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Park G, Norton L, Avery D, Dam HG. Grazers modify the dinoflagellate relationship between toxin production and cell growth. Harmful Algae 2023; 126:102439. [PMID: 37290888 DOI: 10.1016/j.hal.2023.102439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 06/10/2023]
Abstract
Although the typical framework for studies and models of bloom dynamics in toxigenic phytoplankton is predominantly based on abiotic determinants, there is mounting evidence of grazer control of toxin production. We tested for the effect of grazer control of toxin production and cell growth rate during a laboratory-simulated bloom of the dinoflagellate Alexandrium catenella. We measured cellular toxin content and net growth rate when cells were exposed to copepod grazers (direct exposure), copepod cues (indirect exposure), and no copepods (control) throughout the exponential, stationary, and declining phases of the bloom. During the simulated bloom, cellular toxin content plateaued after the stationary phase and there was a significantly positive relationship between growth rate and toxin production, predominantly in the exponential phase. Grazer-induced toxin production was evident throughout the bloom, but highest during the exponential phase. Induction was greater when cells were directly exposed to grazers rather than their cues alone. In the presence of grazers toxin production and cell growth rate were negatively related, indicating a defense-growth trade-off. Further, a fitness reduction associated with toxin production was more evident in the presence than the absence of grazers. Consequently, the relationship between toxin production and cell growth is fundamentally different between constitutive and inducible defense. This suggests that understanding and predicting bloom dynamics requires considering both constitutive and grazer-induced toxin production.
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Affiliation(s)
- Gihong Park
- Department of Marine Sciences, University of Connecticut, 1080 Shennecossett Road, Groton, CT 06340, USA.
| | - Lydia Norton
- Department of Marine Sciences, University of Connecticut, 1080 Shennecossett Road, Groton, CT 06340, USA.
| | - David Avery
- Maine Maritime Academy, 1 Pleasant Street, Castine, Maine 04420, USA.
| | - Hans G Dam
- Department of Marine Sciences, University of Connecticut, 1080 Shennecossett Road, Groton, CT 06340, USA.
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Ipe TS, Le T, Quinn B, Kellar S, Clark M, Carlisle S, Rassmann A, Hennigan S, Ridenour T, Roberts A, Avery D, Ryan S, Pearson S, Kothari A, Patil N. Provision of COVID-19 Convalescent Plasma in a Resource-Constrained State. Transfusion 2020; 60:2828-2833. [PMID: 32989778 PMCID: PMC7536906 DOI: 10.1111/trf.16118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 08/27/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Arkansas is a rural state of 3 million people. It is ranked fifth for poverty nationally. The first case of coronavirus disease 2019 (COVID-19) in Arkansas occurred on 11 March 2020. Since then, approximately 8% of all Arkansans have tested positive. Given the resource limitations of Arkansas, COVID-19 convalescent plasma (CCP) was explored as a potentially lifesaving, therapeutic option. Therefore, the Arkansas Initiative for Convalescent Plasma was developed to ensure that every Arkansan has access to this therapy. STUDY DESIGN AND METHOD This brief report describes the statewide collaborative response from hospitals, blood collectors, and the Arkansas Department of Health (ADH) to ensure that CCP was available in a resource-limited state. RESULTS Early contact tracing by ADH identified individuals who had come into contact with "patient zero" in early March. Within the first week, 32 patients tested positive for COVID-19. The first set of CCP collections occurred on 9 April 2020. Donors had to be triaged carefully in the initial period, as many had recently resolved their symptoms. From our first collections, with appropriate resource and inventory management, we collected sufficient CCP to provide the requested number of units for every patient treated with CCP in Arkansas. CONCLUSIONS The Arkansas Initiative, a statewide effort to ensure CCP for every patient in a resource-limited state, required careful coordination among key players. Collaboration and resource management was crucial to meet the demand of CCP products and potentially save lives.
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Affiliation(s)
- Tina S Ipe
- Department of Pathology and Laboratory Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Tuan Le
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, Oklahoma, USA
| | - Brian Quinn
- Department of Pathology, Baptist Health, Little Rock, Arkansas, USA
| | - Stan Kellar
- Department of Medicine, Baptist Health, Little Rock, Arkansas, USA
| | - Melisa Clark
- Office of Research Regulatory Affairs (ORRA), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Suzanna Carlisle
- Office of Research Regulatory Affairs (ORRA), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anja Rassmann
- Clinical Trials Innovation Unit (CTIU), Translational Research Institute (TRI), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Steve Hennigan
- Washington Regional Medical Center, Fayetteville, Arkansas, USA
| | - Terry Ridenour
- Oklahoma/Texas/and Arkansas Blood Institute, Oklahoma City, Oklahoma, USA
| | - Anthony Roberts
- Community Blood Center of the Ozarks, Springfield, Missouri, USA
| | - David Avery
- Clinical Trials Innovation Unit (CTIU), Translational Research Institute (TRI), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Stefanie Ryan
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Shanna Pearson
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Naveen Patil
- Arkansas Department of Health, Little Rock, Arkansas, USA
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Abstract
SummaryThe mode of occurrence of uraninite, pitchblende and coffinite at five localities in south-west England is described. Chemical and isotopic analyses of concentrates containing these minerals provide the following 206Pb/238U ages (My.): uraninite, South Crofty, Cornwall, 277 ± 10; uraninite, Geevor, Cornwall, 223 ± 5; pitcbblende-coffinite, King's Wood, Devon, 206 ± 5; pitchblende, Wheal Bray, Cornwall, 165 ± 4; pitchblende, South Terras, Cornwall, 474 ± 2; coffinite, Geevor, Cornwall, c. 45 (chemical analysis only). These results are compatible with geological and mineralogical evidence. Consideration of these and other results indicates that there were at least three periods of uranium mineralization in south-west England, at c. 290 My., c. 225 My., and c. 50 My. Other intermediate ages may also be valid but further work is required to substantiate these.
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Jethava Y, Mitchell A, Zangari M, Waheed S, Schinke C, Thanendrarajan S, Sawyer J, Alapat D, Tian E, Stein C, Khan R, Heuck CJ, Petty N, Avery D, Steward D, Smith R, Bailey C, Epstein J, Yaccoby S, Hoering A, Crowley J, Morgan G, Barlogie B, van Rhee F. Dose-dense and less dose-intense total therapy 5 for gene expression profiling-defined high-risk multiple myeloma. Blood Cancer J 2016; 6:e471. [PMID: 27635734 PMCID: PMC5056975 DOI: 10.1038/bcj.2016.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Holden PA, Gardea-Torresdey J, Klaessig F, Turco RF, Mortimer M, Hund-Rinke K, Hubal EAC, Avery D, Barceló D, Behra R, Cohen Y, Deydier-Stephan L, Lee Ferguson P, Fernandes TF, Harthorn BH, Henderson WM, Hoke RA, Hristozov D, Johnston JM, Kane AB, Kapustka L, Keller AA, Lenihan HS, Lovell W, Murphy CJ, Nisbet RM, Petersen EJ, Salinas ER, Scheringer M, Sharma M, Speed DE, Sultan Y, Westerhoff P, White JC, Wiesner MR, Wong EM, Xing B, Horan MS, Godwin HA, Nel AE. Considerations of Environmentally Relevant Test Conditions for Improved Evaluation of Ecological Hazards of Engineered Nanomaterials. Environ Sci Technol 2016; 50:6124-45. [PMID: 27177237 PMCID: PMC4967154 DOI: 10.1021/acs.est.6b00608] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Engineered nanomaterials (ENMs) are increasingly entering the environment with uncertain consequences including potential ecological effects. Various research communities view differently whether ecotoxicological testing of ENMs should be conducted using environmentally relevant concentrations-where observing outcomes is difficult-versus higher ENM doses, where responses are observable. What exposure conditions are typically used in assessing ENM hazards to populations? What conditions are used to test ecosystem-scale hazards? What is known regarding actual ENMs in the environment, via measurements or modeling simulations? How should exposure conditions, ENM transformation, dose, and body burden be used in interpreting biological and computational findings for assessing risks? These questions were addressed in the context of this critical review. As a result, three main recommendations emerged. First, researchers should improve ecotoxicology of ENMs by choosing test end points, duration, and study conditions-including ENM test concentrations-that align with realistic exposure scenarios. Second, testing should proceed via tiers with iterative feedback that informs experiments at other levels of biological organization. Finally, environmental realism in ENM hazard assessments should involve greater coordination among ENM quantitative analysts, exposure modelers, and ecotoxicologists, across government, industry, and academia.
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Affiliation(s)
- Patricia A. Holden
- Bren School of Environmental Science and Management, University of California, Santa Barbara, California 93106, United States
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
| | - Jorge Gardea-Torresdey
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- Department of Chemistry, Environmental Science and Engineering PhD Program, University of Texas, El Paso, Texas 79968, United States
| | - Fred Klaessig
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- Pennsylvania Bio Nano Systems, Doylestown, Pennsylvania 18901, United States
| | - Ronald F. Turco
- College of Agriculture, Laboratory for Soil Microbiology, Purdue University, West Lafayette, Indiana 47907, United States
| | - Monika Mortimer
- Bren School of Environmental Science and Management, University of California, Santa Barbara, California 93106, United States
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- Laboratory of Environmental Toxicology, National Institute of Chemical Physics and Biophysics, Akadeemia tee 23, 12618 Tallinn, Estonia
| | - Kerstin Hund-Rinke
- Fraunhofer Institute for Molecular Biology and Applied Ecology, D-57392 Schmallenberg, Germany
| | - Elaine A. Cohen Hubal
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
| | - David Avery
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
| | - Damià Barceló
- Department of Environmental Chemistry, Institute of Environmental Assessment and Water Research (IDAEA-CSIC), Barcelona 08034, Spain
- Institut Català de Recerca de l’Aigua (ICRA), Parc Científic i Tecnològic de la Universitat de Girona, Girona 17003, Spain
| | - Renata Behra
- Eawag, Swiss Federal Institute of Aquatic Science and Technology, 8600 Dübendorf, Switzerland
- Institute of Biogeochemistry and Pollutant Dynamics, ETH Zürich, 8092 Zürich, Switzerland
| | - Yoram Cohen
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California Los Angeles, California 90095, United States
- Chemical and Biomolecular Engineering Department, University of California Los Angeles, California 90095, United States
| | | | - Patrick Lee Ferguson
- Department of Civil & Environmental Engineering, Duke University, Durham, North Carolina 27708, United States
- Center for the Environmental Implications of NanoTechnology (CEINT), Duke University, Durham, North Carolina 27708, United States
| | | | - Barbara Herr Harthorn
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- Center for Nanotechnology in Society, University of California, Santa Barbara, California 93106
- Department of Anthropology, University of California, Santa Barbara, California 93106
| | - William Matthew Henderson
- Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency, Athens, Georgia 30605, United States
| | - Robert A. Hoke
- E.I. du Pont de Nemours and Company, Newark, Delaware 19711, United States
| | - Danail Hristozov
- Department of Environmental Sciences, Informatics and Statistics, University Ca' Foscari Venice, Venice 30123, Italy
| | - John M. Johnston
- Office of Research and Development, National Exposure Research Laboratory, U.S. Environmental Protection Agency, Athens, Georgia 30605, United States
| | - Agnes B. Kane
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island 02912, United States
| | | | - Arturo A. Keller
- Bren School of Environmental Science and Management, University of California, Santa Barbara, California 93106, United States
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
| | - Hunter S. Lenihan
- Bren School of Environmental Science and Management, University of California, Santa Barbara, California 93106, United States
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
| | - Wess Lovell
- Vive Crop Protection Inc, Toronto, Ontario M5G 1L6, Canada
| | - Catherine J. Murphy
- Department of Chemistry, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Roger M. Nisbet
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- Department of Ecology, Evolution and Marine Biology, University of California, Santa Barbara, California 93106, United States
| | - Elijah J. Petersen
- Biosystems and Biomaterials Division, Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | - Edward R. Salinas
- BASF SE, Experimental Toxicology and Ecology, Ludwigshafen, D-67056, Germany
| | - Martin Scheringer
- Institute for Chemical and Bioengineering, ETH Zürich, 8093 Zürich, Switzerland
| | - Monita Sharma
- PETA International Science Consortium, Ltd., London N1 9RL, England, United Kingdom
| | - David E. Speed
- Globalfoundries, Corporate EHS, Hopewell Junction, New York 12533, United States
| | - Yasir Sultan
- Environment Canada, Gatineau, Quebec J8X 4C8, Canada
| | - Paul Westerhoff
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona 85287, United States
| | - Jason C. White
- Department of Analytical Chemistry, The Connecticut Agricultural Experiment Station, New Haven, Connecticut 06504, United States
| | - Mark R. Wiesner
- Department of Civil & Environmental Engineering, Duke University, Durham, North Carolina 27708, United States
- Center for the Environmental Implications of NanoTechnology (CEINT), Duke University, Durham, North Carolina 27708, United States
| | - Eva M. Wong
- Office of Pollution Prevention and Toxics, U.S. Environmental Protection Agency, Washington, D.C. 20460, United States
| | - Baoshan Xing
- Stockbridge School of Agriculture, University of Massachusetts, Amherst, Massachusetts 01003, United States
| | - Meghan Steele Horan
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
| | - Hilary A. Godwin
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California Los Angeles, California 90095, United States
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California 90095, United States
- Institute of the Environment and Sustainability, University of California, Los Angeles, California 90095, United States
| | - André E. Nel
- University of California Center for Environmental Implications of Nanotechnology (UC CEIN), University of California, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California Los Angeles, California 90095, United States
- Division of NanoMedicine, Department of Medicine, University of California, Los Angeles, California 90095, United States
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Mantovani A, Pavlicova M, Avery D, Nahas Z, McDonald WM, Wajdik CD, Holtzheimer PE, George MS, Sackeim HA, Lisanby SH. Long-Term Efficacy of Repeated Daily Prefrontal Transcranial Magnetic Stimulation (TMS) In Treatmnt-Resistant Depression. Focus (Am Psychiatr Publ) 2016; 14:277-282. [PMID: 31997954 PMCID: PMC6519644 DOI: 10.1176/appi.focus.140204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Depression and Anxiety 2012; 29:833-890).
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Avery D, Swift EJ. Current State of Digital Laboratory Production Processes. J ESTHET RESTOR DENT 2015; 27:181-3. [PMID: 26227477 DOI: 10.1111/jerd.12177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Avery
- David Avery Consulting Services, LLC, Charlotte, NC, USA
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Avery D, Holt LR, Little D. Paradigm shift: digital processing altering denture fabrication. Compend Contin Educ Dent 2015; 36:242-243. [PMID: 25997201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Godwin H, Nameth C, Avery D, Bergeson LL, Bernard D, Beryt E, Boyes W, Brown S, Clippinger AJ, Cohen Y, Doa M, Hendren CO, Holden P, Houck K, Kane AB, Klaessig F, Kodas T, Landsiedel R, Lynch I, Malloy T, Miller MB, Muller J, Oberdorster G, Petersen EJ, Pleus RC, Sayre P, Stone V, Sullivan KM, Tentschert J, Wallis P, Nel AE. Nanomaterial categorization for assessing risk potential to facilitate regulatory decision-making. ACS Nano 2015; 9:3409-17. [PMID: 25791861 DOI: 10.1021/acsnano.5b00941] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
For nanotechnology to meet its potential as a game-changing and sustainable technology, it is important to ensure that the engineered nanomaterials and nanoenabled products that gain entry to the marketplace are safe and effective. Tools and methods are needed for regulatory purposes to allow rapid material categorization according to human health and environmental risk potential, so that materials of high concern can be targeted for additional scrutiny, while material categories that pose the least risk can receive expedited review. Using carbon nanotubes as an example, we discuss how data from alternative testing strategies can be used to facilitate engineered nanomaterial categorization according to risk potential and how such an approach could facilitate regulatory decision-making in the future.
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Affiliation(s)
| | | | | | | | | | - Elizabeth Beryt
- ¶Luskin School of Public Affairs, University of California, Los Angeles, California 90095, United States
| | - William Boyes
- □Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
| | | | - Amy J Clippinger
- ○PETA International Science Consortium Ltd., London, United Kingdom
| | - Yoram Cohen
- ●Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, California 90095, United States
| | - Maria Doa
- △Office of Pollution Prevention and Toxics, U.S. Environmental Protection Agency, Washington, D.C. 20460, United States
| | - Christine Ogilvie Hendren
- ▲Center for the Environmental Implications of Nanotechnology, Duke University, Durham, North Carolina 27708, United States
| | - Patricia Holden
- ▽Bren School of Environmental Science and Management, University of California, Santa Barbara, California 93106, United States
| | - Keith Houck
- □Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina 27711, United States
| | - Agnes B Kane
- ▼Brown University, Providence, Rhode Island 02912, United States
| | - Frederick Klaessig
- ⬡Pennsylvania Bio Nano Systems, Doylestown, Pennsylvania 18901, United States
| | - Toivo Kodas
- ⬢Cabot Corporation, Boston, Massachusetts 02210, United States
| | - Robert Landsiedel
- ††Experimental Toxicology and Ecology, BASF SE, 67056 Ludwigshafen am Rhein, Germany
| | | | - Timothy Malloy
- §§University of California School of Law, Los Angeles, California 90095, United States
| | - Mary Beth Miller
- ⊥⊥Applied NanoStructured Solutions, L.L.C., Lockheed Martin Company, Baltimore, Maryland 21220, United States
| | | | | | - Elijah J Petersen
- □□Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, United States
| | | | - Philip Sayre
- △Office of Pollution Prevention and Toxics, U.S. Environmental Protection Agency, Washington, D.C. 20460, United States
| | - Vicki Stone
- ○○School of Life Sciences, Heriot-Watt University, Edinburgh EH14 4AS, United Kingdom
| | - Kristie M Sullivan
- ●●Physicians Committee for Responsible Medicine, Washington, D.C. 20016, United States
| | | | - Philip Wallis
- ▲▲SouthWest NanoTechnologies, Norman, Oklahoma 73071, United States
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Adler Nevo GW, Avery D, Fiksenbaum L, Kiss A, Mendlowitz S, Monga S, Manassis K. Eight years later: outcomes of CBT-treated versus untreated anxious children. Brain Behav 2014; 4:765-74. [PMID: 25328851 PMCID: PMC4188368 DOI: 10.1002/brb3.274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders of childhood, generate significant distress, are considered precursors to diverse psychiatric disorders, and lead to poor social and employment outcomes in adulthood. Although childhood anxiety has a significant impact on a child's developmental trajectory, only a handful of studies examined the long-term impact of treatment and none included a control group. The aim of this study was to conduct a long-term follow-up (LTFU) of anxious children who were treated with Cognitive-Behavioral Therapy (CBT) compared to a matched group of children who were not. METHODS Subjects comprised 120 children: a treatment group which included the first 60 consecutive consenting children who were diagnosed with an anxiety disorder and treated with CBT between the years 1997 and 2003 and a control group, 60 matched children who were assessed but not treated with CBT. An "ex-post-facto" design was used to compare the two groups. RESULTS Children showed lower rates of anxiety diagnosis (about 50% for both groups) and significantly improved functioning at LTFU (time effect P < 0.0001; no group difference). Anxiety levels were significantly lower in the nontreatment group at LTFU as compared to initial assessment (P = 0.02), but not in the treatment group, and a significant between-group difference was found (P = 0.01) according to child. An inverse relationship was found between self-efficacy/self-esteem and anxiety outcome ([P = 0.0008] and [P = 0.04], respectively). CONCLUSIONS This study supports the assumption that childhood anxiety disorders may improve without treatment and highlights self-efficacy/self-esteem as potential factors in recovery.
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Affiliation(s)
- Gili W Adler Nevo
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - David Avery
- Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | | | - Alex Kiss
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, Sunnybrook Health Sciences Centre Toronto, ON, Canada
| | - Sandra Mendlowitz
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Suneeta Monga
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
| | - Katharina Manassis
- University of Toronto Toronto, ON, Canada ; Department of Psychiatry, The Hospital for Sick Children Toronto, ON, Canada
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Nel AE, Nasser E, Godwin H, Avery D, Bahadori T, Bergeson L, Beryt E, Bonner JC, Boverhof D, Carter J, Castranova V, Deshazo JR, Hussain SM, Kane AB, Klaessig F, Kuempel E, Lafranconi M, Landsiedel R, Malloy T, Miller MB, Morris J, Moss K, Oberdorster G, Pinkerton K, Pleus RC, Shatkin JA, Thomas R, Tolaymat T, Wang A, Wong J. A multi-stakeholder perspective on the use of alternative test strategies for nanomaterial safety assessment. ACS Nano 2013; 7:6422-33. [PMID: 23924032 PMCID: PMC4004078 DOI: 10.1021/nn4037927] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
There has been a conceptual shift in toxicological studies from describing what happens to explaining how the adverse outcome occurs, thereby enabling a deeper and improved understanding of how biomolecular and mechanistic profiling can inform hazard identification and improve risk assessment. Compared to traditional toxicology methods, which have a heavy reliance on animals, new approaches to generate toxicological data are becoming available for the safety assessment of chemicals, including high-throughput and high-content screening (HTS, HCS). With the emergence of nanotechnology, the exponential increase in the total number of engineered nanomaterials (ENMs) in research, development, and commercialization requires a robust scientific approach to screen ENM safety in humans and the environment rapidly and efficiently. Spurred by the developments in chemical testing, a promising new toxicological paradigm for ENMs is to use alternative test strategies (ATS), which reduce reliance on animal testing through the use of in vitro and in silico methods such as HTS, HCS, and computational modeling. Furthermore, this allows for the comparative analysis of large numbers of ENMs simultaneously and for hazard assessment at various stages of the product development process and overall life cycle. Using carbon nanotubes as a case study, a workshop bringing together national and international leaders from government, industry, and academia was convened at the University of California, Los Angeles, to discuss the utility of ATS for decision-making analyses of ENMs. After lively discussions, a short list of generally shared viewpoints on this topic was generated, including a general view that ATS approaches for ENMs can significantly benefit chemical safety analysis.
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Affiliation(s)
- Andre E Nel
- Department of Medicine, Division of NanoMedicine, University of California Center for Environmental Implications of Nanotechnology, University of California, Los Angeles, California 90095, United States.
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Nel A, Malloy T, Avery D, Nasser E, Beryt E. Implications of the French registry for engineered nanomaterials. ACS Nano 2013; 7:4694-4696. [PMID: 23799299 DOI: 10.1021/nn402619s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Borckardt JJ, Nahas ZH, Teal J, Lisanby SH, McDonald WM, Avery D, Durkalski V, Pavlicova M, Long JM, Sackeim HA, George MS. The painfulness of active, but not sham, transcranial magnetic stimulation decreases rapidly over time: results from the double-blind phase of the OPT-TMS Trial. Brain Stimul 2013; 6:925-8. [PMID: 23769413 DOI: 10.1016/j.brs.2013.04.009] [Citation(s) in RCA: 27] [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] [Received: 04/09/2013] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks is an FDA approved treatment for major depression. Although rTMS is generally safe when administered using the FDA guidelines, there are a number of side effects that can make it difficult for patients to complete a course of rTMS. Many patients report that rTMS is painful, although patients appear to accommodate to the initial painfulness. The reduction in pain is hypothesized to be due to prefrontal stimulation and is not solely explained by accommodation to the stimulation. METHODS In a recent 4 site randomized controlled trial (using an active electrical sham stimulation system) investigating the antidepressant effects of daily left dorsolateral prefrontal rTMS (Optimization of TMS, or OPT-TMS), the procedural painfulness of TMS was assessed before and after each treatment session. Computerized visual analog scale ratings were gathered before and after each TMS session in the OPT-TMS trial. Stimulation was delivered with an iron core figure-8 coil (Neuronetics) with the following parameters: 10 Hz, 120% MT (EMG-defined), 4 s pulse train, 26 s inter-train interval, 3000 pulses per session, one 37.5 min session per day. After each session, procedural pain (pain at the beginning of the TMS session, pain toward the middle, and pain toward then end of the session) ratings were collected at all 4 sites. From the 199 patients randomized, we had usable data from 142 subjects for the initial 15 TMS sessions (double-blind phase) delivered over 3 weeks (142 × 2 × 15 = 4260 rating sessions). RESULTS The painfulness of real TMS was initially higher than that of the active sham condition. Over the 15 treatment sessions, subjective reports of the painfulness of rTMS (during the beginning, middle and end of the session) decreased significantly 37% from baseline in those receiving active TMS, with no change in painfulness in those receiving sham. This reduction, although greatest in the first few days, continued steadily over the 3 weeks. Overall, there was a decay rate of 1.56 VAS points per session in subjective painfulness of the procedure in those receiving active TMS. DISCUSSION The procedural pain of left, prefrontal rTMS decreases over time, independently of other emotional changes, and only in those receiving active TMS. These data suggest that actual TMS stimulation of prefrontal cortex maybe related to the reduction in pain, and that it is not a non-specific accommodation to pain. This painfulness reduction softly corresponds with later clinical outcome. Further work is needed to better understand this phenomenon and whether acute within-session or over time painfulness changes might be used as short-term biomarkers of antidepressant response.
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Affiliation(s)
- Jeffrey J Borckardt
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Mantovani A, Pavlicova M, Avery D, Nahas Z, McDonald WM, Wajdik CD, Holtzheimer PE, George MS, Sackeim HA, Lisanby SH. Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (TMS) in treatment-resistant depression. Depress Anxiety 2012; 29:883-90. [PMID: 22689290 PMCID: PMC4413472 DOI: 10.1002/da.21967] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 04/02/2012] [Accepted: 04/28/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up. METHODS Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome. RESULTS Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%≤ HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month. CONCLUSIONS While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.
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Affiliation(s)
- Antonio Mantovani
- Department of Psychiatry, Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute, New York, New York 10032, USA.
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Affiliation(s)
- David Avery
- Department of Operative Dentistry,UNC School of Dentistry, Chapel Hill, NC 27599-7450, USA.
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Johnson KA, Baig M, Ramsey D, Lisanby SH, Avery D, McDonald WM, Li X, Bernhardt ER, Haynor DR, Holtzheimer PE, Sackeim HA, George MS, Nahas Z. Prefrontal rTMS for treating depression: location and intensity results from the OPT-TMS multi-site clinical trial. Brain Stimul 2012; 6:108-17. [PMID: 22465743 DOI: 10.1016/j.brs.2012.02.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/15/2012] [Accepted: 02/17/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Motor cortex localization and motor threshold determination often guide Transcranial Magnetic Stimulation (TMS) placement and intensity settings for non-motor brain stimulation. However, anatomic variability results in variability of placement and effective intensity. OBJECTIVE Post-study analysis of the OPT-TMS Study reviewed both the final positioning and the effective intensity of stimulation (accounting for relative prefrontal scalp-cortex distances). METHODS We acquired MRI scans of 185 patients in a multi-site trial of left prefrontal TMS for depression. Scans had marked motor sites (localized with TMS) and marked prefrontal sites (5 cm anterior of motor cortex by the "5 cm rule"). Based on a visual determination made before the first treatment, TMS therapy occurred either at the 5 cm location or was adjusted 1 cm forward. Stimulation intensity was 120% of resting motor threshold. RESULTS The "5 cm rule" would have placed stimulation in premotor cortex for 9% of patients, which was reduced to 4% with adjustments. We did not find a statistically significant effect of positioning on remission, but no patients with premotor stimulation achieved remission (0/7). Effective stimulation ranged from 93 to 156% of motor threshold, and no seizures were induced across this range. Patients experienced remission with effective stimulation intensity ranging from 93 to 146% of motor threshold, and we did not find a significant effect of effective intensity on remission. CONCLUSIONS Our data indicates that individualized positioning methods are useful to reduce variability in placement. Stimulation at 120% of motor threshold, unadjusted for scalp-cortex distances, appears safe for a broad range of patients.
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McDonald WM, Durkalski V, Ball ER, Holtzheimer PE, Pavlicova M, Lisanby SH, Avery D, Anderson BS, Nahas Z, Zarkowski P, Sackeim HA, George MS. Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety 2011; 28:973-80. [PMID: 21898711 PMCID: PMC4413508 DOI: 10.1002/da.20885] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [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: 04/06/2011] [Revised: 07/05/2011] [Accepted: 07/10/2011] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To assess the efficacy of increasing the number of fast left repetitive transcranial magnetic stimulations (rTMS) (10 Hz @ 120% of motor threshold (MT) over the left dorsolateral prefrontal cortex (DLPFC)) needed to achieve remission in treatment-resistant depression (TRD). And, to determine if patients who do not remit to fast left will remit using slow right rTMS (1 Hz @ 120% MT over the right DLPFC). METHOD Patients were part of a multicenter sham-controlled trial investigating the efficacy of fast left rTMS. Patients who failed to meet minimal response criteria in the sham-controlled study could enroll in this open fast left rTMS study for an additional 3-6 weeks. Patients who failed to remit to fast left could switch to slow right rTMS for up to 4 additional weeks. The final outcome measure was remission, defined as a HAM-D score of <3 or 2 consecutive HAM-D scores less than 10. RESULTS Forty-three of 141 (30.5%) patients who enrolled in the open phase study eventually met criteria for remission. Patients who remitted during fast left treatment received a mean of 26 active treatments (90,000 pulses). Twenty-six percent of patients who failed fast left remitted during slow right treatment. CONCLUSION The total number of rTMS stimulations needed to achieve remission in TRD may be higher than is used in most studies. TRD patients who do not respond to fast left rTMS may remit to slow right rTMS or additional rTMS stimulations.
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Affiliation(s)
| | - Valerie Durkalski
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston
| | - Edward R. Ball
- Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston
| | | | - Martina Pavlicova
- Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York
| | | | - David Avery
- Department of Psychiatry, University of Washington, Seattle
| | - Berry S. Anderson
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Ziad Nahas
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Paul Zarkowski
- Department of Psychiatry, University of Washington, Seattle
| | - Harold A. Sackeim
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston,Ralph H. Johnson Veterans Affairs Medical Center, Charleston
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Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, Meredith P, Solie C, Avery D, Deal Chandler N. Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists. J Prosthodont 2011; 20 Suppl 1:S1-S12. [PMID: 21324026 DOI: 10.1111/j.1532-849x.2010.00683.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.
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Affiliation(s)
- David Felton
- Department of Prosthodontics, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA.
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Felton D, Cooper L, Duqum I, Minsley G, Guckes A, Haug S, Meredith P, Solie C, Avery D, Chandler ND. Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists. J Am Dent Assoc 2011; 142 Suppl 1:1S-20S. [PMID: 21282672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The current rates of edentulism have been estimated to be between 7 percent and 69 percent of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, the American Dental Association Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories and GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting the inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and are being published in The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.
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Affiliation(s)
- David Felton
- Department of Prosthodontics, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA
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Zarkowski P, Navarro R, Pavlicova M, George MS, Avery D. The effect of daily prefrontal repetitive transcranial magnetic stimulation over several weeks on resting motor threshold. Brain Stimul 2010; 2:163-7. [PMID: 20161065 DOI: 10.1016/j.brs.2009.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 10/20/2022] Open
Abstract
BACKGROUND The resting motor threshold (rMT) is an important factor in the selection of treatment intensity for patients receiving repetitive transcranial magnetic stimulation (rTMS). In many clinical studies to date, due to concerns about potential drift, the rMT has been routinely re-measured weekly or every fifth session. OBJECTIVE Our aim is to investigate whether ongoing treatment with rTMS affects the rMT, the degree of change, and whether frequent remeasurement is needed. METHODS Clinical data were drawn from 50 medication free patients receiving treatment for major depression with rTMS in a large U.S. NIH-sponsored multisite study. Four measurements of rMT were obtained including before and after the double blind phase, followed by weekly measurements during the open phase. Active treatment consisted of 75 four second trains of 10Hz stimulation applied over 37.5 minutes with the coil over the left DLPFC at 120% rMT. RESULTS For the group as a whole, there was no significant change in the rMT during a minimum of 2 weeks of treatment with prefrontal rTMS (p=0.911, one way ANOVA). The average within-subject coefficient of variation was 6.58%. On average the last rMT was 2.45% less than the baseline rMT (range 32.3% increase, 40.6% decrease). CONCLUSION Daily left prefrontal rTMS over several weeks as delivered in this trial does not cause systematic changes in rMT. While most subjects had <10% variance in rMT over time, 5 subjects had changes of approximately 20% from baseline, raising dosing and safety issues if undetected. We recommend that clinical trials of rTMS have periodic retesting of rMT, especially if the dose is at or near the edge of the TMS safety tables.
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Affiliation(s)
- Paul Zarkowski
- University of Washington, 325 Ninth Avenue, Seattle WA 98104-2499, USA.
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Anderson BS, Kavanagh K, Borckardt JJ, Nahas ZH, Kose S, Lisanby SH, McDonald WM, Avery D, Sackeim HA, George MS. Decreasing procedural pain over time of left prefrontal rTMS for depression: initial results from the open-label phase of a multi-site trial (OPT-TMS). Brain Stimul 2010; 2:88-92. [PMID: 20161310 DOI: 10.1016/j.brs.2008.09.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is much interest in whether daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) over several weeks may become a clinically useful antidepressant treatment. Although rTMS appears largely safe, many patients report that this procedure is somewhat painful, which may restrict its ultimate appeal and utility. We analyzed interim results from the open-label phase of a multi-site randomized trial of rTMS as a treatment for depression to investigate whether the procedural pain of left prefrontal rTMS changes over time. METHODS Patients with unipolar depression who had failed to respond during at least three weeks of the sham-controlled double-masked rTMS were then offered three more weeks (15 sessions) of open-label rTMS. Retrospective pain ratings and state emotional factors from 20 subjects were assessed using visual analog scales (VAS) recorded on computers before and after each treatment (289 sessions). RESULTS Over the 15 treatment sessions, subjective reports of the painfulness of rTMS decreased 48% from baseline. This reduction, although greatest in the first few days, continued steadily (average 2.11 points per session) over the 3 weeks of treatment. The analysis found a significant effect for rTMS-session (p<0.0001) on rTMS-procedural pain over and above changes in subjective emotional states. CONCLUSION The procedural pain of left, prefrontal rTMS decreases over time, apparently independently of other emotional changes. Since rTMS scalp pain may decline over time, physicians and patients may decide to continue treatment despite initial discomfort. These observational data can be better tested once the data from the blinded phase of the trial becomes available.
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Affiliation(s)
- Berry S Anderson
- Brain Stimulation Laboratory, Psychiatry Department, Medical University of South Carolina, Charleston, SC 29425, USA.
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George MS, Lisanby SH, Avery D, McDonald WM, Durkalski V, Pavlicova M, Anderson B, Nahas Z, Bulow P, Zarkowski P, Holtzheimer PE, Schwartz T, Sackeim HA. Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. ACTA ACUST UNITED AC 2010; 67:507-16. [PMID: 20439832 DOI: 10.1001/archgenpsychiatry.2010.46] [Citation(s) in RCA: 646] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) has been studied as a potential treatment for depression, but previous work had mixed outcomes and did not adequately mask sham conditions. OBJECTIVE To test whether daily left prefrontal rTMS safely and effectively treats major depressive disorder. DESIGN Prospective, multisite, randomized, active sham-controlled (1:1 randomization), duration-adaptive design with 3 weeks of daily weekday treatment (fixed-dose phase) followed by continued blinded treatment for up to another 3 weeks in improvers. SETTING Four US university hospital clinics. PATIENTS Approximately 860 outpatients were screened, yielding 199 antidepressant drug-free patients with unipolar nonpsychotic major depressive disorder. INTERVENTION We delivered rTMS to the left prefrontal cortex at 120% motor threshold (10 Hz, 4-second train duration, and 26-second intertrain interval) for 37.5 minutes (3000 pulses per session) using a figure-eight solid-core coil. Sham rTMS used a similar coil with a metal insert blocking the magnetic field and scalp electrodes that delivered matched somatosensory sensations. MAIN OUTCOME MEASURE In the intention-to-treat sample (n = 190), remission rates were compared for the 2 treatment arms using logistic regression and controlling for site, treatment resistance, age, and duration of the current depressive episode. RESULTS Patients, treaters, and raters were effectively masked. Minimal adverse effects did not differ by treatment arm, with an 88% retention rate (90% sham and 86% active). Primary efficacy analysis revealed a significant effect of treatment on the proportion of remitters (14.1% active rTMS and 5.1% sham) (P = .02). The odds of attaining remission were 4.2 times greater with active rTMS than with sham (95% confidence interval, 1.32-13.24). The number needed to treat was 12. Most remitters had low antidepressant treatment resistance. Almost 30% of patients remitted in the open-label follow-up (30.2% originally active and 29.6% sham). CONCLUSION Daily left prefrontal rTMS as monotherapy produced statistically significant and clinically meaningful antidepressant therapeutic effects greater than sham. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00149838.
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Affiliation(s)
- Mark S George
- Brain Stimulation Division, Department of Psychiatry, Medical University of South Carolina, Charleston, SC 29425, USA.
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O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Reply regarding "efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial". Biol Psychiatry 2010; 67:e15-7. [PMID: 19914602 DOI: 10.1016/j.biopsych.2009.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Accepted: 06/22/2009] [Indexed: 11/16/2022]
Affiliation(s)
- John P O'Reardon
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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Herbsman T, Avery D, Ramsey D, Holtzheimer P, Wadjik C, Hardaway F, Haynor D, George MS, Nahas Z. More lateral and anterior prefrontal coil location is associated with better repetitive transcranial magnetic stimulation antidepressant response. Biol Psychiatry 2009; 66:509-15. [PMID: 19545855 DOI: 10.1016/j.biopsych.2009.04.034] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/31/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The left dorsolateral prefrontal cortex (DLPFC) is the most commonly used target for transcranial magnetic stimulation (TMS) in the treatment of depression. The "5-cm rule" is an empiric method used for probabilistic targeting of the DLPFC in most clinical trials. This rule may be suboptimal, as it does not account for differences in skull size or variations in prefrontal anatomy relative to motor cortex location. This study is a post hoc analysis of data from a large repetitive TMS (rTMS) trial in which we examined the variability of coil placement and how it affects antidepressant efficacy. METHODS Fifty-four depressed subjects enrolled in a randomized, single-site trial received either active rTMS or sham for 3 weeks. Prior to treatment initiation, investigators placed vitamin E capsules at the point of stimulation and used a high-resolution magnetic resonance imaging (MRI) scan to image these fiducials relative to anatomy. We employed a semiautomated imaging-processing algorithm to localize the cortical region stimulated. RESULTS Active TMS significantly reduced Hamilton Depression Rating Scale (HDRS) scores. A linear model for this improvement involving the coordinates of the stimulated cortex location, age, and treatment condition was highly significant. Specifically, individuals with more anterior and lateral stimulation sites were more likely to respond. CONCLUSIONS These results suggest that within the general anatomical area targeted by the 5-cm rule, placing the TMS coil more laterally and anteriorly is associated with improved response rates in TMS depression studies. Controlled studies testing this anatomical hypothesis are needed.
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Affiliation(s)
- Tal Herbsman
- Department of Psychiatry, Brain Stimulation Laboratory, Center for Advanced Imaging Research, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Avery D. Clinical performance of low fusing framework veneering ceramic materials. J ESTHET RESTOR DENT 2009; 20:353-4. [PMID: 19120778 DOI: 10.1111/j.1708-8240.2008.00208.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- David Avery
- Drake Precision Dental Laboratory, Charlotte, NC, USA
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O'Reardon JP, Solvason HB, Janicak PG, Sampson S, Isenberg KE, Nahas Z, McDonald WM, Avery D, Fitzgerald PB, Loo C, Demitrack MA, George MS, Sackeim HA. Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biol Psychiatry 2007; 62:1208-16. [PMID: 17573044 DOI: 10.1016/j.biopsych.2007.01.018] [Citation(s) in RCA: 1108] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 11/25/2006] [Accepted: 01/19/2007] [Indexed: 02/08/2023]
Abstract
BACKGROUND We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression. METHODS In a double-blind, multisite study, 301 medication-free patients with major depression who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec, 120% of motor threshold, 3000 pulses/session, for 4-6 weeks. Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and response and remission rates with the MADRS and HAMD. RESULTS Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post hoc correction for inequality in symptom severity between groups at baseline), as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6. Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a low dropout rate for adverse events (4.5%) that were generally mild and limited to transient scalp discomfort or pain. CONCLUSIONS Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported. It offers clinicians a novel alternative for the treatment of this disorder.
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Affiliation(s)
- John P O'Reardon
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19014, USA
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Janicak PG, Dowd S, Rado J, Welch MJ, Fogg L, O'Reardon J, Avery D, Coffey CE, Sampson S, Boutros N. Repetitive transcranial magnetic stimulation versus electroconvulsive therapy: efficacy of treatment in nonpsychotic patients with depression. Am J Psychiatry 2007; 164:1118; author reply 1118-9. [PMID: 17606665 DOI: 10.1176/ajp.2007.164.7.1118a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
The objective of our research was to quantify the increased risk of suicide associated with registering in local hotels/motels. Medical examiner case files of suicide in King County, Washington, were reviewed for years 2002-2004. The incidence of suicide in local residents registering in local hotels/motels was 223/100,000 which is significantly greater than the incidence of suicide in the general population of King County (11.7/100,000 p < 0.0001). Hotel/motel guests from outside Washington had a significantly reduced incidence of suicide (3.9/100,000 p = 0.002). The study results suggest that there is an increased risk of suicide in local residents who register in local hotel rooms.
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Affiliation(s)
- Paul Zarkowski
- Department of Psychiatry and Behavioral Sciences at Harborview Medical Center, Univeristy of Washington, Seattle, WA 98104-2499, USA.
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Abstract
The motor threshold is an important parameter in selecting the treatment intensity of patients undergoing transcranial magnetic stimulation. The large variance in magnitude of motor evoked responses has forced clinicians to perform many trials and average the results to find a repeatable value for motor threshold. Our objective is to investigate the source of the variance in amplitude. Four clinically healthy adult males participated in an EEG and EMG during transcranial magnetic stimulation of the left motor cortex, 100% motor threshold, 0.1 Hz. Per our hypothesis, a significant negative correlation of .22 was found between the amplitude of the motor evoked potential and the power in the high alpha frequency band during the pre-stimulus period (p < .001). In addition, a significant positive correlation of .17 was found between the motor evoked potential (MEP) amplitude and the gamma band (p < .001). The strongest correlation of .27 (p < .001) was found between the MEP amplitude and the ratio of the power in the low gamma to high alpha band. We conclude that the gamma to alpha power ratio may be a useful indicator of cortical excitability.
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Affiliation(s)
- P Zarkowski
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
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Holtzheimer P, Fawaz W, Wilson C, Avery D. Repetitive transcranial magnetic stimulation may induce language switching in bilingual patients. Brain Lang 2005; 94:274-7. [PMID: 16098377 DOI: 10.1016/j.bandl.2005.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Revised: 01/10/2005] [Accepted: 01/13/2005] [Indexed: 05/04/2023]
Abstract
The dorsolateral prefrontal cortex (DLPFC) may participate in the process of language switching in multilingual individuals. We present two cases of bilingual patients who experienced unexpected language switching after receiving high-frequency, repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC as a treatment for major depression. These preliminary findings support the role of the DLPFC in language switching in polyglots and highlight the potential value of rTMS for non-invasively investigating language function in humans. Further investigation is warranted.
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Affiliation(s)
- Paul Holtzheimer
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
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Abstract
We examined anxiety symptoms, anxiety-related impairment, and further treatment in adolescents who received cognitive behavioral therapy (CBT) for childhood anxiety disorders 6-7 years previously. Forty-three adolescents and their parents (14 boys, 29 girls; mean age 16.7 years) participated in structured telephone interviews. Participants (68% of initial sample of 63) did not differ in age, diagnostic profile, socioeconomic status, or initial severity from nonparticipants but more girls than boys participated. Indices based on child- and parent-reported symptoms and impairment were calculated, and within-sample comparisons by age, gender, diagnosis, and initial severity were done using t tests. Predictors of symptoms and impairment were also examined. On average, adolescents reported modest levels of anxiety-related impairment. Further treatment for anxiety had occurred in 30% (13 of 43) of patients. Stepwise regressions found female gender and diagnosis other than generalized anxiety disorder predictive of increased symptoms by parent report, and initial severity predicted adolescent-reported impairment. Adolescents showed limited internalizing symptomatology and impairment but almost one third had required further treatment. Studies comparing treated and untreated samples are needed to clarify whether CBT alters the natural history of childhood anxiety disorders and to replicate our findings regarding predictors of symptomatology and impairment.
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Affiliation(s)
- Katharina Manassis
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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33
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Lopez AM, Garcia F, Hatch K, Byron J, Kurker S, Guillen J, Major J, Lazarus S, Avery D, Weinstein R. Telecolposcopy in a tertiary care women's clinic: A pilot study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - K. Hatch
- University of Arizona, Tucson, AZ
| | - J. Byron
- University of Arizona, Tucson, AZ
| | | | | | - J. Major
- University of Arizona, Tucson, AZ
| | | | - D. Avery
- University of Arizona, Tucson, AZ
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Manassis K, Mendlowitz SL, Scapillato D, Avery D, Fiksenbaum L, Freire M, Monga S, Owens M. Group and individual cognitive-behavioral therapy for childhood anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry 2002; 41:1423-30. [PMID: 12447028 DOI: 10.1097/00004583-200212000-00013] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the efficacy of group and individual cognitive-behavioral therapy (CBT) in children with Axis I anxiety disorders. It was hypothesized that certain subgroups would respond preferentially to one modality. METHOD Seventy-eight children aged 8-12 years with diagnosed anxiety disorders were randomly assigned to a 12-week, manual-based program of group or individual CBT, both with parental involvement. Outcomes included child anxiety (child and parent report) and global functioning as estimated by clinicians. Repeated-measures analyses of variance (ANOVAs) were done. The sample was then dichotomized by self-reported social anxiety (high/low) and parent-reported hyperactivity (high/low) using median splits, and diagnostically by generalized anxiety disorder versus phobic disorders. ANOVAs were repeated. RESULTS Children and parents reported significantly decreased anxiety and clinicians reported significantly improved global functioning regardless of treatment modality. Children reporting high social anxiety reported greater gains in individual treatment than in group treatment (p <.01). Parent reports of hyperactivity and diagnostic differences were not associated with differential treatment response by modality. CONCLUSIONS Children with anxiety disorders appear to improve with CBT, whether administered in a group or individual format. A subgroup of children reporting high social anxiety may respond preferentially to individual treatment. Replication of these findings is indicated.
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Khan A, Cohen S, Stowell M, Capwell R, Avery D, Dunner DL. Treatment Options in Severe Psychotic Depression. Convuls Ther 2002; 3:93-99. [PMID: 11940902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
In our sample of 15 hospitalized patients with severe psychotic depression, six responded to therapy with tricyclic antidepressants combined with neuroleptics. Of the nine nonresponders, eight showed an excellent clinical response to electroconvulsive therapy (ECT). The clinical outcome after 6 months of treatment was similar in both groups. We recommend that protracted, complicated trials of pharmacotherapy be reevaluated in psychotic depression. A prospective comparative study of ECT and pharmacotherapy is needed to define the optimal treatment for psychotic depression.
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Affiliation(s)
- Arifulla Khan
- Department of Psychiatry and Behavioral Sciences, University of Washington and Harborview Medical Center, Seattle, Washington, USA
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37
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Abstract
The objective of this study was to further describe the relationships between facial hair whorls and temperament in cattle. Cattle (n=1636) from six commercial cattle auctions in Colorado and Texas were observed. Whorl location was classified according to lateral position (left, right, or middle) and height (high: above the top of the eye, middle: at eye level, low: below the bottom of the eye). A 4-point temperament score was used to rate each animal while it was in the auction ring. Cattle with a score of 1 remained calm and stood still or walked around, and those with a score of 4 were highly agitated and hit the ring fence, walls, partitions, or people with its head. The cattle observed were 75% Bos taurus beef breeds, 21% Holstein dairy cattle, 3% Bos indicus beef breeds, and 1% non-Holstein dairy breeds. Ten percent of cattle surveyed had no facial hair whorl, while 86% had a single spiral hair whorl, of which 47% had middle-middle whorl placement. Animals with a high whorl position or no hair whorl had higher temperament scores (P=0.01). Cattle with low whorls were more likely to have greater lateral displacement of whorls off of the centerline than cattle with high or middle whorls (P<0.01). Abnormally shaped whorls were more common on cattle with low whorls (P<0.01) and on cattle with lateral whorls located off of the centerline (P<0.01). Cattle with hair whorls on the centerline had more variable temperament scores (P=0.04). Beef cattle had more abnormal whorls than Holsteins (P<0.01). Temperament scores showed that Holsteins were calmer than beef cattle (P<0.01). Facial hair whorls in cattle may be a useful management tool in assessing which animals may become disturbed in novel environments.
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Affiliation(s)
- J L. Lanier
- Department of Animal Sciences, Colorado State University, Fort Collins, 80523-1171, Colorado, CO, USA
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38
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Feachem RG, Avery D. The Bulletin in 2001. Bull World Health Organ 2001; 79:1. [PMID: 11217660 PMCID: PMC2566339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Lanier JL, Grandin T, Green RD, Avery D, McGee K. The relationship between reaction to sudden, intermittent movements and sounds and temperament. J Anim Sci 2000; 78:1467-74. [PMID: 10875628 DOI: 10.2527/2000.7861467x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Casual observations indicated that some cattle are more sensitive to sudden movement or intermittent sound than other cattle. Six commercial livestock auctions in two states and a total of 1,636 cattle were observed to assess the relationship between breed, sex, and temperament score on the response to sudden, intermittent visual and sound stimuli, such as the ringman swinging his arm for a bid and the sound of him briefly yelling a bid. A 4-point temperament score was used to score each animal while it was in the ring. The scores used were 1) walks and(or) stands still, with slow, smooth body movements; 2) continuously walks or trots, and vigilant; 3) gait is faster than a trot (runs even a couple of steps), with fast, abrupt, jerky movements, and very vigilant; and 4) hits the ring fence, walls, partitions, or people with its head. Animals were observed for flinches, startle responses, or orientation toward sudden, intermittent sounds, motions, and tactile stimulation, such as being touched with a cane or plastic paddle. The cattle observed were mostly Bos taurus beef breeds and Holstein dairy cattle. Holsteins were more sound-sensitive (P = .02) and touch-sensitive (P < .01) than beef cattle. Sensitivity to sudden, intermittent stimuli (e.g., sound, motion, and touch) increased as temperament score (excitability) increased. Cattle with a temperament score of 1 were the least sensitive to sudden, intermittent movement and sound and those with a temperament score of 4 were the most sensitive (P < .01). This same relationship was sometimes observed for touch but was not statistically significant. Motion-sensitive cattle were more likely than nonsensitive cattle to score a temperament rating of 3 or 4 (P < .01). Steers and heifers were more motion-sensitive than the older bulls and cows (P = .03). Beef cattle urinated (P < .01, n = 1,581) and defecated (P < .01, n = 1,582) more often in the ring than did dairy cattle. Cattle that became agitated during handling in an auction ring were the individuals that were most likely to be startled by sudden, intermittent sounds and movements. Reactivity to sudden, intermittent stimuli may be an indicator of an excitable temperament.
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Affiliation(s)
- J L Lanier
- Department of Animal Sciences, Colorado State University, Fort Collins 80523-1171, USA
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40
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Abstract
The epithelial sodium channel (ENaC) is composed of three homologous subunits termed alpha, beta, and gamma. Previous studies suggest that selected residues within a hydrophobic region immediately preceding the second membrane-spanning domain of each subunit contribute to the conducting pore of ENaC. We probed the pore of mouse ENaC by systematically mutating all 24 amino acids within this putative pore region of the alpha-subunit to cysteine and co-expressing these mutants with wild type beta- and gamma-subunits of mouse ENaC in Xenopus laevis oocytes. Functional characteristics of these mutants were examined by two-electrode voltage clamp and single channel recording techniques. Two distinct domains were identified based on the functional changes associated with point mutations. An amino-terminal domain (alpha-Val(569)-alpha-Gly(579)) showed minimal changes in cation selectivity or amiloride sensitivity following cysteine substitution. In contrast, cysteine substitutions within the carboxyl-terminal domain (alpha-Ser(580)-alpha-Ser(592)) resulted in significant changes in cation selectivity and moderately altered amiloride sensitivity. The mutant channels containing alphaG587C or alphaS589C were permeable to K(+), and mutation of a GSS tract (positions alpha587-alpha589) to GYG resulted in a moderately K(+)-selective channel. Our results suggest that the C-terminal portion of the pore region within the alpha-subunit contributes to the selectivity filter of ENaC.
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Affiliation(s)
- S Sheng
- Departments of Medicine and Physiology, School of Medicine, University of Pennsylvania and the Veteran Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA
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41
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George MS, Avery D, Nahas Z, Molloy M, Oliver NC, Risch SC, Arana GW. rTMS studies of mood and emotion. Electroencephalogr Clin Neurophysiol Suppl 1999; 51:304-14. [PMID: 10590964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- M S George
- Department of Radiology, Medical University of South Carolina, Charleston 29425, USA
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42
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Hasbold J, Gett AV, Rush JS, Deenick E, Avery D, Jun J, Hodgkin PD. Quantitative analysis of lymphocyte differentiation and proliferation in vitro using carboxyfluorescein diacetate succinimidyl ester. Immunol Cell Biol 1999; 77:516-22. [PMID: 10571672 DOI: 10.1046/j.1440-1711.1999.00874.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mature T and B lymphocytes respond to receptor-delivered signals received during and following activation. These signals regulate the rates of cell death, growth, differentiation and migration that ultimately establish the behaviour patterns collectively referred to as immune regulation. We have been pursuing the philosophy that in vitro systems of lymphocyte stimulation, when analysed quantitatively, help reveal the logical attributes of lymphocyte behaviour. The development of carboxyfluorescein diacetate succinimidyl ester (CFSE) to track division has enabled the variable of division number to be incorporated into these quantitative analyses. Our studies with CFSE have established a fundamental link between differentiation and division number. Isotype switching, expression of T cell cytokines, surface receptor alterations and changes to intracellular signalling components all display independent patterns of change with division number. The stochastic aspects of these changes and the ability of external signals to independently regulate them argue for a probabilistic modelling framework for describing and understanding immune regulation.
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Affiliation(s)
- J Hasbold
- Immune Regulation Group, Medical Foundation, University of Sydney, The Centenary Institute of Cancer Medicine and Cell Biology, Sydney, New South Wales, Australia
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43
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Whipp BJ, Rossiter HB, Ward SA, Avery D, Doyle VL, Howe FA, Griffiths JR. Simultaneous determination of muscle 31P and O2 uptake kinetics during whole body NMR spectroscopy. J Appl Physiol (1985) 1999; 86:742-7. [PMID: 9931216 DOI: 10.1152/jappl.1999.86.2.742] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Our understanding of O2 uptake (VO2) control mechanisms during exercise may be improved by the simultaneous determination of the kinetics of intramuscular high-energy phosphate turnover and pulmonary VO2. We therefore developed a technique for remote gas-exchange analysis while subjects exercised in a whole body 1.5-T NMR system. Knee-extension exercise was performed against restraining rubber bands in the prone position. Free induction decays were acquired every 1,875 ms by using a transmit-receive coil, which was placed under the quadriceps. This allowed 31P spectra of intramuscular ATP, Pi, and creatine phosphate dynamics to be determined every 15 s. Airflow was measured with a custom-designed turbine and a 45-ft.-long cable to reach the volume-measuring module. This was located in an adjacent radio-frequency-shielded room, as was the respiratory mass spectrometer, which also used a 45-ft.-long sampling line. The respired gas profiles were not discernibly different from those that used the standard inlet; the increase in the delay was readily incorporated into the breathby-breath algorithm, allowing the VO2 kinetics to be determined in concert with those of intramuscular phosphate metabolism.
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Affiliation(s)
- B J Whipp
- Department of Physiology, University of Glasgow, United Kingdom
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44
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Roy-Byrne P, Russo J, Rabin L, Fuller K, Jaffe C, Ries R, Dagadakis C, Avery D. A brief medical necessity scale for mental disorders: reliability, validity, and clinical utility. J Behav Health Serv Res 1998; 25:412-24. [PMID: 9796163 DOI: 10.1007/bf02287511] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Managed care organizations (MCOs) use the concept of "medical necessity" to decide whether a prescribed treatment is warranted for a given medical condition. Because mental disorders lack the objective disease criteria common to medical illness, behavioral health administrators need a validated means to identify and quantify the severity of "medically important" aspects of mental disorders. The authors developed and tested a brief medical necessity scale for mental disorders in 205 patients presenting for initial evaluation. The scale had a factor structure with four subscales; good internal consistency, interrater reliability, and concurrent and predictive validity; and modest ability to identify patients requiring hospitalization and, in hospitalized patients, those requiring involuntary hospitalization. The authors propose use of the scale to better clarify decisions about level of care assignments and to better assess patient characteristics predictive of good outcome.
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Affiliation(s)
- P Roy-Byrne
- University of Washington, Harborview Medical Center, Seattle 98104-2499, USA.
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45
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Abstract
Although compelling logic suggests that melatonin may be effective for a variety of disorders, there are few empirical clinical studies. The optimal dose of melatonin is not clear; most studies have used doses that produce supraphysiological blood levels. The timing of melatonin administration is important. Melatonin has few immediate side-effects except drowsiness, but the effects of chronic administration are unclear. Melatonin may be effective in reducing jet lag. In elderly patients with poor sleep and documented low melatonin production, melatonin may be helpful. In several studies, melatonin has been shown to shorten sleep latency. Further studies are needed to clarify the efficacy and safety of melatonin.
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Affiliation(s)
- D Avery
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98104-2499, USA.
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Russo J, Roy-Byrne P, Jaffe C, Ries R, Dagadakis C, Avery D. Psychiatric status, quality of life, and level of care as predictors of outcomes of acute inpatient treatment. Psychiatr Serv 1997; 48:1427-34. [PMID: 9355170 DOI: 10.1176/ps.48.11.1427] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study examined the role of five types of variables--demographic characteristics, psychiatric status, functional quality of life, satisfaction with quality of life, and level of care--in predicting key outcomes of inpatient treatment. METHODS Multivariate canonical regression and univariate multiple regression models were constructed using data from 1,053 inpatients at a public hospital in Washington State. The models were used to predict length of stay, change in symptom severity during hospitalization, psychiatrists' ratings of patients' insight into their illness at discharge, patients' global satisfaction with life, and rehospitalization within 18 months. Hierarchical stepwise procedures were used to select variables that were significant predictors of outcomes. RESULTS All five classes of predictors were related to the outcomes. The roles of demographic characteristics and diagnoses were minimal. Previous hospitalization and severity of symptoms at admission were strong predictors of psychiatric status. Indicators of functional quality of life and satisfaction with quality of life explained significant variance in all models after accounting for the other classes of predictors. Frequency of family visits was the strongest functional quality-of-life predictor, relating to positive outcomes. Pretreatment satisfaction with life was a significant predictor of most outcomes, and increased satisfaction was associated with positive outcomes. CONCLUSIONS Patients' quality of life before psychiatric inpatient treatment predicted treatment outcomes independently of psychiatric status, demographic characteristics, and level-of-care variables. Prospective studies are needed to predict outcomes using multidimensional constructs.
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Affiliation(s)
- J Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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47
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Dunn JR, Avery D. Patient swallows removable partial denture: a clinical report. J Dent Technol 1997; 14:15-6. [PMID: 9524481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The indications for a unilateral partial denture would appear to be when there is a single posterior tooth missing, bound on both sides by usable abutments. Another consideration for a unilateral partial denture is that the patient does not want to restore the space with a fixed partial denture. One drawback to this treatment modality is that the prosthesis needs to be removed after each meal and cleaned. Other more important reasons for not making a 1-tooth removable partial denture is that it provides no cross-arch stabilization and there is the chance that it may be swallowed if it becomes dislodged. This clinical and laboratory report describes how this patient was treated.
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Affiliation(s)
- J R Dunn
- Drake Precision Dental Laboratory, Charlotte, N.C., USA
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48
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Abstract
The effects of the non-competitive NMDA receptor antagonist dextromethorphan on spatial learning were assessed using the Morris water maze. Dextromethorphan was administered to 4 groups of rats in 10, 20, 30, and 40 mg/kg doses. An additional group of rats was administered saline to serve as a vehicle control group. Dextromethorphan impaired learning dose dependently in the initial training phase of the experiment. During the probe trial, dose-dependent performance deficits were noted in the first 15 s of the trial only. Search strategy differences between the lowest and highest dose groups were also observed during the probe trial. During the reversal training phase, when the platform was moved to a new location, the dose-dependent impairment was seen again, but the 40 mg/kg group perseverated to the former location longer than the other groups. A cued control trial indicated that in addition to the learning impairment produced, the highest dose of dextromethorphan may also impair sensory-motor coordination.
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Affiliation(s)
- A Bane
- Department of Psychology, Colorado State University, Fort Collins 80523, USA
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49
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Cohen SM, Clydesdale FM, Winter C, Graham JD, Weil WB, Kroger M, Pariza MW, Crawford LM, Avery D, Scheuplein RJ. Delaney reform. Science 1995; 268:1829-30. [PMID: 7604249 DOI: 10.1126/science.268.5219.1829-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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50
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Abstract
Codon usage has been analysed in individual gene sequences, derived from a variety of parasitic protozoa in the class Sporozoa of the phylum Apicomplexa using metric multidimensional scaling. The two groups of codon usage patterns detected reflect the two main subgroups of organisms studied (the coccidia and the piroplasms), and it is the pattern of usage of synonymous codons that has the largest influence on overall codon usage in the individual genes, rather than being the pattern of amino acid composition of the gene product. The magnitude of the codon usage bias in the sequences was determined using three commonly used indices-NC, GC3S and B. In general, although relatively low levels of codon usage bias were detected in these gene sequences, codon usage bias does explain at least some of the codon usage patterns observed. Codon usage bias was observed to be dependent on the overall base composition of the genes analysed, which in turn was reflected in the types of codons that were either over- or under-represented in the nucleotide sequences. In keeping with observations on prokaryotic organisms, it is speculated that the codon usage patterns detected in these parasitic protozoa are the result of directional mutation pressure on the base composition of the genomic DNA.
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Affiliation(s)
- J T Ellis
- Department of Microbiology, University of Technology Sydney, New South Wales, Australia
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