681 results on '"Richard A. Goodman"'
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2. The HHS Strategic Framework on Multiple Chronic Conditions: Genesis and Focus on Research
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Anand K. Parekh and Richard A. Goodman MD, JD, MPH
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Medicine - Abstract
Among the 21st century's major emerging health issues, one of the most critical is the increasing prevalence of individuals with comorbidities, or multiple chronic conditions (MCCs), and the myriad challenges this poses for public health, healthcare, social services, and other sectors. Given the increasing prevalence of individuals with MCCs and the paramount role of MCCs as a healthcare cost driver, in 2008 the U.S. Department of Health and Human Services (HHS) launched an initiative to strengthen efforts by the HHS to address the effects of MCCs on health status, quality of life, and cost. In this paper, we first provide an overview of the HHS initiative with a particular focus on the approach used in developing the initiative's centerpiece, the HHS Strategic Framework on Multiple Chronic Conditions ; we next describe progress in implementing one of the framework's four major goal areas (Goal 4) on facilitating research to fill knowledge gaps about, and interventions and systems to benefit, individuals with MCCs; and we conclude by suggesting additional potential priorities for research on MCCs. Although considerable research on MCCs has been reported over the past decade, the HHS Strategic Framework's goal on research provides a set of priority areas and a plan for systematically strengthening the evidence and information foundation necessary to address the challenges of MCCs in the USA. More broadly, the Strategic Framework provides a roadmap to help improve coordination between HHS operating divisions and enhance collaboration with external stakeholders to improve the quality of life for those with MCCs.
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- 2013
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3. Law as a Tool for Preventing Chronic Diseases: Expanding the Spectrum of Effective Public Health Strategies
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George A. Mensah, Richard A. Goodman, Stephanie Zaza, Anthony D. Moulton, Paula L. Kocher, William H. Dietz, Terry F. Pechacek, and James S. Marks
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Law ,CDC ,chronic disease ,public health ,Public aspects of medicine ,RA1-1270 - Abstract
In part one of this 2-part series, we reviewed the important roles that laws have played in public health and provided examples of specific laws and their effectiveness in supporting public health interventions (1). We suggested that conceptual legal frameworks for systematically applying law to preventing and controlling chronic diseases have not been fully recognized and we provided the basic elements of a conceptual legal framework. In part 2 of this series, we first provide an overview of U.S. jurisprudence, describe the legal mechanisms, remedies, and tools for applying law to public health, and summarize the jurisdictional levels at which laws, mechanisms, remedies, and tools operate. We then identify the potential contours for legal frameworks of varying complexity and scope by offering examples of legal frameworks in public health practice. This paper also outlines a plan for increasing the capacity within the Centers for Disease Control and Prevention (CDC) for developing legal frameworks and expanding guidance on using legal tools for preventing and controlling chronic diseases. Finally, we describe resources for building or enhancing the capacity to use law as a tool for preventing diseases, injuries, and disabilities at the local level.
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- 2004
4. Law as a Tool for Preventing Chronic Diseases: Expanding the Range of Effective Public Health Strategies
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George A. Mensah, Richard A. Goodman, Stephanie Zaza, Anthony D. Moulton, Paula L. Kocher, William H. Dietz, Terry F. Pechacek, and James S. Marks
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law ,chronic disease ,public health ,Public aspects of medicine ,RA1-1270 - Published
- 2004
5. Delinquent Mortgages, Neglected Swimming Pools, and West Nile Virus, California
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William K. Reisen, Richard A. Goodman, James W. Buehler, Richard M. Takahashi, Brian D. Carroll, and Rob Quiring
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West Nile virus ,mosquitoes ,surveillance ,mortgages ,swimming pools ,California ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2009
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6. Bioviolence: Preventing Biological Terror and Crime
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Richard A. Goodman
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Medicine ,Infectious and parasitic diseases ,RC109-216 - Published
- 2008
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7. Evaluation of the genotoxic potential of protoporphyrin IX and the safety of a protoporphyrin IX‐rich algal biomass
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Timothy S. Murbach, Róbert Glávits, Niloofar Moghadam Maragheh, John R. Endres, Gábor Hirka, Richard E. Goodman, Guihua Lu, Adél Vértesi, Erzsébet Béres, and Ilona Pasics Szakonyiné
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Mammals ,Proteomics ,Animals ,Protoporphyrins ,Biomass ,Toxicology ,DNA Damage ,Rats - Abstract
Chlamydomonas reinhardtii is a nonpathogenic, nontoxigenic green algae used as a sustainable source of protein in foods. In order to mimic meat-like qualities, a strain rich in protoporphyrin IX (PPIX), an endogenous heme/chlorophyll precursor, was developed using an evolution and selection strategy, and investigations were carried out to evaluate the safety of the novel strain, C. reinhardtii (red), strain TAI114 (TAI114). Digestibility and proteomic evaluations were conducted to determine whether any potentially allergenic or toxic proteins occurred as the result of the mutation process. The genotoxic potential of pure PPIX was evaluated using a bacterial reverse mutation test, an in vitro mammalian chromosomal aberration test, and an in vivo mammalian micronucleus test. Finally, the novel TAI114 biomass was evaluated for general toxicity and identification of target organs in a 90-day repeated-dose oral toxicity study in rats. All proteins were rapidly degraded in pepsin at pH 2.0 suggesting low allergenic potential. The proteomic evaluation indicated that TAI114 biomass contains typical C. reinhardtii proteins. PPIX was unequivocally negative for genotoxic potential and no target organs or adverse effects were observed in rats up to the maximum feasible dose of 4000 mg/kg bw/day TAI114 biomass, which was determined to be the no-observed-adverse-effect-level (NOAEL). These results support the further development and risk characterization of TAI114 biomass as a novel ingredient for use in the meat analogue category of food.
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- 2022
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8. Climate Change Impacts on Broussonetia papyrifera Pollen - Metabolome Investigations and Prospects of Allergy Prevalence in Times of Climate Change
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Muhammad Humayun, Saadia Naseem, Zahid Ali, and Richard E. Goodman
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Broussonetia papyrifera (B. papyrifera) is a tree producing allergenic pollen that grow at varied climatic conditions worldwide. The tree pollen disperse in the air causing allergies in susceptible humans. The study investigates climate change variable’s impact on B. papyrifera pollen’s composition, pollen metabolome, pollen allergenicity and their occurrence in the upcoming years. The tree pollens were collected in summer and spring from different regions in Pakistan. Pollens were subjected to morphological analysis, Fourier Transform Infrared Spectroscopy (FTIR), Liquid Chromatography-Mass Spectrometry (LCMS), and immunoblotting. The tree future-growth invasion was predicted through MaxEnt modeling. Light microscopy and FTIR showed seasonal and regional differences in pollen-morphology and pollen-metabolome that correlated to weather conditions’ shift. LCMS analysis detected four allergenic lipids having a potential role in allergies. Pollen protein immunoblotting-studies identified putative 15 kDa novel allergen, and verified previously known 40 kDa, 33 kDa, and 10 kDa allergens. B. papyrifera MaxEnt modeling through ACCESS10 and CCSM4 under 2-greenhouse gas emissions scenarios {representative concentration pathway (RCP) 4.5 and 8.5} projected the tree invasion by the years 2050 and 2070. The study findings demonstrate that climatic variables differences affect B. papyrifera-pollen physiology. The study discovered allergenic lipids and a 15 kDa potential novel allergen in B. papyrifera-pollen protein extracts, and predicted the tree invasion in future. These results predict potential changes in B. papyrifera-pollen allergy risks in the future and provide a model system for studying pollen morphology, plant invasion, and associated allergies in response to climate changes for other species.
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- 2023
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9. Toxicology and digestibility of Chlamydomonas debaryana green algal biomass
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Timothy S. Murbach, Róbert Glávits, Shyamali Jayasena, Niloofar Moghadam Maragheh, John R. Endres, Gábor Hirka, Richard E. Goodman, Adél Vértesi, Erzsébet Béres, and Ilona Pasics Szakonyiné
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Toxicology - Published
- 2023
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10. Intracellular Transposition of Mobile Genetic Elements Associated with the Colistin Resistance Gene mcr-1
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Richard N. Goodman, Supathep Tansirichaiya, Michael S. M. Brouwer, and Adam P. Roberts
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Host Pathogen Interaction & Diagnostics ,Microbiology (medical) ,General Immunology and Microbiology ,Ecology ,Physiology ,Bacteriologie ,Bacteriology ,Bacteriology, Host Pathogen Interaction & Diagnostics ,Cell Biology ,Host Pathogen Interactie & Diagnostiek ,Infectious Diseases ,Bacteriologie, Host Pathogen Interactie & Diagnostiek ,Genetics ,Life Science - Abstract
Mobile colistin resistance (mcr) genes are often located on conjugative plasmids, where their association with insertion sequences enables intercellular and intracellular dissemination throughout bacterial replicons and populations. Multiple mcr genes have been discovered in every habitable continent, in many bacterial species, on both plasmids and integrated into the chromosome. Previously, we showed the intercellular transfer of mcr-1 on an IncI1 plasmid, pMCR-E2899, between strains of Escherichia coli. Characterizing the intracellular dynamics of mcr-1 transposition and recombination would further our understanding of how these important genes move through bacterial populations and whether interventions can be put in place to stop their spread. In this study, we aimed to characterize transfer events from the mcr-1-containing transposon Tn7511 (ISApl1-mcr-1-pap2-ISApl1), located on plasmid pMCR-E2899, using the pBACpAK entrapment vector. Following the transformation of pBACpAK into our DH5α-Azir/pMCR-E2899 transconjugant, we captured ISApl1 in pBACpAK multiple times and, for the first time, observed the ISApl1-mediated transfer of the mcr-1 transposon (Tn7511) into the chromosome of E. coli DH5α. Whole-genome sequencing allowed us to determine consensus insertion sites of ISApl1 and Tn7511 in this strain, and comparison of these sites allowed us to explain the transposition events observed. These observations reveal the consequences of ISApl1 transposition within and between multiple replicons of the same cell and show mcr-1 transposition within the cell as part of the novel transposon Tn7511.
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- 2023
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11. Intracellular Transposition of Mobile Genetic Elements Associated with the Colistin Resistance Gene
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Richard N, Goodman, Supathep, Tansirichaiya, Michael S M, Brouwer, and Adam P, Roberts
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Mobile colistin resistance (
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- 2022
12. A proof of concept pilot trial of probiotics in symptomatic oral lichen planus (CABRIO)
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Tim Hodgson, R. Leeson, Julie A. Barber, Andrew Smith, Richard N. Goodman, Stefano Fedele, Stephen Porter, Martina Shephard, Erni Marlina, Roddy McMillan, and Valeria Mercadante
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medicine.medical_specialty ,Pain ,Pilot Projects ,Placebo ,law.invention ,Probiotic ,Quality of life ,law ,Internal medicine ,medicine ,Humans ,skin and connective tissue diseases ,Adverse effect ,General Dentistry ,business.industry ,Probiotics ,Pilot trial ,medicine.disease ,Clinical trial ,stomatognathic diseases ,Otorhinolaryngology ,Quality of Life ,Oral lichen planus ,Oral disease ,business ,Lichen Planus, Oral - Abstract
Objective To preliminary evaluate the clinical effects of probiotics in individuals with symptomatic oral lichen planus and the possible mechanisms of action. Subjects and Methods A group of 30 individuals with symptomatic oral lichen planus were recruited in a randomised double-blind parallel group controlled (1:1) proof-of-concept pilot trial of probiotic VSL#3 vs placebo. Efficacy outcomes included changes in pain numeric rating scale, oral disease severity score and the chronic oral mucosal disease questionnaire. Adverse effects, home diary and withdrawals were assessed as feasibility outcomes. Mechanistic outcomes included changes in salivary and serum levels of CXCL10 and IFN-γ and in oral microbial composition. Results The probiotic VSL#3 was safe and well tolerated. We observed no statistically significant change in pain, disease activity, quality of life, serum/salivary CXCL10 or oral microbial composition with respect to placebo. Salivary IFN-γ levels demonstrate a trend for a reduced level in the active group (p = 0.082) after 30 days of probiotic consumption. Conclusions The present proof-of-concept study provides some weak not convincing indication of biological and clinical effects of probiotic VSL#3 in individuals with painful oral lichen planus. Further research in this field is needed, with the current study providing useful information to the design of future clinical trials.
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- 2021
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13. Carbohydrate epitopes currently recognized as targets for IgE antibodies
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Gabriele Gadermaier, Jonas Lidholm, Rob C. Aalberse, Thomas A.E. Platts-Mills, Richard E. Goodman, Ronald van Ree, Behnam Keshavarz, Marianne van Hage, Anna Pomés, Uta Jappe, Christiane Hilger, and Edzard Spillner
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Glycan ,alpha-gal ,Immunology ,Carbohydrates ,Cross Reactions ,medicine.disease_cause ,Immunoglobulin E ,Article ,Epitope ,Epitopes ,Allergen ,medicine ,Animals ,Humans ,Immunology and Allergy ,O-glycans ,cross-reactive carbohydrate determinants ,MMXF ,biology ,MUXF3 ,Cross-reactive carbohydrate determinants ,Allergens ,clinical relevance ,In vitro ,hapten ,biology.protein ,Allergists ,Hapten - Abstract
Until recently, glycan epitopes have not been documented by the WHO/IUIS Allergen Nomenclature Sub-Committee. This was in part due to scarce or incomplete information on these oligosaccharides, but also due to the widely held opinion that IgE to these epitopes had little or no relevance to allergic symptoms. Most IgE-binding glycans recognized up to 2008 were considered to be “classical” cross-reactive carbohydrate determinants (CCD) that occur in insects, some helminths and throughout the plant kingdom. Since 2008, the prevailing opinion on lack of clinical relevance of IgE-binding glycans has been subject to a reevaluation. This was because IgE specific for the mammalian disaccharide galactose-alpha-1,3-galactose (alpha-gal) was identified as a cause of delayed anaphylaxis to mammalian meat in the United States, an observation that has been confirmed by allergists in many parts of the world. Several experimental studies have shown that oligosaccharides with one or more terminal alpha-gal epitopes can be attached as a hapten to many different mammalian proteins or lipids. The classical CCDs also behave like haptens since they can be expressed on proteins from multiple species. This is the explanation for extensive in vitro cross-reactivity related to CCDs. Because of these developments, the Allergen Nomenclature Sub-Committee recently decided to include glycans as potentially allergenic epitopes in an adjunct section of its website (www.allergen.org). In this article, the features of the main glycan groups known to be involved in IgE recognition are revisited, and their characteristic structural, functional, and clinical features are discussed.
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- 2021
14. Monitoring glycolytic dynamics in single cells using a fluorescent biosensor for fructose 1,6-bisphosphate
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John N. Koberstein, Melissa L. Stewart, Chadwick B. Smith, Andrei I. Tarasov, Frances M. Ashcroft, Philip J. S. Stork, and Richard H. Goodman
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Repressor Proteins ,Multidisciplinary ,Insulin-Secreting Cells ,Fructosediphosphates ,Humans ,Biosensing Techniques ,Fructose ,Single-Cell Analysis ,Glycolysis ,Fluorescence - Abstract
Cellular metabolism is regulated over space and time to ensure that energy production is efficiently matched with consumption. Fluorescent biosensors are useful tools for studying metabolism as they enable real-time detection of metabolite abundance with single-cell resolution. For monitoring glycolysis, the intermediate fructose 1,6-bisphosphate (FBP) is a particularly informative signal as its concentration is strongly correlated with flux through the whole pathway. Using GFP insertion into the ligand-binding domain of theBacillus subtilistranscriptional regulator CggR, we developed a fluorescent biosensor for FBP termed HYlight. We demonstrate that HYlight can reliably report the real-time dynamics of glycolysis in living cells and tissues, driven by various metabolic or pharmacological perturbations, alone or in combination with other physiologically relevant signals. Using this sensor, we uncovered previously unknown aspects of β-cell glycolytic heterogeneity and dynamics.
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- 2022
15. Safety evaluation of Neurospora crassa mycoprotein for use as a novel meat alternative and enhancer
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Bradley M. Bartholomai, Katherine M. Ruwe, Jonathan Thurston, Prachi Jha, Kevin Scaife, Ryan Simon, Mohamed Abdelmoteleb, Richard E. Goodman, and Moran Farhi
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Meat ,Neurospora crassa ,Iron ,Food Ingredients ,Potassium ,Animals ,Humans ,General Medicine ,Toxicology ,Food Science - Abstract
Cultivation of filamentous fungi to produce sustainable, nutrient rich meat replacements has recently attracted significant commercial and research interest. Here, we report evidence for the safety and nutritional value of Neurospora crassa mycoprotein, a whole mycelium food ingredient produced by fermentation and minimal downstream processing. N. crassa has a long history of human use in fermented foods and in molecular biology research. A survey of studies that used N. crassa in animal feed revealed no adverse effects to the health of the animals. Furthermore, a review of the literature found no reports of confirmed allergenicity or toxicity in humans involving N. crassa. Genomic toxigenicity analysis and in vitro testing did not identify any toxins in N. crassa mycoprotein. Two independent genomic allergenicity studies did not identify proteins that would be considered a particular risk for allergenic potential. Furthermore, nutritional analysis demonstrated that N. crassa mycoprotein is a good source of complete protein and is rich in fiber, potassium, and iron. Taken together, the presented data and the history of human use without evidence of human or animal harm indicate that foods containing N. crassa can generally be regarded as safe.
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- 2022
16. Development of a Sequence Searchable Database of Celiac Disease-Associated Peptides and Proteins for Risk Assessment of Novel Food Proteins
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Plaimein Amnuaycheewa, Mohamed Abdelmoteleb, John Wise, Barbara Bohle, Fatima Ferreira, Afua O. Tetteh, Steve L. Taylor, and Richard E. Goodman
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General Medicine - Abstract
Celiac disease (CeD) is an autoimmune enteropathy induced by prolamin and glutelin proteins in wheat, barley, rye, and triticale recognized by genetically restricted major histocompatibility (MHC) receptors. Patients with CeD must avoid consuming these proteins. Regulators in Europe and the United States expect an evaluation of CeD risks from proteins in genetically modified (GM) crops or novel foods for wheat-related proteins. Our database includes evidence-based causative peptides and proteins and two amino acid sequence comparison tools for CeD risk assessment. Sequence entries are based on the review of published studies of specific gluten-reactive T cell activation or intestinal epithelial toxicity. The initial database in 2012 was updated in 2018 and 2022. The current database holds 1,041 causative peptides and 76 representative proteins. The FASTA sequence comparison of 76 representative CeD proteins provides an insurance for possible unreported epitopes. Validation was conducted using protein homologs from Pooideae and non-Pooideae monocots, dicots, and non-plant proteins. Criteria for minimum percent identity and maximumE-scores are guidelines. Exact matches to any of the 1,041 peptides suggest risks, while FASTA alignment to the 76 CeD proteins suggests possible risks. Matched proteins should be tested further by CeD-specific CD4/8+ T cell assays orin vivochallenges before their use in foods.
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- 2022
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17. Allergens
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Richard E Goodman and Afua O Tetteh
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- 2020
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18. Health System Approach to Improve Chronic Obstructive Pulmonary Disease Care after Hospital Discharge: Stepped-Wedge Clinical Trial
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David H. Au, Margaret P. Collins, Douglas B. Berger, Paula G. Carvalho, Karin M. Nelson, Lynn F. Reinke, Richard B. Goodman, Rosemary Adamson, Deborah M. Woo, Peter J. Rise, Scott S. Coggeshall, Robert B. Plumley, Eric M. Epler, Brianna R. Moss, Jennifer A. McDowell, and William G. Weppner
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Pulmonary and Respiratory Medicine ,Pulmonary Disease, Chronic Obstructive ,Quality of Life ,Humans ,Critical Care and Intensive Care Medicine ,Patient Readmission ,Hospitals ,Patient Discharge - Published
- 2022
19. First identification of
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Joel, Manyahi, Sabrina J, Moyo, Upendo, Kibwana, Richard N, Goodman, Ellie, Allman, Alasdair T M, Hubbard, Bjørn, Blomberg, Nina, Langeland, and Adam P, Roberts
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Adult ,Carbapenems ,Escherichia coli ,Infant, Newborn ,Humans ,HIV Infections ,Microbial Sensitivity Tests ,Tanzania ,Escherichia coli Infections ,beta-Lactamases ,Anti-Bacterial Agents ,Plasmids - Published
- 2022
20. First identification of bla NDM-5 producing Escherichia coli from neonates and a HIV infected adult in Tanzania
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Joel Manyahi, Sabrina J. Moyo, Upendo Kibwana, Richard N. Goodman, Ellie Allman, Alasdair T. M. Hubbard, Bjørn Blomberg, Nina Langeland, and Adam P. Roberts
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Microbiology (medical) ,General Medicine ,Microbiology - Abstract
Introduction. Carbapenem-resistant members of the family Enterobacteriaceae are emerging as a global public-health threat and cause substantial challenges in clinical practice. Gap Statement. There is a need for increased and continued genomic surveillance of antimicrobial resistance genes globally in order to detect outbreaks and dissemination of clinically important resistance genes and their associated mobile genetic elements in human pathogens. Aim. To describe the resistance mechanisms of carbapenem-resistant Escherichia coli . Methods. Rectal swabs from neonates and newly diagnosed human immunodeficiency virus (HIV) infected adults were collected between April 2017 and May 2018 and screened for faecal carriage of carbapenamases and OXA-48 producing members of the family Enterobacteriaceae. Bacterial isolates were identified using matrix assisted laser desorption ionization time of flight mass spectrometry. Antimicrobial susceptibility testing was performed by E-test. Whole genomes of carbapenem-resistant E. coli were investigated using a hybrid assembly of Illumina and Oxford Nanopore Technologies sequencing reads. Results. Three carbapenem-resistant E. coli were detected, two from neonates and one from an HIV infected adult. All three isolates carried bla NDM-5. Two E. coli from neonates belonged to ST167 and bla NDM-5 co-existed with bla CTX-M-15 and bla OXA-01, and all were carried on IncFIA type plasmids. The E. coli from the HIV infected adult belonged to ST2083, and carried bla NDM-5 on an IncX3 type plasmid and bla CMY-42 on an IncI type plasmid. All bla NDM-5 carrying plasmids contained conjugation related genes. In addition, E. coli from the HIV infected adult carried three more plasmid types; IncFIA, IncFIB and Col(BS512). One E. coli from a neonate also carried one extra plasmid Col(BS512). All three E. coli harboured resistance genes to fluoroquinolone, aminoglycosides, sulfamethoxazole, trimethoprim, macrolides and tetracycline, carried on the IncFIA type plasmid. Furthermore, E. coli from the neonates carried a chloramphenicol resistance gene (catB3), also on the IncFIA plasmid. All three isolates were susceptible to colistin. Conclusion. This is the first report, to our knowledge, from Tanzania detecting bla NDM-5 producing E. coli. The carbapenemase gene was carried on an IncFIA and IncX3 type plasmids. Our findings highlight the urgent need for a robust antimicrobial resistance (AMR) surveillance system to monitor and rapidly report on the incidence and spread of emerging resistant bacteria in Tanzania.
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- 2022
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21. Challenges in Gluten Analysis: A Comparison of Four Commercial Sandwich ELISA Kits
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Plaimein Amnuaycheewa, Lynn Niemann, Richard E. Goodman, Joseph L. Baumert, and Steve L. Taylor
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Health (social science) ,Plant Science ,gluten detection ,ELISA ,gluten-free ,labeling ,grain ,food matrix ,Health Professions (miscellaneous) ,Microbiology ,Food Science - Abstract
Gluten is composed of prolamin and glutelin proteins from several related grains. Because these proteins are not present in identical ratios in the various grains and because they have some differences in sequence, the ability to accurately quantify the overall amount of gluten in various food matrices to support gluten-free labeling is difficult. Four sandwich ELISAs (the R-Biopharm AG R5 RIDASCREEN®, the Neogen Veratox® R5, the Romer Labs AgraQuant® G12, and the Morinaga Wheat kits) were evaluated for their performance to quantify gluten concentrations in various foods and ingredients. The Morinaga and AgraQuant® G12 tests yielded results comparable to the two R5 kits for most, but not for certain, foods. The results obtained with the Morinaga kit were lower when compared to the other kits for analyzing powders of buckwheat and several grass-based products. All four kits were capable of detecting multiple gluten-containing grain sources including wheat, rye, barley, semolina, triticale, spelt, emmer, einkorn, Kamut™, and club wheat. Users of the ELISA kits should verify the performance in their hands, with matrices that are typical for their specific uses. The variation in results for some food matrices between test methods could result in trade disputes or regulatory disagreements.
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- 2022
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22. Climate Change Impacts on Broussenetia papyrifera Pollens - Metabolome Investigations and Prospects of Allergy Prevalence
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Muhammad Humayun, Saadia Naseem, Richard E. Goodman, and Zahid Ali
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otorhinolaryngologic diseases ,food and beverages - Abstract
Broussonetia papyrifera (B. papyrifera) is an allergenic plant in the mulberry family that grows at varied elevations and climatic conditions worldwide. In northern Pakistan, B. papyrifera is abundant and it produces a substantial amount of pollen that disperses in the air causing allergies in some humans. Climate change affects pollen production. To investigate potential changes in pollens development and potential allergenicity, B. papyrifera pollens were collected in summer and in spring from different regions in Pakistan. Study samples were subjected to morphological analysis, Fourier Transform Infrared Spectroscopy (FTIR) analysis for biochemical differences, and Liquid Chromatography-Mass Spectrometry (LCMS) for metabolome analysis. Morphological studies of the dried pollen by light microscopy showed seasonal and regional differences in pollens size and exine morphology. FTIR analysis showed inter-regional and inter-seasonal differences in the metabolome of the pollen. Differences in lipid and protein functional groups of pollen from different regions showed variation in the FTIR spectra. These differences in FTIR spectra correlated with the changing climatic conditions. Metabolome analysis of targeted pollen samples identified 33 organic compounds of seven different groups. Four unsaturated fatty acids were identified that have a potential role in allergic responses. The findings in this study are unique in demonstrating climatic variables that effect B. papyrifera pollen physiology (FTIR analysis) which also confirms differences in pollen-associated lipid metabolites identified by LCMS analysis. These results demonstrate information that may be used to predict potential changes in allergy risks from pollens of B. papyrifera in the future. The findings may provide a model for predicting variation in pollen structure and associated allergies in response to climate changes for other species.
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- 2022
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23. Intracellular Transposition and Capture of Mobile Genetic Elements following Intercellular Conjugation of Multidrug Resistance Conjugative Plasmids from Clinical
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Supathep, Tansirichaiya, Richard N, Goodman, Xinyu, Guo, Issra, Bulgasim, Ørjan, Samuelsen, Mohammed, Al-Haroni, and Adam P, Roberts
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insertion sequence ,Gene Transfer, Horizontal ,transposon ,Enterobacteriaceae Infections ,bla NDM-1 ,Anti-Bacterial Agents ,Klebsiella pneumoniae ,Enterobacteriaceae ,Conjugation, Genetic ,Drug Resistance, Multiple, Bacterial ,DNA Transposable Elements ,Escherichia coli ,Humans ,antimicrobial resistance ,entrapment vector ,Plasmids ,Research Article - Abstract
Mobile genetic elements (MGEs) are often associated with antimicrobial resistance genes (ARGs). They are responsible for intracellular transposition between different replicons and intercellular conjugation and are therefore important agents of ARG dissemination. Detection and characterization of functional MGEs, especially in clinical isolates, would increase our understanding of the underlying pathways of transposition and recombination and allow us to determine interventional strategies to interrupt this process. Entrapment vectors can be used to capture active MGEs, as they contain a positive selection genetic system conferring a selectable phenotype upon the insertion of an MGE within certain regions of that system. Previously, we developed the pBACpAK entrapment vector that results in a tetracycline-resistant phenotype when MGEs translocate and disrupt the cI repressor gene. We have previously used pBACpAK to capture MGEs in clinical Escherichia coli isolates following transformation with pBACpAK. In this study, we aimed to extend the utilization of pBACpAK to other bacterial taxa. We utilized an MGE-free recipient E. coli strain containing pBACpAK to capture MGEs on conjugative, ARG-containing plasmids following conjugation from clinical Enterobacteriaceae donors. Following the conjugative transfer of multiple conjugative plasmids and screening for tetracycline resistance in these transconjugants, we captured several insertion sequence (IS) elements and novel transposons (Tn7350 and Tn7351) and detected the de novo formation of novel putative composite transposons where the pBACpAK-located tet(A) is flanked by ISKpn25 from the transferred conjugative plasmid, as well as the ISKpn14-mediated integration of an entire 119-kb, blaNDM-1-containing conjugative plasmid from Klebsiella pneumoniae. IMPORTANCE By analyzing transposition activity within our MGE-free recipient, we can gain insights into the interaction and evolution of multidrug resistance-conferring MGEs following conjugation, including the movement of multiple ISs, the formation of composite transposons, and cointegration and/or recombination between different replicons in the same cell. This combination of recipient and entrapment vector will allow fine-scale experimental studies of factors affecting intracellular transposition and MGE formation in and from ARG-encoding MGEs from multiple species of clinically relevant Enterobacteriaceae.
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- 2022
24. Cannabis-related allergies: An international overview and consensus recommendations
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Isabel J, Skypala, Samira, Jeimy, Hannelore, Brucker, Ajay P, Nayak, Ine I, Decuyper, Jonathan A, Bernstein, Lori, Connors, Amin, Kanani, Ludger, Klimek, Shun Chi Ryan, Lo, Kevin R, Murphy, Anil, Nanda, Jill A, Poole, Jolanta, Walusiak-Skorupa, Gordon, Sussman, Joanna S, Zeiger, Richard E, Goodman, Anne K, Ellis, William S, Silvers, Didier G, Ebo, and International Cannabis Allergy Collaboration
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Consensus ,Pharmacology. Therapy ,Immunology ,COVID-19 ,Allergens ,Antigens, Plant ,Immunoglobulin E ,Article ,Hypersensitivity ,Immunology and Allergy ,Humans ,Human medicine ,Pandemics ,Food Hypersensitivity ,Cannabis ,Skin Tests - Abstract
Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.
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- 2022
25. Subchronic feeding, allergenicity, and genotoxicity safety evaluations of single strain bacterial protein
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Tom Jonaitis, Elizabeth A. Lewis, Nicky Lourens, Angelique Groot, Richard E. Goodman, Daniel Mitchell, Alon Karpol, and Bryan Tracy
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General Medicine ,Toxicology ,Food Science - Abstract
Microbial proteins are potentially important alternatives to animal protein. A safety assessment was conducted on a Clostridium protein which can serve as a high-quality protein source in human food. A battery of toxicity studies was conducted comprising a 14-day dose-range finding dietary study in rats, 90-day dietary study in rats and in vitro genotoxicity studies. The allergenic potential was investigated by bioinformatics analysis. In the 90-day feeding study, rats were fed diets containing 0, 5.0, 7.5, and 10% Clostridium protein. The Clostridium protein-containing diets were well-tolerated and no adverse effects on the health or growth were observed. Significant reductions in neutrophil counts were observed in all female rats compared to controls, which were slightly outside of reference ranges. These effects were not deemed to be adverse due to the absence of comparable findings in male rats and high physiological variability of measured values within groups. A No-Observed-Adverse-Effect-Level (NOAEL) of at least 10% Clostridium protein, the highest dose tested and corresponding to 5,558 and 6,671 mg/kg body weight/day for male and female rats, respectively, was established. No evidence of genotoxicity was observed and the allergenic potential was low. These results support the use of Clostridium protein as a food ingredient.
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- 2021
26. Safety evaluation of Fy Protein™ (Nutritional Fungi Protein), a macroingredient for human consumption
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Brian Furey, Kathleen Slingerland, Mark R. Bauter, Celeste Dunn, Richard E. Goodman, and Sophia Koo
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Dietary Fiber ,Fungal Proteins ,Fusarium ,Fermentation ,Fungi ,Animals ,Humans ,General Medicine ,Allergens ,Mycotoxins ,Toxicology ,Food Science ,Rats - Abstract
Fy Protein™ (Nutritional Fungi Protein) is a macro-ingredient produced from the fermentation of the fungal microorganism Fusarium strain flavolapis, isolated from springs in Yellowstone National Park. Fy Protein contains all of the essential amino acids plus fiber, fat, carbohydrates, vitamins, and minerals and is developed as an alternative to animal-based protein foods such as meat and dairy. Fy Protein's nutritional, digestibility, genotoxicity, allergenicity, toxicity, secondary metabolites, and pathogenicity were evaluated. Fy Protein did not show mutagenic or genotoxic potential in in vitro tests. In an allergenicity review, Fy Protein was found to be of low allergenic potential. In a 90-day sub chronic dietary study in rats, administration of Fy Protein did not produce any significant toxicologic manifestations, and the no observed effect level (NOAEL) was the highest-level fed of 150,000 ppm (15% in the diet). Regulated secondary metabolites from fungi (termed mycotoxins) were non-detectable and below regulated levels using quantitative analytical techniques. A literature review was completed to identify the potential human pathogenicity of Fusarium sp., showing that Fusarium rarely infects humans, with infections seldom developing even in immunocompromised individuals. The results of these studies confirm that Fy Protein from fermented F. str. flavolapis has low toxicological, genotoxic, pathogenic, and allergenic potential under the conditions tested and anticipated use.
- Published
- 2021
27. Keyblock bolting
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Gen-Hua Shi and Richard E. Goodman
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- 2021
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28. Author response for 'A proof of concept pilot trial of probiotics in symptomatic oral lichen planus (CABRIO)'
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Roddy McMillan, Stefano Fedele, Julie A. Barber, Stephen Porter, Andrew Smith, R. Leeson, Valeria Mercadante, Erni Marlina, Martina Shephard, TA Hodgson, and Richard N. Goodman
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medicine.medical_specialty ,business.industry ,Pilot trial ,Medicine ,Oral lichen planus ,business ,medicine.disease ,Dermatology - Published
- 2021
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29. Genetic variability and evolutionary dynamics of atypical Papaya ringspot virus infecting Papaya
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Amna Binat Imdad, Richard E. Goodman, Muhammad Faheem Akbar, Saadia Naseem, Shyi-Dong Yeh, Anam Saleem, Zahid Ali, and Wajeeha Saeed
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Heredity ,Potyvirus ,Statistics as Topic ,Population genetics ,Geographical Locations ,Pakistan ,3' Untranslated Regions ,Phylogeny ,Data Management ,Genetics ,Recombination, Genetic ,education.field_of_study ,Bangladesh ,Likelihood Functions ,Multidisciplinary ,Phylogenetic tree ,biology ,Geography ,Carica ,Phylogenetic Analysis ,Genomics ,Phylogenetics ,Phylogeography ,Biogeography ,Medicine ,Research Article ,Gene Flow ,Computer and Information Sciences ,Asia ,Science ,Population ,India ,Genome, Viral ,Virus ,Papaya ringspot virus ,Evolution, Molecular ,Genetic variation ,Evolutionary Systematics ,Genetic variability ,education ,Taxonomy ,Plant Diseases ,Evolutionary Biology ,Population Biology ,Base Sequence ,Ecology and Environmental Sciences ,Biology and Life Sciences ,Genetic Variation ,biology.organism_classification ,People and Places ,Earth Sciences ,Population Genetics - Abstract
Papaya ringspot virus biotype-P is a detrimental pathogen of economically important papaya and cucurbits worldwide. The mutation prone feature of this virus perhaps accounts for its geographical dissemination. In this study, investigations of the atypical PRSV-P strain was conducted based on phylogenetic, recombination and genetic differentiation analyses considering of it’s likely spread across India and Bangladesh. Full length genomic sequences of 38 PRSV isolates and 35 CP gene sequences were subjected to recombination analysis. A total of 61 recombination events were detected in aligned complete PRSV genome sequences. 3 events were detected in complete genome of PRSV strain PK whereas one was in its CP gene sequence. The PRSV-PK appeared to be recombinant of a major parent from Bangladesh. However, the genetic differentiation based on full length genomic sequences revealed less frequent gene flow between virus PRSV-PK and the population from America, India, Colombia, other Asian Countries and Australia. Whereas, frequent gene flow exists between Pakistan and Bangladesh virus populations. These results provided evidence correlating geographical position and genetic distances. We speculate that the genetic variations and evolutionary dynamics of this virus may challenge the resistance developed in papaya against PRSV and give rise to virus lineage because of its atypical emergence where geographic spread is already occurring.
- Published
- 2021
30. The blocky nature of rock
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Richard E. Goodman
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- 2020
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31. Field epidemiology and COVID-19: always more lessons to be learned
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Sonja A. Rasmussen and Richard A Goodman
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Evidence-Based Medicine ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,Social Determinants of Health ,business.industry ,Epidemiology ,Field (Bourdieu) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,General Medicine ,Global Health ,Editorial ,Cost of Illness ,Cost of illness ,medicine ,Humans ,AcademicSubjects/MED00860 ,Engineering ethics ,Public Health ,business - Published
- 2020
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32. Toxicological assessment and food allergy of silk fibroin derived from Bombyx mori cocoons
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Samantha E. Roman, Adam M. Behrens, Lester C. Chong, Laith M. Abu-Taleb, Nadia S. Hallaj, Richard E. Goodman, Sezin Yigit, Philip E. Johnson, and James L. Sugarman
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Male ,Food spoilage ,Fibroin ,Administration, Oral ,Toxicology ,Ames test ,Rats, Sprague-Dawley ,03 medical and health sciences ,Mice ,0404 agricultural biotechnology ,Food allergy ,Bombyx mori ,In vivo ,Toxicity Tests ,medicine ,Animals ,Food science ,030304 developmental biology ,0303 health sciences ,Mice, Inbred ICR ,biology ,Chemistry ,fungi ,04 agricultural and veterinary sciences ,General Medicine ,medicine.disease ,biology.organism_classification ,Bombyx ,040401 food science ,In vitro ,Rats ,Toxicity ,Female ,Fibroins ,Food Hypersensitivity ,Food Science - Abstract
Recent studies have demonstrated silk fibroin protein's (SF) ability to extend the shelf life of foods by mitigating the hallmarks of spoilage, namely oxidation and dehydration. Due to the potential for this protein to become more widespread, its safety was evaluated comprehensively. First, a bacterial reverse mutation test (Ames test) was conducted in five bacterial strains. Second, an in vivo erythrocyte test was conducted with Sprague Dawley rats at doses up to 1,000mg/kg-bw/day. Third, a range-finder study was conducted with Sprague Dawley rats at the highest consumption amount given solubility and oral gavage volume constrains (500mg/kg-bw/day). Fourth, a 28-day sub-chronic study in Sprague Dawley rats was conducted with the high dose set at 500mg/kg-bw/day, as limited by solubility of the protein in a single-gavage per-day study. Fifth, an in vitro pepsin digestion assay was performed to assess the potential for protein allergenicity. Sixth, allergenic potential was further assessed using liquid chromatography-mass spectroscopy for detection of allergenic insect proteins. Seventh, the SF protein sequences were subjected to bioinformatic analyses. Together, these studies raise no mutagenic, genotoxic, toxicological, or allergenic concerns with the oral consumption of silk fibroin.
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- 2020
33. Evaluating the Safety and Potential Risks of Food Allergy of Silk Fibroin Derived from Bombyx mori Cocoons
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Laith M. Abu-Taleb, Nadia S. Hallaj, James L. Sugarman, Adam M. Behrens, Lester C. Chong, Sezin Yigit, Samantha E. Roman, Richard E. Goodman, and Philip E. Johnson
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biology ,business.industry ,fungi ,Fibroin ,Food technology ,biology.organism_classification ,medicine.disease ,Food safety ,Shelf life ,Food waste ,SILK ,Bombyx mori ,Food allergy ,medicine ,Food science ,business - Abstract
Recent studies have demonstrated silk fibroin’s ability to extend the shelf life of foods by mitigating the hallmarks of spoilage, namely oxidation and dehydration. Due to the potential for this protein to become more widespread, its safety was evaluated comprehensively. First, a bacterial reverse mutation test (Ames test) was conducted in five bacterial strains. Second, an in vivo erythrocyte test was conducted with Sprague Dawley rats at doses up to 1,000mg/kg-bw/day. Third, a range-finder study was conducted with Sprague Dawley rats at the highest consumption amount given solubility and oral gavage volume constrains (500mg/kg-bw/day). Fourth, a 28-day study in Sprague Dawley rats was conducted at the 500mg/kg-bw/day amount. Fifth, an in vitro pepsin digestion assay was performed to assess the potential for protein allergenicity. Sixth, allergenic potential was further assessed using liquid chromatography-mass spectroscopy for detection of allergenic insect proteins. Seventh, the protein sequences were subjected to bioinformatic analyses. Together, these studies raise no mutagenic, carcinogenic, toxicological, or allergenic concerns with the oral consumption of silk fibroin.
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- 2020
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34. Purification of soybean cupins and comparison of IgE binding with peanut allergens in a population of allergic subjects
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Ghada A. El-Sherbeny, Yehia A. Osman, Justin T. Marsh, El Sayed F. El-Halawany, Samah Ramadan, Philip E. Johnson, Richard E. Goodman, Joseph L. Baumert, and Fulei Luan
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Arachis ,Population ,Cross Reactions ,Toxicology ,Ige binding ,03 medical and health sciences ,0404 agricultural biotechnology ,Tandem Mass Spectrometry ,Lc ms ms ,Humans ,Peanut Hypersensitivity ,Amino Acid Sequence ,education ,030304 developmental biology ,0303 health sciences ,education.field_of_study ,Chemistry ,Immunogenicity ,Seed Storage Proteins ,food and beverages ,Globulins ,04 agricultural and veterinary sciences ,General Medicine ,Antigens, Plant ,Immunoglobulin E ,11s globulin ,040401 food science ,Biochemistry ,Vicilin ,Soybean Proteins ,2s albumin ,Soybeans ,Food Science ,Chromatography, Liquid ,Protein Binding - Abstract
Identification, purification and characterization of allergens is crucial to the understanding of IgE-mediated disease. Immunologic and structural studies with purified allergens is essential for understanding relative immunogenicity and cross-reactivity. In this work, the complex soybean 7S vicilins (Gly m 5) with three subunits and 11S legumins (Gly m 6) with five subunits were purified and characterized along with purified peanut allergens (Ara h 1, 2, 3, and 6) by label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS). Individual subjects plasma IgE binding was tested from subjects allergic to soybeans and or peanuts by immunoblotting, ImmunoCAP™ and ISAC™ ImmunoCAP chip, comparing these soybean proteins with those of purified peanut allergens; vicilin (Ara h 1), 2S albumin (Ara h 2 and Ara h 6) and 11S globulin (Ara h 3). Results show differences between methods and subjects demonstrating the complexity of finding answers to questions of cross-reactivity.
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- 2020
35. The Allergen: Sources, Extracts, and Molecules for Diagnosis of Allergic Disease
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Richard E. Goodman, Jay E. Slater, and Martin D. Chapman
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Dander ,Immunoglobulin E ,medicine.disease_cause ,03 medical and health sciences ,0302 clinical medicine ,Allergen ,otorhinolaryngologic diseases ,medicine ,Immunology and Allergy ,Potency ,Animals ,Humans ,030212 general & internal medicine ,Skin Tests ,biology ,medicine.diagnostic_test ,business.industry ,Plant Extracts ,Radioallergosorbent test ,Allergens ,Molecular diagnostics ,respiratory tract diseases ,030228 respiratory system ,Immunology ,biology.protein ,Pollen ,Allergists ,Protein nitrogen unit ,business - Abstract
Allergenic source materials include pollen, molds, animal dander, and insects; food allergens from nuts, grains, and animals; venoms; and salivary proteins from insects and ticks. Clinical diagnostic tests have used heterogeneous extracts from allergen source materials for skin prick tests (SPTs). In vitro laboratory methods using immunoassays or microarrays can detect serum IgE directed against allergenic proteins where clinical testing may not be suitable. Clinicians rely primarily on licensed commercial extracts of allergens for SPTs. Manufacturers and regulatory agencies have standardized selected extracts for identity, composition, and potency. Allergen sources contain multiple proteins. The IgE antibody responses to these proteins vary between allergic subjects as does the quantity of specific IgE. Component-resolved molecular diagnostics can be used to improve the specificity of allergy testing and resolve clinical cross-reactivities that may affect treatment outcomes. This clinical commentary will review methods for the production, evaluation, and standardization of allergen extracts from the perspective of diagnostic testing that may be useful for allergists in practice.
- Published
- 2020
36. Computational modeling and functional characterization of a GgChi: A class III chitinase from corms of Gladiolus grandiflorus
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Zahid Ali, Kausar Hussain Shah, Binish Khaliq, Ashiq Hussain, Aisha Munawar, Uzma Ishaq, Ahmed Akrem, Qamar Saeed, Friedrich Buck, Mirza Ahsen Baig, Maria Rafiq, Muhammad Umair Sial, Seema Mahmood, and Richard E. Goodman
- Subjects
0301 basic medicine ,Models, Molecular ,Insecticides ,Spectrometry, Mass, Electrospray Ionization ,Antifungal Agents ,Endochitinase activity ,Population ,Microbial Sensitivity Tests ,Iridaceae ,Hemiptera ,03 medical and health sciences ,Rice weevil ,Fusarium oxysporum ,TIM barrel ,Medicine ,Animals ,Homology modeling ,Amino Acid Sequence ,education ,Databases, Protein ,Enzyme Assays ,Plant Proteins ,education.field_of_study ,lcsh:R5-920 ,030102 biochemistry & molecular biology ,biology ,Bacteria ,business.industry ,Sitophilus ,Chitinases ,Fungi ,General Medicine ,biology.organism_classification ,Anti-Bacterial Agents ,030104 developmental biology ,Biochemistry ,Structural Homology, Protein ,Chitinase ,biology.protein ,business ,lcsh:Medicine (General) - Abstract
The present study describes the predicted model and functional characterization of an endochitinase (30 kDa) from corms of Gladiolus grandiflorus. ESI-QTOF-MS generated peptide showed 96% sequence homology with family 18, Class III acidic endochitinase of Gladiolus gandavensis. Purified G. grandiflorus chitinase (GgChi) hydrolyzed 4-methylumbelliferyl β-d-N,N′,N′′-triacetylchitotriose substrate showing specific endochitinase activity. Since no structural details of GgChi were available in the Protein Data Bank (PDB), a homology model was predicted using the coordinate information of Crocus vernus chitinase (PDB ID: 3SIM). Ramachandran plot indicated 84.5% in most favored region, 14.8% in additional and 0.6% in generously allowed region while no residue in disallowed region. The predicted structure indicated a highly conserved (β/α)8 (TIM barrel) structure similar to the family 18, class III chitinases. The GgChi also showed sequence and structural homologies with other active chitinases. The GgChi (50 μg/disc) showed no antibacterial activity, but did provide mild growth inhibition of phytopathogenic fungus Fusarium oxysporum at a concentration of 500 μg/well Similarly, insect toxicity bioassays of GgChi (50 μg) against nymphs of Bemisia tabaci showed 14% reduction in adult emergence and 14% increase in mortality rate in comparison to control values. The GgChi (1.5 mg) protein showed significant reduction in a population of flour beetle (Tribolium castaneum) after 35 days, but lower reactivity against rice weevil (Sitophilus oryzae). The results of this study provide detai.led insight on functional characterization of a family 18 class III acidic plant endochitinase. Keywords: Gladiolus grandiflorus, Endochitinase, TIM barrel, Antibacterial, Antifungal
- Published
- 2018
37. Pharmacological bypass of NAD + salvage pathway protects neurons from chemotherapy-induced degeneration
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Richard H. Goodman, Charles Brenner, Mark S. Schmidt, Xiaolu A. Cambronne, Hui Wen Liu, Michael S. Cohen, Chadwick B. Smith, and Marie E. Migaud
- Subjects
0301 basic medicine ,chemistry.chemical_classification ,Multidisciplinary ,Nicotinamide phosphoribosyltransferase ,Nicotinamide adenine dinucleotide ,Neuroprotection ,Cell biology ,03 medical and health sciences ,chemistry.chemical_compound ,030104 developmental biology ,Enzyme ,Nicotinic agonist ,medicine.anatomical_structure ,chemistry ,Dorsal root ganglion ,medicine ,NAD+ kinase ,Nicotinamide mononucleotide - Abstract
Axon degeneration, a hallmark of chemotherapy-induced peripheral neuropathy (CIPN), is thought to be caused by a loss of the essential metabolite nicotinamide adenine dinucleotide (NAD+) via the prodegenerative protein SARM1. Some studies challenge this notion, however, and suggest that an aberrant increase in a direct precursor of NAD+, nicotinamide mononucleotide (NMN), rather than loss of NAD+, is responsible. In support of this idea, blocking NMN accumulation in neurons by expressing a bacterial NMN deamidase protected axons from degeneration. We hypothesized that protection could similarly be achieved by reducing NMN production pharmacologically. To achieve this, we took advantage of an alternative pathway for NAD+ generation that goes through the intermediate nicotinic acid mononucleotide (NAMN), rather than NMN. We discovered that nicotinic acid riboside (NAR), a precursor of NAMN, administered in combination with FK866, an inhibitor of the enzyme nicotinamide phosphoribosyltransferase that produces NMN, protected dorsal root ganglion (DRG) axons against vincristine-induced degeneration as well as NMN deamidase. Introducing a different bacterial enzyme that converts NAMN to NMN reversed this protection. Collectively, our data indicate that maintaining NAD+ is not sufficient to protect DRG neurons from vincristine-induced axon degeneration, and elevating NMN, by itself, is not sufficient to cause degeneration. Nonetheless, the combination of FK866 and NAR, which bypasses NMN formation, may provide a therapeutic strategy for neuroprotection.
- Published
- 2018
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38. Physician Training in Cancer Prevention and Control: A Population Health Imperative
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Richard A Goodman and Miranda A Moore
- Subjects
medicine.medical_specialty ,Epidemiology ,Control (management) ,Adult population ,Population health ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,Neoplasms ,medicine ,Humans ,Health Workforce ,030212 general & internal medicine ,Mortality ,Preventive healthcare ,Oncologists ,Cancer prevention ,Population Health ,business.industry ,Public Health, Environmental and Occupational Health ,Cancer ,medicine.disease ,United States ,030220 oncology & carcinogenesis ,Family medicine ,Education, Medical, Continuing ,New entrants ,Morbidity ,business ,Delivery of Health Care - Abstract
Cancer is the second leading cause of morbidity and mortality in the U.S. Although reducing the number of new cancer cases is a national health goal, the continuing growth of the older adult population ensures that the burden of cancer will increase. Despite documentation of the shortage of oncologists to meet the growing need, relatively limited attention has been focused on increasing the physician workforce trained in the prevention and control of cancer. The existing physician workforce with such specialized training in cancer prevention and control is small, aging, increasing at a low rate, and likely to decrease because of an imbalance between retiring physicians and new entrants. This commentary addresses the imperative for increasing the number of physicians trained in preventive medicine with a specialization in cancer prevention and control by first providing a brief overview of U.S. cancer morbidity and mortality, then describing the status of, and trends in, physician training in cancer prevention and control, and concluding by suggesting opportunities for bolstering physician training in cancer prevention and control.
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- 2018
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39. Cockroach allergens: Coping with challenging complexity
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Robert G. Hamilton, Jörg Kleine-Tebbe, and Richard E. Goodman
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Allergen immunotherapy ,Coping (psychology) ,Cockroach ,biology ,Plant Extracts ,business.industry ,Immunology ,Cockroaches ,Blattellidae ,respiratory system ,Allergens ,Immunoglobulin E ,biology.organism_classification ,Article ,respiratory tract diseases ,Cockroach allergy ,immune system diseases ,biology.animal ,Adaptation, Psychological ,Animals ,Immunology and Allergy ,Medicine ,business - Abstract
BACKGROUND: Cockroach allergens are an important cause of IgE-mediated sensitization in inner-city asthmatics. However, cockroach extracts used for diagnosis and immunotherapy are not standardized. OBJECTIVE: To determine the allergen content of non-standardized German cockroach extracts and the levels of sensitization to an expanded set of cockroach allergens as determinants of in vitro extract potency for IgE reactivity. METHODS: Twelve German cockroach extracts were compared for allergen content and for potency of IgE reactivity. Bla g 1, Bla g 2 and Bla g 5 were measured by immunoassays. IgE antibody levels to eight purified recombinant allergens from groups 1, 2, 4, 5, 6, 7, 9 and 11 were measured by ImmunoCAP. IgE antibody binding inhibition assays were performed to assess extract in vitro potencies (IC30) relative to an arbitrarily selected reference extract in five cockroach allergic subjects. RESULTS: Allergen levels were highly variable. Three new major allergens (groups 6, 9 and 11), were identified among highly cockroach-sensitized subjects (CAP-class ≥ 3). Sensitization profiles were unique per subject, without immunodominant allergens. The sum of IgE to eight allergen components showed a good correlation with cockroach-specific IgE (r = 0.88; p < 0.001). In vitro potencies varied among different extracts per subject, and among subjects for each extract. CONCLUSIONS: The in vitro potency of German cockroach extracts for IgE reactivity depends on allergen content and allergen-specific IgE titers of the cockroach-allergic subject. These factors are relevant for selection of potent extracts to be used for immunotherapy and for the design and interpretation of data from immunotherapy trials.
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- 2019
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40. Food and Feed Safety of Genetically Engineered Food Crops
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Bryan Delaney, Richard E. Goodman, and Gregory S. Ladics
- Subjects
Crops, Agricultural ,0301 basic medicine ,Food Safety ,food.ingredient ,Animal feed ,Food, Genetically Modified ,Genetically modified crops ,Biology ,Genes, Plant ,Toxicology ,Crop ,03 medical and health sciences ,0404 agricultural biotechnology ,food ,Transgenes ,Sugar ,Canola ,business.industry ,Genetically engineered ,fungi ,food and beverages ,04 agricultural and veterinary sciences ,Food safety ,Animal Feed ,040401 food science ,Biotechnology ,030104 developmental biology ,Mutagenesis ,Hazard analysis and critical control points ,Genetic Engineering ,business ,Hazard Analysis and Critical Control Points - Abstract
The first genetically engineered (GE) food crop (tomato) was introduced in 1995, followed by the successful development and commercial release of maize, soybeans, cotton, canola, potatoes, papaya, alfalfa, squash, and sugar beets with specific new genetic traits. Even though the safety of every new GE crop has been evaluated by various regulatory authorities throughout the world prior to its commercial release, the ongoing public debate about the safety of food and feed derived from GE plants has not abated. Such debates often overshadow an important fact that all crops used as human food or animal feed include varieties that have been developed through conventional breeding and selection over hundreds or thousands of years, or through intentional but random mutagenesis. Developing food crops through such breeding practices result in large-scale genomic changes in the resulting crops, and these genomic changes do not undergo molecular characterization. In contrast, new GE crops are developed using well-characterized DNA fragments and the resulting crops are tested and evaluated with much greater scrutiny. This document reviews the safety data and information of GE crops and foods obtained from them.
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- 2017
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41. miR-132/212 Modulates Seasonal Adaptation and Dendritic Morphology of the Central Circadian Clock
- Author
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Pascale Bouchard-Cannon, Daniel Figeys, Sara Hegazi, Peng Zhang, Arthur H. Cheng, Christopher Lowden, Lucia Mendoza-Viveros, Valérie Simonneaux, Cheng-Kang Chiang, Béatrice Bothorel, Stephen T. Magill, Jonathan L.K. Ong, Matthew G. Michniewicz, Richard H. Goodman, Melissa M. Holmes, Michael Fana, Hai-Ying M. Cheng, Institut des Neurosciences Cellulaires et Intégratives (INCI), Université Louis Pasteur - Strasbourg I-Centre National de la Recherche Scientifique (CNRS), Équipe 'Rythme, vie et mort de la rétine', Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Ottawa Institute of Systems Biology, University of Ottawa [Ottawa] (uOttawa), University of Toronto at Mississauga, University of Toronto, University of Ottawa [Ottawa], Oregon Health and Science University [Portland] (OHSU), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), and R01 MH103361
- Subjects
0301 basic medicine ,Male ,Dendritic spine ,Time Factors ,Light ,Proteome ,Methyl-CpG-Binding Protein 2 ,[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology ,[SDV]Life Sciences [q-bio] ,Circadian clock ,Dendritic morphology ,miR-132 ,0302 clinical medicine ,lcsh:QH301-705.5 ,ComputingMilieux_MISCELLANEOUS ,Regulation of gene expression ,Mice, Knockout ,Neurons ,Behavior, Animal ,microRNA ,Suprachiasmatic nucleus ,TOR Serine-Threonine Kinases ,Adaptation, Physiological ,Cell biology ,miR-132/212 ,Female ,Seasons ,hormones, hormone substitutes, and hormone antagonists ,Signal Transduction ,medicine.medical_specialty ,endocrine system ,Dendritic Spines ,Photoperiod ,Biology ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,Internal medicine ,Circadian Clocks ,medicine ,Animals ,Circadian rhythms ,Circadian rhythm ,Brain-derived neurotrophic factor ,Mesocricetus ,Brain-Derived Neurotrophic Factor ,Seasonal timekeeping ,Dendrites ,Mice, Inbred C57BL ,MicroRNAs ,030104 developmental biology ,Endocrinology ,Light effects on circadian rhythm ,Gene Expression Regulation ,nervous system ,lcsh:Biology (General) ,sense organs ,030217 neurology & neurosurgery ,Gene Deletion - Abstract
Summary: The central circadian pacemaker, the suprachiasmatic nucleus (SCN), encodes day length information by mechanisms that are not well understood. Here, we report that genetic ablation of miR-132/212 alters entrainment to different day lengths and non-24 hr day-night cycles, as well as photoperiodic regulation of Period2 expression in the SCN. SCN neurons from miR-132/212-deficient mice have significantly reduced dendritic spine density, along with altered methyl CpG-binding protein (MeCP2) rhythms. In Syrian hamsters, a model seasonal rodent, day length regulates spine density on SCN neurons in a melatonin-independent manner, as well as expression of miR-132, miR-212, and their direct target, MeCP2. Genetic disruption of Mecp2 fully restores the level of dendritic spines of miR-132/212-deficient SCN neurons. Our results reveal that, by regulating the dendritic structure of SCN neurons through a MeCP2-dependent mechanism, miR-132/212 affects the capacity of the SCN to encode seasonal time. : Seasonal adaptation is believed to require plasticity in the SCN, although the mechanisms are unclear. Mendoza-Viveros et al. report that miR-132/212 modulates dendritic protrusion density and photoperiodic adaptation in mice and hamsters, by regulating the expression of MeCP2, and downstream BDNF and mTOR signaling. Keywords: circadian rhythms, seasonal timekeeping, suprachiasmatic nucleus, microRNA, miR-132/212, entrainment, MeCP2, dendritic morphology, structural plasticity, spinogenesis
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- 2017
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42. Keeping Allergen Names Clear and Defined
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Sanny K. Chan, Anna Pomés, Christiane Hilger, Janet M. Davies, Geoffrey Mueller, Annette Kuehn, Andreas L. Lopata, Gabriele Gadermaier, Marianne van Hage, Monika Raulf, and Richard E. Goodman
- Subjects
0301 basic medicine ,lcsh:Immunologic diseases. Allergy ,Mini Review ,Immunology ,diagnostic ,Computational biology ,Biology ,medicine.disease_cause ,Ige binding ,World health ,WHO/IUIS ,03 medical and health sciences ,taxonomy ,0302 clinical medicine ,Allergen ,Terminology as Topic ,medicine ,Animals ,Humans ,Immunology and Allergy ,Nomenclature ,food ,allergen nomenclature ,Allergens ,dermal ,030104 developmental biology ,airway ,Occupational allergens ,Allergists ,lcsh:RC581-607 ,030215 immunology - Abstract
The World Health Organization/International Union of Immunological Societies (WHO/IUIS) Allergen Nomenclature Sub-Committee was established in 1986 by leading allergists to standardize names given to proteins that cause IgE-mediated reactions in humans. The Sub-Committee's objective is to assign unique names to allergens based on a critical analysis of confidentially submitted biochemical and clinical data from researchers, often prior to publication to preserve consistency. The Sub-Committee maintains and revises the database as the understanding of allergens evolves. This report summarizes recent developments that led to updates in classification of cockroach group 1 and 5 allergens to animal as well as environmental and occupational allergens. Interestingly, routes, doses, and frequency of exposure often affects allergenicity as does the biochemical properties of the proteins and similarity to self and other proteins. Information required by the Sub-Committee now is more extensive than previously as technology has improved. Identification of new allergens requires identification of the amino acid sequence and physical characteristics of the protein as well as demonstration of IgE binding from subjects verified by described clinical histories, proof of the presence of the protein in relevant exposure substances, and demonstration of biological activity (skin prick tests, activation of basophils, or mast cells). Names are assigned based on taxonomy with the abbreviation of genus and species and assignment of a number, which reflects the priority of discovery, but more often now, the relationships with homologous proteins in related species.
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- 2019
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43. Life in Data Sets: Locating and Accessing Data on the Health of Americans Across the Life Span
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Samuel F. Posner, Richard A Goodman, Jaron Hoani King, and Mary Ann Kirkconnell Hall
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Government ,030505 public health ,Data collection ,Computer science ,Health Policy ,Data Collection ,Longevity ,Public Health, Environmental and Occupational Health ,Context (language use) ,Data science ,Discoverability ,Field (computer science) ,United States ,Article ,Metadata repository ,Metadata ,03 medical and health sciences ,Open data ,0302 clinical medicine ,Humans ,030212 general & internal medicine ,0305 other medical science - Abstract
Context The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. Program or policy We sought to identify and consolidate a practical and annotated listing of those data sets. Implementation and/or dissemination Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. Evaluation We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. Discussion The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.
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- 2019
44. Author response: Exercise-induced enhancement of synaptic function triggered by the inverse BAR protein, Mtss1L
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Christina Chatzi, Richard H. Goodman, Wiiliam D Hendricks, Yang Chen, Yingyu Zhang, Gary L. Westbrook, and Eric Schnell
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Physics ,Synaptic function ,Bar (music) ,Biophysics ,Inverse - Published
- 2019
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45. Cancer Risk Among Older Adults: Time for Cancer Prevention to Go Silver
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Dawn M. Holman, Mary C. White, Richard A Goodman, and Lisa C. Richardson
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Gerontology ,medicine.medical_specialty ,Cancer prevention ,Population level ,business.industry ,Cancer ,General Medicine ,medicine.disease ,Article ,Causes of cancer ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Community health ,Medicine ,030212 general & internal medicine ,Cancer development ,Geriatrics and Gerontology ,Cancer risk ,business ,Preventive healthcare - Abstract
Over two-thirds of all new cancers are diagnosed among adults aged ≥60 years. As the number of adults living to older ages continues to increase, so too will the number of new cancer cases. Can we do more as a society to reduce cancer risk and preserve health as adults enter their 60s, 70s, and beyond? Cancer development is a multi-step process involving a combination of factors. Each cancer risk factor represents a component of cancer causation, and opportunities to prevent cancer may exist at any time up to the final component, even years after the first. The characteristics of the community in which one lives often shape cancer risk-related behaviors and exposures over time, making communities an ideal setting for efforts to reduce cancer risk at a population level. A comprehensive approach to cancer prevention at older ages would lower exposures to known causes of cancer, promote healthy social and physical environments, expand the appropriate use of clinical preventive services, and engage older adults in these efforts. The collection of articles in this supplement provide innovative insights for exciting new directions in research and practice to expand cancer prevention efforts for older adults. This brief commentary sets the stage for the papers that follow.
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- 2019
46. Exercise-induced enhancement of synaptic function triggered by the inverse BAR protein, Mtss1L
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Christina Chatzi, William D. Hendricks, Gary L. Westbrook, Richard H. Goodman, Eric Schnell, Yingyu Zhang, and Yang Chen
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0301 basic medicine ,Dendritic spine ,Mouse ,QH301-705.5 ,Postsynaptic Current ,Science ,Action Potentials ,Hippocampal formation ,Hippocampus ,General Biochemistry, Genetics and Molecular Biology ,I-BAR ,Mice ,03 medical and health sciences ,0302 clinical medicine ,In vivo ,Physical Conditioning, Animal ,Animals ,Biology (General) ,synaptic function ,Enhancer ,Microdissection ,030304 developmental biology ,Neurons ,0303 health sciences ,Gene knockdown ,Neuronal Plasticity ,General Immunology and Microbiology ,exercise ,Base Sequence ,Effector ,Chemistry ,General Neuroscience ,Gene Expression Profiling ,Microfilament Proteins ,Membrane Proteins ,General Medicine ,Cell biology ,030104 developmental biology ,Excitatory postsynaptic potential ,Medicine ,Neuroscience ,030217 neurology & neurosurgery ,Research Article - Abstract
Exercise is a potent enhancer of learning and memory, yet we know little of the underlying mechanisms that likely include alterations in synaptic efficacy in the hippocampus. To address this issue, we exposed mice to a single episode of voluntary exercise, and permanently marked mature hippocampal dentate granule cells that were specifically activated during exercise using conditional Fos-TRAP mice. Only a few dentate granule cells were active at baseline, but two hours of voluntary exercise markedly increased the number of activated neurons. Activated neurons (Fos-TRAPed) showed an input-selective increase in dendritic spines and excitatory postsynaptic currents at 3 days post-exercise, indicative of exercise-induced structural plasticity. Laser-capture microdissection and RNASeq of activated neurons revealed that the most highly induced transcript was Mtss1L, a little-studied gene in the adult brain. Overexpression of Mtss1L in neurons increased spine density, leading us to hypothesize that its I-BAR domain initiated membrane curvature and dendritic spine formation. shRNA-mediated Mtss1L knockdown in vivo prevented the exercise-induced increases in spines and excitatory postsynaptic currents. Our results link short-term effects of exercise to activity-dependent expression of Mtss1L, which we propose as a novel effector of activity-dependent rearrangement of synapses.One Sentence SummarySingle episodes of voluntary exercise induced a functional increase in hippocampal synapses mediated by activity-dependent expression of the BAR protein Mtss1L, acting as a novel early effector of synapse formation.
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- 2019
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47. Letter to the Editor
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Richard A, Goodman and Lisa A, Miller
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Health Policy ,Public Health, Environmental and Occupational Health - Published
- 2021
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48. The CDC Field Epidemiology Manual
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Sonja A. Rasmussen, Richard A. Goodman, Sonja A. Rasmussen, and Richard A. Goodman
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- Epidemiology, Epidemics, Epidemiologic Methods
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A NEW AND ESSENTIAL RESOURCE FOR THE PRACTICE OF EPIDEMIOLOGY AND PUBLIC HEALTH The CDC Field Epidemiology Manual is a definitive guide to investigating acute public health events on the ground and in real time. Assembled and written by experts from the Centers for Disease Control and Prevention as well as other leading public health agencies, it offers current and field-tested guidance for every stage of an outbreak investigation -- from identification to intervention and other core considerations along the way. Modeled after Michael Gregg's seminal book Field Epidemiology, this CDC manual ushers investigators through the core elements of field work, including many of the challenges inherent to outbreaks: working with multiple state and federal agencies or multinational organizations; legal considerations; and effective utilization of an incident-management approach. Additional coverage includes: · Updated guidance for new tools in field investigations, including the latest technologies for data collection and incorporating data from geographic information systems (GIS) · Tips for investigations in unique settings, including healthcare and community-congregate sites · Advice for responding to different types of outbreaks, including acute enteric disease; suspected biologic or toxic agents; and outbreaks of violence, suicide, and other forms of injury For the ever-changing public health landscape, The CDC Field Epidemiology Manual offers a new, authoritative resource for effective outbreak response to acute and emerging threats. ••• Oxford University Press will donate a portion of the proceeds from this book to the CDC Foundation, an independent nonprofit and the sole entity created by Congress to mobilize philanthropic and private-sector resources to support the Centers for Disease Control and Prevention's critical health protection work. To learn more about the CDC Foundation, visit www.cdcfoundation.org.
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- 2019
49. Prevalence of dementia subtypes in United States Medicare fee‐for‐service beneficiaries, 2011–2013
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Richard A Goodman, Shari M. Ling, Samuel F. Posner, Kimberly A. Lochner, Madhav Thambisetty, and Thomas S. Wingo
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Adult ,Male ,Gerontology ,medicine.medical_specialty ,Epidemiology ,Population ,Medicare ,Article ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Age Distribution ,0302 clinical medicine ,Developmental Neuroscience ,Prevalence ,medicine ,Humans ,Dementia ,030212 general & internal medicine ,Fee-for-service ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,Lewy body ,business.industry ,Health Policy ,Not Otherwise Specified ,Fee-for-Service Plans ,Retrospective cohort study ,medicine.disease ,United States ,Psychiatry and Mental health ,Family medicine ,Female ,Neurology (clinical) ,Geriatrics and Gerontology ,business ,Medicaid ,030217 neurology & neurosurgery - Abstract
Introduction Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population. Methods We analyzed Centers for Medicare & Medicaid administrative enrollment and claims data for 100% of Medicare fee-for-service beneficiaries enrolled during 2011–2013 and age ≥68 years as of December 31, 2013 (n = 21.6 million). Results Over 3.1 million (14.4%) beneficiaries had a claim for a service and/or treatment for any dementia subtype. Dementia not otherwise specified was the most common diagnosis (present in 92.9%). The most common subtype was Alzheimer's (43.5%), followed by vascular (14.5%), Lewy body (5.4%), frontotemporal (1.0%), and alcohol induced (0.7%). The prevalence of other types of diagnosed dementia was 0.2%. Discussion This study is the first to document concurrent prevalence of primary dementia subtypes among this US population. The findings can assist in prioritizing dementia research, clinical services, and caregiving resources.
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- 2016
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50. An Official American Thoracic Society Workshop Report. A Framework for Addressing Multimorbidity in Clinical Practice Guidelines for Pulmonary Disease, Critical Illness, and Sleep Disorders
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Kevin C, Wilson, Michael K, Gould, Jerry A, Krishnan, Cynthia M, Boyd, Jan L, Brozek, Colin R, Cooke, Ivor S, Douglas, Richard A, Goodman, Min J, Joo, Suzanne, Lareau, Richard A, Mularski, Minal R, Patel, Richard M, Rosenfeld, Hasan, Shanawani, Christopher, Slatore, Marianna, Sockrider, Beth, Sufian, Carey C, Thomson, and Renda Soylemez, Wiener
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Lung Diseases ,Sleep Wake Disorders ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Critical Illness ,media_common.quotation_subject ,Resistance (psychoanalysis) ,Comorbidity ,Disease ,Article ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,medicine ,Humans ,Multimorbidity ,Quality (business) ,030212 general & internal medicine ,Disease management (health) ,Societies, Medical ,media_common ,Evidence-Based Medicine ,business.industry ,Disease Management ,Evidence-based medicine ,medicine.disease ,United States ,Clinical Practice ,030228 respiratory system ,Family medicine ,Practice Guidelines as Topic ,business - Abstract
Coexistence of multiple chronic conditions (i.e., multimorbidity) is the most common chronic health problem in adults. However, clinical practice guidelines have primarily focused on patients with a single disease, resulting in uncertainty about the care of patients with multimorbidity. The American Thoracic Society convened a workshop with the goal of establishing a strategy to address multimorbidity within clinical practice guidelines. In this Workshop Report, we describe a framework that addresses multimorbidity in each of the key steps of guideline development: topic selection, panel composition, identifying clinical questions, searching for and synthesizing evidence, rating the quality of that evidence, summarizing benefits and harms, formulating recommendations, and rating the strength of the recommendations. For the consideration of multimorbidity in guidelines to be successful and sustainable, the process must be both feasible and pragmatic. It is likely that this will be achieved best by the step-wise addition and refinement of the various components of the framework.
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- 2016
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