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Abancourt L, Le Guévelou J, Taillez A, Vu A, de Crevoisier R, Supiot S, Hennequin C, Chapet O, Blanchard P, Mirabel X, Lartigau É, Pasquier D. [Stereotactic body radiation therapy for primary kidney cancer]. Cancer Radiother 2023; 27:568-572. [PMID: 37543493 DOI: 10.1016/j.canrad.2023.06.022] [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: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 08/07/2023]
Abstract
The incidence of primary renal cancer is increasing, particularly in elderly patients who may have comorbidities and/or a surgical contraindications. Stereotactic body radiotherapy has primarily been evaluated retrospectively to date. The most commonly used dose schedules are 40Gy in five fractions, 42Gy in three fractions, and 26Gy in one fraction. The results in terms of local control and toxicity are very encouraging. The advantages of stereotactic body radiotherapy compared to thermal ablative treatments are its non-invasive nature, absence of general anesthesia, ability to treat larger lesions, and those close to the renal hilum. Prospective evaluations are still necessary.
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Affiliation(s)
- L Abancourt
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - J Le Guévelou
- Radiotherapy department, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France
| | - A Taillez
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - A Vu
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R de Crevoisier
- Radiotherapy department, centre régional de lutte contre le cancer Eugène-Marquis, 35042 Rennes, France
| | - S Supiot
- Institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, université de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - O Chapet
- Département of de radiothérapie oncologie, centre hospitalier universitaire Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Université de Lyon, 69000 Lyon, France
| | - P Blanchard
- Département de radiothérapie oncologique, Gustave-Roussy cancer campus, université Paris-Saclay, Oncostat U1018, Inserm, Villejuif, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - É Lartigau
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France; Univ. Lille & CNRS CRIStAL UMR 9189, Lille, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France; Univ. Lille & CNRS CRIStAL UMR 9189, Lille, France.
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Aggarwal S, Vu A, Eremin DB, Persaud R, Fokin VV. Arenes participate in 1,3-dipolar cycloaddition with in situ-generated diazoalkenes. Nat Chem 2023:10.1038/s41557-023-01188-z. [PMID: 37217789 DOI: 10.1038/s41557-023-01188-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/20/2023] [Indexed: 05/24/2023]
Abstract
The venerable 1,3-dipolar cycloaddition has been widely used in organic synthesis for the construction of various heterocycles. However, in its century-long history, the simple and omnipresent aromatic phenyl ring has remained a stubbornly unreactive dipolarophile. Here we report 1,3-dipolar cycloaddition between aromatic groups and diazoalkenes, generated in situ from lithium acetylides and N-sulfonyl azides. The reaction results in densely functionalized annulated cyclic sulfonamide-indazoles that can be further converted into stable organic molecules that are important in organic synthesis. The involvement of aromatic groups in the 1,3-dipolar cycloadditions broadens the synthetic utility of diazoalkenes, a family of dipoles that have been little explored so far and are otherwise difficult to access. The process described here provides a route for the synthesis of medicinally relevant heterocycles and can be extended to other arene-containing starting materials. Computational examination of the proposed reaction pathway revealed a series of finely orchestrated bond-breaking and bond-forming events that ultimately lead to the annulated products.
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Affiliation(s)
- Shubhangi Aggarwal
- The Bridge@USC, Loker Hydrocarbon Research Institute and Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - Alexander Vu
- The Bridge@USC, Loker Hydrocarbon Research Institute and Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - Dmitry B Eremin
- The Bridge@USC, Loker Hydrocarbon Research Institute and Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - Rudra Persaud
- The Bridge@USC, Loker Hydrocarbon Research Institute and Department of Chemistry, University of Southern California, Los Angeles, CA, USA
| | - Valery V Fokin
- The Bridge@USC, Loker Hydrocarbon Research Institute and Department of Chemistry, University of Southern California, Los Angeles, CA, USA.
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Qu M, Zhang G, Qu H, Vu A, Wu R, Tsukamoto H, Jia Z, Huang W, Lenz HJ, Rich JN, Kay SA. Circadian regulator BMAL1::CLOCK promotes cell proliferation in hepatocellular carcinoma by controlling apoptosis and cell cycle. Proc Natl Acad Sci U S A 2023; 120:e2214829120. [PMID: 36595671 PMCID: PMC9926257 DOI: 10.1073/pnas.2214829120] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains a global health challenge whose incidence is growing worldwide. Previous evidence strongly supported the notion that the circadian clock controls physiological homeostasis of the liver and plays a key role in hepatocarcinogenesis. Despite the progress, cellular and molecular mechanisms underpinning this HCC-clock crosstalk remain unknown. Addressing this knowledge gap, we show here that although the human HCC cells Hep3B, HepG2, and Huh7 displayed variations in circadian rhythm profiles, all cells relied on the master circadian clock transcription factors, BMAL1 and CLOCK, for sustained cell growth. Down-regulating Bmal1 or Clock in the HCC cells induced apoptosis and arrested cell cycle at the G2/M phase. Mechanistically, we found that inhibiting Bmal1/Clock induced dysregulation of the cell cycle regulators Wee1 and p21 which cooperatively contribute to tumor cell death. Bmal1/Clock knockdown caused downregulation of Wee1 that led to apoptosis activation and upregulation of p21 which arrested the cell cycle at the G2/M phase. Collectively, our results suggest that the circadian clock regulators BMAL1 and CLOCK promote HCC cell proliferation by controlling Wee1 and p21 levels, thereby preventing apoptosis and cell cycle arrest. Our findings shed light on cellular impact of the clock proteins for maintaining HCC oncogenesis and provide proof-of-principle for developing cancer therapy based on modulation of the circadian clock.
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Affiliation(s)
- Meng Qu
- International Institutes of Medicine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang322000, China
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA90089
| | - Guoxin Zhang
- Hillman Cancer Center and Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA15232
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA15232
| | - Han Qu
- Department of Botany and Plant Sciences, University of California, Riverside, CA92521
| | - Alexander Vu
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA90089
| | - Raymond Wu
- Southern California Research Center for Alcoholic Liver and Pancreatic Diseases and Cirrhosis and Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033
| | - Hidekazu Tsukamoto
- Southern California Research Center for Alcoholic Liver and Pancreatic Diseases and Cirrhosis and Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033
| | - Zhenyu Jia
- Department of Botany and Plant Sciences, University of California, Riverside, CA92521
- Graduate Program in Genetics, Genomics, and Bioinformatics, University of California, Riverside, CA92521
| | - Wendong Huang
- Department of Diabetes Complications and Metabolism, Arthur Riggs Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope National Medical Center, Duarte, CA91010
| | - Heinz-Josef Lenz
- Division of Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA90032
| | - Jeremy N. Rich
- Hillman Cancer Center and Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA15232
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA15232
| | - Steve A. Kay
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA90089
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Vu A, Ngo V, Bui T, Tran T. POS-013 THROMBOTIC MICROANGIOPATHY AFTER COVID-19: LACK OF EVIDENCE OF COMPLEMENT ACTIVATION? A CASE REPORT. Kidney Int Rep 2022. [PMCID: PMC9213007 DOI: 10.1016/j.ekir.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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McNerney KO, Karageorgos S, Ferry GM, Wolpaw AJ, Burudpakdee C, Khurana P, Toland CN, Vemu R, Vu A, Hogarty MD, Bassiri H. TH-MYCN tumors, but not tumor-derived cell lines, are adrenergic lineage, GD2+, and responsive to anti-GD2 antibody therapy. Oncoimmunology 2022; 11:2075204. [PMID: 35646475 PMCID: PMC9132414 DOI: 10.1080/2162402x.2022.2075204] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neuroblastoma is a commonly lethal solid tumor of childhood and intensive chemoradiotherapy treatment cures ~50% of children with high-risk disease. The addition of immunotherapy using dinutuximab, a monoclonal antibody directed against the GD2 disialoganglioside expressed on neuroblasts, improves survival when incorporated into front-line therapy and shows robust activity in regressing relapsed disease when combined with chemotherapy. Still, many children succumb to neuroblastoma progression despite receiving dinutuximab-based immunotherapy, and efforts to counteract the immune suppressive signals responsible are warranted. Animal models of human cancers provide useful platforms to study immunotherapies. TH-MYCN transgenic mice are immunocompetent and develop neuroblastomas at autochthonous sites due to enforced MYCN expression in developing neural crest tissues. However, GD2-directed immunotherapy in this model has been underutilized due to the prevailing notion that TH-MYCN neuroblasts express insufficient GD2 to be targeted. We demonstrate that neuroblasts in TH-MYCN-driven tumors express GD2 at levels comparable to human neuroblastomas but rapidly lose GD2 expression when explanted ex vivo to establish tumor cell lines. This occurs in association with a transition from an adrenergic to mesenchymal differentiation state. Importantly, not only is GD2 expression retained on tumors in situ, treatment with a murine anti-GD2 antibody, 14G2a, markedly extends survival in such mice, including durable complete responses. Tumors in 14G2a-treated mice have fewer macrophage and myeloid-derived suppressor cells in their tumor microenvironment. Our findings support the utility of this model to inform immunotherapy approaches for neuroblastoma and potential opportunities to investigate drivers of adrenergic to mesenchymal fate decisions.
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Affiliation(s)
- KO McNerney
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - S Karageorgos
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - GM Ferry
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - AJ Wolpaw
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Wistar Institute, Philadelphia, PA
| | - C Burudpakdee
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - P Khurana
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - CN Toland
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - R Vemu
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Vu
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - MD Hogarty
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - H Bassiri
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Qian Y, Qian X, Shen M, Vu A, Seres DS. Effect of malnutrition on outcomes in patients with heart failure: A large retrospective propensity score-matched cohort study. Nutr Clin Pract 2022; 37:130-136. [PMID: 34994478 DOI: 10.1002/ncp.10815] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Heart failure (HF) is highly prevalent, whereas malnutrition is generally associated with poorer hospital outcomes, and it is not uncommon in patients with HF. Prior studies of the effect of malnutrition on HF outcomes are limited in size and quality. This study aims to elucidate the association between malnutrition and hospital length of stay (LOS), mortality, and discharge destination in patients with HF. METHODS This is a retrospective review of medical records for inpatients admitted with a primary diagnosis of HF in 2018. Patients with HF and severe protein-calorie malnutrition were compared with those without malnutrition. A two-sided t-test was conducted between patients who have HF with and without malnutrition on hospital outcomes. Multivariate logistic regression was developed to identify potential predictors of malnutrition. A propensity score was calculated for each patient and matched cases (malnutrition with nonmalnutrition) to balance covariates and reduce bias. RESULTS For N = 7079, the median age was 75 years, with 15.79% having severe malnutrition. Overall mortality was 5.57% (394 deceased) . There were significant associations between malnutrition and both mortality (relative risk, 2.22; P < 0.001) and LOS (10 vs 5 days, P < 0.001) in patients with HF. Significantly fewer patients with malnutrition were discharged home (odds ratio, 0.41; P < 0.001). CONCLUSION Patients with HF and malnutrition have higher risk for mortality, increased LOS in the hospital, and decreased chance of being discharged home. Continued study of this population is required to better predict which patients with malnutrition will respond to nutrition interventions.
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Affiliation(s)
- Yunzhi Qian
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Xinxuan Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Max Shen
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
| | - Alexander Vu
- Department of Medicine, New York University Langone Medical Center, New York, New York, USA
| | - David S Seres
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Lucia F, Vu A, Bourbonne V, Pradier O, Abgral R, Schick U. PO-1002 Variability of pretherapeutic FDG PET/CT parameters in patients with head and neck cancers. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bernhardt LJ, Lin S, Swegman C, Sellke R, Vu A, Solomon BS, Cuneo CN. The Refugee Health Partnership: A Longitudinal Experiential Medical Student Curriculum in Refugee/Asylee Health. Acad Med 2019; 94:544-549. [PMID: 30570498 DOI: 10.1097/acm.0000000000002566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PROBLEM In 2017, there were 25.4 million refugees worldwide, of whom 33,400 were resettled in the United States. In fiscal year 2016, 20,455 individuals were granted permanent asylum status in the United Sates. Both in the United States and overseas, refugees/asylees face significant disparities in accessing needed medical, mental health, and social support. APPROACH The Refugee Health Partnership (RHP) was developed by Johns Hopkins University School of Medicine students and colleagues at a local refugee resettlement agency in 2011. The program pairs teams of preclinical medical students with recently resettled refugees/asylees who have special health care needs. After receiving training, students conducted monthly home visits and accompanied patients to appointments to assist them in navigating the health care system over one year. Students participated in monthly reflection exercises to process experiences and attended monthly seminars facilitated by expert faculty and guests. OUTCOMES From 2012 to 2016, the RHP served 20 refugee families and engaged 60 students across four cohorts. Refugee participant retention was 20/22 (90.9%), and student retention was 57/60 (95.0%). In surveys completed at the end of their programs, students reported improvement in all measures, including understanding of different patient perspectives as well as comfort in communicating with patients across cultures and language barriers. NEXT STEPS The authors plan to integrate more objective measures of students' progress into the evaluations. They are scaling this model up both locally and beyond and plan to gather data from refugee/asylee participants to more accurately assess how they benefit from the program.
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Affiliation(s)
- Lydia J Bernhardt
- L.J. Bernhardt is a fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland. S. Lin is a fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland. C. Swegman is project manager, Tahirih Justice Center, Falls Church, Virginia. R. Sellke is program officer, Jhpiego, Baltimore, Maryland. A. Vu is adjunct professor, American University of Beirut, School of Medicine, Beirut, Lebanon. B.S. Solomon is associate professor of pediatrics and assistant dean for medical student affairs, Johns Hopkins University School of Medicine, Baltimore, Maryland. C.N. Cuneo is a resident, Department of Medicine, Brigham and Women's Hospital and Boston Children's Hospital, and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5824-2243
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Vu A, Thompson L, Willcutt E, Petrill S. Sluggish cognitive tempo: longitudinal stability and validity. ACTA ACUST UNITED AC 2019; 11:463-471. [PMID: 30788768 DOI: 10.1007/s12402-019-00287-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/25/2019] [Indexed: 11/25/2022]
Abstract
Emerging research has identified sluggish cognitive tempo (SCT) as a construct separate from ADHD predominately inattentive presentation. The present study explores the longitudinal stability of SCT over a period of 7 years, specifically the independent effects of SCT on behavioural and academic outcomes concurrently over a 3-year period. A sample of 639 twins, aged 6-12 years, participating in the Western Reserve Reading and Math Project (WRRMP) were assessed at seven annual home visits. The WRRMP sample is an unselected sample of twins representative of the general population of typically developing school-age children. The current investigation will focus on parent and teacher reports which assess attention deficit hyperactive/impulsive disorder (ADHD) and standardized achievement measures which assess academic outcomes. Over periods longer than 1 or 2 years, SCT does not display good longitudinal stability (r < .60). SCT also does not have consistent significant independent effects on academic outcomes once the effects of ADHD were controlled for. Over a 7-year period, SCT does not demonstrate consistent longitudinal stability. SCT significantly predicts social problems, internalizing behaviours, and anxious/depressive behaviours after the effects of ADHD are controlled for. SCT has no significant independent effects on cognitive or educational outcomes after the effects of inattentive ADHD are controlled for.
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Affiliation(s)
- Alexander Vu
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA.
- , Cleveland, USA.
- , Houston, USA.
| | - Lee Thompson
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
- Department of Psychological Sciences, Case Western Reserve University, 11220 Bellflower Road, Cleveland, OH, 44106-7123, USA
| | - Erik Willcutt
- Department of Psychology and Neuroscience, University of Colorado Boulder, Muenzinger D313C, UCB 345, Boulder, CO, 80309, USA
| | - Stephen Petrill
- Department of Psychology, Ohio State University, 225 Psychology Building, 1835 Neil Avenue, Columbus, OH, 43210, USA
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Orton M, Agarwal S, Muhoza P, Vasudevan L, Vu A. Strengthening Delivery of Health Services Using Digital Devices. Glob Health Sci Pract 2018; 6:S61-S71. [PMID: 30305340 PMCID: PMC6203413 DOI: 10.9745/ghsp-d-18-00229] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Delivery of high-quality efficient health services is a cornerstone of the global agenda to achieve universal health coverage. According to the World Health Organization, health service delivery is considered good when equitable access to a comprehensive range of high-quality health services is ensured within an integrated and person-centered continuum of care. However, good health service delivery can be challenging in low-resource settings. In this review, we summarize and discuss key advances in health service delivery, particularly in the context of using digital health strategies for mitigating human resource constraints. METHODS The review updates the foundational systematic review conducted by Agarwal et al. in 2015. We used PubMed, EMBASE, and CINAHL to find relevant English-language peer-reviewed articles published 2018. Our search strategy for MEDLINE was based on MeSH (medical subject headings) terms and text words of key articles that we identified a priori. Our search identified 92 articles. After screening, we selected 24 articles for abstract review, of which only 6 met the eligibility criteria and were ultimately included in this review. RESULTS Despite encouraging advances in the evidence base on digital strategies for health service delivery, the current body of evidence is still quite limited in 3 main areas: the effectiveness of interventions on health outcomes, improvement in health system efficiencies for service delivery, and the human capacity required to implement and support digital health strategies at scale. Two particular areas, digital health-enhanced referral coordination and mobile clinical decision support systems, demonstrate considerable potential to improve the quality and comprehensiveness of care received by patients, but they require a greater level of standardization and an expanded scope of health worker engagement across the health system in order to scale them up effectively. CONCLUSIONS Additional research is urgently needed to inform the effectiveness of interventions on health outcomes, improvement in health system efficiencies, and cost-effectiveness of service delivery. In particular, more documentation and research on ways to standardize and engage health workers in digital referral and clinical decision support systems can provide the foundation needed to scale these promising approaches in low- and middle-income settings.
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Affiliation(s)
- Maeghan Orton
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Smisha Agarwal
- Johns Hopkins Global Digital Health Initiative, Baltimore, MD, USA
| | - Pierre Muhoza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lavanya Vasudevan
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA. .,Center for Health Policy and Inequalities Research, Duke Global Health Institute, Durham, NC, USA
| | - Alexander Vu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA.,School of Medicine, American University of Beirut, Beirut, Lebanon
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Meerhoff L, Bruneau J, Vu A, Olivier AH, Pettré J. Guided by gaze: Prioritization strategy when navigating through a virtual crowd can be assessed through gaze activity. Acta Psychol (Amst) 2018; 190:248-257. [PMID: 30149239 DOI: 10.1016/j.actpsy.2018.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022] Open
Abstract
Modelling crowd behavior is essential for the management of mass events and pedestrian traffic. Current microscopic approaches consider the individual's behavior to predict the effect of individual actions in local interactions on the collective scale of the crowd motion. Recent developments in the use of virtual reality as an experimental tool have offered an opportunity to extend the understanding of these interactions in controlled and repeatable settings. Nevertheless, based on kinematics alone, it remains difficult to tease out how these interactions unfold. Therefore, we tested the hypothesis that gaze activity provides additional information about pedestrian interactions. Using an eye tracker, we recorded the participant's gaze behavior whilst navigating through a virtual crowd. Results revealed that gaze was consistently attracted to virtual walkers with the smallest values of distance at closest approach (DCA) and time to closest approach (TtCA), indicating a higher risk of collision. Moreover, virtual walkers gazed upon before an avoidance maneuver was initiated had a high risk of collision and were typically avoided in the subsequent avoidance maneuver. We argue that humans navigate through crowds by selecting only few interactions and that gaze reveals how a walker prioritizes these interactions. Moreover, we pose that combining kinematic and gaze data provides new opportunities for studying how interactions are selected by pedestrians walking through crowded dynamic environments.
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Boriboonsomsin K, Durbin T, Scora G, Johnson K, Sandez D, Vu A, Jiang Y, Burnette A, Yoon S, Collins J, Dai Z, Fulper C, Kishan S, Sabisch M, Jackson D. Real-world exhaust temperature profiles of on-road heavy-duty diesel vehicles equipped with selective catalytic reduction. Sci Total Environ 2018; 634:909-921. [PMID: 29660885 PMCID: PMC6698901 DOI: 10.1016/j.scitotenv.2018.03.362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 03/03/2018] [Accepted: 03/29/2018] [Indexed: 06/01/2023]
Abstract
On-road heavy-duty diesel vehicles are a major contributor of oxides of nitrogen (NOx) emissions. In the US, many heavy-duty diesel vehicles employ selective catalytic reduction (SCR) technology to meet the 2010 emission standard for NOx. Typically, SCR needs to be at least 200°C before a significant level of NOx reduction is achieved. However, this SCR temperature requirement may not be met under some real-world operating conditions, such as during cold starts, long idling, or low speed/low engine load driving activities. The frequency of vehicle operation with low SCR temperature varies partly by the vehicle's vocational use. In this study, detailed vehicle and engine activity data were collected from 90 heavy-duty vehicles involved in a range of vocations, including line haul, drayage, construction, agricultural, food distribution, beverage distribution, refuse, public work, and utility repair. The data were used to create real-world SCR temperature and engine load profiles and identify the fraction of vehicle operating time that SCR may not be as effective for NOx control. It is found that the vehicles participated in this study operate with SCR temperature lower than 200°C for 11-70% of the time depending on their vocation type. This implies that real-world NOx control efficiency could deviate from the control efficiency observed during engine certification.
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Affiliation(s)
- Kanok Boriboonsomsin
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - Thomas Durbin
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - George Scora
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - Kent Johnson
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - Daniel Sandez
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - Alexander Vu
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | - Yu Jiang
- University of California at Riverside, College of Engineering, Center for Environmental Research and Technology, 1084 Columbia Ave, Riverside, CA 92507, USA.
| | | | - Seungju Yoon
- California Air Resources Board, P.O. Box 2815, Sacramento, CA 95812, USA.
| | - John Collins
- California Air Resources Board, P.O. Box 2815, Sacramento, CA 95812, USA.
| | - Zhen Dai
- California Air Resources Board, P.O. Box 2815, Sacramento, CA 95812, USA.
| | - Carl Fulper
- US Environmental Protection Agency, 2000 Traverwood Drive, Ann Arbor, MI 48105, USA.
| | - Sandeep Kishan
- Eastern Research Group, Inc., 3508 Far West Blvd, Suite 210, Austin, TX 78731, USA.
| | - Michael Sabisch
- Eastern Research Group, Inc., 3508 Far West Blvd, Suite 210, Austin, TX 78731, USA.
| | - Doug Jackson
- Eastern Research Group, Inc., 3508 Far West Blvd, Suite 210, Austin, TX 78731, USA.
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Boriboonsomsin K, Durbin T, Scora G, Johnson K, Sandez D, Vu A, Jiang Y, Burnette A, Yoon S, Collins J, Dai Z, Fulper C, Kishan S, Sabisch M, Jackson D. Real-world exhaust temperature and engine load distributions of on-road heavy-duty diesel vehicles in various vocations. Data Brief 2018; 18:1520-1543. [PMID: 29900329 PMCID: PMC5997961 DOI: 10.1016/j.dib.2018.04.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Real-world vehicle and engine activity data were collected from 90 heavy-duty vehicles in California, United States, most of which have engine model year 2010 or newer and are equipped with selective catalytic reduction (SCR). The 90 vehicles represent 19 different groups defined by a combination of vocational use and geographic region. The data were collected using advanced data loggers that recorded vehicle speed, position (latitude and longitude), and more than 170 engine and aftertreatment parameters (including engine load and exhaust temperature) at the frequency of one Hz. This article presents plots of real-world exhaust temperature and engine load distributions for the 19 vehicle groups. In each plot, both frequency distribution and cumulative frequency distribution are shown. These distributions are generated using the aggregated data from all vehicle samples in each group.
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Affiliation(s)
| | - Thomas Durbin
- University of California at Riverside, United States
| | - George Scora
- University of California at Riverside, United States
| | - Kent Johnson
- University of California at Riverside, United States
| | - Daniel Sandez
- University of California at Riverside, United States
| | - Alexander Vu
- University of California at Riverside, United States
| | - Yu Jiang
- University of California at Riverside, United States
| | | | | | | | - Zhen Dai
- California Air Resources Board, United States
| | - Carl Fulper
- US Environmental Protection Agency, United States
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Martin DN, Lam TK, Brignole K, Ashing KT, Blot WJ, Burhansstipanov L, Chen JT, Dignan M, Gomez SL, Martinez ME, Matthews A, Palmer JR, Perez-Stable EJ, Schootman M, Vilchis H, Vu A, Srinivasan S. Recommendations for Cancer Epidemiologic Research in Understudied Populations and Implications for Future Needs. Cancer Epidemiol Biomarkers Prev 2017; 25:573-80. [PMID: 27196089 DOI: 10.1158/1055-9965.epi-15-1297] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
Medically underserved populations in the United States continue to experience higher cancer burdens of incidence, mortality, and other cancer-related outcomes. It is imperative to understand how health inequities experienced by diverse population groups may contribute to our increasing unequal cancer burdens and disparate outcomes. The National Cancer Institute convened a diverse group of scientists to discuss research challenges and opportunities for cancer epidemiology in medically underserved and understudied populations. This report summarizes salient issues and discusses five recommendations from the group, including the next steps required to better examine and address cancer burden in the United States among our rapidly increasing diverse and understudied populations. Cancer Epidemiol Biomarkers Prev; 25(4); 573-80. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".
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Affiliation(s)
- Damali N Martin
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
| | - Tram Kim Lam
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Katy Brignole
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | - Kimlin T Ashing
- Center for Community Alliance for Research and Education, City of Hope Cancer Center, Duarte, California
| | - William J Blot
- Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, Tennessee. International Epidemiology Institute, Rockville, Maryland
| | - Linda Burhansstipanov
- Native American Cancer Research Corporation, Denver, Colorado. Native American Cancer Initiatives, Incorporated, Colorado
| | - Jarvis T Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Dignan
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California
| | - Maria Elena Martinez
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Alicia Matthews
- School of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, Massachusetts
| | - Eliseo J Perez-Stable
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | - Mario Schootman
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Hugo Vilchis
- Burrell College of Osteopathic Medicine/Burrell Institute for Health Policy & Research, Las Cruces, New Mexico
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
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Pham K, Sharpe EC, Weiss WM, Vu A. The use of a lot quality assurance sampling methodology to assess and manage primary health interventions in conflict-affected West Darfur, Sudan. Popul Health Metr 2016; 14:34. [PMID: 27757070 PMCID: PMC5053218 DOI: 10.1186/s12963-016-0103-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 02/17/2016] [Accepted: 09/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizations working in conflict-affected areas have a need to monitor and evaluate their programs, however this is often difficult due to the logistical challenges of conflict areas. Lot quality assurance sampling may be a suitable method of assessing programs in these situations. METHODS We conducted a secondary data analysis of information collected during Medair's routine program management functions. Medair's service area in West Darfur, Sudan was divided into seven supervisory areas. Using the available population information, a sampling frame was developed and interviews were conducted from randomly selected caretakers of children in each supervisory area every six months over 19 months. A survey instrument with questions related to key indicators for immunizations and maternal, newborn, and child health was used for the interviews. Based on Medair's goals for each indicator, decision rules were calculated for the indicators; these decision rules determined which supervisory areas and indicators performed adequately in each assessment period. Pearson's chi-squared tests, adjusted for the survey design using STATA "svy: tab" commands, were used to detect overall differences in coverage in this analysis. RESULTS The coverage of tetanus toxoid vaccination among pregnant women increased from 47.2 to 69.7 % (p value = 0.046), and births attended by a skilled health professional increased from 35.7 to 52.7 % (p value = 0.025) from the first to last assessment periods. Measles vaccinations declined from 72.0 to 54.1 % (p value = 0.046). The estimated coverage for the proportion of women receiving a postpartum dose of vitamin A (54.7 to 61.3 %, p value = 0.44); pregnant women receiving a clean delivery kit (54.6 to 47.1 %, p value = 0.49); and pentavalent vaccinations (49.7 to 42.1 %, p value = 0.28) did not significantly change. CONCLUSIONS Lot quality assurance sampling was a feasible method for Medair staff to evaluate and optimize primary health programs in a conflict-affected area. Medair managers were able to collect, analyze, and disseminate data to staff alongside the routine work of the organization. These results suggest LQAS may be used in other complex humanitarian emergencies in which there are logistical challenges and limited resources.
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Affiliation(s)
- Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - William M Weiss
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Alexander Vu
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Wirtz AL, Glass N, Pham K, Perrin N, Rubenstein LS, Singh S, Vu A. Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings. Confl Health 2016; 10:7. [PMID: 27099617 PMCID: PMC4837612 DOI: 10.1186/s13031-016-0071-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia. Results The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool. Conclusion The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.
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Affiliation(s)
- A L Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Glass
- Johns Hopkins School of Nursing, Baltimore, USA
| | - K Pham
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - N Perrin
- Johns Hopkins School of Nursing, Baltimore, USA ; Center for Health Research, Kaiser Permanente Northwest, Portland, USA
| | - L S Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - S Singh
- Department of Internal Medicine, Johns Hopkins Medical Institute, Baltimore, USA
| | - A Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Deininger K, Vu A, Page R, Ambardekar A, Lindenfeld J, Aquilante C. CYP3A5 Pharmacogenetic Testing Predicts High Tacrolimus Dose Requirements Early after Cardiac Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vu A, Wirtz A, Pham K, Singh S, Rubenstein L, Glass N, Perrin N. Psychometric properties and reliability of the Assessment Screen to Identify Survivors Toolkit for Gender Based Violence (ASIST-GBV): results from humanitarian settings in Ethiopia and Colombia. Confl Health 2016; 10:1. [PMID: 26865857 PMCID: PMC4748528 DOI: 10.1186/s13031-016-0068-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 07/03/2015] [Accepted: 02/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Refugees and internally displaced persons who are affected by armed-conflict are at increased vulnerability to some forms of sexual violence or other types of gender-based violence. A validated, brief and easy-to-administer screening tool will help service providers identify GBV survivors and refer them to appropriate GBV services. To date, no such GBV screening tool exists. We developed the 7-item ASIST-GBV screening tool from qualitative research that included individual interviews and focus groups with GBV refugee and IDP survivors. This study presents the psychometric properties of the ASIST-GBV with female refugees living in Ethiopia and IDPs in Colombia. Methods Several strategies were used to validate ASIST-GBV, including a 3 month implementation to validate the brief screening tool with women/girls seeking health services, aged ≥15 years in Ethiopia (N = 487) and female IDPs aged ≥ 18 years in Colombia (N = 511). Results High proportions of women screened positive for past-year GBV according to the ASIST-GBV: 50.6 % in Ethiopia and 63.4 % in Colombia. The factor analysis identified a single dimension, meaning that all items loaded on the single factor. Cronbach’s α = 0.77. A 2-parameter logistic IRT model was used for estimating the precision and discriminating power of each item. Item difficulty varied across the continuum of GBV experiences in the following order (lowest to highest): threats of violence (0.690), physical violence (1.28), forced sex (2.49), coercive sex for survival (2.25), forced marriage (3.51), and forced pregnancy (6.33). Discrimination results showed that forced pregnancy was the item with the strongest ability to discriminate between different levels of GBV. Physical violence and forced sex also have higher levels of discrimination with threats of violence discriminating among women at the low end of the GBV continuum and coercive sex for survival among women at the mid-range of the continuum. Conclusion The findings demonstrate that the ASIST-GBV has strong psychometric properties and good reliability. The tool can be used to screen and identify female GBV survivors confidentially and efficiently among IDPs in Colombia and refugees in Ethiopia. Early identification of GBV survivors can enable safety planning, early referral for treatment, and psychosocial support to prevent long-term harmful consequence of GBV.
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Affiliation(s)
- Alexander Vu
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA ; Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Andrea Wirtz
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Sonal Singh
- Department of Medicine, Johns Hopkins University, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Leonard Rubenstein
- Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins University, School of Nursing , Baltimore, USA
| | - Nancy Perrin
- Johns Hopkins University, School of Nursing , Baltimore, USA ; Center for Health Research Kaiser Permanente Northwest, Portland, OR USA
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Abstract
Narrow Band Imaging (NBI) is an endoscopic optical imaging enhancement technology that improves the contrast of mucosal surface texture, and enhances visualisation of mucosal and submucosal vasculature. White light is filtered to emit two 30-nm narrow bands of blue (415 nm) and green light (540 nm) light simultaneously, the former corresponding to the main peak absorption spectrum of haemoglobin, and the latter allowing visualisation of blood vessels in the deeper mucosal and submucosal layers. NBI has been used to better assess oral potentially malignant disorders (OPMD), identify oral and oropharyngeal squamous cell carcinoma (SCC), and to define surgical margins of head and neck malignancies. NBI shows great potential in improving detection rates of OPMD, facilitating better assessment of oral and oropharyngeal SCC, and reducing the risk of recurrence for oral SCC. Although further research is required to better understand and define intrapapillary capillary loop (IPCL) patterns and to relate these with clinical, histopathological and molecular parameters especially for early mucosal changes, there is building evidence to recommend its use as the new gold standard for endoscopic assessment in head and neck oncology.
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Affiliation(s)
- A Vu
- The Australian Centre for Oral Oncology Research & Education, School of Dentistry, University of Western Australia, Nedlands, Australia
| | - C S Farah
- The Australian Centre for Oral Oncology Research & Education, School of Dentistry, University of Western Australia, Nedlands, Australia
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Ruiseñor-Escudero H, Vu A, Wirtz AL, Familiar-Lopez I, Berry M, Mfochive I, Engineer C, Farhad A, Tschakarjan S, Wisse E, Paikan FM, Burnham G. Cross-sectional assessments of participants' characteristics and loss to follow-up in the first Opioid Substitution Therapy Pilot Program in Kabul, Afghanistan. Harm Reduct J 2015; 12:28. [PMID: 26337832 PMCID: PMC4559065 DOI: 10.1186/s12954-015-0062-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 08/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background Kabul has over 12,000 people who inject drugs (PWID), most of them heroin users, and opioid substitution therapy has recently been introduced as an effective method to reduce opioid use. We aimed to evaluate a pilot Opioid Substitution Therapy Pilot Program (OSTPP) in Kabul, Afghanistan, particularly to (1) describe characteristics of the participants enrolled in the program and (2) identify factors associated with client retention in the OSTPP. Findings Two cross-sectional surveys evaluated participants attending the OSTPP at baseline (n = 83) and 18 months after (n = 57). Questionnaires assessed socio-demographic, drug use behavior, and general and mental health factors. After 18 months, 57 participants remained in the OSTPP. Participants lost to follow-up were younger (p < 0.01) and married (p < 0.01) and had no family contact (p < 0.01). Participants at 18 months reported no criminal activity in the last month and only two (3.5 %) reported heroin use in the last month, constituting significant decreases from baseline. Conclusions While preliminary results are promising, further evaluation is needed to determine the feasibility of implementing OSTPP in this setting and effectiveness in reducing injection risk behaviors in Afghanistan.
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Affiliation(s)
- Horacio Ruiseñor-Escudero
- Department of Psychiatry, Michigan State University, College of Ostheopathic Medicine, 965 E Fee Hall Suite A227, Lansing, MI, 48824, USA. .,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.,Department of Emergency Medicine, Johns Hopkins University, School of Medicine, 5801 Smith Avenue, Suite 3220, Baltimore, MD, 21205, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Itziar Familiar-Lopez
- Department of Psychiatry, Michigan State University, College of Ostheopathic Medicine, 965 E Fee Hall Suite A227, Lansing, MI, 48824, USA
| | - Mark Berry
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Iliassou Mfochive
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Cyrus Engineer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.,Department of Interprofessional Health Studies, Towson University, Baltimore, MD, 21252, USA
| | | | | | - Ernst Wisse
- Medecins du Monde, Kabul, Afghanistan.,Medecins du Monde, 63 rue de Marcadet, Paris, 75018, France
| | | | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
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Ruiseñor-Escudero H, Wirtz AL, Berry M, Mfochive-Njindan I, Paikan F, Yousufi HA, Yadav RS, Burnham G, Vu A. Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan. Drug Alcohol Depend 2014; 143:127-33. [PMID: 25131717 DOI: 10.1016/j.drugalcdep.2014.07.022] [Citation(s) in RCA: 20] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/12/2014] [Accepted: 07/13/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Injecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009. METHODS Epidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection. RESULTS Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection. CONCLUSIONS There is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat.
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Affiliation(s)
- Horacio Ruiseñor-Escudero
- Department of Psychiatry, Michigan State University, 965 E Fee Hall Suite A227, East Lansing, MI, 48824, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Andrea L Wirtz
- Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Mark Berry
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Iliassou Mfochive-Njindan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Feda Paikan
- National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan
| | - Hussain A Yousufi
- National AIDS Control Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Gilbert Burnham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Alexander Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institution, Baltimore, MD, 21205, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Wirtz AL, Pham K, Glass N, Loochkartt S, Kidane T, Cuspoca D, Rubenstein LS, Singh S, Vu A. Gender-based violence in conflict and displacement: qualitative findings from displaced women in Colombia. Confl Health 2014; 8:10. [PMID: 25076981 PMCID: PMC4115473 DOI: 10.1186/1752-1505-8-10] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Gender-based violence (GBV) is prevalent among, though not specific to, conflict affected populations and related to multifarious levels of vulnerability of conflict and displacement. Colombia has been marked with decades of conflict, with an estimated 5.2 million internally displaced persons (IDPs) and ongoing violence. We conducted qualitative research to understand the contexts of conflict, displacement and dynamics with GBV. This as part of a multi-phase, mixed method study, in collaboration with UNHCR, to develop a screening tool to confidentially identify cases of GBV for referral among IDP women who were survivors of GBV. Methods Qualitative research was used to identify the range of GBV, perpetrators, contexts in conflict and displacement, barriers to reporting and service uptake, as well as to understand experiences of service providers. Thirty-five female IDPs, aged 18 years and older, who self-identified as survivors of GBV were enrolled for in-depth interviews in San Jose de Guaviare and Quibdo, Colombia in June 2012. Thirty-one service providers participated in six focus group discussions and four interviews across these sites. Results Survivors described a range of GBV across conflict and displacement settings. Armed actors in conflict settings perpetrated threats of violence and harm to family members, child recruitment, and, to a lesser degree, rape and forced abortion. Opportunistic violence, including abduction, rape, and few accounts of trafficking were more commonly reported to occur in the displacement setting, often perpetrated by unknown individuals. Intrafamilial violence, intimate partner violence, including physical and sexual violence and reproductive control were salient across settings and may be exacerbated by conflict and displacement. Barriers to reporting and services seeking were reported by survivors and providers alike. Conclusions Findings highlight the need for early identification of GBV cases, with emphasis on confidential approaches and active engagement of survivors in available, quality services. Such efforts may facilitate achievement of the goals of new Colombian laws, which seek to prevent and respond to GBV, including in conflict settings. Ongoing conflict and generalized GBV in displacement, as well as among the wider population, suggests a need to create sustainable solutions that are accessible to both IDPs and general populations.
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Affiliation(s)
- Andrea L Wirtz
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA
| | - Kiemanh Pham
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
| | - Nancy Glass
- Johns Hopkins School of Nursing, Baltimore, USA
| | | | - Teemar Kidane
- United Nations High Commissioner for Refugees, Bogota, Colombia
| | - Decssy Cuspoca
- Departamento de Antropología de la Universidad de los Andes, Bogota, Colombia
| | - Leonard S Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA
| | - Sonal Singh
- Center for Public Health and Human Rights, Department of Epidemiology, Johns School of Public Health, Baltimore, USA ; Department of General Internal Medicine, Johns Hopkins Medical Institute, Baltimore, USA
| | - Alexander Vu
- Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, USA ; Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
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Vu A, Page R, Roscoe N, Lindenfeld J, Aquilante C. Effect of CYP3A4*22 and CYP3A5 Combined Genotypes on Tacrolimus Disposition in Heart Transplantation. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Vu A, Adam A, Wirtz A, Pham K, Rubenstein L, Glass N, Beyrer C, Singh S. The Prevalence of Sexual Violence among Female Refugees in Complex Humanitarian Emergencies: a Systematic Review and Meta-analysis. PLoS Curr 2014; 6. [PMID: 24818066 PMCID: PMC4012695 DOI: 10.1371/currents.dis.835f10778fd80ae031aac12d3b533ca7] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Importance: Refugees and internally displaced persons are highly vulnerable to sexual violence during conflict and subsequent displacement. However, accurate estimates of the prevalence of sexual violence among in these populations remain uncertain.
Objective: Our objective was to estimate the prevalence of sexual violence among refugees and displaced persons in complex humanitarian emergencies.
Data Source: We conducted systematic review of relevant literature in multiple databases (EMBASE, CINAHL, and MEDLINE) through February 2013 to identify studies. We also reviewed reference lists of included articles to identify any missing sources.
Study Selection: Inclusion criteria required identification of sexual violence among refugees and internally displaced persons or those displaced by conflict in complex humanitarian settings. Studies were excluded if they did not provide female sexual violence prevalence, or that included only single case reports, anecdotes, and those that focused on displacement associated with natural disasters. After a review of 1175 citations 19 unique studies were selected.
Data Extraction: Two reviewers worked independently to identify final selection and a third reviewer adjudicated any differences. Descriptive and quantitative information was extracted; prevalence estimates were synthesized. Heterogeneity was assessed using I2.
Main Outcomes: The main outcome of interest was sexual violence among female refugees and internally displaced persons in complex humanitarian settings.
Results: The prevalence of sexual violence was estimated at 21.4% (95% CI, 14.9-28.7; I2=98.3%), using a random effects model. Statistical heterogeneity was noted with studies using probability sampling designs reporting lower prevalence of sexual violence (21.0%, 95% CI, 13.2-30.1; I2=98.6%), compared to lower quality studies (21.7%, 95% CI, 11.5-34.2; I2=97.4%). We could not rule out the presence of publication bias.
Conclusions: The findings suggest that approximately one in five refugees or displaced women in complex humanitarian settings experienced sexual violence. However, this is likely an underestimation of the true prevalence given the multiple existing barriers associated with disclosure. The long-term health and social consequences of sexual violence for women and their families necessitate strategies to improve identification of survivors of sexual violence and increase prevention and response interventions in these complex settings.
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Affiliation(s)
- Alexander Vu
- International Emergency Medicine and Public Health Fellowship Program, Department of Emergency Medicine, Johns Hopkins School of Medicine; Health Systems Program, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Atif Adam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea Wirtz
- Department of Emergency Medicine, Johns Hopkins School of Medicine; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kiemanh Pham
- International Emergency Medicine and Public Health Fellowship Program, Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Leonard Rubenstein
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sonal Singh
- Department of Medicine, Johns Hopkins School of Medicine; Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Richardson M, Vu A, Karp D, Treszezamsky A. A Prospective Multicenter FPRN Study on the Effect of Sacral Neuromodulation on Bowel Function in Women Undergoing Interstim for Overactive Bladder. J Minim Invasive Gynecol 2014. [DOI: 10.1016/j.jmig.2013.12.109] [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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Vu A, Duber HC, Sasser SM, Hansoti B, Lynch C, Khan A, Johnson T, Modi P, Clattenburg EJ, Hargarten S. Emergency care research funding in the global health context: trends, priorities, and future directions. Acad Emerg Med 2013; 20:1259-63. [PMID: 24341581 DOI: 10.1111/acem.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/13/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022]
Abstract
Over the past few decades there has been a steady growth in funding for global health, yet generally little is known about funding for global health research. As part of the 2013 Academic Emergency Medicine consensus conference, a session was convened to discuss emergency care research funding in the global health context. Overall, the authors found a lack of evidence available to determine funding priorities or quantify current funding for acute care research in global health. This article summarizes the initial preparatory research and reports on the results of the consensus conference focused on identifying challenges and strategies to improve funding for global emergency care research. The consensus conference meeting led to the creation of near- and long-term goals to strengthen global emergency care research funding and the development of important research questions. The research questions represent a consensus view of important outstanding questions that will assist emergency care researchers to better understand the current funding landscape and bring evidence to the debate on funding priorities of global health and emergency care. The four key areas of focus for researchers are: 1) quantifying funding for global health and emergency care research, 2) understanding current research funding priorities, 3) identifying barriers to emergency care research funding, and 4) using existing data to quantify the need for emergency services and acute care research. This research agenda will enable emergency health care scientists to use evidence when advocating for more funding for emergency care research.
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Affiliation(s)
- Alexander Vu
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Herbert C. Duber
- The Division of Emergency Medicine; Department of Medicine; University of Washington; Seattle WA
- Institute for Health Metrics and Evaluation; University of Washington; Seattle WA
| | - Scott M. Sasser
- The Department of Emergency Medicine; Emory University; Atlanta GA
| | - Bhakti Hansoti
- The Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Catherine Lynch
- The Division of Emergency Medicine; Department of Surgery; Duke University; Durham NC
| | - Ayesha Khan
- The Division of Emergency Medicine; Department of Surgery; Stanford University; Stanford CA
| | - Tara Johnson
- The Department of Emergency Medicine; Maricopa Integrated Health System; Phoenix AZ
| | - Payal Modi
- The Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | | | - Stephen Hargarten
- The Department of Emergency Medicine; Medical College of Wisconsin; Milwaukee WI
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Abstract
BACKGROUND Children are a special population, particularly susceptible to injury. Registries for various injury types in the pediatric population are important, not only for epidemiological purposes but also for their implications on intervention programs. Although injury registries already exist, there is no uniform injury classification system for traumatic mass casualty events such as earthquakes. OBJECTIVE To systematically review peer-reviewed literature on the patterns of earthquake-related injuries in the pediatric population. METHODS On May 14, 2012, the authors performed a systematic review of literature from 1950 to 2012 indexed in Pubmed, EMBASE, Scopus, Web of Science, and Cochrane Library. Articles written in English, providing a quantitative description of pediatric injuries were included. Articles focusing on other types of disasters, geological, surgical, conceptual, psychological, indirect injuries, injury complications such as wound infections and acute kidney injury, case reports, reviews, and non-English articles were excluded. RESULTS A total of 2037 articles were retrieved, of which only 10 contained quantitative earthquake-related pediatric injury data. All studies were retrospective, had different age categorization, and reported injuries heterogeneously. Only 2 studies reported patterns of injury for all pediatric patients, including patients admitted and discharged. Seven articles described injuries by anatomic location, 5 articles described injuries by type, and 2 articles described injuries using both systems. CONCLUSIONS Differences in age categorization of pediatric patients, and in the injury classification system make quantifying the burden of earthquake-related injuries in the pediatric population difficult. A uniform age categorization and injury classification system are paramount for drawing broader conclusions, enhancing disaster preparation for future disasters, and decreasing morbidity and mortality.
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Affiliation(s)
| | | | - Alexander Vu
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Jamil D Bayram
- Johns Hopkins University, Baltimore, Maryland, USA; Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA; Center for Refugee and Disaster Response, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Jacquet GA, Vu A, Ewen WB, Hansoti B, Andescavage S, Price D, Suter RE, Bayram JD. Fellowships in international emergency medicine in the USA: a comparative survey of program directors’ and fellows’ perspectives on the curriculum. Postgrad Med J 2013; 90:3-7. [DOI: 10.1136/postgradmedj-2012-131714] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wirtz AL, Glass N, Pham K, Aberra A, Rubenstein LS, Singh S, Vu A. Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia. Confl Health 2013; 7:13. [PMID: 23758886 PMCID: PMC3695841 DOI: 10.1186/1752-1505-7-13] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/03/2013] [Indexed: 12/02/2022] Open
Abstract
Background High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-based approaches are necessary to change the current state of GBV amongst these populations. We present the findings of qualitative research, which were used to inform the development of a screening tool as one potential strategy to identify and respond to GBV for females in humanitarian settings. Methods Qualitative research methods were conducted from January-February 2011 to explore the range of experiences of GBV and barriers to reporting GBV among female refugees. Individual interview participants (n=37) included female refugees (≥15 years), who were survivors of GBV, living in urban or one of three camps settings in Ethiopia, and originating from six conflict countries. Focus group discussion participants (11 groups; 77 participants) included health, protection and community service staff working in the urban or camp settings. Interviews and discussions were conducted in the language of preference, with assistance by interpreters when needed, and transcribed for analysis by grounded-theory technique. Results Single and multiple counts of GBV were reported and ranged from psychological and social violence; rape, gang rape, sexual coercion, and other sexual violence; abduction; and physical violence. Domestic violence was predominantly reported to occur when participants were living in the host country. Opportunistic violence, often manifested by rape, occurred during transit when women depended on others to reach their destination. Abduction within the host country, and often across borders, highlighted the constant state of vulnerability of refugees. Barriers to reporting included perceived and experienced stigma in health settings and in the wider community, lack of awareness of services, and inability to protect children while mothers sought services. Conclusions Findings demonstrate that GBV persists across the span of the refugee experience, though there is a transition in the range of perpetrators and types of GBV that are experienced. Further, survivors experience significant individual and system barriers to disclosure and service utilization. The findings suggest that routine GBV screening by skilled service providers offers a strategy to confidentially identify and refer survivors to needed services within refugee settings, potentially enabling survivors to overcome existing barriers.
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Affiliation(s)
- Andrea L Wirtz
- Department of Emergency Medicine, Johns Hopkins Medical Institutes, Baltimore, USA.
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Vu A, Pham K, Tran N, Ahmed S. The Influence of Social Desirability on Self-Reported Sexual Behavior in HIV Survey in Rural Ethiopia. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.34044] [Citation(s) in RCA: 3] [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: 11/20/2022]
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Vu A, Tran N, Pham K, Ahmed S. Reliability of the Marlowe-Crowne social desirability scale in Ethiopia, Kenya, Mozambique, and Uganda. BMC Med Res Methodol 2011; 11:162. [PMID: 22136357 PMCID: PMC3259072 DOI: 10.1186/1471-2288-11-162] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 12/02/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of HIV often use self-reported surveys to measure sexual knowledge, attitudes, and practices. However, the self-reported data are vulnerable to social desirability (SD), a propensity of individuals to report favorable responses. The Marlowe-Crowne Social Desirability Scale (MC-SDS) was developed as a measure of the effect of social desirability, but it has not been adapted for or used in Africa. This study aimed to apply the MC-SDS nested in an HIV behavioral intervention program and to measure its reliability in four African countries. METHODS The MC-SDS was adapted based on consultations with local stakeholders and pilot tested in Ethiopia, Kenya, Mozambique, and Uganda. Trained interviewers administered the modified 28-item MC-SDS survey to 455 men and women (ages 15-24 years). The scores for the social desirability scales were calculated for all participants. An analysis of the internal consistency of responses was conducted using the Cronbach's α coefficient. Acceptable internal consistency was defined as an α coefficient of ≥ 0.70. RESULTS Mean social desirability scores ranged from a low of 15.7 in Kenya to a high of 20.6 in Mozambique. The mean score was 17.5 for Uganda and 20.6 for Mozambique. The Cronbach's α coefficients were 0.63 in Kenya, 0.66 in Mozambique, 0.70 in Uganda, and 0.80 in Ethiopia. CONCLUSIONS The MC-SDS can be effectively adapted and implemented in sub-Saharan Africa. The reliability of responses in these settings suggest that the MC-SDS could be a useful tool for capturing potential SD in surveys of HIV related risk behaviors.
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Affiliation(s)
- Alexander Vu
- International Emergency and Public Health Fellowship Program, Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, USA.
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Abstract
OBJECTIVE Refugees in long-term camp-based settings are often provided health services through health systems parallel to national health systems. This article, through literature review, explores the question of health service delivery in the context of long-term refugee situations, examining in particular the impact on host national population. The objective is to identify data and themes in literature that shed light on the utilization of health services for refugees and host population. DESIGN To explore this objective, a broad literature review was conducted. Literature was categorized into the following three topics: the impact of refugee camps on the health and livelihood of host population, the impact of services on access to care and health outcomes of refugee population, and the impact of services on access to care and health outcomes of host population. CONCLUSIONS Literature reports varied impacts of refugee hosting on host national population. The need for a contextual approach to understand the impact of refugee hosting is indicated through these findings. Some studies found that refugee hosting improved the quality and accessibility of health services and, in some cases, health outcomes for host national population; however, the data supporting integrating health services for refugees and host population are limited, and both reduce the strength of the integration argument. The overall body of evidence to reach conclusions on what is the ideal model of health service delivery for refugees and host population is limited. Improved data collection and analysis of utilization patterns for refugees and host population could strengthen program and policy design in this area.
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Affiliation(s)
- Sarah Meyer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Weiss WM, Vu A, Tappis H, Meyer S, Haskew C, Spiegel P. Utilization of outpatient services in refugee settlement health facilities: a comparison by age, gender, and refugee versus host national status. Confl Health 2011; 5:19. [PMID: 21936911 PMCID: PMC3189098 DOI: 10.1186/1752-1505-5-19] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 09/21/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). METHODS Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. RESULTS Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable to host community members was higher than that for refugees. There was no statistically significant difference between the size of the male and female populations across refugee settlements. Across all settlements reporting to the UNHCR database, the percent of the refugee population that was less than five years of age is 16% on average. CONCLUSIONS The availability of a centralized database of health information across UNHCR-supported refugee settlements is a rich resource. The SPHERE standard for emergencies of 1-4 visits per person per year appears to be relevant for Asia in the post-emergency phase, but not for Africa. In Africa, a post-emergency standard of 1-2 visits per person per year should be considered. Although it is often assumed that the size of the female population in refugee settlements is higher than males, we found no statistically significant difference between the size of the male and female populations in refugee settlements overall. Another assumption---that the under-fives make up 20% of the settlement population during the emergency phase---does not appear to hold for the post-emergency phase; under-fives made up about 16% of refugee settlement populations.
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Affiliation(s)
- William M Weiss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Alexander Vu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Hannah Tappis
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | - Sarah Meyer
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA
| | | | - Paul Spiegel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
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Affiliation(s)
- Melinda J Morton
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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Stansbury D, Naselaris T, Vu A, Gallant J. Visual cortex represents the statistical distributions of objects in natural scenes. J Vis 2010. [DOI: 10.1167/10.7.1260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ahmad M, Liu Y, Slavens Z, Low R, Merkle E, Hwang K, Vu A, Ma J. SU-FF-I-124: Automatic Identification of Water and Fat Images From a Symmetrically-Sampled Dual-Echo Dixon Technique. Med Phys 2009. [DOI: 10.1118/1.3181245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Greenough PG, Lappi MD, Hsu EB, Fink S, Hsieh YH, Vu A, Heaton C, Kirsch TD. Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: a population-based cluster sample. Ann Emerg Med 2007; 51:426-32. [PMID: 17583378 DOI: 10.1016/j.annemergmed.2007.04.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 03/07/2007] [Accepted: 04/04/2007] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Anecdotal evidence suggests that the population displaced to shelters from Hurricane Katrina had a significant burden of disease, socioeconomic vulnerability, and marginalized health care access. For agencies charged with providing health care to at-risk displaced populations, knowing the prevalence of acute and chronic disease is critical to direct resources and prevent morbidity and mortality. METHODS We performed a 2-stage 18-cluster sample survey of 499 evacuees residing in American Red Cross shelters in Louisiana 2 weeks after landfall of Hurricane Katrina. In stage 1, shelters with a population of more than 100 individuals were randomly selected, with probability proportional to size sampling. In stage 2, 30 adult heads of household were randomly chosen within shelters by using a shelter log or a map of the shelter where no log existed. Survey questions focused on demographics, socioeconomic indicators, acute and chronic burden of disease, and health care access. RESULTS Two thirds of the sampled population was single, widowed, or divorced; the majority was female (57.6%) and black (76.4%). Socioeconomic indicators of under- and unemployment (52.9%), dependency on benefits or assistance (38.5%), lack of home ownership (66.2%), and lack of health insurance (47.0%) suggested vulnerability. One third lacked a health provider. Among those who arrived at shelters with a chronic disease (55.6%), 48.4% lacked medication. Hypertension, hypercholesterolemia, diabetes, pulmonary disease, and psychiatric illness were the most common chronic conditions. Risk factors for lacking medications included male sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 0.96 to 2.59) and lacking health insurance (OR 2.25; 95% CI 1.21 to 4.20). More than one third (34.5%) arrived at the shelter with symptoms warranting immediate medical intervention, including dehydration (12.0%), dyspnea (11.5%), injury (9.4%), and chest pain (9.7%). Risk factors associated with presenting to shelters with acute symptoms included concurrent chronic disease with medication (OR 2.60; 95% CI 1.98 to 3.43), concurrent disease and lacking medication (OR 2.22; 95% CI 1.36 to 3.63), and lacking health insurance (OR 1.83; 95% CI 1.10 to 3.02). CONCLUSION A population-based understanding of vulnerability, health access, and chronic and acute disease among the displaced will guide disaster health providers in preparation and response.
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Affiliation(s)
- P Gregg Greenough
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Abstract
Absolute value of access flow (QA) and change in flow (deltaQA) over time are major determinants of access patency. However, QA may change in response to variation in systemic hemodynamics among dialysis sessions. We examined the effect of mean arterial pressure (MAP), cardiac output (CO), and segmental resistances (R) on QA. Access flow and CO (L/min) were determined by Transonic ultrasound dilution. Static intra-access pressures (mm Hg) at the arterial segment (AS) and venous segment (VS) were determined with the access unoccluded. During access occlusion (O), the AS pressure was equated to arterial pressure (MAPo), whereas the VS pressure reflected venous pressure (VP). Total and segmental vascular resistances (mm Hg-min/L) were calculated as deltaP/Q. We studied 58 arteriovenous (AV) grafts and 35 autologous AV fistulae (AVF) with measurements on two or more occasions in 43 grafts and 25 AVF. MAPC differed from MAPo by >20 mm Hg in 22% of patients. AS (58 +/- 2 vs. 31 +/- 2) and VS (40 +/- 1 vs. 25 +/- 2) were greater in grafts than in AVF, whereas VP was equal. Access flow (0.91 +/- 0.03 vs. 0.91 +/- 0.05 L/min), cardiac output (5.1 +/- 0.1 vs. 5.5 +/- 0.2 L/min), and total access resistance (115 +/- 5 vs. 11 +/- 6) were equal in grafts and AVF, but non-access systemic R was lower in patients with AVF that those with grafts (26 +/- 1 vs. 30 +/- 1). AS and VS resistances were greater in AVF than grafts (87 +/- 6 vs. 54 +/- 3 and 37 +/- 3 vs. 16 +/- 3). Multivariate analysis indicated that CO and ipsilateral MAPo affected flow in both access types. In grafts, all three access resistance elements, AS, VS, and total independently influenced flow, whereas in AVF, the VS did not. Unexpectedly, the ratio of systemic to access resistance also influenced access flow. The pressure in the venous system draining the access affected access flow in AVF but not grafts. We conclude that the hemodynamics of grafts and AVF differ. Cardiac output, MAP, and the arterial segment resistance influence QA in both access types and need to be considered when evaluating QA as part of the trend analysis for detecting access dysfunction.
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Affiliation(s)
- A Besarab
- Department of Medicine, West Virginia University School of Medicine, Henry Ford Hospital, USA
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D'hermies F, Meyer A, Morel X, Halhal M, Vu A, Elmaleh C, Bourgade JM, Cisneros B, Behar-Cohen F, Parent De Curzon H, Renard G. [Papillomatous and nevus of the caruncle]. J Fr Ophtalmol 2001; 24:209-12. [PMID: 11240499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A 63-year-old male patient was operated of a single conjunctival papillomatous lesion located on the left caruncle. The curative tumoral excision was followed by its histological analysis. Histologically, the tumor associated an epithelial squamous papilloma with a subepithelial nevus, confirming a combination of two different lesions.
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Affiliation(s)
- F D'hermies
- Service d'Ophtalmologie (Pr. Renard), Hotel Dieu, 1, place du Parvis-Notre-Dame, F-75181 Paris Cedex 04
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Liu C, Marshall P, Schreibman I, Vu A, Gai W, Whitlow M. Interaction between terminal complement proteins C5b-7 and anionic phospholipids. Blood 1999; 93:2297-301. [PMID: 10090939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
We have recently shown that C5b-6 binds to the erythrocyte membrane via an ionic interaction with sialic acid before the addition of C7 and subsequent membrane insertion. In this study we assessed the role of anionic lipids in the binding of the terminal complement proteins to the membrane and the efficiency of subsequent hemolysis. Human erythrocytes were modified by insertion of dipalmitoyl phosphatidylcholine (DPPC), dipalmitoyl phosphatidylserine (DPPS), dipalmitoyl phosphatidylethanolamine (DPPE), or dipalmitoyl phosphatidic acid (DPPA). Lipid incorporation and the hemolytic assays were done in the presence of 100 micromol/L sodium orthovanadate to prevent enzymatic redistribution of lipid. We found that the neutral lipids, DPPC and DPPE, did not affect C5b-7 uptake or hemolysis by C5b-9. In contrast, the two acidic phospholipids, DPPS and DPPA, caused a dose-dependent increase in both lysis and C5b-7 uptake. We conclude that the presence of anionic lipids on the exterior face of the membrane increases C5b-7 uptake and subsequent hemolysis. It is known that sickle cell erythrocytes have increased exposure of phosphatidylserine on their external face and are abnormally sensitive to lysis by C5b-9. The data presented here provide a plausible mechanism for this increased sensitivity.
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Affiliation(s)
- C Liu
- Division of Dermatology, Manhattan Veteran's Administration Medical Center, New York, NY 10010-5050, USA
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