Stewart W.F.,Sutter Health |
Schwartz B.S.,00 North Academy Ave
Health and Place | Year: 2013
Coal abandoned mine lands (AMLs), persistent and prevalent across Pennsylvania, offer an instructive evaluation of potential contextual influences of chronic environmental contamination (CEC) on individual health. We evaluated associations between the burden of AMLs, represented by 10 contextual metrics at the community level, and individual-level type 2 diabetes using hemoglobin A1c (HbA1c) as a biomarker. Cross-sectional and longitudinal multilevel analyses were conducted with over 28,000 diabetic primary care patients of the Geisinger Clinic. Adjusted models revealed five AML burden measures were associated (p<0.05), and three additional were borderline associated (0.05≤. p≤0.10), with higher and/or change in HbA1c levels. This study provides key empirical evidence of adverse impacts of CEC in communities on an important chronic disease, illustrating the contextual effects of living in long-term degraded landscapes and communities. © 2013 Elsevier Ltd.
Dries D.,HealthPartners Medical Group |
Dries D.,University of Minnesota |
Reed M.J.,00 North Academy Ave |
Kissoon N.,University of British Columbia |
And 4 more authors.
Chest | Year: 2014
BACKGROUND: Past disasters have highlighted the need to prepare for subsets of critically ill, medically fragile patients. These special patient populations require focused disaster planning that will address their medical needs throughout the event to prevent clinical deterioration. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with multiple critically ill or injured patients, including frontline clinicians, hospital administrators, and public health or government officials. METHODS: Key questions regarding the care of critically ill or injured special populations during disasters or pandemics were identified, and a systematic literature review (1985-2013) was performed. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. The panel did not include pediatrics as a separate special population because pediatrics issues are embedded in each consensus document. RESULTS: Fourteen suggestions were formulated regarding the care of critically ill and injured patients from special populations during pandemics and disasters. The suggestions cover the following areas: defining special populations for mass critical care, special population planning, planning for access to regionalized service for special populations, triage and resource allocation of special populations, therapeutic considerations, and crisis standards of care for special populations. CONCLUSIONS: Chronically ill, technologically dependent, and complex critically ill patients present a unique challenge to preparing and implementing mass critical care. There are, however, unique opportunities to engage patients, primary physicians, advocacy groups, and professional organizations to lessen the impact of disaster on these special populations. © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS.
Salhia B.,Translational Genomics Research Institute |
Toms S.A.,00 North Academy Ave
International Journal of Molecular Sciences | Year: 2014
Metastasis to the central nervous system (CNS) remains a major cause of morbidity and mortality in patients with systemic cancer. As the length of survival in patients with systemic cancer improves, thanks to multimodality therapies, focusing on metastases to the CNS becomes of paramount importance. Unique interactions between the brain's micro-environment, blood-brain barrier, and tumor cells are hypothesized to promote distinct molecular features in CNS metastases that may require tailored therapeutic approaches. This review will focus on the pathophysiology, epigenetics, and immunobiology of brain metastases in order to understand the metastatic cascade. Cancer cells escape the primary tumor, intravasate into blood vessels, survive the hematogenous dissemination to the CNS, arrest in brain capillaries, extravasate, proliferate, and develop angiogenic abilities to establish metastases. Molecular biology, genetics, and epigenetics are rapidly expanding, enabling us to advance our knowledge of the underlying mechanisms involved. Research approaches using cell lines that preferentially metastasize in vivo to the brain and in vitro tissue-based studies unfold new molecular leads into the disease. It is important to identify and understand the molecular pathways of the metastatic cascade in order to target the investigation and development of more effective therapies and research directions. © 2014 by the authors; licensee MDPI, Basel, Switzerland.
Elston D.M.,00 North Academy Ave
Current Opinion in Infectious Diseases | Year: 2010
Purpose of Review: Fever and a rash following a tick bite can signify a true medical emergency. Ticks are important vectors of disease worldwide, including Rocky Mountain spotted fever, Lyme disease, and Congo-Crimean hemorrhagic fever. This paper will review the major ticks of medical importance and the diseases they transmit, including important emerging pathogens. Recent Findings: Rocky Mountain spotted fever continues to be the most lethal tick-borne illness in the United States and is emerging as an important disease in South America. Other important emerging diseases include human anaplasmosis, southern tick associated rash illness, human monocytic ehrlichiosis, and a variety of rickettsial fevers including those caused by Rickettsia parkeri and Rickettsia amblyommii. Summary: Most tick-borne illnesses respond readily to doxycycline therapy. In the case of Rocky Mountain spotted fever, therapy should be started when the disease is suspected and should never be delayed for confirmatory tests. Accurate identification of tick vectors can help establish a diagnosis and can help guide preventive measures to reduce the burden of disease. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Gogoi R.P.,00 North Academy Ave |
Urban R.,University of Washington |
Sun H.,00 North Academy Ave |
Goff B.,University of Washington
Gynecologic Oncology | Year: 2012
Objectives: The Society of Gynecologic Oncologists has developed two measures to assess and improve the surgical care of patients with ovarian cancer (1) description of residual disease following cytoreduction and (2) adequacy of surgical staging. Our aim was to establish baseline surgeon compliance with these two measures. Methods: A retrospective review of patients with ovarian, fallopian tube or peritoneal cancer undergoing surgery between 7/1/2006 and 7/1/2011 for the purposes of staging and/or cytoreduction was performed at the University of Washington and Geisinger Medical Center. Operative and pathology reports were reviewed to obtain information pertaining to stage, histology, residual disease after surgery and the extent of surgical staging. Results: 537 cases were identified; 91% with ovarian cancer. 61% of patients had at least stage IIIC disease; 15% had recurrent disease and 16% had neoadjuvant therapy. For patients with stages I-IIIB disease, 74% had full surgical staging, 10% did not have full surgical staging but documented the reason for this in the operative report; 15% did not have full surgical staging, no reason was noted. 25% of all operative reports lacked documentation of residual disease with 40% documenting no gross residual disease, 18% with residual disease < 1 cm and 18% had suboptimal debulking with > 1 cm disease remaining. There was a statistically significant increase in appropriate documentation of amount of residual disease over time (p < 0.001). Conclusions: Our study sets benchmarks for evaluation of documentation in gynecologic oncology centers. Improved documentation and staging will allow for equivalent standards of care across institutions. © 2012 Elsevier Inc. All rights reserved.