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Herut B, Goldman R, Ozer T, Lazar A, Biton E, Gertman I, Silverman J, Segal Y, Sisma-Ventura G, Gertner Y, Rubin-Blum M, Belkin N, Rahav E. Tar pollution event (2021) at the Southeastern Levantine oligotrophic basin, short-term impacts and operational oceanography perspectives. Mar Pollut Bull 2024; 198:115892. [PMID: 38086105 DOI: 10.1016/j.marpolbul.2023.115892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/24/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
The Levantine basin (LB) in the Southeastern Mediterranean Sea is a high-risk oil pollution hot spot owing to its dense maritime traffic and intense oil and gas exploration and exploitation activities. In February 2021 the Israeli LB shorelines were impacted by an exceptional tar pollution event (~550 tons; average distribution: ~3 kg tar m-1 front beach) of an unknown oil spill source. Here we report on the immediate numerical modelling assessment of the oil spill propagation and tar distribution; operational use of underwater gliders for tracking water column anomalies of dissolved polycyclic aromatic hydrocarbons (PAHs) and turbidity signals; the beached tar composition and amounts and the short-term response of the microbial population along the ~180 km shoreline. This pollution event emphasizes the need for improving the early warning systems for oil spills and implementing continuous operational monitoring at high-risk, ecologically sensitive and valuable resource areas like the Israeli LB waters.
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Affiliation(s)
- B Herut
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel.
| | - R Goldman
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - T Ozer
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - A Lazar
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - E Biton
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - I Gertman
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - J Silverman
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - Y Segal
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - G Sisma-Ventura
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - Y Gertner
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - M Rubin-Blum
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - N Belkin
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
| | - E Rahav
- Israel Oceanographic and Limnological Research, National Institute of Oceanography, Haifa 310800, Israel
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Jenner Z, Khan A, Ulle N, Filkov V, Goldman R. Abstract No. 533 Deep Learning of Angiographic Signatures in Abdominopelvic Digital Subtraction Angiography. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Andrews R, Di Geronimo R, Virk H, Goldman R, Pillai R, Rao S, King E, Shah A, Vu C. Abstract No. 587 Morbidity and mortality conferencing as a quality assessment tool in interventional radiology: a survey of Society of Interventional Radiology members. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Liou F, Di Geronimo R, Rao S, Shah A, King E, Pillai R, Andrews R, Vu C, Goldman R. Abstract No. 92 Effect on intra-procedural metrics of repeat imaging with CT arteriography prior to conventional angiography: analysis of trauma patients with active extravasation on initial portal venous phase imaging. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.173] [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: 11/17/2022] Open
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Lau A, Figueredo C, Vu C, Goldman R. Abstract No. 279 Serial transthoracic echocardiography for clinical assessment of submassive pulmonary embolism. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.360] [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] Open
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Taebi A, Janibek N, Goldman R, Pillai R, Vu CT, Roncali E. The Impact of Injection Distance to Bifurcations on Yttrium-90 Distribution in Liver Cancer Radioembolization. J Vasc Interv Radiol 2022; 33:668-677.e1. [PMID: 35301128 PMCID: PMC9156550 DOI: 10.1016/j.jvir.2022.03.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/22/2022] [Accepted: 03/06/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To model the effect of the injection location on the distribution of yttrium-90 (90Y) microspheres in the liver during radioembolization using computational simulation and to determine the potential effects of radial movements of the catheter tip. MATERIALS AND METHODS Numerical studies were conducted using images from a representative patient with hepatocellular carcinoma. The right hepatic artery (RHA) was segmented from contrast-enhanced cone-beam computed tomography scans. The blood flow was investigated in the trunk of the RHA using numerical simulations for 6 injection position scenarios at 2 sites located at a distance of approximately 5 and 20 mm upstream of the first bifurcation (RHA diameters of approximately 4.6 mm). The 90Y delivery to downstream vessels was calculated from the simulated hepatic artery hemodynamics. RESULTS Varying the injection location along the RHA and across the vessel cross-section resulted in different simulated microsphere distributions in the downstream vascular bed. When the catheter tip was 5 mm upstream of the bifurcation, 90Y distribution in the downstream branches varied by as much as 53% with a 1.5-mm radial movement of the tip. However, the catheter radial movement had a weaker effect on the microsphere distribution when the injection plane was farther from the first bifurcation (20 mm), with a maximum delivery variation of 9% to a downstream branch. CONCLUSIONS An injection location far from bifurcations is recommended to minimize the effect of radial movements of the catheter tip on the microsphere distribution.
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Affiliation(s)
- Amirtaha Taebi
- Department of Agricultural and Biological Engineering, Mississippi State University
| | - Nursultan Janibek
- Department of Mechanical and Aerospace Engineering, University of California Davis
| | - Roger Goldman
- Department of Radiology, University of California Davis
| | - Rex Pillai
- Department of Radiology, University of California Davis
| | | | - Emilie Roncali
- Department of Radiology, University of California Davis,Department of Biomedical Engineering, University of California Davis
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Jenner Z, Di Geronimo R, Goldman R, Pillai R, Albertson T, Roudsari B. Abstract No. 534 Evolving role of radiology in performing basic procedures for Medicare beneficiaries from 1996 to 2018. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Yap S, Liou F, Khan A, Pillai R, Vu C, Andrews R, King E, Shah A, Goldman R. Abstract No. 472 Alternate venous access sites for ported catheters: experience at a single quaternary care institution. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Di Geronimo R, Kim P, Andrews R, King E, Shah A, Vu C, Pillai R, Goldman R. Abstract No. 568 Interpretation of diagnostic vascular imaging studies for Medicare patients by interventional radiologists: a comparison to other specialties and implications for interventional radiology. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tocco M, Pikalov A, Deng L, Goldman R. Lurasidone in adolescents with schizophrenia: Sustained remission and recovery during 2 years of open-label treatment. Eur Psychiatry 2021. [PMCID: PMC9471544 DOI: 10.1192/j.eurpsy.2021.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Compared with adult onset, early onset schizophrenia is typically characterized by greater illness severity and less favorable prognosis. Objectives To evaluate the proportion of adolescent patients with schizophrenia who achieved sustained remission and recovery during 2 years of treatment with lurasidone. Methods Patients aged 13-17 years with a DSM-IV-TR diagnosis of schizophrenia, and a Positive and Negative Symptom Scale (PANSS) total score ≥70 and <120, were randomized to 6 weeks of double-blind (DB), fixed-dose treatment with lurasidone (37 or 74 mg/d) or placebo. Patients who completed 6 weeks of DB treatment were eligible to enroll in a 2-year, open-label (OL), flexible dose extension study of lurasidone (18.5-74 mg/d). Criteria for sustained remission, were the 6-month consensus criteria summarized by Andreasen (Am J Psych 2005;162:441-9). Criteria for sustained recovery consisted of meeting sustained remission criteria with a Children’s Global Assessment Scale (CGAS) score ≥70 for at least 6-months indicating no clinically significant functional impairment. Results A total of 271 patients completed the 6-week DB study and entered the extension study, and 186 (68.6%) and 156 (57.6%) completed 52 weeks and 104 weeks of treatment, respectively. During OL treatment with lurasidone, 52.8% met sustained remission criteria, with a Kaplan-Meier (KM) estimate of 64.1 weeks for median time to sustained remission; and 28.8% met sustained recovery criteria, KM estimate of 104.6 weeks for median time to sustained recovery. Conclusions For adolescents with schizophrenia, treatment with lurasidone was associated with high rates of sustained remission and sustained recovery over a two-year period. Disclosure Employee of Sunovion Pharmaceuticals Inc. The study summarized in this Abstract was supported by funding from Sunovion Pharmaceuticals Inc
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Calisti F, Costamagna I, Hsu J, Tocco M, Pikalov A, Goldman R. Efficacy and safety of lurasidone in adolescents and young adults with schizophrenia: Pooled analysis of double-blind, placebo-controlled 6-week studies. Eur Psychiatry 2021. [PMCID: PMC9471458 DOI: 10.1192/j.eurpsy.2021.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Onset of schizophrenia commonly occurs during late adolescence or early adulthood and is often characterized by greater symptom severity and impairment. Objectives To evaluate the efficacy and safety of lurasidone in the treatment of acute schizophrenia in adolescents and young adults. Methods The 4 studies in this pooled analysis used similar study designs. Patients (ages 13-25 years) were randomized to 6 weeks of double-blind, placebo-controlled treatment with once-daily lurasidone (37 mg, 74 mg, 111 mg, 148 mg). The primary outcome was endpoint change in the Positive and Negative Syndrome Scale (PANSS) total score; secondary measures included the Clinical Global Impression, Severity scale (CGI-S). Results The safety population consisted of 537 patients; 79.1% completed the studies. Treatment with lurasidone was significant (P<0.001) at Week 6 endpoint for change in the PANSS total score, with higher effect sizes (ES) at higher doses (37 mg, 0.53; 74 mg, 0.57; 111 mg, 0.67; 148 mg, 1.35); significance was also observed for change in the CGI-S (37 mg, 0.51; 74 mg, 0.49; 111 mg, 0.57; 148 mg, 1.75). For lurasidone (combined doses), 3 adverse events occurred with a frequency ≥5% (nausea, 13.5%; somnolence, 12.1%; akathisia, 10.1%); 4.8% of patients discontinued due to an adverse event. At LOCF-endpoint, 3.6% of patients had weight gain ≥7%, and 1.5% had weight loss ≥7%. Minimal median changes were observed at endpoint in metabolic lab values. Conclusions In adolescents and young adults with schizophrenia, treatment with lurasidone in doses of 37-148 mg/d was a safe, well-tolerated, and effective treatment. Disclosure Presenter is an employee of Sunovion Pharmaceuticals Inc. The study summarized in this Abstract was supported by Funding from Sunovion Pharmaceuticals Inc.
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Dunnmon JA, Ratner AJ, Saab K, Khandwala N, Markert M, Sagreiya H, Goldman R, Lee-Messer C, Lungren MP, Rubin DL, Ré C. Cross-Modal Data Programming Enables Rapid Medical Machine Learning. Patterns (N Y) 2020; 1. [PMID: 32776018 PMCID: PMC7413132 DOI: 10.1016/j.patter.2020.100019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A major bottleneck in developing clinically impactful machine learning models is a lack of labeled training data for model supervision. Thus, medical researchers increasingly turn to weaker, noisier sources of supervision, such as leveraging extractions from unstructured text reports to supervise image classification. A key challenge in weak supervision is combining sources of information that may differ in quality and have correlated errors. Recently, a statistical theory of weak supervision called data programming has shown promise in addressing this challenge. Data programming now underpins many deployed machine-learning systems in the technology industry, even for critical applications. We propose a new technique for applying data programming to the problem of cross-modal weak supervision in medicine, wherein weak labels derived from an auxiliary modality (e.g., text) are used to train models over a different target modality (e.g., images). We evaluate our approach on diverse clinical tasks via direct comparison to institution-scale, hand-labeled datasets. We find that our supervision technique increases model performance by up to 6 points area under the receiver operating characteristic curve (ROC-AUC) over baseline methods by improving both coverage and quality of the weak labels. Our approach yields models that on average perform within 1.75 points ROC-AUC of those supervised with physician-years of hand labeling and outperform those supervised with physician-months of hand labeling by 10.25 points ROC-AUC, while using only person-days of developer time and clinician work—a time saving of 96%. Our results suggest that modern weak supervision techniques such as data programming may enable more rapid development and deployment of clinically useful machine-learning models. We propose cross-modal data programming (XMDP) for machine learning (ML) in medicine XMDP reduces labeling costs by 96% versus hand labeling on 4 diverse medical ML tasks Days of XMDP and years of hand labeling often yield similarly performing models XMDP performance continually improves as more unlabeled data becomes available
Machine learning can achieve record-breaking performance on many tasks, but machine learning development is often hindered by insufficient hand-labeled data for model training. This issue is particularly prohibitive in areas such as medical diagnostic analysis, where data are private and require expensive labeling by clinicians. A promising approach to handle this bottleneck is weak supervision, where machine learning models are trained using cheaper, noisier labels. We extend a recent, theoretically grounded weak supervision paradigm—data programming—wherein subject matter expert users write labeling functions to label training data imprecisely rather than hand-labeling data points. We show that our approach allows us to train machine learning models using person-days of effort that previously required person-years of hand labeling. Our methods could enable researchers and practitioners to leverage machine learning models over high-dimensional data (e.g., images, time series) even when labeled training sets are unavailable.
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Affiliation(s)
- Jared A Dunnmon
- Department of Computer Science, Stanford University, Stanford, CA, USA.,These authors contributed equally.,Lead Contact
| | - Alexander J Ratner
- Department of Computer Science, Stanford University, Stanford, CA, USA.,These authors contributed equally
| | - Khaled Saab
- Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Nishith Khandwala
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Matthew Markert
- Department of Neurology, Stanford University, Stanford, CA, USA
| | - Hersh Sagreiya
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Roger Goldman
- Department of Radiology, Stanford University, Stanford, CA, USA
| | | | | | - Daniel L Rubin
- Department of Radiology, Stanford University, Stanford, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,These authors contributed equally
| | - Christopher Ré
- Department of Computer Science, Stanford University, Stanford, CA, USA.,These authors contributed equally
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Stewart M, Johnson J, Bar-Ad V, Goldman R, Cognetti D, Curry J, Luginbuhl A. A Systematic Method to Increase Enrollment in Head and Neck Cancer Clinical Trials. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.241] [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: 11/17/2022]
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Abittan B, Domney A, Brownridge B, Mullin M, Goldman R. ANTIMULLERIAN HORMONE (AMH) LEVELS: PREDICTIVE OF ANEUPLOIDY RATES? Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Correll C, Goldman R, Cucchiaro J, Deng L, Loebel A. The Efficacy of Lurasidone on PANSS Subscales in Adolescent Patients with Schizophrenia: Results from a 6-week, Double-blind, Placebo-controlled, Multicenter Study. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2017.01.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionLurasidone is an atypical antipsychotic that demonstrated efficacy in the treatment of adults with schizophrenia in the dose range of 37–148 mg/day.Objective/AimsThe objective of this analysis was to evaluate the efficacy of lurasidone in adolescent patients with schizophrenia.MethodsAdolescents (13–17 years old) diagnosed with schizophrenia were randomly assigned to six weeks of double-blind treatment with lurasidone 37 mg/day, 74 mg/day or placebo. Changes from baseline to week 6 in PANSS total and subscale (positive, negative, general psychopathology, excitability) scores were evaluated using mixed-model repeated-measures analysis.ResultsA total of 326 patients (mean age, 15.4 years) were randomized and received lurasidone 37 mg/day (n = 108), 74 mg/day (n = 106), or placebo (n = 112). The PANSS total score at week 6 demonstrated a placebo-adjusted, least-squares (LS) mean improvement of –8.0 (P < 0.001; effect size [ES], 0.51) for the 37 mg/day group and –7.7 (P < 0.001; ES = 0.48) for the 74 mg/day group. Placebo-adjusted LS mean change for lurasidone 37 mg/day and 74 mg/day, respectively, was –3.2 (P < 0.001; ES = 0.62) and –3.2 (P < 0.001; ES = 0.60) on the PANSS positive subscale, –1.7 (P = 0.011; ES = 0.41) and –1.6 (P = 0.022; ES = 0.35) on the PANSS negative subscale, –2.8 (P = 0.012; ES = 0.38) and –2.8 (P = 0.011; ES = 0.37) on the PANSS general psychopathology subscale, and –1.1 (P = 0.016; ES = 0.36) and –1.8 (P < 0.001; ES = 0.53) on the PANSS excitability subscale.ConclusionsIn adolescent patients with schizophrenia, lurasidone (37 mg/day and 74 mg/day) demonstrated statistically significant efficacy and clinically meaningful improvement across a wide spectrum of symptoms associated with schizophrenia. Sponsored by Sunovion Pharmaceuticals Inc. ClinicalTrials.gov identifier: NCT01911429.Disclosure of interestDr Correll reports being a consultant and/or advisor for Alkermes, Forum Pharmaceuticals Inc., Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, Medavante, Medscape, Otsuka, Pfizer Inc, ProPhase, Sunovion Pharmaceuticals Inc., Supernus, Takeda, and Teva providing expert testimony for Bristol-Myers Squibb Company, Janssen, and Otsuka serving on a Data Safety Monitoring Board for Lundbeck and Pfizer Inc and receiving grant support from Takeda. Drs Goldman, Cucchiaro, Deng and Loebel are employees of Sunovion Pharmaceuticals Inc.
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Hui J, Goldman R, Mabud T, Arendt V, Kuo W, Hofmann R. Abstract No. 699 Diagnostic performance of lower extremity Doppler ultrasound in detecting iliocaval obstruction. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Richa T, Johnson J, Cognetti D, Argiris A, Luginbuhl A, Zinner R, Axelrod R, Bar-Ad V, Goldman R, Rodeck U, Martinez-Outschoorn U, Curry J. Window of opportunity for durvalumab (MEDI4736) plus metformin trial in squamous cell carcinoma of the head and neck (SCCHN): Interim safety analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.021] [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: 11/13/2022] Open
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Downar J, Moorhouse P, Goldman R, Grossman D, Sinha S, Sussman T, Kaasalainen S, MacDonald S, Moser A, You JJ. Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canad. J Frailty Aging 2019; 7:240-246. [PMID: 30298172 DOI: 10.14283/jfa.2018.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.
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Affiliation(s)
- J Downar
- James Downar, MDCM, MHSc, Interdepartmental Division of Critical Care Medicine and Palliative Care, Department of Medicine, University of Toronto, 200 Elizabeth St. 9N-926, Toronto, ON, M5G 2C4, canada, T. (416) 340-4800 x2674, F. (416) 340-4823. E.
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George M, Saber G, McIntosh J, Doose J, Faller J, Lin Y, Moss H, Goldman R, Sajda P, Brown T. Combined TMS-EEG-fMRI. The level of TMS-evoked activation in anterior cingulate cortex depends on timing of TMS delivery relative to frontal alpha phase. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.924] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Filinson R, Goldman R. IDENTIFYING AND MEASURING CHANGE IN STUDENT AND PROFESSIONAL TRAINEES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Filinson
- Gerontology Center, Rhode Island College, Providence, Rhode Island, United States
| | - R Goldman
- Alpert Medical School, Brown University, Providence, RI, USA
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Turocy J, Goldman R, Farland L, Agarwal R, Thomas A, Fox J. Opioid use and postoperative pain after oocyte retrieval. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.696] [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: 11/17/2022]
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Ratner A, Hancock B, Dunnmon J, Goldman R, Ré C. Snorkel MeTaL: Weak Supervision for Multi-Task Learning. Proc Second Workshop Data Manag End End Mach Learn (2018) 2018; 2018. [PMID: 30931438 DOI: 10.1145/3209889.3209898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Many real-world machine learning problems are challenging to tackle for two reasons: (i) they involve multiple sub-tasks at different levels of granularity; and (ii) they require large volumes of labeled training data. We propose Snorkel MeTaL, an end-to-end system for multi-task learning that leverages weak supervision provided at multiple levels of granularity by domain expert users. In MeTaL, a user specifies a problem consisting of multiple, hierarchically-related sub-tasks-for example, classifying a document at multiple levels of granularity-and then provides labeling functions for each sub-task as weak supervision. MeTaL learns a re-weighted model of these labeling functions, and uses the combined signal to train a hierarchical multi-task network which is automatically compiled from the structure of the sub-tasks. Using MeTaL on a radiology report triage task and a fine-grained news classification task, we achieve average gains of 11.2 accuracy points over a baseline supervised approach and 9.5 accuracy points over the predictions of the user-provided labeling functions.
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Hammer M, Tsui C, Balmain S, Kobulnik J, Goldman R, Husain A, Steinberg L, Mak S. THE IMPACT OF HEARTFULL ON PLACE OF DEATH FOR ADVANCED HEART FAILURE PATIENTS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.104] [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] Open
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Ivezaj V, Stoeckel LE, Avena NM, Benoit SC, Conason A, Davis JF, Gearhardt AN, Goldman R, Mitchell JE, Ochner CN, Saules KK, Steffen KJ, Stice E, Sogg S. Obesity and addiction: can a complication of surgery help us understand the connection? Obes Rev 2017; 18:765-775. [PMID: 28429582 DOI: 10.1111/obr.12542] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 02/12/2017] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
Obesity is a multifactorial, chronic disease that has proven difficult to treat. An increased understanding of aetiological mechanisms is critical to the development of more effective obesity prevention and treatment strategies. A growing body of empirical evidence has demonstrated parallels between obesity, overeating and substance abuse, including shared behavioural, psychological and neurophysiological factors implicated in the excessive intake of both food and substances of abuse. Several different lines of research have recently emerged that hold the potential to shed light on the connection between obesity, food reward and addiction, with studies examining changes in alcohol use/misuse after weight loss surgery providing a particularly interesting perspective on these interrelationships. However, these lines of investigation have proceeded in relative isolation, and relevant research findings have yet to be integrated in a synthesized, comprehensive manner. To provide an opportunity to achieve such a synthesis, a scientific symposium was convened at the Radcliffe Institute in Cambridge, Massachusetts. Invited participants were researchers working in diverse domains related to the intersection between obesity and addiction. Extensive discussion was generated suggesting novel research directions. In this article, we summarize and synthesize the symposium participants' ongoing research in this area, incorporating additional relevant research holding potential clues regarding the connections between obesity, weight loss surgery and addiction.
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Affiliation(s)
- V Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - L E Stoeckel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N M Avena
- Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S C Benoit
- Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - A Conason
- Division of Endocrinology, Diabetes, and Metabolism, Mt. Sinai West, New York, NY, USA
| | - J F Davis
- Department of Integrative Physiology & Neuroscience, Washington State University College of Veterinary Medicine, Pullman, WA, USA
| | - A N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - R Goldman
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - J E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.,Neuropsychiatric Research Institute, Fargo, ND, USA
| | - C N Ochner
- Kendall Regional Medical Center, Hospital, Corporation of America - Physician Services Group, Miami, FL, USA
| | - K K Saules
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - K J Steffen
- Neuropsychiatric Research Institute, Fargo, ND, USA.,School of Pharmacy, North Dakota State University, Fargo, ND, USA
| | - E Stice
- Oregon Research Institute, Eugene, OR, USA
| | - S Sogg
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Weight Center, Boston, MA, USA
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Heshmati A, Goldman R, Perry GV, Beckerman R. 0950 NARCOLEPSY WITH AND WITHOUT NSOREMP IN PEDIATRIC PATIENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Loebel A, Silva R, Goldman R, Watabe K, Pikalov A, Cucchiaro J, Kane J. Optimizing Treatment with Lurasidone in Patients with Schizophrenia: Results of a Randomized, Double-blind, Placebo-controlled Trial. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)32096-4] [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: 10/23/2022] Open
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Findling R, Chiu Y, Silva R, Goldman R, Jin F, Pikalov A, Loebel A. Pharmacokinetic and Safety Evaluation of Lurasidone in Pediatric Patients with Psychiatric Disorders. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30944-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Babul S, Korn P, Goldman R, Pike I, Hay C. PREVENTING ADVERSE CONCUSSION OUTCOMES: THE ONLINE CONCUSSION AWARENESS TRAINING TOOLKIT (CATT). Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.11] [Citation(s) in RCA: 2] [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: 11/03/2022]
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Hoit G, Hinkewich C, Tiao J, Porgo V, Moore L, Moore L, Tiao J, Wang C, Moffatt B, Wheeler S, Gillman L, Bartens K, Lysecki P, Pallister I, Patel S, Bradford P, Bradford P, Kidane B, Holmes A, Trajano A, March J, Lyons R, Kao R, Rezende-Neto J, Leblanc Y, Rezende-Neto J, Vogt K, Alzaid S, Jansz G, Andrusiek D, Andrusiek D, Bailey K, Livingston M, Calthorpe S, Hsu J, Lubbert P, Boitano M, Leeper W, Williamson O, Reid S, Alonazi N, Lee C, Rezende-Neto J, Aleassa E, Jennings P, Jennings P, Mador B, Hoffman K, Riley J, Vu E, Alburakan A, Alburakan A, Alburakan A, Mckee J, Bobrovitz N, Gabbe B, Gabbe B, Hodgkinson J, Hodgkinson J, Ali J, Ali J, Grant M, Roberts D, Holodinsky J, Cooper C, Santana M, Kruger K, Hodgkinson J, Waggott M, Da Luz L, Banfield J, Santana M, Dorigatti A, Birn K, Bobrovitz N, Zakirova R, Davies D, Das D, Gamme G, Pervaiz F, Almarhabi Y, Brainard A, Brown R, Bell N, Bell N, Jowett H, Jowett H, Bressan S, Hogan A, Watson I, Woodford S, Hogan A, Boulay R, Watson I, Howlett M, Atkinson P, Chesters A, Hamadani F, Atkinson P, Azzam M, Fraser J, Doucet J, Atkinson P, Muakkassa F, Sathivel N, Chadi S, Joseph B, Takeuchi L, Bradley N, Al Bader B, Kidane B, Harrington A, Nixon K, Veigas P, Joseph B, O’Keeffe T, Bracco D, Rezende-Neto J, Azzam M, Lin Y, Bailey K, Bracco D, Nash N, Alhabboubi M, Slobogean G, Spicer J, Heidary B, Joos E, Berg R, Berg R, Sankarankutty A, Zakrison T, Babul S, Lockhart S, Faux S, Jackson A, Lee T, Bailey K, Pemberton J, Green R, Tallon J, Moore L, Turgeon A, Boutin A, Moore L, Reinartz D, Lapointe G, Turgeon A, Stelfox H, Turgeon A, Nathens A, Neveu X, Stelfox H, Turgeon A, Nathens A, Neveu X, Moore L, Turgeon A, Bratu I, Gladwin C, Voaklander D, Lewis M, Vogt K, Eckert K, Williamson J, Stewart TC, Parry N, Gray D, L’Heureux R, Ziesmann M, Kortbeek J, Brindley P, Hicks C, Fata P, Engels P, Ball C, Paton-Gay D, Widder S, Vogt K, Hernandez-Alejandro R, Gray D, Vanderbeek L, Forrokhyar F, Anatharajah R, Howatt N, Lamb S, Sne N, Kahnamoui K, Lyons R, Walters A, Brooks C, Pinder L, Rahman S, Walters A, Kidane B, Parry N, Donnelly E, Lewell M, Mellow R, Hedges C, Morassutti P, Bulatovic R, Morassutti P, Galbraith E, McKenzie S, Bradford D, Lewell M, Peddle M, Dukelow A, Eby D, McLeod S, Bradford P, Stewart TC, Parry N, Williamson O, Fraga G, Pereira B, Sareen J, Doupe M, Gawaziuk J, Chateau D, Logsetty S, Pallister I, Lewis J, O’Doherty D, Hopkins S, Griffiths S, Palmer S, Gabbe B, Xu X, Martin C, Xenocostas A, Parry N, Mele T, Rui T, Abreu E, Andrade M, Cruz F, Pires R, Carreiro P, Andrade T, Lampron J, Balaa F, Fortuna R, Issa H, Dias P, Marques M, Fernandes T, Sousa T, Inaba K, Smith J, Okoye O, Joos E, Shulman I, Nelson J, Parry N, Rhee P, Demetriades D, Ostrofsky R, Butler-Laporte G, Chughtai T, Khwaja K, Fata P, Mulder D, Razek T, Deckelbaum D, Bailey K, Pemberton J, Evans D, Anton H, Wei J, Randall E, Sobolev B, Scott BB, van Heest R, Frankfurter C, Pemberton J, McKerracher S, Stewart TC, Merritt N, Barber L, Kimmel L, Hodgson C, Webb M, Holland A, Gruen R, Harrison K, Hwang M, Hsee L, Civil I, Muizelaar A, Baillie F, Leeper T, Stewart TC, Gray D, Parry N, Sutherland A, Hart M, Gabbe B, Tuma F, Coates A, Farrokhyar F, Faidi S, Gastaldo F, Paskar D, Reid S, Faidi S, Petrisor B, Bhandari M, Loh WL, Ho C, Chong C, Rodrigues G, Gissoni M, Martins M, Andrade M, Cunha-Melo J, Rizoli S, Abu-Zidan F, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, Masci K, Gabbe B, Simpson P, Smith K, Cox S, Cameron P, Evans D, West A, Barratt L, Rozmovits L, Livingstone B, Vu M, Griesdale D, Schlamp R, Wand R, Alhabboubi M, Alrowaili A, Alghamdi H, Fata P, Essbaiheen F, Alhabboubi M, Fata P, Essbaiheen F, Chankowsky J, Razek T, Stephens M, Vis C, Belton K, Kortbeek J, Bratu I, Dufresne B, Guilfoyle J, Ibbotson G, Martin K, Matheson D, Parks P, Thomas L, Kirkpatrick A, Santana M, Kline T, Kortbeek J, Stelfox H, Lyons R, Macey S, Fitzgerald M, Judson R, Cameron P, Sutherland A, Hart M, Morgan M, McLellan S, Wilson K, Cameron P, Sorvari A, Chaudhry Z, Khawaja K, Ali A, Akhtar J, Zubair M, Nickow J, Sorvari A, Holodinsky J, Jaeschke R, Ball C, Blaser AR, Starkopf J, Zygun D, Kirkpatrick A, Roberts D, Ball C, Blaser AR, Starkopf J, Zygun D, Jaeschke R, Kirkpatrick A, Santana M, Stelfox H, Stelfox H, Rizoli S, Tanenbaum B, Stelfox H, Redondano BR, Jimenez LS, Zago T, de Carvalho RB, Calderan TA, Fraga G, Campbell S, Widder S, Paton-Gay D, Engels P, Ferri M, Santana M, Kline T, Kortbeek J, Stelfox H, Nathens A, Lashoher A, McFarlan A, Ahmed N, Booy J, McDowell D, Nasr A, Wales P, Roberts D, Mercado M, Vis C, Kortbeek J, Kirkpatrick A, Lall R, Stelfox H, Ball C, Niven D, Dixon E, Stelfox H, Kirkpatrick A, Kaplan G, Hameed M, Ball C, Qadura M, Sne N, Reid S, Coates A, Faidi S, Veenstra J, Hennecke P, Gardner R, Appleton L, Sobolev B, Simons R, van Heest R, Hameed M, Sobolev B, Simons R, van Heest R, Hameed M, Palmer C, Bevan C, Crameri J, Palmer C, Hogan D, Grealy L, Bevan C, Palmer C, Jowett H, Boulay R, Chisholm A, Beairsto E, Goulette E, Martin M, Benjamin S, Boulay R, Watson I, Boulay R, Watson I, Watson I, Savoie J, Benjamin S, Martin M, Hogan A, Woodford S, Benjamin S, Chisholm A, Ondiveeran H, Martin M, Atkinson P, Doody K, Fraser J, Leblanc-Duchin D, Strack B, Naveed A, vanRensburg L, Madan R, Atkinson P, Boulva K, Deckelbaum D, Khwaja K, Fata P, Razek T, Fraser J, Verheul G, Parks A, Milne J, Nemeth J, Fata P, Correa J, Deckelbaum D, Bernardin B, Al Bader B, Khwaja K, Razek T, Atkinson P, Benjamin S, Sproul E, Mehta A, Galarneau M, Mahadevan P, Bansal V, Dye J, Hollingsworth-Fridlund P, Stout P, Potenza B, Coimbra R, Madan R, Marley R, Salvator A, Pisciotta D, Bridge J, Lin S, Ovens H, Nathens A, Abdo H, Dencev-Bihari R, Parry N, Lawendy A, Ibrahim-Zada I, Pandit V, Tang A, O’Keeffe T, Wynne J, Gries L, Friese R, Rhee P, Hameed M, Simons R, Taulu T, Wong H, Saleem A, Azzam M, Boulva K, Razek T, Khwaja K, Mulder D, Deckelbaum D, Fata P, Plourde M, Chadi S, Forbes T, Parry N, Martin G, Gaunt K, Bandiera G, Bawazeer M, MacKinnon D, Ahmed N, Spence J, Sankarankutty A, Nascimento B, Rizoli S, Ibrahim-Zada I, Aziz H, Tang A, Friese R, Wynne J, O’keeffe T, Vercruysse G, Kulvatunyou N, Rhee P, Sakles J, Mosier J, Wynne J, Kulvatunyou N, Tang A, Joseph B, Rhee P, Khwaja K, Fata P, Deckelbaum D, Razek T, Dias P, Issa H, Fortuna R, Sousa T, Abreu E, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Bracco D, Khwaja K, Fata P, Deckelbaum D, Razek T, Norman D, Li J, Pemberton J, Al-Oweis J, Khwaja K, Fata P, Deckelbaum D, Razek T, Albuz O, Karamanos E, Vogt K, Okoye O, Talving P, Inaba K, Demetriades D, Elhusseini M, Sudarshan M, Deckelbaum D, Fata P, Razek T, Khwaja K, MacPherson C, Sun T, Pelletier M, Hameed M, Khalil MA, Azzam M, Valenti D, Fata P, Deckelbaum D, Razek T, Brown R, Simons R, Evans D, Hameed M, Inaba K, Vogt K, Okoye O, Gelbard R, Moe D, Grabo D, Demetriades D, Inaba K, Karamanos E, Okoye O, Talving P, Demetriades D, Inaba K, Karamanos E, Pasley J, Teixeira P, Talving P, Demetriades D, Fung S, Alababtain I, Brnjac E, Luz L, Nascimento B, Rizoli S, Parikh P, Proctor K, Murtha M, Schulman C, Namias N, Goldman R, Pike I, Korn P, Flett C, Jackson T, Keith J, Joseph T, Giddins E, Ouellet J, Cook M, Schreiber M, Kortbeek J. Trauma Association of Canada (TAC) Annual Scientific Meeting. The Westin Whistler Resort & Spa, Whistler, BC, Thursday, Apr. 11 to Saturday, Apr. 13, 2013Testing the reliability of tools for pediatric trauma teamwork evaluation in a North American high-resource simulation settingThe association of etomidate with mortality in trauma patientsDefinition of isolated hip fractures as an exclusion criterion in trauma centre performance evaluations: a systematic reviewEstimation of acute care hospitalization costs for trauma hospital performance evaluation: a systematic reviewHospital length of stay following admission for traumatic injury in Canada: a multicentre cohort studyPredictors of hospital length of stay following traumatic injury: a multicentre cohort studyInfluence of the heterogeneity in definitions of an isolated hip fracture used as an exclusion criterion in trauma centre performance evaluations: a multicentre cohort studyPediatric trauma, advocacy skills and medical studentsCompliance with the prescribed packed red blood cell, fresh frozen plasma and platelet ratio for the trauma transfusion pathway at a level 1 trauma centreEarly fixed-wing aircraft activation for major trauma in remote areasDevelopment of a national, multi-disciplinary trauma crisis resource management curriculum: results from the pilot courseThe management of blunt hepatic trauma in the age of angioembolization: a single centre experienceEarly predictors of in-hospital mortality in adult trauma patientsThe impact of open tibial fracture on health service utilization in the year preceding and following injuryA systematic review and meta-analysis of the efficacy of red blood cell transfusion in the trauma populationSources of support for paramedics managing work-related stress in a Canadian EMS service responding to multisystem trauma patientsAnalysis of prehospital treatment of pain in the multisystem trauma patient at a community level 2 trauma centreIncreased mortality associated with placement of central lines during trauma resuscitationChronic pain after serious injury — identifying high risk patientsEpidemiology of in-hospital trauma deaths in a Brazilian university teaching hospitalIncreased suicidality following major trauma: a population-based studyDevelopment of a population-wide record linkage system to support trauma researchInduction of hmgb1 by increased gut permeability mediates acute lung injury in a hemorrhagic shock and resuscitation mouse modelPatients who sustain gunshot pelvic fractures are at increased risk for deep abscess formation: aggravated by rectal injuryAre we transfusing more with conservative management of isolated blunt splenic injury? A retrospective studyMotorcycle clothesline injury prevention: Experimental test of a protective deviceA prospective analysis of compliance with a massive transfusion protocol - activation alone is not enoughAn evaluation of diagnostic modalities in penetrating injuries to the cardiac box: Is there a role for routine echocardiography in the setting of negative pericardial FAST?Achievement of pediatric national quality indicators — an institutional report cardProcess mapping trauma care in 2 regional health authorities in British Columbia: a tool to assist trauma sys tem design and evaluationPatient safety checklist for emergency intubation: a systematic reviewA standardized flow sheet improves pediatric trauma documentationMassive transfusion in pediatric trauma: a 5-year retrospective reviewIs more better: Does a more intensive physiotherapy program result in accelerated recovery for trauma patients?Trauma care: not just for surgeons. Initial impact of implementing a dedicated multidisciplinary trauma team on severely injured patientsThe role of postmortem autopsy in modern trauma care: Do we still need them?Prototype cervical spine traction device for reduction stabilization and transport of nondistraction type cervical spine injuriesGoing beyond organ preservation: a 12-year review of the beneficial effects of a nonoperative management algorithm for splenic traumaAssessing the construct validity of a global disability measure in adult trauma registry patientsThe mactrauma TTL assessment tool: developing a novel tool for assessing performance of trauma traineesA quality improvement approach to developing a standardized reporting format of ct findings in blunt splenic injuriesOutcomes in geriatric trauma: what really mattersFresh whole blood is not better than component therapy (FFP:RBC) in hemorrhagic shock: a thromboelastometric study in a small animal modelFactors affecting mortality of chest trauma patients: a prospective studyLong-term pain prevalence and health related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomized controlled trialDescribing pain following trauma: predictors of persistent pain and pain prevalenceManagement strategies for hemorrhage due to pelvic trauma: a survey of Canadian general surgeonsMajor trauma follow-up clinic: Patient perception of recovery following severe traumaLost opportunities to enhance trauma practice: culture of interprofessional education and sharing among emergency staffPrehospital airway management in major trauma and traumatic brain injury by critical care paramedicsImproving patient selection for angiography and identifying risk of rebleeding after angioembolization in the nonoperative management of high grade splenic injuriesFactors predicting the need for angioembolization in solid organ injuryProthrombin complex concentrates use in traumatic brain injury patients on oral anticoagulants is effective despite underutilizationThe right treatment at the right time in the right place: early results and associations from the introduction of an all-inclusive provincial trauma care systemA multicentre study of patient experiences with acute and postacute injury carePopulation burden of major trauma: Has introduction of an organized trauma system made a difference?Long-term functional and return to work outcomes following blunt major trauma in Victoria, AustraliaSurgical dilemma in major burns victim: heterotopic ossification of the tempromandibular jointWhich radiological modality to choose in a unique penetrating neck injury: a differing opinionThe Advanced Trauma Life Support (ATLS) program in CanadaThe Rural Trauma Team Development Course (RTTDC) in Pakistan: Is there a role?Novel deployment of BC mobile medical unit for coverage of BMX world cup sporting eventIncidence and prevalence of intra-abdominal hypertension and abdominal compartment syndrome in critically ill adults: a systematic review and meta-analysisRisk factors for intra-abdominal hypertension and abdominal compartment syndrome in critically ill or injured adults: a systematic review and meta-analysisA comparison of quality improvement practices at adult and pediatric trauma centresInternational trauma centre survey to evaluate content validity, usability and feasibility of quality indicatorsLong-term functional recovery following decompressive craniectomy for severe traumatic brain injuryMorbidity and mortality associated with free falls from a height among teenage patients: a 5-year review from a level 1 trauma centreA comparison of adverse events between trauma patients and general surgery patients in a level 1 trauma centreProcoagulation, anticoagulation and fibrinolysis in severely bleeding trauma patients: a laboratorial characterization of the early trauma coagulopathyThe use of mobile technology to facilitate surveillance and improve injury outcome in sport and physical activityIntegrated knowledge translation for injury quality improvement: a partnership between researchers and knowledge usersThe impact of a prevention project in trauma with young and their learningIntraosseus vascular access in adult trauma patients: a systematic reviewThematic analysis of patient reported experiences with acute and post-acute injury careAn evaluation of a world health organization trauma care checklist quality improvement pilot programProspective validation of the modified pediatric trauma triage toolThe 16-year evolution of a Canadian level 1 trauma centre: growing up, growing out, and the impact of a booming economyA 20-year review of trauma related literature: What have we done and where are we going?Management of traumatic flail chest: a systematic review of the literatureOperative versus nonoperative management of flail chestEmergency department performance of a clinically indicated and technically successful emergency department thoracotomy and pericardiotomy with minimal equipment in a New Zealand institution without specialized surgical backupBritish Columbia’s mobile medical unit — an emergency health care support resourceRoutine versus ad hoc screening for acute stress: Who would benefit and what are the opportunities for trauma care?A geographical analysis of the Early Development Instrument (EDI) and childhood injuryDevelopment of a pediatric spinal cord injury nursing course“Kids die in driveways” — an injury prevention campaignEpidemiology of traumatic spine injuries in childrenA collaborative approach to reducing injuries in New Brunswick: acute care and injury preventionImpact of changes to a provincial field trauma triage tool in New BrunswickEnsuring quality of field trauma triage in New BrunswickBenefits of a provincial trauma transfer referral system: beyond the numbersThe field trauma triage landscape in New BrunswickImpact of the Rural Trauma Team Development Course (RTTDC) on trauma transfer intervals in a provincial, inclusive trauma systemTrauma and stress: a critical dynamics study of burnout in trauma centre healthcare professionalsUltrasound-guided pediatric forearm fracture reduction with sedation in the emergency departmentBlock first, opiates later? The use of the fascia iliaca block for patients with hip fractures in the emergency department: a systematic reviewRural trauma systems — demographic and survival analysis of remote traumas transferred from northern QuebecSimulation in trauma ultrasound trainingIncidence of clinically significant intra-abdominal injuries in stable blunt trauma patientsWake up: head injury management around the clockDamage control laparotomy for combat casualties in forward surgical facilitiesDetection of soft tissue foreign bodies by nurse practitioner performed ultrasoundAntihypertensive medications and walking devices are associated with falls from standingThe transfer process: perspectives of transferring physiciansDevelopment of a rodent model for the study of abdominal compartment syndromeClinical efficacy of routine repeat head computed tomography in pediatric traumatic brain injuryEarly warning scores (EWS) in trauma: assessing the “effectiveness” of interventions by a rural ground transport service in the interior of British ColumbiaAccuracy of trauma patient transfer documentation in BCPostoperative echocardiogram after penetrating cardiac injuries: a retrospective studyLoss to follow-up in trauma studies comparing operative methods: a systematic reviewWhat matters where and to whom: a survey of experts on the Canadian pediatric trauma systemA quality initiative to enhance pain management for trauma patients: baseline attitudes of practitionersComparison of rotational thromboelastometry (ROTEM) values in massive and nonmassive transfusion patientsMild traumatic brain injury defined by GCS: Is it really mild?The CMAC videolaryngosocpe is superior to the glidescope for the intubation of trauma patients: a prospective analysisInjury patterns and outcome of urban versus suburban major traumaA cost-effective, readily accessible technique for progressive abdominal closureEvolution and impact of the use of pan-CT scan in a tertiary urban trauma centre: a 4-year auditAdditional and repeated CT scan in interfacilities trauma transfers: room for standardizationPediatric trauma in situ simulation facilitates identification and resolution of system issuesHospital code orange plan: there’s an app for thatDiaphragmatic rupture from blunt trauma: an NTDB studyEarly closure of open abdomen using component separation techniqueSurgical fixation versus nonoperative management of flail chest: a meta-analysisIntegration of intraoperative angiography as part of damage control surgery in major traumaMass casualty preparedness of regional trauma systems: recommendations for an evaluative frameworkDiagnostic peritoneal aspirate: An obsolete diagnostic modality?Blunt hollow viscus injury: the frequency and consequences of delayed diagnosis in the era of selective nonoperative managementEnding “double jeopardy:” the diagnostic impact of cardiac ultrasound and chest radiography on operative sequencing in penetrating thoracoabdominal traumaAre trauma patients with hyperfibrinolysis diagnosed by rotem salvageable?The risk of cardiac injury after penetrating thoracic trauma: Which is the better predictor, hemodynamic status or pericardial window?The online Concussion Awareness Training Toolkit for health practitioners (CATT): a new resource for recognizing, treating, and managing concussionThe prevention of concussion and brain injury in child and youth team sportsRandomized controlled trial of an early rehabilitation intervention to improve return to work Rates following road traumaPhone call follow-upPericardiocentesis in trauma: a systematic review. Can J Surg 2013. [DOI: 10.1503/cjs.005813] [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: 11/01/2022] Open
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Abstract
The dynamic range of complex biological samples represents a challenge for mass spectrometric -characterization. Removal of high abundant proteins is a prerequisite for a successful mass spectrometric analysis of low abundant analytes. In particular, plasma and serum proteome span at least ten orders of magnitude and represent a major challenge for biomarker discovery. Immunoaffinity depletion is the most common methods of removal of high abundant proteins. Here we describe coupling of denaturing ultrafiltration, an alternative depletion strategy, with reverse-phase fractionation and mass spectrometry for characterization of low-molecular-weight proteins and peptides.
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Affiliation(s)
- Y An
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
| | - R Goldman
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC
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Lee B, Slack R, Hwang JJ, Steadman K, Harter W, Davidson BJ, Newkirk KA, Shields PG, Goldman R, Deeken JF. Association of pharmacogenetic variations in ABCG2 with cisplatin toxicity in patients with head and neck squamous cell carcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5586] [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: 11/20/2022] Open
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Abstract
Surgical robots have revolutionized a number of surgical subspecialties, including laparoscopic surgery, urology, gynecology, and orthopedics. Robots offer a number of potential improvements over unassisted human hands, such as tremor filtration, scaling of motion, enhanced dexterity in confined spaces, and extremely high precision. Several designs and prototypes have recently been introduced for use in ophthalmic surgery and they have been tested in animal models. Ophthalmic surgical robots have the potential to expand our treatment armamentarium, reduce complication rates, and hold future promise to treat surgical conditions that remain incurable today.
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Affiliation(s)
- Howard F Fine
- Department of Ophthalmology, Robert Wood Johnson University Hospital, New Brunswick, NJ 08901, USA.
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Kosti O, Goldman L, Saha DT, Orden RA, Pollock AJ, Madej HL, Hsing AW, Chu LW, Lynch JH, Goldman R. DNA damage phenotype and prostate cancer risk. Mutat Res 2010; 719:41-6. [PMID: 21095241 DOI: 10.1016/j.mrgentox.2010.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 11/11/2010] [Accepted: 11/15/2010] [Indexed: 12/30/2022]
Abstract
The capacity of an individual to process DNA damage is considered a crucial factor in carcinogenesis. The comet assay is a phenotypic measure of the combined effects of sensitivity to a mutagen exposure and repair capacity. In this paper, we evaluate the association of the DNA repair kinetics, as measured by the comet assay, with prostate cancer risk. In a pilot study of 55 men with prostate cancer, 53 men without the disease, and 71 men free of cancer at biopsy, we investigated the association of DNA damage with prostate cancer risk at early (0-15 min) and later (15-45 min) stages following gamma-radiation exposure. Although residual damage within 45 min was the same for all groups (65% of DNA in comet tail disappeared), prostate cancer cases had a slower first phase (38% vs. 41%) and faster second phase (27% vs. 22%) of the repair response compared to controls. When subjects were categorized into quartiles, according to efficiency of repairing DNA damage, high repair-efficiency within the first 15 min after exposure was not associated with prostate cancer risk while higher at the 15-45 min period was associated with increased risk (OR for highest-to-lowest quartiles=3.24, 95% CI=0.98-10.66, p-trend=0.04). Despite limited sample size, our data suggest that DNA repair kinetics marginally differ between prostate cancer cases and controls. This small difference could be associated with differential responses to DNA damage among susceptible individuals.
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Affiliation(s)
- O Kosti
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Shefrin AE, Goldman R, Milner RA. Adolescent Satisfaction in An Urban Pediatric Emergency Department. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.53aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heuchan AM, Goldman R. Letter to Lee et al. J Perinatol 2009; 29:650; author reply 650-1. [PMID: 19710663 DOI: 10.1038/jp.2009.77] [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: 11/09/2022]
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Doody RS, Ferris SH, Salloway S, Sun Y, Goldman R, Watkins WE, Xu Y, Murthy AK. Donepezil treatment of patients with MCI: a 48-week randomized, placebo-controlled trial. Neurology 2009; 72:1555-61. [PMID: 19176895 DOI: 10.1212/01.wnl.0000344650.95823.03] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Treatment of mild cognitive impairment (MCI) with cholinesterase inhibitors may improve symptoms. METHODS In this multicenter, randomized, placebo-controlled trial, subjects with MCI entered a 3-week placebo run-in period followed by 48 weeks of double-blind donepezil (5 mg/day for 6 weeks, then 10 mg/day for 42 weeks) or placebo treatment. Primary efficacy variables included change from baseline in the modified Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-Cog) and Clinical Dementia Rating Scale-sum of boxes (CDR-SB) after 48 weeks of treatment (modified intention-to-treat analysis). Secondary efficacy measures evaluated cognition, behavior, and function. RESULTS The dual primary efficacy endpoint was not reached. We noted a small, but significant, decrease in modified ADAS-Cog scores in favor of donepezil at study endpoint. Little change from baseline in CDR-SB and secondary variables was observed for either group. Patient Global Assessment scores favored donepezil at all time points except week 12 (p < or = 0.05). Perceived Deficits Questionnaire scores favored donepezil at week 24 (p = 0.05). Clinical Global Impression of Change-MCI scores favored donepezil only at week 6 (p = 0.04). Adverse events were generally mild or moderate. More donepezil-treated subjects (18.4%) discontinued treatment due to adverse events than placebo-treated subjects (8.3%). CONCLUSIONS Donepezil demonstrated small but significant improvement on the primary measure of cognition but there was no change on the primary measure of global function. Most other measures of global impairment, cognition, and function were not improved, possibly because these measures are insensitive to change in MCI. Responses on subjective measures suggest subjects perceived benefits with donepezil treatment.
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Affiliation(s)
- R S Doody
- Alzheimer's Disease and Memory Disorders Center, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030, USA
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Gebreselassie D, Lan R, Loffredo C, Goldman R, Abdel-Hamid M. Abstract B57: UBE3A (E6AP) auto antibodies in hepatocellular carcinoma. Cancer Prev Res (Phila) 2008. [DOI: 10.1158/1940-6207.prev-08-b57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
B57
UBE3A (E6AP) auto antibodies in hepatocellular carcinoma
1Gebreselassie, D., 1Lan, R., 1Loffredo, C.A., 2Abdel-Hamid, M., 1Goldman, R.
1Lombardi Comprehensive Cancer Center Georgetown University Washington, D.C. & 2National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
Patients with cancer produce auto antibodies that could serve as biomarkers for detection and classification of the disease. To identify auto antibodies associated with hepatocellular carcinoma (HCC), we used a protein array of 5,000 human proteins (Invitrogen) to compare sera of ten cancer free controls and ten patients with HCC matched on age, gender, and viral infection. Thirty six proteins significantly associated with HCC (p<0.05) were spotted on a custom array. The array experiments confirmed increased auto antibodies in HCC for 20 of the 36 candidates. The frequency of increase was as high as 45% for some of the auto antibodies in a comparison of 20 HCC cases and 10 matched controls. To further validate the observed auto antibody response to Ubiquitin protein ligase E3A (UBE3A), we fused cDNA for the protein, with an N-terminal FLAG tag and an enzyme reporter gene, humanized Renilla luciferase (hRluc). The construct was expressed in the Cos-1 mammalian cell line and crude cell lysates were used for quantification of auto antibodies in serum of the same individuals used in the protein array experiment. The assay is based on immunoprecipitation (IP) of the antigenic protein-construct on protein G beads followed by the quantification of hRluc chemiluminescence. Antibodies to the FLAG tag and the antigen of interest were used to optimize the assay. We found that HCC patient sera contain significantly elevated auto antibodies to UBE3A (t-test P<0.01). The autoantibody response to UBE3A was observed in approximately 20% of the HCC patients and correlates with the results of the protein array experiment.
Citation Information: Cancer Prev Res 2008;1(7 Suppl):B57.
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Affiliation(s)
- Daniel Gebreselassie
- Lombardi Comprehensive Cancer Center, Washington, DC, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - R. Lan
- Lombardi Comprehensive Cancer Center, Washington, DC, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - C. Loffredo
- Lombardi Comprehensive Cancer Center, Washington, DC, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - R. Goldman
- Lombardi Comprehensive Cancer Center, Washington, DC, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - M. Abdel-Hamid
- Lombardi Comprehensive Cancer Center, Washington, DC, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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Freedman S, Deiratany S, Goldman R, Benseler S. 43: Development and Validation of a Caregiver Gastroenteritis Knowledge Questionnaire. Ann Emerg Med 2008. [DOI: 10.1016/j.annemergmed.2008.01.311] [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: 10/22/2022]
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Isailovic D, Kurulugama RT, Plasencia MD, Stokes ST, Kyselova Z, Goldman R, Mechref Y, Novotny MV, Clemmer DE. Profiling of human serum glycans associated with liver cancer and cirrhosis by IMS-MS. J Proteome Res 2008; 7:1109-17. [PMID: 18237112 PMCID: PMC3727278 DOI: 10.1021/pr700702r] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aberrant glycosylation of human glycoproteins is related to various physiological states, including the onset of diseases such as cancer. Consequently, the search for glycans that could be markers of diseases or targets of therapeutic drugs has been intensive. Here, we describe a high-throughput ion mobility spectrometry/mass spectrometry analysis of N-linked glycans from human serum. Distributions of glycans are assigned according to their m/z values, while ion mobility distributions provide information about glycan conformational and isomeric composition. Statistical analysis of data from 22 apparently healthy control patients and 39 individuals with known diseases (20 with cirrhosis of the liver and 19 with liver cancer) shows that ion mobility distributions for individual m/z ions appear to be sufficient to distinguish patients with liver cancer or cirrhosis. Measurements of glycan conformational and isomeric distributions by IMS-MS may provide insight that is valuable for detecting and characterizing disease states.
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Hu T, Allen PK, Goldman R, Hogle NJ, Fowler DL. In vivo pan/tilt endoscope with integrated light source, zoom and auto-focusing. Stud Health Technol Inform 2008; 132:174-179. [PMID: 18391281] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe a surgical imaging device with pan, tilt, zoom and integrated LED light source. It can be fully inserted into the abdomen, leaving the insertion port free for tooling. Using a porcine model we have tested the device and performed surgical procedures including cholecystectomy, appendectomy, running (measuring) the bowel, suturing, and nephrectomy. The tests show that the new device is: * Easier and more intuitive to use than a standard laparoscope. * Joystick operation requires no specialized operator training. * Field of view and access to relevant regions of the body were superior to a standard laparoscope using a single port. * Time to perform procedures was better or equivalent to a standard laparoscope. We believe these insertable platforms will be an integral part of future surgical systems.
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Affiliation(s)
- Tie Hu
- Department of Computer Science, Columbia University, New York, NY 10027, USA
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Wei W, Goldman R, Simaan N, Fine H, Chang S. Design and Theoretical Evaluation of Micro-Surgical Manipulators for Orbital Manipulation and Intraocular Dexterity. ACTA ACUST UNITED AC 2007. [DOI: 10.1109/robot.2007.363996] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ressom HW, Varghese RS, Drake SK, Hortin GL, Abdel-Hamid M, Loffredo CA, Goldman R. Peak selection from MALDI-TOF mass spectra using ant colony optimization. Bioinformatics 2007; 23:619-26. [PMID: 17237065 DOI: 10.1093/bioinformatics/btl678] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [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
MOTIVATION Due to the large number of peaks in mass spectra of low-molecular-weight (LMW) enriched sera, a systematic method is needed to select a parsimonious set of peaks to facilitate biomarker identification. We present computational methods for matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) spectral data preprocessing and peak selection. In particular, we propose a novel method that combines ant colony optimization (ACO) with support vector machines (SVM) to select a small set of useful peaks. RESULTS The proposed hybrid ACO-SVM algorithm selected a panel of eight peaks out of 228 candidate peaks from MALDI-TOF spectra of LMW enriched sera. An SVM classifier built with these peaks achieved 94% sensitivity and 100% specificity in distinguishing hepatocellular carcinoma from cirrhosis in a blind validation set of 69 samples. Area under the receiver operating characteristic (ROC) curve was 0.996. The classification capability of these peaks is compared with those selected by the SVM-recursive feature elimination method. AVAILABILITY Supplementary material and MATLAB scripts to implement the methods described in this article are available at http://microarray.georgetown.edu/web/files/bioinf.htm. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- H W Ressom
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057, USA.
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Katchalski E, Silman I, Goldman R. Effect of the microenvironment on the mode of action of immobilized enzymes. Adv Enzymol Relat Areas Mol Biol 2006; 34:445-536. [PMID: 4947344 DOI: 10.1002/9780470122792.ch7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Salloway S, Ferris S, Kluger A, Goldman R, Griesing T, Kumar D, Richardson S. Efficacy of donepezil in mild cognitive impairment: a randomized placebo-controlled trial. Neurology 2005; 63:651-7. [PMID: 15326237 DOI: 10.1212/01.wnl.0000134664.80320.92] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of the acetylcholinesterase inhibitor donepezil in a placebo-controlled trial in patients with mild cognitive impairment (MCI). METHODS A total of 270 patients with MCI were enrolled in a 24-week, multicenter, randomized, double-blind, placebo-controlled study. Patients were randomized to receive donepezil (n = 133; 5 mg/day for 42 days, followed by forced dose escalation to 10 mg/day) or placebo (n = 137). Primary efficacy measures were the New York University (NYU) Paragraph Delayed Recall test and the Alzheimer disease (AD) Cooperative Study Clinician's Global Impression of Change for MCI (ADCS CGIC-MCI). Secondary efficacy measures included the modified AD Assessment Scale-cognitive subscale (ADAS-cog), the Patient Global Assessment (PGA), and additional neuropsychologic measures. Efficacy analyses were performed on intent-to-treat (ITT) and fully evaluable (FE) populations. RESULTS Primary efficacy measures of the NYU Paragraph Recall test and the ADCS CGIC-MCI did not show significant treatment effects in the ITT population. Some secondary measures showed effects favoring donepezil. More donepezil-treated patients showed improvements in ADAS-cog total scores, in tests of attention and psychomotor speed, and in PGA scores. More donepezil-treated than placebo-treated patients experienced adverse events, most of which were mild to moderate and transient. CONCLUSION Although significant treatment effects were not seen in the primary efficacy measures, outcomes on secondary measures suggest promising directions for further evaluation of donepezil treatment in patients with MCI.
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Affiliation(s)
- S Salloway
- Department of Clinical Neurosciences, Brown University, Providence, RI, USA.
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Friedman J, Goldman R, Srivastava R, Parkin PC. Development of a Clinical Dehydration Score for use in Children Between 1 and 36 Months of age. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.61aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sevy S, Robinson DG, Holloway S, Alvir JM, Woerner MG, Bilder R, Goldman R, Lieberman J, Kane J. Correlates of substance misuse in patients with first-episode schizophrenia and schizoaffective disorder. Acta Psychiatr Scand 2001; 104:367-74. [PMID: 11722318 DOI: 10.1034/j.1600-0447.2001.00452.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify factors associated with substance misuse in first-episode patients with schizophrenia or schizoaffective disorder. METHOD Twenty-seven patients with a past or current history of substance misuse were compared with 91 patients with no history of misuse on demographic and psychopathological measures before being treated for their first episode of psychosis, and on cognitive measures after 6 months of treatment. RESULTS There were no statistically significant differences between groups for sex, schizophrenia subtype, marital status, education, family history of schizophrenia, course of illness, age of onset, baseline symptoms, time to treatment response, medication side effects, attention span, memory and executive functioning. However, dual diagnosis patients were found to have a higher parental social class, better premorbid cognitive functioning, higher IQ and better language skills. CONCLUSION First-episode patients with a history of substance misuse have higher intellectual functioning, which may be associated with higher premorbid socioeconomic status and cognitive functioning.
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Affiliation(s)
- S Sevy
- Long Island Jewish Medical Center, Hillside Division, Leon Lowenstein Research Building, 266th Street @ 7th Avenue, Glen Oaks, NY 11004, USA
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Goldman R, Enewold L, Pellizzari E, Beach JB, Bowman ED, Krishnan SS, Shields PG. Smoking increases carcinogenic polycyclic aromatic hydrocarbons in human lung tissue. Cancer Res 2001; 61:6367-71. [PMID: 11522627] [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: 02/21/2023]
Abstract
Tobacco smoke is a major source of human exposure to polycyclic aromatic hydrocarbons (PAHs). The concentration of PAHs in lung tissue would reflect an individual's dose, and its variation could perhaps reflect cancer risk. Eleven PAHs were measured in 70 lung tissue samples from cancer-free autopsy donors by gas chromatography-mass spectrometry. There were 37 smokers and 33 nonsmokers as estimated by serum cotinine concentration. The sum of PAH concentrations was higher in smokers (P = 0.01), and there was a dose-response relationship for greater smoking (P < 0.01). Smoking increased the concentration of five PAHs including benzo(a)pyrene, which increased approximately 2-fold. The risk for increasing carcinogenic PAHs (odds ratio, 8.20; 95% confidence interval, 2.39-28.09) was 3-fold compared with noncarcinogenic PAHs (odds ratio, 2.61; 95% confidence interval, 0.75-9.12). A higher concentration of PAHs was detected in the lung tissue of males, although the estimated smoking was similar in males and females. Race was not associated with PAH concentrations overall, but PAH concentrations appeared to be higher in African-American males than in any other group. Age was weakly correlated with an increase in fluoranthene and pyrene. The measurement of PAHs in human lung tissue can be used to estimate the actual dose to the target organ.
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Affiliation(s)
- R Goldman
- Georgetown University Medical Center, Lombardi Cancer Center, Washington, DC 20007, USA
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Yaghoubi S, Barrio JR, Dahlbom M, Iyer M, Namavari M, Satyamurthy N, Goldman R, Herschman HR, Phelps ME, Gambhir SS. Human pharmacokinetic and dosimetry studies of [(18)F]FHBG: a reporter probe for imaging herpes simplex virus type-1 thymidine kinase reporter gene expression. J Nucl Med 2001; 42:1225-34. [PMID: 11483684] [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: 02/21/2023] Open
Abstract
UNLABELLED 9-[4-[(18)F]fluoro-3-(hydroxymethyl)butyl]guanine ([(18)F]FHBG) has been used as a reporter probe to image expression of herpes simplex virus type-1 thymidine kinase (HSV1-tk) reporter gene in living animals. Our aim was to study the kinetics, biodistribution, stability, dosimetry, and safety of [(18)F]FHBG in healthy human volunteers, preparatory to imaging patients undergoing HSV1-tk gene therapy. METHODS [(18)F]FHBG was synthesized with a specific activity of 37,000--444,000 GBq/mmol and a radiochemical purity > 99%. Ten healthy volunteers consented to participate in the study. A transmission scan was obtained before bolus injection of 70.3--229.4 MBq [(18)F]FHBG into a hand vein, followed by dynamic PET imaging with 4 consecutive emission scans. Warmed hand-vein blood was withdrawn at various times after injection for blood time--activity measurements. Electrocardiography, blood pressure, and blood and urine pharmacologic parameters were measured before and after injection of the [(18)F]FHBG tracer (n = 5). The stability of [(18)F]FHBG in the urine was analyzed. Attenuation-corrected images were reconstructed using the ordered-subsets expectation maximization algorithm. Image region-of-interest time-activity data were used with the MIRD program to estimate absorbed radiation dosages. RESULTS [(18)F]FHBG had rapid blood clearance; only 8.42% +/- 4.76% (mean +/- SD) of the peak blood activity remained at approximately 30 min. The average ratio of plasma activity to whole-blood activity during the study was 0.91 +/- 0.04. Penetration of [(18)F]FHBG across the blood-brain barrier was not observed. The primary routes of clearance were renal and hepatobiliary. High activities were observed in the bladder, gut, liver, and kidneys, but <0.0002% of the injected dose per gram was observed in other tissues. In the urine, 83% of activity 180 min after injection was stable [(18)F]FHBG. Blood and urine pharmacologic parameters did not change significantly after injection of the [(18)F]FHBG tracer. The bladder absorbed the highest radiation dose. CONCLUSION [(18)F]FHBG has the desirable in vivo characteristics of stability, rapid blood clearance, low background signal, biosafety, and acceptable radiation dosimetry in humans. This study forms the foundation for using [(18)F]FHBG in applications to monitor HSV1-tk reporter gene expression.
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Affiliation(s)
- S Yaghoubi
- Crump Institute for Molecular Imaging, UCLA--DOE Laboratory of Structural Biology and Molecular Medicine, UCLA School of Medicine, University of California, Los Angeles, 90095-1770, USA
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Mohler ER, Klugherz B, Goldman R, Kimmel SE, Wade M, Sehgal CM. Trial of a novel prostacyclin analog, UT-15, in patients with severe intermittent claudication. Vasc Med 2001; 5:231-7. [PMID: 11213235] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Prostacyclin is an endothelially derived vasodilator and inhibitor of platelet aggregation. Despite its therapeutic potential for peripheral arterial disease, the short half-life and chemical instability are barriers to routine therapy. Accordingly, prostacyclin analogs are being evaluated in patients with peripheral arterial disease. State-of-the-art non-invasive ultrasonography allows for serial testing of the hemodynamic effects of vasoactive drugs. The safety, efficacy and hemodynamic effects of UT-15, a novel, long-acting prostacyclin analog, were studied in patients with severe intermittent claudication. A total of eight patients with stable severe intermittent claudication, Fontaine classes IIb-III, were admitted to the hospital for intravenous infusion of UT-15. A symptom-limited, dose-escalation protocol was instituted, beginning with placebo and then with increasing dosage at 60-min intervals, followed by a 2-h period of maintenance dose at the maximum well-tolerated infusion rate. The hemodynamic response in the lower limbs was assessed with serial ultrasonography, segmental arterial pressures and pulse volumes. Blood flow in the common femoral artery increased 29% (p = 0.003) by the end of the maintenance period and remained above baseline throughout the washout period (p = 0.044). Blood velocity in the lower limb increased in most of the peripheral arteries. These increases achieved statistical significance in the common femoral artery (p = 0.025) and anterior tibial artery (p = 0.019), and approached significance in the popliteal artery (p = 0.062). In two of four patients in whom blood flow was undetectable before the infusion, arterial blood flow at the ankle level became apparent on ultrasonography during maintenance infusion. UT-15 infusion improved the pulse volume recording (p = 0.016) but the ankle/brachial index did not change significantly. Common side effects at peak dose included headache and nausea. There were no serious adverse events attributable to UT-15 treatment. In most patients, the optimal infusion rate was 10-20 ng/kg per min. In conclusion, ultrasonography is a novel approach for assessing the hemodynamic response to vasoactive agents. UT-15 is well tolerated when given for up to 2 h and increases arterial blood flow and velocity in patients with severe intermittent claudication.
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Affiliation(s)
- E R Mohler
- Department of Medicine, University of Pennsylvania, School of Medicine, Philadelphia, USA
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