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Miller HE, Montemayor D, Levy S, Sharma K, Frost B, Bishop AJR. RLSuite: An Integrative R-Loop Bioinformatics Framework. J Bioinform Syst Biol 2023; 6:364-378. [PMID: 38292828 PMCID: PMC10827345 DOI: 10.26502/jbsb.5107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
We recently described the development of a database of 810 R-loop mapping datasets and used this data to conduct a meta-analysis of R-loops. R-loops are three-stranded nucleic acid structures containing RNA:DNA hybrids and we were able to verify that 30% of expressed genes have an associated R-loop in a location conserved manner.. Moreover, intergenic R-loops map to enhancers, super enhancers and with TAD domain boundaries. This work demonstrated that R-loop mapping via high-throughput sequencing can reveal novel insight into R-loop biology, however the analysis and quality control of these data is a non-trivial task for which few bioinformatic tools exist. Herein we describe RLSuite, an integrative R-loop bioinformatics framework for pre-processing, quality control, and downstream analysis of R-loop mapping data. RLSuite enables users to compare their data to hundreds of public datasets and generate a user-friendly analysis report for sharing with non-bioinformatician colleagues. Taken together, RLSuite is a novel analysis framework that should greatly benefit the emerging R-loop bioinformatics community in a rapidly expanding aspect of epigenetic control that is still poorly understood.
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Affiliation(s)
- H E Miller
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Greehey Children's Cancer Research Institute, UT Health San Antonio, San Antonio, TX, USA
- Bioinformatics Research Network, Atlanta, GA, USA
| | - D Montemayor
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Center for Precision Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - S Levy
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Bioinformatics Research Network, Atlanta, GA, USA
- Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - K Sharma
- Department of Medicine, UT Health San Antonio, San Antonio, TX, USA
- Center for Precision Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - B Frost
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Sam & Ann Barshop Institute for Longevity & Aging Studies, UT Health San Antonio, San Antonio, TX, USA
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - A J R Bishop
- Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, TX, USA
- Greehey Children's Cancer Research Institute, UT Health San Antonio, San Antonio, TX, USA
- May's Cancer Center, UT Health San Antonio, San Antonio, TX, USA
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Solomon J, Dauber-Decker K, Richardson S, Levy S, Khan S, Coleman B, Persaud R, Chelico J, King D, Spyropoulos A, McGinn T. Integrating Clinical Decision Support Into Electronic Health Record Systems Using a Novel Platform (EvidencePoint): Developmental Study. JMIR Form Res 2023; 7:e44065. [PMID: 37856193 PMCID: PMC10623239 DOI: 10.2196/44065] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/21/2023] [Accepted: 07/31/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. OBJECTIVE The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. METHODS We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. RESULTS The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells' criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform's flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells' criteria tool will be reported in a future publication. CONCLUSIONS The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics "nudges" on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint.
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Affiliation(s)
- Jeffrey Solomon
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Katherine Dauber-Decker
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Safiya Richardson
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sera Levy
- Department of Psychiatry, Heersink School of Medicine, University of Alabama at Birmingham Medicine, Birmingham, AL, United States
| | - Sundas Khan
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Benjamin Coleman
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Rupert Persaud
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - John Chelico
- Physician Enterprise, CommonSpirit Health, Chicago, IL, United States
| | - D'Arcy King
- School of Psychology, Fielding Graduate University, Santa Barbara, CA, United States
| | - Alex Spyropoulos
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Thomas McGinn
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Physician Enterprise, CommonSpirit Health, Chicago, IL, United States
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Gamliel A, Lee YN, Lev A, AbuZaitun O, Rechavi E, Levy S, Simon AJ, Somech R. Immunologic Heterogeneity in 2 Cartilage-Hair Hypoplasia Patients With a Distinct Clinical Course. J Investig Allergol Clin Immunol 2023; 33:263-270. [PMID: 35166674 DOI: 10.18176/jiaci.0792] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Cartilage-hair hypoplasia (CHH) syndrome is a rare autosomal recessive syndrome associated with skeletal dysplasia, varying degrees of combined immunodeficiency (CID), short stature, hair hypoplasia, macrocytic anemia, increased risk of malignancies, and Hirschsprung disease. To provide clinical and immunological insights obtained from 2 unrelated patients who displayed clinical characteristics of CHH. METHODS Two patients with suspected CHH syndrome due to skeletal dysplasia and immunodeficiency underwent an immunological and genetic work-up using flow cytometry, next-generation sequencing (NGS) of the immune repertoire, and Sanger sequencing to identify the underlying defects. RESULTS Patient 1 presented with low birth weight and skeletal dysplasia. Newborn screening was suggestive of T-cell immunodeficiency, as T-cell receptor excision circle levels were undetectable. Both the T-cell receptor (TCR) Vß and TCR-g (TRG) repertoires were restricted, with evidence of clonal expansion. Genetic analysis identified compound heterozygous RMRP variants inherited from both parents. Patient 2 presented with recurrent lung and gastrointestinal infections, skeletal dysplasia, failure to thrive, and hepatomegaly. The polyclonal pattern of the TCRß repertoire was normal, with only slight overexpression of TCR-ßV20 and restricted expression of Vßs. TRG expressed a normal diverse repertoire, similar to that of the healthy control sample. Genetic analysis identified biallelic novel regulatory variants in RMRP. Both parents are carriers of this mutation. CONCLUSION Our findings demonstrate how the immunological work-up, supported by genetic findings, can dramatically change treatment and future outcome in patients with the same clinical syndrome.
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Affiliation(s)
- A Gamliel
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y N Lee
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Lev
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O AbuZaitun
- Ambulatory Pediatrics, Nablus, Palestinian Authority
| | - E Rechavi
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Levy
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - A J Simon
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Hematology Laboratory, Hemato-Immunology Unit, and Sheba Cancer Research Center, Sheba Medical Center, Tel Hashomer, Israel
| | - R Somech
- Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Solomon DA, Beieler AM, Levy S, Eaton EF, Sikka MK, Thornton A, Dhanireddy S. Perspectives on the Use of Outpatient Parenteral Antibiotic Therapy for People who Inject Drugs: Results From an Online Survey of Infectious Diseases Clinicians. Open Forum Infect Dis 2023; 10:ofad372. [PMID: 37520410 PMCID: PMC10372854 DOI: 10.1093/ofid/ofad372] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/01/2023] Open
Abstract
Injection-related infections require prolonged antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be feasible for people who inject drugs (PWID) in some settings. We report a national survey on practice patterns and attitudes of infectious diseases clinicians in the United States regarding use of OPAT for PWID.
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Affiliation(s)
- Daniel A Solomon
- Correspondence: Daniel A. Solomon, MD, 75 Francis St, Boston, MA 02115 ()
| | | | - Sera Levy
- University of Alabama, Birmingham, Alabama, USA
| | | | - Monica K Sikka
- Oregon Health & Sciences University, Portland, Oregon, USA
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Gagnon KW, Levy S, Figge C, Wolford Clevenger C, Murray L, Kane JC, Bosomprah S, Sharma A, Nghiem VTH, Chitambi C, Vinikoor M, Eaton E, Cropsey K. Telemedicine for unhealthy alcohol use in adults living with HIV in Alabama using common elements treatment approach: A hybrid clinical efficacy-implementation trial protocol. Contemp Clin Trials Commun 2023; 33:101123. [PMID: 37063165 PMCID: PMC10090240 DOI: 10.1016/j.conctc.2023.101123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Background Unhealthy alcohol use is an unaddressed barrier to achieving and maintaining control of the human immunodeficiency virus (HIV) epidemic. Integrated screening, treatment of common behavioral and mental health comorbidities, and telemedicine can improve alcohol treatment and HIV clinical and quality of life outcomes for rural and underserved populations. Objective In a randomized controlled clinical trial, we will evaluate the effectiveness and implementation of telephone-delivered Common Elements Treatment Approach (T-CETA), a transdiagnostic cognitive behavioral therapy protocol, on unhealthy alcohol use, HIV, other substance use and mental health outcomes among predominantly rural adults with HIV receiving care at community clinics in Alabama. Methods Adults with HIV receiving care at four selected community clinics in Alabama will receive a telephone-delivered alcohol brief intervention (BI), and then be assigned at random (stratified by clinic and sex) to no further intervention or T-CETA. Participants will be recruited after screening positively for unhealthy alcohol use or when referred by a provider. The target sample size is 308. The primary outcome will be change in the Alcohol Use Disorder Identification Test (AUDIT) at six- and 12-months post-enrollment. Additional outcomes include HIV (retention in care and viral suppression), patient-reported mental health (anxiety, depression, posttraumatic stress), and quality of life. A range of implementation measures be evaluated including T-CETA provider and client acceptability, feasibility, cost and cost-effectiveness. Conclusions This trial will inform alcohol treatment within HIV care programs, including the need to consider comorbidities, and the potential impact of alcohol interventions on HIV and quality of life outcomes.
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Bradford D, Parman M, Levy S, Turner WH, Li L, Leisch L, Eaton E, Crockett KB. HIV and Addiction Services for People Who Inject Drugs: Healthcare Provider Perceptions on Integrated Care in the U.S. South. J Prim Care Community Health 2023; 14:21501319231161208. [PMID: 36941754 PMCID: PMC10031597 DOI: 10.1177/21501319231161208] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This qualitative study evaluates physician training and experience with treatment and prevention services for people who inject drugs (PWID) including medications for opioid use disorder (MOUD) and HIV pre-exposure prophylaxis (PrEP). The Behavioral Model of Healthcare Utilization for Vulnerable Populations was applied as a framework for data analysis and interpretation. Two focus groups were conducted, one with early career physicians (n = 6) and one with mid- to late career physicians (n = 3). Focus group transcripts were coded and analyzed using thematic analysis to identify factors affecting implementation of treatment and prevention services for PWID. Respondents identified that increasing the availability of providers prescribing MOUD was a critical enabling factor for PWID seeking and receiving care. Integrated, interdisciplinary services were identified as an additional resource although these remain fragmented in the current healthcare system. Barriers to care included provider awareness, stigma associated with substance use, and access limitations. Providers identified the interwoven risk factors associated with injection drug use that must be addressed, including the risk of HIV acquisition, notably more at the forefront in the minds of early career physicians. Additional research is needed addressing the medical education curriculum, health system, and healthcare policy to address the addiction and HIV crises in the U.S. South.
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Affiliation(s)
- Davis Bradford
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mariel Parman
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sera Levy
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wesli H Turner
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Li Li
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Leah Leisch
- Department of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ellen Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Levy S, Bassler J, Gagnon K, Prados M, Jeziorski M, McCleskey B, Crockett K, Li L, Bradford D, Cropsey K, Eaton E. Methamphetamines and Serious Injection-Related Infections: Opioid Use Care Continuum and Opportunities to End Alabama's Drug Crisis. Open Forum Infect Dis 2022; 10:ofac708. [PMID: 36726543 PMCID: PMC9879754 DOI: 10.1093/ofid/ofac708] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Increasingly, injection opioid use and opioid use disorder (OUD) are complicated by methamphetamine use, but the impact of stimulant use on the care of people who inject drugs (PWID) with serious injection-related infections (SIRIs) is unknown. The objective of this study was to explore hospital outcomes and postdischarge trends for a cohort of hospitalized PWID to identify opportunities for intervention. Methods We queried the electronic medical record for patients hospitalized at the University of Alabama at Birmingham with injection drug use-related infections between 1/11/2016 and 4/24/2021. Patients were categorized as having OUD only (OUD), OUD plus methamphetamine use (OUD/meth), or injection of other substance(s) (other). We utilized statistical analyses to assess group differences across hospital outcomes and postdischarge trends. We determined the OUD continuum of care for those with OUD, with and without methamphetamine use. Results A total of 370 patients met inclusion criteria-many with readmissions (98%) and high mortality (8%). The majority were White, male, and uninsured, with a median age of 38. One in 4 resided outside of a metropolitan area. There were significant differences according to substance use in terms of sociodemographics and hospital outcomes: patients with OUD/meth were more likely to leave via patient-directed discharge, but those with OUD only had the greatest mortality. Comorbid methamphetamine use did not significantly impact the OUD care continuum. Conclusions The current drug crisis in AL will require targeted interventions to engage a young, uninsured population with SIRI in evidence-based addiction and infection services.
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Affiliation(s)
- Sera Levy
- Correspondence: Sera Levy, MS, Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, UAB, The University of Alabama at Birmingham, L107 Volker Hall, 1670 University Blvd, Birmingham, AL 35233 ()
| | - John Bassler
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Gagnon
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Prados
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Madison Jeziorski
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandi McCleskey
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kaylee Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Li
- Department of Psychiatry, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Davis Bradford
- Department of Internal Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Solomon DA, Beieler AM, Levy S, Eaton E, Sikka MK, Thornton AC, Dhanireddy S. 744. Infectious Diseases Providers Perspectives Around the Use of Outpatient Parenteral Antibiotic Therapy (OPAT) for Persons Who Inject Drugs (PWID), US, 2022. Open Forum Infect Dis 2022. [PMCID: PMC9752315 DOI: 10.1093/ofid/ofac492.035] [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: 12/23/2022] Open
Abstract
Background Injection drug use-related infections are life threatening and may require prolonged courses of antibiotic therapy. There is no consensus on best practices for serious infections when patients are stable for discharge. Outpatient parenteral antimicrobial therapy (OPAT) has been shown to be feasible for people who inject drugs (PWID) especially when paired with medication for opioid use disorder. We set out to determine the current practice patterns and attitudes of infectious diseases (ID) clinicians in the United States regarding the use of OPAT for PWID. Methods We surveyed ID clinicians between January 2022 and March 2022. Topics focused on PWID including OPAT access, barriers to inclusion in OPAT, and factors clinicians considered for OPAT success. Responses from those who perceived PWID were eligible for OPAT (PWID-E) were compared to those who believed PWID were ineligible (PWID-I) using the Pearson chi-squared test. Results Of 239 clinician respondents, 80% were MD, 6% DO, 5% NP, 2% PA, and 7% Pharmacists. 187 (78.2%) work at an academic practice and 179 (75%) work in an urban setting. 182 (76%) respondents have access to inpatient addiction medicine services and 206 (86%) reported availability of outpatient addiction treatment, but only 86 (36%) described patient access to outpatient services as “good” or “excellent.” Respondents were categorized as PWID-E (n=171, 72%) and PWID-I (n=68, 28%). Of the PWID-E group, only 48 (28%) have an institutional policy for determining eligibility. There was no significant difference in practice setting or access to addiction services between PWID-E and PWID-I. Access to inpatient and outpatient social work/case management was significantly higher for PWID-E. (Table 1). Clinicians reporting PWID-I were more likely to cite risk of tampering with PICC (76.5% vs 62.6%, p = 0.04) and medical-legal risk (47.1% vs 19.3%, p < 0.001) as barriers to OPAT. (Table 2). Conclusion A high proportion of respondents to this national survey offer OPAT for PWID, but only a minority have an institutional policy for eligibility. Guidelines that outline a framework for discharge decision making, education regarding medical and legal risk, and development of best practices may help to standardize care across settings. Disclosures Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support Monica K. Sikka, MD, F2G: Site research investigator.
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Affiliation(s)
- Daniel A Solomon
- Brigham and Women's Hospital / Harvard Medical School, Boston, MA
| | | | - Sera Levy
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Ellen Eaton
- University of Alabama, Birmingham, Birmingham, Alabama
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Prados MD, Eaton E, Levy S, Bassler JR, Gagnon K, Jeziorski MM, Bradford D, Leisch LJ, Li L. 1410. Methamphetamines and Serious Injection Related Infections: Epidemiology and Outcomes of Alabama’s Drug Crisis. Open Forum Infect Dis 2022. [PMCID: PMC9752793 DOI: 10.1093/ofid/ofac492.1239] [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: 12/23/2022] Open
Abstract
Background The U.S. is facing a steep increase in infectious consequences of intravenous drug use due to the ongoing opioid crisis, surging methamphetamine use, and health care disruptions caused by COVID-19. We hypothesize that the sociodemographic and clinical outcomes of persons who inject drugs (PWID) differ based on their drug of choice (opioids, methamphetamines). Further, we hypothesize that the OUD (opioid use disorder) continuum, including linkage and retention in OUD treatment, will vary depending on co-occurring methamphetamine use. By elucidating differences in these groups, we aim to identify opportunities for interventions along the care continuum. Methods This is a retrospective study of hospitalized PWID receiving care at the University of Alabama at Birmingham Hospital for a serious injection related infection (SIRI) between 1/11/2016 and 4/24/2021. We queried the EMR for clinical data and health outcomes. We extracted data on substance use disorder(s), treatments, and linkage to care through review of primary and addiction medicine consultation notes. Using statistical measures of association, we compared demographic factors and clinical outcomes among groups; delineating between those with and without methamphetamine use, and without OUD. When appropriate, additional comparisons were made to detect statistical differences between factors and those with and without methamphetamine use. Results Of 370 PWID, 286 had OUD, 94 had OUD and methamphetamine use, and 84 had another substance use disorder. There were significant differences according to drug use disorder with patients with OUD and meth use being mostly White (99%), 42% female, and younger relative to those who use opioids only. Patient directed discharge was most common among those with OUD plus meth use, but death was highest for those with OUD only. The OUD care continuum was similar and alarming for both groups with many gaps in care.
![]() OUD Care continuum for PWID with SIRI for those with and without comorbid meth use disorder ![]() Conclusion PWID with SIRI are a diverse group with significant differences based on substance of choice, but all experience suboptimal hospital outcomes. There are opportunities to improve linkage and retention across the care continuum, most noticeably outpatient linkage. Disclosures Ellen Eaton, MD, MPH, Gilead HIV Research Scholar: Grant/Research Support|Gilead HIV research scholar: Grant/Research Support.
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Affiliation(s)
| | - Ellen Eaton
- University of Alabama, Birmingham, Birmingham, Alabama
| | - Sera Levy
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John R Bassler
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly Gagnon
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Davis Bradford
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Leah J Leisch
- University of Alabama at Birmingham, Birmingham, Alabama
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Feng F, Ning Y, Xue Y, Friedl V, Hann D, Gibb B, Bergamaschi A, Guler G, Hazen K, Scott A, Phillips T, McCarthy E, Ellison C, Malta R, Nguyen A, Lopez V, Cavet R, Chowdhury S, Volkmuth W, Levy S. 69MO 5-Hydroxymethycytosine analysis reveals stable epigenetic changes in tumor tissue that enable cfDNA cancer predictions. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Eaton EF, Burgan K, McCollum G, Levy S, Willig J, Mugavero MJ, Reddy S, Wallace E, Creger T, Baral S, Fogger S, Cropsey K. Expanding access to substance use services and mental health care for people with HIV in Alabama, a technology readiness assessment using a mixed methods approach. BMC Health Serv Res 2022; 22:919. [PMID: 35841096 PMCID: PMC9284957 DOI: 10.1186/s12913-022-08280-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alabama is one of seven priority states for the National Ending the HIV Epidemic Initiative due to a large rural burden of disease. Mental health (MH) and substance use disorders (SUD) represent obstacles to HIV care in rural areas lacking Medicaid expansion and infrastructure. Evidence-informed technologies, such as telehealth, may enhance SUD and MH services but remain understudied in rural regions. METHODS We conducted a readiness assessment using a mixed methods approach to explore opportunities for enhanced SUD and MH screening using electronic patient reported outcomes (ePROs) and telehealth at five Ryan White HIV/AIDS Program-funded clinics in AL. Clinic providers and staff from each site (N = 16) completed the Organizational Readiness to Implement Change (ORIC) assessment and interviews regarding existing services and readiness to change. People with HIV from each site (PLH, N = 18) completed surveys on the acceptability and accessibility of technology for healthcare. RESULTS Surveys and interviews revealed that all clinics screen for depression annually by use of the Patient Health Questionnaire-9 (PHQ9). SUD screening is less frequent and unstandardized. Telehealth is available at all sites, with three of the five sites beginning services due to the COVID-19 pandemic; however, telehealth for MH and SUD services is not standardized across sites. Results demonstrate an overall readiness to adopt standardized screenings and expand telehealth services beyond HIV services at clinics. There were several concerns including Wi-Fi access, staff capacity, and patients' technological literacy. A sample of 18 people with HIV (PWH), ages 18 to 65 years, participated in surveys; all demonstrated adequate technology literacy. A majority had accessed telehealth and were not concerned about it being too complicated or limiting communication. There were some concerns around lack of in-person interaction and lack of a physical exam and high-quality care with telehealth. CONCLUSION This study of PWH and the clinics that serve them reveals opportunities to expand SUD and MH services in rural regions using technology. Areas for improvement include implementing routine SUD screening, expanding telehealth while maintaining opportunities for in-person interaction, and using standardized ePROs that are completed by patients, in order to minimize stigma and bias.
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Affiliation(s)
- Ellen F Eaton
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA.
| | - Kaylee Burgan
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - Greer McCollum
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - Sera Levy
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - James Willig
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - Sushanth Reddy
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, 2000 6th Avenue South, Birmingham, AL, 35233, USA
| | - Eric Wallace
- Division of Nephrology, Heersink School of Medicine, University of Alabama at Birmingham, 1600 7th Ave S, Birmingham, AL, 35233, USA
| | - Tom Creger
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, BBRB 206-E
- 845 19th Street South, Birmingham, AL, 35205, USA
| | - Stefan Baral
- Division of Infectious Disease Epidemiology, Department of Epidemiology, Bloomberg School of Public Health, John Hopkins University, E7146
- 615 N. Wolf Street, Baltimore, MD, 21205, USA
| | - Susanne Fogger
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, Birmingham, AL, 35294, USA
| | - Karen Cropsey
- Department of Psychiatry, Heersink School of Medicine, University of Alabama at Birmingham, VH L107
- 1670 University Blvd, Birmingham, AL, 35233, USA
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12
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Garcia E, Sanchez-Rodriguez D, Levy S, Claessens M, Van Hauwermeiren C, Taliha M, Benoit F, Surquin M. [Factors associated with intrahospital mortality in older patients with COVID-19 in Belgium : The COVID-AgeBru study]. Rev Med Liege 2022; 77:146-152. [PMID: 35258862] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We aimed at assessing the association between demographical and clinical data and the intrahospital mortality in older patients with COVID-19 in Belgium. METHODS Descriptive, retrospective study of consecutive patients admitted to Brugmann university hospital, Brussels (Belgium) due to COVID-19 (Mars-September-2020). INCLUSION CRITERIA Patients aged ≥ 70 years admitted to acute care with a positive PCR-RT test, or a highly indicative computed tomography scan. EXCLUSION CRITERIA Patients transferred to another institution during hospitalization. OUTCOME MEASURE All-cause intrahospital mortality. Demographic, clinical data, presence of comordibidties and comprehensive geriatric assessment were collected. Adjusted and unadjusted logistic regression were performed. RESULTS From the 226 eligible patients, 160 (82.7 ± 6.5-year-old; 57.5 % females) met inclusion criteria, from which 67 (42 %) died during hospital stay. The adjusted logistic regression showed an association between intrahospital mortality and increasing age [OR = 1.09 per every year increase (95 % CI 1.02-1.16); p <0.001], type 2 diabetes [OR = 2.75 ( 1.17-6.46); p = 0.021], and acute respiratory distress syndrome (ARDS) [OR = 8.67 ( 3.48-21.61); p < 0.01]. CONCLUSIONS A higher positive association between intrahospital mortality and increasing age, type 2 diabetes, and ARDS was found. The prognosis value of the comprehensive geriatric assessment in older people with COVID-19 in Belgium requires further studies.
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Affiliation(s)
- E Garcia
- Faculté de Médecine, ULB, Bruxelles, Belgique
| | - D Sanchez-Rodriguez
- Faculté de Médecine, ULB, Bruxelles, Belgique
- Unité de Recherche Clinique, CHU Brugmann, Bruxelles, Belgique
- Centre Collaborateur de l'OMS pour l'étude de la santé et du vieillissement de l'Appareil musculosquelettique. Division de Santé publique, Épidémiologie et Économie de la Santé, ULiège, Belgique
- Département de Gériatrie, Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelone, Espagne
| | - S Levy
- Département de Gériatrie, CHU Brugmann, Bruxelles, Belgique
| | - M Claessens
- Département de Gériatrie, CHU Brugmann, Bruxelles, Belgique
| | | | - M Taliha
- Département de Gériatrie, CHU Brugmann, Bruxelles, Belgique
| | - F Benoit
- Faculté de Médecine, ULB, Bruxelles, Belgique
- Département de Gériatrie, CHU Brugmann, Bruxelles, Belgique
| | - M Surquin
- Faculté de Médecine, ULB, Bruxelles, Belgique
- Département de Gériatrie, CHU Brugmann, Bruxelles, Belgique
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Mukherjee S, O'Connor H, Harman R, O'Donovan M, Debiram-Beecham I, Alias B, Bailey A, Bateman A, de Caestecker J, Crosby T, Falk S, Gollins S, Hawkins M, Levy S, Radhakrishna G, Roy R, Sripadam R, Fitzgerald R. P-109 CYTOFLOC: Evaluation of a non-endoscopic immunocytological device (Cytosponge™) for post-chemo-radiotherapy surveillance in patients with oesophageal cancer – a feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.164] [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] Open
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14
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Baucher G, Rasoanandrianina H, Levy S, Pini L, Troude L, Roche PH, Callot V. T1 Mapping for Microstructural Assessment of the Cervical Spinal Cord in the Evaluation of Patients with Degenerative Cervical Myelopathy. AJNR Am J Neuroradiol 2021; 42:1348-1357. [PMID: 33985954 DOI: 10.3174/ajnr.a7157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 02/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Although current radiologic evaluation of degenerative cervical myelopathy by conventional MR imaging accurately demonstrates spondylosis or degenerative disc disease causing spinal cord dysfunction, conventional MR imaging still fails to provide satisfactory anatomic and clinical correlations. In this context, we assessed the potential value of quantitative cervical spinal cord T1 mapping regarding the evaluation of patients with degenerative cervical myelopathy. MATERIALS AND METHODS Twenty patients diagnosed with mild and moderate-to-severe degenerative cervical myelopathy and 10 healthy subjects were enrolled in a multiparametric MR imaging protocol. Cervical spinal cord T1 mapping was performed with the MP2RAGE sequence procedure. Retrieved data were processed and analyzed regarding the global spinal cord and white and anterior gray matter on the basis of the clinical severity and the spinal canal stenosis grading. RESULTS Noncompressed levels in healthy controls demonstrated significantly lower T1 values than noncompressed, mild, moderate, and severe stenotic levels in patients. Concerning the entire spinal cord T1 mapping, patients with moderate-to-severe degenerative cervical myelopathy had higher T1 values compared with healthy controls. Regarding the specific levels, patients with moderate-to-severe degenerative cervical myelopathy demonstrated a T1 value increase at C1, C7, and the level of maximal compression compared with healthy controls. Patients with mild degenerative cervical myelopathy had lower T1 values than those with moderate-to-severe degenerative cervical myelopathy at the level of maximal compression. Analyses of white and anterior gray matter confirmed similar results. Strong negative correlations between individual modified Japanese Orthopaedic Association scores and T1 values were also observed. CONCLUSIONS In this preliminary study, 3D-MP2RAGE T1 mapping demonstrated increased T1 values in the pathology tissue samples, with diffuse medullary alterations in all patients with degenerative cervical myelopathy, especially relevant at C1 (nonstenotic level) and at the maximal compression level. Encouraging correlations observed with the modified Japanese Orthopaedic Association score make this novel approach a potential quantitative biomarker related to clinical severity in degenerative cervical myelopathy. Nevertheless, patients with mild degenerative cervical myelopathy demonstrated nonsignificant results compared with healthy controls and should now be studied in multicenter studies with larger patient populations.
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Affiliation(s)
- G Baucher
- From the Neurochirurgie adulte (G.B., L.T., P.-H.R.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Nord, Marseille, France
- Center for Magnetic Resonance in Biology and Medicine (G.B., H.R., L.P., S.L., V.C.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
- iLab-Spine International Associated Laboratory (G.B., H.R., S.L., P.-H.R., V.C.), Marseille-Montreal, France-Canada
| | - H Rasoanandrianina
- Center for Magnetic Resonance in Biology and Medicine (G.B., H.R., L.P., S.L., V.C.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
- Center for Magnetic Resonance in Biology and Medicine (H.R., L.P., S.L., V.C.), Aix-Marseille Université, Center National de la Recherche Scientifique, Marseille, France
- iLab-Spine International Associated Laboratory (G.B., H.R., S.L., P.-H.R., V.C.), Marseille-Montreal, France-Canada
| | - S Levy
- Center for Magnetic Resonance in Biology and Medicine (G.B., H.R., L.P., S.L., V.C.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
- Center for Magnetic Resonance in Biology and Medicine (H.R., L.P., S.L., V.C.), Aix-Marseille Université, Center National de la Recherche Scientifique, Marseille, France
- iLab-Spine International Associated Laboratory (G.B., H.R., S.L., P.-H.R., V.C.), Marseille-Montreal, France-Canada
| | - L Pini
- Center for Magnetic Resonance in Biology and Medicine (G.B., H.R., L.P., S.L., V.C.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
- Center for Magnetic Resonance in Biology and Medicine (H.R., L.P., S.L., V.C.), Aix-Marseille Université, Center National de la Recherche Scientifique, Marseille, France
| | - L Troude
- From the Neurochirurgie adulte (G.B., L.T., P.-H.R.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Nord, Marseille, France
| | - P-H Roche
- From the Neurochirurgie adulte (G.B., L.T., P.-H.R.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Nord, Marseille, France
- iLab-Spine International Associated Laboratory (G.B., H.R., S.L., P.-H.R., V.C.), Marseille-Montreal, France-Canada
| | - V Callot
- Center for Magnetic Resonance in Biology and Medicine (G.B., H.R., L.P., S.L., V.C.), Assistance Publique-Hôpitaux de Marseille, Hôpital Universitaire Timone, Marseille, France
- Center for Magnetic Resonance in Biology and Medicine (H.R., L.P., S.L., V.C.), Aix-Marseille Université, Center National de la Recherche Scientifique, Marseille, France
- iLab-Spine International Associated Laboratory (G.B., H.R., S.L., P.-H.R., V.C.), Marseille-Montreal, France-Canada
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15
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Richardson S, Gitlin J, Kozel Z, Levy S, Rahman H, Hirsch JS, McGinn T, Diefenbach MA. In-Hospital 30-Day Survival Among Young Adults With Coronavirus Disease 2019: A Cohort Study. Open Forum Infect Dis 2021; 8:ofab233. [PMID: 34183983 PMCID: PMC8135976 DOI: 10.1093/ofid/ofab233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/05/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Our objective was to characterize young adult patients hospitalized with coronavirus disease 2019 (COVID-19) and identify predictors of survival at 30 days. METHODS This retrospective cohort study took place at 12 acute care hospitals in the New York City area. Patients aged 18-39 hospitalized with confirmed COVID-19 between March 1 and April 27, 2020 were included in the study. Demographic, clinical, and outcome data were extracted from electronic health record reports. RESULTS A total of 1013 patients were included in the study (median age, 33 years; interquartile range [IQR], 28-36; 52% female). At the study end point, 940 (92.8%) patients were discharged alive, 18 (1.8%) remained hospitalized, 5 (0.5%) were transferred to another acute care facility, and 50 (4.9%) died. The most common comorbidities in hospitalized young adult patients were obesity (51.2%), diabetes mellitus (14.8%), and hypertension (13%). Multivariable analysis revealed that obesity (adjusted hazard ratio [aHR], 2.71; 95% confidence interval [CI], 1.28-5.73; P = .002) and Charlson comorbidity index score (aHR, 1.20; 95% CI, 1.07-1.35; P = .002) were independent predictors of in-hospital 30-day mortality. CONCLUSIONS Obesity was identified as the strongest negative predictor of 30-day in-hospital survival in young adults with COVID-19.
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Affiliation(s)
- Safiya Richardson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Jordan Gitlin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Zachary Kozel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Sera Levy
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Husneara Rahman
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Great Neck, New York, USA
| | - Jamie S Hirsch
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Thomas McGinn
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Michael A Diefenbach
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
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16
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Leung MHY, Tong X, Bøifot KO, Bezdan D, Butler DJ, Danko DC, Gohli J, Green DC, Hernandez MT, Kelly FJ, Levy S, Mason-Buck G, Nieto-Caballero M, Syndercombe-Court D, Udekwu K, Young BG, Mason CE, Dybwad M, Lee PKH. Characterization of the public transit air microbiome and resistome reveals geographical specificity. Microbiome 2021; 9:112. [PMID: 34039416 PMCID: PMC8157753 DOI: 10.1186/s40168-021-01044-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/08/2021] [Accepted: 03/09/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND The public transit is a built environment with high occupant density across the globe, and identifying factors shaping public transit air microbiomes will help design strategies to minimize the transmission of pathogens. However, the majority of microbiome works dedicated to the public transit air are limited to amplicon sequencing, and our knowledge regarding the functional potentials and the repertoire of resistance genes (i.e. resistome) is limited. Furthermore, current air microbiome investigations on public transit systems are focused on single cities, and a multi-city assessment of the public transit air microbiome will allow a greater understanding of whether and how broad environmental, building, and anthropogenic factors shape the public transit air microbiome in an international scale. Therefore, in this study, the public transit air microbiomes and resistomes of six cities across three continents (Denver, Hong Kong, London, New York City, Oslo, Stockholm) were characterized. RESULTS City was the sole factor associated with public transit air microbiome differences, with diverse taxa identified as drivers for geography-associated functional potentials, concomitant with geographical differences in species- and strain-level inferred growth profiles. Related bacterial strains differed among cities in genes encoding resistance, transposase, and other functions. Sourcetracking estimated that human skin, soil, and wastewater were major presumptive resistome sources of public transit air, and adjacent public transit surfaces may also be considered presumptive sources. Large proportions of detected resistance genes were co-located with mobile genetic elements including plasmids. Biosynthetic gene clusters and city-unique coding sequences were found in the metagenome-assembled genomes. CONCLUSIONS Overall, geographical specificity transcends multiple aspects of the public transit air microbiome, and future efforts on a global scale are warranted to increase our understanding of factors shaping the microbiome of this unique built environment.
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Affiliation(s)
- M H Y Leung
- School of Energy and Environment, City University of Hong Kong, Hong Kong SAR, China
| | - X Tong
- School of Energy and Environment, City University of Hong Kong, Hong Kong SAR, China
| | - K O Bøifot
- Comprehensive Defence Division, Norwegian Defence Research Establishment FFI, Kjeller, Norway
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK
| | - D Bezdan
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - D J Butler
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - D C Danko
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - J Gohli
- Comprehensive Defence Division, Norwegian Defence Research Establishment FFI, Kjeller, Norway
| | - D C Green
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK
| | - M T Hernandez
- Environmental Engineering Program, College of Engineering and Applied Science, University of Colorado, Boulder, CO, USA
| | - F J Kelly
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK
| | - S Levy
- HudsonAlpha Institute of Biotechnology, Huntsville, AL, USA
| | - G Mason-Buck
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK
| | - M Nieto-Caballero
- Environmental Engineering Program, College of Engineering and Applied Science, University of Colorado, Boulder, CO, USA
| | - D Syndercombe-Court
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK
| | - K Udekwu
- Department of Aquatic Sciences & Assessment, Swedish University of Agriculture, Uppsala, Sweden
| | - B G Young
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - C E Mason
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA.
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA.
- The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY, USA.
- The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - M Dybwad
- Comprehensive Defence Division, Norwegian Defence Research Establishment FFI, Kjeller, Norway.
- Department of Analytical, Environmental & Forensic Sciences, King's College London, London, UK.
| | - P K H Lee
- School of Energy and Environment, City University of Hong Kong, Hong Kong SAR, China.
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Cox-Smith A, Cooper T, Punjabi P, Barton C, Levy S, Plymen C, Cole G. 95 Lack of Evidence for Reduced Efficacy of Medical Therapy for Heart Failure in Older Adults. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.56] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
There are almost a million people with heart failure (HF) in the UK; the incidence increases sharply with age. Older adults receive less evidence-based therapy with few trials specifically examining therapeutic efficacy in older age groups representative of a contemporary UK HF population. Concern that efficacy is less in older adults may underlie under-prescription. With important recent advances in HF therapy, we reviewed the contemporary evidence base for any signal of different efficacy in older adults.
Methods
We reviewed recent RCTs of medical therapy for heart failure alongside meta-analyses updated with recent therapies including Angiotensin-Neprilysin inhibitors and SGLT2 inhibitors. For those trials in which effect size was presented for age subgroups we compared the effect size.
Results
Of 68 randomised controlled trials, 10 presented effect sizes for different age groups. The median average cut-off between younger and older age groups was 66 years (IQR 65 to 72.5 years) and the highest cut-off used was 75 years. The median hazard ratio was 0.77 (IQR 0.67 to 0.80) for the younger age group and 0.76 (IQR 0.73 to 0.88) for the older age group. In 8 of the 10 trials, the effect size in the oldest age group was statistically significant on its own including Sacubitril-Valsartan and Dapagliflozin.
Conclusion
When considering the medical therapeutic armamentarium for heart failure as a totality, there is no evidence it is any less effective in older adults than younger adults. The recent Zannad et al cross-trial analysis supported this showing significant additional life years in the patients over 80 years on HF therapy. Whilst there may be practical and frailty-related reasons for not prescribing life-prolonging therapy, the proportional survival benefits of these medications is similar in older adults. This should be utilised where practically possible and discussed with patients when making an informed choice.
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Affiliation(s)
- A Cox-Smith
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - T Cooper
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - P Punjabi
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - C Barton
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - S Levy
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - C Plymen
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - G Cole
- Hammersmith Hospital, Imperial College Healthcare NHS Trust
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Alcala N, Dayton T, Mangiante L, Den Hartigh L, Levy S, Van Den Berg J, Moonen L, Derks J, Buikhuisen W, Speel E, Valk G, Tesselaar M, Vriens M, Clevers H, Foll M, Fernandez-Cuesta L. P47.03 Understanding Lung Neuroendocrine Tumor Progression Combining Organoid Models and Multi-Omic Analyses. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.859] [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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19
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Witte TH, Weymouth BB, Gajos JM, Penunuri A, Levy S. Trauma Exposure and Problem Drinking in Late Adolescence: A Latent Profile Analysis. J Trauma Stress 2020; 33:1048-1059. [PMID: 33038904 DOI: 10.1002/jts.22599] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/06/2022]
Abstract
Exposure to early traumatic events has been implicated in problem drinking during late adolescence, and this association may be stronger among youth with emotion regulation deficits. The purpose of this study was to identify subgroups of late adolescents based on trauma type, including loss, posttraumatic stress disorder (PTSD) symptoms; and emotion regulation deficits that confer the risk for problematic drinking behaviors. A sample of 946 participants (M age = 18.84 years, SD = 1.06) was analyzed with mixed-indicator latent profile analysis to identify subgroups and explore whether these subgroups displayed significant differences regarding elevated drinking frequency, alcohol quantity, and problematic alcohol use. A four-profile model yielded the best fit to the data, and four groups were identified and labeled "high functioning" (29.4%), "loss regulated" (32.3%), "loss dysregulated" (28.1%), and "multiple trauma dysregulated" (10.1%). Individuals in the high functioning group reported the lowest rates on all three measures of alcohol misuse (14.6-24.9%), whereas those in the multiple trauma dysregulated group reported the highest rates on all three measures (31.6-71.5%). Individuals in the multiple trauma dysregulated group (M = 0.25) differed significantly from those in the other three groups (Ms = 0.42-0.72) on the measure of problematic alcohol use but scored similarly to those in the loss dysregulated group on measures of drinking frequency (M = 0.32 and 0.24, respectively) and quantity (M = 0.43 and 0.39, respectively). These findings have implications for prevention programs targeted for alcohol use disorders among older adolescents.
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Affiliation(s)
- Tricia H Witte
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Tuscaloosa, Alabama, USA
| | - Bridget B Weymouth
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Tuscaloosa, Alabama, USA
| | - Jamie M Gajos
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Tuscaloosa, Alabama, USA
| | - Andrew Penunuri
- Department of Management, The University of Alabama, Tuscaloosa, Tuscaloosa, Alabama, USA
| | - Sera Levy
- Department of Psychology, The University of Alabama, Tuscaloosa, Tuscaloosa, Alabama, USA
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Gilad O, Rabinowich L, Levy S, Gotlieb N, Lubezky N, Goykhman Y, Nachmany I, Katz P, Shibolet O, Katchman H. Metabolic and Renal Effects of Mammalian Target of Rapamycin Inhibitors Treatment After Liver Transplantation: Real-Life Single-Center Experience. Transplant Proc 2020; 53:221-227. [PMID: 32650991 DOI: 10.1016/j.transproceed.2020.05.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mammalian target of rapamycin (mTOR) inhibitors following liver transplantation (LT) are used to minimize calcineurin inhibitor (CNI)-related nephrotoxicity. Data about metabolic effects of mTOR inhibitors are still limited. AIM This study aims to determine the renal and metabolic effects of different mTOR inhibitor-based protocols in real-life LT patients. METHODS This is a retrospective cohort study of patients treated with mTOR inhibitors after LT. Demographics, treatment protocols, glomerular filtration rate (GFR), and metabolic parameters were collected over a period of 4 years. Initiation of blood pressure (BP), diabetes mellitus, and lipid medications was also noted. RESULTS Fifty-two LT recipients received mTOR inhibitors. GFR improved significantly (by 1.96 mL/min/year), with greater improvement in patients with baseline renal dysfunction (+13.3 mL/min vs +4.5 mL/min at 3 years). Conversion to an mTOR inhibitor during the first post-transplant year resulted in a more durable improvement in GFR (for 4 years vs only 1 year for later conversion).No significant weight gain or new-onset diabetes mellitus was observed. However, there was some increase in total cholesterol (+7 mg/dL) and blood pressure (+2 mm Hg during the third year and +8 mm Hg in the fourth years), followed by initiation of lipid-lowering and BP medications in 25% and 13% of patients, respectively. CONCLUSIONS Treatment with an mTOR inhibitor following LT resulted in improved kidney functions without significant negative metabolic effects such as weight gain or new-onset diabetes mellitus. This makes mTOR inhibitors a valuable immunosuppressive option in the face of the growing incidence of nonalcoholic steatohepatitis as a leading cause for LT.
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Affiliation(s)
- O Gilad
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - L Rabinowich
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Levy
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Gotlieb
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - N Lubezky
- Devision of Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Goykhman
- Devision of Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Nachmany
- Devision of Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - P Katz
- Devision of Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Shibolet
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Katchman
- Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rodav O, Levy S, Hamdan S. Clinical characteristics and functions of non-suicide self-injury in youth. Eur Psychiatry 2020; 29:503-8. [DOI: 10.1016/j.eurpsy.2014.02.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
AbstractPurposeLittle is known about the clinical characteristics and motivations for engaging in non-suicide self-injury (NSSI) behaviors in adolescence. The aim of this study was to examine the prevalence, characteristics and functions of NSSI among adolescents in community settings, and to explore risk factors related to this behavior.Subjects and methodsTwo hundred and seventy-five adolescents aged 12 to 17 were recruited randomly from different High Schools in Israel. They completed self-report questionnaires assessing NSSI (Ottawa Self-Injury Inventory), depression (Children's Depression Inventory – CDI) and impulsivity (Barratt Impulsiveness Scale – BIS-II).ResultsIn the past year, 20.7% of the participants reported engaging NSSI at least once. Among them, 42.1% declared they are still engaging in NSSI at the present. Motives for NSSI were internal emotion regulation reasons, external emotion regulation reasons for social influences. In addition, the NSSI group reported significantly higher levels of depressive, impulsivity and suicidal ideations. Depressive symptoms were found as significant predictors of NSSI in the future.Discussion and conclusionsHigh rates of NSSI among community adolescents were found. Depression, impulsivity and suicidal ideation were found significantly related to NSSI. Mental health professionals in schools and in primary care should routinely assess NSSI among adolescents.
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22
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Domanovits H, Carbajosa Dalamau J, Hartikainen J, Juhlin T, Ritz B, Levy S. P4775Efficacy and safety of vernakalant for cardioversion of recent-onset atrial fibrillation in real-world clinical practice: the SPECTRUM post-approval safety study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1151] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vernakalant is an antiarrhythmic agent designed for pharmacological conversion of recent onset of atrial fibrillation (AF) with combined action on cardiac potassium and sodium currents mainly concentrated in the atria.
Purpose
SPECTRUM was a post-authorisation safety study of vernakalant, conducted to collect information about real-life conditions of use and appropriate dosing, and to quantify possible medically significant risks associated with the use of vernakalant in real-world clinical practice.
Methods
This prospective and retrospective registry was conducted from Sep 2011 to Apr 2018 in 53 hospitals in EU countries including Austria, Denmark, Finland, Germany, Spain and Sweden. A total of 1,778 patients with 2,009 episodes of recent-onset AF received vernakalant and were followed up for 24 hours after the last infusion or until hospital discharge/end of medical encounter to obtain information on medically significant health outcomes of interest (HOIs, defined as significant hypotension, significant ventricular arrhythmia, significant atrial flutter, significant bradycardia), and serious adverse events (SAEs).
Results
In more than 99% of treatments, vernakalant was used in accordance to the labelled indication for conversion of AF for non-surgery (94.7%) or post-cardiac surgery patients (5.2%). Vernakalant was administered in the emergency department in 64.2% of cases, with a median stay of 7.5 hours and successfully converted 70.2% (95% CI: 68.1–72.2) of patients in the effectiveness analysis population with a median time to conversion of 11 minutes (95% CI: 8.0–27.0). A total of 19 HOIs were reported in 17 patients (0.8%, 95% CI: 0.5– .4%) with individual HOIs ranging from <0.1% to 0.7% suggesting these HOIs are uncommon. Significant bradycardia was the most common HOI observed in 15 patients (0.8%, 95% CI: 0.4–1.2%), with all events occurring within the first two hours (0.8%, 95% CI: 0.4–1.2%). The incidence of significant hypotension was 0.1% (2/2,009), significant atrial flutter (with 1:1 conduction) was 0.1% (2/2,009), and significant ventricular arrhythmia (sustained ventricular tachycardia) was <0.1% (1/2,009). A total of 28 SAEs, including all HOIs, were observed (1.3%, 95% CI: 0.8–1.9%); all patients fully recovered, except one who recovered with sequelae after an SAE of pericardial effusion definitely not related to vernakalant. There were no cases of torsades de pointes, ventricular fibrillation, or deaths reported in the SPECTRUM study.
Conclusion(s)
SPECTRUM is, to our knowledge, the largest drug registry conducted on the cardioversion of recent onset AF. The cumulative data from 2,009 vernakalant treatment episodes demonstrate an incidence of HOIs and SAEs similar or lower to what has been reported in earlier vernakalant IV clinical trials. The observed conversion rate was higher than reported in pivotal trials supporting vernakalant's efficacy and allowing early discharge.
Acknowledgement/Funding
Study funded by Correvio International Sarl, Geneva, Switzerland
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Affiliation(s)
- H Domanovits
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | | | | | - T Juhlin
- Skane University Hospital, Lund, Sweden
| | - B Ritz
- Correvio International Sarl, Geneva, Switzerland
| | - S Levy
- Aix-Marseille University, Marseille, France
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23
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Levy S, Aarts M, Eskens F, Keymeulen K, Been L, Grünhagen D, van Akkooi A, Jalving M, Tesselaar M. Avelumab for advanced Merkel cell carcinoma in the Netherlands: A nationwide survey. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.008] [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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24
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Levy S, Hahner C, Carhart F. P1.07-07 An Interdisciplinary Collaborative Approach to Discharge Readiness on a Thoracic Surgery Specialty Unit. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1016] [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]
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25
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Levy S, Moschandreas J, Debiram-Beecham I, O’Donovan M, Brooks C, Bailey A, Hawkins M, Kadri S, de Caestecker J, Crosby T, Fitzgerald R, Mukherjee S. Cytosponge™ for post‐chemoradiation surveillance of oesophageal cancer: a feasibility study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.209] [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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26
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Scher N, Riet F, Janoray G, Debbi K, Levy S, Louisot P, Chajon E, Salame E, Barillot I, De Crevoisier R, Calais G, Chapet S. EP-1414 SBRT for the treatment of hepatocellular carcinoma: a retrospective multicenter study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mathieu J, Detraux D, Kuppers D, Wang Y, Cavanaugh C, Sidhu S, Levy S, Robitaille AM, Ferreccio A, Bottorff T, McAlister A, Somasundaram L, Artoni F, Battle S, Hawkins RD, Moon RT, Ware CB, Paddison PJ, Ruohola-Baker H. Folliculin regulates mTORC1/2 and WNT pathways in early human pluripotency. Nat Commun 2019; 10:632. [PMID: 30733432 PMCID: PMC6367455 DOI: 10.1038/s41467-018-08020-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/05/2018] [Indexed: 01/05/2023] Open
Abstract
To reveal how cells exit human pluripotency, we designed a CRISPR-Cas9 screen exploiting the metabolic and epigenetic differences between naïve and primed pluripotent cells. We identify the tumor suppressor, Folliculin(FLCN) as a critical gene required for the exit from human pluripotency. Here we show that FLCN Knock-out (KO) hESCs maintain the naïve pluripotent state but cannot exit the state since the critical transcription factor TFE3 remains active in the nucleus. TFE3 targets up-regulated in FLCN KO exit assay are members of Wnt pathway and ESRRB. Treatment of FLCN KO hESC with a Wnt inhibitor, but not ESRRB/FLCN double mutant, rescues the cells, allowing the exit from the naïve state. Using co-immunoprecipitation and mass spectrometry analysis we identify unique FLCN binding partners. The interactions of FLCN with components of the mTOR pathway (mTORC1 and mTORC2) reveal a mechanism of FLCN function during exit from naïve pluripotency. The pathways involved in exit from pluripotency in human embryonic stem cells are poorly understood. Here, the authors performed a CRISPR-based screen to identify genes that promote exit from naïve pluripotency and find a role for folliculin (FLCN) by regulating the mTOR and Wnt pathways.
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Affiliation(s)
- J Mathieu
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - D Detraux
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Laboratory of Cellular Biochemistry and Biology (URBC), University of Namur, Namur, 5000, Belgium
| | - D Kuppers
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Y Wang
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA, 98109, USA
| | - C Cavanaugh
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Sidhu
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Levy
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - A M Robitaille
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Pharmacology, University of Washington, Seattle, WA, 98195, USA
| | - A Ferreccio
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - T Bottorff
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - A McAlister
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - L Somasundaram
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - F Artoni
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA.,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - S Battle
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Medical Genetics & Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - R D Hawkins
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Medical Genetics & Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - R T Moon
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Pharmacology, University of Washington, Seattle, WA, 98195, USA
| | - C B Ware
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, 98109, USA
| | - P J Paddison
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA. .,Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - H Ruohola-Baker
- Department of Biochemistry, University of Washington, Seattle, WA, 98195, USA. .,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, 98109, USA.
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Bomzon Z, Naveh A, Levy S, Kirson E, Weinberg U. P01.048 A novel transducer array layout for delivering Tumor Treating Fields to the infratentorial brain at therapeutic levels. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
| | - A Naveh
- Novocure ltd., Haifa, Israel
| | - S Levy
- Novocure ltd., Haifa, Israel
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Urman N, Levy S, Frenkel A, Naveh A, Hershkovich HS, Kirson E, Wenger C, Lavy-Shahaf G, Manzur D, Yesharim O, Bomzon Z. P04.57 Creating patient-specific computational head models for the study of tissue-electric field interactions using deformable templates. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.291] [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)
- N Urman
- Novocure ltd., Haifa, Israel
| | - S Levy
- Novocure ltd., Haifa, Israel
| | | | - A Naveh
- Novocure ltd., Haifa, Israel
| | | | | | - C Wenger
- Novocure Gmbh, root D4, Switzerland
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Urman N, Hershkovich HS, Naveh A, Levy S, Bomzon Z. P04.31 Defining Tumor Treating Fields (TTFields) dosimetry using Power Density Loss and related measures. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.265] [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: 11/13/2022] Open
Affiliation(s)
- N Urman
- Novocure ltd., Haifa, Israel
| | | | - A Naveh
- Novocure ltd., Haifa, Israel
| | - S Levy
- Novocure ltd., Haifa, Israel
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Cabello FC, Cohen SN, Curtiss R, Dougan G, van Embden J, Finlay BB, Heffron F, Helinski D, Hull R, Hull S, Isberg R, Kopecko DJ, Levy S, Mekalanos J, Ortiz JM, Rappuoli R, Roberts MC, So M, Timmis KN. Farewell Stan Stanley Falkow: 1934-2018. Environ Microbiol 2018; 20:2322-2333. [PMID: 30146753 DOI: 10.1111/1462-2920.14308] [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: 11/30/2022]
Affiliation(s)
- F C Cabello
- Department of Microbiology and Immunology, New York Medical College, Valhalla, NY, USA
| | - S N Cohen
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - R Curtiss
- Departments of Infectious Diseases and Immunology and Comparative, Diagnostic and Population Medicine, University of Florida, Gainesville, FL, USA
| | - G Dougan
- Microbial Pathogenesis Group, Welcome Sanger Institute, Hinxton, UK
| | - J van Embden
- Division of Infectious Diseases, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - B B Finlay
- Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
| | - F Heffron
- Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA
| | - D Helinski
- Biological Sciences, University of California San Diego, La Jolla, CA, USA
| | - R Hull
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - S Hull
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - R Isberg
- Department of Molecular Biology and Microbiology, Tufts University School of Medicine, Boston, MA, USA
| | | | - S Levy
- Department of Molecular Biology and Microbiology, Tufts University, Boston, MA, USA
| | - J Mekalanos
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA
| | - J M Ortiz
- Departamento de Biologia Molecular, Universidad de Cantabria, Santander, Spain
| | | | - M C Roberts
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - M So
- Department of Immunobiology, University of Arizona, Tucson, AZ, USA
| | - K N Timmis
- Institute of Microbiology, Technical University of Braunschweig, Braunschweig, Germany
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Nossel HL, Lanzkowsky P, Levy S, Mibashan RS, Hansen JDL. A Study of Coagulation Factor Levels in Women during Labour and in Their Newborn Infants. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1655636] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summary1. Coagulation factors levels were measured in 10 normal mothers and in their infants within 15 min of birth and at 48-96 hrs of age.2. In the mothers the levels of fibrinogen (532 mg/%), factors VIII (196%), IX (130%) and X (122%) were elevated; the levels of prothrombin (107%) and factor V (108%) were normal ; and the level of factor XI (69%) was reduced.3. The infants blood examined within 15 min of birth had a slightly elevated factor VIII level (138%), slightly reduced fibrinogen (195 mg/%) and factor V levels (79%), low levels of prothrombin (55%) and factors IX (27%), X (35%) and XI (32%).4. Blood from the infants at 48-96 hrs of age showed little change from the birth levels of factors V (89%), and VIII (116%) and a slight increase in factor XI level (39%). Four of the infants had received vitamin K1 and had higher levels of prothrombin and factors IX and X than the 7 who had not received vitamin K1.5. These results are compared with those of previous studies and the possible mechanisms underlying the changes is discussed.
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Levy S, Chaouat M, Malca N, Serror K, Mimoun M, Boccara D. [Not Available]. Ann Burns Fire Disasters 2018; 31:4-9. [PMID: 30174563 PMCID: PMC6116657] [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] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Chemical burns raise diagnostic and treatment issues because they have specific appearances and evolution. Our objective was to study the characteristics of chemical burns and to assess the quality of our treatment. This retrospective observational study examined the records of all patients admitted for chemical burns to the burn treatment center of Saint Louis Hospital in Paris from January 1, 1990, through December 31, 2015. During this period, 162 patients came to our center for chemical burn treatment. Most of them were men (67%). The majority of the burns were caused by alkalis (27%) and resulted from workplace accidents (29%). The average time before consultation was 5.36 days. The areas mainly damaged were the hands (36%) and the burn areas averaged 1.2% of the total body surface area (TBSA). Forty-eight patients had at least one deep patch. In total, 59 patients (36.4%) were hospitalized for an average duration of 4.18 days. Thirty-eight of them underwent surgery. Lastly, 92% of the operations had been anticipated from the first consultation. In our center, the population affected, the circumstances and the topography of our patients' burns were similar to the data from the literature. It appears that the principal specificity of our series is a very low body surface burned. This can be attributed to the prevention measures we have in France and underlines their importance. Only 8% of the patients who had surgery were underestimated or their burns became deeper secondarily. This number is lower than the data from other series.
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Affiliation(s)
- S. Levy
- Samuel Levy
Centre de Traitement des Brûlés, Hôpital St Louis1, avenue Claude Vellefaux, 75010 ParisFrance+33630212158
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Thakur U, Levy S, Sivaratnam D, Herath D, Nadesapillai S, Toh H, Westcott J, Lichtenstein M, Hepworth G, Better N. The Relationship Between Ischaemia on Myocardial Perfusion Imaging and Chest Pain or Electrocardiogram Changes During Exercise. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.532] [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]
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Levy S, Vences-Catalán F, Kuo C, Rajapaksa R, Duault C, Levy R, Levy S. EFFECTIVE THERAPY BY ANTI-CD81 AGAINST B CELL LYMPHOMAS ENGAGES BOTH DIRECT AND INDIRECT IMMUNE MECHANISMS. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_126] [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: 11/06/2022]
Affiliation(s)
- S. Levy
- Medicine/Oncology, Stanford; Stanford USA
| | | | - C. Kuo
- Medicine/Oncology, Stanford; Stanford USA
| | | | - C. Duault
- Medicine/Oncology, Stanford; Stanford USA
| | - R. Levy
- Medicine/Oncology, Stanford; Stanford USA
| | - S. Levy
- Medicine/Oncology, Stanford; Stanford USA
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Levy S, Banerjee S, Theofanous TG, Hsu YY. Preface: Nuclear Reactor Thermal Hydraulics. NUCL SCI ENG 2017. [DOI: 10.13182/nse84-a18577] [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]
Affiliation(s)
- S. Levy
- S. Levy Incorporate, 3425 South Bascom Avenue Campbell, California 95008-70006
| | - S. Banerjee
- University of Californ, Department of Chemical and Nuclear Engineering, Santa Barbara, California 93106
| | - T. G. Theofanous
- Purdue University, Department of Nuclear ar Engineering, West Lafayette, Indiana 47907
| | - Y. Y. Hsu
- University of Marylan, Department of Chemical and Nuclear Engineering, College Park, Maryland 20742
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Cornelius T, Earnshaw VA, Menino D, Bogart LM, Levy S. Treatment motivation among caregivers and adolescents with substance use disorders. J Subst Abuse Treat 2017; 75:10-16. [PMID: 28237049 DOI: 10.1016/j.jsat.2017.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/09/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
Abstract
Substance use disorders (SUDs) in adolescence have negative long-term health effects, which can be mitigated through successful treatment. Caregivers play a central role in adolescent treatment involvement; however, studies have not examined treatment motivation and pressures to enter treatment in caregiver/adolescent dyads. Research suggests that internally motivated treatment (in contrast to coerced treatment) tends to lead to better outcomes. We used Self-determination theory (SDT) to examine intersecting motivational narratives among caregivers and adolescents in SUD treatment. Relationships between motivation, interpretation of caregiver pressures, adolescent autonomy, and relatedness were also explored. Adolescents in SUD treatment and their caregivers (NDyads=15) were interviewed about treatment experiences. Interviews were coded for treatment motivation, including extrinsic (e.g., motivated by punishment), introjected (e.g., motivated by guilt), and identified/integrated motivation (e.g., seeing a behavior as integral to the self). Internalization of treatment motivation, autonomy support/competence (e.g., caregiver support for adolescent decisions), and relatedness (e.g., acceptance and support) were also coded. Four dyadic categories were identified: agreement that treatment was motivated by the adolescent (intrinsic); agreement that treatment was motivated by the caregiver (extrinsic); agreement that treatment was motivated by both, or a shift towards adolescent control (mixed/transitional); and disagreement (adolescents and caregivers each claimed they motivated treatment; conflicting). Autonomy support and relatedness were most prominent in intrinsic dyads, and least prominent in extrinsic dyads. The mixed/transitional group was also high in autonomy support and relatedness. The extrinsic group characterized caregiver rules as an unwelcome mechanism for behavioral control; caregivers in the other groups saw rules as a way to build adolescent competence and repair relationships, and adolescents saw rules as indicating care rather than control. Adolescents with intrinsic motivations were the most engaged in treatment. Results suggest the importance of intrinsically motivated treatment, and highlight autonomy support and relatedness as mechanisms that might facilitate treatment engagement.
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Affiliation(s)
- T Cornelius
- University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT 06269, United States.
| | - V A Earnshaw
- University of Delaware, Department of Human Development and Family Studies, 111 Alison Hall West, Newark, DE 19716, United States; Boston Children's Hospital, Division of General Pediatrics, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Department of Pediatrics, 25 Shattuck Street, Boston, MA 02115, United States
| | - D Menino
- Boston Children's Hospital, Division of General Pediatrics, 300 Longwood Avenue, Boston, MA 02115, United States
| | - L M Bogart
- Boston Children's Hospital, Division of General Pediatrics, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Department of Pediatrics, 25 Shattuck Street, Boston, MA 02115, United States; RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, United States
| | - S Levy
- Harvard Medical School, Department of Pediatrics, 25 Shattuck Street, Boston, MA 02115, United States; Boston Children's Hospital, Division of Developmental Medicine, 300 Longwood Avenue, Boston, MA 02115, United States
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Kaabour M, Guerisse F, Mols P, Levy S. [Pseudotumor cerebri due to taking minocycline]. Rev Med Brux 2017; 38:169-172. [PMID: 28653520] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The cerebral pseudotumor (PTC) is defined by the increase in cerebrospinal fluid (CSF) pressure, a normal composition of the latter in the absence of identified intracranial structural abnormalities, in particular by neuroimaging. The pathophysiology of PTC is poorly understood although its diagnostic criteria are well established. Drugs such as minocycline, tetracycline and doxycycline have been repeatedly implicated as a causative factor in PTC. The prognosis of PTC related to minocycline, reported in the literature is quite variable. Some authors suggest a benign condition with spontaneous healing by stopping the antibiotic, while others report permanent loss of vision. A 12-year-old girl is admitted to the emergency room for progressively progressive pulsatile temporal headaches associated with diplopia. The patient reported the use of minocycline 50 mg / d for five months, prescribed by her attending physician as part of an acne treatment. PTC will be demonstrated by severe papillary edema and cerebral NMR will demonstrate an enlargement of the subarachnoid space around the optic nerves. After three lumbar punctures, the condition of the patient stabilized and there was a marked improvement in headache despite the persistence of bilateral papillary edema. This work describes a clinical case of PTC induced by the use of minocycline and reviews the physiopathology, the diagnosis and the management of this one.
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Affiliation(s)
- M Kaabour
- Service des Urgences Pédiatriques, H.U.D.E.R.F
| | - F Guerisse
- Service de Médecine Interne-Urgences, C.H.U. Tivoli, La Louvière
| | - P Mols
- Service des Urgences et du SMUR, C.H.U. Saint-Pierre
| | - S Levy
- Service de Médecine interne, Hôpital Erasme
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Marshall T, VanBuren J, Cavanaugh J, Warren J, Curtis A, Levy S. Beverage Clusters Have Limited Associations with Dental Caries During Adolescence. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2016.06.026] [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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Abstract
This paper summarizes a current study examining the availability, appropriateness and acceptability of a technologically dependable healthcare provision to both service users and staff. An interface between the Electronic Patient Record (EPR) and future home care technology (Telecare) is suggested in the form of a ‘technology prescription’. It is argued that appropriately prescribed technology will enable people to benefit from a modern, evidence-based service, which promotes a proactive means of addressing and preventing future health and care needs. The paper argues that technological innovations in care must not be perceived as a threat to the partnerships necessary in achieving maximum health gains, but rather be an aid to a patient centred clinical encounter.
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Affiliation(s)
- S. Levy
- School of Science and Engineering University of Abertay Dundee DD1 1HG, UK Tel: +44 (0)1382 308696
| | - D. A. Bradley
- School of Science and Engineering, University of Abertay, Dundee
| | - M. T. Swanston
- School of Social and Health Sciences, University of Abertay, Dundee
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Korecka J, Levy S, Isacson O. In vivo modeling of neuronal function, axonal impairment and connectivity in neurodegenerative and neuropsychiatric disorders using induced pluripotent stem cells. Mol Cell Neurosci 2016; 73:3-12. [DOI: 10.1016/j.mcn.2015.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/04/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023] Open
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Porter A, Kennard D, Lang SJ, Levy S, Wang Q, Djedovic N, Chua E. 65ARE TOO MANY PATIENTS GREATER THAN 80 YEARS OLD WITH NON-VALVULAR ATRIAL FIBRILLATION EXPOSED TO UNDUE BLEEDING RISK FROM WARFARIN? Age Ageing 2016. [DOI: 10.1093/ageing/afw034.02] [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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Levy S, Porter A, Desai A, Nallamuthu N, Shah N, Swart E, Thum LP, Chua E. 26ADMISSION AVOIDANCE USING GERIATRICIAN LED VIRTUAL WARD ROUNDS IN A RAPID RESPONSE SERVICE: THE HARROW STARRS MODEL. Age Ageing 2016. [DOI: 10.1093/ageing/afw024.26] [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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Affiliation(s)
- S Levy
- Royal Eye Infirmary, Derriford Hospital, Plymouth, Devon, UK
| | - A Booth
- Royal Eye Infirmary, Derriford Hospital, Plymouth, Devon, UK
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Cohen-Zubary N, Gingold-Belfer R, Levy S, Wasserberg N, Dickman R. Home electrical stimulation for women with fecal incontinence: a preliminary randomized controlled trial. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.441] [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]
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Abstract
In patients with WPW syndrome the maximal ventricular rate attained during ectopic rapid supraventricular thythms depended on the type of arrhythmia as well as on the physiological properties of the AP. During reciprocating tachycardias the impulse is almost invariably conducted to the ventricles through the AV node. Therefore, the maxiaml ventricular rate is a function of the AV nodal ERP. On the other hand, when atrial flutter or atrial fibrillation were present the ventricular rate could be moderately elevated (when the ERP of the AP was longer than that of the AV node) or very rapid where the ERP of the AP was significantly short. Therefore, from the electrophysiological viewpoint, the AP appears to behave as His-Purkinje tissue in some cases and as ordinary artrial muscle in other patients. These assumptions await further documentation.
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Polk DE, Geng M, Levy S, Koerber A, Flay BR. Frequency of daily tooth brushing: predictors of change in 9- to 11-year old US children. Community Dent Health 2014; 31:136-140. [PMID: 25300146 PMCID: PMC4197133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate whether an increase in daily tooth brushing frequency in children was predicted by either a) having a strong intention to brush twice a day or b) their parents receiving information about their new caries experience. BASIC RESEARCH DESIGN Secondary data analyses were conducted on two waves of data from the Aban Aya Youth Project and the Iowa Fluoride Study. PARTICIPANTS The Aban Aya study included 576 10- and 11-year olds from Chicago, Illinois. The Iowa Fluoride Study included a convenience sample of 709 babies born in Iowa. The present study includes those children at age 9. MAIN OUTCOME MEASURES In both studies, reported daily tooth brushing frequency was assessed twice six months apart. RESULTS In the Aban Aya data, compared with children with a weak intention at wave 1 to brush twice a day, children with a strong intention to brush twice a day were more likely to increase their brushing frequency by wave 2, OR 7.0, 95%CI 1.5,32.9. In the Iowa Fluoride Study, compared with children who did not have new caries at wave 1, children who had new caries experience were less likely to increase their brushing frequency by wave 2, OR 0.4, 95%CI 0.2,0.9. CONCLUSIONS Strengthening intention to brush twice a day might increase children's brushing frequency. However, simply providing parents with information about new caries probably will not. Future studies should assess tooth brushing frequency, habit strength, intention, and situational cues at closely-spaced waves.
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Scott-Van Zeeland AA, Bloss CS, Tewhey R, Bansal V, Torkamani A, Libiger O, Duvvuri V, Wineinger N, Galvez L, Darst BF, Smith EN, Carson A, Pham P, Phillips T, Villarasa N, Tisch R, Zhang G, Levy S, Murray S, Chen W, Srinivasan S, Berenson G, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell JE, Strober M, Rotondo A, Treasure J, Woodside DB, Bulik CM, Keel P, Klump KL, Lilenfeld L, Plotnicov K, Topol EJ, Shih PB, Magistretti P, Bergen AW, Berrettini W, Kaye W, Schork NJ. Evidence for the role of EPHX2 gene variants in anorexia nervosa. Mol Psychiatry 2014; 19:724-32. [PMID: 23999524 PMCID: PMC3852189 DOI: 10.1038/mp.2013.91] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 06/19/2013] [Accepted: 06/24/2013] [Indexed: 01/08/2023]
Abstract
Anorexia nervosa (AN) and related eating disorders are complex, multifactorial neuropsychiatric conditions with likely rare and common genetic and environmental determinants. To identify genetic variants associated with AN, we pursued a series of sequencing and genotyping studies focusing on the coding regions and upstream sequence of 152 candidate genes in a total of 1205 AN cases and 1948 controls. We identified individual variant associations in the Estrogen Receptor-ß (ESR2) gene, as well as a set of rare and common variants in the Epoxide Hydrolase 2 (EPHX2) gene, in an initial sequencing study of 261 early-onset severe AN cases and 73 controls (P=0.0004). The association of EPHX2 variants was further delineated in: (1) a pooling-based replication study involving an additional 500 AN patients and 500 controls (replication set P=0.00000016); (2) single-locus studies in a cohort of 386 previously genotyped broadly defined AN cases and 295 female population controls from the Bogalusa Heart Study (BHS) and a cohort of 58 individuals with self-reported eating disturbances and 851 controls (combined smallest single locus P<0.01). As EPHX2 is known to influence cholesterol metabolism, and AN is often associated with elevated cholesterol levels, we also investigated the association of EPHX2 variants and longitudinal body mass index (BMI) and cholesterol in BHS female and male subjects (N=229) and found evidence for a modifying effect of a subset of variants on the relationship between cholesterol and BMI (P<0.01). These findings suggest a novel association of gene variants within EPHX2 to susceptibility to AN and provide a foundation for future study of this important yet poorly understood condition.
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Affiliation(s)
- A A Scott-Van Zeeland
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - C S Bloss
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tewhey
- Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Bansal
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - A Torkamani
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - O Libiger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - V Duvvuri
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N Wineinger
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - L Galvez
- The Scripps Translational Science Institute, La Jolla, CA, USA
| | - B F Darst
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - E N Smith
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - A Carson
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - P Pham
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - T Phillips
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - N Villarasa
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - R Tisch
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - G Zhang
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA
| | - S Levy
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - S Murray
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - W Chen
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - S Srinivasan
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - G Berenson
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - H Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - M M Fichter
- Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - K A Halmi
- Eating Disorder Research Program Weill Cornell Medical College, White Plains, NY, USA
| | - C Johnson
- Eating Recovery Center, Denver, CO, USA
| | - A S Kaplan
- Center for Addiction and Mental Health, Toronto, ON, Canada,Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - M La Via
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - M Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - A Rotondo
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
| | - J Treasure
- Department of Academic Psychiatry, Bermondsey Wing Guys Hospital, University of London, London, UK
| | - D B Woodside
- Department of Psychiatry, Toronto General Hospital, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - C M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Keel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - K L Klump
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - L Lilenfeld
- Clinical Psychology Program, American School of Professional Psychology at Argosy University, Washington, DC, USA
| | - K Plotnicov
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - E J Topol
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - P B Shih
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - P Magistretti
- Laboratory of Neuroenergetics and Cellular Dynamics, The University of Lausanne, Lausanne, Switzerland
| | - A W Bergen
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - W Berrettini
- Department of Psychiatry, The University of Pennsylvania, Philadelphia, PA, USA
| | - W Kaye
- Department of Pediatrics, The University of California, San Diego, La Jolla, CA, USA
| | - N J Schork
- The Scripps Translational Science Institute, La Jolla, CA, USA,Scripps Health, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA,Department of Molecular and Experimental Medicine, The Scripps Research Institute, 3344 N Torrey Pines Court, Room 306, La Jolla, CA 92037, USA. E-mail:
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Putnam L, Levy S, Johnson E, Williams K, Taylor K, Lally K, Tsao K. Same-Day Discharge for Simple Pediatric Appendicitis: Sustainable Quality Improvement Requires Ongoing Surveillance. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.602] [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]
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50
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Putnam L, Levy S, Sajid M, Dubuisson D, Rogers N, Kao L, Lally K, Tsao K. Multi-Faceted Interventions Significantly Improve Checklist Adherence. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.579] [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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