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Labuschagne D, Fleisher J, Woo K, Fitchett G. Feasibility and Acceptability of Dignity Therapy for People with Advanced Neurodegenerative Disease. J Pain Symptom Manage 2024; 67:e499-e502. [PMID: 38307374 DOI: 10.1016/j.jpainsymman.2024.01.034] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Affiliation(s)
| | - Jori Fleisher
- Rush University Medical Center, Chicago, Illinois, USA
| | - Katheryn Woo
- Rush University Medical Center, Chicago, Illinois, USA
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Fleisher JE, Suresh M, Levin ME, Hess SP, Akram F, Dodson D, Tosin M, Stebbins GT, Woo K, Ouyang B, Chodosh J. Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia. Parkinsonism Relat Disord 2023; 113:105492. [PMID: 37385161 PMCID: PMC10527787 DOI: 10.1016/j.parkreldis.2023.105492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input. OBJECTIVE We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers' knowledge, dementia attitudes, and mastery. METHODS Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention. RESULTS Thirty mentor-mentee pairs completed a median of 15 calls (range: 8-19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors' LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively). CONCLUSIONS This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04649164ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Madhuvanthi Suresh
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melissa E Levin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Chicago Medical School - Rosalind Franklin University, North Chicago, IL, USA
| | - Serena P Hess
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Faizan Akram
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michelle Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Chodosh
- Department of Medicine, New York University School of Medicine, New York, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York, NY, USA
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Fleisher JE, Suresh M, Klostermann EC, Lee J, Hess SP, Myrick E, Mitchem D, Woo K, Sennott BJ, Witek NP, Chen SM, Beck JC, Ouyang B, Wilkinson JR, Hall DA, Chodosh J. IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease. Parkinsonism Relat Disord 2023; 106:105222. [PMID: 36446676 PMCID: PMC9825655 DOI: 10.1016/j.parkreldis.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION NCT03189459.
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Affiliation(s)
- Jori E Fleisher
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Madhuvanthi Suresh
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Ellen C Klostermann
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Serena P Hess
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Brianna J Sennott
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie P Witek
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Sarah Mitchell Chen
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - James C Beck
- Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA.
| | - Bichun Ouyang
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jayne R Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Deborah A Hall
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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Fleisher JE, Hess SP, Klostermann EC, Lee J, Myrick E, Mitchem D, Niemet C, Woo K, Sennott BJ, Sanghvi M, Witek N, Beck JC, Wilkinson JR, Ouyang B, Hall DA, Chodosh J. IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease. Parkinsonism Relat Disord 2022; 102:68-76. [PMID: 35963046 PMCID: PMC9578443 DOI: 10.1016/j.parkreldis.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
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Affiliation(s)
- Jori E. Fleisher
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Rush Graduate College, Rush University Medical Center, 600 South Paulina Street, Suite 438, Chicago, IL, 60612, USA,Corresponding author. Department of Neurological Sciences, Division of Movement Disorders, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA. (J.E. Fleisher)
| | - Serena P. Hess
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Ellen C. Klostermann
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Claire Niemet
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Loyola University Chicago College of Arts and Sciences, 1032 West Sheridan Road, Chicago, IL, 60660, USA.
| | - Brianna J. Sennott
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA
| | - Maya Sanghvi
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie Witek
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - James C. Beck
- Parkinson’s Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA
| | - Jayne R. Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA,Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA.
| | - Deborah A. Hall
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
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Hess SP, Levin M, Akram F, Woo K, Andersen L, Trenkle K, Brown P, Ouyang B, Fleisher JE. The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home. BMC Med Educ 2022; 22:506. [PMID: 35761252 PMCID: PMC9238152 DOI: 10.1186/s12909-022-03430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. METHODS Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0-10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. RESULTS Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. CONCLUSIONS A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.
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Affiliation(s)
- Serena P Hess
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Melissa Levin
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Chicago Medical School - Rosalind Franklin University, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| | - Faizan Akram
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Loyola University Chicago College of Arts and Sciences, 1032 W. Sheridan Road, Chicago, IL, 60660, USA
| | - Lauren Andersen
- Department of Physical Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
| | - Kristie Trenkle
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
- Department of Occupational Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
| | - Patricia Brown
- Memorycare Corporation, 634 Brooklyn Drive, Aurora, IL, 60502, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jori E Fleisher
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA.
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Sennott B, Woo K, Hess S, Mitchem D, Klostermann EC, Myrick E, Anderson S, Savica R, Fleisher JE. Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic. J Parkinsons Dis 2021; 12:475. [PMID: 34487014 DOI: 10.3233/jpd-219009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Fleisher J, Hess S, Sennott B, Myrick E, Wallace EK, Lee J, Sanghvi M, Woo K, Ouyang B, Wilkinson J, Beck J, Johnson T, Hall D, Chodosh J. Longitudinal, Interdisciplinary Home Visits vs. Usual Care for Homebound People with Advanced Parkinson's Disease (IN-HOME-PD): Study protocol for a controlled trial. JMIR Res Protoc 2021; 10:e31690. [PMID: 34238753 PMCID: PMC8479607 DOI: 10.2196/31690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID) PRR1-10.2196/31690
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Affiliation(s)
- Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Brianna Sennott
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Ellen Klostermann Wallace
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Jeanette Lee
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Social Work and Community Health, Rush University Medical Center, Chicago, US
| | - Maya Sanghvi
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Yale College, Yale University, New Haven, US
| | - Katheryn Woo
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, US
| | - Jayne Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, US.,Department of Neurology, University of Pennsylvania, Philadelphia, US
| | | | - Tricia Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, US
| | - Deborah Hall
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, US.,VA New York Harbor Healthcare System, New York, US
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Sennott B, Woo K, Hess S, Mitchem D, Klostermann EC, Myrick E, Anderson S, Savica R, Fleisher JE. Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic. J Parkinsons Dis 2020; 10:1383-1388. [PMID: 32804103 DOI: 10.3233/jpd-202156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended daily life and neurologic care for most patients, including those with Parkinson's disease and parkinsonism. Disruptions to routine care, high volumes of patient and caregiver calls, and our patients' risk of infection and complications inspired a proactive COVID-19 outreach program. This program targets patients with advanced Parkinson's disease and related disorders, specifically those who are homebound, receiving or eligible for palliative care, and/or lacking support networks. We describe the program and practical strategies providers can implement to support wellbeing and successful telehealth uptake during this time of social isolation and gradual reopening.
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Affiliation(s)
- Brianna Sennott
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daniela Mitchem
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ellen C Klostermann
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sharlet Anderson
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jori E Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Van Tiggelen H, LeBlanc K, Campbell K, Woo K, Baranoski S, Chang Y, Dunk A, Gloeckner M, Hevia H, Holloway S, Idensohn P, Karadağ A, Koren E, Kottner J, Langemo D, Ousey K, Pokorná A, Romanelli M, Santos V, Smet S, Tariq G, Van den Bussche K, Van Hecke A, Verhaeghe S, Vuagnat H, Williams A, Beeckman D. Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory Panel Classification System in 44 countries. Br J Dermatol 2020; 183:146-154. [PMID: 31605618 PMCID: PMC7384145 DOI: 10.1111/bjd.18604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Skin tears are acute wounds that are frequently misdiagnosed and under-reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way. OBJECTIVES To measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally. METHODS A multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two-round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter-rater reliability and intrarater reliability of the instrument. RESULTS A definition for the concept of a 'skin flap' in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79-0·80] and sensitivity ranged from 0·74 (95% CI 0·73-0·75) to 0·88 (95% CI 0·87-0·88). The inter-rater reliability was 0·57 (95% CI 0·57-0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73-0·75). CONCLUSIONS The ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under-reported too often. A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries. Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.
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Kim B, Shin H, Kim W, Kim H, Cho Y, Yoon H, Baek J, Woo K, Lee Y, Ryoo H. PIN1 Attenuation Improves Midface Hypoplasia in a Mouse Model of Apert Syndrome. J Dent Res 2019; 99:223-232. [PMID: 31869252 DOI: 10.1177/0022034519893656] [Citation(s) in RCA: 7] [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: 01/08/2023] Open
Abstract
Premature fusion of the cranial suture and midface hypoplasia are common features of syndromic craniosynostosis caused by mutations in the FGFR2 gene. The only treatment for this condition involves a series of risky surgical procedures designed to correct defects in the craniofacial bones, which must be performed until brain growth has been completed. Several pharmacologic interventions directed at FGFR2 downstream signaling have been tested as potential treatments for premature coronal suture fusion in a mouse model of Apert syndrome. However, there are no published studies that have targeted for the pharmacologic treatment of midface hypoplasia. We used Fgfr2S252W/+ knock-in mice as a model of Apert syndrome and morphometric analyses to identify causal hypoplastic sites in the midface region. Three-dimensional geometric and linear analyses of Fgfr2S252W/+ mice at postnatal day 0 demonstrated distinct morphologic variance. The premature fusion of anterior facial bones, such as the maxilla, nasal, and frontal bones, rather than the cranium or cranial base, is the main contributing factor toward the anterior-posterior skull length shortening. The cranial base of the mouse model had a noticeable downward slant around the intersphenoid synchondrosis, which is related to distortion of the airway. Within a skull, the facial shape variance was highly correlated with the cranial base angle change along Fgfr2 S252W mutation-induced craniofacial anomalies. The inhibition of an FGFR2 downstream signaling enzyme, PIN1, via genetic knockdown or use of a PIN1 inhibitor, juglone, attenuated the aforementioned deformities in a mouse model of Apert syndrome. Overall, these results indicate that FGFR2 signaling is a key contributor toward abnormal anterior-posterior dimensional growth in the midface region. Our study suggests a novel therapeutic option for the prevention of craniofacial malformations induced by mutations in the FGFR2 gene.
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Affiliation(s)
- B Kim
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - H Shin
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - W Kim
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - H Kim
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - Y Cho
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea.,Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - H Yoon
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - J Baek
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - K Woo
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - Y Lee
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
| | - H Ryoo
- Department of Molecular Genetics and Dental Pharmacology, Seoul National University, Seoul, Republic of Korea
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Kuczmarska-Haas A, Lee A, Macomber M, Woo K, Freese C, Morris Z. International Survey on the Use of Complementary and Alternative Medicines for Common Toxicities of Radiation Therapy. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beeckman D, Van den Bussche K, Alves P, Arnold Long M, Beele H, Ciprandi G, Coyer F, de Groot T, De Meyer D, Deschepper E, Dunk A, Fourie A, García-Molina P, Gray M, Iblasi A, Jelnes R, Johansen E, Karadağ A, Leblanc K, Kis Dadara Z, Meaume S, Pokorna A, Romanelli M, Ruppert S, Schoonhoven L, Smet S, Smith C, Steininger A, Stockmayr M, Van Damme N, Voegeli D, Van Hecke A, Verhaeghe S, Woo K, Kottner J. Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. Br J Dermatol 2018. [DOI: 10.1111/bjd.16754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Beeckman D, Van den Bussche K, Alves P, Arnold Long M, Beelev H, Ciprandi G, Coyer F, de Groot T, De Meyer D, Deschepper E, Dunk A, Fourie A, García-Molina P, Gray M, Iblasi A, Jelnes R, Johansen E, Karadag A, Leblanc K, Kis Dadara Z, Meaume S, Pokorna A, Romanelli M, Ruppert S, Schoonhoven L, Smet S, Smith C, Steininger A, Stockmayr M, Van Damme N, Voegeli D, Van Hecke A, Verhaeghe S, Woo K, Kottner J. 建立失禁相关性皮炎(IAD)相关国际通用术语:在30个国家/地区进行根特全球(IAD)分类工具(GLOBIAD)心理测量特性的设计和评估. Br J Dermatol 2018. [DOI: 10.1111/bjd.16766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Beeckman D, Van den Bussche K, Alves P, Arnold Long MC, Beele H, Ciprandi G, Coyer F, de Groot T, De Meyer D, Deschepper E, Dunk AM, Fourie A, García-Molina P, Gray M, Iblasi A, Jelnes R, Johansen E, Karadağ A, Leblanc K, Kis Dadara Z, Meaume S, Pokorna A, Romanelli M, Ruppert S, Schoonhoven L, Smet S, Smith C, Steininger A, Stockmayr M, Van Damme N, Voegeli D, Van Hecke A, Verhaeghe S, Woo K, Kottner J. Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. Br J Dermatol 2018; 178:1331-1340. [PMID: 29315488 DOI: 10.1111/bjd.16327] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Incontinence-associated dermatitis (IAD) is a specific type of irritant contact dermatitis with different severity levels. An internationally accepted instrument to assess the severity of IAD in adults, with established diagnostic accuracy, agreement and reliability, is needed to support clinical practice and research. OBJECTIVES To design the Ghent Global IAD Categorization Tool (GLOBIAD) and evaluate its psychometric properties. METHODS The design was based on expert consultation using a three-round Delphi procedure with 34 experts from 13 countries. The instrument was tested using IAD photographs, which reflected different severity levels, in a sample of 823 healthcare professionals from 30 countries. Measures for diagnostic accuracy (sensitivity and specificity), agreement, interrater reliability (multirater Fleiss kappa) and intrarater reliability (Cohen's kappa) were assessed. RESULTS The GLOBIAD consists of two categories based on the presence of persistent redness (category 1) and skin loss (category 2), both of which are subdivided based on the presence of clinical signs of infection. The agreement for differentiating between category 1 and category 2 was 0·86 [95% confidence interval (CI) 0·86-0·87], with a sensitivity of 90% and a specificity of 84%. The overall agreement was 0·55 (95% CI 0·55-0·56). The Fleiss kappa for differentiating between category 1 and category 2 was 0·65 (95% CI 0·65-0·65). The overall Fleiss kappa was 0·41 (95% CI 0·41-0·41). The Cohen's kappa for differentiating between category 1 and category 2 was 0·76 (95% CI 0·75-0·77). The overall Cohen's kappa was 0·61 (95% CI 0·59-0·62). CONCLUSIONS The development of the GLOBIAD is a major step towards a better systematic assessment of IAD in clinical practice and research worldwide. However, further validation is needed.
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Affiliation(s)
- D Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K Van den Bussche
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - P Alves
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Catholic University of Portugal, Oporto, Portugal
| | - M C Arnold Long
- Department of Nursing, Roper Hospital, Charleston, SC, U.S.A
| | - H Beele
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - G Ciprandi
- Department of Pediatric Surgery, Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - F Coyer
- Intensive Care Services, Royal Brisbane and Women's Hospital and School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - T de Groot
- Wond Expertise Centrum, Lange Land Ziekenhuis, Zoetermeer, the Netherlands
| | - D De Meyer
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - E Deschepper
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - A M Dunk
- Tissue Viability Unit, Canberra Hospital, ACT Health, Canberra, Australia
| | - A Fourie
- Scientific Affairs & Education Manager, 3M (Critical and Chronic Care Solutions), Johannesburg, South Africa
| | - P García-Molina
- Department of Nursing, University of Valencia, Valencia, Spain
| | - M Gray
- Department of Urology, University of Virginia, Charlottesville, VA, U.S.A
| | - A Iblasi
- Wound Care, King Saud Medical City (KSMC), Riyadh, Saudi Arabia
| | - R Jelnes
- Wound Clinic, Sygehus Sonderjylland, Sonderborg, Denmark
| | - E Johansen
- University College of Southeast Norway, Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, Drammen, Norway
| | - A Karadağ
- School of Nursing, Koc University, Istanbul, Turkey
| | - K Leblanc
- School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Z Kis Dadara
- Development of Care, Barmherzige Brüder Austria, Vienna, Austria
| | - S Meaume
- Geriatric and Wound Healing Department, APHP, Hôpital Rothschild, Paris, France
| | - A Pokorna
- Department of Nursing, Masaryk University, Faculty of Medicine, Brno, Czech Republic
| | - M Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - S Ruppert
- Department of Medicine II, Vienna General Hospital, Vienna, Austria
| | - L Schoonhoven
- Faculty of Health Sciences, University of Southampton, Southampton, U.K.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC Wessex), University of Southampton, Southampton, U.K.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, the Netherlands
| | - S Smet
- Wound Care Center, Ghent University Hospital, Ghent, Belgium
| | - C Smith
- Wound Ostomy Clinic, Marion General Hospital, Marion, IN, U.S.A
| | - A Steininger
- Private Universität für Medizinische Informatik und Technik (UMIT) und Pflegeakademie der Barmherzigen Brüder Wien Pflegewissenschaft und Gerontologie, Vienna, Austria
| | - M Stockmayr
- Department of Surgery, Vienna General Hospital, Vienna, Austria
| | - N Van Damme
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - D Voegeli
- Faculty of Health Sciences, University of Southampton, Southampton, U.K
| | - A Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - S Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium
| | - K Woo
- Department of Nursing, Queen's University, Kingston, Canada
| | - J Kottner
- University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universtitätsmedizin Berlin, Berlin, Germany
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Shang WL, Betti R, Hu SX, Woo K, Hao L, Ren C, Christopherson AR, Bose A, Theobald W. Electron Shock Ignition of Inertial Fusion Targets. Phys Rev Lett 2017; 119:195001. [PMID: 29219482 DOI: 10.1103/physrevlett.119.195001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Indexed: 06/07/2023]
Abstract
It is shown that inertial confinement fusion targets designed with low implosion velocities can be shock-ignited using laser-plasma interaction generated hot electrons (hot-e's) to obtain high energy gains. These designs are robust to multimode asymmetries and are predicted to ignite even for significantly distorted implosions. Electron shock ignition requires tens of kilojoules of hot-e's which can be produced only at a large laser facility like the National Ignition Facility, with the laser-to-hot-e conversion efficiency greater than 10% at laser intensities ∼10^{16} W/cm^{2}.
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Affiliation(s)
- W L Shang
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - R Betti
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - S X Hu
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - K Woo
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - L Hao
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - C Ren
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - A R Christopherson
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - A Bose
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
- Departments of Mechanical Engineering and Physics and Astronomy, University of Rochester, Rochester, New York 14623, USA
| | - W Theobald
- Fusion Science Center and Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
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Spencer R, Alexander V, Eickhoff J, Woo K, Costanzo E, Marx N, Rose S. A digital media diversion improves mood in patients receiving chemotherapy for recurrent gynecologic malignancies: Results of a randomized clinical trial. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Cho Y, Kim B, Bae H, Kim W, Baek J, Woo K, Lee G, Seol Y, Lee Y, Ku Y, Rhyu I, Ryoo H. Direct Gingival Fibroblast/Osteoblast Transdifferentiation via Epigenetics. J Dent Res 2017; 96:555-561. [PMID: 28081379 DOI: 10.1177/0022034516686745] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/15/2022] Open
Abstract
Alveolar bone resorption caused by trauma or periodontal diseases has represented a challenge for both dental clinicians and researchers. In this study, we evaluate the osteogenic potential of human gingival fibroblasts (HGFs) through a direct transdifferentiation from HGFs to functional osteoblasts via epigenetic modification and osteogenic signaling with bone morphogenetic protein 2 (BMP2) in vitro and in vivo. HGF treatment with 5-aza-2'-deoxycytidine (5-aza-dC) induced demethylation in the hypermethylated CpG islands of the osteogenic lineage marker genes RUNX2 and ALP, and subsequent BMP2 treatment successfully drove the fibroblasts to the osteoblasts' lineage. Cell morphological changes viewed under microscopy and alkaline phosphatase (ALP) and alizarin red S (ARS) staining confirmed the osteoblastic change mediated by epigenetic modification as did real-time polymerase chain reaction (PCR), methylation-specific PCR (MSP), and chromatin immunoprecipitation (ChIP) assay, which demonstrated the altered methylation patterns in the RUNX2 and ALP promoter regions and their effect on gene expression. Furthermore, micro-computed tomography (CT) analysis of in vivo mouse cell transplantation experiments showed high-density signal in the epigenetically modified HGF group; in addition, a significant amount of bone formation was observed in the transplanted material using hematoxylin and eosin (H&E) staining as well. Collectively, our results indicate that epigenetic modification permits the direct programming of HGFs into functional osteoblasts, suggesting that this approach might open a novel therapeutic avenue in alveolar bone regeneration.
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Affiliation(s)
- Y Cho
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea.,2 Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - B Kim
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - H Bae
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - W Kim
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - J Baek
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - K Woo
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - G Lee
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - Y Seol
- 2 Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - Y Lee
- 2 Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - Y Ku
- 2 Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - I Rhyu
- 2 Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
| | - H Ryoo
- 1 Department of Molecular Genetics, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, South Korea
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Gosper M, McNeill M, Phillips R, Preston G, Woo K, Green D. Web-based lecture technologies and learning and teaching: a study of change in four Australian universities. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/09687769.2010.529111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Gosper
- Learning and Teaching CentreMacquarie University SydneyAustralia
| | - M. McNeill
- Learning and Teaching CentreMacquarie University SydneyAustralia
| | - R. Phillips
- Teaching and Learning CentreMurdoch University PerthAustralia
| | - G. Preston
- School of EducationUniversity of Newcastle NewcastleAustralia
| | - K. Woo
- Learning and Teaching CentreMacquarie University SydneyAustralia
| | - D. Green
- Staff Development & Training UnitFlinders University AdelaideAustralia
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Zumsteg Z, Spratt D, Pei X, Zhang Z, Woo K, Kollmeier M, McBride S, Sandler H, Zelefsky M. Redefining Unfavorable Risk Prostate Cancer: A Novel Risk Stratification Paradigm for Enhanced Outcome Prediction Via Harmonization and Unification of Risk Stratification Criteria. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Blanchette A, Demers M, Woo K, Solomon J, Shah A, Mullick A, Levin M. Attitudes of clinicians towards spasticity assessment. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Litvak A, Iyriboz T, Zakowski M, Woo K, Krug L, Rudin C, Pietanza C. Clinical Characteristics and Outcomes for 61 Patients With Metastatic Pulmonary Carcinoids. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hellmann M, Creelan B, Woo K, Sima C, Iams W, Antonia S, Horn L, Brahmer J, Gettinger S, Harbison C, Rizvi N. Smoking History and Response to Nivolumab in Patients with Advanced Nsclcs. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu349.8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Litvak A, Iyriboz T, Zakowski M, Woo K, Krug L, Rudin C, Pietanza M. Clinical Characteristics and Outcomes for 61 Patients with Metastatic Pulmonary Carcinoids. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu357.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Naidoo J, Santos-Zabala M, Iyriboz T, Woo K, Sima C, Fiore J, Kris M, Veach S, Riely G, Iqbal A, Smith-Marrone S, Sarkaria I, Krug L, Rudin C, Rekhtman N, Pietanza M. Large Cell Neuroendocrine Carcinomas (Lcnec) of the Lung: Pathologic Features, Treatment and Outcomes. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu345.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wu A, Gillis A, Foster A, Woo K, Zhang Z, Gelblum D, Downey R, Rosenzweig K, Ong L, Perez C, Pietanza M, Krug L, Rimner A. Should All Limited-Stage Small Cell Lung Cancer Be Treated Alike? Impact of AJCC Stage on Brain Metastasis, Survival, and Patterns of Failure. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.210] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ioannou K, Bennett M, Ignaszewski A, Tung S, Krahn A, Wilson-McManus J, Dai D, Assadian S, Hollander Z, McManus B, Park H, Woo K, Kang H, Ng R. Ensemble Analysis Using Blood-Based Biomarkers, Ambulatory Electrocardiography and Clinical Variables Predicts 30 Day Hospitalization in Patients With Heart Failure. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Yanchar NL, Woo K, Brennan M, Palmer C, Ee M, Crameri J, Sweeney B. Chest X-ray as a screening tool for blunt thoracic trauma in children. Scand J Trauma Resusc Emerg Med 2013. [PMCID: PMC3665529 DOI: 10.1186/1757-7241-21-s1-s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Leitman I, Suzuki K, Wengrofsky A, Menashe E, Poplawski M, Woo K, Geller C, Zeifer B, Patton B, Bernik T. Early Recognition and Triage of Acute Thoracic Aortic Dissection and Aneurysm: Impossible Challenge or Achievable Task? J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Woo K, Garg J, Hye R. Contemporary Results for Carotid Endarterectomy for Asymptomatic Carotid Stenosis. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ostrow B, Sibbald R, Woo K, Rambaran M. Sixty second screening identifies persons at risk for diabetic foot ulcers. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rambaran M, Ostrow B, Sibbald R, Woo K. Early impact of a comprehensive diabetic foot centre on diabetes-related amputation rates at Georgetown Public Hospital corporation, Guyana. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sibbald R, Woo K, Rambaran M, Ostrow B. International collaboration in Guyana to reduce amputations in persons with diabetes. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33325-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wong J, Gao Z, Selvaggi P, Woo K, Merrick S, El-Gabry M, Chen T, Cheng C, Uematsu M. Comparison of Interfractional Prostate Motion Among Normal, Overweight, and Obese Patient Groups. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.2294] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jiao LR, Szyszko T, Al-Nahhas A, Tait P, Canelo R, Stamp G, Wasan H, Lowdell C, Philips R, Thillainayagam A, Bansi D, Rubello D, Limongelli P, Woo K, Habib NA. Clinical and imaging experience with yttrium-90 microspheres in the management of unresectable liver tumours. Eur J Surg Oncol 2007; 33:597-602. [PMID: 17433608 DOI: 10.1016/j.ejso.2007.02.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 02/12/2007] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Selective internal radiation therapy (SIRT) is emerging as a new therapeutic modality in recent years for management of non-resectable hepatic malignancies. Our experience in clinical application of this treatment is reported here. MATERIAL AND METHODS From June 2004, patients whose liver tumours were no longer amenable for any conventional treatment with either chemotherapy or surgery were considered for yttrium-90 microspheres treatment after discussion at our multidisciplinary meeting. A pre-treatment planning was carried out with visceral angiography and technetium-99m macroaggregated albumin (MAA) for assessment of both tumour volume and extrahepatic shunting in addition to a baseline PET and CT scans, respectively. Two weeks later, a second visceral angiogram was performed to deliver the calculated dosage of microspheres into the arterial system supplying the tumour. Patients were then followed up with tumour markers, repeat PET and CT scans of abdomen at 6 weeks and 3 monthly thereafter. RESULT Twenty-one patients (F=11, M=10; age range 40-75 years, mean=58 years) received yttrium-90 microspheres consisting of liver metastases from colorectal primary (n=10) and non-colorectal primaries (n=8), and primary liver tumours (n=3). One patient received 2 treatments. The mean administered activity of microspheres delivered was 1.9 GBq (range 1.2-2.5 GBq). Injection of microspheres had no immediate effect on either clinical haematology or liver function tests. At follow-up, 86% of patients showed decreased activity on PET scan at 6 weeks (p=0.01). The mean pre-treatment SUV was 12.2+/-3.7 and the mean post-treatment SUV was 9.3+/-3.7, indicating a significant improvement measured with PET activity. Only 13% showed a reduction in the size of tumour on CT scan. For patients with colorectal liver metastases, there was no significant reduction in CEA level (127+/-115 vs 75+/-72 micro/l, p=0.39). Complications were seen in 4 patients (19%) including radiation hepatitis (n=2), cholecystitis (n=1) and duodenal ulceration (n=1). All resolved without surgical intervention. Seven patients died at follow-up from progressive extrahepatic disease (33%). CONCLUSION SIRT should be considered for patients with advanced liver cancer. It has a significant effect on liver disease in the absence of extrahepatic disease. PET imaging has an integral role in the assessment of patients treated with yttrium-90 SIR-Spheres.
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Affiliation(s)
- L R Jiao
- Department of HPB Surgery, Hammersmith Hospital and Imperial College School of Medicine, London, United Kingdom
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Selcuk S, Woo K, Tanner DB, Hebard AF, Borisov AG, Shabanov SV. Trapped electromagnetic modes and scaling in the transmittance of perforated metal films. Phys Rev Lett 2006; 97:067403. [PMID: 17026204 DOI: 10.1103/physrevlett.97.067403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Indexed: 05/12/2023]
Abstract
We describe measurements and simulations of the enhanced transmittance by subwavelength hole arrays in silver films. The array period and hole size are systematically varied to give peak transmittances at wavelengths spanning a factor of 14. The spectra coincide when scaled using the array geometry and substrate refractive index alone, thus showing no significant dependence on the dielectric function of the metal. We argue that the spectra can be explained by interference of diffractive and resonant scattering. The resonant contribution comes from electromagnetic modes trapped in the film vicinity.
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Affiliation(s)
- S Selcuk
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
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Andreopoulos S, Wasserman M, Woo K, Li PP, Warsh JJ. Chronic lithium treatment of B lymphoblasts from bipolar disorder patients reduces transient receptor potential channel 3 levels. Pharmacogenomics J 2005; 4:365-73. [PMID: 15354175 DOI: 10.1038/sj.tpj.6500266] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic lithium treatment of B-lymphoblast cell lines (BLCLs) from bipolar-I disorder (BD-I) patients and healthy subjects ex vivo attenuates agonist- and thapsigargin-stimulated intracellular calcium (Ca(2+)) responses. As these findings suggest that chronic lithium treatment modifies receptor (ROCE) and/or store-operated Ca(2+) entry (SOCE) mechanisms, we determined whether chronic lithium treatment of BLCLs modified the expression of two members of the transient receptor potential channels (TRPC1 & 3), which participate in ROCE/SOCE. Chronic lithium treatment significantly reduced BLCL TRPC3 immunoreactivity (repeated-measures ANOVA, P=0.00005), with interaction effects of diagnosis (P=0.037) and sex (P=0.040). The lithium-induced decrease was greatest in BLCLs from female BD-I patients compared with those from healthy females (-27%) and with vehicle-treated BLCLs from female BD-I patients (-33%). However, lithium treatment did not affect TRPC1 and 3 mRNA levels, and TRPC1 immunoreactivity. Downregulation of TRPC3 may be an important mechanism by which lithium ameliorates pathophysiological Ca(2+) disturbances as observed in BD.
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Affiliation(s)
- S Andreopoulos
- Laboratory of Cellular and Molecular Pathophysiology, Center for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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McCullough A, Woo K, Telegrafi S, Lepor H. Is sildenafil failure in men after radical retropubic prostatectomy (RRP) due to arterial disease? Penile duplex Doppler findings in 174 men after RRP. Int J Impot Res 2002; 14:462-5. [PMID: 12494278 DOI: 10.1038/sj.ijir.3900909] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2002] [Revised: 03/05/2002] [Accepted: 04/27/2002] [Indexed: 11/08/2022]
Abstract
Sildenafil is frequently the first-line treatment for post-radical retropubic prostatectomy (RRP) erectile dysfunction (ED) with maximum treatment satisfaction rates of 43%-80%. The etiology of erectile dysfunction after RRP has been attributed to psychogenic, vascular, veno- occlusive or nerve injury causes. The purpose of this study was to gain insight into the penile duplex Doppler arterial parameters in men with ED after RRP who failed sildenafil. The purpose was to assess whether sildenafil failure after RRP is associated with underlying corporal arterial disease. A total of 174 consecutive men presenting with sildenafil refractory ED after nerve-sparing RRP underwent color duplex penile Doppler evaluation with vasoactive injection. Mean age was 59.6 y and mean time from surgery was 11.6 months. Some 81% (141/174) of the men had no pre-operative ED (PED). Significant differences in penile duplex Doppler parameters for arterial disease were seen between men with and without PED. In men without PED, 19% (27/141) manifested arterial insufficiency. However, in men with PED, 50% (16/33) demonstrated arterial disease. Nerve sparing status did not affect the presence of arterial disease. Sildenafil refractory erectile dysfunction after RRP in men without PED is not predominantly associated with penile Doppler parameters consistent with arterial insufficiency.
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Affiliation(s)
- A McCullough
- Department of Urology, New York University School of Medicine, New York 10016, USA.
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Woo K. Aspiration pneumonia in patients with enteral feeding tube. Perspectives 2002; 23:2-3. [PMID: 12026409] [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: 02/25/2023]
Affiliation(s)
- K Woo
- Mount Sinai Hospital, Toronto, Ontario
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Woo K. Is vitamin E the magic bullet for the treatment of Alzheimer's disease (AD)? Perspectives 2002; 24:7-10. [PMID: 12026332] [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: 02/25/2023]
Affiliation(s)
- K Woo
- Mount Sinai Hospital, Toronto
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Ficazzola MA, Fraiman M, Gitlin J, Woo K, Melamed J, Rubin MA, Walden PD. Antiproliferative B cell translocation gene 2 protein is down-regulated post-transcriptionally as an early event in prostate carcinogenesis. Carcinogenesis 2001; 22:1271-9. [PMID: 11470758 DOI: 10.1093/carcin/22.8.1271] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
B cell translocation gene 2 (BTG2) is a p53 target that negatively regulates cell cycle progression in response to DNA damage and other stress. The objective of this study was to examine the expression, regulation and tumor suppressor properties of BTG2 in prostate cells. By immunohistochemistry BTG2 protein was detected in approximately 50% of basal cells in benign glands from the peripheral zone of the human prostate. BTG2 was expressed in all hyperproliferative atrophic peripheral zone lesions examined (simple atrophy, post-atrophic hyperplasia and proliferative inflammatory atrophy), but was undetectable or detectable at very low levels in the hyperproliferative epithelial cells of HGPIN and prostate cancer. BTG2 mRNA was detected in non-malignant prostate epithelial (PE) cells and in LNCaP cells, but not in PC-3 cells, consistent with p53-dependent regulation. In PE cells BTG2 protein was detected in areas of cell confluence by immunohistochemistry. BTG2 protein in LNCaP cells was undetectable by immunohistochemistry but was detected by immunoblotting at 8- to 9-fold lower levels than in PE cells. BTG2 protein levels were shown to be regulated by the ubiquitin-proteosome system. Forced expression of BTG2 in PC-3 cells was accompanied by a decreased rate of cell proliferation and decreased tumorigenicity of these cells in vivo. Taken together, these findings suggest that BTG2 functions as a tumor suppressor in prostate cells that is activated by cell quiescence, cell growth stimuli as part of a positive feedback mechanism and in response to DNA damage or other cell stress. The low steady-state levels of BTG2 protein in HGPIN and prostate cancer, a potential consequence of increased proteosomal degradation, may have important implications in the initiation and progression of malignant prostate lesions. Furthermore, these findings suggest that a significant component of the p53 G(1) arrest pathway might be inactivated in prostate cancer even in the absence of genetic mutations in p53.
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Affiliation(s)
- M A Ficazzola
- Department of Urology, New York University School of Medicine, 540 First Avenue, New York, NY 10016, USA
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Woo K, Wieczorek R, Torre P, Lepor H. Prostate adenocarcinoma presenting as a large supraclavicular mass. Rev Urol 2001; 3:102-5. [PMID: 16985698 PMCID: PMC1476041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Metastatic prostate cancer is classically associated with bony or pelvic lymphatic metastasis. This case review represents an unusual case of prostate cancer presenting with a large left supraclavicular neck mass.
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Woo K. Physical activity as a mediator between dyspnea and fatigue in patients with chronic obstructive pulmonary disease. Can J Nurs Res 2000; 32:85-98. [PMID: 11928136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
A cross-sectional design was used to examine the mediating effect of physical activity between dyspnea and fatigue in patients with chronic obstructive pulmonary disease (COPD). Dyspnea was measured using a vertical visual analogue scale, fatigue using the Profile of Mood States-Fatigue subscale, and physical activity using the 6-minute-walk (6MW) test. A convenience sample of 17 male and 22 female patients with COPD provided data for analysis. The sample was characterized by relatively high forced expiratory volume in 1 second (FEV1) of predicted normal values, indicating mild lung impairment and high mean levels of fatigue and dyspnea. Controlling for age and FEV1, dyspnea, physical activity, and fatigue were significantly interrelated. Results of the regression analysis suggested the mediating function of physical activity between dyspnea and fatigue. Limitations and suggestions for practice and future research are presented.
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Affiliation(s)
- K Woo
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Abstract
A descriptive-correlational design was used to examine the relationships between dyspnoea, physical activity, and fatigue in patients with chronic obstructive pulmonary disease (COPD). Lazarus and Folkman's theory of stress, appraisal, and coping provided a framework to guide the study. Dyspnoea was measured by a vertical visual analogue scale, fatigue by the Fatigue subscale of the Profile of Mood States, and physical activity by the six-minute walk (6 MW) test and an open-ended question. A convenience sample of seven male and 15 female patients with COPD provided data for analysis. The sample was characterized by relatively high forced expiratory volume in one second (FEV1) indicating mild lung impairment and high mean levels of fatigue and dyspnoea. No significant gender difference was found in the ratings of dyspnoea and fatigue and the 6 MW distance. Dyspnoea, physical activities, and fatigue were all significantly inter-related (P < 0.001). Results indicated that the higher the dyspnoea scores, the shorter the 6 MW distance walked, and the higher the fatigue scores. Limitations and suggestions for nursing practice and future research are presented.
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Affiliation(s)
- K Woo
- Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5
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Jochová J, Quaglino D, Zakeri Z, Woo K, Sikorska M, Weaver V, Lockshin RA. Protein synthesis, DNA degradation, and morphological changes during programmed cell death in labial glands of Manduca sexta. Dev Genet 2000; 21:249-57. [PMID: 9438339 DOI: 10.1002/(sici)1520-6408(1997)21:4<249::aid-dvg2>3.0.co;2-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Labial glands of the tobacco hornworm Manduca sexta (Lepidoptera: Sphingiidae, homologues of Drosophila salivary glands, undergo programmed cell death (PCD) in a 4-day period during larva-to-pupa metamorphosis. The programmed death of the labial gland was examined by electron microscopy and measurement of protein synthesis as well as measurement of DNA synthesis, end-labeling of single strand breaks, and pulsed-field gel electrophoresis. One of the earliest changes observed is a sharp drop in synthesis of most proteins, coupled with synthesis of a glycine-rich protein, reminiscent of silk-like proteins. From a morphological standpoint, during the earliest phases the most prominent changes are the formation of small autophagic vacuoles containing ribosomes and an apparent focal dissolution of the membranes of the endoplasmic reticulum, whereas later changes include differing destruction at the lumenal and basal surfaces of the cell and erosion of the basement membrane. By the fourth day of metamorphosis, individual cells become rapidly vacuolated in a cell-independent manner. In the vacuolated cells on day 3, chromatin begins to coalesce. It is at this period that unequivocal nucleosomal ladders are seen and end-labeling in situ or electrophoretic techniques document single on double-strand breaks, respectively. DNA synthesis ceases shortly after the molt to the fifth instar, as detected by incorporation of tritiated thymidine and weak TUNEL labeling. Large size fragments of DNA are seen shortly after DNA synthesis ceases and thence throughout the instor, raising the possibility of potential limitations built into the cells before their final collapse.
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Affiliation(s)
- J Jochová
- Department of Biological Sciences, St. John's University, Jamaica, New York 11439, USA
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Woo K, Waisman J, Melamed J, Lepor H. Primary aldosteronism caused by unilateral adrenal hyperplasia. Rev Urol 2000; 2:100-4. [PMID: 16985748 PMCID: PMC1476104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
In the hypertensive population, primary aldosteronism has been reported to have a prevalence of 0.1% to 2%, with the main causes being aldosterone-producing adenomas and bilateral hyperplasia. However, there is a third rare entity, called unilateral adrenal hyperplasia, that contributes to primary aldosteronism. Unilateral hyperplasia and primary aldosteronism are the subjects of this case review.
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Abstract
OBJECTIVE Despite current recommendations calling for regular screening flexible sigmoidoscopies over the age of 50, only a small percentage of the population have regular examinations. Improving patient tolerance of flexible sigmoidoscopies could therefore increase patient compliance with these recommended guidelines. The aim of this study was to determine whether audio and visual stimulation reduces discomfort during flexible sigmoidoscopy and whether the effects of the stimulation are secondary to distraction. METHODS A total of 37 patients undergoing routine screening flexible sigmoidoscopy were randomized to receive no intervention, audio stimulation alone, or audio and visual stimulation. Patient discomfort ratings and affect states were measured prior to and immediately following flexible sigmoidoscopy using a visual analogue scale and the Stress Symptom Ratings (SSR) ratings. RESULTS Patients receiving audio and visual intervention had lower abdominal discomfort ratings (7.1 +/- 1.4) than patients receiving audio stimulation (9.5 +/- 1.3) or no intervention (10.8 +/- 1.6) (p < 0.05). Patients receiving audio and visual intervention also had higher arousal (7.3 +/- 0.4) and attention (9.2 +/- 0.2) ratings than patients receiving no intervention (6.1 +/- 0.4 and 6.2 +/- 0.7, respectively) (p < 0.05). Anxiety and anger ratings, on the other hand, were significantly lower in patients receiving audio and visual intervention (2.5 +/- 0.4, 1.4 +/- 0.3, respectively) than patients receiving no intervention (4.4 +/- 0.6, 3.6 +/- 0.7). CONCLUSION Audio and visual stimulation reduces abdominal discomfort associated with flexible sigmoidoscopy. This effect appears to be due to distraction.
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Affiliation(s)
- T Lembo
- Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
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Abstract
We determine the timing of neural commitment by hindbrain tissue in the zebrafish using microsurgical transplantation. When transplanted at shield stage to the ventral side of the embryo, presumptive hindbrain cells are not committed, as they can adapt to their environment and give rise to epidermis. In contrast, when transplanted at 80% epiboly, hindbrain cells retain their neural fate and express neural-specific antigens. Moreover, they are able to maintain regional fate, as is evident by the expression of the hindbrain-specific marker, Krox20. In addition, we observe that committed hindbrain tissues are able to induce presumptive ventral epidermis to form neural crest derivatives, otic vesicles, and neural tissues. We propose that hindbrain progenitors have acquired regional identity as a group at 80% epiboly even before making vertical contact with axial mesoderm. These results suggest that planar induction may constitute a significant component in the zebrafish neural patterning pathway.
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Affiliation(s)
- K Woo
- Biological Imaging Center, Beckman Institute, California Institute of Technology, Pasadena 91125, USA
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Jang M, Lee E, Woo K. Income, language, and citizenship status: factors affecting the health care access and utilization of Chinese Americans. Health Soc Work 1998; 23:136-145. [PMID: 9598396 DOI: 10.1093/hsw/23.2.136] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This article reports the results of a randomly administered interview of 1,808 Chinese American residents of San Francisco. The study examines income, language, and citizenship status and their effect on the use of health care services by this population. The articles discusses the implications of the findings for low-income and uninsured individuals, particularly people of immigrant status, and concludes with suggestions for local health care planners and advocates.
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Affiliation(s)
- M Jang
- Four Winds Research Corporation, San Francisco, CA 94107, USA
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Abstract
The organizer of the amphibian gastrula provides the neurectoderm with both neuralizing and posteriorizing (transforming) signals. In zebrafish, transplantations show that a spatially distinct transformer signal emanates from tissues other than the organizer. Cells of the germring (nonaxial mesendoderm) posteriorized forebrain progenitors when grafted nearby, resulting in an ectopic hindbrain-like structure; in contrast, cells of the organizer (axial mesendoderm) caused no posterior transformation. Local application of basic fibroblast growth factor, a candidate transformer in Xenopus, caused malformation but not hindbrain transformation in the forebrain. Thus, the zebrafish gastrula may integrate spatially distinct signals from the organizer and the germring to pattern the neural axis.
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Affiliation(s)
- K Woo
- Division of Biology and Biological Imaging Center, Beckman Institute, California Institute of Technology, Pasadena, CA 91125, USA.
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Abstract
Studies of defective interfering (DI) RNAs of the murine coronavirus mouse hepatitis virus (MHV) suggest that a 69-nucleotide-long packaging signal is necessary for MHV genomic RNA packaging into MHV particles. In this study we showed that when RNA transcripts that consisted of a non-MHV sequence and the packaging signal were expressed in MHV-infected cells, they were packaged into MHV particles. Those RNA transcripts that lacked the packaging signal or those containing a mutated packaging signal did not package efficiently. Thus, the presence of the packaging signal was sufficient for RNA packaging into MHV particles.
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Affiliation(s)
- K Woo
- Department of Microbiology, The University of Texas at Austin, 78712-1095, USA
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