Publications by authors named "Steven Friedman"

94 Publications

Heartrate variability biofeedback for migraine using a smartphone application and sensor: A randomized controlled trial.

Gen Hosp Psychiatry 2021 Mar-Apr;69:41-49. Epub 2021 Jan 7.

Department of Neurology, Yeshiva University Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10461, United States.

Introduction: Although hand temperature and electromyograph biofeedback have evidence for migraine prevention, to date, no study has evaluated heartrate variability (HRV) biofeedback for migraine.

Methods: 2-arm randomized trial comparing an 8-week app-based HRV biofeedback (HeartMath) to waitlist control. Feasibility/acceptability outcomes included number and duration of sessions, satisfaction, barriers and adverse events. Primary clinical outcome was Migraine-Specific Quality of Life Questionnaire (MSQv2).

Results: There were 52 participants (26/arm). On average, participants randomized to the Hearthmath group completed 29 sessions (SD = 29, range: 2-86) with an average length of 6:43 min over 36 days (SD = 27, range: 0, 88) before discontinuing. 9/29 reported technology barriers. 43% said that they were likely to recommend Heartmath to others. Average MSQv2 decreases were not significant between the Heartmath and waitlist control (estimate = 0.3, 95% CI = -3.1 - 3.6). High users of Heartmath reported a reduction in MSQv2 at day 30 (-12.3 points, p = 0.010) while low users did not (p = 0.765).

Discussion: App-based HRV biofeedback was feasible and acceptable on a time-limited basis for people with migraine. Changes in the primary clinical outcome did not differ between biofeedback and control; however, high users of the app reported more benefit than low users.
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http://dx.doi.org/10.1016/j.genhosppsych.2020.12.008DOI Listing
January 2021

A modern measles outbreak: understanding maternal immunity and impact on postpartum vaccination uptake.

Am J Obstet Gynecol MFM 2021 Jan 13;3(3):100309. Epub 2021 Jan 13.

Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York University Langone Health, New York, NY.

Background: In October 2018, a measles (rubeola) outbreak was identified in New York City and Rockland County, and a public health campaign and hospital policy changes were made to increase awareness of the importance of vaccination and increase vaccination rates.

Objective: We describe the prevalence of rubeola immunity in pregnant women and the change in uptake of postpartum measles, mumps, and rubella vaccination before and during the measles outbreak.

Study Design: A multipronged intervention was developed by the health system with the intent of raising awareness of the outbreak, identifying patients at risk of contracting measles during pregnancy, and limiting exposure of inpatients to the disease. This was a quality improvement study to assess the impact of the intervention and public health policy on the rates of documentation of rubeola immunity and rubeola vaccination rates in nonimmune women. Women who delivered at New York University Langone Health before the outbreak July 1, 2016 to July 1, 2017 were compared with women who delivered during the outbreak July 1, 2018 to July 1, 2019. The primary outcome was acceptance of measles, mumps, and rubella vaccination in nonimmune women during the postpartum period. Analysis was conducted using logistic regression and chi-square tests, and alpha was set at 0.05.

Results: A total of 19,585 patients were analyzed; 9162 women delivered before the outbreak and 10,423 delivered during the outbreak. Of these, 2589 (13.2%) were documented as living in a high-risk zone improvement plan code, which were areas at the epicenter of the measles outbreak. Notably, 14,731 women (75.2%) were tested for rubeola immunity and 3270 of those tested (22.2%) were not immune. In the year of the outbreak, a higher proportion of women had rubeola immunity documented with serum titers than in the year before the outbreak (81% vs 69%; P<.001). Inpatient compliance with postpartum measles, mumps, and rubella administration was greater during the outbreak than before it (76% vs 59%; P<.001) for patients from both low-risk and high-risk zone improvement plan codes.

Conclusion: The New York City and Rockland County measles outbreak, together with the implementation of a health system-wide education program and a change in public health policy, led to an increase in the proportion of pregnant women being screened for rubeola immunity. It also led to an increase in uptake of the immediate postpartum measles, mumps, and rubella vaccine.
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http://dx.doi.org/10.1016/j.ajogmf.2021.100309DOI Listing
January 2021

Mask shortage during epidemics and pandemics: a scoping review of interventions to overcome limited supply.

BMJ Open 2020 11 27;10(11):e040547. Epub 2020 Nov 27.

Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada.

Objective: To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics.

Design: Systematic scoping review.

Settings: All healthcare settings relevant to epidemics and pandemics.

Search Strategy: English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers.

Results: Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination.

Conclusion: There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.
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http://dx.doi.org/10.1136/bmjopen-2020-040547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703444PMC
November 2020

Regional anesthesia in Canadian emergency departments: Emergency physician practices, perspectives, and barriers to use.

CJEM 2020 07;22(4):499-503

University Health Network, Department of Emergency Medicine, Toronto, ON, Canada.

Objectives: Regional anesthesia has many applications in the emergency department (ED). It has been shown to reduce general anesthetic dose, requirement for post-procedural opioids, and recovery time. We sought to characterize the use of regional anesthesia by Canadian emergency physicians, including practices, perspectives and barriers to use in the ED.

Methods: A cross-sectional survey was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical response questions. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables.

Results: The survey was completed by 149/1144 staff emergency physicians, with a response rate of 13%. Respondents used regional anesthesia a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of respondents, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). Respondents agreed that regional anesthesia is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had point of care ultrasound available, however less than half (49.0%) felt comfortable using it for RA. Respondents indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use of RA.

Conclusion: Canadian emergency physicians use regional anesthesia infrequently but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake.
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http://dx.doi.org/10.1017/cem.2020.51DOI Listing
July 2020

Evaluating the impact of implementing public bicycle share programs on cycling: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS).

Int J Behav Nutr Phys Act 2019 11 20;16(1):107. Epub 2019 Nov 20.

School of Human Kinetics and Recreation, Memorial University of Newfoundland, Physical Education Building, St. John's, Newfoundland, A1C 5S7, Canada.

Background: Despite rapid expansion of public bicycle share programs (PBSP), there are limited evaluations of the population-level impacts of these programs on cycling, leaving uncertainty as to whether these programs lead to net health gains at a population level or attract those that already cycle and are sufficiently physically active. Our objective was to determine whether the implementation of PBSPs increased population-level cycling in cities across the US and Canada.

Methods: We conducted repeat cross-sectional surveys with 23,901 residents in cities with newly implemented PBSPs (Chicago, New York), existing PBSPs (Boston, Montreal, Toronto) and no PBSPs (Detroit, Philadelphia, Vancouver) at three time points (Fall 2012, 2013, 2014). We used a triple difference in differences analysis to assess whether there were increases in cycling over time amongst those living in closer proximity (< 500 m) to bicycle share docking stations in cities with newly implemented and existing PBSPs, relative to those in cities with no PBSPs.

Results: Living in closer proximity to bicycle share predicted increases in cycling over time for those living in cities with newly implemented PBSPs at 2-year follow-up. No change was seen over time for those living in closer proximity to bicycle share in cities with existing PBSPs relative to those in cities with no PBSP.

Conclusion: These findings indicate that PBSPs are associated with increases in population-level cycling for those who live near to a docking station in the second year of program implementation.
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http://dx.doi.org/10.1186/s12966-019-0871-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868775PMC
November 2019

A multifaceted primary care practice-based intervention to reduce ED visits and hospitalization for complex medical patients: A mixed methods study.

PLoS One 2019 2;14(1):e0209241. Epub 2019 Jan 2.

Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.

Background: The management of complex, multi-morbid patients is challenging for solo primary care providers (PCPs) with limited access to resources. The primary objective of the intervention was to reduce the overall rate of Emergency Department (ED) visits among patients in participating practices.

Methods And Findings: An interrupted time series design and qualitative interviews were used to evaluate a multifaceted intervention, SCOPE (Seamless Care Optimizing the Patient Experience), offered to solo PCPs whose patients were frequent users of the ED. The intervention featured a navigation hub (nurse, homecare coordinator) to link PCPs with hospital and community resources, a general internist on-call to provide phone advice or urgent assessments, and access to patient results on-line. Continuous quality improvement (QI) strategies were employed to optimize each component of the intervention. The primary outcome was the relative pre-post intervention change in ED visit rate for patients of participating practices compared with that for a propensity-matched control group of physicians over the contemporaneous period. Themes were identified from semi-structured interviews on PCP's experiences and influential factors in their engagement. Twenty-nine physicians agreed to participate and were provided access to the intervention over an 18-month time period. There were a total of 1,525 intervention contacts over the 18-months (average: 50.6±60.8 per PCP). Both intervention and control groups experienced a trend towards lower rates of ED use by their patients over the study time period. The pre-post difference in trend for the intervention group compared to the controls was not significant at 1.4% per year (RR = 1.014; p = 0.59). Several themes were identified from qualitative interviews including: PCPs felt better supported in the care of their patients; they experienced a greater sense of community, and; they were better able to provide shared primary-specialty care.

Conclusions: This multifaceted intervention to support solo PCPs in the management of their complex patients did not result in a reduced rate of ED visits compared to controls, likely related to variable uptake among PCPs. It did however result in more comprehensive and coordinated care for their patients. Future directions will focus on increasing uptake by improving ease of use, increasing the range of services offered and expanding to a larger number of PCPs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0209241PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314574PMC
September 2019

Ambroise Pare: Barber vascular surgeon.

J Vasc Surg 2018 08;68(2):646-649

Weill Cornell Medical College, Lake Success, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2018.04.053DOI Listing
August 2018

Degree of twisting and duration of symptoms are prognostic factors of testis salvage during episodes of testicular torsion.

Transl Androl Urol 2017 Dec;6(6):1159-1166

Department of Urology, Winthrop University Hospital, Mineola, NY, USA.

Background: Testicular torsion is surgical emergency. Prompt diagnosis and treatment of testicular torsion is essential for testicular viability. At surgical exploration, the spermatic cord is seen twisted a variable number of times around its longitudinal axis. There is scant data regarding the degree of twisting and its association with testis outcomes. The purpose of our study is to explore how the degree of torsion factors into testicular outcome using follow-up data.

Methods: We retrospectively reviewed the records of adolescent males who presented with testicular torsion to our institution, looking at duration of pain symptoms, degree of torsion documented in the operative note, procedure performed (orchiopexy versus orchiectomy), and follow-up clinic data for whether testicular atrophy after orchiopexy was present. A non-salvageable testis was defined as orchiectomy or atrophy. Receiver operator characteristics (ROC), multivariate, and logistic regression analyses were performed to determine the probability of a non-salvageable torsed testis based on time and degree of twisting.

Results: Eighty-one patients met our study criteria, with 55 testes deemed viable and 26 non-salvageable. We found a 25.7% atrophy rate after orchiopexy. Cut-off values of 8.5 h and 495 degrees of torsion would provide sensitivities of 73% and 53%, respectively, with specificity of 80% for both. Only duration and age were correlated with the risk of non-salvage on multivariate analysis. Logistic regression generated linear probability formulas of 4 + (3 ¡Á hours) and 7 + (0.05 ¡Á degrees) in calculating the probability of non-salvage with strong correlation.

Conclusions: We were able to derive separate formulas to determine the viability of the torsed testis based on symptom duration and degrees of twisting. Fifteen h of symptoms and 860 degrees of torsion gives testes a 50% salvage rate. Interestingly, we also found that about 1 out of every 4 testes undergoes atrophy after orchiopexy.
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http://dx.doi.org/10.21037/tau.2017.09.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760391PMC
December 2017

Shifting Patterns in Cesarean Delivery Scheduling and Timing in Oregon before and after a Statewide Hard Stop Policy.

Health Serv Res 2018 08 12;53 Suppl 1:2839-2857. Epub 2017 Nov 12.

Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.

Objectives: To assess the use and timing of scheduled cesareans and other categories of cesarean delivery and the prevalence of neonatal morbidity among cesareans in Oregon before and after the implementation of Oregon's statewide policy limiting elective early deliveries.

Data Sources: Oregon vital statistics records, 2008-2013.

Study Design: Retrospective cohort study, with multivariable logistic regression, regression controlling for time trends, and interrupted time series analyses, to compare the odds of different categories of cesarean delivery and the odds of neonatal morbidity pre- and postpolicy.

Data Collection/extraction Methods: We analyzed vital statistics data on all term births in Oregon (2008-2013), excluding births in 2011.

Principal Findings: The odds of early-term scheduled cesareans decreased postpolicy (adjusted odds ratio [aOR], 0.70; 95 percent confidence interval [CI], 0.66-0.74). In the postpolicy period, there were mixed findings regarding assisted neonatal ventilation and neonatal intensive care unit admission, with regression models indicating higher postpolicy odds in some categories, but lower postpolicy odds after controlling for time trends.

Conclusions: Oregon's hard stop policy limiting elective early-term cesarean delivery was associated with lower odds of cesarean delivery in the category of women who were targeted by the policy; more research is needed on impact of such policies on neonatal outcomes.
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http://dx.doi.org/10.1111/1475-6773.12797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056593PMC
August 2018

Evolving Centromeres and Kinetochores.

Adv Genet 2017 1;98:1-41. Epub 2017 Sep 1.

Oregon State University, Corvallis, OR, United States.

The genetic material, contained on chromosomes, is often described as the "blueprint for life." During nuclear division, the chromosomes are pulled into each of the two daughter nuclei by the coordination of spindle microtubules, kinetochores, centromeres, and chromatin. These four functional units must link the chromosomes to the microtubules, signal to the cell when the attachment is made so that division can proceed, and withstand the force generated by pulling the chromosomes to either daughter cell. To perform each of these functions, kinetochores are large protein complexes, approximately 5MDa in size, and they contain at least 45 unique proteins. Many of the central components in the kinetochore are well conserved, yielding a common core of proteins forming consistent structures. However, many of the peripheral subcomplexes vary between different taxonomic groups, including changes in primary sequence and gain or loss of whole proteins. It is still unclear how significant these changes are, and answers to this question may provide insights into adaptation to specific lifestyles or progression of disease that involve chromosome instability.
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http://dx.doi.org/10.1016/bs.adgen.2017.07.001DOI Listing
May 2018

Centrochromatin of Fungi.

Prog Mol Subcell Biol 2017;56:85-109

Department of Biochemistry and Biophysics, Oregon State University, 2011 ALS Bldg, Corvallis, OR, 97331, USA.

The centromere is an essential chromosomal locus that dictates the nucleation point for assembly of the kinetochore and subsequent attachment of spindle microtubules during chromosome segregation. Research over the last decades demonstrated that centromeres are defined by a combination of genetic and epigenetic factors. Recent work showed that centromeres are quite diverse and flexible and that many types of centromere sequences and centromeric chromatin ("centrochromatin") have evolved. The kingdom of the fungi serves as an outstanding example of centromere plasticity, including organisms with centromeres as diverse as 0.15-300 kb in length, and with different types of chromatin states for most species examined thus far. Some of the species in the less familiar taxa provide excellent opportunities to help us better understand centromere biology in all eukaryotes, which may improve treatment options against fungal infection, and biotechnologies based on fungi. This review summarizes the current knowledge of fungal centromeres and centrochromatin, including an outlook for future research.
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http://dx.doi.org/10.1007/978-3-319-58592-5_4DOI Listing
May 2019

Robert Abbe: The life and times of a 19th century surgeon.

J Vasc Surg 2017 10 16;66(4):1290-1292. Epub 2017 Aug 16.

Division of Vascular Surgery, Hofstra Northwell School of Medicine, Lake Success, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2017.06.096DOI Listing
October 2017

A Matter of Scale and Dimensions: Chromatin of Chromosome Landmarks in the Fungi.

Microbiol Spectr 2017 07;5(4)

Department of Biochemistry and Biophysics, Oregon State University, Corvallis, OR 97331.

Chromatin and chromosomes of fungi are highly diverse and dynamic, even within species. Much of what we know about histone modification enzymes, RNA interference, DNA methylation, and cell cycle control was first addressed in , , , and . Here, we examine the three landmark regions that are required for maintenance of stable chromosomes and their faithful inheritance, namely, origins of DNA replication, telomeres and centromeres. We summarize the state of recent chromatin research that explains what is required for normal function of these specialized chromosomal regions in different fungi, with an emphasis on the silencing mechanism associated with subtelomeric regions, initiated by sirtuin histone deacetylases and histone H3 lysine 27 (H3K27) methyltransferases. We explore mechanisms for the appearance of "accessory" or "conditionally dispensable" chromosomes and contrast what has been learned from studies on genome-wide chromosome conformation capture in , , , and . While most of the current knowledge is based on work in a handful of genetically and biochemically tractable model organisms, we suggest where major knowledge gaps remain to be closed. Fungi will continue to serve as facile organisms to uncover the basic processes of life because they make excellent model organisms for genetics, biochemistry, cell biology, and evolutionary biology.
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http://dx.doi.org/10.1128/microbiolspec.FUNK-0054-2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536859PMC
July 2017

Korea, M*A*S*H, and the accidental pioneers of vascular surgery.

J Vasc Surg 2017 08 8;66(2):666-670. Epub 2017 Apr 8.

Division of Vascular Surgery, Hofstra Northwell School of Medicine, Lake Success, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2017.01.055DOI Listing
August 2017

Oregon's Hard-Stop Policy Limiting Elective Early-Term Deliveries: Association With Obstetric Procedure Use and Health Outcomes.

Obstet Gynecol 2016 12;128(6):1389-1396

Departments of Obstetrics and Gynecology and Public Health & Preventive Medicine, Oregon Health & Science University, Providence Health & Services, Legacy Health, Kaiser Permanente, Northwest Region, and the March of Dimes, Portland, Oregon; and the Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.

Objective: To evaluate the association of Oregon's hard-stop policy limiting early elective deliveries (before 39 weeks of gestation) and the rate of elective early-term inductions and cesarean deliveries and associated maternal-neonatal outcomes.

Methods: This was a population-based retrospective cohort study of Oregon births between 2008 and 2013 using vital statistics data and multivariable logistic regression models. Our exposure was the Oregon hard-stop policy, defined as the time periods prepolicy (2008-2010) and postpolicy (2012-2013). We included all term or postterm, cephalic, nonanomalous, singleton deliveries (N=181,034 births). Our primary outcomes were induction of labor and cesarean delivery at 37 or 38 weeks of gestation without a documented indication on the birth certificate (ie, elective early term delivery). Secondary outcomes included neonatal intensive care unit admission, stillbirth, macrosomia, chorioamnionitis, and neonatal death.

Results: The rate of elective inductions before 39 weeks of gestation declined from 4.0% in the prepolicy period to 2.5% during the postpolicy period (P<.001); a similar decline was observed for elective early-term cesarean deliveries (from 3.4% to 2.1%; P<.001). There was no change in neonatal intensive care unit admission, stillbirth, or assisted ventilation prepolicy and postpolicy, but chorioamnionitis did increase (from 1.2% to 2.2%, P<.001; adjusted odds ratio 1.94, 95% confidence interval 1.80-2.09).

Conclusions: Oregon's statewide policy to limit elective early-term delivery was associated with a reduction in elective early-term deliveries, but no improvement in maternal or neonatal outcomes.
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http://dx.doi.org/10.1097/AOG.0000000000001737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5121072PMC
December 2016

Credit where due.

J Vasc Surg 2016 Aug 8;64(2):530-533. Epub 2016 Jun 8.

Department of Surgery, Weill Cornell Medical College, New York, NY. Electronic address:

The history of medicine is filled with stories of tireless researchers who failed to get credit for their hard work. Examples of this include Rosalind Franklin, who helped to elucidate the structure of DNA; Frederick Banting, who helped to discover insulin; and Jay McLean, who discovered heparin. The founding of the field of vascular surgery provides one of the most vivid examples of uncredited work. Even though Alexis Carrel was an unpaid, untitled assistant in Charles Guthrie's laboratory, it was Carrel alone who received a Nobel Prize for their work. In an attempt to give credit where due, the reasons for this injustice are described.
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http://dx.doi.org/10.1016/j.jvs.2016.04.033DOI Listing
August 2016

Time to change the general surgery MOC exam.

Bull Am Coll Surg 2016 Feb;101(2):45

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February 2016

Assessing anxiety in Black men with prostate cancer: further data on the reliability and validity of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC).

Support Care Cancer 2016 07 4;24(7):2905-11. Epub 2016 Feb 4.

Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY, 10022, USA.

Purpose: The National Cancer Institute has highlighted the need for psychosocial research to focus on Black cancer patients. This applies to Black men with prostate cancer, as there is little systematic research concerning psychological distress in these men. This study was designed to validate the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) in Black men with prostate cancer to help facilitate research within this group.

Methods: At three institutions, Black men with prostate cancer (n = 101) completed the MAX-PC, the Hospital Anxiety and Depression Scale (HADS), the Functional Assessment of Cancer Therapy (FACT) Quality of Life Questionnaire, and the Distress Thermometer.

Results: The average age of the 101 men was 66 (SD = 10) and 58 % had early-stage disease. The MAX-PC and its subscales (Prostate Cancer Anxiety, PSA Anxiety, and Fear of Recurrence) produced strong coefficient alphas (0.89, 0.88, 0.71, and 0.77, respectively). Factor analysis supported the three-factor structure of the scale established in earlier findings. The MAX-PC also demonstrated strong validity. MAX-PC total scores correlated highly with the Anxiety subscale of the HADS (r = 0.59, p < 0.01) and the FACT Emotional Well-Being subscale (r = -0.55, p < 0.01). Demonstrating discriminant validity, the correlation with the HADS Depression subscale (r = 0.40, p < 0.01) and the CES-D (r = 0.42, p < 0.01) was lower compared to that with the HADS Anxiety subscale.

Conclusions: The MAX-PC is valid and reliable in Black men with prostate cancer. We hope the validation of this scale in Black men will help facilitate psychosocial research in this group that is disproportionately adversely affected by this cancer.
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http://dx.doi.org/10.1007/s00520-016-3092-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879077PMC
July 2016

The end-to-end anastomosis of John B. Murphy.

J Vasc Surg 2015 Aug 6;62(2):515-7. Epub 2015 Jun 6.

Department of Surgery, Weill Cornell Medical College, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2015.03.046DOI Listing
August 2015

Helmet-Wearing Practices and Barriers in Toronto Bike-Share Users: a Case-Control Study.

CJEM 2016 Jan 1;18(1):28-36. Epub 2015 Jun 1.

¶Faculty of Medicine,University of Ottawa,ON.

Background: Helmet use among bike-share users is low. We sought to characterize helmet-use patterns, barriers to helmet use, and cycling safety practices among bike-share users in Toronto.

Methods: A standardized survey of public bike-share program (PBSP) users at semi-random distribution of PBSP stations was undertaken. By maintaining a ratio of one helmet-wearer (HW): two non-helmet-wearers (NHW) per survey period, we controlled for location, day, time, and weather.

Results: Surveys were completed on 545 (180 HW, 365 NHW) unique users at 48/80 PBSP locations, from November 2012 to August 2013. More females wore helmets (F: 41.1%, M: 30.9%, p=0.0423). NHWs were slightly younger than HWs (NHW mean age 34.4 years vs HW 37.3, p=0.0018). The groups did not differ by employment status, education, or income. Helmet ownership was lower among NHWs (NHW: 62.4% vs HW: 99.4%, p<0.0001), as was personal bike ownership (NHW: 65.8%, vs HW: 78.3%, p=0.0026). NHWs were less likely to always wear a helmet on personal bikes (NHW: 22.2% vs HW: 66.7%, p<0.0001), and less likely to wear a helmet always or most of the time on PBSP (NHW: 5.8% vs HW: 92.3%, p<0.0001). Both groups, but more HWs, had planned to use PBSP when leaving their houses (HW: 97.2% vs NHW: 85.2%, p<0.0001), primarily to get to work (HW: 88.3% vs NHW: 84.1%, p=0.19). NHWs were more likely to report that they would wear a helmet more (NHW: 61.4% vs HW: 13.9%, p<0.0001), and/or cycle less (NHW: 22.5% vs HW: 4.4%) if helmet use was mandatory.

Conclusions: PBSP users surveyed appear to make deliberate decisions regarding helmet use. NHWs tended to be male, slightly younger, and less likely to use helmets on their personal bikes. As Toronto cyclists who do not wear helmets on PBSP generally do not wear helmets on their personal bikes, interventions to increase helmet use should target both personal and bike-share users. Legislating helmet use and provision of rental helmets could improve helmet use among bike-share users, but our results suggest some risk of reduced cycling with legislation.
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http://dx.doi.org/10.1017/cem.2015.22DOI Listing
January 2016

Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics.

BMJ Open 2015 Jan 5;5(1):e006654. Epub 2015 Jan 5.

School of Population and Public Health, University of British Columbia, Vancouver, Canada.

Objective: To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics.

Methods: Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics.

Results: Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission).

Conclusions: In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians.
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http://dx.doi.org/10.1136/bmjopen-2014-006654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289714PMC
January 2015

Bicycling crash circumstances vary by route type: a cross-sectional analysis.

BMC Public Health 2014 Nov 22;14:1205. Epub 2014 Nov 22.

School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada.

Background: Widely varying crash circumstances have been reported for bicycling injuries, likely because of differing bicycling populations and environments. We used data from the Bicyclists' Injuries and the Cycling Environment Study in Vancouver and Toronto, Canada, to describe the crash circumstances of people injured while cycling for utilitarian and leisure purposes. We examined the association of crash circumstances with route type.

Methods: Adult cyclists injured and treated in a hospital emergency department described their crash circumstances. These were classified into major categories (collision vs. fall, motor vehicle involved vs. not) and subcategories. The distribution of circumstances was tallied for each of 14 route types defined in an earlier analysis. Ratios of observed vs. expected were tallied for each circumstance and route type combination.

Results: Of 690 crashes, 683 could be characterized for this analysis. Most (74%) were collisions. Collisions included those with motor vehicles (34%), streetcar (tram) or train tracks (14%), other surface features (10%), infrastructure (10%), and pedestrians, cyclists, or animals (6%). The remainder of the crashes were falls (26%), many as a result of collision avoidance manoeuvres. Motor vehicles were involved directly or indirectly with 48% of crashes. Crash circumstances were distributed differently by route type, for example, collisions with motor vehicles, including "doorings", were overrepresented on major streets with parked cars. Collisions involving streetcar tracks were overrepresented on major streets. Collisions involving infrastructure (curbs, posts, bollards, street furniture) were overrepresented on multiuse paths and bike paths.

Conclusions: These data supplement our previous analyses of relative risks by route type by indicating the types of crashes that occur on each route type. This information can guide municipal engineers and planners towards improvements that would make cycling safer.
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http://dx.doi.org/10.1186/1471-2458-14-1205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253622PMC
November 2014

Evaluating the impact of environmental interventions across 2 countries: the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS) Study protocol.

BMC Public Health 2014 Oct 25;14:1103. Epub 2014 Oct 25.

Department of Community Health and Epidemiology, University of Saskatchewan, Saskatchewan, Canada.

Background: Few international studies examine public bicycle share programs (PBSP) health impacts. We describe the protocol for the International Bikeshare Impacts on Cycling and Collisions Study (IBICCS).

Methods: A quasi-experimental non-equivalent groups design was used. Intervention cities (Montreal, Toronto, Boston, New York and Vancouver) were matched to control cities (Chicago, Detroit, and Philadelphia) on total population, population density, cycling rates, and average yearly temperature. The study used three repeated, cross-sectional surveys in intervention and control cities in Fall 2012 (baseline), 2013 (year 1), and 2014 (year 2). A non-probabilistic online panel survey with a sampling frame of individuals residing in and around areas where PBSP are/would be implemented was used. A total of 12,000 respondents will be sampled. In each of the 8 cities 1000 respondents will be sampled with an additional 4000 respondents sampled based on the total population of the city. Survey questions include measures of self-rated health, and self-reported height and weight, knowledge and experience using PBSP, physical activity, bicycle helmet use and history of collisions and injuries while cycling, socio-demographic questions, and home/workplace locations. Respondents could complete questionnaires in English, French, and Spanish. Two weights will be applied to the data: inverse probability of selection and post-stratification on age and sex.A triple difference analysis will be used. This approach includes in the models, time, exposure, and treatment group, and interaction terms between these variables to estimate changes across time, between exposure groups and between cities.

Discussion: There are scientific and practical challenges in evaluating PBSP. Methodological challenges included: appropriate sample recruitment, exchangeability of treatment and control groups, controlling unmeasured confounding, and specifying exposure. Practical challenges arise in the evaluation of environmental interventions such as a PBSP: one of the companies involved filed for bankruptcy, a Hurricane devastated New York City, and one PBSP was not implemented. Overall, this protocol provides methodological and practical guidance for researchers wanting to study PBSP impacts on health.
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http://dx.doi.org/10.1186/1471-2458-14-1103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232659PMC
October 2014

Charles Dotter and the fiftieth anniversary of endovascular surgery.

J Vasc Surg 2015 Feb 11;61(2):556-8. Epub 2014 Oct 11.

Department of Surgery, Weill Cornell Medical College, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2014.09.012DOI Listing
February 2015

The first carotid endarterectomy.

J Vasc Surg 2014 Dec 16;60(6):1703-8.e1-4. Epub 2014 Sep 16.

Department of Surgery, Weill Cornell Medical College, New York, NY. Electronic address:

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http://dx.doi.org/10.1016/j.jvs.2014.08.059DOI Listing
December 2014

Heterochromatin controls γH2A localization in Neurospora crassa.

Eukaryot Cell 2014 Aug 30;13(8):990-1000. Epub 2014 May 30.

Department of Microbiology, University of Georgia, Athens, Georgia, USA

In response to genotoxic stress, ATR and ATM kinases phosphorylate H2A in fungi and H2AX in animals on a C-terminal serine. The resulting modified histone, called γH2A, recruits chromatin-binding proteins that stabilize stalled replication forks or promote DNA double-strand-break repair. To identify genomic loci that might be prone to replication fork stalling or DNA breakage in Neurospora crassa, we performed chromatin immunoprecipitation (ChIP) of γH2A followed by next-generation sequencing (ChIP-seq). γH2A-containing nucleosomes are enriched in Neurospora heterochromatin domains. These domains are comprised of A·T-rich repetitive DNA sequences associated with histone H3 methylated at lysine-9 (H3K9me), the H3K9me-binding protein heterochromatin protein 1 (HP1), and DNA cytosine methylation. H3K9 methylation, catalyzed by DIM-5, is required for normal γH2A localization. In contrast, γH2A is not required for H3K9 methylation or DNA methylation. Normal γH2A localization also depends on HP1 and a histone deacetylase, HDA-1, but is independent of the DNA methyltransferase DIM-2. γH2A is globally induced in dim-5 mutants under normal growth conditions, suggesting that the DNA damage response is activated in these mutants in the absence of exogenous DNA damage. Together, these data suggest that heterochromatin formation is essential for normal DNA replication or repair.
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http://dx.doi.org/10.1128/EC.00117-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135800PMC
August 2014

Incidental findings of elevated random plasma glucose in the ED as a prompt for outpatient diabetes screening: a retrospective study.

BMJ Open 2013 Dec 18;3(12):e003486. Epub 2013 Dec 18.

Faculty of Medicine, DFCM, Emergency Medicine, University Health Network, University of Toronto, Toronto, Canada.

Objective: To determine whether random plasma glucose (RPG) collected from patients without known impaired glucose metabolism (IGM) in the emergency department (ED) is a useful screen for diabetes or prediabetes.

Design: Retrospective cohort study.

Setting: ED of a Canadian teaching hospital over 1 month.

Participants: Adult patients in ED with RPG over 7 mmol/L were recruited for participation. Exclusion criteria included known diabetes, hospital admission and inability to consent. Participants were contacted by mail, encouraged to follow-up with their family physician (FP) for further testing and subsequently interviewed.

Outcome Measures: The primary outcome measure was the proportion of patients in the ED with RPG over 7 mmol/L and no previous diagnosis of IGM who were diagnosed with diabetes or prediabetes after secondary testing by FP with oral glucose tolerance test or fasting plasma glucose (FPG). Secondary outcomes included patient characteristics (age, gender, body mass index and language) and (2) compliance with advice to seek an appropriate follow-up care.

Results: RPG was drawn on approximately one-third (33%, n=1149) of the 3470 patients in the ED in March 2010. RPG over 7 mmol/L was detected in 24% (n=278) of patients, and after first telephone follow-up, 32% (n=88/278) met the inclusion criteria and were advised to seek confirmatory testing. 41% (n=114/278) of patients were excluded for known diabetes. 73% of patients contacted (n=64/88) followed up with their FP. 12.5% (n=11/88) of patients had abnormal FPG, and of these 11% (n=10/88) were encouraged to initiate lifestyle modifications and 1% (n=1/88) was started on an oral hypoglycaemic agent. For 7% (n=6/88) of patients, FP's declined to do follow-up fasting blood work.

Conclusions: Elevated RPG in the ED is useful for identification of patients at risk for IGM and in need of further diabetic screening. Emergency physicians should advise patients with elevated RPG to consider screening for diabetes. For ED screening to be successful, patient education and collaboration with FPs are essential.
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http://dx.doi.org/10.1136/bmjopen-2013-003486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884805PMC
December 2013

Clinical impact of diagnostic imaging discrepancy by radiology trainees in an urban teaching hospital emergency department.

Int J Emerg Med 2013 Jul 16;6(1):24. Epub 2013 Jul 16.

Emergency Medicine - University Health Network, Faculty of Medicine, University of Toronto, RFE G-S434, 200 Elzaibeth Street, Toronto, Ontario M5G 2C4, Canada.

Background: To characterize clinically significant diagnostic imaging (DI) discrepancies by radiology trainees and the impact on emergency department (ED) patients.

Methods: Consecutive case series methodology over a 6-month period in an urban, tertiary care teaching hospital. Emergency physicians (EPs) were recruited to flag discrepant DI interpretations by radiology trainees that the EP deemed clinically significant. Cases were characterized using chart review and EP interview.

Results: Twenty-eight discrepant reports were identified (representing 0.1% of 18,185 images interpreted). The mean time between provisional discrepant diagnosis (PDDx) and revised diagnosis (RDx) by attending radiology staff was 8.6 h (median 4.8 h, range 1.1-48.4), and 67.9% (n = 19) of the patients had left the ED by time of notification. The most frequently reported PDDx was CT abd/pelvis (32.1%, n = 9) and CT head (28.6%, n = 8). The impact of RDx was deemed major in 57.1% (n = 16) for reasons including altered admitting status (32.1%, n = 9), immediate subspecialty referral (n = 16, 57.1%), impact on management (25%, n = 7), and surgical management (21.4%, n = 6). EPs reported likely perceived impact of PDDx as resulting in increased pain (17. 9%, n = 5), morbidity (10.7%, n = 3), and prolonged hospitalization (25%, n = 7), but not altered long-term outcome or mortality.

Conclusions: Relatively few clinically important discrepant reads were reported. Revised diagnosis (RDx) was associated with major clinical impact in 57.1% of reports, but few patients experienced increased morbidity, and none increased mortality. The importance of expedient communication of discrepant reports by staff radiologists is stressed, as is EP verification of patient contact information prior to discharge.
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http://dx.doi.org/10.1186/1865-1380-6-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716958PMC
July 2013

Implementation of timeline reforms speeds initiation of National Cancer Institute-sponsored trials.

J Natl Cancer Inst 2013 Jul 17;105(13):954-9. Epub 2013 Jun 17.

Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD 20852, USA.

Background: The National Cancer Institute (NCI) organized the Operational Efficiency Working Group in 2008 to develop recommendations for improving the speed with which NCI-sponsored clinical trials move from the idea stage to a protocol open to patient enrollment.

Methods: Given the many stakeholders involved, the Operational Efficiency Working Group advised a multifaceted approach to mobilize the entire research community to improve their business processes. New staff positions to monitor progress, protocol-tracking Web sites, and strategically planned conference calls were implemented. NCI staff and clinical teams at Cooperative Groups and Cancer Centers strived to achieve new target timelines but, most important, agreed to abide by absolute deadlines. For phase I-II studies and phase III studies, the target timelines are 7 months and 10 months, whereas the absolute deadlines were set at 18 and 24 months, respectively. Trials not activated by the absolute deadline are automatically disapproved.

Results: The initial experience is encouraging and indicates a reduction in development times for phase I-II studies from the historical median of 541 days to a median of 442 days, an 18.3% decrease. The experience with phase III studies to date, although more limited (n = 25), demonstrates a 45.7% decrease in median days.

Conclusions: Based upon this progress, the NCI and the investigator community have agreed to reduce the absolute deadlines to 15 and 18 months for phase I-II and III trials, respectively. Emphasis on initiating trials rapidly is likely to help reduce the time it takes for clinical trial results to reach patients in need of new treatments.
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http://dx.doi.org/10.1093/jnci/djt137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699438PMC
July 2013

Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case-crossover design.

Inj Prev 2013 Oct 14;19(5):303-10. Epub 2013 Feb 14.

School of Occupational and Public Health, Ryerson University, , Toronto, Ontario, Canada.

Background: This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk.

Methods: In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case-crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801).

Results: At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections.

Conclusions: These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.
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http://dx.doi.org/10.1136/injuryprev-2012-040561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786647PMC
October 2013