Publications by authors named "Evan Davis"

18 Publications

  • Page 1 of 1

Performance of peripheral catheters inserted with ultrasound guidance versus landmark technique after a simulation-based mastery learning intervention.

J Vasc Access 2021 Sep 15:11297298211044363. Epub 2021 Sep 15.

Feinberg School of Medicine, Departments of Medicine and Medical Education, Northwestern University, Chicago, IL, USA.

Problem: Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is an effective method to gain vascular access in patients with difficult intravenous access (DIVA). While USGPIV success rates are reported to be high, some studies have reported a concerning incidence of USGPIV premature failures.

Aims: The purpose of this study was to compare differences in USGPIV and landmark peripheral intravenous catheter (PIV) utilization and failure following a hospital-wide USGPIV training program for nurses.

Methods: The authors performed a retrospective, electronic medical record review of all USGPIVs and PIVs inserted at a tertiary, urban, academic medical center from September 1, 2018, through September 30, 2019. The primary outcome was differences between USGPIV and PIV time to failure.

Results: A total of 43,470 short peripheral intravenous catheters (PIVCs) were inserted in 23,713 patients. Of these, 7972 (16.8%) were USGPIV. At 30 days of follow-up, for PIVCs with an indication for removal documented, USGPIVs had higher Kaplan-Meier survival probabilities than PIVs ( < 0.001).

Conclusions: The use of simulation-based mastery associated with USGPIVs, demonstrated lower failure rates than standard PIVs after 2 days and USGPIVs exhibited improved survival rates in patients with DIVA. These findings suggest that rigorous simulation-based insertion training demonstrates improved USGPIV survival when compared to traditional PIVCs. SBML is an extremely useful tool to ensure appropriately trained clinicians acquire the necessary knowledge and skillset to improve USGPIV outcomes.
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http://dx.doi.org/10.1177/11297298211044363DOI Listing
September 2021

Failure modes and effects analysis of mechanical thrombectomy for stroke discovered in human brains.

J Neurosurg 2021 Jun 4:1-8. Epub 2021 Jun 4.

3Neurosurgery, University of Michigan, Ann Arbor, Michigan.

Objective: Despite advancement of thrombectomy technologies for large-vessel occlusion (LVO) stroke and increased user experience, complete recanalization rates linger around 50%, and one-third of patients who have undergone successful recanalization still experience poor neurological outcomes. To enhance the understanding of the biomechanics and failure modes, the authors conducted an experimental analysis of the interaction of emboli/artery/devices in the first human brain test platform for LVO stroke described to date.

Methods: In 12 fresh human brains, 105 LVOs were recreated by embolizing engineered emboli analogs and recanalization was attempted using aspiration catheters and/or stent retrievers. The complex mechanical interaction between diverse emboli (elastic, stiff, and fragment prone), arteries (anterior and posterior circulation), and thrombectomy devices were observed, analyzed, and categorized. The authors systematically evaluated the recanalization process through failure modes and effects analysis, and they identified where and how thrombectomy devices fail and the impact of device failure.

Results: The first-pass effect (34%), successful (71%), and complete (60%) recanalization rates in this model were consistent with those in the literature. Failure mode analysis of 184 passes with thrombectomy devices revealed the following. 1) Devices loaded the emboli with tensile forces leading to elongation and intravascular fragmentation. 2) In the presence of anterograde flow, small fragments embolize to the microcirculation and large fragments result in recurrent vessel occlusion. 3) Multiple passes are required due to recurrent (15%) and residual (73%) occlusions, or both (12%). 4) Residual emboli remained in small branching and perforating arteries in cases of alleged complete recanalization (28%). 5) Vacuum caused arterial collapse at physiological pressures (27%). 6) Device withdrawal caused arterial traction (41%), and severe traction provoked avulsion of perforating and small branching arteries.

Conclusions: Biomechanically superior thrombectomy technologies should prevent unrestrained tensional load on emboli, minimize intraluminal embolus fragmentation and release, improve device/embolus integration, recanalize small branching and perforating arteries, prevent arterial collapse, and minimize traction.
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http://dx.doi.org/10.3171/2020.11.JNS203684DOI Listing
June 2021

A human brain test bed for research in large vessel occlusion stroke.

J Neurosurg 2021 Jan 22:1-9. Epub 2021 Jan 22.

1Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.

Objective: Endovascular removal of emboli causing large vessel occlusion (LVO)-related stroke utilizing suction catheter and/or stent retriever technologies or thrombectomy is a new standard of care. Despite high recanalization rates, 40% of stroke patients still experience poor neurological outcomes as many cases cannot be fully reopened after the first attempt. The development of new endovascular technologies and techniques for mechanical thrombectomy requires more sophisticated testing platforms that overcome the limitations of phantom-based simulators. The authors investigated the use of a hybrid platform for LVO stroke constructed with cadaveric human brains.

Methods: A test bed for embolic occlusion of cerebrovascular arteries and mechanical thrombectomy was developed with cadaveric human brains, a customized hydraulic system to generate physiological flow rate and pressure, and three types of embolus analogs (elastic, stiff, and fragment-prone) engineered to match mechanically and phenotypically the emboli causing LVO strokes. LVO cases were replicated in the anterior and posterior circulation, and thrombectomy was attempted using suction catheters and/or stent retrievers.

Results: The test bed allowed radiation-free visualization of thrombectomy for LVO stroke in real cerebrovascular anatomy and flow conditions by transmural visualization of the intraluminal elements and procedures. The authors were able to successfully replicate 105 LVO cases with 184 passes in 12 brains (51 LVO cases and 82 passes in the anterior circulation, and 54 LVO cases and 102 passes in the posterior circulation). Observed recanalization rates in this model were graded using a Recanalization in LVO (RELVO) scale analogous to other measures of recanalization outcomes in clinical use.

Conclusions: The human brain platform introduced and validated here enables the analysis of artery-embolus-device interaction under physiological hemodynamic conditions within the unmodified complexity of the cerebral vasculature inside the human brain.
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http://dx.doi.org/10.3171/2020.7.JNS202278DOI Listing
January 2021

Simulation-Based Mastery Learning Improves Ultrasound-Guided Peripheral Intravenous Catheter Insertion Skills of Practicing Nurses.

Simul Healthc 2021 Jan 8;Publish Ahead of Print. Epub 2021 Jan 8.

From the University of Washington (A.E.A.), Seattle, WA; Loyola University (S.E.F.), Chicago, IL; University of Michigan Medical School (E.M.D.), Ann Arbor, MI; Northwestern University (J.S., P.T., A.G.M., V.G., K.C., A.C., W.F., J.F., J.H.B.), Evanston; and Northwestern Memorial Hospital (V.M.), Chicago, IL.

Introduction: Difficult intravenous (IV) access (DIVA) is frequently encountered in the hospital setting. Ultrasound-guided peripheral IV catheter (USGPIV) insertion has emerged as an effective procedure to establish access in patients with DIVA. Despite the increased use of USGPIV, little is known about the optimal training paradigms for bedside nurses. Therefore, we developed and evaluated a novel, sustainable, USGPIV simulation-based mastery learning (SBML) curriculum for nurses.

Methods: This is a prospective cohort study of an USGPIV SBML training program for bedside nurses over a 12-month period. We evaluated skills and self-confidence before and after training and measured the proportion of the nurses achieving independent, proctor, and instructor status. Procedure logs and surveys were used to explore the nurse experience and utilization of USGPIV on real patients with DIVA 3 months after the intervention.

Results: Two hundred thirty-eight nurses enrolled in the study. The USGPIV skill checklist scores increased from median of 6.0 [interquartile range = 4.0-9.0 (pretest) to 29.0, interquartile range = 28-30 (posttest), P < 0.001]. The USGPIV confidence improved from before (mean = 2.32, SD = 1.17) to after (mean = 3.85, SD = 0.73, P < 0.001) training (5-point Likert scale). Sixty-two percent of the nurses enrolled achieved independent status, 47.5% became proctors, and 11.3% course trainers. At 3-month posttraining, the nurses had attempted a mean of 35.6 USGPIV insertions with an 89.5% success rate.

Conclusions: This novel USGPIV SBML curriculum improves nurses' insertion skills, self-confidence, and progresses patient care through USGPIV insertions on hospitalized patients with DIVA.
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http://dx.doi.org/10.1097/SIH.0000000000000545DOI Listing
January 2021

Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses.

Am J Emerg Med 2021 08 7;46:539-544. Epub 2020 Nov 7.

Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address:

Background: Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA.

Objectives: We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA.

Methods: We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV.

Results: A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p < 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p < 0.001).

Conclusion: DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.
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http://dx.doi.org/10.1016/j.ajem.2020.11.013DOI Listing
August 2021

Construction of a comprehensive endovascular test bed for research and device development in mechanical thrombectomy in stroke.

J Neurosurg 2020 Apr 3;134(3):1190-1197. Epub 2020 Apr 3.

Departments of1Neurosurgery and.

Objective: The development of new endovascular technologies and techniques for mechanical thrombectomy in stroke has greatly relied on benchtop simulators. This paper presents an affordable, versatile, and realistic benchtop simulation model for stroke.

Methods: A test bed for embolic occlusion of cerebrovascular arteries and mechanical thrombectomy was developed with 3D-printed and commercially available cerebrovascular phantoms, a customized hydraulic system to generate physiological flow rate and pressure, and 2 types of embolus analogs (elastic and fragment-prone) capable of causing embolic occlusions under physiological flow.

Results: The test bed was highly versatile and allowed realistic, radiation-free mechanical thrombectomy for stroke due to large-vessel occlusion with rapid exchange of geometries and phantom types. Of the transparent cerebrovascular phantoms tested, the 3D-printed phantom was the easiest to manufacture, the glass model offered the best visibility of the interaction between embolus and thrombectomy device, and the flexible model most accurately mimicked the endovascular system during device navigation. None of the phantoms modeled branches smaller than 1 mm or perforating arteries, and none underwent realistic deformation or luminal collapse from device manipulation or vacuum. The hydraulic system created physiological flow rate and pressure leading to iatrogenic embolization during thrombectomy in all phantoms. Embolus analogs with known fabrication technique, structure, and tensile strength were introduced and consistently occluded the middle cerebral artery bifurcation under physiological flow, and their interaction with the device was accurately visualized.

Conclusions: The test bed presented in this study is a low-cost, comprehensive, realistic, and versatile platform that enabled high-quality analysis of embolus-device interaction in multiple cerebrovascular phantoms and embolus analogs.
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http://dx.doi.org/10.3171/2020.1.JNS192732DOI Listing
April 2020

Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries.

Nutrients 2020 Mar 17;12(3). Epub 2020 Mar 17.

Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.

Suboptimal nutritional status of a newborn is a risk factor for short- and long-term morbidity and mortality. The objectives of this review were to assess the efficacy and effectiveness of neonatal synthetic vitamin A supplementation, dextrose gel and probiotic supplementation for prevention of morbidity and mortality during infancy in low and middle-income countries. We included randomized trials. Primary outcome was all-cause mortality. We conducted electronic searches on multiple databases. Data were meta-analyzed to obtain relative risk (RR) and 95% confidence interval (CI). Studies for vitamin A and Probiotics were analyzed separately. No studies were found for dextrose gel supplementation during neonatal period. The overall rating of evidence was determined by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Sixteen studies assessed the effect of vitamin A supplementation during the neonatal period. Based on pooled data from community-based studies only, there was no significant effect of vitamin A on all-cause mortality at age 1 month (RR 0.99, 95% CI 0.90, 1.08), 6 months (RR 0.98; 95% CI 0.89-1.08) and 12 months (RR 1.04, 95% CI 0.94, 1.14) but increased risk of bulging fontanelle (RR 1.53, 95% CI 1.12, 2.09). The overall quality of evidence was high for the above outcomes. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period and were mostly conducted in the hospital setting. Probiotics reduced the risk of all-cause mortality (RR 0.80, 95% CI 0.66, 0.96), necrotizing enterocolitis (RR 0.46, 95% CI 0.35, 0.59) and neonatal sepsis (RR 0.78, 95% CI 0.70, 0.86). The grade ratings for the above three outcomes were high. Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in low and middle-income countries in the community setting. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born low birth weight and/or preterm in the hospital setting.
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http://dx.doi.org/10.3390/nu12030791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146603PMC
March 2020

Analysis of human emboli and thrombectomy forces in large-vessel occlusion stroke.

J Neurosurg 2020 Feb 28;134(3):893-901. Epub 2020 Feb 28.

Departments of3Neurosurgery and.

Objective: This study's purpose was to improve understanding of the forces driving the complex mechanical interaction between embolic material and current stroke thrombectomy devices by analyzing the histological composition and strength of emboli retrieved from patients and by evaluating the mechanical forces necessary for retrieval of such emboli in a middle cerebral artery (MCA) bifurcation model.

Methods: Embolus analogs (EAs) were generated and embolized under physiological pressure and flow conditions in a glass tube model of the MCA. The forces involved in EA removal using conventional endovascular techniques were described, analyzed, and categorized. Then, 16 embolic specimens were retrieved from 11 stroke patients with large-vessel occlusions, and the tensile strength and response to stress were measured with a quasi-static uniaxial tensile test using a custom-made platform. Embolus compositions were analyzed and quantified by histology.

Results: Uniaxial tension on the EAs led to deformation, elongation, thinning, fracture, and embolization. Uniaxial tensile testing of patients' emboli revealed similar soft-material behavior, including elongation under tension and differential fracture patterns. At the final fracture of the embolus (or dissociation), the amount of elongation, quantified as strain, ranged from 1.05 to 4.89 (2.41 ± 1.04 [mean ± SD]) and the embolus-generated force, quantified as stress, ranged from 63 to 2396 kPa (569 ± 695 kPa). The ultimate tensile strain of the emboli increased with a higher platelet percentage, and the ultimate tensile stress increased with a higher fibrin percentage and decreased with a higher red blood cell percentage.

Conclusions: Current thrombectomy devices remove emboli mostly by applying linear tensile forces, under which emboli elongate until dissociation. Embolus resistance to dissociation is determined by embolus strength, which significantly correlates with composition and varies within and among patients and within the same thrombus. The dynamic intravascular weakening of emboli during removal may lead to iatrogenic embolization.
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http://dx.doi.org/10.3171/2019.12.JNS192187DOI Listing
February 2020

Flow cytometric analysis of CD200 expression by pulmonary small cell carcinoma.

Cytometry B Clin Cytom 2016 11 22;90(6):493-498. Epub 2015 Dec 22.

Western Washington Pathology, Tacoma, Washington.

Background: CD200 is a membrane bound glycoprotein that is expressed by a variety of normal tissues and hematopoietic malignancies. Flow cytometric analysis of CD200 expression has utility in the evaluation of mature B-cell neoplasms, myeloma, and acute leukemia; however, CD200 expression in nonhematopoietic malignancies has not been extensively studied.

Methods: We studied 14 cases of biopsy proven pulmonary small cell carcinoma in which a discrete CD45 negative, CD56 positive abnormal cell population was identified by flow cytometry. We retrospectively evaluated these cases for flow cytometric and immunohistochemical evidence of CD200 expression.

Results: Twelve of the 14 cases of pulmonary small cell carcinoma showed convincing expression of CD200 by both immunohistochemistry and flow cytometry.

Conclusions: Pulmonary small cell carcinoma frequently expresses CD200 at a level that can be detected by flow cytometry and immunohistochemistry. CD200 expression therefore may be used to help identify pulmonary small cell carcinoma in flow cytometry specimens and tissue sections. CD200 may also play a role in the biology of pulmonary small cell carcinoma and is a potential target of future therapies. © 2015 International Clinical Cytometry Society.
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http://dx.doi.org/10.1002/cyto.b.21340DOI Listing
November 2016

Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after discharge: A pilot study with the Kansas City Cardiomyopathy Questionnaire.

J Card Fail 2014 May;20(5):378.e11-5

Robert Wood Johnson Foundation Clinical Scholars Program and Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Department of Veterans Affairs, VA Center for Clinical Management and Research, Ann Arbor VA Healthcare System, Ann Arbor, Michigan,

Background: There are no well validated patient-reported disease status instruments for acute heart failure(HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ)during acute heart failure hospitalization, and the association of acute changes with 30-day readmission.Methods and Results: A convenience sample of acute HF patients were administered the KCCQ on presentation,discharge, and 30 days after discharge. We examined mean differences in KCCQ scores overtime, and we stratified by readmission status to examine differences in hospital-based changes with the use of t test and logistic regression. Among 52 patients (mean age 63 ± 15 years, 56.9% male, 46.2% white), discharge and 30-day assessments were each completed by 90%. Scores were lowest at presentation,improved during hospitalization, and were highest at 30 days. The mean change was +11.9 ± 27.0(P 5 .007) between presentation and discharge and +19.8 ± 17.8 (P <. .001) between discharge and 30 days. Within the 30-day follow-up, 10 patients were readmitted, and there were no significant differences in score changes during hospitalization between patients with and without readmission (readmitted patients: +4.8 ± 21.5 vs no readmission +16.2 ± 27.4; P = .32).Conclusions: In this pilot study, the KCCQ is feasible to use during acute HF hospitalizations and demonstrates sensitivity to acute changes, but score changes during hospitalization did not predict 30-day readmission.
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May 2014

Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after discharge: a pilot study with the Kansas City Cardiomyopathy Questionnaire.

J Card Fail 2014 Jan 1;20(1):18-22. Epub 2013 Dec 1.

Department of Emergency Medicine, Chicago, Illinois; Center for Cardiovascular Innovation, Department of Medicin, Chicago, Illinois; Institute for Public Health and Medicine, Chicago, Illinois.

Background: There are no well validated patient-reported disease status instruments for acute heart failure (HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ) during acute heart failure hospitalization, and the association of acute changes with 30-day readmission.

Methods And Results: A convenience sample of acute HF patients were administered the KCCQ on presentation, discharge, and 30 days after discharge. We examined mean differences in KCCQ scores over time, and we stratified by readmission status to examine differences in hospital-based changes with the use of t test and logistic regression. Among 52 patients (mean age 63 ± 35 years, 56.9% male, 46.2% white), discharge and 30-day assessments were each completed by 90%. Scores were lowest at presentation, improved during hospitalization, and were highest at 30 days. The mean change was +11.9 ± 97.0 (P = .007) between presentation and discharge and +19.8 ± 87.8 (P < .001) between discharge and 30 days. Within the 30-day follow-up, 10 patients were readmitted, and there were no significant differences in score changes during hospitalization between patients with and without readmission (readmitted patients: +4.8 ± 81.5 vs no readmission +16.2 ± 27.4; P = .32).

Conclusions: In this pilot study, the KCCQ is feasible to use during acute HF hospitalizations and demonstrates sensitivity to acute changes, but score changes during hospitalization did not predict 30-day readmission.
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http://dx.doi.org/10.1016/j.cardfail.2013.11.010DOI Listing
January 2014

Perifosine treatment in chronic lymphocytic leukemia: results of a phase II clinical trial and in vitro studies.

Leuk Lymphoma 2014 May 31;55(5):1067-75. Epub 2013 Aug 31.

Department of Medicine, Duke University Medical Center , Durham, NC , USA.

Abstract Because of the importance of the phosphoinositide 3-kinase (PI3K)/AKT pathway in chronic lymphocytic leukemia (CLL), we evaluated in vitro cytotoxicity induced by perifosine, an AKT inhibitor, in CLL lymphocytes and found that the mean 50% effective dose (ED50) was 313 nM. We then performed a phase II trial of perifosine in patients with relapsed/refractory CLL to assess response, outcomes, toxicity and ex vivo correlative measures. After 3 months of treatment, six of eight patients showed stable disease, one achieved a partial response and one had progressive disease. Median event-free survival and overall survival in all patients treated were 3.9 and 9.7 months. Adverse events included hematologic, infectious/fever, pain, gastrointestinal and constitutional toxicities. Unexpectedly, AKT phosphorylation in CLL lymphocytes from treated patients was not correlated with response. Additionally, perifosine did not inhibit AKT phosphorylation in cultured CLL lymphocytes. Perifosine is cytotoxic to CLL cells in vitro, and largely induces stabilized disease in vivo, with an AKT-independent mechanism.
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http://dx.doi.org/10.3109/10428194.2013.824080DOI Listing
May 2014

CD38 variation as a prognostic factor in chronic lymphocytic leukemia.

Leuk Lymphoma 2014 Jan 2;55(1):191-4. Epub 2013 May 2.

Department of Medicine, Duke University Medical Center , Durham, NC , USA.

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http://dx.doi.org/10.3109/10428194.2013.786070DOI Listing
January 2014

SET oncoprotein overexpression in B-cell chronic lymphocytic leukemia and non-Hodgkin lymphoma: a predictor of aggressive disease and a new treatment target.

Blood 2011 Oct 15;118(15):4150-8. Epub 2011 Aug 15.

Oncotide Pharmaceuticals, Durham, NC, USA.

B-cell chronic lymphocytic leukemia (CLL), an incurable leukemia, is characterized by defective apoptosis. We found that the SET oncoprotein, a potent inhibitor of the protein phosphatase 2A (PP2A) tumor suppressor, is overexpressed in primary CLL cells and B-cell non-Hodgkin lymphoma (NHL) cell line cells. In CLL, increased levels of SET correlated significantly with disease severity (shorter time to treatment and overall survival). We developed SET antagonist peptides that bound SET, increased cellular PP2A activity, decreased Mcl-1 expression, and displayed selective cytotoxicity for CLL and NHL cells in vitro. In addition, shRNA for SET was cytotoxic for NHL cells in vitro. The SET antagonist peptide COG449 inhibited growth of NHL tumor xenografts in mice. These data demonstrate that SET is a new treatment target in B-cell malignancies and that SET antagonists represent novel agents for treatment of CLL and NHL.
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http://dx.doi.org/10.1182/blood-2011-04-351072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204732PMC
October 2011

Are some children harder to coparent than others? Children's negative emotionality and coparenting relationship quality.

J Fam Psychol 2009 Aug;23(4):606-10

Department of Human Development and Family Studies, University of Missouri-Columbia, MO 65211, USA.

The current study examined relations between child temperament--specifically, negative emotionality--and parents' supportive and undermining coparenting behavior, and further tested whether marital adjustment moderated relations between child negative affect and coparenting. One-hundred eleven two-parent families with a 4-year old child participated in this study. Parents completed questionnaires to provide information on children's negative affectivity, marital adjustment, and the quality of their coparenting relationships. Furthermore, parents and children participated together in two 10-minute task-oriented interactions that were coded to assess coparenting behavior. As hypothesized, parents of children higher on levels of negative affect demonstrated greater undermining coparenting behavior. In addition, marital adjustment moderated relations between children's negative affect and parents' supportive coparenting behavior. However, contrary to expectations, couples with higher levels of marital adjustment were most vulnerable to effects of child negativity on supportive coparenting. Results suggest that high-quality marital relationships may not buffer the coparenting relationship from the effects of temperamentally difficult preschoolers.
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http://dx.doi.org/10.1037/a0015992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150515PMC
August 2009

Coparenting behavior moderates longitudinal relations between effortful control and preschool children's externalizing behavior.

J Child Psychol Psychiatry 2009 Jun 21;50(6):698-706. Epub 2009 Jan 21.

Department of Human Development and Family Science, The Ohio State University, Columbus, OH 43210, USA.

Background: Temperamental effortful control involves the voluntary control of attention and behavior. Deficits in effortful control put children at risk for developing externalizing behavior problems. Coparenting behavior, or the extent to which parents support or undermine each other's parenting efforts, has also been identified as an important correlate of children's socioemotional adjustment. The present study tested whether coparenting behavior moderated longitudinal relations between preschool children's effortful control and their externalizing behavior.

Methods: Ninety-two families (mother, father, 4-year-old child) participated. Parents' coparenting behavior was observed during family interaction, and children's effortful control was rated by parents. At that time and one year later, mothers and teachers reported on children's externalizing behavior.

Results: Supportive coparenting behavior moderated longitudinal relations between children's effortful control and mothers' and teachers' reports of their externalizing behavior, even when taking into account initial levels of externalizing behavior.

Conclusions: Effective coparenting served as a buffer for children, such that when parents displayed high levels of supportive coparenting behavior, the link between low effortful control and increases in externalizing behavior was not observed.
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http://dx.doi.org/10.1111/j.1469-7610.2008.02009.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2915773PMC
June 2009

The Role of Infant Temperament in Stability and Change in Coparenting Across the First Year of Life.

Parent Sci Pract 2009;9(1-2):143-159

University of Illinois at Urbana-Champaign.

Objective: The current study investigated the role of infant temperament in stability and change in coparenting behavior across the infant's first year. Specifically, bidirectional relations between infant temperament and coparenting were examined and temperament was further considered as a moderator of longitudinal stability in coparenting behavior.

Design: Fifty-six two-parent families were recruited to participate during their third trimester of pregnancy. Coparenting behavior was assessed in families' homes when infants were age 3.5 months and in a laboratory setting at 13 months postpartum. Mothers and fathers also reported on their infant's temperamental difficulty at 3.5 and 13 months.

Results: Evidence for bidirectional relations between infant temperament and coparenting was obtained. Early infant difficulty, as reported by fathers, was associated with a decrease in supportive coparenting behavior across time; conversely, early supportive coparenting behavior was associated with a decrease in infant difficulty. Moreover, infant difficult temperament moderated stability in undermining coparenting behavior, such that undermining behavior at 3.5 months predicted undermining behavior at 13 months only when infants had less difficult temperaments.

Conclusions: These findings suggest that infants may play a role in the early course of the family processes that shape their development. With respect to practice, these results suggest that early intervention in the coparenting subsystem is essential for families, particularly those with temperamentally difficult infants.
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http://dx.doi.org/10.1080/15295190802656836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430200PMC
January 2009

Learning about tools in infancy.

Dev Psychol 2007 Mar;43(2):352-68

Department of Psychological and Brain Sciences, Duke University, Durham, NC 27708-0086, USA.

These experiments explored the role of prior experience in 12- to 18-month-old infants' tool-directed actions. In Experiment 1, infants' use of a familiar tool (spoon) to accomplish a novel task (turning on lights inside a box) was examined. Infants tended to grasp the spoon by its handle even when doing so made solving the task impossible (the bowl did not fit through the hole in the box, but the handle did) and even though the experimenter demonstrated a bowl-grasp. In contrast, infants used a novel tool flexibly and grasped both sides equally often. In Experiment 2, infants received training using the novel tool for a particular function; 3 groups of infants were trained to use the tool differently. Later, infants' performance was facilitated on tasks that required infants to grasp the part of the tool they were trained to grasp. The results suggest that (a) infants' prior experiences with tools are important to understanding subsequent tool use, and (b) rather than learning about tool function (e.g., hammering), infants learn about which part of the tool is meant to be held, at least early in their exposure to a novel tool.
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http://dx.doi.org/10.1037/0012-1649.43.2.352DOI Listing
March 2007
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