59 results on '"Michelle Chiu"'
Search Results
2. Psychological and situational profiles of social distance compliance during COVID-19
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Michael Robert Haupt, Staci Meredith Weiss, Michelle Chiu, Raphael Cuomo, Jason M. Chein, and Tim Mackey
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Health Information Management ,Communication - Published
- 2022
3. Predicting Oxygen Utilization & Nurse Staffing Needs for SARS-CoV-2
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Satori Iwamoto, Bahaar Kaur Muhar, Ashwin Sidhu, Harrison Chu, Michelle Chiu, Heidi Spantzel, Hillary Chu, Norah Zhou, Arnold Spantzel, Eric Zhang, Gary Chu, MD
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COVID-19, nurse staffing, resource management, machine learning, oxygen utilization - Abstract
Supplemental oxygen is an essential part of in-hospital care for most patients hospitalized with SARS-CoV-2 pneumonia. This study seeks to identify hospitalized patients who will require advanced oxygen support (high flow oxygen, CPAP, BiPAP, or mechanical ventilation) within 96 hours of admission using a machine learning model. This information can be useful for hospitals to plan for nurse staffing, as patients will consume more resources and will need more staff assistance. Data from 302 SARS-CoV-2 patients was used to create a classifier to predict whether or not patients would require advanced oxygen support within 96 hours of admission. Of the 302 cases, 211 were randomly selected to train the model, and 91 were randomly selected for testing. Through a labeled dataset, we performed supervised learning by using a random forest ensemble model which included demographic, clinical comorbidities, vitals, and laboratory values. We used 5-fold cross-validation to evaluate our trained model and employed a majority vote decision across the five trained models in order to produce the final prediction for a given patient. Through the models, we yielded results through sensitivity, specificity, positive predictive value, negative predictive value, and F1 score with the 91 cases of training data. An additional 24 cases were used to test the validity of the ensemble consensus model. Approximately 40% of all patients progressed to require advanced oxygen support 96 hours after the initial presentation. Although the insight gained from the model may not definitively predict the course of an individual patient, this model may help hospital administrators plan for staffing needs with a 48- hour lead time. Patients on high oxygen support require high acuity beds, which have increased nurse-topatient ratios. Additional samples may increase its statistical significance. Nevertheless, this model demonstrates the potential and viability of using data science to help manage hospital resources.
- Published
- 2022
- Full Text
- View/download PDF
4. Predicting Oxygen Utilization & Nurse Staffing Needs for SARS-CoV-2
- Author
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Satori Iwamoto, Bahaar Kaur Muhar, Ashwin Sidhu, Harrison Chu, Michelle Chiu, Heidi Spantzel, Hillary Chu, Norah Zhou, Arnold Spantzel, Eric Zhang, Gary Chu, MD
- Subjects
COVID-19, nurse staffing, resource management, machine learning, oxygen utilization - Abstract
Supplemental oxygen is an essential part of in-hospital care for most patients hospitalized with SARS-CoV-2 pneumonia. This study seeks to identify hospitalized patients who will require advanced oxygen support (high flow oxygen, CPAP, BiPAP, or mechanical ventilation) within 96 hours of admission using a machine learning model. This information can be useful for hospitals to plan for nurse staffing, as patients will consume more resources and will need more staff assistance. Data from 302 SARS-CoV-2 patients was used to create a classifier to predict whether or not patients would require advanced oxygen support within 96 hours of admission. Of the 302 cases, 211 were randomly selected to train the model, and 91 were randomly selected for testing. Through a labeled dataset, we performed supervised learning by using a random forest ensemble model which included demographic, clinical comorbidities, vitals, and laboratory values. We used 5-fold cross-validation to evaluate our trained model and employed a majority vote decision across the five trained models in order to produce the final prediction for a given patient. Through the models, we yielded results through sensitivity, specificity, positive predictive value, negative predictive value, and F1 score with the 91 cases of training data. An additional 24 cases were used to test the validity of the ensemble consensus model. Approximately 40% of all patients progressed to require advanced oxygen support 96 hours after the initial presentation. Although the insight gained from the model may not definitively predict the course of an individual patient, this model may help hospital administrators plan for staffing needs with a 48- hour lead time. Patients on high oxygen support require high acuity beds, which have increased nurse-topatient ratios. Additional samples may increase its statistical significance. Nevertheless, this model demonstrates the potential and viability of using data science to help manage hospital resources.
- Published
- 2022
- Full Text
- View/download PDF
5. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians
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Walter Tavares, Dominique Piquette, Dorothy Luong, Michelle Chiu, Christopher Dyte, Kristin Fraser, and Marcia Clark
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General Medicine ,Education - Published
- 2022
6. Predicting Oxygen Utilization & Nurse Staffing Needs For COVID-19
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Ashwin Sidhu, Satori Iwamoto, Harrison Chu, Michelle Chiu, Heidi Spantzel, Hillary Chu, Norah Zhou, Bahaar Kaur Muhar, Arnold Spantzel, Eric Zhang, and Gary Chu
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- 2022
7. Acute Ischemic Stroke in a Young Woman with an Otherwise Asymptomatic SARS-CoV-2 Infection
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Satori Iwamoto, Mason Johnstone, Michelle Chiu, and Hillary Chu
- Abstract
It was well-observed that SARS-CoV-2 may cause a hypercoagulable state in hospitalized patients. Often these hospitalized patients exhibit severe upper respiratory symptoms with hypoxia, requiring high amounts of oxygen support. In this study, we report a young healthy 30-year-old woman with no medical problems, who experienced an embolic stroke due to an otherwise asymptomatic SARS-CoV-2 infection in July 2020. The patient presented to the emergency department after experiencing sudden slurred speech, dizziness, and acute left leg weakness during a social gathering on a river boat the day prior to admission. She also vomited once, non-bilious. The patient had no upper respiratory symptoms and had not been practicing social distancing nor wearing a mask. She did not have any sick contacts or significant travel history. Patient used oral contraceptives but never smoked. The workup included a Computed Tomography (CT) angiogram, an Magnetic Resonance Imaging (MRI) and an Magnetic Resonance Angiography (MRA) of the brain. It was significant for acute stroke with acute intraluminal thrombus causing partial occlusion of the distal basilar artery with left pontine stroke. Given that the onset of symptoms was greater than 4 hours, she was outside of the tissue Plasminogen Activator (tPA) administration window. Patient was also not a candidate for embolectomy as National Institute of Health Stroke Scale (NIHSS) was 3 and the occlusion was partial. SARS-CoV-2 PCR test was positive. D-Dimer level was elevated but CRP was normal. Echocardiogram was unremarkable. The patient had no history of autoimmune disorder. Patient was initially treated with antiplatelet medications aspirin and clopidogrel (Plavix). Her condition improved and she could ambulate with a front wheel walker and stand by to assist. She was discharged four days later with anticoagulation medication rivaroxaban (Xarelto) for 3 months. This case illustrates that patients with an otherwise asymptomatic SARS-CoV-2 infection may still suffer from complications of SARS-CoV-2. Do women on oral contraceptives have higher risk of arterial embolism when infected with SARS-CoV-2? More study is needed.
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- 2022
8. Influence of Polarity Change and Photophysical Effects on Photosurfactant-Driven Wetting
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Michelle Chiu, Megan T. Valentine, Friedrich Stricker, Lei Zhao, Julia M. Fisher, Miranda Sroda, Serena Seshadri, Sophia J. Bailey, Matthew E. Helgeson, and Javier Read de Alaniz
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Work (thermodynamics) ,Materials science ,Photoswitch ,Polarity (physics) ,Kinetics ,Electrochemistry ,General Materials Science ,Nanotechnology ,Surfaces and Interfaces ,Dewetting ,Wetting ,Condensed Matter Physics ,Spectroscopy - Abstract
Photosurfactants have shown considerable promise for enabling stimuli-responsive control of the properties and motion of fluid interfaces. Recently, a number of photoswitch chemistries have emerged to tailor the photoresponsive properties of photosurfactants. However, systematic studies investigating how photoresponsive surfactant behavior depends on the photochemical and photophysical properties of the switch remain scarce. In this work, we develop synthetic schemes and surfactant designs to produce a well-controlled library of photosurfactants to comparatively assess the behavior of photoswitch chemistry on interfacial behavior. We employ photoinduced spreading of droplets at fluid interfaces as a model for such studies. We show that although photosurfactant response is largely guided by expected trends with changes in polarity of the photoswitch, interfacial behavior also depends nontrivially and sometimes counter-intuitively on the kinetics and mechanisms of photoswitching, particularly at the interface of two solvents, as well as on complex interactions with other surfactants. Understanding these complexities enables the design of new photosurfactant systems and their optimization toward responsive functions including triggered spreading, dewetting, and destabilization of droplets on solid and fluid surfaces.
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- 2021
9. Digital Media and the Developing Brain
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Michelle Chiu and Jason Chein
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- 2022
10. Patient-reported outcome measurement implementation in cancer survivors: a systematic review
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Surbhi Singhal, James Dickerson, Michael J. Glover, Mohana Roy, Michelle Chiu, Timothy Ellis-Caleo, Gavin Hui, Carla Tamayo, Nele Loecher, Hong-nei Wong, Lauren C. Heathcote, and Lidia Schapira
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Oncology ,Oncology (nursing) - Abstract
PURPOSE: Patient-reported outcome measurements (PROMs) are increasingly used for cancer patients receiving active treatment, but little is known about the implementation and usefulness of PROMs in cancer survivorship care. This systematic review evaluates how cancer survivors and healthcare providers (HCPs) perceive PROM implementation in survivorship care, and how PROM implementation impacts cancer survivors' health outcomes.METHODS: We systematically searched PubMed/MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Database of Systematic Reviews from database inception to February 2022 to identify randomized and nonrandomized studies of PROM implementation in cancer survivors.RESULTS: Based on prespecified eligibility criteria, we included 29 studies that reported on 26 unique PROMs. The studies were heterogeneous in study design, PROM instrument, patient demographics, and outcomes. Several studies found that cancer survivors and HCPs had favorable impressions of the utility of PROMs, and a few studies demonstrated that PROM implementation led to improvements in patient quality of life (QoL), with small to moderate effect sizes.CONCLUSIONS: We found implementation of PROMs in cancer survivorship care improved health outcomes for select patient populations. Future research is needed to assess the real-world utility of PROM integration into clinical workflows and the impact of PROMs on measurable health outcomes.IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors accepted PROMs. When successfully implemented, PROMs can improve health outcomes after completion of active treatment. We identify multiple avenues to strengthen PROM implementation to support cancer survivors.
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- 2022
11. Executive Function and Smartphone Use Habits in Young Adults
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Michelle Chiu, Staci M. Weiss, and Jason M. Chein
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- 2022
12. Role of Cation Ordering on Device Performance in (Ag,Cu)InSe2 Solar Cells with KF Post-Deposition Treatment
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William N. Shafarman, April M. Jeffries, Trumann Walker, Michelle Chiu, Archana Sinha, Tara Nietzold, Mariana I. Bertoni, Barry Lai, Michael Stuckelberger, Laura T. Schelhas, and Nicholas Valdes
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010302 applied physics ,Materials science ,Tandem ,Energy Engineering and Power Technology ,X-ray fluorescence ,02 engineering and technology ,021001 nanoscience & nanotechnology ,01 natural sciences ,7. Clean energy ,Coupling (electronics) ,Crystallography ,symbols.namesake ,0103 physical sciences ,Materials Chemistry ,Electrochemistry ,symbols ,Chemical Engineering (miscellaneous) ,Electrical and Electronic Engineering ,0210 nano-technology ,Raman spectroscopy ,Deposition (law) - Abstract
CuInSe2 (CIS) has been proposed as an attractive bottom cell candidate in tandem solar cells. However, to justify the coupling with high-performance top cells (e.g., perovskites, GaAs), significant...
- Published
- 2021
13. Attention and cardiac phase boost judgments of trust
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Michelle Chiu, Xinyi Li, Adam K. Anderson, Khena M. Swallow, and Eve De Rosa
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Value (ethics) ,Adult ,Male ,Boosting (machine learning) ,Adolescent ,media_common.quotation_subject ,Neurophysiology ,lcsh:Medicine ,Trust ,050105 experimental psychology ,Article ,Task (project management) ,03 medical and health sciences ,Fluency ,Electrocardiography ,Judgment ,Young Adult ,0302 clinical medicine ,Perception ,Human behaviour ,Humans ,0501 psychology and cognitive sciences ,Attention ,lcsh:Science ,media_common ,Multidisciplinary ,05 social sciences ,lcsh:R ,Heart ,Trustworthiness ,Heart Function Tests ,Regression Analysis ,Female ,lcsh:Q ,Psychology ,030217 neurology & neurosurgery ,Cardiac phase ,Cognitive psychology - Abstract
Fluctuations in mental and bodily states have both been shown to be associated with negative affective experience. Here we examined how momentary fluctuations in attentional and cardiac states combine to regulate the perception of positive social value. Faces varying in trustworthiness were presented during a go/no-go letter target discrimination task synchronized with systolic or diastolic cardiac phase. Go trials lead to an attentional boosting of perceived trust on high trust and ambiguous neutral faces, suggesting attention both boosted existing and generated positive social value. Cardiac phase during face presentation interacted with attentional boosting of trust, enhancing high trust faces specifically during relaxed diastolic cardiac states. Confidence judgments revealed that attentional trust boosting, and its cardiac modulation, did not reflect altered perceptual or response fluency. These results provide evidence for how moment-to moment fluctuations in top-down mental and bottom-up bodily inputs combine to enhance a priori and generate de novo positive social value.
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- 2020
14. Safety and efficacy of independent allied healthcare professionals in the assessment and management of plagiocephaly patients
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Yahya H. Khormi, Ronette Goodluck Tyndall, Paul Steinbok, David Roy Smith, Michelle Chiu, and Patricia Mortenson
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Canada ,medicine.medical_specialty ,Pediatrics ,Referral ,Plagiocephaly ,Psychological intervention ,Craniosynostosis ,Broadcast control channel ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Humans ,Medicine ,Child ,Retrospective Studies ,Plagiocephaly, Nonsynostotic ,business.industry ,Incidence (epidemiology) ,Infant ,030206 dentistry ,General Medicine ,medicine.disease ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,Neurosurgery ,business ,Delivery of Health Care ,Torticollis - Abstract
Background The incidence of positional plagiocephaly has increased significantly over the last two decades, which has caused a service delivery challenge for pediatric neurosurgeons. As a potential solution to the long waitlists for abnormal head shape, a plagiocephaly clinic was established at BC Children's Hospital (BCCH) in Vancouver, Canada. This clinic was supervised by an occupational therapist who had been trained by a neurosurgeon to independently assess and manage patients with a referring diagnosis of positional plagiocephaly. Objectives To determine the efficiency of the BCCH Plagiocephaly Clinic in the management of positional plagiocephaly patients and to investigate the clinic's ability to appropriately identify and refer patients with craniosynostosis to pediatric neurosurgeons for further assessment. Methods A retrospective chart review was conducted to identify patients who were assessed and managed at the BCCH Plagiocephaly Clinic between 2008 and 2014. Data on patient demographics, head shape measurements, and treatment recommendations were collected, and the BC Children's neurosurgical database was cross-referenced to identify craniosynostosis cases missed by the Plagiocephaly Clinic. A descriptive analysis of the clinic's average wait times, severity of the patients' plagiocephaly, and recommended interventions was conducted. In addition, the sensitivity and specificity of the clinic's ability to appropriately refer craniosynostosis patients to pediatric neurosurgery were calculated. Results Of 1752 patients seen in the BC Children's Plagiocephaly Clinic between 2008 and 2014, 66% of patients received counseling about repositioning, 34% were referred for head banding, 19% were referred to physiotherapy for torticollis, and 1.4% were referred to the BC Children's Pediatric Neurosurgery Clinic for suspicion of craniosynostosis. The mean time from referral to first assessment by the Plagiocephaly Clinic was 41 days, and time from referral by the plagiocephaly clinic to diagnosis of craniosynostosis by a pediatric neurosurgeon was 8 days. Pediatric neurosurgeons requested imaging for 6 of the referred patients (25% ). The sensitivity and specificity of the plagiocephaly clinic for referral of craniosynostosis patients to the Pediatric Neurosurgery Clinic were 100 and 99%, respectively. Conclusion The BC Children's Plagiocephaly Clinic is efficient and safe for the initial evaluation and treatment of patients with positional plagiocephaly. The clinic's model decreases wait times, appropriately manages patients with positional plagiocephaly, screens for craniosynostosis with high sensitivity and specificity, and takes pressure off outpatient neurosurgical clinics. This model for assessment of plagiocephaly could be considered in other medical centers.
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- 2019
15. Physical health risks during simulation-based COVID-19 pandemic readiness training
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Sylvain Boet, Amy B. Fraser, Purnima M Rao, Simone Crooks, and Michelle Chiu
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2019-20 coronavirus outbreak ,Inservice Training ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Training (civil) ,Betacoronavirus ,Pandemic ,Correspondence ,Medicine ,Humans ,Patient simulation ,Simulation based ,Personal protective equipment ,Pandemics ,Personal Protective Equipment ,Medical education ,business.industry ,SARS-CoV-2 ,Physical health ,COVID-19 ,General Medicine ,Patient Simulation ,Anesthesiology and Pain Medicine ,Anesthesia ,business ,Coronavirus Infections - Published
- 2020
- Full Text
- View/download PDF
16. A detailed smoking history and determination of MYC status predict response to checkpoint inhibitors in advanced non-small cell lung cancer
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Pingfu Fu, Priyanka Bhateja, Mary Beth Lipka, Michelle Chiu, and Afshin Dowlati
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Oncology ,Mutation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,STK11 ,Context (language use) ,Immunotherapy ,Gene mutation ,medicine.disease_cause ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,medicine ,Immunohistochemistry ,Original Article ,030212 general & internal medicine ,KRAS ,Lung cancer ,business - Abstract
Background Although many studies have determined that PD-L1 expression by immunohistochemistry can be somewhat predictive of a response to checkpoint inhibitor the impact of specific genomic changes and smoking history in the context of PD-L1 expression is limited. This single-center study examined clinical and genomic factors beyond STK11 and EGFR in patients with advanced non-small cell lung cancer (NSCLC) to determine which patients benefit from therapy with immune checkpoint inhibitors (ICIs). Methods Clinical and genomic features of patients with NSCLC treated with immunotherapy were compiled into a database. Genomic information collected included gene mutations via next generation sequencing, tumor mutation burden (TMB), and PD-L1 tumor proportional scores. Results A total of 131 patients with advanced NSCLC treated with ICIs were examined. Race was not associated with response. A positive response to immunotherapy was associated with smoke year increase (P=0.042). KRAS mutation and MYC amplification were associated with a positive response to immunotherapy while EGFR, RB1, and NF1 mutations were associated with a lack of response. KRAS mutation (P=0.007) and high TMB (P=0.070) were positively associated with smoking history. EGFR mutation was negatively associated with smoking history (P=0.002) . In multivariate analysis controlling for age and smoking history, MYC amplification continued to be the only predictive genomic marker with a trend toward response to therapy (P=0.092) beyond the smoking history. Conclusions Among the clinical and genomic factors examined in this study, smoking status is the most predictive of response to ICIs. Only MYC amplification continued to predict a trend toward response to immunotherapy when controlling for smoking history. Other genomic predictors such as EGFR and KRAS simply reflect their association with smoking. Detailed smoking history and MYC amplification alone can predict response to ICI.
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- 2020
17. Pathophysiology of and therapeutic options for a GABRA1 variant linked to epileptic encephalopathy
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Peter Axerio-Cilies, Michelle Demos, Lidong Liu, Yun-Fei Bai, Mary B. Connolly, Yu Tian Wang, Michelle Chiu, Matthew J. Farrer, Jie Lu, Zhi-Qing David Xu, Ilaria Guella, Elizabeth S. Chan, and Linda Huh
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0301 basic medicine ,medicine.drug_class ,medicine.medical_treatment ,Mutant ,Pharmacology ,medicine.disease_cause ,lcsh:RC346-429 ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,medicine ,Receptor ,GABA a receptor ,Molecular Biology ,lcsh:Neurology. Diseases of the nervous system ,Mutation ,Benzodiazepine ,Epileptic encephalopathy ,GABAA receptor ,Chemistry ,Research ,Insulin ,HEK 293 cells ,3. Good health ,030104 developmental biology ,Therapeutic options ,Verapamil ,030217 neurology & neurosurgery ,medicine.drug - Abstract
We report the identification of a de novo GABRA1 (R214C) variant in a child with epileptic encephalopathy (EE), describe its functional characterization and pathophysiology, and evaluate its potential therapeutic options. The GABRA1 (R214C) variant was identified using whole exome sequencing, and the pathogenic effect of this mutation was investigated by comparing wild-type (WT) α1 and R214C α1 GABAA receptor-expressing HEK cells. GABA-evoked currents in these cells were recorded using whole-cell, outside-out macro-patch and cell-attached single-channel patch-clamp recordings. Changes to surface and total protein expression levels of WT α1 and R214C α1 were quantified using surface biotinylation assay and western blotting, respectively. Finally, potential therapeutic options were explored by determining the effects of modulators, including diazepam, insulin, and verapamil, on channel gating and receptor trafficking of WT and R214C GABAA receptors. We found that the GABRA1 (R214C) variant decreased whole-cell GABA-evoked currents by reducing single channel open time and both surface and total GABAA receptor expression levels. The GABA-evoked currents in R214C GABAA receptors could only be partially restored with benzodiazepine (diazepam) and insulin. However, verapamil treatment for 24 h fully restored the function of R214C mutant receptors, primarily by increasing channel open time. We conclude that the GABRA1 (R214C) variant reduces channel activity and surface expression of mutant receptors, thereby contributing to the pathogenesis of genetic EE. The functional restoration by verapamil suggests that it is a potentially new therapeutic option for patients with the R214C variant and highlights the value of precision medicine in the treatment of genetic EEs.
- Published
- 2019
18. Seizure action plans in the pediatric population with epilepsy: Uptake, determinants, and parental interest in a mobile application
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Dewi V. Schrader, Mahtab Borhani, Michelle Chiu, Sharon Peinhof, Cindy Siu, Conrado De Guzman, Boris Kuzeljevic, Linda Huh, and Mary B. Connolly
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Male ,Parents ,medicine.medical_specialty ,Multivariate analysis ,genetic structures ,Status epilepticus ,Logistic regression ,03 medical and health sciences ,Behavioral Neuroscience ,Epilepsy ,Status Epilepticus ,0302 clinical medicine ,Seizures ,Chart review ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Univariate analysis ,business.industry ,Univariate ,medicine.disease ,Mobile Applications ,Neurology ,Emergency medicine ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Pediatric population - Abstract
Background Status epilepticus (SE) is a common pediatric neurological emergency that requires timely treatment to minimize morbidity and mortality, yet administration of rescue medications is often delayed and underdosed. Seizure action plans (SAPs) outline the steps that should be taken by parents and caregivers in case of SE in order to optimize patient outcomes. Our study determined the uptake of SAPs in a pediatric population with epilepsy and assessed parental interest in a SAP mobile application. Methods A survey was distributed to parents of patients with epilepsy aged 1 month to 19 years at British Columbia Children’s Hospital. Following chart review, univariate and multivariate analyses were performed to identify variables that predict whether patients have SAPs. A systematic search of available mobile applications for epilepsy management was conducted. Results Of 192 participants, 62% have SAPs. On univariate analysis, history of prior SE and male gender increased likelihood of SAP. On logistic regression, Nagelkerke R2 was 0.204 and our model correctly predicted 82% of patients with SAPs. 83% of parents were interested in a SAP mobile application. There are currently 40 mobile applications available for epilepsy management, but only 15% of respondents reported using them. Conclusions There is a need to increase the percentage of patients with epilepsy with SAPs, particularly in those at greater risk of SE. Most parents would find a SAP mobile application valuable in their child’s epilepsy management. There is a gap between the high parental interest in mobile applications for epilepsy management and their current use of such applications.
- Published
- 2021
19. Oxytocin (OXT)-stimulated inhibition of Kir7.1 activity is through PIP 2 -dependent Ca 2+ response of the oxytocin receptor in the retinal pigment epithelium in vitro
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Michelle Chiu, Nathaniel W. York, De-Ann M. Pillers, Bikash R. Pattnaik, Patrick Halbach, and Ian M. Bird
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Phosphatidylinositol 4,5-Diphosphate ,0301 basic medicine ,medicine.medical_specialty ,Cell signaling ,Neuropeptide ,Retinal Pigment Epithelium ,Oxytocin ,Article ,Cell Line ,03 medical and health sciences ,0302 clinical medicine ,Calcium imaging ,Internal medicine ,medicine ,Animals ,Humans ,Potassium Channels, Inwardly Rectifying ,Receptor ,Cells, Cultured ,Retinal pigment epithelium ,biology ,Cell Biology ,Oxytocin receptor ,Mice, Inbred C57BL ,HEK293 Cells ,030104 developmental biology ,medicine.anatomical_structure ,Endocrinology ,Receptors, Oxytocin ,Rhodopsin ,biology.protein ,Calcium ,sense organs ,hormones, hormone substitutes, and hormone antagonists ,030217 neurology & neurosurgery ,Signal Transduction ,medicine.drug - Abstract
Oxytocin (OXT) is a neuropeptide that activates the oxytocin receptor (OXTR), a rhodopsin family G-protein coupled receptor. Our localization of OXTR to the retinal pigment epithelium (RPE), in close proximity to OXT in the adjacent photoreceptor neurons, leads us to propose that OXT plays an important role in RPE-retinal communication. An increase of RPE [Ca2+]i in response to OXT stimulation implies that the RPE may utilize oxytocinergic signaling as a mechanism by which it accomplishes some of its many roles. In this study, we used an established human RPE cell line, a HEK293 heterologous OXTR expression system, and pharmacological inhibitors of Ca2+ signaling to demonstrate that OXTR utilizes capacitative Ca2+ entry (CCE) mechanisms to sustain an increase in cytoplasmic Ca2+. These findings demonstrate how multiple functional outcomes of OXT-OXTR signaling could be integrated via a single pathway. In addition, the activated OXTR was able to inhibit the Kir7.1 channel, an important mediator of sub retinal waste transport and K+ homeostasis.
- Published
- 2017
20. Correction to: Pathophysiology of and therapeutic options for a GABRA1 variant linked to epileptic encephalopathy
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Linda Huh, Michelle Demos, Elizabeth S. Chan, Ilaria Guella, Lidong Liu, Matthew J. Farrer, Jie Lu, Michelle Chiu, Peter Axerio-Cilies, Yun-Fei Bai, Yu Tian Wang, Mary B. Connolly, and Zhi-Qing David Xu
- Subjects
0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Neurology ,Genotype ,MEDLINE ,lcsh:RC346-429 ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Chloride Channels ,Humans ,Insulin ,Medicine ,Amino Acid Sequence ,Child ,Molecular Biology ,lcsh:Neurology. Diseases of the nervous system ,Diazepam ,Epilepsy ,business.industry ,Epileptic encephalopathy ,Correction ,Electroencephalography ,Receptors, GABA-A ,Magnetic Resonance Imaging ,Pathophysiology ,Kinetics ,Protein Subunits ,HEK293 Cells ,Phenotype ,030104 developmental biology ,Verapamil ,Mutation ,Female ,Psychopharmacology ,business ,Ion Channel Gating ,030217 neurology & neurosurgery - Abstract
We report the identification of a de novo GABRA1 (R214C) variant in a child with epileptic encephalopathy (EE), describe its functional characterization and pathophysiology, and evaluate its potential therapeutic options. The GABRA1 (R214C) variant was identified using whole exome sequencing, and the pathogenic effect of this mutation was investigated by comparing wild-type (WT) α1 and R214C α1 GABA
- Published
- 2020
21. Childhood Small Vessel Primary Angiitis of the Central Nervous System: A Treatable Cause of Super-refractory Status Epilepticus
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Anita N Datta and Michelle Chiu
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Male ,Pediatrics ,medicine.medical_specialty ,Cyclophosphamide ,medicine.medical_treatment ,Status epilepticus ,Methylprednisolone ,03 medical and health sciences ,0302 clinical medicine ,Status Epilepticus ,Maintenance therapy ,medicine ,Humans ,Child ,Vasculitis, Central Nervous System ,030203 arthritis & rheumatology ,medicine.diagnostic_test ,business.industry ,Brain biopsy ,Immunoglobulins, Intravenous ,Immunosuppression ,Electroencephalography ,Burst suppression ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,Headaches ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Immunosuppressive Agents ,medicine.drug ,Ketogenic diet - Abstract
Childhood primary angiitis of the central nervous system (cPACNS) is a rare inflammatory disease of brain vessels. The small vessel subtype is diagnosed on brain biopsy and often presents with cognitive and behavioral changes, headaches, and seizures. However, there are few reported cases of super-refractory status epilepticus in children. We present a case of small vessel cPACNS complicated by super-refractory status epilepticus requiring burst suppression for 4 weeks in addition to multiple antiseizure medications and the ketogenic diet. Our patient was also treated with intravenous and oral steroids, intravenous immunoglobulin, and cyclophosphamide before starting maintenance therapy with mycophenolate mofetil. After prolonged rehabilitation, he recovered almost completely and has a normal neurologic examination with rare epileptiform activity on electroencephalogram (EEG). This is one of the longest cases of status epilepticus in small vessel cPACNS in the literature. We illustrate that super-refractory status epilepticus can be the first manifestation of small vessel cPACNS in previously healthy children and that symptomatic management of seizures with concurrent immunosuppression to treat the underlying pathology resulted in favorable neurologic outcomes.
- Published
- 2019
22. Retinoblastoma mutation predicts poor outcomes in advanced non small cell lung cancer
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Gary Wildey, Priyanka Bhateja, Neelesh Sharma, Michael Chiu Lee Yang, Fatemeh Ardeshir-Larijani, Pingfu Fu, Afshin Dowlati, Mary Beth Lipka, and Michelle Chiu
- Subjects
0301 basic medicine ,Oncology ,Male ,Cancer Research ,Lung Neoplasms ,medicine.medical_treatment ,Mutant ,0302 clinical medicine ,Antineoplastic Agents, Immunological ,Mutation Rate ,Carcinoma, Non-Small-Cell Lung ,Original Research ,response ,Retinoblastoma ,Hazard ratio ,Cell cycle ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Retinoblastoma Binding Proteins ,Treatment Outcome ,030220 oncology & carcinogenesis ,Mutation (genetic algorithm) ,Female ,immunotherapy ,Adult ,medicine.medical_specialty ,Ubiquitin-Protein Ligases ,lcsh:RC254-282 ,retinoblastoma ,Diagnosis, Differential ,03 medical and health sciences ,Internal medicine ,medicine ,genomics ,Humans ,Radiology, Nuclear Medicine and imaging ,Lung cancer ,Aged ,Neoplasm Staging ,Chemotherapy ,non small cell lung cancer ,business.industry ,Clinical Cancer Research ,Immunotherapy ,medicine.disease ,Small Cell Lung Carcinoma ,Survival Analysis ,eye diseases ,respiratory tract diseases ,030104 developmental biology ,Mutation ,small cell lung cancer ,business - Abstract
The retinoblastoma gene (RB1) encodes the retinoblastoma (RB) pocket protein that plays an important role in cell cycle progression. Here we determine the frequency and prognostic significance of RB1 mutation in non small cell lung cancer (NSCLC), restricting inclusion to Stage III and IV patients with linked genomic and clinical data. The primary outcome was median overall survival (OS). We identified RB1 mutation in 8.2% of NSCLC patients. The median OS for wild‐type (wt) RB1 was 28.3 months vs 8.3 months for mutant RB1 (Hazard Ratio = 2.59, P = 0.002). Of special interest, RB1 mutation also correlated with lack of response to immunotherapy. Our study focused on RB1 mutation in locally advanced and advanced non small cell lung cancer to better facilitate comparisons with small cell lung cancer (SCLC). In our SCLC cohort, RB1 mutation was identified in 75% of patients and wt RB1 was associated with significantly shorter OS (P = 0.002). The different outcomes of RB1 mutation observed among lung cancer subtypes suggest a more complicated mechanism than simple regulation of cell cycle or response to chemotherapy.
- Published
- 2018
23. Simulation-based assessment of anesthesiology residents’ competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC)
- Author
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Noel O'Regan, D. Noseworthy, N. Cowie, Tobias Everett, Greg Peachey, Simone Crooks, Megan Hayter, Arnaud Robitaille, Jordan Tarshis, Michelle Chiu, K. Doyle, D. Dubois, Marshall Tenenbein, Michael Sullivan, T. L. Bosma, Marie-Hélène Tremblay, Jessica E. Burjorjee, Genevieve McKinnon, Rachel Fisher, and Andreas Antoniou
- Subjects
Program evaluation ,medicine.medical_specialty ,Canada ,020205 medical informatics ,Specialty ,02 engineering and technology ,Certification ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Anesthesiology ,030202 anesthesiology ,0202 electrical engineering, electronic engineering, information engineering ,Curriculum development ,Medicine ,Computer Simulation ,Simulation based ,Curriculum ,Competence (human resources) ,Medical education ,business.industry ,Internship and Residency ,030208 emergency & critical care medicine ,General Medicine ,National curriculum ,Competency-Based Education ,Anesthesiology and Pain Medicine ,Needs assessment ,Clinical Competence ,business - Abstract
The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force. The goals were to develop, implement, and evaluate a set of consensus-driven standardized mannequin-based simulation scenarios that every trainee must complete satisfactorily prior to completion of anesthesiology residency and certification. Curriculum development followed Kern's principles and was accomplished via monthly teleconferences and annual face-to-face meetings. The development and implementation processes included the following key elements: 1) Curriculum needs assessment: 368 of 958 invitees (38.4%) responded to a national survey resulting in 64 suggested scenario topics. Use of a modified Delphi technique resulted in seven important and technically feasible scenarios. 2) Scenario development: All scenarios have learning objectives from the National Curriculum for Canadian Anesthesiology Residency. Standardized scenario templates were created, and the content was refined and piloted. 3) Assessment: A validated Global Rating Scale (GRS) is the primary assessment tool, informed by using scenario-specific checklists (created via a modified Delphi technique) and the Anesthesia Non-Technical Skills GRS. 4) Implementation: Standardized implementation guidelines, pre-brief/debrief documents, and rater training videos, guide, and commentary were generated. National implementation of the scenarios and program evaluation is currently underway. It is highly feasible to achieve specialty-based consensus on the elements of a national simulation-based curriculum. Our process could be adapted by any specialty interested in implementing a simulation-based curriculum incorporating competency-based assessment on a national scale.
- Published
- 2016
24. Foundational Elements of Applied Simulation Theory: Development and Implementation of a Longitudinal Simulation Educator Curriculum
- Author
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Michelle Chiu, Susan Humphrey-Murto, and Glenn Posner
- Subjects
curriculum development ,020205 medical informatics ,simulation educator training ,Computer science ,curriculum ,02 engineering and technology ,simulation specialist training ,Computational science ,03 medical and health sciences ,0302 clinical medicine ,Collaborative leadership ,ComputingMilieux_COMPUTERSANDEDUCATION ,0202 electrical engineering, electronic engineering, information engineering ,Curriculum development ,030212 general & internal medicine ,Curriculum ,Medical Simulation ,Medical education ,Education theory ,faculty development ,General Engineering ,simulation ,Focus group ,Popularity ,Medical Education ,postgraduate medical education ,Needs assessment ,simulation based medical education ,Faculty development ,curriculum development research - Abstract
Simulation-based education has gained popularity, yet many faculty members feel inadequately prepared to teach using this technique. Fellowship training in medical education exists, but there is little information regarding simulation or formal educational programs therein. In our institution, simulation fellowships were offered by individual clinical departments. We recognized the need for a formal curriculum in educational theory. Kern’s approach to curriculum development was used to develop, implement, and evaluate the Foundational Elements of Applied Simulation Theory (FEAST) curriculum. Needs assessments resulted in a 26-topic curriculum; each biweekly session built upon the previous. Components essential to success included setting goals and objectives for each interactive session and having dedicated faculty, collaborative leadership and administrative support for the curriculum. Evaluation data was collated and analyzed annually via anonymous feedback surveys, focus groups, and retrospective pre-post self-assessment questionnaires. Data collected from 32 fellows over five years of implementation showed that the curriculum improved knowledge, challenged thinking, and was excellent preparation for a career in simulation-based medical education. Themes arising from focus groups demonstrated that participants valued faculty expertise and the structure, practicality, and content of the curriculum. We present a longitudinal simulation educator curriculum that adheres to a well-described framework of curriculum development. Program evaluation shows that FEAST has increased participant knowledge in key areas relevant to simulation-based education and that the curriculum has been successful in meeting the needs of novice simulation educators. Insights and practice points are offered for educators wishing to implement a similar curriculum in their institution.
- Published
- 2017
25. Index of Suspicion in the NurseryCase 1: Preterm Infant With Pleural Effusions and CardiomyopathyCase 2: Pericardial Effusion in the Neonate
- Author
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Michelle Chiu, Emily F. Fishman, Allen Ligon, and Amit M. Mathur
- Subjects
Polyhydramnios ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Pleural effusion ,medicine.medical_treatment ,Thoracentesis ,medicine.disease ,Pericardial effusion ,Surgery ,Right ventricular hypertrophy ,Hydrops fetalis ,Pediatrics, Perinatology and Child Health ,medicine ,Patent foramen ovale ,business ,Chest radiograph - Abstract
A 3,220-g male infant is born at 34 weeks’ gestation by urgent cesarean delivery because of concerns for fetal well-being to a 33-year-old gravida 3 para 1 now 2 mother with serologies significant for O positive, rubella nonimmune, hepatitis B surface antigen negative, rapid plasma reagin nonreactive, human immunodeficiency virus negative, Group B streptococcus status unknown. Resuscitation of the infant is significant for the need for positive pressure ventilation, intubation, chest compressions for 1 minute and bilateral thoracentesis with no drainage of fluid. Pregnancy was complicated by previous herpes simplex virus infection with negative bright light examination at time of delivery, previous Cesarean delivery, and new-onset hydrops fetalis. One week before delivery, ultrasound of the fetus was significant for bilateral pleural effusions, cardiac enlargement, increased middle cerebral artery Doppler flow, and polyhydramnios with an amniotic fluid index of 40. Initial assessment reveals a large-for-gestational age infant with generalized edema. He is placed on the high-frequency oscillator on admission. His abdominal examination is significant for the liver edge palpated 3 cm below the right costal margin. An initial chest radiograph reveals bilateral pleural effusions, with right greater than left and hazy lung fields (Fig 1). A cardiology consultation is urgently requested after admission, and the initial echocardiogram reveals a small patent foramen ovale, a small midseptal muscular ventricular septal defect both with left to right flow, right ventricular hypertrophy with normal function, and a tiny pericardial effusion. Figure 1. Initial chest and abdomen radiograph on admission to the NICU displaying a small left pleural effusion and moderate right pleural effusion. Cardiac size is normal for gestational age. ### Initial Evaluation Initial arterial blood gas is pH 7.36 mm Hg, pCO2 45 mm Hg, pO2 132 mm Hg, HCO3 26 mmol/L with base deficit of 0.2 mmol/L. His initial complete blood count reveals white blood cell count …
- Published
- 2014
26. T109. Reward-Dependent Connectivity With Orbitofrontal Cortex in Subclinical Depression
- Author
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Lauren B. Alloy, David Roy Smith, Michelle Chiu, and Tommy H. Ng
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business.industry ,Medicine ,Orbitofrontal cortex ,business ,Neuroscience ,Biological Psychiatry ,Depression (differential diagnoses) ,Subclinical infection - Published
- 2018
27. Reducing Persistent Postoperative Pain and Disability 1 Year After Breast Cancer Surgery: A Randomized, Controlled Trial Comparing Thoracic Paravertebral Block to Local Anesthetic Infiltration
- Author
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Gregory L. Bryson, Michelle Chiu, Monica Taljaard, James M. Watters, Howard J. Nathan, and Anne Lui
- Subjects
medicine.medical_specialty ,medicine.drug_class ,medicine.medical_treatment ,Breast Neoplasms ,Breast Oncology ,Thoracic Vertebrae ,law.invention ,Breast cancer ,Double-Blind Method ,Randomized controlled trial ,law ,medicine ,Humans ,Paravertebral Block ,Anesthetics, Local ,Mastectomy ,Neoplasm Staging ,Pain Measurement ,Pain, Postoperative ,Ropivacaine ,business.industry ,Local anesthetic ,Nerve Block ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Lymphedema ,Oncology ,Anesthesia ,Thoracic vertebrae ,Nerve block ,Female ,business ,Follow-Up Studies ,medicine.drug - Abstract
Background The objective of this study was to compare the effect of thoracic paravertebral block (TPVB) and local anesthetic (LA) on persistent postoperative pain (PPP) 1 year following breast cancer surgery. Secondary objectives were to compare the effect on arm morbidity and quality of life. Methods Women scheduled for elective breast cancer surgery were randomly assigned to either TPVB or LA followed by general anesthesia. An NRS value of >3 at rest or with movement 1 year following surgery defined PPP. Blinded interim analysis suggested rates of PPP much lower than anticipated, making detection of the specified 20 % absolute reduction in the primary outcome impossible. Recruitment was stopped, and all enrolled patients were followed to 1 year. Results A total of 145 participants were recruited; 65 were randomized to TPVB and 64 to LA. Groups were similar with respect to demographic and treatment characteristics. Only 9 patients (8 %; 95 % CI 4–14 %) met criteria for PPP 1 year following surgery; 5 were in the TPVB and 4 in the LA group. Brief Pain Inventory severity and interference scores were low in both groups. Arm morbidity and quality of life were similar in both groups. The 9 patients with PPP reported shoulder-arm morbidity and reduced quality of life. Conclusions This study reports a low incidence of chronic pain 1 year following major breast cancer surgery. Although PPP was uncommon at 1 year, it had a large impact on the affected patients’ arm morbidity and quality of life.
- Published
- 2013
28. Ten-year follow-up of pediatric patients with non-hodgkin lymphoma treated with allogeneic or autologous stem cell transplantation
- Author
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Rosanna Ricafort, Lisa Giulino-Roth, Richard J. O'Reilly, Andromachi Scaradavou, Tanya M. Trippett, Peter G. Steinherz, Michelle Chiu, Susan E. Prockop, Trudy N. Small, Nancy A. Kernan, and Farid Boulad
- Subjects
Oncology ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Lymphoblastic lymphoma ,Hematology ,Hematopoietic stem cell transplantation ,medicine.disease ,Peripheral T-cell lymphoma ,Surgery ,Lymphoma ,Autologous stem-cell transplantation ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Young adult ,business ,Anaplastic large-cell lymphoma - Abstract
Background Autologous or allogeneic hematopoietic stem cell transplant (SCT) is often considered in patients with relapsed or refractory non-Hodgkin lymphoma (NHL) but there are limited data on the use of SCT for the treatment of NHL in the pediatric setting. Procedure To evaluate the role of SCT for children with NHL, we reviewed 36 consecutive pediatric patients with NHL who underwent an allogeneic (n = 21) or autologous (n = 15) SCT at our institution between 1982 and 2004. Pathologic classification included: lymphoblastic lymphoma (n = 12), Burkitt lymphoma (BL) (n = 5), diffuse large B-cell lymphoma (n = 4), anaplastic large cell lymphoma (ALCL) (n = 13), peripheral T cell lymphoma (n = 1), and undifferentiated NHL (n = 1). Donor source for allogeneic-SCT recipients was an HLA-matched related donor (n = 15), a matched unrelated donor (n = 4), or a mismatched donor (related n = 1; unrelated n = 1). Twenty-eight patients (78%) had chemotherapy responsive disease at the time of transplant (either CR or PR). Results Overall survival (OS) and disease-free survival (DFS) were 55% and 53% with a median follow-up of 9.75 years. Outcomes were similar in patients receiving autologous and allogeneic-SCT (DFS 53% in both groups). Patients with ALCL had a DFS of 76.9%. In contrast, of five patients transplanted for BL, none survived. DFS among patients with chemotherapy sensitive disease was 61%, compared with 25% among patients with relapsed/refractory disease (P = 0.019). Conclusions Allogeneic and autologous SCT offer the prospect of durable, disease-free survival for a significant proportion of pediatric patients with relapsed or refractory NHL. Survival is superior among patients with chemotherapy sensitive disease. Pediatr Blood Cancer 2013;60:2018–2024. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
29. Does warm-up using mental practice improve crisis resource management performance? A simulation study
- Author
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Nicole Riem, Megan A. Hayter, Sylvain Boet, Michelle Chiu, M. Afsari, and M. D. Bould
- Subjects
Adult ,Male ,medicine.medical_specialty ,Epinephrine ,Endpoint Determination ,medicine.medical_treatment ,Electric Countershock ,Intervention group ,Shock, Hemorrhagic ,Manikins ,Crisis resource management ,law.invention ,Mental practice ,Randomized controlled trial ,Anesthesiology ,law ,Monitoring, Intraoperative ,Intervention (counseling) ,Humans ,Vasoconstrictor Agents ,Medicine ,Blood Transfusion ,Computer Simulation ,Cardiopulmonary resuscitation ,business.industry ,Significant difference ,Internship and Residency ,Cardiopulmonary Resuscitation ,Heart Arrest ,Crisis Intervention ,Anesthesiology and Pain Medicine ,Practice, Psychological ,Sample Size ,Emergency medicine ,Physical therapy ,Female ,business ,Case Management ,Crisis intervention - Abstract
Background Mental practice (MP) is defined as the ‘symbolic rehearsal of a physical activity in the absence of any gross-muscular movements' and has been used in sport and music to enhance performance. In healthcare, MP has been demonstrated to improve technical skill performance of surgical residents. However, its effect on crisis resource management (CRM) skills has yet to be determined. We aimed to investigate the effect of warm-up with MP on CRM skill performance during a simulated crisis scenario. Methods Following ethics board approval, 40 anaesthesia residents were randomized. The intervention group performed 20 min of MP of a script based on CRM principles. The control group received a 20 min didactic teaching session on an unrelated topic. Each subject then managed a simulated cardiac arrest. Two CRM experts rated the video recordings of each performance using the previously validated Ottawa GRS. The time to start chest compressions, administer epinephrine, and give blood was recorded. Results There was no significant difference between the intervention and control groups: total Ottawa GRS score was 24.50 (18.63–28.88 [6.50–34.50]) (median (inter-quartile range [range]) vs 20.50 (13.00–29.13 [6.50–34.50]) (P=0.53); the time to start chest compressions 146.0 s (138.0–231.0 [115.0–323.0]) vs 162.5 s (138.0–231.0 [100.0–460.0]) (P=0.27), the time to epinephrine administration 163.0 s (151.0–187.0 [111.0–337.0]) vs 187.0 s (164.0–244.0 [115.0–310.0]) (P=0.09), and the time to blood administration 220.5 s (130.8–309.0 [92.0–485.0]) vs 252.5 (174.5–398.8 [65.0–527.0]) (P=0.48). Conclusion Unlike technical skills, warm-up with MP does not seem to improve CRM skills in simulated crisis scenarios.
- Published
- 2013
30. An experiential teaching session on the anesthesia machine check improves resident performance
- Author
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Robert Elliott, Viren N. Naik, Abeer A Arab, and Michelle Chiu
- Subjects
Medical education ,business.industry ,Teaching ,Internship and Residency ,General Medicine ,Experiential learning ,Checklist ,Test (assessment) ,Simulation training ,Patient Simulation ,Anesthesiology and Pain Medicine ,Anesthesia machine check ,Anesthesiology ,Cohort ,Humans ,Medicine ,Clinical Competence ,Session (computer science) ,business ,Residency training - Abstract
A preoperative machine check is imperative, yet machine faults are missed despite experience. We hypothesized that a simulation training session would improve junior residents’ ability to perform a machine check beyond the level of final year residents who received only didactic training. In 2005, an experiential machine check training session was introduced into residency training at the postgraduate year 1 (PGY-1) level. Three weeks later, the simulation residents were asked to perform a machine check and detect ten preset faults. The control group consisted of PGY-5 residents who had received a didactic anesthesia machine lecture during their residency; these control residents were asked to perform the same machine check as the simulation residents. Data were collected from 2005 to 2008 with each cohort of incoming PGY-1 residents and graduating PGY-5 residents. When the first group of PGY-1 residents became PGY-5 residents in 2009, they were invited to return for a retention test. In all tests, the number of faults detected was recorded, and the machine check was evaluated using a checklist. Thirty-seven simulation residents and 27 control residents participated in the study. Simulation residents had significantly higher checklist scores than the control residents, and they identified more machine faults (both P
- Published
- 2011
31. Evaluation of a Disaster-Surge Training for Public Health Nurses
- Author
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Barbara J. Polivka, Michelle Chiu, and Sharon A. R. Stanley
- Subjects
Program evaluation ,Attitude of Health Personnel ,business.industry ,education ,Public Health, Environmental and Occupational Health ,Human factors and ergonomics ,Public health nursing ,Poison control ,Repeated measures design ,Disaster Planning ,Emergency Nursing ,Nurse's Role ,Disasters ,Blended learning ,Professional Competence ,Nursing ,Public Health Nursing ,Preparedness ,Humans ,Medicine ,business ,General Nursing ,Program Evaluation ,Emergency nursing - Abstract
OBJECTIVE: To examine the effect of a blended educational intervention (in-class and independent learning modules) developed to enhance Ohio PHN confidence in 25 disaster surge competencies that address the PHN role and skills in Preparedness, Response, and Recovery. DESIGN AND SAMPLE: This was a quasi-experimental one group pre and post design. Participants (N = 54) completed pre- and postintervention surveys to evaluate intervention impact on self-perceived confidence and need for further training in the 25 competencies. MEASURES: Parallel pre and post surveys assessed participant evaluation of confidence and need for further competency training. Paired t tests and repeated measures ANOVA compared pre- and postsurvey results. RESULTS: Confidence in Preparedness, Response, and Recovery PHN disaster surge competencies significantly increased, whereas self-perceived need for further competency training correspondingly significantly decreased. CONCLUSIONS: A blended learning approach to disaster surge training effectively improved PHNs confidence in competency achievement and reduced perceived need for further training. Language: en
- Published
- 2011
32. The crystal structure of a bacterial Sufu-like protein defines a novel group of bacterial proteins that are similar to the N-terminal domain of human Sufu
- Author
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Gye Won Han, Dana Weekes, Lian Duan, Keith O. Hodgson, Polat Abdubek, Winnie W Lam, Joanna C Grant, Hsiu-Ju Chiu, Herbert L. Axelrod, Mitchell D. Miller, Dennis Carlton, Ashley M. Deacon, Anna Grzechnik, Ian A. Wilson, Christina Puckett, Sanjay Krishna, Kyle Ellrott, Mark W. Knuth, John Wooley, Abhinav Kumar, Ron Reyes, Connie Chen, Thomas Clayton, Qingping Xu, Kevin K. Jin, Henry van den Bedem, Debanu Das, Andrew P. Yeh, Tiffany Wooten, Edward Nigoghossian, Tamara Astakhova, Christine B Trame, Jiadong Zhou, Robert D. Finn, Lukasz Jaroszewski, Julie Feuerhelm, Linda Okach, Scott A. Lesley, Marc C. Deller, Andrew T. Morse, Marc André Elsliger, Constantina Bakolitsa, Xiaohui Cai, Piotr Kozbial, David Marciano, Henry J Tien, Adam Godzik, Heath E. Klock, Carol L. Farr, Amanda Nopakun, and Michelle Chiu
- Subjects
0303 health sciences ,Sequence analysis ,Repressor ,Sequence alignment ,Plasma protein binding ,Biology ,Biochemistry ,Hedgehog signaling pathway ,Structural genomics ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Molecular Biology ,Peptide sequence ,Function (biology) ,030304 developmental biology - Abstract
Sufu (Suppressor of Fused), a two-domain protein, plays a critical role in regulating Hedgehog signaling and is conserved from flies to humans. A few bacterial Sufu-like proteins have previously been identified based on sequence similarity to the N-terminal domain of eukaryotic Sufu proteins, but none have been structurally or biochemically characterized and their function in bacteria is unknown. We have determined the crystal structure of a more distantly related Sufu-like homolog, NGO1391 from Neisseria gonorrhoeae, at 1.4 A resolution, which provides the first biophysical characterization of a bacterial Sufu-like protein. The structure revealed a striking similarity to the N-terminal domain of human Sufu (r.m.s.d. of 2.6 A over 93% of the NGO1391 protein), despite an extremely low sequence identity of ∼15%. Subsequent sequence analysis revealed that NGO1391 defines a new subset of smaller, Sufu-like proteins that are present in ∼200 bacterial species and has resulted in expansion of the SUFU (PF05076) family in Pfam.
- Published
- 2010
33. Structure ofBacteroides thetaiotaomicronBT2081 at 2.05 Å resolution: the first structural representative of a new protein family that may play a role in carbohydrate metabolism
- Author
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Andrew P. Yeh, John Wooley, Edward Nigoghossian, Qingping Xu, Christine B Trame, Gye Won Han, Kevin K. Jin, Dana Weekes, Kyle Ellrott, David Marciano, Lian Duan, Scott A. Lesley, Lukasz Jaroszewski, Debanu Das, Ashley M. Deacon, Linda Okach, Herbert L. Axelrod, Hsiu-Ju Chiu, Abhinav Kumar, Thomas Clayton, Connie Chen, Heath E. Klock, Marc André Elsliger, Carol L. Farr, Henry van den Bedem, Andrew T. Morse, Mitchell D. Miller, Anna Grzechnik, Daniel McMullan, Dennis Carlton, Keith O. Hodgson, Joanna C Grant, Winnie W Lam, Amanda Nopakun, Polat Abdubek, Tiffany Wooten, Julie Feuerhelm, Sanjay Krishna, Michelle Chiu, Adam Godzik, Marc C. Deller, Tamara Astakhova, Constantina Bakolitsa, Xiaohui Cai, Piotr Kozbial, Henry J Tien, Ron Reyes, Ian A. Wilson, Christina Puckett, and Mark W. Knuth
- Subjects
Models, Molecular ,gut microbiome ,Crystallography, X-Ray ,Biochemistry ,fluids and secretions ,Protein structure ,Models ,Structural Biology ,polycyclic compounds ,Bacteroides ,Peptide sequence ,0303 health sciences ,Crystallography ,Human Gut Microbiome ,030302 biochemistry & molecular biology ,Biological Sciences ,Condensed Matter Physics ,immunoglobulin-like fold ,GenBank ,Carbohydrate Metabolism ,Bacteroides thetaiotaomicron ,Protein Structure ,Protein family ,1.1 Normal biological development and functioning ,Molecular Sequence Data ,Carbohydrates ,Biophysics ,Sequence alignment ,Biology ,digestive system ,Structural genomics ,03 medical and health sciences ,jelly-roll fold ,Bacterial Proteins ,Underpinning research ,Genetics ,Amino Acid Sequence ,Binding site ,Structural Homology ,030304 developmental biology ,Binding Sites ,Protein ,Molecular ,structural genomics ,Protein Structure, Tertiary ,carbohydrates (lipids) ,sugars ,Structural Homology, Protein ,Chemical Sciences ,X-Ray ,bacteria ,Sequence Alignment ,Tertiary - Abstract
The crystal structure of BT2081 from B. thetaiotaomicron reveals a two-domain protein with a putative carbohydrate-binding site in the C-terminal domain., BT2081 from Bacteroides thetaiotaomicron (GenBank accession code NP_810994.1) is a member of a novel protein family consisting of over 160 members, most of which are found in the different classes of Bacteroidetes. Genome-context analysis lends support to the involvement of this family in carbohydrate metabolism, which plays a key role in B. thetaiotaomicron as a predominant bacterial symbiont in the human distal gut microbiome. The crystal structure of BT2081 at 2.05 Å resolution represents the first structure from this new protein family. BT2081 consists of an N-terminal domain, which adopts a β-sandwich immunoglobulin-like fold, and a larger C-terminal domain with a β-sandwich jelly-roll fold. Structural analyses reveal that both domains are similar to those found in various carbohydrate-active enzymes. The C-terminal β-jelly-roll domain contains a potential carbohydrate-binding site that is highly conserved among BT2081 homologs and is situated in the same location as the carbohydrate-binding sites that are found in structurally similar glycoside hydrolases (GHs). However, in BT2081 this site is partially occluded by surrounding loops, which results in a deep solvent-accessible pocket rather than a shallower solvent-exposed cleft.
- Published
- 2010
34. A conserved fold for fimbrial components revealed by the crystal structure of a putative fimbrial assembly protein (BT1062) from Bacteroides thetaiotaomicron at 2.2 Å resolution
- Author
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Gye Won Han, Mark W. Knuth, Natasha Sefcovic, Marc André Elsliger, Tamara Astakhova, Marc C. Deller, Heath E. Klock, Carol L. Farr, Xiaohui Cai, Piotr Kozbial, Adam Godzik, Thomas Clayton, Edward Nigoghossian, Qingping Xu, Ian A. Wilson, Herbert L. Axelrod, Henry J Tien, Constantina Bakolitsa, Christine B Trame, Lian Duan, Dana Weekes, Debanu Das, Daniel McMullan, Amanda Nopakun, Christina Puckett, Keith O. Hodgson, Joanna C Grant, Ron Reyes, Kevin K. Jin, David Marciano, Connie Chen, Jiadong Zhou, Dennis Carlton, Abhinav Kumar, Kyle Ellrott, Lukasz Jaroszewski, Andrew Yeh, Tiffany Wooten, Andrew T. Morse, Polat Abdubek, Michelle Chiu, Henry van den Bedem, Linda Okach, Sanjay Krishna, John Wooley, Ashley M. Deacon, Hsiu-Ju Chiu, Mitchell D. Miller, Anna Grzechnik, Scott A. Lesley, and Julie Feuerhelm
- Subjects
Models, Molecular ,Protein Folding ,Fimbria ,Crystallography, X-Ray ,Biochemistry ,fimbriae ,Pilus ,Fimbriae Proteins ,fluids and secretions ,Structural Biology ,Models ,Bacteroides ,Peptide sequence ,0303 health sciences ,Crystallography ,biology ,Human Gut Microbiome ,Bacterial ,food and beverages ,Biological Sciences ,Condensed Matter Physics ,pili ,PG0179 ,Bacteroides thetaiotaomicron ,Protein Structure ,DUF1812 ,Mfa2 ,Molecular Sequence Data ,Biophysics ,Sequence alignment ,digestive system ,Fimbriae ,03 medical and health sciences ,Genetics ,Amino Acid Sequence ,BT1062 ,Porphyromonas gingivalis ,PGN0288 ,030304 developmental biology ,Structural Homology ,030306 microbiology ,Protein ,Molecular ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Protein Structure, Tertiary ,carbohydrates (lipids) ,Structural Homology, Protein ,Fimbriae, Bacterial ,Chemical Sciences ,X-Ray ,bacteria ,PF08842 ,Digestive Diseases ,Sequence Alignment ,Tertiary - Abstract
The crystal structure of BT1062 from Bacteroides thetaiotaomicron revealed a conserved fold that is widely adopted by fimbrial components., BT1062 from Bacteroides thetaiotaomicron is a homolog of Mfa2 (PGN0288 or PG0179), which is a component of the minor fimbriae in Porphyromonas gingivalis. The crystal structure of BT1062 revealed a conserved fold that is widely adopted by fimbrial components.
- Published
- 2010
35. Second-line age-adjusted International Prognostic Index in patients with advanced non-Hodgkin lymphoma after T-cell depleted allogeneic hematopoietic SCT
- Author
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Katharine C. Hsu, Richard J. O'Reilly, G. Heller, Sinda S. Lee, Andrew Wilton, M.-A. Perales, Suzanne L. Wolden, Trudy N. Small, Nancy H. Collins, Ann A. Jakubowski, Jenna D. Goldberg, Nancy A. Kernan, Esperanza B. Papadopoulos, Farid Boulad, James W. Young, Robert R. Jenq, Tarun Kewalramani, Michelle Chiu, Hugo Castro-Malaspina, and M.R.M. van den Brink
- Subjects
Adult ,Oncology ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Graft vs Host Disease ,Hematopoietic stem cell transplantation ,ThioTEPA ,Disease-Free Survival ,Lymphocyte Depletion ,Article ,Young Adult ,International Prognostic Index ,Predictive Value of Tests ,Risk Factors ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Child ,Transplantation Chimera ,Transplantation ,business.industry ,Incidence ,Lymphoma, Non-Hodgkin ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,Total body irradiation ,Prognosis ,medicine.disease ,Surgery ,Fludarabine ,Lymphoma ,surgical procedures, operative ,Graft-versus-host disease ,Child, Preschool ,business ,Follow-Up Studies ,medicine.drug - Abstract
T-cell depleted allogeneic hematopoietic stem cell transplants (TCD-HSCT) have demonstrated durable disease-free survival with a low risk of graft vs. host disease (GVHD) in patients with AML. We investigated this approach in 61 patients with primary refractory or relapsed non-Hodgkin lymphoma (NHL), who underwent TCD-HSCT from January 1992 through September 2004. Patients received myeloablative cytoreduction consisting of hyperfractionated total body irradiation, followed by either thiotepa and cyclophosphamide (45 patients) or thiotepa and fludarabine (16 patients). We determined the second-line age-adjusted International Prognostic Index score (sAAIPI) prior to transplant. Median follow-up of surviving patients is 6 years. The 10-year overall (OS) and event-free-survival (EFS) were 50% and 43%, respectively. The relapse rate at 10 years was 21% in patients with chemosensitive disease and 52% in those with resistant disease at time of HSCT. Nine of the 18 patients who relapsed entered a subsequent CR. Overall survival (p=0.01) correlated with the sAAIPI. The incidence of grade II-IV acute GVHD was 18%. We conclude that allogeneic TCD-HSCT can induce high rates of OS and EFS in advanced NHL with a low incidence of GVHD. Furthermore, the sAAIPI can predict outcomes and may be used to select the most appropriate patients for this type of transplant.
- Published
- 2010
36. The structure of the first representative of Pfam family PF09836 reveals a two-domain organization and suggests involvement in transcriptional regulation
- Author
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Christopher L. Rife, Kyle Ellrott, Linda Okach, Dustin C. Ernst, Prasad Burra, Dana Weekes, Edward Nigoghossian, Polat Abdubek, Gye Won Han, Silvya Oommachen, Piotr Kozbial, John Wooley, Jessica Paulsen, Henry J Tien, Slawomir K. Grzechnik, Sanjay Krishna, Amanda Nopakun, Julie Feuerhelm, Abhinav Kumar, Henry van den Bedem, Lian Duan, Mark W. Knuth, Marc C. Deller, Tamara Astakhova, Michelle Chiu, Heath E. Klock, Carol L. Farr, Hsiu-Ju Chiu, Connie Chen, Joanna C Grant, Ron Reyes, Daniel McMullan, Tiffany Wooten, Ashley M. Deacon, Nick V. Grishin, Constantina Bakolitsa, Mitchell D. Miller, Anna Grzechnik, Ian A. Wilson, Christina Puckett, Thomas Clayton, Marc André Elsliger, Andrew T. Morse, Dennis Carlton, Adam Godzik, Herbert L. Axelrod, Keith O. Hodgson, Kevin K. Jin, Scott A. Lesley, Christine B Trame, David Marciano, Hope A. Johnson, Natasha Sefcovic, Qingping Xu, Lukasz Jaroszewski, and Debanu Das
- Subjects
Models, Molecular ,Transcription, Genetic ,Domains of Unknown Function ,Crystallography, X-Ray ,medicine.disease_cause ,Biochemistry ,putative transcription regulators ,Models ,Structural Biology ,Transcription (biology) ,Transcriptional regulation ,Peptide sequence ,Genetics ,Regulation of gene expression ,0303 health sciences ,Crystallography ,Genome ,PF09836 ,030302 biochemistry & molecular biology ,Bacterial ,Biological Sciences ,Condensed Matter Physics ,Neisseria ,Transcription ,Protein Structure ,1.1 Normal biological development and functioning ,Molecular Sequence Data ,Biophysics ,Biology ,Structural genomics ,Quaternary ,DUF2063 ,03 medical and health sciences ,Genetic ,Bacterial Proteins ,Underpinning research ,medicine ,Amino Acid Sequence ,putative DNA-binding proteins ,Protein Structure, Quaternary ,Structural Homology ,030304 developmental biology ,Protein ,NGO1945 ,Molecular ,structural genomics ,biology.organism_classification ,Neisseria gonorrhoeae ,Sequence identity ,Protein Structure, Tertiary ,Gene Expression Regulation ,Structural Homology, Protein ,Chemical Sciences ,X-Ray ,Tertiary ,Genome, Bacterial - Abstract
The crystal structure of the NGO1945 gene product from N. gonorrhoeae (UniProt Q5F5IO) reveals that the N-terminal domain assigned as a domain of unknown function (DUF2063) is likely to bind DNA and that the protein may be involved in transcriptional regulation., Proteins with the DUF2063 domain constitute a new Pfam family, PF09836. The crystal structure of a member of this family, NGO1945 from Neisseria gonorrhoeae, has been determined and reveals that the N-terminal DUF2063 domain is likely to be a DNA-binding domain. In conjunction with the rest of the protein, NGO1945 is likely to be involved in transcriptional regulation, which is consistent with genomic neighborhood analysis. Of the 216 currently known proteins that contain a DUF2063 domain, the most significant sequence homologs of NGO1945 (∼40–99% sequence identity) are from various Neisseria and Haemophilus species. As these are important human pathogens, NGO1945 represents an interesting candidate for further exploration via biochemical studies and possible therapeutic intervention.
- Published
- 2009
37. The structure of KPN03535 (gi|152972051), a novel putative lipoprotein from Klebsiella pneumoniae, reveals an OB-fold
- Author
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Thomas Clayton, Debanu Das, John Wooley, Marc-André Elsliger, Heath E. Klock, Polat Abdubek, Edward Nigoghossian, Marc C. Deller, Carol L. Farr, Christopher L. Rife, Sanjay Krishna, Linda Okach, Abhinav Kumar, Mark W. Knuth, Constantina Bakolitsa, Tamara Astakhova, Joanna C Grant, Adam Godzik, Kyle Ellrott, Scott A. Lesley, Qingping Xu, Hsiu-Ju Chiu, Lian Duan, Ron Reyes, Daniel McMullan, Mitchell D. Miller, Dustin C. Ernst, Dana Weekes, Anna Grzechnik, Andrew T. Morse, Gye Won Han, Julie Feuerhelm, Silvya Oommachen, Piotr Kozbial, Henry van den Bedem, Henry J Tien, Jessica Paulsen, Tiffany Wooten, Kevin K. Jin, Ashley M. Deacon, Ian A. Wilson, Christina Puckett, Keith O. Hodgson, Michelle Chiu, Amanda Nopakun, Herbert L. Axelrod, Lukasz Jaroszewski, Natasha Sefcovic, Christine B Trame, Connie Chen, David Marciano, Hope A. Johnson, and Dennis Carlton
- Subjects
Models, Molecular ,Protein Folding ,Klebsiella pneumoniae ,Gut flora ,Crystallography, X-Ray ,Biochemistry ,Protein structure ,Models ,Structural Biology ,BOF ,2.1 Biological and endogenous factors ,Aetiology ,Lung ,Peptide sequence ,0303 health sciences ,Crystallography ,biology ,030302 biochemistry & molecular biology ,toxins ,Hematology ,Biological Sciences ,Condensed Matter Physics ,3. Good health ,Infectious Diseases ,Pneumonia & Influenza ,Protein folding ,Infection ,Protein Structure ,1.1 Normal biological development and functioning ,Lipoproteins ,Molecular Sequence Data ,Biophysics ,single-stranded DNA-binding proteins ,DNA-binding protein ,Structural genomics ,Microbiology ,03 medical and health sciences ,Bacterial Proteins ,Underpinning research ,Genetics ,Amino Acid Sequence ,030304 developmental biology ,Molecular ,Pneumonia ,structural genomics ,biology.organism_classification ,Protein Structure, Tertiary ,NipE-like protein ,Chemical Sciences ,X-Ray ,human gut pathogens ,OB-fold ,Novel Variants of Known Folds and Function ,Tertiary ,Lipoprotein - Abstract
KPN03535 is a protein unique to K. pneumoniae. The crystal structure reveals that KPN03535 represents a novel variant of the OB-fold and is likely to be a DNA-binding lipoprotein., KPN03535 (gi|152972051) is a putative lipoprotein of unknown function that is secreted by Klebsiella pneumoniae MGH 78578. The crystal structure reveals that despite a lack of any detectable sequence similarity to known structures, it is a novel variant of the OB-fold and structurally similar to the bacterial Cpx-pathway protein NlpE, single-stranded DNA-binding (SSB) proteins and toxins. K. pneumoniae MGH 78578 forms part of the normal human skin, mouth and gut flora and is an opportunistic pathogen that is linked to about 8% of all hospital-acquired infections in the USA. This structure provides the foundation for further investigations into this divergent member of the OB-fold family.
- Published
- 2009
38. A Comparison of Global Rating Scale and Checklist Scores in the Validation of an Evaluation Tool to Assess Performance in the Resuscitation of Critically Ill Patients During Simulated Emergencies (Abbreviated as 'CRM Simulator Study IB')
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Michelle Chiu, David Neilipovitz, John Kim, and Pierre Cardinal
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Adult ,Male ,Epidemiology ,Critical Illness ,Resuscitation ,MEDLINE ,Medicine (miscellaneous) ,Manikins ,Education ,Crisis resource management ,Humans ,Medicine ,Computer Simulation ,Global rating scale ,Observer Variation ,business.industry ,Critically ill ,Gold standard ,Internship and Residency ,Reproducibility of Results ,medicine.disease ,Checklist ,Modeling and Simulation ,Female ,Educational Measurement ,Medical emergency ,Emergencies ,business ,Observer variation - Abstract
Crisis resource management (CRM) skills are a set of nonmedical skills required to manage medical emergencies. There is currently no gold standard for evaluation of CRM performance. A prior study examined the use of a global rating scale (GRS) to evaluate CRM performance. This current study compared the use of a GRS and a checklist as formal rating instruments to evaluate CRM performance during simulated emergencies.First-year and third-year residents participated in two simulator scenarios each. Three raters then evaluated resident performance in CRM using edited video recordings using both a GRS and a checklist. The Ottawa GRS provides a seven-point anchored ordinal scale for performance in five categories of CRM, and an overall performance score. The Ottawa CRM checklist provides 12 items in the five categories of CRM, with a maximum cumulative score of 30 points. Construct validity was measured on the basis of content validity, response process, internal structure, and response to other variables. T-test analysis of Ottawa GRS scores was conducted to examine response to the variable of level of training. Intraclass correlation coefficient (ICC) scores were used to measure inter-rater reliability for both scenarios.Thirty-two first-year and 28 third-year residents participated in the study. Third-year residents produced higher mean scores for overall CRM performance than first-year residents (P0.05), and in all individual categories within the Ottawa GRS (P0.05) and the Ottawa CRM checklist (P0.05). This difference was noted for both scenarios and for each individual rater (P0.05). No statistically significant difference in resident scores was observed between scenarios for both instruments. ICC scores of 0.59 and 0.61 were obtained for Scenarios 1 and 2 with the Ottawa GRS, whereas ICC scores of 0.63 and 0.55 were obtained with the Ottawa CRM checklist. Users indicated a strong preference for the Ottawa GRS given ease of scoring, presence of an overall score, and the potential for formative evaluation.Construct validity seems to be present when using both the Ottawa GRS and CRM checklist to evaluate CRM performance during simulated emergencies. Data also indicate the presence of moderate inter-rater reliability when using both the Ottawa GRS and CRM checklist.
- Published
- 2009
39. Intravenous Busulfan and Melphalan, Tacrolimus, and Short-Course Methotrexate Followed by Unmodified HLA-Matched Related or Unrelated Hematopoietic Stem Cell Transplantation for the Treatment of Advanced Hematologic Malignancies
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Miguel-Angel Perales, Trudy N. Small, Michelle Chiu, Esperanza B. Papadopoulos, Susan E. Prockop, Katherine C. Hsu, Richard J. O'Reilly, Ann A. Jakubowski, Nancy A. Kernan, Hugo Castro-Malaspina, James W. Young, Andrew Wilton, Farid Boulad, and Glenn Heller
- Subjects
Adult ,Male ,Melphalan ,medicine.medical_specialty ,Transplantation Conditioning ,Allogeneic transplantation ,Myeloid ,Adolescent ,medicine.medical_treatment ,Hematopoietic stem cell transplantation ,Gastroenterology ,Tacrolimus ,Folinic acid ,hemic and lymphatic diseases ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,MDS ,medicine ,Mucositis ,Humans ,Prospective Studies ,Child ,Busulfan ,Transplantation ,Leukemia ,business.industry ,Histocompatibility Testing ,Hematopoietic Stem Cell Transplantation ,Infant ,Hematology ,Middle Aged ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,medicine.disease ,Survival Analysis ,Surgery ,Leukemia, Myeloid, Acute ,Methotrexate ,surgical procedures, operative ,medicine.anatomical_structure ,Child, Preschool ,Myelodysplastic Syndromes ,Female ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Results of allogeneic hematopoietic stem cell transplantation (HCT) to treat advanced leukemia or myelodysplastic syndrome (MDS) remain poor due to excessive relapse and transplant-related mortality. To improve transplant outcome in this patient population, 43 patients (median age, 46.1 years) with high-risk or advanced lymphoid (n = 5) or myeloid malignancy (n = 38) were prospectively enrolled on a pilot trial of cytoreduction with intravenous busulfan and melphalan followed by an unmodified HLA-A, -B, and –DRβ1–matched related (n = 18) or unrelated (n = 25) HCT. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus and methotrexate. Thirty-four patients had ≥ 5% blasts at the time of HCT; 12 of these had > 20% blasts. Seventeen patients had unfavorable cytogenetics, 8 patients underwent transplantation for secondary MDS or acute myelogenous leukemia, and 4 patients had relapsed after a previous allogeneic transplantation. Although mucositis was the most significant regimen-related toxicity, requiring the addition of folinic acid rescue and failure to receive all 4 doses of methotrexate in 23 patients, the nonrelapse mortality at 30 and 100 days was low at 0% and 16%, respectively. The cumulative incidence of grade II-IV acute GVHD was 24%, and that of extensive chronic GVHD was 7%. With a minimum follow-up of 18 months, the estimated 3-year overall survival is 37% and the estimated disease-free survival (DFS) is 33%. For 18 patients with MDS (≤ RAEB-2) or high-risk myeloproliferative disorder, the estimated 3 year DFS is 61%. These data demonstrate the curative potential of this regimen in patients with high-risk myeloid malignancies.
- Published
- 2007
40. A Student Collaboration to Address Mental Health Wellness in Medical School
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Katharine, Brooks, Lianna, Karp, Haiyan Ramirez, Batlle, Michelle, Chiu, and Christine, Montross
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Male ,Mental Health ,Students, Medical ,Social Isolation ,Depression ,Humans ,Rhode Island ,Female ,Health Promotion ,Cooperative Behavior ,Schools, Medical ,Education ,Education, Medical, Undergraduate - Published
- 2015
41. Oxytocin Expression and Function in the Posterior Retina: A Novel Signaling Pathway
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Michelle Chiu, De-Ann M. Pillers, Bikash R. Pattnaik, Patrick Halbach, Sara Tokarz, Wenxiang Luo, Matti P. Asuma, Ian M. Bird, and Nathaniel W. York
- Subjects
medicine.medical_specialty ,Cell signaling ,genetic structures ,Blotting, Western ,Neuropeptide ,Retinal Pigment Epithelium ,Biology ,Oxytocin ,Real-Time Polymerase Chain Reaction ,Cellular and Molecular Neuroscience ,Paracrine signalling ,Internal medicine ,medicine ,Animals ,Humans ,RNA, Messenger ,Cells, Cultured ,Retina ,Retinal pigment epithelium ,Gene Expression Regulation, Developmental ,Articles ,Oxytocin receptor ,Immunohistochemistry ,Macaca mulatta ,Sensory Systems ,eye diseases ,Cell biology ,Ophthalmology ,Endocrinology ,medicine.anatomical_structure ,sense organs ,Signal transduction ,hormones, hormone substitutes, and hormone antagonists ,medicine.drug ,Signal Transduction - Abstract
Purpose Oxytocin (OXT) is recognized as an ubiquitously acting nonapeptide hormone that is involved in processes ranging from parturition to neural development. Its effects are mediated by cell signaling that occurs as a result of oxytocin receptor (OXTR) activation. We sought to determine whether the OXT-OXTR signaling pathway is also expressed within the retina. Methods Immunohistochemistry using cell-specific markers was used to localize OXT within the rhesus retina. Reverse transcriptase PCR and immunohistochemistry were used to assess the expression of OXTR in both human and rhesus retina. Single-cell RT-PCR and Western blot analyses were used to determine the expression of OXTR in cultured human fetal RPE (hfRPE) cells. Human fetal RPE cells loaded with FURA-2 AM were studied by ratiometric Ca(2+) imaging to assess transient mobilization of intracellular Ca(2+) ([Ca(2+)]i). Results Oxytocin was expressed in the cone photoreceptor extracellular matrix of the rhesus retina. Oxytocin mRNA and protein were expressed in the human and rhesus RPE. Oxytocin mRNA and protein expression were observed in cultured hfRPE cells, and exposure of these cells to 100 nM OXT induced a transient 79 ± 1.5 nM increase of [Ca(2+)]i. Conclusions Oxytocin and OXTR are present in the posterior retina, and OXT induces an increase in hfRPE [Ca(2+)]i. These results suggest that the OXT-OXTR signaling pathway is active in the retina. We propose that OXT activation of the OXTR occurs in the posterior retina and that this may serve as a paracrine signaling pathway that contributes to communication between the cone photoreceptor and the RPE.
- Published
- 2015
42. Designing and Implementing a Competency-Based Training Program for Anesthesiology Residents at the University of Ottawa
- Author
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Christopher Hudson, Simone Crooks, Michelle Chiu, Emma J. Stodel, Stéphane Moffett, and Anna Wyand
- Subjects
medicine.medical_specialty ,Medical education ,Article Subject ,Computer science ,education ,Alternative medicine ,Specialty ,Critical Care and Intensive Care Medicine ,lcsh:RD78.3-87.3 ,Anesthesiology and Pain Medicine ,Transformational leadership ,Blueprint ,lcsh:Anesthesiology ,Family medicine ,Anesthesiology ,medicine ,Training program ,Curriculum ,Competence (human resources) ,Research Article - Abstract
Competency-based medical education is gaining traction as a solution to address the challenges associated with the current time-based models of physician training. Competency-based medical education is an outcomes-based approach that involves identifying the abilities required of physicians and then designing the curriculum to support the achievement and assessment of these competencies. This paradigm defies the assumption that competence is achieved based on time spent on rotations and instead requires residents to demonstrate competence. The Royal College of Physicians and Surgeons of Canada (RCPSC) has launched Competence by Design (CBD), a competency-based approach for residency training and specialty practice. The first residents to be trained within this model will be those in medical oncology and otolaryngology-head and neck surgery in July, 2016. However, with approval from the RCPSC, the Department of Anesthesiology, University of Ottawa, launched an innovative competency-based residency training program July 1, 2015. The purpose of this paper is to provide an overview of the program and offer a blueprint for other programs planning similar curricular reform. The program is structured according to the RCPSC CBD stages and addresses all CanMEDS roles. While our program retains some aspects of the traditional design, we have made many transformational changes.
- Published
- 2015
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43. What have we really learned from SARS?
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Earl Wynands, Joseph Po, Homer Yang, and Michelle Chiu
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Anesthesiology and Pain Medicine ,business.industry ,Medicine ,General Medicine ,business - Published
- 2006
44. Assessing the Quality of Manual Respiratory Rate Measurements using Mobile Devices
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John Mark Ansermino, Dustin Dunsmuir, Heng Gan, Michelle Chiu, Guy A. Dumont, Matthew O. Wiens, and Walter Karlen
- Subjects
Measurement variability ,Respiratory rate ,Current practice ,business.industry ,Statistics ,Breathing ,Medicine ,business ,Mobile device - Abstract
We have designed a mobile device application (RRate), to provide an efficient measurement of respiratory rate with clinically acceptable accuracy. The method is based on analysis of multiple consecutive breath intervals. We investigated in this study the difference in measurement variability between breaths as a representative of recording quality. Respiratory rate of 322 children aged 0 - 12 years at a Ugandan rural health centre were recorded using the RRate mobile application, and compared to respiratory rate recordings obtained from 22 volunteers using the RRate application while observing 10 videos of children breathing in a lab setting. The variability of the recorded breaths (confidence) of both groups follow a similar Weibull distribution. However, we observed a trend towards higher variability in the data obtained in the field (median 89.7% confidence) compared to the data obtained in the laboratory setting (median 92.6% confidence). This suggests that it is more difficult to obtain consistent measurements when assessing patients in a clinical setting, and therefore the confidence in the measured respiratory rate is reduced. The mobile device application provided a respiratory rate value up to 6 times faster than the current practice of one minute counting. The measure of variability between individual measured breaths provided a powerful way to display confidence in a measurement.
- Published
- 2014
45. Simulation as an educational modality in an Anesthesiology Resident Wellness Program
- Author
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Michelle Chiu
- Subjects
medicine.medical_specialty ,Educational measurement ,Modality (human–computer interaction) ,business.industry ,Pain medicine ,MEDLINE ,Internship and Residency ,Health Promotion ,General Medicine ,Anesthesiology and Pain Medicine ,Health promotion ,Anesthesiology ,Physicians ,Family medicine ,medicine ,Humans ,Clinical Competence ,Educational Measurement ,Clinical competence ,business - Published
- 2016
46. Board #109 - Research Abstract Implementation of a Pediatric Mock Code Blue PRogram at a Tertiary Care Facility
- Author
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Crystal L. Bencken, Jo Anna Leuck, Chad Scarboro, Michael S. Runyon, Nigel Rozario, Mark Bullard, David Pubantz, Sydney Primis, Dawn Swiderski, and Michelle Chiu
- Subjects
Teamwork ,Engineering ,Epidemiology ,business.industry ,Modeling and Simulation ,media_common.quotation_subject ,Code (cryptography) ,Medicine (miscellaneous) ,Software engineering ,business ,Tertiary care ,Education ,media_common - Published
- 2014
47. Ten-year follow-up of pediatric patients with non-Hodgkin lymphoma treated with allogeneic or autologous stem cell transplantation
- Author
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Lisa, Giulino-Roth, Rosanna, Ricafort, Nancy A, Kernan, Trudy N, Small, Tanya M, Trippett, Peter G, Steinherz, Susan E, Prockop, Andromachi, Scaradavou, Michelle, Chiu, Richard J, O'Reilly, and Farid, Boulad
- Subjects
Male ,Young Adult ,Adolescent ,Child, Preschool ,Lymphoma, Non-Hodgkin ,Hematopoietic Stem Cell Transplantation ,Humans ,Transplantation, Homologous ,Female ,Autografts ,Child ,Disease-Free Survival ,Follow-Up Studies - Abstract
Autologous or allogeneic hematopoietic stem cell transplant (SCT) is often considered in patients with relapsed or refractory non-Hodgkin lymphoma (NHL) but there are limited data on the use of SCT for the treatment of NHL in the pediatric setting.To evaluate the role of SCT for children with NHL, we reviewed 36 consecutive pediatric patients with NHL who underwent an allogeneic (n = 21) or autologous (n = 15) SCT at our institution between 1982 and 2004. Pathologic classification included: lymphoblastic lymphoma (n = 12), Burkitt lymphoma (BL) (n = 5), diffuse large B-cell lymphoma (n = 4), anaplastic large cell lymphoma (ALCL) (n = 13), peripheral T cell lymphoma (n = 1), and undifferentiated NHL (n = 1). Donor source for allogeneic-SCT recipients was an HLA-matched related donor (n = 15), a matched unrelated donor (n = 4), or a mismatched donor (related n = 1; unrelated n = 1). Twenty-eight patients (78%) had chemotherapy responsive disease at the time of transplant (either CR or PR).Overall survival (OS) and disease-free survival (DFS) were 55% and 53% with a median follow-up of 9.75 years. Outcomes were similar in patients receiving autologous and allogeneic-SCT (DFS 53% in both groups). Patients with ALCL had a DFS of 76.9%. In contrast, of five patients transplanted for BL, none survived. DFS among patients with chemotherapy sensitive disease was 61%, compared with 25% among patients with relapsed/refractory disease (P = 0.019).Allogeneic and autologous SCT offer the prospect of durable, disease-free survival for a significant proportion of pediatric patients with relapsed or refractory NHL. Survival is superior among patients with chemotherapy sensitive disease.
- Published
- 2013
48. Structure of the γ-D-glutamyl-L-diamino acid endopeptidase YkfC from Bacillus cereus in complex with L-Ala-γ-D-Glu: insights into substrate recognition by NlpC/P60 cysteine peptidases
- Author
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Dennis Carlton, Andrew Yeh, Henry van den Bedem, Amanda Nopakun, Lukasz Jaroszewski, Dana Weekes, Polat Abdubek, Mark W. Knuth, Gye Won Han, Keith O. Hodgson, Qingping Xu, Sanjay Krishna, Michelle Chiu, Winnie W Lam, Joanna C Grant, Edward Nigoghossian, Tiffany Wooten, Marc André Elsliger, Connie Chen, Scott A. Lesley, John Wooley, Ron Reyes, Linda Okach, Julie Feuerhelm, Tamara Astakhova, Herbert L. Axelrod, Ashley M. Deacon, Abhinav Kumar, Kyle Ellrott, Lian Duan, Hsiu-Ju Chiu, Adam Godzik, Ian A. Wilson, Heath E. Klock, Christina Puckett, Carol L. Farr, Xiaohui Cai, Piotr Kozbial, Henry J Tien, Marc C. Deller, Christine B Trame, Constantina Bakolitsa, David Marciano, Kevin K. Jin, Debanu Das, Thomas Clayton, Mitchell D. Miller, Anna Grzechnik, and Andrew T. Morse
- Subjects
Models, Molecular ,Ligands That Aid in Function Characterization ,Bacillus subtilis ,Crystallography, X-Ray ,cysteine peptidases ,Biochemistry ,Conserved sequence ,Substrate Specificity ,chemistry.chemical_compound ,Protein structure ,Structural Biology ,Models ,Cysteine Proteases ,SH3b ,Alanine ,0303 health sciences ,Crystallography ,Genome ,biology ,030302 biochemistry & molecular biology ,Bacterial ,Biological Sciences ,Condensed Matter Physics ,Endopeptidase ,3. Good health ,Infectious Diseases ,Protein Binding ,Protein Structure ,Stereochemistry ,Molecular Sequence Data ,Biophysics ,Diamino acid ,03 medical and health sciences ,Bacillus cereus ,Endopeptidases ,Genetics ,Amino Acid Sequence ,enzyme specificity ,030304 developmental biology ,Structural Homology ,γ-d-glutamyl-l-diamino acid endopeptidase ,Protein ,fungi ,NlpC/P60 ,Active site ,Molecular ,biology.organism_classification ,Protein Structure, Tertiary ,chemistry ,Structural Homology, Protein ,cell-wall recycling ,Chemical Sciences ,biology.protein ,X-Ray ,bacteria ,Sequence Alignment ,Genome, Bacterial ,Tertiary ,Cysteine - Abstract
The crystal structure of the highly specific γ-d-glutamyl-l-diamino acid endopeptidase YkfC from Bacillus cereus in complex with l-Ala-γ-d-Glu reveals the structural basis for the substrate specificity of NlpC/P60-family cysteine peptidases., Dipeptidyl-peptidase VI from Bacillus sphaericus and YkfC from Bacillus subtilis have both previously been characterized as highly specific γ-d-glutamyl-l-diamino acid endopeptidases. The crystal structure of a YkfC ortholog from Bacillus cereus (BcYkfC) at 1.8 Å resolution revealed that it contains two N-terminal bacterial SH3 (SH3b) domains in addition to the C-terminal catalytic NlpC/P60 domain that is ubiquitous in the very large family of cell-wall-related cysteine peptidases. A bound reaction product (l-Ala-γ-d-Glu) enabled the identification of conserved sequence and structural signatures for recognition of l-Ala and γ-d-Glu and, therefore, provides a clear framework for understanding the substrate specificity observed in dipeptidyl-peptidase VI, YkfC and other NlpC/P60 domains in general. The first SH3b domain plays an important role in defining substrate specificity by contributing to the formation of the active site, such that only murein peptides with a free N-terminal alanine are allowed. A conserved tyrosine in the SH3b domain of the YkfC subfamily is correlated with the presence of a conserved acidic residue in the NlpC/P60 domain and both residues interact with the free amine group of the alanine. This structural feature allows the definition of a subfamily of NlpC/P60 enzymes with the same N-terminal substrate requirements, including a previously characterized cyanobacterial l-alanine-γ-d-glutamate endopeptidase that contains the two key components (an NlpC/P60 domain attached to an SH3b domain) for assembly of a YkfC-like active site.
- Published
- 2010
49. The structure of BVU2987 from Bacteroides vulgatus reveals a superfamily of bacterial periplasmic proteins with possible inhibitory function
- Author
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Debanu Das, Kevin K. Jin, Mark W. Knuth, Gye Won Han, Henry van den Bedem, Ian A. Wilson, Amanda Nopakun, Qingping Xu, Christina Puckett, Kyle Ellrott, Connie Chen, Adam Godzik, Christopher L. Rife, Thomas Clayton, Mitchell D. Miller, Anna Grzechnik, Herbert L. Axelrod, Marc André Elsliger, Lian Duan, Dana Weekes, Tamara Astakhova, Keith O. Hodgson, Heath E. Klock, Christine B Trame, Abhinav Kumar, Carol L. Farr, Andrew T. Morse, Joanna C Grant, Julie Feuerhelm, Natasha Sefcovic, David Marciano, Marc C. Deller, Michelle Chiu, Polat Abdubek, Constantina Bakolitsa, Lukasz Jaroszewski, Sanjay Krishna, John Wooley, Daniel McMullan, Ron Reyes, Robert D. Finn, Piotr Kozbial, Henry J Tien, Scott A. Lesley, Dennis Carlton, Linda Okach, Hsiu-Ju Chiu, Tiffany Wooten, Edward Nigoghossian, Ashley M. Deacon, and Dustin C. Ernst
- Subjects
Models, Molecular ,Plasma protein binding ,Crystallography, X-Ray ,Biochemistry ,Conserved sequence ,putative inhibitor proteins ,PF11396 ,Protein structure ,Structural Biology ,Models ,β-lactamase inhibitor protein-like fold ,Bacteroides ,Peptide sequence ,Conserved Sequence ,0303 health sciences ,Crystallography ,biology ,Human Gut Microbiome ,030302 biochemistry & molecular biology ,Biological Sciences ,Condensed Matter Physics ,BVU2987 ,3. Good health ,Infectious Diseases ,Periplasmic Proteins ,Protein Binding ,Protein Structure ,Sequence analysis ,1.1 Normal biological development and functioning ,Molecular Sequence Data ,Biophysics ,Sequence alignment ,Vaccine Related ,03 medical and health sciences ,Tandem repeat ,Underpinning research ,Biodefense ,Genetics ,Amino Acid Sequence ,030304 developmental biology ,Structural Homology ,Prevention ,Protein ,Molecular ,biology.organism_classification ,Protein Structure, Tertiary ,Emerging Infectious Diseases ,Structural Homology, Protein ,Chemical Sciences ,X-Ray ,DUF2874 ,Sequence Alignment ,Tertiary - Abstract
The crystal structure of the BVU2987 gene product from B. vulgatus (UniProt A6L4L1) reveals that members of the new Pfam family PF11396 (domain of unknown function; DUF2874) are similar to β-lactamase inhibitor protein and YpmB., Proteins that contain the DUF2874 domain constitute a new Pfam family PF11396. Members of this family have predominantly been identified in microbes found in the human gut and oral cavity. The crystal structure of one member of this family, BVU2987 from Bacteroides vulgatus, has been determined, revealing a β-lactamase inhibitor protein-like structure with a tandem repeat of domains. Sequence analysis and structural comparisons reveal that BVU2987 and other DUF2874 proteins are related to β-lactamase inhibitor protein, PepSY and SmpA_OmlA proteins and hence are likely to function as inhibitory proteins.
- Published
- 2010
50. T cell depleted stem-cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin
- Author
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Miguel-Angel Perales, Katherine C. Hsu, Michelle Chiu, Nancy A. Kernan, Richard J. O'Reilly, Marcel R.M. van den Brink, Trudy N. Small, Hugo Castro-Malaspina, Esperanza B. Papadopoulos, Christine Cisek, Ann A. Jakubowski, James W. Young, and Nancy H. Collins
- Subjects
Adult ,Male ,medicine.medical_specialty ,Transplantation Conditioning ,medicine.medical_treatment ,Immunology ,Graft vs Host Disease ,Hematopoietic stem cell transplantation ,ThioTEPA ,Opportunistic Infections ,Biochemistry ,Gastroenterology ,Disease-Free Survival ,Lymphocyte Depletion ,HLA Antigens ,Internal medicine ,medicine ,Humans ,Transplantation, Homologous ,Antilymphocyte Serum ,Transplantation ,business.industry ,Graft Survival ,Hematopoietic Stem Cell Transplantation ,Cell Biology ,Hematology ,Total body irradiation ,Middle Aged ,medicine.disease ,Fludarabine ,Surgery ,Regimen ,Graft-versus-host disease ,surgical procedures, operative ,Hematologic Neoplasms ,Female ,business ,medicine.drug - Abstract
Antithymocyte globulin (ATG) has been used in allogeneic stem-cell transplantation to prevent graft rejection and graft-versus-host disease (GvHD). Its use, however, has been associated with delayed T-cell reconstitution and prolonged susceptibility to opportunistic infections (OIs) especially in patients undergoing T cell–depleted (TCD) transplantation. Recently, a prospective trial was conducted in 52 adult patients (median age, 47 years) with various hematologic malignancies undergoing TCD transplantation from HLA-matched related donors without the use of ATG. The cytoreductive regimen consisted of hyperfractionated total body irradiation (HFTBI), thiotepa, and fludarabine. The preferred source of the graft was peripheral blood stem cells (PBSCs). No additional graft rejection or GvHD prophylaxis was given. All evaluable patients engrafted without any immune-mediated graft rejections. Disease-free survival (DFS) at 3 years was 61% in all patients, and 70% in patients with standard-risk disease. Acute GvHD was limited to grade 2 in 8% and chronic GvHD in 9% of patients. Life-threatening OIs occurred in 3 of 52 patients and was fatal in 1. This study demonstrates durable engraftment with a low incidence of GvHD despite the lack of ATG, as well as the curative potential of this regimen.
- Published
- 2007
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