Publications by authors named "Cynthia Davis"

39 Publications

Textile Based Sensing Blanket for ECG Monitoring in the Intensive Care Unit.

Annu Int Conf IEEE Eng Med Biol Soc 2020 07;2020:4551-4554

Multiple designs of textile-based sensors were developed and integrated into blankets for the measurement of Electrocardiogram (ECG) signals. Once the patient makes direct skin contact with the electrodes, the ECG signals are acquired and transmitted wirelessly by a wireless data acquisition unit to an associated computer for analysis, assessment and storage. A variety of designs and manufacturing methods were tested. An adult human subjects' study was conducted to test the feasibility of these measurements as well as to test the different design types and manufacturing methods. The heart rate and Signal to Noise ratio (SNR) are comparable to the gold standard adhesive lead measurements.
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http://dx.doi.org/10.1109/EMBC44109.2020.9176071DOI Listing
July 2020

Low Cost, High Performance, 16-Channel Microwave Measurement System for Tomographic Applications.

Sensors (Basel) 2020 09 22;20(18). Epub 2020 Sep 22.

Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA.

We have developed a multichannel software defined radio-based transceiver measurement system for use in general microwave tomographic applications. The unit is compact enough to fit conveniently underneath the current illumination tank of the Dartmouth microwave breast imaging system. The system includes 16 channels that can both transmit and receive and it operates from 500 MHz to 2.5 GHz while measuring signals down to -140 dBm. As is the case with multichannel systems, cross-channel leakage is an important specification and must be lower than the noise floors for each receiver. This design exploits the isolation inherent when the individual receivers for each channel are physically separate; however, these challenging specifications require more involved signal isolation techniques at both the system design level and the individual, shielded component level. We describe the isolation design techniques for the critical system elements and demonstrate specification compliance at both the component and system level.
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http://dx.doi.org/10.3390/s20185436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570920PMC
September 2020

REST: Break through to resilience.

Nursing 2020 Aug;50(8):53-56

Santhiny Rajamohan is an associate professor of nursing at the Roberts Wesleyan College School of Nursing in Rochester, N.Y. Also at Roberts Wesleyan College, Cynthia R. Davis is a biological and chemical sciences professor of biology, and Meredith Ader is Golisano Library access services librarian.

Strong evidence suggests that resilience is crucial to improving quality of care and supporting nurses in reducing burnout. This article discusses how nurses and students can use the REST mnemonic described here as a tool for building the resilience they will need to meet challenges throughout their nursing careers.
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http://dx.doi.org/10.1097/01.NURSE.0000684196.97792.03DOI Listing
August 2020

The Paradigm Shift-The Impact of HIV/AIDS on Black Women and Families: Speaking Truth to Power.

Ethn Dis 2020 23;30(2):241-246. Epub 2020 Apr 23.

College of Medicine & College of Science and Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA.

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http://dx.doi.org/10.18865/ed.30.2.241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186049PMC
April 2020

Deformable Mapping Method to Relate Lesions in Dedicated Breast CT Images to Those in Automated Breast Ultrasound and Digital Breast Tomosynthesis Images.

Ultrasound Med Biol 2020 Mar 2;46(3):750-765. Epub 2019 Dec 2.

Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.

This work demonstrates the potential for using a deformable mapping method to register lesions between dedicated breast computed tomography (bCT) and both automated breast ultrasound (ABUS) and digital breast tomosynthesis (DBT) images (craniocaudal [CC] and mediolateral oblique [MLO] views). Two multi-modality breast phantoms with external fiducial markers attached were imaged by the three modalities. The DBT MLO view was excluded for the second phantom. The automated deformable mapping algorithm uses biomechanical modeling to determine corresponding lesions based on distances between their centers of mass (d) in the deformed bCT model and the reference model (DBT or ABUS). For bCT to ABUS, the mean d was 5.2 ± 2.6 mm. For bCT to DBT (CC), the mean d was 5.1 ± 2.4 mm. For bCT to DBT (MLO), the mean d was 4.7 ± 2.5 mm. This application could help improve a radiologist's efficiency and accuracy in breast lesion characterization, using multiple imaging modalities.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2019.10.016DOI Listing
March 2020

Deformable mapping using biomechanical models to relate corresponding lesions in digital breast tomosynthesis and automated breast ultrasound images.

Med Image Anal 2020 02 7;60:101599. Epub 2019 Nov 7.

Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr. Ann Arbor, MI 48109, USA.

This work investigates the application of a deformable localization/mapping method to register lesions between the digital breast tomosynthesis (DBT) craniocaudal (CC) and mediolateral oblique (MLO) views and automated breast ultrasound (ABUS) images. This method was initially validated using compressible breast phantoms. This methodology was applied to 7 patient data sets containing 9 lesions. The automated deformable mapping algorithm uses finite element modeling and analysis to determine corresponding lesions based on the distance between their centers of mass (d) in the deformed DBT model and the reference ABUS model. This technique shows that location information based on external fiducial markers is helpful in the improvement of registration results. However, use of external markers are not required for deformable registration results described by this methodology. For DBT (CC view) mapped to ABUS, the mean d was 14.9 ± 6.8 mm based on 9 lesions using 6 markers in deformable analysis. For DBT (MLO view) mapped to ABUS, the mean d was 13.7 ± 6.8 mm based on 8 lesions using 6 markers in analysis. Both DBT views registered to ABUS lesions showed statistically significant improvements (p ≤ 0.05) in registration using the deformable technique in comparison to a rigid registration. Application of this methodology could help improve a radiologist's characterization and accuracy in relating corresponding lesions between DBT and ABUS image datasets, especially for cases of high breast densities and multiple masses.
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http://dx.doi.org/10.1016/j.media.2019.101599DOI Listing
February 2020

A 4-channel, vector network analyzer microwave imaging prototype based on software defined radio technology.

Rev Sci Instrum 2019 Apr;90(4):044708

Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755, USA.

We have implemented a prototype 4-channel transmission-based, microwave measurement system built on innovative software defined radio (SDR) technology. The system utilizes the B210 USRP SDR developed by Ettus Research that operates over a 70 MHz-6 GHz bandwidth. While B210 units are capable of being synchronized with each other via coherent reference signals, they are somewhat unreliable in this configuration and the manufacturer recommends using N200 or N210 models instead. For our system, N-series SDRs were less suitable because they are not amenable to RF shielding required for the cross-channel isolation necessary for an integrated microwave imaging system. Consequently, we have configured an external reference that overcame these limitations in a compact and robust package. Our design exploits the rapidly evolving technology being developed for the telecommunications environment for test and measurement tasks with the higher performance specifications required in medical microwave imaging applications. In a larger channel configuration, the approach is expected to provide performance comparable to commercial vector network analyzers at a fraction of the cost and in a more compact footprint.
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http://dx.doi.org/10.1063/1.5083842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483785PMC
April 2019

Image Registration for Microwave Tomography of the Breast Using Priors From Nonsimultaneous Previous Magnetic Resonance Images.

IEEE J Electromagn RF Microw Med Biol 2018 Mar 27;2(1):2-9. Epub 2017 Dec 27.

Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH 03755 USA.

Microwave imaging is a low-cost imaging method that has shown promise for breast imaging and, in particular, neoadjuvant chemotherapy monitoring. The early studies of microwave imaging in the therapy monitoring setting are encouraging. For the neoadjuvant therapy application, it would be desirable to achieve the most accurate possible characterization of the tissue properties. One method to achieve increased resolution and specificity in microwave imaging reconstruction is the use of a soft prior regularization. The objective of this study is to develop a method to use magnetic resonance (MR) images, taken in a different imaging configuration, as this soft prior. To enable the use of the MR images as a soft prior, it is necessary to register the MR images to the microwave imaging space. Registration fiducials were placed around the breast that are visible in both the MRI and with an optical scanner integrated into the microwave system. Utilizing these common registration locations, numerical algorithms have been developed to warp the original breast MR images into a geometry closely resembling that in which the breast is pendant in the microwave system.
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http://dx.doi.org/10.1109/JERM.2017.2786025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132061PMC
March 2018

Deformable mapping technique to correlate lesions in digital breast tomosynthesis and automated breast ultrasound images.

Med Phys 2018 Oct 31;45(10):4402-4417. Epub 2018 Aug 31.

Department of Radiology, University of Michigan Health System, Ann Arbor, MI, 48109, USA.

Purpose: To develop a deformable mapping technique to match corresponding lesions between digital breast tomosynthesis (DBT) and automated breast ultrasound (ABUS) images.

Methods: External fiducial markers were attached to the surface of two CIRS multi-modality compressible breast phantoms (A and B) containing multiple simulated lesions. Both phantoms were imaged with DBT (upright positioning with cranial-caudal compression) and ABUS (supine positioning with anterior-to-chest wall compression). The lesions and markers were manually segmented by three different readers. Reader segmentation similarity and reader reproducibility were assessed using Dice similarity coefficients (DSC) and distances between centers of mass (d ). For deformable mapping between the modalities each reader's segmented dataset was processed with an automated deformable mapping algorithm as follows: First, Morfeus, a finite element (FE) based multi-organ deformable image registration platform, converted segmentations into triangular surface meshes. Second, Altair HyperMesh, a FE pre-processor, created base FE models for the ABUS and DBT data sets. All deformation is performed on the DBT image data; the ABUS image sets remain fixed throughout the process. Deformation was performed on the external skin contour (DBT image set) to match the external skin contour on the ABUS set, and the locations of the external markers were used to morph the skin contours to be within a user-defined distance. Third, the base DBT-FE model was deformed with the FE analysis solver, Optistruct. Deformed DBT lesions were correlated with matching lesions in the base ABUS FE model. Performance (lesion correlation) was assessed with d for all corresponding lesions and lesion overlap. Analysis was performed to determine the minimum number of external fiducial markers needed to create the desired correlation and the improvement of correlation with the use of external markers.

Results: Average DSC for reader similarity ranged from 0.88 to 0.91 (ABUS) and 0.57 to 0.83 (DBT). Corresponding d ranged from 0.20 to 0.36 mm (ABUS) and 0.11 to 1.16 mm (DBT). Lesion correlation is maximized when all corresponding markers are within a maximum distance of 5 mm. For deformable mapping of phantom A, without the use of external markers, only two of six correlated lesions showed overlap with an average lesion d of 6.8 ± 2.8 mm. With use of three external fiducial markers, five of six lesions overlapped and average d improved to 4.9 ± 2.4 mm. For deformable mapping of Phantom B without external markers analysis, four lesions were correlated of seven with overlap between only one of seven lesions, and an average lesion d of 9.7 ± 3.5 mm. With three external markers, all seven possible lesions were correlated with overlap between four of seven lesions. The average d was 8.5 ± 4.0 mm.

Conclusion: This work demonstrates the potential for a deformable mapping technique to relate corresponding lesions in DBT and ABUS images by showing improved lesion correspondence and reduced lesion registration errors with the use of external fiducial markers. The technique should improve radiologists' characterization of breast lesions which can reduce patient callbacks, misdiagnoses and unnecessary biopsies.
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http://dx.doi.org/10.1002/mp.13113DOI Listing
October 2018

Preliminary Clinical Experience with a Combined Automated Breast Ultrasound and Digital Breast Tomosynthesis System.

Ultrasound Med Biol 2018 03 5;44(3):734-742. Epub 2018 Jan 5.

Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.

We analyzed the performance of a mammographically configured, automated breast ultrasound (McABUS) scanner combined with a digital breast tomosynthesis (DBT) system. The GE Invenia ultrasound system was modified for integration with GE DBT systems. Ultrasound and DBT imaging were performed in the same mammographic compression. Our small preliminary study included 13 cases, six of whom had contained invasive cancers. From analysis of these cases, current limitations and corresponding potential improvements of the system were determined. A registration analysis was performed to compare the ease of McABUS to DBT registration for this system with that of two systems designed previously. It was observed that in comparison to data from an earlier study, the McABUS-to-DBT registration alignment errors for both this system and a previously built combined system were smaller than those for a previously built standalone McABUS system.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2017.12.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5801205PMC
March 2018

Clinical characteristics and prognostic factors in multiple myeloma patients with light chain deposition disease.

Am J Hematol 2017 Aug 1;92(8):739-745. Epub 2017 Jun 1.

Myeloma Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Light chain deposition disease (LCDD) is characterized by monotypic immunoglobulin depositions which will eventually lead to loss of organ function if left untreated. While the kidney is almost always affected, the presence and degree of LCDD in other organs vary. Ten to thirty percent of LCDD patients have underlying Multiple Myeloma (MM), yet outcome and prognostic markers in this particular patient group are still lacking. Here, we analyzed 69 patients with MM and biopsy proven LCDD and report on renal and extra-renal involvement and its impact on prognosis as well as renal response depending on hematologic response. Coexisting light chain diseases such as AL amyloid and cast nephropathy were found in 30% of patients; those with LCDD and concurrent amyloid tended to have shorter survival. Cardiac involvement by LCDD was seen in one-third of our patients and was associated with shorter overall survival; such patients also had a significantly higher risk of treatment-related mortality (TRM) after stem cell transplant (SCT) compared to LCDD patients without cardiac involvement. This study highlights that MM patients with LCDD present with different clinical features compared to previously reported LCDD cohorts. Rapid initiation of treatment is necessary to prevent progressive renal disease and worse outcome. Coexisting light chain diseases and cardiac involvement are more common than previously reported and confer worse clinical outcome, emphasizing the need for careful patient careful patient evaluation and treatment selection.
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http://dx.doi.org/10.1002/ajh.24756DOI Listing
August 2017

Metabolic pathways link childhood adversity to elevated blood pressure in midlife adults.

Obes Res Clin Pract 2016 Sep - Oct;10(5):580-588. Epub 2015 Dec 1.

Boston VA Healthcare System, Boston, MA, United States; Division of Endocrinology, Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.

Childhood adversity is a risk factor for adult health outcomes, including obesity and hypertension. This study examines whether childhood adversity predicted mean arterial pressure through mechanisms of central obesity and leptin, adiponectin, and/or insulin resistance, and including dietary quality. 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Path analyses were used to specify a chain of predictive variables in which childhood adversity predicted waist-hip ratio and dietary quality, circulating levels of hormones, and in turn, mean arterial pressure, adjusting for race, gender, and antihypertensive medications. Direct paths were found between childhood adversity, waist-hip ratio, and leptin levels and between leptin and dietary quality to mean arterial pressure. Systolic and diastolic blood pressures were similarly predicted. Early adversity appears to developmentally overload and dysregulate endocrine systems through increased risk for obesity, and through a direct impact on leptin that in turn, impacts blood pressure.
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http://dx.doi.org/10.1016/j.orcp.2015.10.009DOI Listing
October 2017

Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study.

Metabolism 2015 Nov 26;64(11):1597-610. Epub 2015 Sep 26.

Section of Endocrinology, Boston VA Healthcare System/Harvard Medical School, 150 S. Huntington Avenue, Jamaica Plain, MA 02130, USA; Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.

Background: Early life adversity (ELA) and post-traumatic stress disorder (PTSD) are associated with poorer psychological and physical health. Potential underlying mechanisms and mediators remain to be elucidated, and the lifestyle habits and characteristics of individuals with ELA and/or PTSD have not been fully explored. We investigated whether the presence of ELA and/or PTSD are associated with nutrition, physical activity, resting and sleeping and smoking.

Methods: A cross-sectional sample of 151 males and females (age: 45.6±3.5 years, BMI: 30.0±7.1 kg/m(2)) underwent anthropometric measurements, as well as detailed questionnaires for dietary assessment, physical activity, resting and sleeping, smoking habits and psychosocial assessments. A prospective follow-up visit of 49 individuals was performed 2.5 years later and the same outcomes were assessed. ELA and PTSD were evaluated as predictors, in addition to a variable assessing the combined presence/severity of ELA-PTSD. Data were analyzed using analysis of covariance after adjusting for several socioeconomic, psychosocial and anthropometric characteristics.

Results: Individuals with higher ELA or PTSD severity were found to have a poorer diet quality (DASH score: p=0.006 and p=0.003, respectively; aHEI-2010 score: ELA p=0.009), including further consumption of trans fatty acids (ELA p=0.003); the differences were significantly attenuated null after adjusting mainly for education or income and/or race. Further, individuals with higher ELA severity reported less hours of resting and sleeping (p=0.043) compared to those with zero/lower ELA severity, and the difference remained significant in the fully adjusted model indicating independence from potential confounders. When ELA and PTSD were combined, an additive effect was observed on resting and sleeping (p=0.001); results remained significant in the fully adjusted model. They also consumed more energy from trans fatty acids (p=0.017) tended to smoke more (p=0.008), and have less physical activity (PTSD p=0.024) compared to those with no or lower ELA and PTSD severity. Adjustments for sociodemographic factors and/or BMI rendered results of the above lifestyle parameters non-significant. The analysis of the prospective data showed similar trends to the cross-sectional analysis, further supporting the conclusions, although statistical significance of results was lower due to the lower number of participants.

Conclusion: Fewer hours of resting and sleeping and poorer diet quality are linked to ELA and/or PTSD, indicating that these pathways might underlie the development of several metabolic abnormalities in individuals with ELA and/or PTSD. Differences in terms of diet quality are significantly attenuated by race and/or education and/or income, whereas differences in other lifestyle habits of individuals with and without ELA and/or PTSD, such as physical activity, are mostly explained by confounding sociodemographic variables and/or body mass index.
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http://dx.doi.org/10.1016/j.metabol.2015.08.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609606PMC
November 2015

Therapeutic ultrasound: Increased HDL-Cholesterol following infusions of acoustic microspheres and apolipoprotein A-I plasmids.

Atherosclerosis 2015 Jul 5;241(1):92-9. Epub 2015 May 5.

Sulpizio Cardiovascular Center, University of California, San Diego, CA, USA.

Background: Low levels of HDL-C are an independent cardiovascular risk factor associated with increased premature cardiovascular death. However, HDL-C therapies historically have been limited by issues relating to immunogenicity, hepatotoxicity and scalability, and have been ineffective in clinical trials.

Objective: We examined the feasibility of using injectable acoustic microspheres to locally deliver human ApoA-I DNA plasmids in a pre-clinical model and quantify increased production of HDL-C in vivo.

Methods: Our novel site-specific gene delivery system was examined in naïve rat model and comprised the following steps: (1) intravenous co-administration of a solution containing acoustically active microspheres (Optison™, GE Healthcare, Princeton, New Jersey) and human ApoA-I plasmids; (2) ultrasound verification of the presence of the microspheres within the liver vasculature; (3) External application of locally-directed acoustic energy, (4) induction of microsphere disruption and in situ sonoporation; (4) ApoA-I plasmid hepatic uptake; (5) transcription and expression of human ApoA-I protein; and (6) elevation of serum HDL-C.

Results: Co-administration of ApoA-I plasmids and acoustic microspheres, activated by external ultrasound energy, resulted in transcription and production of human ApoA-I protein and elevated serum HDL-C in rats (up to 61%; p-value < 0.05).

Conclusions: HDL-C was increased in rats following ultrasound directed delivery of human ApoA-I plasmids by microsphere sonoporation. The present method provides a novel approach to promote ApoA-I synthesis and nascent HDL-C elevation, potentially permitting the use of a minimally-invasive ultrasound-based, gene delivery system for treating individuals with low HDL-C.
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http://dx.doi.org/10.1016/j.atherosclerosis.2015.04.817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466163PMC
July 2015

Diet quality and diet patterns in relation to circulating cardiometabolic biomarkers.

Clin Nutr 2016 Apr 7;35(2):484-490. Epub 2015 Apr 7.

Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA. Electronic address:

Background & Aims: We examined the effects of diet quality and dietary patterns in relation to biomarkers of risk including leptin, soluble intracellular adhesion molecule 1 (sICAM-1), C-reactive protein (CRP), and irisin.

Methods: We analyzed data from 196 adults cross-sectionally. Dietary patterns were identified by factor analysis and diet quality scores were generated using a validated food-frequency questionnaire.

Results: Both the alternate healthy eating index-2010 (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) scores were negatively related to CRP, even after controlling for body mass index and total energy intake. Similarly, the prudent diet pattern was negatively related to leptin, sICAM-1, and CRP, whereas the Western diet pattern showed positive associations with these markers; however, after adjusting for all confounders, the associations only remained significant for leptin and sICAM-1. Irisin was positively associated with DASH and the prudent diet after controlling for all confounders (standardized β = 0.23, P = 0.030; standardized β = 0.25, P = 0.021, respectively). Irisin showed positive associations with increasing fruit consumption, whereas the levels of irisin decreased as meat consumption increased.

Conclusions: Irisin was directly associated with healthy diet types and patterns. Further studies regarding these mechanisms are warranted. This trial is registered at http://www.clinicaltrials.gov. Identifier: NCT01853332.
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http://dx.doi.org/10.1016/j.clnu.2015.03.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596724PMC
April 2016

Attachment and the metabolic syndrome in midlife: the role of interview-based discourse patterns.

Psychosom Med 2014 Oct;76(8):611-21

From Judge Baker Children's Center (C.R.D., N.U., C.C-D., J.A.C.), Boston, Massachusetts; Boston College (E.D.), Boston, Massachusetts; Department of Psychiatry, Cambridge Health Alliance (A.R.B.), Cambridge, Massachusetts; Department of Psychology (S.D.N.), North Carolina State University, Raleigh, North Carolina; Division of Endocrinology (C.S.M.), Diabetes & Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, Massachusetts (C.S.M.); Department of Psychiatry (J.A.C.), Stony Brook University School of Medicine, Stony Brook, New York.

Objective: Adult attachment discourse patterns and current family relationship quality were examined as correlates of health behaviors and number of metabolic syndrome (MetS) criteria met, and as mediators of the link between childhood adversity and these health outcomes.

Methods: A sample of 215 white/European American and black/African American adults aged 35 to 55 years were examined using a cross-sectional study design. Discourse was assessed with the Adult Attachment Interview, using coherence (a marker of attachment security), unresolved trauma/loss (a marker of disorganized cognitions related to trauma or loss), and idealization (minimizing stressful experiences and their impact) scores. Relationship quality, adverse childhood experiences, and current depressive symptoms were assessed, as were health behaviors of diet, exercise, and smoking. MetS includes obesity, elevated blood pressure, elevated fasting glucose, high triglycerides, and low high-density lipoprotein cholesterol.

Results: Using path analysis and including childhood adversity severity and depressive symptoms in the model, both Adult Attachment Interview coherence and unresolved trauma/loss were directly linked to the number of MetS criteria (r = 0.186 and r = 0.170, respectively). Idealization was indirectly linked to MetS through poor diet (r = 0.183). The final model explained 21% of the variance in scores for the number of MetS criteria met.

Conclusions: Insecure adult attachment is associated with increased risk of MetS.
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http://dx.doi.org/10.1097/PSY.0000000000000107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483991PMC
October 2014

Early life adversity is associated with elevated levels of circulating leptin, irisin, and decreased levels of adiponectin in midlife adults.

J Clin Endocrinol Metab 2014 Jun 20;99(6):E1055-60. Epub 2014 Mar 20.

Division of Newborn Medicine (K.E.J.), Boston Children's Hospital, Boston, Division of Endocrinology and Metabolism (K.E.J., K.-H.P., L.Z., A.S.-E., B.T., M.B., C.S.M.), Beth Israel Deaconess Medical Center, and Harvard Medical School (K.E.J., C.S.M.), Boston, Massachusetts 02215; Department of Family Medicine (K.-H.P.), Hallym University Sacred Heart Hospital, Hallym University, Gyeonggi-do 431-070, Korea; Section of Endocrinology (L.Z., A.S.-E., B.T., M.B., C.S.M.), Division of Endocrinology, Boston Veterans Affairs Healthcare System, Jamaica Plain, Massachusetts 02130; Section of Endocrinology, Diabetes, and Nutrition (A.S.-E., B.T., C.S.M.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118; Judge Baker Children's Center (N.U., D.W., C.R.D., J.A.C.), Boston, Massachusetts 02120; and Department of Psychiatry and Behavioral Sciences (J.A.C.), Stony Brook University School of Medicine, Stony Brook, New York 11794.

Context: Early-life adversity, defined as physical, emotional, or sexual abuse and neglect before 18 years of age, is associated with metabolic syndrome, obesity, and type 2 diabetes mellitus in adult life. However, the underlying mechanism is not fully understood, and whether adipomyokines are associated with early-life adversity independent of other factors such as body mass index, psychosocial risks, and health behaviors is not known.

Objectives: The objective of the study was to evaluate the association between early-life adversity and circulating the levels of the adipomyokines such as leptin, adiponectin, and irisin and the inflammatory marker, C-reactive protein (CRP). DESIGN/SUBJECTS/SETTING: This study was a cross-sectional study of 95 adults at a university-based research center. We collected venous blood from participants and analyzed serum for leptin, adiponectin, irisin, and CRP.

Results: Circulating leptin, irisin, and CRP levels were significantly higher in the highest adversity tertile group compared with low and middle tertile groups (P < .001 for leptin, P = .01 for irisin, and P = .02 for CRP). Adiponectin levels were lower in the highest tertile group compared with the low and middle tertile groups (P = .03). After adjusting for demographic variables, physical activity, diet, current mental health, and body mass index, the associations between early-life adversity leptin, irisin, and did not change. However, adiponectin and CRP levels were no longer significantly related to early life adversity.

Conclusion: Early-life adversity is directly associated with elevated circulating leptin and irisin, and indirectly associated with elevated CRP and decreased adiponectin. These findings suggest that these adipomyokines may play a role in the pathogenesis of metabolic abnormality in a population with significant early life adversity.
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http://dx.doi.org/10.1210/jc.2013-3669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5377585PMC
June 2014

Diet quality is associated with circulating C-reactive protein but not irisin levels in humans.

Metabolism 2014 Feb 29;63(2):233-41. Epub 2013 Oct 29.

Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA 02130, USA.

Objective: Adherence to a healthy diet has been shown to decrease the incidence of obesity and associated comorbidities. C-reactive protein (CRP) is an established inflammatory marker and irisin was recently identified as a molecule which may play a role in energy regulation and obesity but whether diet alters irisin levels remains unknown. We aimed to investigate the association between circulating irisin, leptin, and CRP levels and dietary quantity and quality using the Alternate Healthy Eating Index (AHEI) and the Alternate Mediterranean Diet Score (aMED).

Materials/methods: The study evaluated dietary data and biomarker levels of 151 participants between 2009 and 2011 (71 male vs. 80 female, over 35 years old, obese 43.7%). AHEI and aMED scores were calculated based on data derived from self-administered 110-item food-frequency questionnaires estimating usual nutrient intake over the past year. Cross-sectional associations between dietary quantity, quality, body composition by bioelectric impedance, and biomarker levels including irisin, leptin, and CRP after fasting were assessed.

Results: CRP, but not irisin, was negatively correlated with AHEI (r=-0.34) and aMED (r=-0.31). Irisin was positively correlated with BMI (r=0.22), fat mass (r=0.21), waist circumference (r=0.24), waist-hip ratio (r=0.20), leptin (r=0.32), and CRP (r=0.25). Participants with the highest AHEI scores tended to have 11.6% lower concentrations of irisin (P for trend =0.09), but they were not significant after adjustment for potential confounders. Better diet quality was associated with lower CRP concentrations (P for trend=0.02) in multivariate model. Percentage of energy from carbohydrate was inversely associated with CRP.

Conclusions: Unlike CRP, irisin is not associated with dietary quality or quantity.
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http://dx.doi.org/10.1016/j.metabol.2013.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373656PMC
February 2014

Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors.

Metabolism 2014 Feb 7;63(2):199-206. Epub 2013 Nov 7.

Judge Baker Children's Center, 53 Parker Hill Avenue, Boston, MA 02120, USA; Department of Psychiatry and Behavioral Science, Stony Brook University School of Medicine, Stony Brook, NY.

Objective: This study examined whether a novel indicator of overall childhood adversity, incorporating number of adversities, severity, and chronicity, predicted central obesity beyond contributions of "modifiable" risk factors including psychosocial characteristics and health behaviors in a diverse sample of midlife adults. The study also examined whether the overall adversity score (number of adversities × severity × chronicity) better predicted obesity compared to cumulative adversity (number of adversities), a more traditional assessment of childhood adversity.

Materials/methods: 210 Black/African Americans and White/European Americans, mean age=45.8; ±3.3 years, were studied cross-sectionally. Regression analysis examined overall childhood adversity as a direct, non-modifiable risk factor for central obesity (waist-hip ratio) and body mass index (BMI), with and without adjustment for established adult psychosocial risk factors (education, employment, social functioning) and heath behavior risk factors (smoking, drinking, diet, exercise).

Results: Overall childhood adversity was an independent significant predictor of central obesity, and the relations between psychosocial and health risk factors and central obesity were not significant when overall adversity was in the model. Overall adversity was not a statistically significant predictor of BMI.

Conclusions: Overall childhood adversity, incorporating severity and chronicity and cumulative scores, predicts central obesity beyond more contemporaneous risk factors often considered modifiable. This is consistent with early dysregulation of metabolic functioning. Findings can inform practitioners interested in the impact of childhood adversity and personalizing treatment approaches of obesity within high-risk populations. Prevention/intervention research is necessary to discover and address the underlying causes and impact of childhood adversity on metabolic functioning.
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http://dx.doi.org/10.1016/j.metabol.2013.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423443PMC
February 2014

Circulating irisin in relation to insulin resistance and the metabolic syndrome.

J Clin Endocrinol Metab 2013 Dec 20;98(12):4899-907. Epub 2013 Sep 20.

Harvard Medical School, JP9B52A, Boston, MA 02130.

Context: Irisin, a recently identified hormone, has been proposed to regulate energy homeostasis and obesity in mice. Whether irisin levels are associated with risk of the metabolic syndrome (MetS), cardiometabolic variables, and cardiovascular disease (CVD) risk in humans remains unknown.

Objective: Our objective was to assess the associations between baseline serum irisin levels and MetS, cardiometabolic variables, and CVD risk.

Design, Setting, And Subjects: We conducted a comparative cross-sectional evaluation of baseline circulating levels of the novel hormone irisin and the established adipokine adiponectin with MetS, cardiometabolic variables, and CVD risk in a sample of 151 subjects.

Results: Baseline irisin levels were significantly higher in subjects with MetS than in subjects without MetS. Irisin was associated negatively with adiponectin (r = -0.4, P < .001) and positively with body mass index (r = 0.22, P = .008), systolic (r = 0.17, P = .04) and diastolic (r = 0.27, P = .001) blood pressure, fasting glucose (r = 0.25, P = .002), triglycerides (r = 0.25, P = .003), and homeostasis model assessment for insulin resistance (r = 0.33, P < .001). After adjustment for potential confounders, including body mass index, subjects in the highest tertile of irisin levels were more likely to have MetS (odds ratio [OR] = 9.44, 95% confidence interval [CI] = 2.66-33.44), elevated fasting blood glucose (OR = 5.80, 95% CI = 1.72-19.60), high triglycerides (OR = 3.89, 95% CI = 1.16-13.03), and low high-density lipoprotein cholesterol (OR = 3.30, 95% CI = 1.18-9.20). Irisin was independently associated with homeostasis model assessment for insulin resistance and general Framingham risk profile in multiple linear regression analyses after adjustment for confounders. Adiponectin demonstrated the expected associations with outcomes.

Conclusions: Irisin is associated with increased risk of MetS, cardiometabolic variables, and CVD in humans, indicating either increased secretion by adipose/muscle tissue and/or a compensatory increase of irisin to overcome an underlying irisin resistance in these subjects.
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http://dx.doi.org/10.1210/jc.2013-2373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849667PMC
December 2013

Relationship between dual-energy X-ray absorptiometry volumetric assessment and X-ray computed tomography-derived single-slice measurement of visceral fat.

J Clin Densitom 2014 Jan-Mar;17(1):78-83. Epub 2013 Apr 18.

Cardiovascular Medicine Division, Oregon Health and Sciences University, Portland, OR, USA.

To reduce radiation exposure and cost, visceral adipose tissue (VAT) measurement on X-ray computed tomography (CT) has been limited to a single slice. Recently, the US Food and Drug Administration has approved a dual-energy X-ray absorptiometry (DXA) application validated against CT to measure VAT volume. The purpose of this study was to develop an algorithm to compute single-slice area values on DXA at 2 common landmarks, L2/3 and L4/5, from an automated volumetrically derived measurement of VAT. Volumetric CT and total body DXA were measured in 55 males (age: 21-77 yr; body mass index [BMI]: 21.1-37.9) and 60 females (age: 21-85 yr; BMI: 20.0-39.7). Equations were developed by applying the relationship of CT single-slice area and volume measurements of VAT to the DXA VAT volume measure as well as validating these against the CT single-slice measurements. Correlation coefficients between DXA estimate of single-slice area and CT were 0.94 for L2/3 and 0.96 for L4/5. The mean difference between DXA estimate of single-slice area and CT was 5 cm(2) at L2/3 and 3.8 cm(2) at L4/5. Bland-Altman analysis showed a fairly constant difference across the single-slice range in this study, and the 95% limits of agreement for the 2 methods were -44.6 to +54.6 cm(2) for L2/3 and -47.3 to +54.9 cm(2) for L4/5. In conclusion, a volumetric measurement of VAT by DXA can be used to estimate single-slice measurements at the L2/3 and the L4/5 landmarks.
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http://dx.doi.org/10.1016/j.jocd.2013.03.007DOI Listing
April 2014

Imatinib mesylate for plexiform neurofibromas in patients with neurofibromatosis type 1: a phase 2 trial.

Lancet Oncol 2012 Dec 23;13(12):1218-24. Epub 2012 Oct 23.

Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Background: Plexiform neurofibromas are slow-growing chemoradiotherapy-resistant tumours arising in patients with neurofibromatosis type 1 (NF1). Currently, there are no viable therapeutic options for patients with plexiform neurofibromas that cannot be surgically removed because of their proximity to vital body structures. We undertook an open-label phase 2 trial to test whether treatment with imatinib mesylate can decrease the volume burden of clinically significant plexiform neurofibromas in patients with NF1.

Methods: Eligible patients had to be aged 3-65 years, and to have NF1 and a clinically significant plexiform neurofibroma. Patients were treated with daily oral imatinib mesylate at 220 mg/m(2) twice a day for children and 400 mg twice a day for adults for 6 months. The primary endpoint was a 20% or more reduction in plexiform size by sequential volumetric MRI imaging. Clinical data were analysed on an intention-to-treat basis; a secondary analysis was also done for those patients able to take imatinib mesylate for 6 months. This trial is registered with ClinicalTrials.gov, number NCT01673009.

Findings: Six of 36 patients (17%, 95% CI 6-33), enrolled on an intention-to-treat basis, had an objective response to imatinib mesylate, with a 20% or more decrease in tumour volume. Of the 23 patients who received imatinib mesylate for at least 6 months, six (26%, 95% CI 10-48) had a 20% or more decrease in volume of one or more plexiform tumours. The most common adverse events were skin rash (five patients) and oedema with weight gain (six). More serious adverse events included reversible grade 3 neutropenia (two), grade 4 hyperglycaemia (one), and grade 4 increases in aminotransferase concentrations (one).

Interpretation: Imatinib mesylate could be used to treat plexiform neurofibromas in patients with NF1. A multi-institutional clinical trial is warranted to confirm these results.

Funding: Novartis Pharmaceuticals, the Indiana University Simon Cancer Centre, and the Indiana University Herman B Wells Center for Pediatric Research.
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http://dx.doi.org/10.1016/S1470-2045(12)70414-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380388PMC
December 2012

The effectiveness of clinical supervision for a group of ward managers based in a district general hospital: an evaluative study.

J Nurs Manag 2012 Sep 12;20(6):782-93. Epub 2011 Aug 12.

Mayday Healthcare NHS Trust, Kingston University and St George's University of London, London, UK.

Aim: To present an evaluative audit assessing the effectiveness of clinical supervision for ward managers.

Background: A year-long project to introduce clinical supervision to ward managers was implemented and evaluated. The objectives were to evaluate staff perceptions of implementing clinical supervision and determine its outcomes.

Method: An audit evaluation process was used.

Results: Findings are presented against perceptions, implementation and reported outcomes of clinical supervision. Insights were gained into its relevance and importance to nurses and the organisation. Findings show that clinical supervision was perceived to be effective and helped improve patient care, but some feared it becoming a form of managerial control.

Conclusions: Ward managers perceived advantages for personal and professional development from adopting this process.

Implications For Nursing Management: There is a need for greater understanding of clinical supervision before Trusts implement it. The introduction of a resource pack for clinical areas would also be of value. Finally, there needs to be a named person who has a special knowledge of clinical supervision to act as a champion and change agent in effecting implementation at both the executive level and within each clinical area.
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http://dx.doi.org/10.1111/j.1365-2834.2011.01277.xDOI Listing
September 2012

Fat-referenced MR thermometry in the breast and prostate using IDEAL.

J Magn Reson Imaging 2012 Sep 11;36(3):722-32. Epub 2012 May 11.

GE Global Research, 1 Research Circle, Niskayuna, NY 12309, USA.

Purpose: To demonstrate a three-echo fat-referenced MR thermometry technique that estimates and corrects for time-varying phase disturbances in heterogeneous tissues.

Materials And Methods: Fat protons do not exhibit a temperature-dependent frequency shift. Fat-referenced thermometry methods exploit this insensitivity and use the signal from fat to measure and correct for magnetic field disturbances. In this study, we present a fat-referenced method that uses interpolation of the fat signal to correct for phase disturbances in fat free regions. Phantom and ex vivo tissue cool-down experiments were performed to evaluate the accuracy of this method in the absence of motion. Non-heated in vivo imaging of the breast and prostate was performed to demonstrate measurement robustness in the presence of systemic and motion-induced field disturbances. Measurement accuracy of the method was compared to conventional proton resonance frequency shift MR thermometry.

Results: In the ex vivo porcine tissue experiment, maximum measurement error of the fat-referenced method was reduced 42% from 3.3 to 1.9°C when compared to conventional MR thermometry. In the breasts, measurement errors were reduced by up to 70% from 6.4 to 1.9°C.

Conclusion: Ex vivo and in vivo results show that the proposed method reduces measurement errors in the heterogeneous tissue experiments when compared to conventional MR thermometry.
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http://dx.doi.org/10.1002/jmri.23692DOI Listing
September 2012

Precision of GE Lunar iDXA for the measurement of total and regional body composition in nonobese adults.

J Clin Densitom 2012 Oct-Dec;15(4):399-404. Epub 2012 Apr 26.

Nestec Ltd., Nestle Research Center, Lausanne, Switzerland.

Dual-energy X-ray absorptiometry (DXA) is a well-accepted technique for measuring body composition. Knowledge of measurement precision is critical for monitoring of changes in bone mineral content (BMC), and fat and lean masses. The purpose of this study was to characterize in vivo precision of total body and regional body composition parameters using the GE Lunar iDXA (GE Healthcare Lunar, Madison, WI) system in a sample of nonobese subjects. We also evaluated the difference between expert and automatic region-of-interest (ROI) analysis on body composition precision. To this end, 2 total body scans were performed on each subject with repositioning between scans. Total body precision for BMC, fat and lean mass were 0.5%, 1.0%, and 0.5% coefficient of variation (CV), respectively. Regional body composition precision error was less than 2.5% CV for all regions except arms. Precision error was higher for the arms (CV: BMC 1.5%; fat mass 2.8%; lean mass 1.6%), likely owing to the placement of arms relative to torso leading to differences in ROI. There was a significant correlation between auto ROI and expert ROI (r>0.99). Small, but statistically significant differences were found between auto and manual ROI. Differences were small in total body, leg, trunk, and android and gynoid regions (0.004-2.8%), but larger in arm region (3.0-6.3%). Total body and regional precision for iDXA are small and it is suggested that iDXA may be useful for monitoring changes in body composition during longitudinal trials.
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http://dx.doi.org/10.1016/j.jocd.2012.02.009DOI Listing
January 2013

Dual-energy X-ray absorptiometry for quantification of visceral fat.

Obesity (Silver Spring) 2012 Jun 26;20(6):1313-8. Epub 2012 Jan 26.

Cardiovascular Medicine Division, Oregon Health & Science University, Portland, Oregon, USA.

Obesity is the major risk factor for metabolic syndrome and through it diabetes as well as cardiovascular disease. Visceral fat (VF) rather than subcutaneous fat (SF) is the major predictor of adverse events. Currently, the reference standard for measuring VF is abdominal X-ray computed tomography (CT) or magnetic resonance imaging (MRI), requiring highly used clinical equipment. Dual-energy X-ray absorptiometry (DXA) can accurately measure body composition with high-precision, low X-ray exposure, and short-scanning time. The purpose of this study was to validate a new fully automated method whereby abdominal VF can be measured by DXA. Furthermore, we explored the association between DXA-derived abdominal VF and several other indices for obesity: BMI, waist circumference, waist-to-hip ratio, and DXA-derived total abdominal fat (AF), and SF. We studied 124 adult men and women, aged 18-90 years, representing a wide range of BMI values (18.5-40 kg/m(2)) measured with both DXA and CT in a fasting state within a one hour interval. The coefficient of determination (r(2)) for regression of CT on DXA values was 0.959 for females, 0.949 for males, and 0.957 combined. The 95% confidence interval for r was 0.968 to 0.985 for the combined data. The 95% confidence interval for the mean of the differences between CT and DXA VF volume was -96.0 to -16.3 cm(3). Bland-Altman bias was +67 cm(3) for females and +43 cm(3) for males. The 95% limits of agreement were -339 to +472 cm(3) for females and -379 to +465 cm(3) for males. Combined, the bias was +56 cm(3) with 95% limits of agreement of -355 to +468 cm(3). The correlations between DXA-derived VF and BMI, waist circumference, waist-to-hip ratio, and DXA-derived AF and SF ranged from poor to modest. We conclude that DXA can measure abdominal VF precisely in both men and women. This simple noninvasive method with virtually no radiation can therefore be used to measure VF in individual patients and help define diabetes and cardiovascular risk.
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http://dx.doi.org/10.1038/oby.2011.393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361068PMC
June 2012

Eighteen-year follow-up of a patient with cobalamin F disease (cblF): report and review.

Am J Med Genet A 2011 Oct 9;155A(10):2571-7. Epub 2011 Sep 9.

Division of Biochemical Diseases, Department of Pediatrics, BC Children's Hospital Vancouver, British Columbia, Canada.

Cobalamin F disease (cblF) is a rare disorder of intracellular cobalamin metabolism resulting in failure to thrive, recurrent stomatitis, skin rash, megaloblastic anemia, hypotonia, seizures, and intellectual disability. Data on long-term outcomes are not available. We report on the outcome of a patient with cblF disease with a frameshift mutation in the LMBRD1 gene after 18 years of intramuscular hydroxycobalamin treatment.
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http://dx.doi.org/10.1002/ajmg.a.34220DOI Listing
October 2011

Treatment of intractable epilepsy in a female with SLC6A8 deficiency.

Mol Genet Metab 2010 Dec 26;101(4):409-12. Epub 2010 Aug 26.

Department of Pediatrics, Division of Biochemical Diseases, British Columbia Children's Hospital, UBC, Canada.

A female heterozygous for a novel, disease causing, missense mutation in the X-linked cerebral creatine transporter (SLC6A8) gene (c.1067G>T, p.Gly356Val) presented with intractable epilepsy, mild intellectual disability and moderately reduced cerebral creatine levels. Treatment with creatine monohydrate, to enhance cerebral creatine transport, combined with L-arginine and L-glycine, to enhance cerebral creatine synthesis, resulted in complete resolution of seizures. Heterozygous SLC6A8 deficiency is a potentially treatable condition and should be considered in females with intractable epilepsy and developmental delay/intellectual disability.
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http://dx.doi.org/10.1016/j.ymgme.2010.08.016DOI Listing
December 2010

The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population.

AIDS Patient Care STDS 2007 Aug;21(8):584-92

Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA.

Perceived stigma in clinical settings may discourage HIV-infected individuals from accessing needed health care services. Having good access to care is imperative for maintaining the health, well being, and quality of life of persons living with HIV/AIDS (PLWHAs). The purpose of this prospective study, which took place from January 2004 through June 2006, was to evaluate the relationship between perceived stigma from a health care provider and access to care among 223 low income, HIV-infected individuals in Los Angeles County. Approximately one fourth of the sample reported perceived stigma from a health care provider at baseline, and about one fifth reported provider stigma at follow up. We also found that access to care among this population was low, as more than half of the respondents reported difficulty accessing care at baseline and follow up. Perceived stigma was found to be associated with low access to care both at baseline (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.55, 7.01) and 6-month follow up (2.85; 95% CI = 1.06, 7.65), even after controlling for sociodemographic characteristics and most recent CD4 count. These findings are of particular importance because lack of access or delayed access to care may result in clinical presentation at more advanced stages of HIV disease. Interventions are needed to reduce perceived stigma in the health care setting. Educational programs and modeling of nonstigmatizing behavior can teach health care providers to provide unbiased care.
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http://dx.doi.org/10.1089/apc.2006.0202DOI Listing
August 2007