206 results on '"Mary Le"'
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2. Public Responses to a Proposed Wind Farm and their Application to Technical Communication Methods
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Rouge, Mary Le, primary
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- 2022
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3. Embodied Environmental Risk in Technical Communication
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Stinson, Samuel, primary and Rouge, Mary Le, additional
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- 2022
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4. How Literate Responses to Technical Communication Can Promote Practical Responses to Environmental Change.
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Mary Le Rouge
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- 2020
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5. Using situational analysis to reimagine infrastructure
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Mary Le Rouge, Clancy Ratliff, and Donnie Johnson Sackey
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General Medicine - Abstract
In this article, we ask what it means to think of infrastructure discursively through situational analysis. First, we consider how policymakers have historically used writing and rhetoric to redefine, reframe, and resituate what infrastructure can be in technical documents. Second, we address the impact of policymakers' discursive practices on the spaces and material realities of communities. We view the infrastructural function of writing "as a conceptual foundation for revealing structures and foundations of organizations that affect people" (Read, 2019, p. 237). We use three texts as the space of our discourse mapping: President Franklin Roosevelt's "Fireside Chat on the Recovery Program," the Green New Deal, and President Joseph Biden's recently proposed American Jobs Plan. Through these three cases, we argue that infrastructure has always been defined in relation to environment. Any definition of infrastructure is rooted in environment or seeks to change environment. These shifts in definition have been used strategically to bring more visibility to marginalized communities and make their concerns central to the concerns of the United States' socio-economic agenda. We close with implications for both communities and policymakers.
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- 2022
6. Examining use of telehealth in jails: linking women to community OUD services
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Michele Staton, Mary Levi, Erin Winston, Carrie B. Oser, Amanda Fallin-Bennett, Megan Dickson, J. Matthew Webster, Carl Leukefeld, and Martha Tillson
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Women ,Opioid use disorder ,Jails ,Telehealth ,Gynecology and obstetrics ,RG1-991 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Opioid use disorder (OUD) remains a significant health care need for women, particularly those involved in the criminal legal system (CLS). There are no studies to date that focus on the utilization of telehealth as a platform for assessment and linkage to medications to treat opioid use disorder (MOUD) at community re-entry for women, despite the fact that women have unique risk factors that may contribute to opioid relapse in the community. The purpose of this mixed-methods study is to provide an overview of the innovative use of telehealth for linking incarcerated women to community MOUD treatment in the Kentucky-hub of the Justice Community Opioid Innovation Network (JCOIN). Methods This study incorporates qualitative and quantitative data collection with MOUD providers, recovery staff involved in peer navigation services, and women who are incarcerated to understand perceptions of the use of telehealth prior to jail release as a linkage to community services. Results Findings from this study suggest overall support for the use of telehealth between community MOUD treatment providers and women who are incarcerated using videoconferencing technology. On average, there was very little variation in provider favorable feedback related to clinical engagement or in face-to-face comparability, as well as how telehealth allowed the participant to discuss personal and sensitive issues during the clinical assessment. Conclusions Study findings suggest benefits associated with the use of telehealth in increasing access to treatment for women with OUD. Jails are critical venues for telehealth interventions because they provide the opportunity to reach women who have been actively using illicit substances, often have advanced-stage substance use disorders which have compromised their health and mental health, and often have not been previously identified as needing treatment. Trial registration : This study was originally registered on 8/23/19, ClinicalTrials.gov, #NCT04069624.
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- 2024
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7. Fusobacterium is toxic for head and neck squamous cell carcinoma and its presence may determine a better prognosis
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Anjali Chander, Jacopo Iacovacci, Aize Pellon, Radhika Kataria, Anita Grigoriadis, John Maher, Cynthia Sears, Gilad Bachrach, Teresa Guerrero Urbano, Mary Lei, Imran Petkar, Anthony Kong, Tony Ng, Ester Orlandi, Nicola Alessandro Iacovelli, Loris De Cecco, Mara Serena Serafini, David Moyes, Tiziana Rancati, and Miguel Reis Ferreira
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2024
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8. Using situational analysis to reimagine infrastructure
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Rouge, Mary Le, primary, Ratliff, Clancy, additional, and Sackey, Donnie Johnson, additional
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- 2022
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9. Post-acute COVID-19 outcomes including participant-reported long COVID: amubarvimab/romlusevimab versus placebo in the ACTIV-2 trialResearch in context
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Teresa H. Evering, Carlee Moser, Nikolaus Jilg, Justin Ritz, David A. Wohl, Jonathan Z. Li, David Margolis, Arzhang Cyrus Javan, Joseph J. Eron, Judith S. Currier, Eric S. Daar, Davey M. Smith, Michael D. Hughes, Kara W. Chew, Kara Chew, David (Davey) Smith, Eric Daar, David Wohl, Judith Currier, Joseph Eron, Michael Hughes, Mark Giganti, Lara Hosey, Jhoanna Roa, Nilam Patel, Kelly Colsh, Irene Rwakazina, Justine Beck, Scott Sieg, Jonathan Li, Courtney Fletcher, William Fischer, Rachel Bender Ignacio, Sandra Cardoso, Katya Corado, Prasanna Jagannathan, Alan Perelson, Sandy Pillay, Cynthia Riviere, Upinder Singh, Babafemi Taiwo, Joan Gottesman, Matthew Newell, Susan Pedersen, Joan Dragavon, Cheryl Jennings, Brian Greenfelder, William Murtaugh, Jan Kosmyna, Morgan Gapara, Akbar Shahkolahi, Verónica Lacal, Diego Salusso, Sebastian Nuñez, Marcelo Rodrigo Rodriguez, Luciana Laborde, Marcelo Papasidero, Luis Wehbe, Mariana Gonzalez, Felicitas Fernandez Voena, Tomas Alvarez, Amaru Lopez, Virginia Huhn, Ulises D'Andrea Nores, Pablo Dieser, Fernando Bordese, Marisa Mussi, Rodrigo de Carvalho Santana, Adriana Aparecida Tiraboschi Bárbaro, Breno Santos, Rita de Cássia Alves Lira, Andre Luiz Machado da Silva, Sandra Wagner Cardoso, Maria Pia Diniz Ribeiro, Nathália Soliva, Eduardo Vasconcellos, Jorge Eurico Ribeiro, Miriam Amaral Enéas, Jorge Pinto, Julia Fonseca de Morais Caporali, Flávia Gomes Faleiro Ferreira, Norma Erendira Rivera Martinez, Victor Casildo Bohorquez Lopez, Melchor Victor Frias, Krystle Fetalvero, Alyxzza Maranan, Jennifer Rosa, Thomas Coetzer, Maureen Mohata, Sr., Umesh Lalloo, Penelope Madlala, Larisha Pillay-Ramaya, Jaclyn Ann Bennet, Noluthando Mwelase, Nokuphiwa Mbhele, Frederick Petrick, Leonard Joubert, Rose Mbali, Sr., Natasha Joseph, Mmatsie Manentsa, Eugene van der Walt, Mduduzi Sandile Lawrance Masilela, Zinhle Zwane, Tendai Chiperera, Lerato Mohapi, Suri Moonsamy, Usha Singh, Kirsten McHarry, Elizma Snyman, Pieter Lennox, James Craig Innes, Oteng Letlape, Olebogeng Jonkane, William Brumskine, Tania Adonis, Ni Ni Sein, Modulakgotla Sebe, Yacoob Vahed, Nazreen Jeewa Hussen, Ismail Mitha, Vasundhara Cheekati, Purna Cheekati, Christie Lummus, Samuel Idarraga, Andrew Kim, David N. Pham, Wei-Hsin Kao, Michael M. Pfeffer, Miriam Batule Dominguez, Anju Malik, Anna Bryan, Melanie Arnold, Idania Fernandez, Cinzia Karpf, Aniuska Ruiz, David Taylor, Eric Folkens, Jennifer Manne, Sigal Yawetz, Cheryl Keenan, Emeka Eziri, Carl Fichtenbaum, Jenifer Baer, Sarah Trentman, Robert Call, Leroy Vaughan, Aaron Milstone, Jamie Alex Slandzicki, Jessica Wallan, Clinton Guillory, Nancy Andrews, Leslie Hughes, Jonathan Berardi, Celine Arar, Randall Quinn, Jorge P. Amaya, Marissa Gomez-Martinez, Luis Cantu, Monica Betancourt-Garcia, Nwora Lance Okeke, Charles M. Burns, Fadi Haddad, Victoria Haddad, Augusto Focil, Griselda Rosas, Susana Moyano, Yaneicy Gonzalez Rojas, Ahmad Aswad, Yevgeniy Bukhman, Manish Jain, Eugene Bukhman, Humam Farah, Rebekah McClain, Sadia Shaik, Timothy Hatlen, Deepa Gotur, Joseph Surber, Jeffrey Kingsley, April Pixler, Alex Zopo, Jack Herman, Craig Herman, Ramon Leon, Boris Nikolov, Fernando Gonzalez Vergara, Ana I. Gonzalez, Noemi Gonzalez, Michael Gelman, Olga Andriunas, Zarema Jagizarov, Jan Westerman, David Davis, Donna Sherer, Kelly Dooley, Becky Becker, Adaliah Wilkins, Jose Pérez, Eloy Roman, Heriberto Fernández, Bharat Mocherla, Kelly Beck, Valarie Maldonado, Jennifer Veltman, Rajesh Gandhi, Katrina Shea, Matthew Planchon, Laura Bogan Herpel, Kaushlendra K. Tripathi, Donald C. Day, John Pullman, Sr., Erin Williams-Leber, Misty Johnson, Michelle Hecker, Ann Avery, Keila Hoover, George W. Monlux, Elizabeth Juneja, Jr., Arthur Wernick, Karelia Ruiz, Maureen Hernández, Yadilys Pérez, Babafemi O. Taiwo, Claudia Hawkins, Baiba Berzins, Carlos Malvestutto, Heather Harber, Robyn Cicarella, Edwin DeJesus, Charlotte-Paige Rolle, Almena L. Free, Sallie D. Pulliam, Debra Weinstein, Rosa M. Suarez, Ezequiel Socorro, Estefania Socorro, Gene Neytman, Raymond Easley, Mariam Aziz, Joan Swiatek, Avish Nagpal, Breanna Kompelien, Kathryn McEvoy, Susan E. Hoover, Allison Lutz, Jessica Just, Manuel Hernandez, Yanly B. Victoria, Gabriel Rodriguez, Divya Pathak, Joshua J. Ordway, Megan Heffner, Patrick Weston, Khalilah Weston, Madhu Choudhary, Jennifer Sullivano, Olayemi Osiyemi, Myriam Izquierdo, Odelsey Torna, Brian Clemency, Renoj Varughese, Joshua Lynch, Aleen Khodabakhshian, Samantha Fortier, Christopher Coyne, Alexandrea Cronin, Constance Benson, Steven Hendrickx, Rosemarie Ramirez, Anne Luetkemeyer, Suzanne Hendler, Dennis Dentoni-Lasofsky, Mobeen Rathore, Saniyyah Mahmoudi, Amna Riaz, Mario Castro, Leslie Spikes, Chase Hall, Jonathan Oakes, Amy James Loftis, Pablo Tebas, William Short, Michael P. Dube, Saahir Khan, Luis M. Mendez, Sarah McGuffin, Chris Jonsson, Mamta K. Jain, Smruthi Senthil, Kimberly Turner-Gray, Sanjay Mehta, Mary Lewinski, Masoud Azizad, Christopher Chow, Lisa Nakatani, Derrick Williamson, Hisham Atriss, Matthew Caloura, Midhun Malla, Hannah Hazard-Jenkins, Aimee Wilkin, Jamraus Fayssoux, Hannah Seagle, Rachel Presti, and Alem Haile
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COVID-19 ,Monoclonal antibodies ,Outpatient treatment ,Clinical trial ,Post COVID conditions ,Long COVID ,Medicine (General) ,R5-920 - Abstract
Summary: Background: It is unknown if early COVID-19 monoclonal antibody (mAb) therapy can reduce risk of Long COVID. The mAbs amubarvimab/romlusevimab were previously demonstrated to reduce risk of hospitalization/death by 79%. This study assessed the impact of amubarvimab/romlusevimab on late outcomes, including Long COVID. Methods: Non-hospitalized high-risk adults within 10 days of COVID-19 symptom onset enrolled in a randomized, double-blind, placebo-controlled phase 2/3 trial of amubarvimab/romlusevimab for COVID-19 treatment. Late symptoms, assessed using a participant-completed symptom diary, were a pre-specified exploratory endpoint. The primary outcome for this analysis was the composite of Long COVID by participant self-report (presence of COVID-19 symptoms as recorded in the diary at week 36) or hospitalization or death by week 36. Inverse probability weighting (IPW) was used to address incomplete outcome ascertainment, giving weighted risk ratios (wRR) comparing amubarvimab/romlusevimab to placebo. Findings: Participants received amubarvimab/romlusevimab (n = 390) or placebo (n = 390) between January and July 2021. Median age was 49 years, 52% were female, 18% Black/African American, 49% Hispanic/Latino, and 9% COVID-19-vaccinated at entry. At week 36, 103 (13%) had incomplete outcome ascertainment, and 66 (17%) on amubarvimab/romlusevimab and 92 (24%) on placebo met the primary outcome (wRR = 0.70, 95% confidence interval (CI) 0.53–0.93). The difference was driven by fewer hospitalizations/deaths with amubarvimab/romlusevimab (4%) than placebo (13%). Among 652 participants with available diary responses, 53 (16%) on amubarvimab/romlusevimab and 44 (14%) on placebo reported presence of Long COVID. Interpretation: Amubarvimab/romlusevimab treatment, while highly effective in preventing hospitalizations/deaths, did not reduce risk of Long COVID. Additional interventions are needed to prevent Long COVID. Funding: National Institute of Allergy and Infectious Diseases of the National Institutes of Health. Amubarvimab and romlusevimab supplied by Brii Biosciences.
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- 2024
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10. Embodied Environmental Risk in Technical Communication
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Samuel Stinson and Mary Le Rouge
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- 2022
11. Public Responses to a Proposed Wind Farm and their Application to Technical Communication Methods
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Mary Le Rouge
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- 2022
12. Introduction
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Mary Le Rouge and Samuel Stinson
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- 2022
13. Divergent Pathogenesis and Transmission of Highly Pathogenic Avian Influenza A(H5N1) in Swine
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Bailey Arruda, Amy L. Vincent Baker, Alexandra Buckley, Tavis K. Anderson, Mia Torchetti, Nichole Hines Bergeson, Mary Lea Killian, and Kristina Lantz
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influenza A virus ,influenza ,viruses ,H5N1 subtype ,swine ,porcine ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Highly pathogenic avian influenza (HPAI) viruses have potential to cross species barriers and cause pandemics. Since 2022, HPAI A(H5N1) belonging to the goose/Guangdong 2.3.4.4b hemagglutinin phylogenetic clade have infected poultry, wild birds, and mammals across North America. Continued circulation in birds and infection of multiple mammalian species with strains possessing adaptation mutations increase the risk for infection and subsequent reassortment with influenza A viruses endemic in swine. We assessed the susceptibility of swine to avian and mammalian HPAI H5N1 clade 2.3.4.4b strains using a pathogenesis and transmission model. All strains replicated in the lung of pigs and caused lesions consistent with influenza A infection. However, viral replication in the nasal cavity and transmission was only observed with mammalian isolates. Mammalian adaptation and reassortment may increase the risk for incursion and transmission of HPAI viruses in feral, backyard, or commercial swine.
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- 2024
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14. Visuals that Portray a Wind Farm
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Mary Le Rouge
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Visual arts - Abstract
John Debes, the founder of the IVLA, argues that our first language is body language – visual and tactile information together helping us make sense of the world (Debes, 1972). During research of the public response to what could be the first freshwater offshore wind farm in North America, on Lake Erie, participants have a distinctly embodied understanding of environmental information. Their oral stories, drawings, and written responses reflect use of visual literacy that personifies wind turbines, the lake, fish and birds, and Earth’s processes as human in nature. In return, participants’ perception of the wind farm’s features, size, and distance is skewed toward an immediate, physical presence. Between anthropomorphism and embodiment, what the general population sees as important in a large-scale sustainable energy project is very different from what is shown in technical documentation from scientists, engineers, and policymakers, complicating public decision making.
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- 2021
15. Case Report: Primary Duodenal Melanoma with Brain Metastasis
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Sonha Nguyen, Naila Khan, Christine Duong, Mary Le, and Vishal Ranpura
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Brain Neoplasms ,Duodenum ,Humans ,Case Report ,General Medicine ,Immunotherapy ,Adenocarcinoma ,Melanoma - Abstract
Malignant duodenal tumors can be primary or secondary. Although the most common primary tumor involving the duodenum is an adenocarcinoma, primary malignant melanomas arising in the small intestine are exceedingly rare and remain a controversial clinical entity. In this report, we present a unique case of primary duodenal melanoma with brain metastasis managed successfully by surgical excision, stereotactic radiation, and adjuvant immunotherapy.
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- 2021
16. Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial
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Ling Wang, Ian Norman, Tao Xiao, Yamin Li, Xizhao Li, Ting Liu, Jianjian Wang, Lina Zeng, Ziqing Zhong, Chengzhu Jian, and Mary Leamy
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Psychological first aid training ,front-line healthcare workers ,mental health and well-being ,feasibility randomized controlled trial ,Capacitación en primeros auxilios psicológicos ,trabajadores sanitarios de primera línea ,Psychiatry ,RC435-571 - Abstract
ABSTRACTBackground: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking.Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected.Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p
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- 2024
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17. Interventions to improve system-level coproduction in the Cystic Fibrosis Learning Network
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Rachel Gordon, Lillian O’Leary, Gregory Sawicki, Don B Sanders, David Miller, Peter J Murphy, Michael Seid, John Dickinson, Mary Lester, Catherine Hopkins, Adrienne Savant, Rebekah Brown, Preeti Sharma, Christian Merlo, Michelle Roberts, Kathryn A Sabadosa, David Hansen, Peter Michelson, Amy Filbrun, Jordan Dunitz, Christopher M Siracusa, Thida Ong, Stacy Bichl, Ahmet Uluer, Joanne Cullina, Michael Powers, Rhonda List, Lindsay Somerville, Lauren Williamson, Dana Albon, Hossein Sadeghi, Clement Ren, Thomas Keens, Nicholas Antos, Fadi Asfour, Mike Price, Kristen Nowak, Robert Balk, Erin Moore, Prigi Varghese, Cori Daines, Glenda Drake, Amy Lucero, Amanda Sharpe, Lindsey McMahon, Meghan Murray, Meghana Sathe, Traci Liberto, Rachel Linnemann, Pornchai Tirakitsoontorn, Maivy Sou, Michael Schechter, Andrea Molzhon, Karen Wunschel, Lisa A Mullen, Kyle Traver, Travis Burgett, Alex Gifford, Nicola Felicetti, Heidi Dolan, Tracey Gendreau, Danielle Beachler, Shine-Ann Pai, Stephanie Robbins, Ben McCullar, Lauren Mitchell, Andrew Scaljon, Stefanie Rushing, Golnar Raissi, Bean Corcoran, Michelle Prickett, Rachel Nelson, Stacy Allen, Lisa Greene, Sara Renschen, Betsy Price, Catherine Kier, Teresa Carney, Sandy Corr, Barbara Leyva, Jillian Salvatore, George M Solomon, Julianna Bailey, James Lawlor, Samya Z Nasr, Rebekah Raines, Catherine Enochs, Kristen Jesse, Jonathan Flath, Mackenzie Wharram, James Tolle, Susan Eastman, Nauman Chaudary, Mahsa Farsad, Kimberly Wingo, Kathryn Moffett, Erin Brozik, Paige Krack, Kevin Martin, Laura Roth, Joshua Wang, Sarah Dykes, Erin Newbill, Misty Thompson, Danielle Poulin, Breck Gamel, Srujana Bandla, David W Davison, Lindsay Silva, Raouf Amin, Maria Britto, Anna Saulitis, Kate Barnico, Cindy Murphy, Amanda Lemieux, Georgia Dangel, Melanie Lawrence, Danielle Goetz, Danielle Woerner, Megan Whelan, Katelyn Violanti, Susan Attel, Alexia Hernández Cargal, Kelly Clute, Olivia Ries, Susan Gage, Bridget Kominek, Kristin Lawrence, Megan Martin, Jessica Roach, Errin Newman, Phillip Vaden, Esther Giezendanner, Marsha Triana, Sujal Rangwalla, Meghann Weil, Randy Hunt, Emily Walker, Caroline Starnes, Kendra Adderhold, Megan Barker, Johanna Zea-Hernandez, Beth Debri, Ann Kaiser, Cindy Brown, Pi Chun Cheng, Jana Yeley, Laura Jay-Ballinger, Julian McConnie, Meghana Malapaka, Perry Aulie, Ginger Birnbaum, Cynthia Driskill, Janerisa Encarnacion, Amanda Oswald, Stephanie Fullmer, Anthony Fashoda, Laura Steinhaus, Maureen Tinley, Jame’ Vajda, Janine Cassidy, Mey Lee, Megan Akers, Susan Whitmore, Christian Santaniello, Robert Abdullah, Bryan Garcia, Cameron Crenshaw, Kandice Amos, Veronica Indihar, Lisa Shively, Anissa Hostetter, Angela Oder, Brandi Morgan, Kayla Hubley, Deborah K Froh, Holly Carroll-Owen, Lauren Miller Ahrens, Brielle Evangelista, Lucy Gettle, Tracie O'Sullivan, Autumn Bonstein, Stacey Miller, Angela Bender, Billie Jo Bennett, John Palla, Cathy O'Malley, Maria Dowell, Allison Fitch-Markham, Chladd Ford, Carolyn Heyman, Terri Laguna, Debbie Benitez, Lynn Fukushima, Martha Markovitz, Adupa Rao, Gregory Storm, Vai Jun Lam, John Mercer, Cori Muirhead, Jeff Gold, Aaron Trimble, Gopal Allada, Wendy Palmrose, Sue Sullivan, Kim Keeling, Rob Shradar, Jill Fliege, Heidi Klasna, Janelle Sorensen, Stacy Millikan, Joe Poler, Jill Rollins, Sandy Wahl, Cristy Batten, Laura Romero, Whitney Gore, Kimberly Morse, Rocio Munter, Danieli Salinas, Sylvia Sanchez, Virginia Anderson, Jami Dunn, Stephanie Gamble, Hector Gutierrez, Kelli Lachowicz, Isabel Lowell, Cathy Mims, LaShonna Stodghill, Gabriela Oates, Amanda Phillips, Linda Russo, Staci Self, Julie Desch, Ilene Hollin, Emily Kramer-Golinkoff, Pamela Mertz, Sarah Gomez, Nancy Griffin, and Drew Warmin
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Medicine (General) ,R5-920 - Abstract
Background Coproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide insights to integrate coproduction with QI efforts from programmes from various health systems.Objective We describe interventions to develop and maintain patient and family partner (PFP) coproduction, measured by PFP-reported and programme-reported scales. We aim to increase percentage of programmes with PFPs reporting active QI work within their programme, while maintaining satisfaction in PFP-clinician relationships.Methods Conducted in the Cystic Fibrosis Learning Network (CFLN), an LHN comprising over 30 cystic fibrosis (CF) programmes, people with CF, caregivers and clinicians cocreated interventions in readiness awareness, inclusive PFP recruitment, onboarding process, partnership development and leadership opportunities. Interventions were adapted by CFLN programmes and summarised in a change package for existing programmes and the orientation of new ones. We collected monthly assessments for PFP and programme perceptions of coproduction and PFP self-rated competency of QI skills and satisfaction with programme QI efforts. We used control charts to analyse coproduction scales and run charts for PFP self-ratings.Results Between 2018 and 2022, the CFLN expanded to 34 programmes with 52% having ≥1 PFP reporting active QI participation. Clinicians from 76% of programmes reported PFPs were actively participating or leading QI efforts. PFPs reported increased QI skills competency (17%–32%) and consistently high satisfaction and feeling valued in their work.Conclusions Implementing system-level programmatic strategies to engage and sustain partnerships between clinicians and patients and families with CF improved perceptions of coproduction to conduct QI work. Key adaptable strategies for programmes included onboarding and QI training, supporting multiple PFPs simultaneously and developing financial recognition processes. Interventions may be applicable in other health conditions beyond CF seeking to foster the practice of coproduction.
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- 2024
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18. Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review
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Cyd K Eaton, Emma McWilliams, Dana Yablon, Irem Kesim, Renee Ge, Karissa Mirus, Takeera Sconiers, Alfred Donkoh, Melanie Lawrence, Cynthia George, Mary Leigh Morrison, Emily Muther, Gabriela R Oates, Meghana Sathe, Gregory S Sawicki, Carolyn Snell, and Kristin Riekert
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Information technology ,T58.5-58.64 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract BackgroundMobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management–promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions. ObjectiveThis study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands. MethodsA registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form. ResultsA total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P ConclusionsTo support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.
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- 2024
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19. Experiences of living with overweight/obesity and early type 2 diabetes in Singapore—a qualitative interview study
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Mary Lee, Eng Sing Lee, Hwee Sing Khoo, Wern Ee Tang, Shu Yun Tan, Charmaine Krishnasamy, May Eng Loo, S K W Wong, San Chye Cheng, Eileen Bei, and Pauline Xie
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Medicine - Abstract
Objectives To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants’ attitudes to weight management.Design Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective.Setting Primary care clinics located in northern and central Singapore.Participants 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3–44.0kg/m2) and type 2 diabetes for 6 years or less.Results The main themes – everyday life, people around me and within me – pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change.Conclusion An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual’s efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants’ stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.
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- 2024
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20. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews:Systematic review
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Karsten Juhl Jørgensen, Mary Le, Asbjørn Hróbjartsson, Anders W Jørgensen, Camilla Hansen Nejstgaard, Andreas Lundh, and Lisa Bero
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medicine.medical_specialty ,Advisory Committees/ethics ,Advisory Committees ,Specialty ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Research Support as Topic/ethics ,0302 clinical medicine ,Bias ,Research Support as Topic ,medicine ,Conflict of Interest/economics ,Humans ,Narrative ,030212 general & internal medicine ,Association (psychology) ,Expert Testimony ,Protocol (science) ,Expert Testimony/ethics ,Conflict of Interest ,Research ,General Medicine ,Grey literature ,Review Literature as Topic ,Data extraction ,Relative risk ,Family medicine ,Practice Guidelines as Topic ,Psychology - Abstract
Objective To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Design Systematic review. Eligibility criteria Studies that compared the association between conflicts of interest and favourable recommendations of drugs or devices (eg, recommending a drug) in clinical guidelines, advisory committee reports, opinion pieces (eg, editorials), or narrative reviews. Data sources PubMed, Embase, Cochrane Methodology Register (from inception to February 2020), reference lists, Web of Science, and grey literature. Data extraction and analysis Two authors independently extracted data and assessed the methodological quality of the studies. Pooled relative risks and 95% confidence intervals were estimated using random effects models (relative risk >1 indicates that documents with conflicts of interest more often had favourable recommendations than documents with no conflicts of interest). Financial and non-financial conflicts of interest were analysed separately, and the four types of documents were analysed separately (preplanned) and combined (post hoc). Results 21 studies that analysed 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews were included. Unpublished data were received for 11 studies (eight full datasets and three summary datasets). 15 studies showed risk of confounding because the compared documents could differ in factors other than conflicts of interest (eg, different drugs used for different populations). The relative risk for associations between financial conflicts of interest and favourable recommendations for clinical guidelines was 1.26 (95% confidence interval 0.93 to 1.69; four studies of 86 clinical guidelines), for advisory committee reports was 1.20 (0.99 to 1.45; four studies of 629 advisory committee reports), for opinion pieces was 2.62 (0.91 to 7.55; four studies of 284 opinion pieces), and for narrative reviews was 1.20 (0.97 to 1.49; four studies of 457 narrative reviews). An analysis of all four types of documents combined supported these findings (1.26, 1.09 to 1.44). In one study that investigated specialty interests, the association between including radiologists as authors of guidelines and recommending routine breast cancer was: relative risk 2.10, 95% confidence interval 0.92 to 4.77; 12 clinical guidelines). Conclusions We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Limitations of this review were risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest influence recommendations. Systematic review registration Cochrane Methodology Review Protocol MR000040.
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- 2020
21. Conflicts of interest in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews:associations with recommendations
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Camilla Hansen Nejstgaard, Anders W Jørgensen, Lisa Bero, Mary Le, Andreas Lundh, Karsten Juhl Jørgensen, and Asbjørn Hróbjartsson
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medicine.medical_specialty ,Advisory Committees/ethics ,Drug Industry ,Consultants ,Advisory Committees ,Specialty ,MEDLINE ,Psychological intervention ,Datasets as Topic ,Equipment and Supplies/ethics ,03 medical and health sciences ,Breast cancer screening ,0302 clinical medicine ,Bias ,Radiologists ,medicine ,Conflict of Interest/economics ,Humans ,Pharmacology (medical) ,Narrative ,030212 general & internal medicine ,medicine.diagnostic_test ,Conflict of Interest ,business.industry ,Publications ,Drug Industry/ethics ,Guideline ,Grey literature ,Authorship ,Review Literature as Topic ,Equipment and Supplies ,Relative risk ,Family medicine ,Practice Guidelines as Topic ,Publications/ethics ,Datasets as Topic/ethics ,business ,030217 neurology & neurosurgery ,Editorial Policies - Abstract
BACKGROUND: Treatment and diagnostic recommendations are often made in clinical guidelines, reports from advisory committee meetings, opinion pieces such as editorials, and narrative reviews. Quite often, the authors or members of advisory committees have industry ties or particular specialty interests which may impact on which interventions are recommended. Similarly, clinical guidelines and narrative reviews may be funded by industry sources resulting in conflicts of interest. OBJECTIVES: To investigate to what degree financial and non-financial conflicts of interest are associated with favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. SEARCH METHODS: We searched PubMed, Embase, and the Cochrane Methodology Register for studies published up to February 2020. We also searched reference lists of included studies, Web of Science for studies citing the included studies, and grey literature sources. SELECTION CRITERIA: We included studies comparing the association between conflicts of interest and favourable recommendations of drugs or devices (e.g. recommending a particular drug) in clinical guidelines, advisory committee reports, opinion pieces, or narrative reviews. DATA COLLECTION AND ANALYSIS: Two review authors independently included studies, extracted data, and assessed risk of bias. When a meta-analysis was considered meaningful to synthesise our findings, we used random-effects models to estimate risk ratios (RRs) with 95% confidence intervals (CIs), with RR > 1 indicating that documents (e.g. clinical guidelines) with conflicts of interest more often had favourable recommendations. We analysed associations for financial and non-financial conflicts of interest separately, and analysed the four types of documents both separately (pre-planned analyses) and combined (post hoc analysis). MAIN RESULTS: We included 21 studies analysing 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews. We received unpublished data from 11 studies; eight full data sets and three summary data sets. Fifteen studies had a risk of confounding, as they compared documents that may differ in other aspects than conflicts of interest (e.g. documents on different drugs used for different populations). The associations between financial conflicts of interest and favourable recommendations were: clinical guidelines, RR: 1.26, 95% CI: 0.93 to 1.69 (four studies of 86 clinical guidelines); advisory committee reports, RR: 1.20, 95% CI: 0.99 to 1.45 (four studies of 629 advisory committee reports); opinion pieces, RR: 2.62, 95% CI: 0.91 to 7.55 (four studies of 284 opinion pieces); and narrative reviews, RR: 1.20, 95% CI: 0.97 to 1.49 (four studies of 457 narrative reviews). An analysis combining all four document types supported these findings (RR: 1.26, 95% CI: 1.09 to 1.44). One study investigating specialty interests found that the association between including radiologist guideline authors and recommending routine breast cancer screening was RR: 2.10, 95% CI: 0.92 to 4.77 (12 clinical guidelines). AUTHORS' CONCLUSIONS: We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. However, we also stress risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest impact on recommendations.
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- 2020
22. Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards
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Mary Leamy, Sarah Sims, Ros Levenson, Nigel Davies, Sally Brearley, Stephen Gourlay, Giampiero Favato, Fiona Ross, and Ruth Harris
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Intentional rounding ,Nursing care delivery ,Patient safety ,Fundamental nursing care ,Compassionate care ,Checklist ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In response to concerns about high hospital mortality rates, patient and carer complaints, a Mid Staffordshire NHS Foundation Trust public inquiry was conducted at the request of the UK government. This inquiry found serious failures in the quality of basic care provided and as a consequence, recommended that patients should have more regular visits, organised at predictable times from nursing staff. Intentional rounding, also known as nursing ward rounds, was widely adopted to meet this need. Objective To test, refine or refute eight programme theories to understand what works, for whom, and in what circumstances. Setting Six wards (older people and acute wards) in three NHS trusts in England. Participants Board level and senior nursing managers (N = 17), nursing ward staff (N = 33), allied health and medical professionals (N = 26), patients (N = 34) and relatives (N = 28) participated in an individual, in-depth interview using the realist method. In addition, ward-based nurses (N = 39) were shadowed whilst they conduced intentional rounds (240 rounds in total) and the direct care of patients (188 h of patient care in total) was observed. Methods The mixed methods design included: Phase (1) Theory development - A realist synthesis was undertaken to identify any programme theories which were tested, refined and/or refuted, using data from phases 2 and 3; Phase (2) A survey of all English NHS acute Trusts; Phase (3) Six case studies of wards involving realist interviews, shadowing and non-participant observations, analysis of ward outcome and cost data; and Phase (4) Synthesis of findings from phases 1, 2 and 3. Results The realist synthesis identified eight programme theories of intentional rounding: ‘Consistency and comprehensiveness’, ‘Accountability’, ‘Visibility of nurses’, ‘Anticipation’, ‘Allocated time to care’, ‘Nurse-patient relationships’, ‘Multi-disciplinary teamwork and communication’ and ‘Patient empowerment’. Key findings showed that of the original eight programme theories of intentional rounding, only two partially explained how the intervention worked (‘Consistency and comprehensiveness’ and ‘Accountability’). Of the remaining six programme theories, the evidence for two was inconclusive (‘Visibility of nurses’ and ‘Anticipation’) and there was no evidence for four (‘Allocated time to care’; ‘Nurse-patient relationships’; ‘Multi-disciplinary teamwork and communication’; and ‘Patient empowerment’). Conclusions This first theory-informed evaluation of intentional rounding, demonstrates that the effectiveness of intentional rounding in the English healthcare context is very weak. Furthermore, the evidence collected in this study has challenged and refuted some of the underlying assumptions about how intentional rounding works. This study has demonstrated the crucial role context plays in determining the effectiveness of an intervention and how caution is needed when implementing interventions developed for the health system of one country into another.
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- 2023
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23. High BMI Is Associated with Changes in Peritumor Breast Adipose Tissue That Increase the Invasive Activity of Triple-Negative Breast Cancer Cells
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Cora E. Miracle, Chelsea L. McCallister, Krista L. Denning, Rebecca Russell, Jennifer Allen, Logan Lawrence, Mary Legenza, Diane Krutzler-Berry, and Travis B. Salisbury
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triple negative breast cancer ,obesity ,breast cancer invasion ,JAG1 ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Breast cancer is the most common cancer in women with multiple risk factors including smoking, genetics, environmental factors, and obesity. Smoking and obesity are the top two risk factors for the development of breast cancer. The effect of obesity on adipose tissue mediates the pathogenesis of breast cancer in the context of obesity. Triple-negative breast cancer (TNBC) is a breast cancer subtype within which the cells lack estrogen, progesterone, and HER2 receptors. TNBC is the deadliest breast cancer subtype. The 5-year survival rates for patients with TNBC are 8–16% lower than the 5-year survival rates for patients with estrogen-receptor-positive breast tumors. In addition, TNBC patients have early relapse rates (3–5 years after diagnosis). Obesity is associated with an increased risk for TNBC, larger TNBC tumors, and increased breast cancer metastasis compared with lean women. Thus, novel therapeutic approaches are warranted to treat TNBC in the context of obesity. In this paper, we show that peritumor breast adipose-derived secretome (ADS) from patients with a high (>30) BMI is a stronger inducer of TNBC cell invasiveness and JAG1 expression than peritumor breast ADS from patients with low (
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- 2024
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24. Translation, Cross-Cultural Adaptation and Validation of the Lymphedema Quality of Life Questionnaire (LYMQOL) in German-Speaking Patients with Upper Limb Lymphedema
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Torsten Schulz, Mary Lee Warg, Simon Heister, Kristin Lidzba, Günce Ciklatekerlio, Yasmin Molter, Stefan Langer, and Rima Nuwayhid
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lymphedema ,LYMQOL ,upper limb lymphedema ,quality of life ,physiotherapy ,decongestive therapy ,Medicine - Abstract
Objectives: The LYMQOL is the most frequently translated, validated, objective tool for assessing Health-Related Quality of Life (HRQoL) in individuals with upper limb lymphedema (ULL). There have been adaptations and validations in a number of different countries. While a German version of LYMQOL Leg for lower limb lymphedema is available, a validated translation of LYMQOL Arm to German is lacking. We aimed to perform a cross-cultural adaption and translation according to ISPOR principles. Methods: Patients suffering from ULL from Germany, Austria, and Switzerland (n = 52) were questioned twice using the translated LYMQOL Arm, SF-36, and an evaluation questionnaire. The assessment of the content validity and face validity proved this version of LYMQOL Arm to be acceptable for interviewing German-speaking patients with ULL in Germany. Results: Comparison of LYMQOL Arm and SF-36 demonstrated good construct validity. Test–retest reliability was moderate to good (intraclass correlation coefficients 0.66–0.73). Cronbach’s alpha values varied between 0.79 and 0.89 in both interviews, indicating good internal consistency. Factor analysis revealed a cumulative variance of 59.5% for the four domains of the questionnaire. Conclusion: There was no significant association between lymphedema stage and LYMQOL Arm score. This trial tested the appropriateness of the German version of the LYMQOL Arm for measuring HRQoL in German-speaking individuals with ULL.
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- 2024
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25. Embodied Environmental Risk in Technical Communication : Problems and Solutions Toward Social Sustainability
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Samuel Stinson, Mary Le Rouge, Samuel Stinson, and Mary Le Rouge
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- Sustainability--Social aspects, Communication in the environmental sciences, Communication of technical information--Environmental aspects, Risk communication
- Abstract
This collection calls for improved technical communication for the public through an embodied, situated understanding of environmental risk that promotes social justice.In addition to providing a series of chapters about recent issues on risk communication, this volume offers a diverse look at methodological practices for students, researchers, and practitioners looking to address embodied aspects of crisis and risk that incorporate UX, storytelling, and dynamic text. It includes chapters that bring embodiment to the forefront of risk communication, highlighting the cycle of content creation, dissemination, public response and decision making, continuing iterations of educational efforts, and recovery, toward increasing adaptive capacity as a whole. In addition, this work directs necessary attention to overcoming perceptual difficulties, memory lapses, definitional differences, access issues, and pedagogical problems in the communication of risks to diverse publics.This collection is essential reading for scholars and can be used as a supplemental text or casebook for courses in technical communication, environmental communication, risk and crisis communication, science communication, and public health.
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- 2022
26. A Protocol for Custom Biomineralization of Enzymes in Metal–Organic Frameworks (MOFs)
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Zoe Armstrong, Drew Jordahl, Austin MacRae, Qiaobi Li, Mary Lenertz, Patrick Shen, Anastasiia Botserovska, Li Feng, Angel Ugrinov, and Zhongyu Yang
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Biology (General) ,QH301-705.5 - Abstract
Enzyme immobilization offers a number of advantages that improve biocatalysis; however, finding a proper way to immobilize enzymes is often a challenging task. Implanting enzymes in metal–organic frameworks (MOFs) via co-crystallization, also known as biomineralization, provides enhanced reusability and stability with minimal perturbation and substrate selectivity to the enzyme. Currently, there are limited metal–ligand combinations with a proper protocol guiding the experimental procedures. We have recently explored 10 combinations that allow custom immobilization of enzymes according to enzyme stability and activity in different metals/ligands. Here, as a follow-up of that work, we present a protocol for how to carry out custom immobilization of enzymes using the available combinations of metal ions and ligands. Detailed procedures to prepare metal ions, ligands, and enzymes for their co-crystallization, together with characterization and assessment, are discussed. Precautions for each experimental step and result analysis are highlighted as well. This protocol is important for enzyme immobilization in various research and industrial fields.Key features• A wide selection of metal ions and ligands allows for the immobilization of enzymes in metal–organic frameworks (MOFs) via co-crystallization.• Step-by-step enzyme immobilization procedure via co-crystallization of metal ions, organic linkers, and enzymes.• Practical considerations and experimental conditions to synthesize the enzyme@MOF biocomposites are discussed.• The demonstrated method can be generalized to immobilize other enzymes and find other metal ion/ligand combinations to form MOFs in water and host enzymes.Graphical overview
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- 2024
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27. A systematic review of measures of the personal recovery orientation of mental health services and staff
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Mary Leamy, Una Foye, Anne Hirrich, Dagfin Bjørgen, Josh Silver, Alan Simpson, Madeline Ellis, and Karl Johan-Johanson
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Systematic review ,Recovery ,Measure ,Reliability ,Validity ,Mental health services. ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Purpose This review aimed to update and extend the Williams and colleagues 2012 systematic review of measures of recovery-orientation of mental health services by examining whether any of the specific knowledge gaps identified in this original review had subsequently been addressed. Methods A systematic review using CINAHL, ASSIA, Embase, PsycINFO, Medline and other sources, searched from 2012 until 2021. The conceptualisation of recovery and recovery-orientation of services was explored. Psychometric properties of measures were evaluated using quality criteria and according to ease of use. Results Fourteen measures assessing aspects of the recovery orientation of services and staff were identified, of which ten met the eligibility. Psychometric properties were evaluated, and conceptualisations of recovery and recovery-orientation of services investigated. Conclusion After over a decade of research in the field of recovery outcome measurement, there remains a lack of a single gold-standard measure of recovery-orientation of mental health services. There is a need for researchers to develop a new gold standard measure of recovery-orientation of services that is psychometrically valid and reliable, demonstrates sensitivity to change and is easy to use. It needs to show a good fit to an underpinning conceptual model/ framework of both personal recovery and recovery-oriented services and/or systems, with different versions for stakeholders at each level of an organisation or system.
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- 2023
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28. Conflicts of interest and recommendations in clinical guidelines, opinion pieces, and narrative reviews
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Mary Le, Camilla Hansen, Anders W Jørgensen, Lisa Bero, Andreas Lundh, Karsten Juhl Jørgensen, and Asbjørn Hróbjartsson
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business.industry ,Medicine ,Pharmacology (medical) ,Engineering ethics ,Narrative ,business - Abstract
This is a protocol for a Cochrane Review (Methodology). The objectives are as follows: We will investigate whether: • Clinical guidelines written by authors with financial or non-financial conflicts of interest are more likely to recommend an intervention; • Opinion pieces written by authors with financial or non-financial conflicts of interest are more likely to recommend an intervention; • Narrative reviews written by authors with financial or non-financial conflicts of interest are more likely to recommend an intervention.
- Published
- 2019
29. A Protocol to Depict the Proteolytic Processes Using a Combination of Metal–Organic Materials (MOMs), Electron Paramagnetic Resonance (EPR), and Mass Spectrometry (MS)
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Qiaobi Li, Mary Lenertz, Zoe Armstrong, Austin MacRae, Li Feng, Angel Ugrinov, and Zhongyu Yang
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Biology (General) ,QH301-705.5 - Abstract
Proteolysis is a critical biochemical process yet a challenging field to study experimentally due to the self-degradation of a protease and the complex, dynamic degradation steps of a substrate. Mass spectrometry (MS) is the traditional way for proteolytic studies, yet it is challenging when time-resolved, step-by-step details of the degradation process are needed. We recently found a way to resolve the cleavage site, preference/selectivity of cleavage regions, and proteolytic kinetics by combining site-directed spin labeling (SDSL) of protein substrate, time-resolved two-dimensional (2D) electron paramagnetic resonance (EPR) spectroscopy, protease immobilization via metal–organic materials (MOMs), and MS. The method has been demonstrated on a model substrate and protease, yet there is a lack of details on the practical operations to carry out our strategy. Thus, this protocol summarizes the key steps and considerations when carrying out the EPR/MS study on proteolytic processes, which can be generalized to study other protein/polypeptide substrates in proteolysis. Details for the experimental operation and cautions of each step are reported with figures illustrating the concepts. This protocol provides an effective approach to understanding the proteolytic process with the advantages of offering time-resolved, residue-level resolution of structural basis underlying the process. Such information is important for revealing the cleavage site and proteolytic mechanisms of unknown proteases. The advantage of EPR, probing the target substrate regardless of the complexities caused by the proteases and their self-degradation, offers a practically effective, rapid, and easy-to-operate approach to studying proteolysis.Key features• Combining protease immobilization, EPR, spin labeling, and MS experimental methods allows for the analysis of proteolysis process in real time.• Reveals cleavage site, kinetics of product generation, and preference of cleavage regions via time-resolved SDSL-EPR.• MS confirms EPR findings and helps depict the sequences and populations of the cleaved segments in real time.• The demonstrated method can be generalized to other proteins or polypeptide substrates upon proteolysis by other proteases.Graphical overview
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- 2024
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30. Investigation of a monophasic Salmonella Typhimurium outbreak linked to chocolate products as part of wider international outbreak: A matched case–control study, Ireland, 2022
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Charlotte Salgaard Nielsen, Patricia Garvey, Martin Cormican, Niall DeLappe, Mary Lenahan, Orla Moore, Kay Casey, Suzanne Cotter, Sarah Gee, Benjamin Aniugbo, Gerard Meagher, Elaine Brabazon, Keith Ian Quintyne, Anthony Breslin, RoseMary McBride, Eimear Burke, Margaret White, Marie Casey, Leah Evans, Catherine Conlon, Annette Dillon, Regina Kiernan, Donna Kilmartin, Cale Lawlor, Ruth McDermott, Paul McKeown, and Outbreak Control Team
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chocolate ,foodborne disease ,outbreak ,Salmonella Typhimurium ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background In March 2022, an outbreak investigation was initiated in Ireland after identifying a cluster of monophasic Salmonella Typhimurium cases, affecting primarily small children. Microbiological investigations revealed that the cluster was part of a wider international outbreak. Methods A total of 18 Irish outbreak cases were identified. We undertook a matched case–control study using the case–case method to determine if exposure to the implicated products was associated with illness. Results In univariable analysis, the highest odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were obtained for a chocolate Product A of Brand A [matched odds ratio (mOR) = 7.77, 95% confidence intervals (CI): 0.89–67.20]. When grouping the implicated products in a composite variable, the odds of disease due to monophasic S. Typhimurium versus other gastrointestinal disease were 10.5 times higher with a consumption of at least one of the implicated products [mOR = 10.50, 95% CI: 1.24–88.60, p = 0.031]. Conclusion This analytical study supported the internationally generated hypothesis which led to the implementation of control measures. Owing to the high levels of chocolate purchasing with Easter approaching, early outbreak identification and involvement in the internationally coordinated investigation was essential to an efficient response and to minimise the risk of further harm to a particularly vulnerable population group.
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- 2023
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31. Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory
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Annik Mahalia Sorhaindo, Sarah Castle, Lola Flomen, Eva Lathrop, Shirine Mohagheghpour, Rasha Dabash, Francelle Kwankam Toedtli, Rebecca Wilkins, Laurence Läser, Patricia Titulaer, Ernest Nyamato, Mary Lea Dakouo, Ammal Awadallah, Raman Shrestha, Malena Morales, and Ulrika Rehnström Loi
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medical abortion ,service adaptation ,COVID-19 ,Nepal ,Mali ,Bolivia ,Diseases of the genitourinary system. Urology ,RC870-923 ,The family. Marriage. Woman ,HQ1-2044 - Abstract
AbstractThe COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as “interlocutors” between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.
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- 2023
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32. CD8 + T cell infiltration is associated with improved survival and negatively correlates with hypoxia in clear cell ovarian cancer
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Nancy Guo, Aijun Yang, Fabiha Binte Farooq, Shreena Kalaria, Elena Moss, Lindsay DeVorkin, Mary Lesperance, François Bénard, Don Wilson, Anna V. Tinker, Farouk S. Nathoo, Phineas T. Hamilton, and Julian J. Lum
- Subjects
Medicine ,Science - Abstract
Abstract Unlike other histological types of epithelial ovarian carcinoma, clear cell ovarian carcinoma (CCOC) has poor response to therapy. In many other carcinomas, expression of the hypoxia-related enzyme Carbonic anhydrase IX (CAIX) by cancer cells is associated with poor prognosis, while the presence of CD8 + tumor-infiltrating lymphocytes (TIL) is positively prognostic. We employed [18F]EF5-PET/CT imaging, transcriptome profiling, and spatially-resolved histological analysis to evaluate relationships between CAIX, CD8, and survival in CCOC. Tissue microarrays (TMAs) were evaluated for 218 cases in the Canadian COEUR study. Non-spatial relationships between CAIX and CD8 were investigated using Spearman rank correlation, negative binomial regression and gene set enrichment analysis. Spatial relationships at the cell level were investigated using the cross K-function. Survival analysis was used to assess the relationship of CAIX and CD8 with patient survival for 154 cases. CD8 + T cell infiltration positively predicted survival with estimated hazard ratio 0.974 (95% CI 0.950, 1000). The negative binomial regression analysis found a strong TMA effect (p-value
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- 2023
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33. Using a patient-centred composite endpoint in a secondary analysis of the Control of Hypertension in Pregnancy Study (CHIPS) Trial
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Rebecca K. Metcalfe, Mark Harrison, Joel Singer, Mary Lewisch, Terry Lee, Peter von Dadelszen, Laura A. Magee, Nick Bansback, and the CHIPS Study Group
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Patient-centred ,Randomized controlled trial ,Composite endpoints ,Pregnancy hypertension ,Perinatal ,Medicine (General) ,R5-920 - Abstract
Abstract Background Clinical trials commonly use multiple endpoints to measure the impact of an intervention. While this improves the comprehensiveness of outcomes, it can make trial results difficult to interpret. We examined the impact of integrating patient weights into a composite endpoint on the interpretation of Control of Hypertension in Pregnancy Study (CHIPS) Trial results. Methods Outcome weights were extracted from a previous patient preferences study in pregnancy hypertension (N = 183 women) which identified (i) seven outcomes most important to women (taking medication, severe hypertension, pre-eclampsia, blood transfusion, Caesarean, delivery < 34 weeks, and baby born smaller-than-expected) and (ii) three preference subgroups: (1) ‘equal prioritizers’, 62%; (2) ‘early delivery avoiders’, 23%; and (3) ‘medication minimizers’, 14%. Outcome weights from the preference subgroups were integrated with CHIPS data for the seven outcomes identified in the preference study. A weighted composite score was derived for each participant by multiplying the preference weight for each outcome by the binary outcome if it occurred. Analyses considered equal weights and those from the preference subgroups. The mean composite scores were compared between trial arms (t-tests). Results Composite scores were similar between trial arms with the use of equal weights or those of subgroup (1) (95% confidence intervals [CIs]: − 0.03, 0.02; p > 0.50 for each). ‘Tight’ control was superior when using subgroup (2) weights (95% CIs: 0.002, 0.07; p = 0.03), and ‘less-tight’ control was superior when using subgroup (3) weights (95% CIs: − 0.11, − 0.04; p < 0.01). Conclusions Evidence-based recommendations for ‘tight’ control are consistent with most women’s preferences, but for a sixth of women, ‘less-tight’ control is more preference consistent. Depending on patient preferences, a single trial may support different interventions. Future trials should specify component weights to improve interpretation. Trial registration ClinicalTrials.gov NCT01192412
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- 2023
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34. Translation, Cross-Cultural Adaptation and Validation of the Lymphedema Quality of Life Questionnaire (LYMQOL) in German-Speaking Patients with Lymphedema of the Lower Limbs
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Rima Nuwayhid, Mary Lee Warg, Simon Heister, Stefan Langer, and Torsten Schulz
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lymphedema ,LYMQOL ,German ,lower limbs ,quality of life ,cross-cultural adaptation ,Medicine - Abstract
The LYMQOL Leg questionnaire is the most widely used, evidence-based tool for the assessment of health-related quality of life (HRQoL) in patients with lower limb lymphedema (LLL). It has been translated into several languages, but a German version is currently lacking. The aim of our study was to validate a German translation of LYMQOL Leg. Translation and cross-cultural adaptation were performed in accordance with ISPOR principles. A total of 103 patients with LLL from Germany, Austria, and Switzerland were interviewed twice. The content and face validity assessments indicated that the German LYMQOL Leg questionnaire was acceptable for interviewing patients with lymphedema. Comparing the LYMQOL Leg with the SF-36 demonstrated good construct validity. Reliability determined by the test–retest procedure was good (intra-class-correlation coefficients 0.68–0.92). Cronbach’s alpha values ranged from 0.76 to 0.90 in both interviews, showing an acceptable internal consistency. The four domains of the questionnaire reached a cumulative variance of 52.7% in the factor analysis. The association between the lymphedema stages and the LYMQOL Leg domain scores was not significant. In conclusion, the validity of the German version of LYMQOL Leg, called LYMQOL Bein, was confirmed and thus represents a suitable tool for measuring HRQoL in German-speaking patients with LLL.
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- 2024
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35. Interdisciplinary Collaboration for Diagnosis and Management of a Rare Tumor: Primary Cutaneous Adenocarcinoma
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Christopher A. Barker, Karen L. Connolly, Nina R. Blank, Mary Sue Brady, Travis J. Hollmann, Erica H. Lee, and Mary Le
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medicine.medical_specialty ,business.industry ,General surgery ,Dermatology ,medicine.disease ,Adnexal tumors ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Rare tumor ,0302 clinical medicine ,Oncology ,Surgical oncology ,030220 oncology & carcinogenesis ,Radiation oncology ,Immunohistochemistry ,Medicine ,Adenocarcinoma ,business - Published
- 2016
36. Internet-Based Recruitment and Retention of Young Adults With Type 1 Diabetes: Cross-Sectional Study
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Stephanie Griggs, Garrett I Ash, Grant Pignatiello, AnnMarie Papik, Johnathan Huynh, Mary Leuchtag, and Ronald L Hickman Jr
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Medicine - Abstract
BackgroundMultiple research strategies are required to recruit and engage a representative cohort of young adults in diabetes research. In this report, we describe an approach for internet-based recruitment for a repeated-measures descriptive study. ObjectiveThe objective of this cross-sectional study was to determine whether internet-based recruitment through multiple social media platforms, a clinical research platform, and cooperation with community partnerships—College Diabetes Network and Beyond Type 1—would serve as an effective way to recruit a representative sample of young adults aged 18-25 years with type 1 diabetes (T1D). MethodsWe conducted a repeated-measures descriptive study. We captured enrollment rates and participant characteristics acquired from each social media platform through survey data and Facebook analytics. This study was advertised via paid postings across a combination of different social media platforms (eg, Facebook, Instagram, Twitter, and Reddit). We used quarterly application postings, quarterly newsletters, and participation in the ResearchMatch registry to identify potentially eligible participants from February 3, 2021, to June 6, 2022. ResultsResearchMatch proved to be the most cost-effective strategy overall, yielding the highest gender and racial diversity compared to other internet platforms (eg, Facebook, Instagram, Twitter, and Reddit), application postings (eg, Beyond Type 1), and newsletters (eg, College Diabetes Network and a local area college). However, we propose that the combination of these approaches yielded a larger, more diverse sample compared to any individual strategy. Our recruitment cost was US $16.69 per eligible participant, with a 1.27% conversion rate and a 30% eligibility rate. ConclusionsRecruiting young adults with T1D across multiple internet-based platforms was an effective strategy to yield a moderately diverse sample. Leveraging various recruitment strategies is necessary to produce a representative sample of young adults with T1D. As the internet becomes a larger forum for study recruitment, participants from underrepresented backgrounds may continue engaging in research through advertisements on the internet and other internet-based recruitment platforms.
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- 2023
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37. Do mast cells play a pathogenetic role in neurofibromatosis type 1 and ulcerative colitis?
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Felicita Baratelli, Samuel W. French, George Gershman, and Mary Le
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Male ,Pathology ,medicine.medical_specialty ,Neurofibromatosis 1 ,Adolescent ,Clinical Biochemistry ,H&E stain ,Inflammatory bowel disease ,Pathology and Forensic Medicine ,medicine ,Humans ,Mast Cells ,Neurofibromatosis ,Molecular Biology ,Neurofibromatosis type I ,Lamina propria ,biology ,CD117 ,business.industry ,medicine.disease ,Mast cell ,Ulcerative colitis ,digestive system diseases ,medicine.anatomical_structure ,Immunology ,biology.protein ,Colitis, Ulcerative ,Schwann Cells ,business - Abstract
Concurrent association of neurofibromatosis type I and ulcerative colitis has been reported in one clinical case (Tavakkoli et al., 2009). Although this association may represent a casual finding, a common pathophysiology is postulated. Mast cells have been implicated in the pathogenesis of both neurofibromatosis type 1 and ulcerative colitis (He, 2004; Yoshida et al., 2010). Mast cells are typically present in neurofibromas microenvironment where they appear to contribute to tumor initiation, progression and angiogenesis (Staser et al., 2010, 2013). Moreover, interaction of mast cells with nerves throughout the gastrointestinal tract has been correlated with progression and maintenance of ulcerative colitis (Stoyanova and Gulubova, 2002). We describe a 14 year-old male with history of neurofibromatosis type 1 and new onset of ulcerative colitis diagnosed on clinical and histological findings. On gross examination the entire colonic mucosa appeared edematous showing a peculiar granular pattern, with focal erythema, shallow ulcers and multiple sessile polyps. Hematoxylin and eosin stained tissue biopsies from the colonic mucosa showed chronic inflammatory bowel disease, severe activity, consistent with chronic ulcerative colitis. Immunohistochemistry stain of the intestinal lesions revealed high expression of Neuron Specific Enolase (NSE) and S100 highlighting the presence of a Schwann cell component. In addition, c-kit/CD117 positive stain indicated a marked increase of mast cells in the lamina propria. This pattern of cellularity in the lamina propria showing increased mast cells and augmented Schwann cell component was absent in the colonic mucosa of a normal control or a patient with ulcerative colitis alone. Our observation supports the evidence of a pathogenetic role of the mast cell in ulcerative colitis associated with neurofibromatosis type 1. Further investigations are warranted to confirm the significance of this correlation as it may impact therapeutic approaches of these pathologies.
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- 2014
38. Improving sustainable agriculture promotion: an explorative analysis of NRCS assistance programs and farmer perspectives
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Carson D. Thompson, Emilee Severe, Adam J. Norris, Jacob Gudmundsen, Mary Lewis, Elisabeth Currit, Nicholas Newbold, and Benjamin W. Abbott
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sustainable agriculture ,assistance programmes ,nrcs ,farmer perspectives ,survey ,Agriculture - Abstract
Unsustainable agriculture practices are undermining the world's future ability to reliably produce food. Assistance programmes, such as those offered by the Natural Resource Conservation Service (NRCS) of the United States, can increase the uptake of sustainable practices, yet implementation of these alternatives in the US remains discouragingly limited. In this context, we used an interdisciplinary approach involving quantitative and qualitative data to assess the current efficacy of NRCS assistance programmes and identify areas for improvement. To do so, we first analyzed national reports of NRCS expenditures and acres treated over the last 15 years and then distributed an explorative survey to farmers and ranchers throughout Utah state. Our NRCS programme analysis suggested that historical increases in expenditures have been ineffective at increasing the number of acres treated. The survey responses indicated that both financial and non-financial factors were influential in farmer decisions. Farmers that assigned a high importance to sustainable practices were motivated by public perception and environmental stewardship while those that assigned a moderate importance were motivated by the potential return on investment. Overall, participants in NRCS programs reported more positive outcomes than expected by non-participants. We hope the findings from this study can guide future research and inform efforts to improve NRCS assistance programmes in Utah and other regions in the US and elsewhere.
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- 2022
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39. Differences in Responses of Immunosuppressed Kidney Transplant Patients to Moderna mRNA-1273 versus Pfizer-BioNTech
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Dulat Bekbolsynov, Andrew Waack, Camryn Buskey, Shalmali Bhadkamkar, Keegan Rengel, Winnifer Petersen, Mary Lee Brown, Tanaya Sparkle, Dinkar Kaw, Fayeq Jeelani Syed, Saurabh Chattopadhyay, Ritu Chakravarti, Sadik Khuder, Beata Mierzejewska, Michael Rees, and Stanislaw Stepkowski
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SARS-CoV-2 ,kidney transplantation ,mRNA vaccine ,seropositivity ,immunocompromised ,Medicine - Abstract
Immunosuppressed kidney transplant (KT) recipients produce a weaker response to COVID-19 vaccination than immunocompetent individuals. We tested antiviral IgG response in 99 KT recipients and 66 healthy volunteers who were vaccinated with mRNA-1273 Moderna or BNT162b2 Pfizer-BioNTech vaccines. A subgroup of participants had their peripheral blood leukocytes (PBLs) evaluated for the frequency of T helper 1 (Th1) cells producing IL-2, IFN-γ and/or TNF-α, and IL-10-producing T-regulatory 1 (Tr) cells. Among KT recipients, 45.8% had anti-SARS-CoV-2 IgG compared to 74.1% of healthy volunteers (p = 0.009); also, anti-viral IgG levels were lower in recipients than in volunteers (p = 0.001). In terms of non-responders (≤2000 U/mL IgG), Moderna’s group had 10.8% and Pfizer-BioNTech’s group had 34.3% of non-responders at 6 months (p = 0.023); similarly, 15.7% and 31.3% were non-responders in Moderna and Pfizer-BioNTech groups at 12 months, respectively (p = 0.067). There were no non-responders among controls. Healthy volunteers had higher Th1 levels than KT recipients, while Moderna produced a higher Th1 response than Pfizer-BioNTech. In contrast, the Pfizer-BioNTech vaccine induced a higher Tr1 response than the Moderna vaccine (p < 0.05); overall, IgG levels correlated with Th1(fTTNF-α)/Tr1(fTIL-10) ratios. We propose that the higher number of non-responders in the Pfizer-BioNTech group than the Moderna group was caused by a more potent activity of regulatory Tr1 cells in KT recipients vaccinated with the Pfizer-BioNTech vaccine.
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- 2024
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40. Sign Language Studies with Chimpanzees in Sanctuary
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Mary Lee Jensvold, Kailie Dombrausky, and Emily Collins
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chimpanzee ,sign language ,sanctuary ,ASL ,vocabulary ,communicative function ,Veterinary medicine ,SF600-1100 ,Zoology ,QL1-991 - Abstract
Adult chimpanzees Tatu and Loulis lived at the Fauna Foundation sanctuary. They had acquired signs of American Sign Language (ASL) while young and continued to use them as adults. Caregivers with proficiency in ASL maintained daily sign language records during interactions and passive observation. Sign checklists were records of daily vocabulary use. Sign logs were records of signed interactions with caregivers and other chimpanzees. This study reports sign use from eight years of these records. Tatu and Loulis used a majority of their base vocabularies consistently over the study period. They used signs that they had acquired decades earlier and new signs. Their utterances served a variety of communicative functions, including responses, conversational devices, requests, and descriptions. They signed to caregivers, other chimpanzees, including those who did not use signs, and to themselves privately. This indicates the importance of a stimulating and interactive environment to understand the scope of ape communication and, in particular, their use of sign language.
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- 2023
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41. Intercontinental Movement of Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4 Virus to the United States, 2021
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Sarah N. Bevins, Susan A. Shriner, James C. Cumbee, Krista E. Dilione, Kelly E. Douglass, Jeremy W. Ellis, Mary Lea Killian, Mia K. Torchetti, and Julianna B. Lenoch
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influenza ,highly pathogenic avian influenza A(H5N1) virus ,clade 2.3.4.4 ,influenza viruses ,viruses ,intercontinental movement ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
We detected Eurasian-origin highly pathogenic avian influenza A(H5N1) virus belonging to the Gs/GD lineage, clade 2.3.4.4b, in wild waterfowl in 2 Atlantic coastal states in the United States. Bird banding data showed widespread movement of waterfowl within the Atlantic Flyway and between neighboring flyways and northern breeding grounds.
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- 2022
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42. A unique case of acute bilateral internal iliac deep vein thrombosis leading to right iliofemoral venous outflow obstruction
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Christina M. Melian, MS, Stefanos Giannopoulos, MD, Mary Lee, DO, and Angela A. Kokkosis, MD
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Deep venous thrombosis ,Hypogastric vein ,Iliofemoral ,Internal iliac vein ,Phlegmasia ,Thrombectomy ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Venous thromboembolism has been associated with high morbidity and mortality, with a cost burden for the U.S. health care system owing to secondary complications such as pulmonary embolism and post-thrombotic syndrome. The current standard of therapy for acute deep vein thrombosis (DVT) is anticoagulation. For patients with venous outflow obstruction of the iliac vein system, several minimally invasive recanalization techniques are now available. In the present report, we have described a case of bilateral internal iliac DVT that had progressed to right-sided iliofemoral DVT in a young athletic adult, in the absence of anatomic abnormalities, that was treated with thrombolysis-free mechanical thrombectomy.
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- 2023
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43. Is repeat fine needle aspiration required in thyroid nodules with initial benign cytology? Results from a large Irish series
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Hafiz M. Zia-ul-Hussnain, Oratile Kgosidialwa, Carmel Kennedy, Mark Quinn, Emma Dolan, Paul Deignan, Mark Sherlock, Chris J. Thompson, Diarmuid Smith, James P. O’Neill, Arnold Hill, Mary Leader, Helen Barrett, Cliona Ryan, Frank Keeling, Martina M. Morrin, and Amar Agha
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Benign ,Thyroid nodule ,Thy classification ,Fine needle aspiration ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background Fine needle aspiration (FNA) cytology is the preferred method for assessing thyroid nodules for malignancy. Concern remains about the rate of false negative results. The primary aim of this study is to investigate the malignancy rate of thyroid nodules initially classified as benign (Thy 2). Methods We retrospectively examined 658 nodules in 653 (429 female) patients between January 2013 to December 2017. All FNA biopsies (FNABs) were performed under ultrasound (US) guidance by a radiologist with expertise in thyroid pathology. Nodules were cytologically classified according to the UK Royal College of Pathologists guidelines. Decisions about further management were made at a regular thyroid multidisciplinary meeting. Follow up of the Thy 2 nodules was determined based on clinical and radiological criteria. Results The mean age (± SD) was 53.2 (14.6) years. Five hundred out of 658 (76.0%) nodules were classified as Thy 2 (benign) after the first FNAB. Of these thyroid nodules initially classified as benign, 208 (41.6%) underwent repeat FNAB and 9 (1.8%) were surgically removed without repeat FNAB. The remainder were followed up clinically and/or radiologically. Seven (1.4%) of nodules initially classified as Thy 2 were later shown to be or to harbor malignancy after a follow-up of 74.5 (± 19.7) months. Papillary thyroid microcarcinomas were found co-incidentally in two thyroid glands of benign nodules, giving a true prevalence of 5/500 (1.0%). Conclusions With a well targeted FNAB, the false negative rate of an initial benign thyroid FNA is very low thus routine second FNAB is not required in patients with a thyroid nodule initially deemed benign. Multidisciplinary input is imperative in informing decision making.
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- 2022
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44. Transmission of SARS‐CoV‐2 from humans to a 16‐year‐old domestic cat with comorbidities in Pennsylvania, USA
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Deepanker Tewari, Lore Boger, Steven Brady, Julia Livengood, Mary Lea Killian, Meera Surendran Nair, Nagaraja Thirumalapura, Suresh V. Kuchipudi, Corey Zellers, Betsy Schroder, Mia Torchetti, Ann Carpenter, Amber Kunkel, and Kevin Brightbill
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cat ,histopathology ,infection ,lungs ,rRT‐PCR ,SARS‐CoV‐2 ,Veterinary medicine ,SF600-1100 - Abstract
Abstract Background and Objectives Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), besides causing human infection, has been shown to naturally infect several susceptible animal species including large cats (tigers, lions, pumas, spotted leopards), dogs, cats, ferrets, gorillas and minks. Cats and minks are continuing to be the most reported species with SARS‐CoV‐2 infections among animals but it needs to be investigated further. Methods and Results We report the detection of SARS‐CoV‐2 from a domestic cat that exhibited respiratory disease after being exposed to SARS‐CoV‐2 virus from humans in the same household. SARS‐CoV‐2 RNA was detected in two oropharyngeal swabs collected at two time points, 11 days apart; the first, when the cat was reported to be sick and the second, before euthanasia due to poor prognosis. The viral nucleic acid detected at two time points showed no genomic variation and resembled the clade GH circulating in humans in the United States. Clinical and pathological findings noted in this 16‐year‐old cat were consistent with respiratory and cardiac insufficiency. Conclusions SARS‐CoV‐2 viral infection was likely an incidental clinical finding, as the virus was not detected in fixed lungs, heart, or kidney tissues. Only fresh lung tissue collected at necropsy showed the presence of viral nucleic acid, albeit at a very low level. Further research is needed to clarify the clinical course of SARS‐CoV‐2 in companion animals of advanced age and underlying cardiac disease.
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- 2022
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45. SARS-CoV-2 Infection Dynamics in the Pittsburgh Zoo Wild Felids with Two Viral Variants (Delta and Alpha) during the 2021–2022 Pandemic in the United States
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Deepanker Tewari, Ryan Miller, Julia Livengood, Leyi Wang, Mary Lea Killian, Felipe Bustamante, Candy Kessler, Nagaraja Thirumalapura, Karen Terio, Mia Torchetti, Kristina Lantz, and Justin Rosenberg
- Subjects
SARS-CoV-2 ,coronavirus ,RRT-PCR ,Felidae ,zoo ,lions ,Veterinary medicine ,SF600-1100 ,Zoology ,QL1-991 - Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in multiple animal species besides humans. The goal of this study was to report clinical signs, infection progression, virus detection and antibody response in a group of wild felids housed in adjacent but neighboring areas at the Pittsburgh Zoo. Initially, five African lions (Panthera leo krugeri) housed together exhibited respiratory clinical signs with viral shedding in their feces in March of 2021 coinciding with infection of an animal keeper. During the second infection wave in December 2021, four Amur tigers (Panthera tigris altaica) and a Canadian lynx (Lynx canadensis) showed clinical signs and tested positive for viral RNA in feces. In infected animals, viral shedding in feces was variable lasting up to 5 weeks and clinical signs were observed for up to 4 weeks. Despite mounting an antibody response to initial exposure, lions exhibited respiratory clinical signs during the second infection wave, but none shed the virus in their feces. The lions were positive for alpha variant (B.1.1.7 lineage) during the first wave and the tiger and lynx were positive for delta variant (AY.25.1. lineage) during the second wave. The viruses recovered from felids were closely related to variants circulating in human populations at the time of the infection. Cheetahs (Acinonyx jubatus) in the park did not show either the clinical signs or the antibody response.
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- 2023
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46. The practice of genomic medicine: A delineation of the process and its governing principles
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Julia Handra, Adrienne Elbert, Nour Gazzaz, Ashley Moller-Hansen, Stephanie Hyunh, Hyun Kyung Lee, Pierre Boerkoel, Emily Alderman, Erin Anderson, Lorne Clarke, Sara Hamilton, Ronnalea Hamman, Shevaun Hughes, Simon Ip, Sylvie Langlois, Mary Lee, Laura Li, Frannie Mackenzie, Millan S. Patel, Leah M. Prentice, Karan Sangha, Laura Sato, Kimberly Seath, Margaret Seppelt, Anne Swenerton, Lynn Warnock, Jessica L. Zambonin, Cornelius F. Boerkoel, Hui-Lin Chin, and Linlea Armstrong
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genomic medicine ,precision medicine ,distributed cognition ,workflow optimization ,integrated care ,Medicine (General) ,R5-920 - Abstract
Genomic medicine, an emerging medical discipline, applies the principles of evolution, developmental biology, functional genomics, and structural genomics within clinical care. Enabling widespread adoption and integration of genomic medicine into clinical practice is key to achieving precision medicine. We delineate a biological framework defining diagnostic utility of genomic testing and map the process of genomic medicine to inform integration into clinical practice. This process leverages collaboration and collective cognition of patients, principal care providers, clinical genomic specialists, laboratory geneticists, and payers. We detail considerations for referral, triage, patient intake, phenotyping, testing eligibility, variant analysis and interpretation, counseling, and management within the utilitarian limitations of health care systems. To reduce barriers for clinician engagement in genomic medicine, we provide several decision-making frameworks and tools and describe the implementation of the proposed workflow in a prototyped electronic platform that facilitates genomic care. Finally, we discuss a vision for the future of genomic medicine and comment on areas for continued efforts.
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- 2023
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47. Excited State Photoreaction between the Indole Side Chain of Tryptophan and Halocompounds Generates New Fluorophores and Unique Modifications
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Mary Le, Khai Tran, Robert A. Edwards, Raymond J. Turner, and Carol L. Ladner
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Indoles ,Magnetic Resonance Spectroscopy ,Light ,Imine ,Ethylene Chlorohydrin ,Ring (chemistry) ,Photochemistry ,Biochemistry ,chemistry.chemical_compound ,Acetamides ,Side chain ,Chloroacetates ,Physical and Theoretical Chemistry ,Methylene ,Fluorescent Dyes ,Indole test ,Staining and Labeling ,Chemistry ,Tryptophan ,General Medicine ,Photochemical Processes ,Fluorescence ,Molecular Weight ,Amine gas treating ,Chloroform ,Imines ,Trihalomethanes - Abstract
Photoreaction of indole containing compounds with chloroform and other trichlorocompounds generates products with redshifted fluorescence. In proteins, this reaction can be used for the fluorescent detection of proteins. Little characterization of products generated through the photochemical reaction of indoles with halocompounds has been done, yet is fundamental for the development of other fluorophores, protein labeling agents, and bioactive indole derivatives. Here, we have characterized which isomers form in the photoreaction between tryptophan and chloroform using (1)H-NMR of tryptophan and methylated derivatives to reveal that the two major products that are formed result from modification at the 4- and 6-carbon positions of the indole ring. Reaction at position 6 generates 6-formyl tryptophan and the reaction at position 4 generates an imine because the formyl derivative that is initially formed reacts further with the tryptophan amine group. The spectroscopic properties and product molecular weights of photoproducts formed from photoreaction of tryptophan with other trihalo and monohalocompounds are also determined. The indole ring of tryptophan can be modified with various additions from halocompounds, including the addition of labels to the indole ring via methylene groups. This opens possibilities for generating novel tryptophan based fluorophores and protein labeling strategies using this photochemistry.
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- 2014
48. Long-term Cost-effectiveness in the Veterans Affairs Open vs Endovascular Repair Study of Aortic Abdominal Aneurysm
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Hosam Farouk El Sayed, Cinda Sobotta, Reba Jones, Kellie R. Brown, Henry M. Baraniewski, Amanda J. Snodgrass, C. Keith Ozaki, Fred N. Littooy, Roderick A. Barke, Christian De Virgillio, Richard J. Massen, Anne S. Irwin, Gregory L. Moneta, George Pisimisis, Sister Frances Randall, Sheila M. Coogan, Joseph S. Giglia, Caron Rockman, Richard L. McCann, David Whitley, Erika R. Ketteler, Jeffrey H. Lawson, Matthew W. Mell, John L. Gray, Angela G. Vouyouka, Howard Greisler, Roy M. Fujitani, John W. Hallett, James M. Goff, Kathleen Hickson, Elizabeth Latts, Claudia Yales, Margaret Antonelli, Mina Behdad, Andrea M. Escalante, Karen Chong, Stephen M. Kubaska, Jorge Lopez, Joseph J. Cullen, Glenn C. Hunter, Brenda J. Jasper, John M. Marek, Kimberly Yan, Dennis F. Bandyk, June Poulton, Thomas S. Burdick, Bassem Safadi, Richard J. Gusberg, Sally Reinhardt, Erik Owens, Randy Baum, Robert J. Guerra, Laura Ashe, Mary T. O'Sullivan, Edward Perry, Michael A. Golden, Lynn Durant, Peter H. Lin, Margaret L. Schwarze, Jennifer Poirier, Jessie M. Jean-Claude, Jane Guidot, J. David Pitcher, Elaine O'Brien, Steven J. Busuttil, Stephanie Ross, Darra D. Kingsley, Vicki Bishop, Anna Busman, Kathleen M. Swanson, Rebecca L. Reinhard, Scott Zellner, Beth A. Forbes, John L. Mills, Carmelene Joncas, Georgia Purviance, Theodore Karrison, Sherilyn Pillack, Christine Maagas, Mark Langsfeld, Nancy Oberle, Stephen G. Lalka, Clair M. Haakenson, Carlos F. Bechara, Scott A. Berceli, Murray L. Shames, Michelle A. Bhola, Mary Le Gwin, Anna Rockich, Stephen P. Johnson, Robert W. Zickler, Julie A. Freischlag, John P. Matts, Heather G. Allore, Christian Bianchi, Bernadette Aulivola, Terry O'Connor, Richard A. Yeager, Brad Johnson, Ronald M. Fairman, John F. Eidt, Melita Braganza, Alice Kossack, Rajni Mehta, Bauer E. Sumpio, David Minion, Joseph H. Rapp, Brajesh K. Lal, Michelle Endo, Jon S. Matsumura, Iraklis I. Pipinos, Melanie Estes, Girma Tefera, Mitzi Rusomaroff, Gregory J. Landry, John R. Hoch, Cindy Inman, Janice Rieder, Loretta Cole, Gary Lemmon, Shemuel B. Psalms, James M. Edwards, Ted R. Kohler, Peter R. Nelson, David A. Katz, Hugh A. Gelabert, James Ebaugh, Brian D. Lewis, Nancy N. Day, Nikhil Kansal, Glenn R. Jacobowitz, Ruth L. Bush, Reverend Michael Zeman, Sandra M. Walsh, Jill Warner-Carpenter, Catherine Cagiannos, Mark R. Nehler, Carlos H. Timaran, Prakash Chand, Leah J. Caropolo, Ling Ge, Shirley Joyner, Karen Eschberger, Mohammed Moursi, Michael P. Lilly, Susan Framberg, Christa Kallio, Robyn A. Macsata, Barbara Salabsky, Charles W. Acher, Frank A. Lederle, Jason M. Johanning, Tammy Nguyen, Gerald Treiman, Ian L. Gordon, Deanna Maples, Catherine Proebstle, Joy Kimbrough, William Farrell, Satish Muluk, Gilles Pinault, Beth Dunlap, Sandra C. Carr, William D. Jordan, Erin Olgren, Thomas A. Whitehill, Donald Beckwith, Peter Guarino, Lloyd M. Taylor, Wendy Meadows, Vanessa McBride, Subodh Arora, James Niederman, E. Lynne Kelly, Jonathan Weiswasser, David G. Glickerman, Gene Guinn, Pamela Strecker, Bart E. Muhs, Eleanor Cannady, Heron E. Rodriguez, Christopher Owens, Karen L. Wilson, Shawna Thunen, Elizabeth Davis, Stanislav V. Kasl, Shelley S. Dwyer, Julie Thornton, Maria Foster, Vickie Beach, Doghdoo D. Bahmani, Penny Vasilas, Luis R. Leon, Matthew Nalbandian, Reza Azadegan, Diane C. Robertson, Richard A. Marottoli, Ross Milner, John M. Stuart, David A. Rigberg, Nina M. Peterson, Mary Evans, David Chew, Subhash Lathi, Nadine White, Macario Riveros, Jeffrey Pollak, Timothy J. O'Leary, Yvonne Jonk, Frank T. Padberg, Richard Feldman, Stephanie Hatton-Ward, J. Gregory Modrall, Paul J. Gagne, James Wong, Kimberly Pedersen, Norman Hertzer, Brian D. Matteson, Wei Zhou, Nina Lee, Mark W. Sebastian, Steven M. Santilli, William C. Krupski, Neal Cayne, Anton N. Sidawy, Neal R. Barshes, Christina Paap, Sherry M. Wren, Alex Westerband, Sandra Brock, Vivian Gahtan, John D. Hughes, Panagiotis Kougias, Jonathan B. Towne, Michael Ranella, W. Anthony Lee, Ryan Nachreiner, Cynthia K. Shortell, Patricia A. Prinzo, Kea Ellis, Ronald L. Dalman, Thomas G. Lynch, Karthikeshwar Kasirajan, H. Edward Garrett, Joaquim J. Cerveira, Peter Peduzzi, Marcelo Spector, Carla Blackwell, Omran Abul-Khoudoud, Dolores F. Cikrit, Jean Kistler Tetterton, Martin Back, Darrell N. Jones, Darryl S. Weiman, Donna Kerns, Mark Wilson, Preet Kang, Kenneth Granke, Gary R. Johnson, Linda M. Reilly, Marilyn Bader, Lauri Lee Johnson, Ravi K. Veeraswamy, Sandra L. Perez, W. John Sharp, Gary R. Seabrook, Karthnik Kasirajan, Brenda Allende, John D. Corson, Kathy Zalecki, Joseph D. Raffetto, Thomas H. Schwarcz, Mark A. Patterson, Matthew Eiseman, John K.Y. Chacko, Mark Adelman, Holly De Spiegelaere, Alan Dardik, Madeline Ruf, Kevin T. Stroupe, Grant D. Huang, M. Burress Welborn, Alexandre C. D'Audiffret, Rajaabrata Sarkar, Michael Sobel, Steve M. Taylor, Barbara Guillory, Sandra C. Thomas, Thomas S. Hatsukami, Robert A. Cambria, Jeanne L. McCandless, Susan Stratton, Cindy Cushing, Karen A. Hauck, Atef Salam, Melina R. Kibbe, Tassos C. Kyriakides, Amy B. Reed, Jason T. Lee, Jamal J. Hoballah, Marc E. Mitchell, Hasan H. Dosluoglu, Marc A. Passman, Edith Tzeng, Patricia Cleary, and John Aruny
- Subjects
Diagnostic Imaging ,Male ,medicine.medical_specialty ,Time Factors ,Cost effectiveness ,Cost-Benefit Analysis ,Comparative effectiveness research ,030204 cardiovascular system & hematology ,030230 surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Humans ,Medicine ,cardiovascular diseases ,Veterans Affairs ,health care economics and organizations ,Aged ,Intention-to-treat analysis ,business.industry ,Endovascular Procedures ,Health Care Costs ,Length of Stay ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Quality-adjusted life year ,Surgery ,Elective Surgical Procedures ,Quality of Life ,Health Resources ,Female ,Quality-Adjusted Life Years ,business ,Aortic Aneurysm, Abdominal ,Follow-Up Studies ,Abdominal surgery - Abstract
Importance Because of the similarity in clinical outcomes after elective open and endovascular repair of abdominal aortic aneurysm (AAA), cost may be an important factor in choosing a procedure. Objective To compare total and AAA-related use of health care services, costs, and cost-effectiveness between groups randomized to open or endovascular repair. Design, Setting, and Participants This unblinded randomized clinical trial enrolled 881 patients undergoing planned elective repair of AAA who were candidates for open and endovascular repair procedures. Patients were randomized from October 15, 2002, to April 15, 2008, at 42 Veterans Affairs medical centers. Follow-up was completed on October 15, 2011, and data were analyzed from April 15, 2013, to April 15, 2016, based on intention to treat. Main Outcomes and Measures Mean total and AAA-related health care cost per life-year and per quality-adjusted life-year (QALY). Results A total of 881 patients (876 men [99.4%]; 5 women [0.6%]; mean [SD] age, 70 [7.8] years) were included in the analysis. After a mean of 5.2 years of follow-up, mean life-years were 4.89 in the endovascular group and 4.84 in the open repair group ( P = .68), and mean QALYs were 3.72 in the endovascular group and 3.70 in the open repair group ( P = .82). Total mean health care costs did not differ significantly between the 2 groups (endovascular group, $142 745; open repair group, $153 533; difference, −$10 788; 95% CI, −$29 796 to $5825; P = .25). Costs related to AAA, including the initial repair, constituted nearly 40% of total costs and did not differ significantly between the 2 groups (endovascular group, $57 501; open repair group, $57 893; difference, −$393; 95% CI, −$12 071 to $7928; P = .94). Lower costs due to shorter hospitalization for initial endovascular repair were offset by increased costs from AAA-related secondary procedures and imaging studies. The probability of endovascular repair being less costly and more effective was 56.8% when effectiveness was measured in life-years and 55.4% when effectiveness was measured in QALYs for total costs and 31.3% and 34.3%, respectively, for AAA-related costs. Conclusions and Relevance In this multicenter randomized clinical trial with follow-up to 9 years, survival, quality of life, costs, and cost-effectiveness did not differ between elective open and endovascular repair of AAA. Trial Registration clinicaltrials.gov Identifier:NCT00094575
- Published
- 2016
49. Signs and Docents in Zoo Visitor Education: Using Affinitive Chimpanzee (Pan troglodytes) Behaviors
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Lindsay N. Zager and Mary Lee A. Jensvold
- Subjects
zoo ,visitor behavior ,visitor education ,species-specific behavior ,animal visitor interaction ,visitor effect ,Zoology ,QL1-991 - Abstract
The goals of zoos are providing an entertaining and educational experience for visitors, promoting environmental conservation, and promoting positive welfare for nonhuman residents. Education can unify these goals. In this study, data were collected on visitors to the chimpanzee (Pan troglodytes) exhibit at The Zoo Northwest Florida. Researchers implemented three conditions of education at the chimpanzee viewing platform: a graphic sign, a trained docent, and a control condition with no intervention. The sign and docent encouraged visitors to use affinitive chimpanzee behaviors. Visitors were significantly more active in the graphic sign condition and significantly less active in the docent condition, and their behavior did not vary from the expected value during the control condition. Visitors used the affinitive behaviors that were demonstrated in each experimental condition. These results suggest that both graphic signs and docent interaction affect visitor behavior and can be considered useful educational tools for fulfilling the goals of the zoos.
- Published
- 2021
- Full Text
- View/download PDF
50. Exploring teacher adoption, adaptation, and implementation of a daily report card intervention when using the daily report card online platform
- Author
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Julie Sarno Owens, Mary Lee, Kelsey Eackles, Dassiell Medina, Steven W. Evans, and Jacob Reid
- Subjects
daily report card ,technology ,adoption ,adaptation ,implementation ,classroom intervention ,Education (General) ,L7-991 - Abstract
Technology-based supports offer promise for helping elementary school teachers implement Tier 2 interventions to address challenging student behavior. The Daily Report Card Online (DRCO) platform is a cloud-based web application designed to support teachers’ adoption and implementation of a high-quality daily report card (DRC) intervention through the use of professional development resources, guided intervention design workflows, algorithm-based decision-making tools, and real-time progress monitoring. We examined teacher adoption, adaptation, and implementation of a DRC intervention when using the DRCO platform with support from a consultant during the 2021–2022 school year. Participants were 29 teachers, 20 of whom used the DRCO to implement a DRC with a student (n = 20). The most frequently chosen target behaviors were student interruptions, non-compliance, and work completion. When using the DRCO platform, teachers achieved several procedures that align with evidence-based guidelines (e.g., screening, baseline tracking, setting achievable goals, tracking behaviors over time). However, goal criterion changes and shaping procedures were used less often than expected. Despite the option to track behaviors solely with technology, 60% of teachers tracked student behaviors via paper methods (e.g., printed the DRC card, used sticky notes). Adaptations were made by 40% teachers; however, all adaptations involved modifying printed materials to be more student-friendly (e.g., add clipart to the DRC) and did not change the guiding principles of the intervention. Tau-effect sizes for academic and behavioral target behaviors on the DRC showed small to moderate change over time and change in target behaviors showed some association with change in global teacher ratings. Lastly, we identified associations between teacher characteristics and adoption and implementation, as well as associations between implementation and student outcomes.
- Published
- 2022
- Full Text
- View/download PDF
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