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Abstract 5225: Temporal inhibition of ERK is sufficient for tumor growth inhibition in KRAS-mutant or BRAF-mutant tumors. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-5225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The combination of BRAF and MEK inhibitors have been clinically studied, and three different combinations (dabrafenib plus trametinib, vemurafenib plus cobimetinib and encorafenib plus binimetinib) are approved by the FDA for treatment of melanoma patients with BRAF V600E mutation. Published reports indicate that each combination has a different efficacy and toxicity profile. It is believed that the toxicity profile of some of these drugs is linked to their pharmacokinetic (PK) profile leading to prolonged pharmacodynamics (PD) or target inhibition. ERK inhibitors have been discovered recently to overcome the acquired resistance to BRAF plus MEK inhibitors in BRAF-mutant melanoma and for combination therapies in RAS/MAPK altered cancers including KRAS-mutant cancers. Several ERK inhibitors have entered clinical development as monotherapy or in combination. However, it is not clear what the minimum time on target is required for efficacy without causing significant toxicity, and whether that would differentiate the therapeutic index of one inhibitor from another. Therefore, we have conducted PK-PD-efficacy relationship studies of different MEK and ERK inhibitors with different PK profiles in mice in BRAF-mutant or KRAS-mutant xenograft models to determine the minimum time on target required for efficacy. We have tested the PK-PD-efficacy of MEK inhibitors trametinib and cobimetinib, as well as ERK inhibitors BVD-523, GDC-0994 and LY3214996 in BRAF V600E or KRAS mutant xenograft models including A375 BRAF V600E melanoma, Colo205 BRAF V600E colorectal carcinoma and HCT116 KRAS G13D colorectal carcinoma. Additionally, an infusion study with LY3214996 was conducted in rats implanted with HCT116 colorectal carcinoma tumors, where drug exposure was controlled for a specified time to get ≥50% pRSK1 inhibition. Our data suggests that ≥50% inhibition of pRSK1 for 8h is required for significant efficacy of ERK inhibitor LY3214996, which is similar to the data presented for GDC-0994 (Robarge K et al, Abstract number DDT02-03, AACR Annual Meeting 2014). Overall assessment of the data in different models suggested that ≥50% target inhibition for 8-16h is enough for significant tumor growth inhibition and regressions by an ERK inhibitor in BRAF-mutant or KRAS-mutant tumors without any obvious toxicity as measured by body weight loss or mortality. LY3214996 is in Phase 1 clinical development and the preliminary PK profile in patients looks as predicted from preclinical data. Therefore, we believe that the PK profile of LY3214996 offers flexibility with dose and schedule to balance efficacy and safety, and to achieve a better therapeutic index in combination therapy for RAS/MAPK pathway altered cancers.
Citation Format: Shripad V. Bhagwat, Weihua Shen, Baohui Zhao, Shufen Cai, Lisa Kindler, William T. McMillen, Eunice Yuen, Denis McCann, Jason Manro, Andrew J. Dropsey, Melinda D. Willard, Sajan Joseph, Sheng-Bin Peng. Temporal inhibition of ERK is sufficient for tumor growth inhibition in KRAS-mutant or BRAF-mutant tumors [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5225.
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Interactive computation and visualization of deep brain stimulation effects using Duality. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2020; 8:3-14. [PMID: 32742820 DOI: 10.1080/21681163.2018.1484817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Deep brain stimulation (DBS) is an established treatment for movement disorders such as Parkinson's disease or essential tremor. Currently, the selection of optimal stimulation settings is performed by iteratively adjusting the stimulation parameters and is a time consuming procedure that requires multiple clinic visits of several hours. Recently, computational models to predict and visualize the effect of DBS have been developed with the goal to simplify and accelerate this procedure by providing visual guidance and such models have been made available also on mobile devices. However, currently available visualization software still either lacks mobility, i.e., it is running on desktop computers and not easily available in clinical praxis, or flexibility, as the simulations that are visualized on mobile devices have to be precomputed. The goal of the pipeline presented in this paper is to close this gap: Using Duality, a newly developed software for the interactive visualization of simulation results, we implemented a pipeline that allows to compute DBS simulations in near-real time and instantaneously visualize the result on a tablet computer. Therefore, a client-server setup is used, so that the visualization and user interaction occur on the tablet computer, while the computations are carried out on a remote server. We present two examples for the use of Duality, one for postoperative programming and one for the planning of DBS surgery in a pre- or intraoperative setting. We carry out a performance analysis and present the results of a case study in which the pipeline for postoperative programming was applied.
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0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia.
Methods
Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons.
Results
After Bonferroni corrections (p<.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes.
Conclusion
Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted.
Support
Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).
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Abstract LB-274: Identification and characterization of LY3410738, a novel covalent inhibitor of cancer-associated mutant Isocitrate Dehydrogenase 1 (IDH1). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-lb-274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Somatic gain-of-function mutations in IDH1 have been identified in multiple tumor types including AML, glioma, cholangiocarcinoma and chondrosarcoma. The neo-enzymatic activity of mutant IDH1 results in accumulation of the oncometabolite 2-hydroxyglutarate (2-HG), leading to a hyper-methylation phenotype, a block in cell differentiation, and tumor growth. Using a structure-based drug design approach, we have developed a highly potent covalent inhibitor of mutant IDH1. LY3410738 modifies a single cysteine (Cys269) in the allosteric binding pocket and rapidly inactivates the enzyme with a KI/Kinact = 84,257 M-1sec-1. The compound selectively inhibits the 2-HG in IDH1 mutant tumor cells without depleting the levels of a-ketoglutarate. Using patient-derived primary AML cells, we demonstrated that LY3410738 was more potent than AG120 in reversing the block in differentiation associated with IDH1 mutant activity. In vivo, LY3410738 displayed prolonged pharmacodynamic activity, depleting 2-HG levels in tumors at low circulating exposures and for an extended time after clearance of compound. Importantly, LY3410738 has the ability to cross the blood-brain barrier and can achieve concentrations in the brain that exceed those needed to engage the target. Consistent with this, LY3410738 effectively inhibits 2HG in orthotopic glioma models. Using patient-derived IDH1 mutant orthotopic AML models, we demonstrated that LY3410738 effectively inhibited 2-HG, induced differentiation, and cleared AML from mice. Collectively, LY3410738 represents the first covalent brain-penetrant mutant IDH1 inhibitor with potential for Best-in-Class activity.
Citation Format: Nathan Brooks, Robin DeWalt, Serge Boulet, ZhaoHai Lu, Lisa Kays, Rachel cavitt, Sandra Gomez, John Strelow, Paul Milligan, Kenneth Roth, Renato Bauer, Stephen Antonysamy, Patric Hahn, Zoran Rankovic, Denis McCann, Gary Mo, Ramon Tiu, Timothy Burkholder, Sandaruwan Geeganage, Raymond Gilmour. Identification and characterization of LY3410738, a novel covalent inhibitor of cancer-associated mutant Isocitrate Dehydrogenase 1 (IDH1) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr LB-274.
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An Interactionist Approach to Rumination. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.05.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Does continuous partial attention offer a new understanding of the required vigilance and associated stress for parents of children with complex needs? Child Care Health Dev 2015; 41:1238-41. [PMID: 26282887 DOI: 10.1111/cch.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 06/01/2015] [Accepted: 06/28/2015] [Indexed: 11/28/2022]
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Inhibition of RAF Isoforms and Active Dimers by LY3009120 Leads to Anti-tumor Activities in RAS or BRAF Mutant Cancers. Cancer Cell 2015; 28:384-98. [PMID: 26343583 DOI: 10.1016/j.ccell.2015.08.002] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/29/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
LY3009120 is a pan-RAF and RAF dimer inhibitor that inhibits all RAF isoforms and occupies both protomers in RAF dimers. Biochemical and cellular analyses revealed that LY3009120 inhibits ARAF, BRAF, and CRAF isoforms with similar affinity, while vemurafenib or dabrafenib have little or modest CRAF activity compared to their BRAF activities. LY3009120 induces BRAF-CRAF dimerization but inhibits the phosphorylation of downstream MEK and ERK, suggesting that it effectively inhibits the kinase activity of BRAF-CRAF heterodimers. Further analyses demonstrated that LY3009120 also inhibits various forms of RAF dimers including BRAF or CRAF homodimers. Due to these unique properties, LY3009120 demonstrates minimal paradoxical activation, inhibits MEK1/2 phosphorylation, and exhibits anti-tumor activities across multiple models carrying KRAS, NRAS, or BRAF mutation.
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Discovery of 1-(3,3-dimethylbutyl)-3-(2-fluoro-4-methyl-5-(7-methyl-2-(methylamino)pyrido[2,3-d]pyrimidin-6-yl)phenyl)urea (LY3009120) as a pan-RAF inhibitor with minimal paradoxical activation and activity against BRAF or RAS mutant tumor cells. J Med Chem 2015; 58:4165-79. [PMID: 25965804 DOI: 10.1021/acs.jmedchem.5b00067] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The RAS-RAF-MEK-MAPK cascade is an essential signaling pathway, with activation typically mediated through cell surface receptors. The kinase inhibitors vemurafenib and dabrafenib, which target oncogenic BRAF V600E, have shown significant clinical efficacy in melanoma patients harboring this mutation. Because of paradoxical pathway activation, both agents were demonstrated to promote growth and metastasis of tumor cells with RAS mutations in preclinical models and are contraindicated for treatment of cancer patients with BRAF WT background, including patients with KRAS or NRAS mutations. In order to eliminate the issues associated with paradoxical MAPK pathway activation and to provide therapeutic benefit to patients with RAS mutant cancers, we sought to identify a compound not only active against BRAF V600E but also wild type BRAF and CRAF. On the basis of its superior in vitro and in vivo profile, compound 13 was selected for further development and is currently being evaluated in phase I clinical studies.
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Characterization of LY2228820 dimesylate, a potent and selective inhibitor of p38 MAPK with antitumor activity. Mol Cancer Ther 2013; 13:364-74. [PMID: 24356814 DOI: 10.1158/1535-7163.mct-13-0513] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
p38α mitogen-activated protein kinase (MAPK) is activated in cancer cells in response to environmental factors, oncogenic stress, radiation, and chemotherapy. p38α MAPK phosphorylates a number of substrates, including MAPKAP-K2 (MK2), and regulates the production of cytokines in the tumor microenvironment, such as TNF-α, interleukin-1β (IL-1β), IL-6, and CXCL8 (IL-8). p38α MAPK is highly expressed in human cancers and may play a role in tumor growth, invasion, metastasis, and drug resistance. LY2228820 dimesylate (hereafter LY2228820), a trisubstituted imidazole derivative, is a potent and selective, ATP-competitive inhibitor of the α- and β-isoforms of p38 MAPK in vitro (IC(50) = 5.3 and 3.2 nmol/L, respectively). In cell-based assays, LY2228820 potently and selectively inhibited phosphorylation of MK2 (Thr334) in anisomycin-stimulated HeLa cells (at 9.8 nmol/L by Western blot analysis) and anisomycin-induced mouse RAW264.7 macrophages (IC(50) = 35.3 nmol/L) with no changes in phosphorylation of p38α MAPK, JNK, ERK1/2, c-Jun, ATF2, or c-Myc ≤ 10 μmol/L. LY2228820 also reduced TNF-α secretion by lipopolysaccharide/IFN-γ-stimulated macrophages (IC(50) = 6.3 nmol/L). In mice transplanted with B16-F10 melanoma, tumor phospho-MK2 (p-MK2) was inhibited by LY2228820 in a dose-dependent manner [threshold effective dose (TED)(70) = 11.2 mg/kg]. Significant target inhibition (>40% reduction in p-MK2) was maintained for 4 to 8 hours following a single 10 mg/kg oral dose. LY2228820 produced significant tumor growth delay in multiple in vivo cancer models (melanoma, non-small cell lung cancer, ovarian, glioma, myeloma, breast). In summary, LY2228820 is a p38 MAPK inhibitor, which has been optimized for potency, selectivity, drug-like properties (such as oral bioavailability), and efficacy in animal models of human cancer.
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Factors influencing paediatric nurses' responses to medication administration. BMJ Qual Saf 2010; 19:e4. [DOI: 10.1136/qshc.2008.028852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Compliance of acute and long stay geriatric patients with nutritional supplementation. IRISH MEDICAL JOURNAL 2007; 100:473-5. [PMID: 17727125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Nutritional supplements are prescribed to improve nutritional status, and reduce hospital stays in manourised hospital patients. Clinical benefits are dependant on compliance, the level of which remains unclear. AIMS To assess compliance levels with oral nutritional supplementation and determine methods to improve compliance. METHODS Compliance was observed over 10 days by measuring total supplements prescribed and weighing wastage remaining after use. Areas for improvement were identified and implemented for 6 months. Specifically, a distinct supplement administration round was established and those patients requiring assistance with supplement consumption were identified with signage above their beds. Compliance was re-assessed in a sub sample of patients. RESULTS Thirty seven elderly patients (mean age 85 years; 57% female) prescribed nutritional supplements were studied. Mean compliance was significantly greater in males than females (85.7% vs 74%) and acute wards compared to longstay (89.5% vs. 74.2 Compliance with supplements was significantly greater following intervention (mean 74.2% vs. 93%, p < 0.0001). CONCLUSION Compliance with nutritional supplementation is variable among institutionalized geriatric patients. Timing of supplementation dispensation and improving staff vigilance can positively affect compliance.
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Abstract
Recent technological advances have made feasible universal newborn hearing screening and therefore early detection of permanent childhood hearing impairment. Over the past three years, new information has been published on whether early intervention is beneficial, the possibility of harm arising from newborn screening, and its cost. Dramatic progress has been made in the large scale implementation of universal screening in many parts of the western world.
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A chemical switch regulates fibrate specificity for peroxisome proliferator-activated receptor alpha (PPARalpha ) versus liver X receptor. J Biol Chem 2003; 278:2403-10. [PMID: 12441342 DOI: 10.1074/jbc.m209629200] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Fenofibrate is clinically successful in treating hypertriglyceridemia and mixed hyperlipidemia presumably through peroxisome proliferator-activated receptor alpha (PPARalpha)-dependent induction of genes that control fatty acid beta-oxidation. Lipid homeostasis and cholesterol metabolism also are regulated by the nuclear oxysterol receptors, liver X receptors alpha and beta (LXRalpha and LXRbeta). Here we show that fenofibrate ester, but not fenofibric acid, functions as an LXR antagonist by directly binding to LXRs. Likewise, ester forms, but not carboxylic acid forms, of other members of the fibrate class of molecules antagonize the LXRs. The fibrate esters display greater affinity for LXRs than the corresponding fibric acids have for PPARalpha. Thus, these two nuclear receptors display a degree of conservation in their recognition of ligands; yet, the acid/ester moiety acts as a chemical switch that determines PPARalpha versus LXR specificity. Consistent with its LXR antagonistic activity, fenofibrate potently represses LXR agonist-induced transcription of hepatic lipogenic genes. Surprisingly, fenofibrate does not repress LXR-induced transcription of various ATP-binding cassette transporters either in liver or in macrophages, suggesting that fenofibrate manifests variable biocharacter in the context of differing gene promoters. These findings provide not only an unexpected mechanism by which fenofibrate inhibits lipogenesis but also the basis for examination of the pharmacology of an LXR ligand in humans.
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Treating patients with Alzheimer's disease. The challenges and rewards. CDS REVIEW 2000; 93:10-3. [PMID: 11276772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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The imaging of a controlled-release pellet formulation using scanning electron microscopy--potential for artefact generation. Pharm Dev Technol 1998; 3:135-9. [PMID: 9532609 DOI: 10.3109/10837459809028488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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State leaders share their thoughts on government relations. J Am Dent Assoc 1996; 127:454-7. [PMID: 8655865 DOI: 10.14219/jada.archive.1996.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
Employees in a large work organization participated in an investigation of relationships between drug use and absenteeism and tardiness. Specifically, the study investigated the extent to which both self-reported and urine-screened drug use accounted for variance in several types of absenteeism, as well as tardiness, above and beyond that accounted for by demographic and work reaction variables. The results showed that employee drug use accounted for additional statistically significant variance in overall absenteeism and in absenteeism due to injuries and suspensions, as well as days tardy. Implications of these findings for organizational drug testing are discussed.
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Mouthwashes: how effective are they? J Am Dent Assoc 1993; 124:55-6. [PMID: 8335799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Whiteners. DENTAL TEAMWORK 1993; 6:21-4. [PMID: 8299498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Surgeon general warns against use of smokeless tobacco. J Am Dent Assoc 1993; 124:22. [PMID: 8429180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Survey shows emerging trends among adult dental patients. J Am Dent Assoc 1992; 123:20. [PMID: 1484131 DOI: 10.14219/jada.archive.1992.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Source of HIV transmission in Florida remains a mystery, says CDC. J Am Dent Assoc 1992; 123:22, 24. [PMID: 1320063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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A life in science. Dr. Genco receives Gold Medal for research. J Am Dent Assoc 1991; 122:42-5. [PMID: 1918666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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The role of marketing research in securing a certificate of need for a new renal transplant facility. JOURNAL OF HEALTH CARE MARKETING 1991; 11:63-9. [PMID: 10111404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors describe how a negative Certificate of Need decision on the establishment of a new renal transplantation center was reversed by the reintroduction of arguments based on primary data. Specifically, a research project was undertaken to survey attitudes of past and potential patients toward using the new facility. In addition to overturning the negative decision, the data gathered were of significant value to hospital and transplantation facility administrators.
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Abstract
A large New England family with autosomal dominant familial spastic paraplegia is described. In a pedigree of 173 individuals, 71 affected individuals are identified. Seventeen cases examined by the authors are described with regard to the natural history of FSP in this family. A staging system for following progress and planning interventions is proposed. Three illustrative cases are presented. In this family, FSP is found to have a homogeneous clinical course with nearly complete penetrance. Onset occurs at or before 3 years of age with involvement limited to the lower extremities. After the initial onset, no significant progression was noted. Early aggressive habilitative care may result in more functional ambulation.
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Dental research: the clinical trial formula. J Am Dent Assoc 1990; 120:384-92. [PMID: 2181010 DOI: 10.14219/jada.archive.1990.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Reflections from the trenches. CMAJ 1989; 141:968-9. [PMID: 2804855 PMCID: PMC1451446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Periodontal research: exploring new horizons. J Am Dent Assoc 1989; 119:481-4, 487-9. [PMID: 2677082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Correlates of neuropsychological deficits in impaired workers exposed to organic solvents. Arch Clin Neuropsychol 1989. [DOI: 10.1093/arclin/4.2.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Emphasis. Building a winning team: dentists and their staff. J Am Dent Assoc 1988; 117:707-11. [PMID: 3198880 DOI: 10.14219/jada.archive.1988.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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A hospital team approach with parents of a Down's syndrome infant. CANADA'S MENTAL HEALTH 1987; 35:12-4. [PMID: 10313732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This article is a description of a multidisciplinary team approach with parents of a Down's syndrome infant in the obstetrical department of the Royal Victoria Hospital in Montreal. After a brief explanation on the reason why a refinement of this approach became necessary, the authors give an account of the in-service training that was implemented for professionals as well as some comments on parents' initial reactions to the birth of a Down's syndrome child and the role of professionals in these situations. Finally, a "Protocol for management of Down's syndrome infants in hospital" is included in the last part of the article.
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Who are we and what do we want to be? The role of hospital image analysis in marketing strategy. JOURNAL OF HOSPITAL MARKETING 1987; 1:81-94. [PMID: 10301725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Responding to the challenges of an uncertain education environment. SPECIAL CARE IN DENTISTRY 1987; 7:73-7. [PMID: 3473697 DOI: 10.1111/j.1754-4505.1987.tb00606.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Previous studies have demonstrated circadian fluctuations of systemic catecholamines in man. However, methodological differences and conflicting results with epinephrine are apparent. In the present study, plasma and urinary epinephrine and norepinephrine and plasma cortisol were studied in healthy young adult males over 24 hr with 20 min plasma sampling and EEG monitoring of sleep. Plasma epinephrine did not have a circadian variation in supine subjects. Urinary epinephrine levels and small urinary circadian variations were increased by normal posture and activity. Sleep and sleep stage were not associated with different plasma epinephrine levels, and no ultradian fluctuation was observed. Levels of norepinephrine and cortisol were normal. Based on all studies to date, it appears that basal plasma epinephrine has either a very small amplitude or no circadian rhythm, but that changes in posture and activity or the rest/activity cycle may modify this pattern.
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Metabolism and clinical assessment of L-dopa in parkinsonism. Neurology 1970; 20:402. [PMID: 4935027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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