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Opioid Overdose Deaths And Potentially Inappropriate Opioid Prescribing Practices (Pip): A Spatial Epidemiological Study, Thomas J. Stopka, Harsha Amaravadi, Anna R. Kaplan, Rachel Hoh, Dana Bernson, Kenneth K.H. Chui, Thomas Land, Alexander Y. Walley, Marc R. LaRochelle, Adam J. Rose 2019 Tufts University

Opioid Overdose Deaths And Potentially Inappropriate Opioid Prescribing Practices (Pip): A Spatial Epidemiological Study, Thomas J. Stopka, Harsha Amaravadi, Anna R. Kaplan, Rachel Hoh, Dana Bernson, Kenneth K.H. Chui, Thomas Land, Alexander Y. Walley, Marc R. Larochelle, Adam J. Rose

Open Access Articles

INTRODUCTION: Opioid overdose deaths quintupled in Massachusetts between 2000 and 2016. Potentially inappropriate opioid prescribing practices (PIP) are associated with increases in overdoses. The purpose of this study was to conduct spatial epidemiological analyses of novel comprehensively linked data to identify overdose and PIP hotspots.

METHODS: Sixteen administrative datasets, including prescription monitoring, medical claims, vital statistics, and medical examiner data, covering >98% of Massachusetts residents between 2011-2015, were linked in 2017 to better investigate the opioid epidemic. PIP was defined by six measures: > /=100 morphine milligram equivalents (MMEs), co-prescription of benzodiazepines and opioids, cash purchases of opioid prescriptions, opioid prescriptions ...


Knee Range Of Motion: Reliability And Agreement Of 3 Measurement Methods, Paul G. Peters, Michael A. Herbenick, Philip A. Anloague, Ronald J. Markert, L. Joseph Rubino 2019 Wright State University - Main Campus

Knee Range Of Motion: Reliability And Agreement Of 3 Measurement Methods, Paul G. Peters, Michael A. Herbenick, Philip A. Anloague, Ronald J. Markert, L. Joseph Rubino

Ronald Markert

We conducted a study to compare 3 methods of measuring knee range of motion: visual estimation by physicians, hand goniometry by physical therapists, and radiographic goniometry. We hypothesized that reliability would be high within and across all techniques. We found intrarater and interrater reliability to be satisfactory for visual estimation, hand goniometry, and radiographic goniometry. Interrater reliability across methods did not agree satisfactorily. Between-methods differences in estimating knee range of motion may result from variations in technique among physicians and physical therapists.


Durability Of Symptomatic Responses Obtained With Adjunctive Vagus Nerve Stimulation In Treatment-Resistant Depression, Arun Kumar, Mark T. Bunker, Scott T. Aaronson, Charles R. Conway, Anthony J. Rothschild, Giacomo Mordenti, Augustus J. Rush 2019 LivaNova USA PLC

Durability Of Symptomatic Responses Obtained With Adjunctive Vagus Nerve Stimulation In Treatment-Resistant Depression, Arun Kumar, Mark T. Bunker, Scott T. Aaronson, Charles R. Conway, Anthony J. Rothschild, Giacomo Mordenti, Augustus J. Rush

Anthony J. Rothschild

Objective: To compare the durations of response achieved with adjunctive vagus nerve stimulation (VNS + TAU) vs treatment as usual (TAU) alone in treatment-resistant depression (TRD) over a 5-year period in the TRD registry.

Materials and methods: Data from 271 participants on TAU and 328 participants on VNS + TAU were analyzed. Response was defined as > /=50% decrease in baseline Montgomery-Asberg Depression Rating Scale (MADRS) score at postbaseline visit and was considered retained until the decrease was < 40%. MADRS was obtained quarterly in year 1 and biannually thereafter. Time-to-events were estimated using Kaplan-Meier method and compared using log-rank test. HR was estimated using Cox proportion hazard model.

Results: In the VNS + TAU arm, 62.5% (205/328) of participants had a first response over 5 years compared with 39.9% (108/271 ...


Bridging From Intramuscular To Limb Perfusion Delivery Of Raav: Optimization In A Non-Human Primate Study, Alisha Gruntman, Gwladys Gernoux, Qiushi Tang, Guo-Jie Ye, Dave R. Knop, Gensheng Wang, Janet Benson, Kristen E. Coleman, Allison M. Keeler, Christian Mueller, Louis G. Chicoine, Jeffrey D. Chulay, Terence R. Flotte 2019 University of Massachusetts Medical School

Bridging From Intramuscular To Limb Perfusion Delivery Of Raav: Optimization In A Non-Human Primate Study, Alisha Gruntman, Gwladys Gernoux, Qiushi Tang, Guo-Jie Ye, Dave R. Knop, Gensheng Wang, Janet Benson, Kristen E. Coleman, Allison M. Keeler, Christian Mueller, Louis G. Chicoine, Jeffrey D. Chulay, Terence R. Flotte

Christian Mueller

Phase 1 and phase 2 gene therapy trials using intramuscular (IM) administration of a recombinant adeno-associated virus serotype 1 (rAAV1) for replacement of serum alpha-1 antitrypsin (AAT) deficiency have shown long-term (5-year) stable transgene expression at approximately 2% to 3% of therapeutic levels, arguing for the long-term viability of this approach to gene replacement of secreted serum protein deficiencies. However, achieving these levels required 100 IM injections to deliver 135 mL of vector, and further dose escalation is limited by the scalability of direct IM injection. To further advance the dose escalation, we sought to bridge the rAAV-AAT clinical development ...


The Healthcare Systems Research Network (Hcsrn) As An Environment For Dissemination And Implementation Research: A Case Study Of Developing A Multi-Site Research Study In Precision Medicine, Alanna Kulchak Rahm, Ilene Ladd, Andrea N. Burnett-Hartman, Mara M. Epstein, Jan T. Lowery, Christine Y. Lu, Pamala A. Pawloski, Ravi N. Sharaf, Su-Ying Liang, Jessica Ezzell. Hunter 2019 Geisinger

The Healthcare Systems Research Network (Hcsrn) As An Environment For Dissemination And Implementation Research: A Case Study Of Developing A Multi-Site Research Study In Precision Medicine, Alanna Kulchak Rahm, Ilene Ladd, Andrea N. Burnett-Hartman, Mara M. Epstein, Jan T. Lowery, Christine Y. Lu, Pamala A. Pawloski, Ravi N. Sharaf, Su-Ying Liang, Jessica Ezzell. Hunter

Open Access Articles

Context: In existence for nearly 25 years, the Healthcare Systems Research Network (HCSRN) is an established and sustainable network of health care systems that serves as a "real world" laboratory to enable the integration of research findings into practice. The objective of this paper is to demonstrate how the HCSRN serves as an ideal environment for studying dissemination and implementation of evidence-based practices into health care systems through the example of developing a multi-site study on the implementation of evidence-based precision medicine practices.

Case description: The "Implementing Universal Lynch Syndrome Screening (IMPULSS)" study (NIH R01CA211723) involves seven HCSRN health care ...


Therapeutic Peptide Sequences And Gatekeepers Loaded With Mesoporous Silica Nanoparticles, Dursitu Hassen 2019 Kansas State university

Therapeutic Peptide Sequences And Gatekeepers Loaded With Mesoporous Silica Nanoparticles, Dursitu Hassen

Kansas State University Undergraduate Research Conference

The research community is developing and looking into new ways of effectively delivering anti-cancer treatment. According to National Cancer Institute over 1.5 million new cases of cancer are predicted in the United States, just alone in 2018. The major hurdles that have been identified by scientists are finding mechanisms that assist in decreasing the side effects of cancer treatment and to increase the effectiveness of the drug. In our lab, a highly toxic peptide sequence, SA-K6L9-AS is encapsulated in MSNs (mesoporous silica nanoparticles) and capped with a gatekeeper. The function of a gatekeeper is preventing ...


Comparing The Effects Of Tissue Flossing And Instrument Assisted Soft Tissue Mobilization On Ankle Dorsiflexion, Sean Carlson, Garrett Rife, Zachary Williams 2019 Cedarville University

Comparing The Effects Of Tissue Flossing And Instrument Assisted Soft Tissue Mobilization On Ankle Dorsiflexion, Sean Carlson, Garrett Rife, Zachary Williams

The Research and Scholarship Symposium

Purpose: The purpose of this study is to evaluate the claimed effects of a new technique called Tissue Flossing and compare those effects with Instrument Assisted Soft Tissue Mobilization, or IASTM. Background: Tissue flossing is a relatively new technique that utilizes a large rubber band that is wrapped around the involved joint. Once applied, range of motion exercises are completed, and the band is removed. The goal is to increase joint range of motion. IASTM involves using a specialized tool to scrape an effected muscle or tendon of the body. The goal is to reduce any adhesions or scar tissue ...


The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace LeBlanc, Brenda Valenti, Lawrence D. Garber 2019 University of Massachusetts Medical School

The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace Leblanc, Brenda Valenti, Lawrence D. Garber

Lawrence D. Garber

The All of Us Research Program (AoURP), funded by the National Institutes of Health, is an ambitious ten-year effort to enroll over one million participants across the country. The AoURP is a key part of the Precision Medicine Initiative and seeks to build a national cohort collecting self-reported health data, medical record data, biospecimen samples and physical measurements to accelerate precision medicine. Precision Medicine is an emerging approach for healthcare treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Researchers at the Meyers Primary Care Institute and the University of Massachusetts Medical ...


The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace LeBlanc, Brenda Valenti, Lawrence D. Garber 2019 University of Massachusetts Medical School

The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace Leblanc, Brenda Valenti, Lawrence D. Garber

Kathleen M. Mazor

The All of Us Research Program (AoURP), funded by the National Institutes of Health, is an ambitious ten-year effort to enroll over one million participants across the country. The AoURP is a key part of the Precision Medicine Initiative and seeks to build a national cohort collecting self-reported health data, medical record data, biospecimen samples and physical measurements to accelerate precision medicine. Precision Medicine is an emerging approach for healthcare treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Researchers at the Meyers Primary Care Institute and the University of Massachusetts Medical ...


A Smart Bandage Equipped With Miniaturized Needle Arrays And Wirelessly-Controlled Drug Delivery System For The Treatment Of Chronic Wounds, Hossein Derakhshandeh 2019 University of Nebraska-Lincoln

A Smart Bandage Equipped With Miniaturized Needle Arrays And Wirelessly-Controlled Drug Delivery System For The Treatment Of Chronic Wounds, Hossein Derakhshandeh

Mechanical (and Materials) Engineering -- Dissertations, Theses, and Student Research

Chronic wounds are one of the most challenging complications of diabetes and are the leading cause of non-traumatic limb amputation. Despite the progress in identifying factors and promising in vitro results for the treatment of chronic wounds, their clinical translation has been limited. Given the range of disruptive processes necessary for wound healing, different pharmacological agents are needed at different stages of tissue regeneration. This requires the capability of wearable devices to deliver agents to critical layers of the epidermis with minimum invasiveness. Here, for the first time, I have engineered a programmable platform which is capable of actively delivering ...


Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye 2019 Harvard Medical School

Low Back Pain, A Comprehensive Review: Pathophysiology, Diagnosis, And Treatment (Poster), Ivan Urits, Aaron Burshtein, Medha Sharma, Lauren Testa, Peter A. Gold, Vwaire Orhurhu, Omar Viswanath, Mark R. Jones, Moises A. Sidransky, Alan D. Kaye

Senior Scholars Program

Purpose of Review: Low back pain encompasses three distinct sources: axial lumbosacral, radicular, and referred pain. Annually, the prevalence of low back pain in the general U.S. adult population is 10-30%, and the lifetime prevalence of U.S. adults is as high as 65-80%.

Recent Findings: Patient history, physical exam, and diagnostic testing are important components to accurate diagnosis and identification of patient pathophysiology. Etiologies of low back pain include myofascial pain, facet joint pain, sacroiliac joint pain, discogenic pain, and spinal stenosis, and failed back surgery. In chronic back pain patients, a multidisciplinary, logical approach to treatment is ...


The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace LeBlanc, Brenda Valenti, Lawrence D. Garber 2019 University of Massachusetts Medical School

The All Of Us Research Program: Engaging The Community For The Future Of Health, Mara M. Epstein, Kathleen M. Mazor, Joann L. Wagner, Peggy Preusse, Candace Leblanc, Brenda Valenti, Lawrence D. Garber

Community Engagement and Research Symposia

The All of Us Research Program (AoURP), funded by the National Institutes of Health, is an ambitious ten-year effort to enroll over one million participants across the country. The AoURP is a key part of the Precision Medicine Initiative and seeks to build a national cohort collecting self-reported health data, medical record data, biospecimen samples and physical measurements to accelerate precision medicine. Precision Medicine is an emerging approach for healthcare treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person. Researchers at the Meyers Primary Care Institute and the University of Massachusetts Medical ...


Women-Reported Barriers And Facilitators Of Adherence To Medications For Opioid Use Disorder, Alice Fiddian-Green, Aline C. Gubrium, Calla Harrington, Elizabeth Evans 2019 University of Massachusetts Amherst

Women-Reported Barriers And Facilitators Of Adherence To Medications For Opioid Use Disorder, Alice Fiddian-Green, Aline C. Gubrium, Calla Harrington, Elizabeth Evans

Community Engagement and Research Symposia

AIM: A poorly understood challenge is why many women with opioid use disorder do not remain engaged with medications for opioid use disorder (MOUD; e.g., methadone, buprenorphine, naltrexone) long enough to achieve sustained benefits. We aimed to identify barriers and facilitators that impact women's MOUD adherence.

METHODS: We conducted in-person interviews and focus groups with 20 women who had received MOUD for at least 90 days in Springfield and Holyoke, Massachusetts in 2018. Using grounded theory, we inductively identified major themes and selected illustrative quotations.

FINDINGS: Gender-specific barriers to treatment are shaped by MOUD-related stigma stemming from multiple ...


Effect Of Exercise Position On Percent Changes In Serratus Anterior Muscle Thickness, Joseph M. Day 2019 University of Dayton

Effect Of Exercise Position On Percent Changes In Serratus Anterior Muscle Thickness, Joseph M. Day

Joseph M. "Matt" Day

Objective: A reliable method for measuring SA thickness with ultrasound imaging has been reported, yet the ability to detect differences in levels of contractility has yet to be established. The purpose of this study was to determine if there are differences in the percent change in thickness of the SA during four different exercise positions performed by healthy individuals.

Design: Observational study

Setting: Laboratory

Participants: Twenty-eight healthy participants, mean age 26 (SD 4, 57% female, 100% right handed)

Methods: Volunteers were positioned in a standardized sitting posture and anatomical landmarks were marked for ultrasound probe positioning. Two resting and two ...


Immunosuppressive Treatment And The Risk Of Diabetes In Rheumatoid Arthritis, Siri Lillegraven, Jeffrey D. Greenberg, George W. Reed, Katherine Saunders, Jeffrey R. Curtis, Leslie R. Harrold, Marc C. Hochberg, Dimitrios A. Pappas, Joel M. Kremer, Daniel H. Solomon 2019 Diakonhjemmet Hospital

Immunosuppressive Treatment And The Risk Of Diabetes In Rheumatoid Arthritis, Siri Lillegraven, Jeffrey D. Greenberg, George W. Reed, Katherine Saunders, Jeffrey R. Curtis, Leslie R. Harrold, Marc C. Hochberg, Dimitrios A. Pappas, Joel M. Kremer, Daniel H. Solomon

Leslie R. Harrold

OBJECTIVE: Inflammation and anti-inflammatory treatments might influence the risk of diabetes. The objective of this study was to assess factors associated with incident diabetes in rheumatoid arthritis (RA).

METHODS: The study population consisted of RA patients from a multi-center cohort study, Corrona. To assess risk associated with disease modifying antirheumatic drug (DMARD) exposure, we assessed five mutually exclusive DMARD groups. Additionally, we assessed the risk associated with body mass index (BMI, < 25, 25-30, > 30 kg/m2) and glucocorticoid usage. Incident cases of diabetes were confirmed through adjudication, and Cox regression models were fit to estimate the risk of incident diabetes.

RESULTS: We ...


Successful Extracorporeal Membrane Oxygenation In The Management Of Acute Respiratory Distress Syndrome And Cardiopulmonary Collapse Secondary To Amniotic Fluid Embolism, Sumon Roy, Nishit A. Biniwale, Venkata S. Pendela, Patricia Oates, Katrina Wojciechowski, Scott C. Feitell 2019 Rochester General Hospital

Successful Extracorporeal Membrane Oxygenation In The Management Of Acute Respiratory Distress Syndrome And Cardiopulmonary Collapse Secondary To Amniotic Fluid Embolism, Sumon Roy, Nishit A. Biniwale, Venkata S. Pendela, Patricia Oates, Katrina Wojciechowski, Scott C. Feitell

The VAD Journal

Amniotic fluid embolism (AFE) is one of the most devastating complications of pregnancy that typically manifests as acute cardiopulmonary collapse during delivery or in the postpartum period. The potential role of extracorporeal membrane oxygenation (ECMO) as a management technique in severe cases of AFE remains largely unknown given the limited literature available. In this report, we present the first case, to our knowledge, of successful implementation of ECMO as a life-saving measure in a case of hemorrhagic shock due to postpartum bleeding complicated by severe AFE leading to acute respiratory distress syndrome (ARDS) ultimately requiring tracheostomy. Hemodynamic decompensation is often ...


Genome-Wide Prediction Of Synthetic Rescue Mediators Of Resistance To Targeted And Immunotherapy, Avinash Das Sahu, Olga Ponomarova, Eytan Ruppin 2019 Harvard Medical School

Genome-Wide Prediction Of Synthetic Rescue Mediators Of Resistance To Targeted And Immunotherapy, Avinash Das Sahu, Olga Ponomarova, Eytan Ruppin

Open Access Articles

Most patients with advanced cancer eventually acquire resistance to targeted therapies, spurring extensive efforts to identify molecular events mediating therapy resistance. Many of these events involve synthetic rescue (SR) interactions, where the reduction in cancer cell viability caused by targeted gene inactivation is rescued by an adaptive alteration of another gene (the rescuer). Here, we perform a genome-wide in silico prediction of SR rescuer genes by analyzing tumor transcriptomics and survival data of 10,000 TCGA cancer patients. Predicted SR interactions are validated in new experimental screens. We show that SR interactions can successfully predict cancer patients' response and emerging ...


Anti-Drug Antibody Responses Impair Prophylaxis Mediated By Aav-Delivered Hiv-1 Broadly Neutralizing Antibodies, Matthew R. Gardner, Ina Fetzer, Lisa M. Kattenhorn, Meredith E. Davis-Gardner, Amber S. Zhou, Barnett Alfant, Jesse A. Weber, Hema R. Kondur, Jose M. Martinez-Navio, Sebastian P. Fuchs, Ronald C. Desrosiers, Guangping Gao, Jeffrey D. Lifson, Michael Farzan 2019 The Scripps Research Institute

Anti-Drug Antibody Responses Impair Prophylaxis Mediated By Aav-Delivered Hiv-1 Broadly Neutralizing Antibodies, Matthew R. Gardner, Ina Fetzer, Lisa M. Kattenhorn, Meredith E. Davis-Gardner, Amber S. Zhou, Barnett Alfant, Jesse A. Weber, Hema R. Kondur, Jose M. Martinez-Navio, Sebastian P. Fuchs, Ronald C. Desrosiers, Guangping Gao, Jeffrey D. Lifson, Michael Farzan

Open Access Articles

Adeno-associated virus (AAV) delivery of potent and broadly neutralizing antibodies (bNAbs is a promising approach for the prevention of HIV-1 infection. The immunoglobulin G (IgG)1 subtype is usually selected for this application, because it efficiently mediates antibody effector functions and has a somewhat longer half-life. However, the use of IgG1-Fc has been associated with the generation of anti-drug antibodies (ADAs) that correlate with loss of antibody expression. In contrast, we have shown that expression of the antibody-like molecule eCD4-Ig bearing a rhesus IgG2-Fc domain showed reduced immunogenicity and completely protected rhesus macaques from simian-HIV (SHIV)-AD8 challenges. To directly ...


Management Of Microscopic Colitis: Challenges And Solutions, Julia Shor, Gustavo Churrango, Nooshin Hosseini, Christopher Marshall 2019 University of Massachusetts Medical School

Management Of Microscopic Colitis: Challenges And Solutions, Julia Shor, Gustavo Churrango, Nooshin Hosseini, Christopher Marshall

Open Access Articles

Microscopic colitis (MC) is a chronic inflammatory bowel disease characterized by nonbloody diarrhea in the setting of normal appearing colonic mucosa. MC has two main subtypes based on histopathologic features, collagenous colitis and lymphocytic colitis. Management of both subtypes is the same, with treatment goal of reducing the number of bowel movements and improving consistency. First-line treatment involves counseling the patient about decreasing their risk factors, like discontinuing smoking and avoiding medications with suspected association such as NSAIDs, proton pump inhibitor, ranitidine, and sertraline. Starting loperamide for immediate symptomatic relief is used as an adjunct to therapy with glucocorticoids. Budesonide ...


Targeting Lipooligosaccharide (Los) For A Gonococcal Vaccine, Sunita Gulati, Jutamas Shaughnessy, Sanjay Ram, Peter A. Rice 2019 University of Massachusetts Medical School

Targeting Lipooligosaccharide (Los) For A Gonococcal Vaccine, Sunita Gulati, Jutamas Shaughnessy, Sanjay Ram, Peter A. Rice

Open Access Articles

The increasing incidence of gonorrhea worldwide and the global spread of multidrug-resistant strains of Neisseria gonorrhoeae, constitute a public health emergency. With dwindling antibiotic treatment options, there is an urgent need to develop safe and effective vaccines. Gonococcal lipooligosaccharides (LOSs) are potential vaccine candidates because they are densely represented on the bacterial surface and are readily accessible as targets of adaptive immunity. Less well-understood is whether LOSs evoke protective immune responses. Although gonococcal LOS-derived oligosaccharides (OSs) are major immune targets, often they undergo phase variation, a feature that seemingly makes LOS less desirable as a vaccine candidate. However, the identification ...


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