internally valid and adaptable to the 'real-world'. TRIAL REGISTRATION ClinicalTrials.gov, NCT03244917 . Registered on 10 August 2017.
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Affiliation(s)
- Andrea J Loizeau
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA.
| | - Erika M C D'Agata
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Michele L Shaffer
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Laura C Hanson
- Division of Geriatric Medicine, Palliative Care Program, Chapel Hill, NC, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Timothy Tsai
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Daniel A Habtemariam
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Elaine H Bergman
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Ruth P Carroll
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Simon M Cohen
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Erin M E Scott
- Division of Palliative Care and Geriatrics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin Stevens
- Division of Palliative Care and Geriatrics, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jeremy D Whyman
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Liao B, Hsu W, Lee J, Yang C, Tsai T, Liao W, Ho C, Lin C, Shih J, Yu C, Yang J. P2.01-39 Serial Plasma ctDNA Tests Identify Genomic Alterations for Early Prediction of Osimertinib Treatment Outcome in T790M+ NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lipsitz LA, Macklin EA, Travison TG, Manor B, Gagnon P, Tsai T, Aizpurúa II, Lo OY, Wayne PM. A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: The MI-WiSH Study. J Am Geriatr Soc 2019; 67:1812-1819. [PMID: 31116883 DOI: 10.1111/jgs.15986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Tai Chi (TC) may benefit older adults with a variety of diseases and disabilities. We tested the hypothesis that TC improves physical function in older adults living in low-income housing facilities. DESIGN Cluster randomized controlled trial. SETTING Subsidized housing facilities in Boston, Massachusetts, and neighboring communities. PARTICIPANTS Volunteers were recruited from 15 facilities. The 180 randomized participants were 60 years of age or older, able to understand English and participate in TC, expected to remain in the facility for 1 year, and able to walk independently. INTERVENTION TC classes were conducted in the housing facilities twice/week for 1 year and compared with monthly health promotion educational classes and social calls. MEASUREMENTS The primary outcome was physical function measured by the Short Physical Performance Battery (SPPB). Secondary outcomes included other aspects of physical and cognitive function, and falls. RESULTS An interim analysis revealed less improvement over 12 months in SPPB scores among TC participants (+.20 units; 95% confidence interval [CI] = -.20 to +.60; P = .69) vs control participants (+.51 units; 95% CI = +.15 to +.87; P = .007), a difference of -.31 units (95% CI = -.66 to .04; P = .082). This met the criterion for futility, and the Data Safety Monitoring Board recommended trial termination. No differences were found in 6- or 12-month changes favoring TC in any secondary outcomes or adverse events. CONCLUSION In older adults with multiple chronic conditions living in subsidized housing facilities, 6 and 12 months of twice/week TC classes were not associated with improvements in functional health. J Am Geriatr Soc 67:1812-1819, 2019.
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Affiliation(s)
- Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Eric A Macklin
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
| | - Thomas G Travison
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peggy Gagnon
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts
| | - Timothy Tsai
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts
| | - Ilean Isaza Aizpurúa
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peter M Wayne
- Harvard Medical School, Boston, Massachusetts.,Osher Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Knapp J, Tsai T, Maxwell C, Apple J, Chewning J. PSIV-4 The effect of peptide product and ZnO on growth performance in nursery pigs fed different levels of crude protein diets. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Wichita, KS, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Apple
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Chewning
- Swine Research Services, Inc.,Springdale, AR, United States
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Wang X, Tsai T, Chewning J, Maxwell C. PSI-8 Characterizing biological functions of Lactobacillus brevis 1E1 in porcine jejunal epithelial cell line (IPEC-J2). J Anim Sci 2018. [DOI: 10.1093/jas/sky404.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Wang
- University of Arkansas,Fayetteville, AR, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, AR, United States
| | - J Chewning
- Swine Research Services, Inc.,Springdale, AR, Springdale, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, AR, United States
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Wei X, Tsai T, Maxwell C, Zhao J. PSXII-42 Peptide product (FPM), zinc oxide and lactobacillus acidophilus fermented product (LAFP) alter gut microbiota of nursery pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- X Wei
- University of Arkansas,Fayetteville, AR, United States
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - C Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas,Fayetteville, Fayetteville, AR, United States
| | - J Zhao
- University of Arkansas,Fayetteville, AR, United States
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Sampath S, Yuh B, Frankel P, Liu A, Schultheiss T, Del Vecchio B, Tsai T, Wong J. Maximum Tolerated Dose (MTD) Reached in a Phase I Dose Escalation Trial of Prostate Bed Stereotactic Body Radiation Therapy (PB-SBRT). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tsai T, Isaza Aizpurua II, Zhu H, Gagnon MM, Lipsitz LA, Kiel DP, Travison TG. IMPROVING THE REPRODUCIBILITY OF AGING RESEARCH VIA DYNAMIC RESEARCH MANAGEMENT AND QUALITY CONTROL. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Tsai
- Hebrew SeniorLife Institute for Aging Research, Roslindale, Massachusetts, United States
| | | | - H Zhu
- Hebrew SeniorLife Institute for Aging Research, Roslindale, Massachusetts, United States
| | - M M Gagnon
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA
| | - L A Lipsitz
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D P Kiel
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - T G Travison
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
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Travison TG, Zhu H, Tsai T, Pencina KM, Grosicki GJ, Gouskova NA, Fielding RA. ROBUST REPORTING AND DISSEMINATION FOR REPRODUCIBLE INTERVENTIONAL SCIENCE IN AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T G Travison
- Hebrew SeniorLife Institute for Aging Research and Assistant Professor of Medicine at Harvard Medical School, Roslindale, Massachusetts, United States
| | - H Zhu
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA
| | - T Tsai
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA
| | - K M Pencina
- Brigham and Women’s Hospital, Brighton, MA USA; Harvard Medical School, Boston, MA, USA
| | - G J Grosicki
- Tufts University Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, USA
| | - N A Gouskova
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA
| | - R A Fielding
- Tufts University Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, USA; Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
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24
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Zhu H, Tsai T, Poole VN, Manor B, Dufour AB, Isaza Aizpurua II, Travison TG. INTERACTIVE DATA VISUALIZATION AND ANALYTICS FOR SENSOR AND BIOIMAGE DATA IN AGING RESEARCH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Zhu
- Hebrew SeniorLife Institute for Aging Research, Roslindale, Massachusetts, United States
| | - T Tsai
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA
| | - V N Poole
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Manor
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A B Dufour
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - T G Travison
- Hebrew SeniorLife Institute for Aging Research, Roslindale, MA, USA; Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
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Tsai T, Liu C. P3.16-29 Prediction of Lymph Node Metastases in Clinical T1aN0M0 Non-Small Cell Lung Cancer. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1936] [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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Chan T, Sanyal R, Pavel A, Glickman J, Zheng X, Cho Y, Tsai T, Peng X, Krueger J, Guttman-Yassky E. 058 Variable TH2/TH17-skewing places Chinese atopic dermatitis and psoriasis on an inflammatory spectrum. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.062] [Citation(s) in RCA: 2] [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] [Indexed: 10/17/2022]
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Tsai T, Knapp JP, Chewning JJ, Shieh T, Maxwell CV. 219 Effect of a Peptide Product (FPM), Zinc Oxide and a Lactobacillus Acidophilus Fermented Product (LAFP) on Growth Performance of Nursery Pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - J P Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | | | - T Shieh
- Vitech Bio-Chem Corp, Glendale, CA
| | - C V Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
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Tsai T, Sales MA, Wang X, Erf GF, Kegley EB, Zhao J, Maxwell CV. 360 Effect of Simulated Outdoor Rearing on Growth Performance, Health, Blood Minerals, and Complete Blood Cell Count in Wean-to-Finish Pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - M A Sales
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - X Wang
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - G F Erf
- Department of Poultry Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - E B Kegley
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - J Zhao
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - C V Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
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Knapp JP, Tsai T, Broomhead JN, Maxwell CV, Chewning JJ. 277 The Effect of Corn-Expressed Phytase Supplementation in Adequate or Low Levels of Phosphorous and Calcium Diets on Growth Performance and Bone Ash of Nursery Pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J P Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | | | - C V Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
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Knapp JP, Tsai T, Broomhead JN, Chewning JJ, Maxwell CV. 137 Effects of a Corn-Expressed Phytase on Growth Performance and Bone Ash of Nursery Pigs. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J P Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | | | | | - C V Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
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Knapp JP, Wells JE, Maxwell CV, Tsai T, Durso LM, Oliver WT. 288 The Effects of Lactobacillus Acidophilus Fermentation Products As an Alternative to Antibiotics. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J P Knapp
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - J E Wells
- USDA, ARS, U.S. Meat Animal Research Center, Clay Center, NE
| | - C V Maxwell
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - T Tsai
- Department of Animal Science, Division of Agriculture, University of Arkansas, Fayetteville, AR
| | - L M Durso
- USDA, ARS, Agroecosystem Management Research Unit, Lincoln, NE
| | - W T Oliver
- USDA, ARS, U.S. Meat Animal Research Center, Clay Center, NE
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Tsai T, Diggle PK, Frye HA, Jones CS. Contrasting lengths of Pelargonium floral nectar tubes result from late differences in rate and duration of growth. Ann Bot 2018; 121:549-560. [PMID: 29293992 PMCID: PMC5838813 DOI: 10.1093/aob/mcx171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/14/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND AIMS Much of morphological evolution in flowers has arisen from pollinator-mediated selection, often manifest as a match between the length of the pollinator's proboscis and the depth of tubular corollas or spurs. We investigate development, growth and homology of the unique nectar tube of Pelargonium, frequently described as 'a spur adnate to the pedicel'. METHODS We focused on two species. The nectar tube of P. ionidiflorum is three times longer than that of P. odoratissimum. Light and scanning electron microscopy were carried out, and daily growth measurements were used to compare nectar tube development and vascular patterns. KEY RESULTS Nectar tubes in both species are initiated centripetally to the dorsal sepal in a space created by lateral displacement of two antepetalous stamens. The cavity deepens through subsequent intercalary growth of the receptacle that proceeds at the same rate in both species until tubes reach approx. 10 mm in length. Differences in final nectar tube lengths arise via an increase in the rate and duration of growth of the receptacle that begins just before anthesis (floral opening) and continues for several days past anthesis in P. ionidiflorum but does not occur in P. odoratissimum. Epidermal cells of the dorsal surface of the nectar tube in P. ionidiflorum are approx. 1.6 times longer than those in P. odoratissimum. Histological sections show no evidence that the nectar tube is a spur that became evolutionarily fused to the pedicel. CONCLUSIONS Nectar tubes in Pelargonium are localized cavities that form in the receptacle via intercalary growth. Differences in the rate and duration of growth just prior to and following anthesis underlie differences in final tube lengths. Because differences in cell lengths do not fully account for differences in nectar tube lengths, evolutionary diversification must involve changes in both cell cycle and cell expansion.
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Affiliation(s)
- Timothy Tsai
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - Pamela K Diggle
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - Henry A Frye
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - Cynthia S Jones
- Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
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Yang J, Yu C, Shih J, Ho C, Liao W, Lee J, Tsai T, Su K, Shih M, Chang Y, Bai Y, Huang D, Thress K, Lin C. P3.01-074 Genomic Analysis of Tumor and Plasma in T790M Mutant Positive EGFR Lung Cancer Patients before and after Osimertinib Treatment. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sales MA, Tsai T, Maxwell CV, Koltes DA, Koltes JE. 864 Identification of differentially expressed microRNAs in peripheral blood mononuclear cells of topsoil-exposed piglets. J Anim Sci 2017. [DOI: 10.2527/asasann.2017.864] [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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Chéret J, Chéret J, Bertolini M, Tsai T, Alam M, Hatt H, Paus R. 884 Olfactory receptor stimulation promotes human hair growth. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tsai T, Dove C, Cline P, Owusu-Asiedu A, Walsh M, Azain M. The effect of adding xylanase or β-glucanase to diets with corn distillers dried grains with solubles (CDDGS) on growth performance and nutrient digestibility in nursery pigs. Livest Sci 2017. [DOI: 10.1016/j.livsci.2017.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kramer DB, Tsai T, Natarajan P, Tewksbury E, Mitchell SL, Travison TG. Frailty, Physical Activity, and Mobility in Patients With Cardiac Implantable Electrical Devices. J Am Heart Assoc 2017; 6:JAHA.116.004659. [PMID: 28188253 PMCID: PMC5523763 DOI: 10.1161/jaha.116.004659] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background This study aimed to demonstrate the feasibility of measuring frailty in patients with cardiac implantable electrical devices while validating the physiologic significance of device‐detected physical activity by evaluating its association with frailty and mobility. Methods and Results Outpatients with cardiac implantable electrical devices compatible with physical activity analysis with at least 7 days of data were eligible. Office testing included frailty status (Study of Osteoporotic Fractures instrument), gait speed (m/s), mobility according to the Timed Up and Go (TUG) test (seconds), and daily physical activity (h/d) as measured by cardiac implantable electrical device. Among 219 patients, Study of Osteoporotic Fractures testing found 39.7% to be robust, 47.5% prefrail, and 12.8% frail. The mean gait speed for the cohort was 0.8±0.3 m/s, mean TUG time was 10.9±4.4 seconds, and mean activity was 2.8±1.9 h/d. Frail patients were markedly more likely to have gait speeds <0.8 m/s (OR 6.25, 95% CI 1.79‐33.3). In unadjusted analyses each 1‐hour increase in mean daily activity was associated with a 46% reduction of frail phenotype (OR 0.54, 95% CI 0.40‐0.74) versus robust and with a 27% reduction in the odds of having the prefrail phenotype (OR 0.73, 95% CI 0.62‐0.86). After adjustment this association per hour of activity persisted, with an adjusted OR for frailty of 0.71 (95% CI 0.51‐0.99) and adjusted OR for prefrailty of 0.81 (95% CI 0.67‐0.99). Conclusions Frailty and mobility limitation are common among cardiac implantable electrical device patients and are correlated to device‐detected physical activity.
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Affiliation(s)
- Daniel B Kramer
- Hebrew SeniorLife Institute for Aging Research, Boston, MA .,Harvard Medical School, Boston, MA.,Division of Cardiology, Department of Medicine, Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Timothy Tsai
- Hebrew SeniorLife Institute for Aging Research, Boston, MA
| | - Poorna Natarajan
- Harvard Medical School, Boston, MA.,Division of Cardiology, Department of Medicine, Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Elise Tewksbury
- Harvard Medical School, Boston, MA.,Division of Cardiology, Department of Medicine, Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Susan L Mitchell
- Hebrew SeniorLife Institute for Aging Research, Boston, MA.,Harvard Medical School, Boston, MA
| | - Thomas G Travison
- Hebrew SeniorLife Institute for Aging Research, Boston, MA.,Harvard Medical School, Boston, MA
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Kuehn S, Hurst J, Rensinghoff F, Tsai T, Grauthoff S, Satgunarajah Y, Dick HB, Schnichels S, Joachim SC. Degenerative effects of cobalt-chloride treatment on neurons and microglia in a porcine retina organ culture model. Exp Eye Res 2017; 155:107-120. [PMID: 28089775 DOI: 10.1016/j.exer.2017.01.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/06/2016] [Revised: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 01/08/2023]
Abstract
In order to understand the pathological processes of retinal diseases, experimental models are necessary. Cobalt, as part of the vitamin B12 complex, is important for neuronal integrity. However, it is known that high quantities of cobalt induce cytotoxic mechanisms via hypoxia mimicry. Therefore, we tested the degenerative effect of cobalt chloride (CoCl2) on neurons and microglia in a porcine retina organ culture model. Organotypic cultures of porcine retinas were cultured and treated with different concentrations of CoCl2 (0, 100, 300 and 500 μM) for 48 h. After four and eight days, CoCl2 induced a strong degeneration of the porcine retina, starting at 300 μM. A loss of retinal ganglion cells (RGCs, Brn-3a), amacrine cells (calretinin) and bipolar cells (PKCα) was observed. Additionally, a high expression of hypoxia induced factor-1a (HIF-1a) and heat shock protein 70 (HSP70) was noted at both points in time. Also, the Caspase 3 protein was activated and P21 expression was induced. However, only at day four, the Bax/Bcl-2 ratio was increased. The effect of CoCl2 was not restricted to neurons. CoCl2 concentrations reduced the microglia amount (Iba1) and activity (Iba1 + Fcγ-Receptor) at both points in time. These damaging effects on microglia were surprising, since CoCl2 causes hypoxia and a pro-inflammatory environment. However, high concentrations of CoCl2 also seem to be toxic to these cells. Similar degenerative mechanisms as in comparison to retinal ischemia animal models were observed. In summary, an effective and reproducible hypoxia-mimicking organotypic model for retinal degeneration was established, which is easy to handle and ready for drug studies.
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Affiliation(s)
- S Kuehn
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - J Hurst
- University Eye Hospital Tübingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Germany
| | - F Rensinghoff
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - T Tsai
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - S Grauthoff
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - Y Satgunarajah
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - H B Dick
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany
| | - S Schnichels
- University Eye Hospital Tübingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, 72076, Tübingen, Germany.
| | - S C Joachim
- Experimental Eye Research, Eye Hospital, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany.
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Feng H, Tsai T. Impact of different vitrification devices on oocyte DNA integrity in oocytes. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.417] [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: 10/21/2022]
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Chéret J, Ponce Moya L, Bertolini M, Tsai T, Alam M, Hatt H, Paus R. 216 Human hair follicles can “smell”: OR2AT4-mediated hair growth regulation. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.235] [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: 11/30/2022]
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Chin Y, Tsai T, Wu Y, Chen H, Lin S. 113 UV light and direct arsenic contact synergistically enhances carcinogenesis through activating inflammasome pathway in keratinocytes. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.139] [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: 10/21/2022]
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Hetts SW, Tsai T, Cooke DL, Amans MR, Settecase F, Moftakhar P, Dowd CF, Higashida RT, Lawton MT, Halbach VV. Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. AJNR Am J Neuroradiol 2015. [PMID: 26206813 DOI: 10.3174/ajnr.a4391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A minority of intracranial dural arteriovenous fistulas progress with time. We sought to determine features that predict progression and define outcomes of patients with progressive dural arteriovenous fistulas. MATERIALS AND METHODS We performed a retrospective imaging and clinical record review of patients with intracranial dural arteriovenous fistula evaluated at our hospital. RESULTS Of 579 patients with intracranial dural arteriovenous fistulas, 545 had 1 fistula (mean age, 45 ± 23 years) and 34 (5.9%) had enlarging, de novo, multiple, or recurrent fistulas (mean age, 53 ± 20 years; P = .11). Among these 34 patients, 19 had progressive dural arteriovenous fistulas with de novo fistulas or fistula enlargement with time (mean age, 36 ± 25 years; progressive group) and 15 had multiple or recurrent but nonprogressive fistulas (mean age, 57 ± 13 years; P = .0059, nonprogressive group). Whereas all 6 children had fistula progression, only 13/28 adults (P = .020) progressed. Angioarchitectural correlates to chronically elevated intracranial venous pressures, including venous sinus dilation (41% versus 7%, P = .045) and pseudophlebitic cortical venous pattern (P = .048), were more common in patients with progressive disease than in those without progression. Patients with progressive disease received more treatments than those without progression (median, 5 versus 3; P = .0068), but as a group, they did not demonstrate worse clinical outcomes (median mRS, 1 and 1; P = .39). However, 3 young patients died from intracranial venous hypertension and intracranial hemorrhage related to progression of their fistulas despite extensive endovascular, surgical, and radiosurgical treatments. CONCLUSIONS Few patients with dural arteriovenous fistulas follow an aggressive, progressive clinical course despite treatment. Younger age at initial presentation and angioarchitectural correlates to venous hypertension may help identify these patients prospectively.
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Affiliation(s)
- S W Hetts
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - T Tsai
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - D L Cooke
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - M R Amans
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - F Settecase
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - P Moftakhar
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.)
| | - C F Dowd
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.) Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.) Neurology (C.F.D., R.T.H., V.V.H.) Anesthesia and Perioperative Care (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - R T Higashida
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.) Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.) Neurology (C.F.D., R.T.H., V.V.H.) Anesthesia and Perioperative Care (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
| | - M T Lawton
- Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.)
| | - V V Halbach
- From the Departments of Radiology and Biomedical Imaging (S.W.H., T.T., D.L.C., M.R.A., F.S., P.M., C.F.D., R.T.H., V.V.H.) Neurological Surgery (C.F.D., R.T.H., M.T.L., V.V.H.) Neurology (C.F.D., R.T.H., V.V.H.) Anesthesia and Perioperative Care (C.F.D., R.T.H., V.V.H.), University of California, San Francisco, San Francisco, California
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Woskie L, Scott K, Tsai T, Lamond M, Allardi S, Jha A. Expanding the access conversation: An edX course on global health
quality. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cook D, Apple J, Maxwell C, Bassinger K, Young A, Johnson T, Kim H, Tsai T. Effects of crystalline amino acid supplementation of reduced crude protein (RCP) diet on net energy basis on Longissimus muscle (LM) quality of growing-finishing swine. Meat Sci 2015. [DOI: 10.1016/j.meatsci.2014.09.056] [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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Tsai T, Rajasekar S, St. John JC. The relationship between mitochondrial DNA haplotype and litter size in commercial pigs. Anim Prod Sci 2015. [DOI: 10.1071/anv55n12ab123] [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: 11/23/2022]
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Kamalaraj N, Tsai T, Massasso D. Abdominal pain in systemic lupus erythematosus: lupus enteritis, mesenteric thrombosis, or median arcuate ligament syndrome? Scand J Rheumatol 2014; 44:85-6. [PMID: 25379650 DOI: 10.3109/03009742.2014.965741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Kamalaraj
- Rheumatology Department, Liverpool Hospital , Sydney , Australia
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Wang WE, Michel APM, Wang L, Tsai T, Baeck ML, Smith JA, Wysocki G. A quantum cascade laser-based water vapor isotope analyzer for environmental monitoring. Rev Sci Instrum 2014; 85:093103. [PMID: 25273703 DOI: 10.1063/1.4894161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A field-deployable mid-infrared quantum cascade laser-based spectrometer was designed and developed for measurements of H2(16)O and H2(18)O at 7.12 μm. H2(16)O and H2(18)O absorption features at 1390.52 cm(-1) and 1389.91 cm(-1), respectively, accessible within current tuning range of the laser, were targeted. The target lines were carefully selected to assure similar absorption levels and similar temperature sensitivities of the line strength due to comparable lower state energies. A real-time spectral fitting algorithm was implemented for isotopic concentration retrieval. Detection limits for H2(16)O and H2(18)O of 2.2 ppm and 7.0 ppb, respectively, were achieved at a dew point of 14 °C (volume mixing ratio of 15,766 ppm) in 1 s integration time, which resulted in a δ(18)O isotopic ratio measurement precision of 0.25‰. The ultimate minimum detection limits obtained after 160 s integration time for H2(16)O and H2(18)O, and δ(18)O measurements were 0.6 ppm, 1.7 ppb, and 0.05‰, respectively.
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Affiliation(s)
- W E Wang
- Department of Electrical Engineering, Princeton University, Princeton, New Jersey 08544, USA
| | - A P M Michel
- Princeton Institute for the Science and Technology of Materials, Princeton University, Princeton, New Jersey 08540, USA
| | - L Wang
- Department of Civil and Environmental Engineering, Princeton University, Princeton, New Jersey 08544, USA
| | - T Tsai
- Department of Electrical Engineering, Princeton University, Princeton, New Jersey 08544, USA
| | - M L Baeck
- Department of Civil and Environmental Engineering, Princeton University, Princeton, New Jersey 08544, USA
| | - J A Smith
- Department of Civil and Environmental Engineering, Princeton University, Princeton, New Jersey 08544, USA
| | - G Wysocki
- Department of Electrical Engineering, Princeton University, Princeton, New Jersey 08544, USA
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Hetts S, Tsai T, Cooke D, Amans M, Narvid J, Dowd C, Higashida R, Halbach V. E-021 De Novo, Progressive, Multiple, and Recurrent Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.88] [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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Hsieh C, Hou M, Wang L, Tai H, Tsai T, Chen Y. EP-1828: Local irradiation modulates pharmacokinetics of 5-Fluorouracil in plasma but not in lymphatic fluid. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31946-0] [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: 10/23/2022]
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