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Coral Gables, FL, United States

The University of Miami is a private, nonsectarian university located in Coral Gables, Florida, United States. As of 2012, the university currently enrolls 15,613 students in 12 separate colleges, including a medical school located in Miami's Civic Center neighborhood, a law school on the main campus, and a school focused on the study of oceanography and atmospheric science on Virginia Key. These colleges offer approximately 115 undergraduate, 114 master's, 51 doctoral, and two professional areas of study. Over the years, the University's students have represented all 50 states and close to 150 foreign countries. With more than 13,000 full and part-time faculty and staff, UM is the sixth largest employer in Miami-Dade County.Research is a component of each academic division, with UM attracting $346.6 million per year in sponsored research grants. UM offers a large library system with over 3.1 million volumes and exceptional holdings in Cuban heritage and music. UM also offers a wide range of student activities, including fraternities and sororities, a student newspaper and radio station. UM's intercollegiate athletic teams, collectively known as the Miami Hurricanes, compete in Division I of the National Collegiate Athletic Association, and its football team has won five national championships since 1983. Wikipedia.

DiNezio P.N.,University of Hawaii at Manoa | Vecchi G.A.,National Oceanic and Atmospheric Administration | Clement A.C.,University of Miami
Journal of Climate | Year: 2013

Changes in the gradients in sea level pressure (SLP) and sea surface temperature (SST) along the equatorial Pacific are analyzed in observations and 101 numerical experiments performed with 37 climate models participating in the fifth phase of the Coupled Model Intercomparison Project (CMIP5). The ensemble of numerical experiments simulates changes in the earth's climate during the 2004-1870 period in response to changes in natural (solar variations and volcanoes) and anthropogenic (well-mixed greenhouse gases, ozone, direct aerosol forcing, and land use) radiative forcings. A reduction in the zonal SLP gradient is present in observational records and is the typical response of the ensemble, yet only 26 out of the 101 experiments exhibit a reduced SLP gradient within 95% statistical confidence of the observed value. The multimodel response indicates a reduction of the Walker circulation to historical forcings, albeit an order of magnitude smaller than the observed value. There are multiple nonexclusive interpretations of these results: (i) the observed trend may not be entirely forced and includes a substantial component from internal variability; (ii) there are problems with the observational record that lead to a spuriously large trend; and (iii) the strength of theWalker circulation, as measured by the zonal SLP gradient, may be less sensitive to external forcing in models than in the real climate system. Analysis of a subset of experiments suggests that greenhouse gases act to weaken the circulation, but aerosol forcing drives a strengthening of the circulation, which appears to be overestimated by the models, resulting in a muted response to the combined anthropogenic forcings. © 2013 American Meteorological Society.

Korotkova O.,University of Miami | Shchepakina E.,Samara State Aerospace University
Optics Letters | Year: 2010

The dependence of spectral shifts and switches in optical stochastic beams propagating through nonclassic turbulent medium on the slope of the power spectrum of fluctuations in the refractive index is revealed. © 2010 Optical Society of America.

Dietz N.A.,University of Miami
Preventing chronic disease | Year: 2010

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n approximately 1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking.

Campos M.P.,University of Miami
Revista da Associação Médica Brasileira (1992) | Year: 2011

Cancer-related fatigue is the most prevalent cancer symptom, reported in 50%-90% of patients and severely impacts quality of life and functional capacity. The condition remains underreported and often goes untreated. Guidelines suggest screening for fatigue at the initial visit, when the diagnosis of advanced disease is made, and at each chemotherapy session, as well as the identification of treatable contributing factors such as anemia, hypothyroidism, depression and sleep disorders. Brief assessment tools such as the Brief Fatigue Inventory or the Visual Analog Scale may be appropriate in the initial scoring of fatigue severity, but the initial approach to treatment usually requires a more comprehensive assessment, education, and the determination of an individualized treatment plan. Patients with moderate or severe fatigue may benefit from both pharmacological and non-pharmacological interventions, whereas mild fatigue that does not interfere with quality of life can be treated with non-pharmacological measures alone. Non-pharmacological measures that have shown to be promising include cognitive-behavioral interventions such as energy conservation and activity management (ECAM), exercise and perhaps sleep therapy. Many other modalities may be beneficial and can be used on an individual basis, but there is insufficient evidence to promote any single treatment. Pharmacological therapies that have shown to be promising include the psycho-stimulants methylphenidate and dexmethylphenidate, modafinil (in severely fatigued patients only), and erythropoietin-stimulating agents in patients with chemotherapy-associated anemia and hemoglobin levels < 10 g/dL. Recently, our group reported impressive results with the use of the dry extract of Guarana (Paullinia cupana), with no significant side effects and at low cost, for the treatment of physical and mental cancer-related fatigue.

Kerdel F.A.,University of Miami
Seminars in cutaneous medicine and surgery | Year: 2014

Several nonsurgical strategies for managing hidradenitis suppurativa (HS) are used that are successful in many patients. The overall goals of pharmacologic therapy are to clear or reduce the number and extent of current lesions and to prevent new lesions from forming. No pharmacologic agent is universally effective in all patients with HS, and, to date, none has been approved for this indication by the US Food and Drug Administration. Among the agents most commonly used are topical and systemic antibiotics and intralesional and systemic corticosteroids. Within the past decade, clinical experience with biologic agents-principally, tumor necrosis factor inhibitors-has been described, and the results of clinical trials with these agents in patients with HS have been promising. 2014 published by Frontline Medical Communications.

Lebwohl M.,Mount Sinai School of Medicine | Swanson N.,Oregon Health And Science University | Anderson L.L.,Dermatology Associates of Tyler | Melgaard A.,Data Management | And 2 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Actinic keratosis is a common precursor to sun-related squamous-cell carcinoma. Treating actinic keratoses and the surrounding skin area (i.e., field therapy) can eradicate clinical and subclinical actinic keratoses. Topical field therapy currently requires weeks or months of treatment. We investigated the efficacy and safety of a new topical field therapy for actinic keratosis, ingenol mebutate gel (0.015% for face and scalp and 0.05% for trunk and extremities). METHODS: In four multicenter, randomized, double-blind studies, we randomly assigned patients with actinic keratoses on the face or scalp or on the trunk or extremities to receive ingenol mebutate or placebo (vehicle), self-applied to a 25-cm 2 contiguous field once daily for 3 consecutive days for lesions on the face or scalp or for 2 consecutive days for the trunk or extremities. Complete clearance (primary outcome) was assessed at 57 days, and local reactions were quantitatively measured. RESULTS: In a pooled analysis of the two trials involving the face and scalp, the rate of complete clearance was higher with ingenol mebutate than with placebo (42.2% vs. 3.7%, P<0.001). Local reactions peaked at day 4, with a mean maximum composite score of 9.1 on the local-skin-response scale (which ranges from 0 to 4 for six types of reaction, yielding a composite score of 0 to 24, with higher numbers indicating more severe reactions), rapidly decreased by day 8, and continued to decrease, approaching baseline scores by day 29. In a pooled analysis of the two trials involving the trunk and extremities, the rate of complete clearance was also higher with ingenol mebutate than with placebo (34.1% vs. 4.7%, P<0.001). Local skin reactions peaked between days 3 and 8 and declined rapidly, approaching baseline by day 29, with a mean maximum score of 6.8. Adverse events were generally mild to moderate in intensity and resolved without sequelae. CONCLUSIONS: Ingenol mebutate gel applied topically for 2 to 3 days is effective for field treatment of actinic keratoses. (Funded by LEO Pharma; ClinicalTrials.gov numbers, NCT00742391, NCT00916006, NCT00915551, and NCT00942604.) Copyright © 2012 Massachusetts Medical Society.

Swords R.,University of Miami | Freeman C.,St. Bartholomews Hospital | Giles F.,National University of Ireland
Leukemia | Year: 2012

Acute myeloid leukemia (AML) is a highly heterogenous disease with multiple signaling pathways contributing to its pathogenesis. A key driver of AML is the FMS-like tyrosine kinase receptor-3 (FLT3). Activating mutations in FLT3, primarily the FLT3-internal tandem duplication (FLT3-ITD), are associated with decreased progression-free and overall survival. Identification of the importance of FLT3-ITD and the FLT3 pathway in the prognosis of patients with AML has stimulated efforts to develop therapeutic inhibitors of FLT3. Although these inhibitors have shown promising antileukemic activity, they have had limited efficacy to date as single agents and may require use in combination with cytotoxic chemotherapies. Here, we review clinical and preclinical results for the clinically mature FLT3 inhibitors currently in development. We conclude that multitargeted FLT3 inhibitors may have more utility earlier in the course of disease, when in vitro evidence suggests that AML cells are less dependent on FLT3 signaling, perhaps because of upregulation of multiple other signaling pathways. More potent agents may have greater utility in relapsed and heavily pretreated patients, in whom high levels of circulating FLT3 ligand may necessitate use of an agent with a very favorable pharmacokinetic/ pharmacodynamic profile. Novel combination regimens are also discussed. © 2012 Macmillan Publishers Limited.

De Mamani A.G.W.,University of Miami
Journal of Nervous and Mental Disease | Year: 2010

This study examined the association of self-conscious emotions (shame and guilt) with general emotional distress (GED) and expressed emotion (EE) in family members of patients with schizophrenia. Fifty-seven relatives were given the test of self-conscious affect Tangney et al., 1989, The Test of Self-Conscious Affect. Fairfax, VA: George Mason University) to evaluate their proneness to shame and guilt and the Depression Anxiety Stress Scale Lovibond and Lovibond, 1995. Behav Res Ther. 33:335-343) to assess GED. Participants were also interviewed using the Camberwell Family Interview to measure EE. Consistent with Tangney's theory of self-conscious emotions and with study hypotheses, simultaneous regression analyses indicated that increasing shame proneness was strongly and positively associated with caregivers' reported GED whereas increasing guilt proneness was negatively associated with GED. Expressed emotion was not found to relate to self-conscious emotions nor to GED when rated as a dichotomous variable (high vs. low). However, greater shame proneness was associated with lower ratings of emotional overinvolvement, one component of EE. Study implications are discussed. Copyright © 2010 by Lippincott Williams & Wilkins.

Korotkova O.,University of Miami | Mei Z.,Huzhou University
Optics Letters | Year: 2015

The electromagnetic Schell-model beams whose cross-spectral matrices have elements belonging to different families of functions are considered for the first time. The spatial distributions of polarization properties of such beams are shown to be made completely or partially different from that of the average intensity. © 2015 Optical Society of America.

INTRODUCTION: Successfully addressing childhood onset obesity requires multilevel (individual, community, and governmental), multi-agency collaboration. METHODS: The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys (OWG) quasi-experimental controlled pilot study (four intervention schools, one control school, total N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention designed to keep children at a normal, healthy weight, and improve health status and academic achievement. The HOPS/OWG included the following replicable, holistic components: (1) modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]), blood pressure, and academic data were collected during the two-year study period (2004-6). RESULTS: Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls. CONCLUSION: Holistic school-based obesity prevention interventions can improve health outcomes and academic performance, in particular among high-risk populations.

Mei Z.,Huzhou University | Korotkova O.,University of Miami
Optics Letters | Year: 2015

We establish a sufficient condition under which the alternation series of cross-spectral densities (CSD) constitutes a valid CSD. Using such a condition, we introduce a novel class of multi-sinc Schell-model sources with circular and Cartesian symmetries. It is demonstrated that far fields produced by the new sources carry interesting characteristics, being adjustable multi-rings and lattice patterns. © 2015 Optical Society of America.

Mitchell J.W.,University of Miami | Sullivan P.S.,Emory University
Sexually Transmitted Diseases | Year: 2015

Background Many men who have sex with men acquire HIV while in a same-sex relationship. Studies with gay male couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, an in-home rapid HIV test (HT) has become available for purchase in the United States. However, HIV-negative partnered men's attitudes toward using an HT and whether characteristics of their relationship affect their use of HTs remain largely unknown. This information is relevant for the development of HIV prevention interventions targeting at-risk HIV-negative and HIV-discordant male couples. Methods To assess HIV-negative partnered men's attitudes and associated factors toward using an HT, a cross-sectional Internet-based survey was used to collect dyadic data from a national sample of 275 HIV-negative and 58 HIV-discordant gay male couples. Multivariate multilevel modeling was used to identify behavioral and relationship factors associated with 631 HIV-negative partnered men's attitudes toward using an HT. Results HIV-negative partnered men were "very likely" to use an HT. More positive attitudes toward using an HT were associated with being in a relationship of mixed or nonwhite race and with one or both men recently having had sex with a casual male partner. Less positive attitudes toward using an HT were associated with both partners being well educated, with greater resources (investment size) in the relationship, and with one or both men having a primary care provider. Conclusions These findings may be used to help improve testing rates via promotion of HTs among gay male couples. © 2015 by the American Sexually Transmitted Diseases Association.

Edwards K.J.,University of Southern California | Becker K.,University of Miami | Colwell F.,Oregon State University
Annual Review of Earth and Planetary Sciences | Year: 2012

Most ecosystems on Earth exist in permanent darkness, one or more steps removed from the light-driven surface world. This collection of dark habitats is the most poorly understood on Earth, in particular the size, function, and activity of these ecosystems and what influence they have on global biogeochemical processes. The vastest of these ecosystems constitute the "deep biosphere"-habitats physically located below the surface of continents and the bottom of the ocean. The deep biosphere has been the subject of considerable-and increasing-study and scrutiny in recent years. New deep biosphere realms are being explored from deep in mines in South Africa, to sediments in the middle of oceanic gyres-and beyond. New technologies are emerging, permitting researchers to do active, manipulable experimentation in situ within the subsurface. This review highlights recent history of the research and the exciting new directions this field of research is going in, and discusses some of the most active and interesting field realms currently under scrutiny by researchers examining this deep, dark, intraterrestrial life. © 2012 by Annual Reviews. All rights reserved.

Budenz D.L.,University of North Carolina at Chapel Hill | Gedde S.J.,University of Miami
Current Opinion in Ophthalmology | Year: 2014

PURPOSE OF REVIEW: To review the current literature regarding the effectiveness and risks of new surgeries that can be combined with phacoemulsification in the management of cataract and glaucoma. RECENT FINDINGS: Surgical options for concurrently managing cataract and glaucoma have expanded in recent years. Endoscopic cyclophotocoagulation, trabecular micro-bypass stent, ab interno trabeculectomy, and canaloplasty may be performed in conjunction with cataract extraction to provide additional intraocular pressure (IOP) reduction. Studies evaluating these new glaucoma procedures combined with phacoemulsification generally include retrospective case series without a comparison group. Because cataract surgery alone is associated with IOP reduction, the relative contribution of the glaucoma procedure in lowering IOP cannot be determined in these studies. Randomized clinical trials are needed to better evaluate the efficacy and safety of newer glaucoma procedures in combination with cataract surgery. SUMMARY: The newer glaucoma procedures appear less effective than trabeculectomy, but they are associated with a lower risk of surgical complications. © 2014 Wolters Kluwer Health.

Wong K.V.,University of Miami
Journal of Energy Resources Technology, Transactions of the ASME | Year: 2015

The clean, renewable sources of energy are the wind, water, and the sun. Geothermal energy from the Earth is a good source of energy for electricity generation that has not been fully utilized. Sustainable energy sources must have "respect for environment" in the center of the 4-cornered diamond. Respect for the environment is very critical for the energy sources to be long lasting and thus sustainable. Respect for the environment needs to be the central philosophy of keeping the three components of the environment clean and healthy. These components - air, water and the land, overlap three of the four sources of clean energy. Mankind has to be responsible custodians of these three natural resources. One main cause of the energy-water nexus is that about 90% of the world's electricity is manufactured following the Rankine cycle for power generation, and water is used for the removal of heat from the condenser. The energy-water-food nexus arise in some parts of the world mainly because of the local climatic conditions. High population density involved mainly with agriculture and adverse climatic events (floods from melting glaciers owing to climate change) are the major factors that cause these energy-water-food nexus problems. Areas identified to have these energy-water-food problems include several parts of Saharan Africa, Sub-Saharan Africa, the Arabian Peninsula, Japan, and the Punjab. Copyright © 2015 by ASME.

Negahdaripour S.,University of Miami
IEEE Transactions on Robotics | Year: 2013

Visual odometry involves the computation of 3-D motion and (or) trajectory by tracking features in the video or image sequences recorded by the camera(s) on some autonomous terrestrial, aerial, and marine robotics platform. For exploration, mapping, inspection, and surveillance operations within turbid waters, high-frequency 2-D forward-scan sonar systems offer a significant advantage over cameras by providing both imagery with target details and attractive tradeoff in range, resolution, and data rate. Operating these at grazing incidence gives larger scene coverage and improved image quality due to the dominance of diffuse backscattered reflectance but induces cast shadows that are typically more distinct than brightness patterns due to the direct reflectance of casting objects. For the computation of 3-D motion by automatic video processing, the estimation accuracy and robustness can be enhanced by integrating the visual cues from shadow dynamics with the image flow of stationary 3-D objects, both induced by sonar motion. In this paper, we present the mathematical models of image flow for 3-D objects and their cast shadows, utilize them in devising various 3-D sonar motion estimation solutions, and study their robustness. We present results of experiments with both synthetic and real data in order to assess the accuracy and performance of these methods. © 2004-2012 IEEE.

Tien J.M.,University of Miami
Journal of Systems Science and Systems Engineering | Year: 2013

At present, it is projected that about 4 zettabytes (or 10**21 bytes) of digital data are being generated per year by everything from underground physics experiments to retail transactions to security cameras to global positioning systems. In the U. S., major research programs are being funded to deal with big data in all five sectors (i.e., services, manufacturing, construction, agriculture and mining) of the economy. Big Data is a term applied to data sets whose size is beyond the ability of available tools to undertake their acquisition, access, analytics and/or application in a reasonable amount of time. Whereas Tien (2003) forewarned about the data rich, information poor (DRIP) problems that have been pervasive since the advent of large-scale data collections or warehouses, the DRIP conundrum has been somewhat mitigated by the Big Data approach which has unleashed information in a manner that can support informed - yet, not necessarily defensible or valid - decisions or choices. Thus, by somewhat overcoming data quality issues with data quantity, data access restrictions with on-demand cloud computing, causative analysis with correlative data analytics, and model-driven with evidence-driven applications, appropriate actions can be undertaken with the obtained information. New acquisition, access, analytics and application technologies are being developed to further Big Data as it is being employed to help resolve the 14 grand challenges (identified by the National Academy of Engineering in 2008), underpin the 10 breakthrough technologies (compiled by the Massachusetts Institute of Technology in 2013) and support the Third Industrial Revolution of mass customization. © 2013 Systems Engineering Society of China and Springer-Verlag Berlin Heidelberg.

Baim S.,University of Miami | Leslie W.D.,University of Manitoba
Current Osteoporosis Reports | Year: 2012

Osteoporosis-related fractures (low-trauma, fragility fractures) are associated with significant morbidity, mortality, and health care expenditure worldwide. In the absence of a defining fracture, the diagnosis of osteoporosis is based on the World Health Organization's T-score criteria using central dual-energy x-ray absorptiometry (DXA). Paradoxically, the majority of those patients who will sustain a low-trauma fracture do not meet the T-score definition of osteoporosis. Conversely, younger individuals with bone density in the osteoporotic range but no other risk factors have relatively low fracture rates and yet are frequently considered candidates for osteoporosis therapies. The limited accuracy of bone density testing alone to predict fractures has led to the development of a variety of fracture assessment tools that utilize the combination of bone density and clinical risk factors to improve the prediction of low-trauma fractures. These fracture assessment tools quantitatively predict the 10-year fracture probability of hip and major osteoporosis-related fractures, and can be used to define cost-effective intervention strategies for primary and secondary fracture prevention. © Springer Science+Business Media, LLC 2012.

Silverstein R.N.,University of Miami
Proceedings. Biological sciences / The Royal Society | Year: 2012

Some reef-building corals have been shown to respond to environmental change by shifting the composition of their algal symbiont (genus Symbiodinium) communities. These shifts have been proposed as a potential mechanism by which corals might survive climate stressors, such as increased temperatures. Conventional molecular methods suggest this adaptive capacity may not be widespread because few (∼25%) coral species have been found to associate with multiple Symbiodinium clades. However, these methods can fail to detect low abundance symbionts (typically less than 10-20% of the total algal symbiont community). To determine whether additional Symbiodinium clades are present, but are not detected using conventional techniques, we applied a high-resolution, real-time PCR assay to survey Symbiodinium (in clades A-D) from 39 species of phylogenetically and geographically diverse scleractinian corals. This survey included 26 coral species thought to be restricted to hosting a single Symbiodinium clade ('symbiotic specialists'). We detected at least two Symbiodinium clades (C and D) in at least one sample of all 39 coral species tested; all four Symbiodinium clades were detected in over half (54%) of the 26 symbiotic specialist coral species. Furthermore, on average, 68 per cent of all sampled colonies within a given coral species hosted two or more symbiont clades. We conclude that the ability to associate with multiple symbiont clades is common in scleractinian (stony) corals, and that, in coral-algal symbiosis, 'specificity' and 'flexibility' are relative terms: specificity is rarely absolute. The potential for reef corals to adapt or acclimatize to environmental change via symbiont community shifts may therefore be more phylogenetically widespread than has previously been assumed.

Wong K.V.,University of Miami
Journal of Energy Resources Technology, Transactions of the ASME | Year: 2014

The chronic water problems in parts of India are probably due mainly to mismanagement. The rolling blackout and brownout problems in the larger Indian cities are due to lack of generation capacity. Since about ninety percent of the world's electricity is generated based on the steam Rankine cycle, environmental water is necessary for cooling, and freshwater is used as the working fluid. Furthermore, electricity is tied to water as part of the bigger water energy nexus phenomena occurring worldwide. China has started and continued with many initiatives to correct problems with water management. Projects do exist where the climatically dry north is being fed water from the wet south. China has water energy nexus conditions occurring too. The review of the scientific literature on studies about the sources of the Ganges, the Yangtze, the Yellow river, the Indus and the Mekong (the drinking water source of about forty percent of the World's population), the glaciers that feed these sources and how they are shrinking with global warming, has yielded a simple policy decision. Mass balance considerations provide the answer that the logical solution of the recent accelerated water changing from solid to liquid on mountain tops, requires dams and storage areas (lakes) to prevent all that freshwater from escaping to the lowlands, and ultimately being discharged into the oceans. One of the other major contributions in this work is to suggest conversion of (old) Rankine cycle generation of electricity to (new) combined gas cycle generation and/or simple gas cycle generation. The combined gas cycle generation can achieve efficiencies of 55-60%, while that of the Rankine cycle power generation languishes around 30%. Less water is required per MW electric power generated for condenser cooling in the combined cycle. The simple gas cycle generation can achieve 40% thermal efficiency on the average and use no water for cooling. There is also the suggestion to upgrade to supercritical power plants due to the advances in power plant technologies. The improved thermal efficiencies gained from this upgrade generate other benefits as well. Another contribution is the suggestion to use seawater for closed system condenser cooling in power plants that are not near the sea or ocean or any large body of freshwater. The open system seawater condenser cooling has been practiced for years throughout the world. This will definitely reduce the demand for freshwater, which could otherwise be used for human consumption or agriculture. Additionally, the rising seas problem locally may be reduced somewhat if enough of the seawater is used. Copyright © 2014 by ASME.

Samson F.L.,University of Miami
Social Science and Medicine | Year: 2015

Racial resentment (also known as symbolic racism) is among the most widely tested measures of contemporary prejudice in political science and social psychological research over the past thirty years. Proponents argue that racial resentment reflects anti-black emotion obtained through pre-adult socialization. In light of affect-based models of substance use, this paper examined the association between racial resentment and smoking in a national sample of non-Hispanic white, black, and Hispanic respondents. Data come from the 2012 American National Election Study, which contained two measures of smoking. The results of ordinal logistic regression models indicate a positive association between racial resentment and smoking among non-Hispanic whites (N=2133) that is not present among blacks (N=693) or Hispanics (N=660). Models controlled for age, education, income, gender, political ideology, region, and mode of interview. Furthermore, analyses indicated that a measure of race-related affect, admiration and sympathy towards blacks, partially mediated the association between racial resentment and smoking. For non-Hispanic whites, racial resentment appears to constitute a risk factor for smoking. Future studies should further specify the conditions linking substance use to the race-related affective component of racial resentment. © 2014 Elsevier Ltd.

Korotkova O.,University of Miami
Optics Letters | Year: 2014

A class of random sources producing far fields with rectangular intensity profiles is introduced by modeling the source degree of coherence with the help of two one-dimensional multi-Gaussian distributions. By changing the rms correlation widths along the x and y directions and the number of terms in the summation of the multi-Gaussian functions, the shapes and the edge sharpness of the beams can be adjusted. The results based on the derived analytical expression for the far-zone spectral density are supplemented by the computer simulations. © 2013 Optical Society of America.

Wang C.,National Oceanic and Atmospheric Administration | Wang X.,University of Miami | Wang X.,National Oceanic and Atmospheric Administration
Journal of Climate | Year: 2013

Based on their opposite influences on rainfall in southern China during boreal fall, this paper classifies El Niño Modoki into two groups: El Niñ o Modoki I and II, which show different origins and patterns of SST anomalies. The warm SST anomalies originate in the equatorial central Pacific and subtropical northeastern Pacific for El Niño Modoki I and II, respectively. Thus, El Niñ o Modoki I shows a symmetric SST anomaly distribution about the equator with the maximum warming in the equatorial central Pacific, whereas El Niñ o Modoki II displays an asymmetric distribution with the warm SST anomalies extending from the northeastern Pacific to the equatorial central Pacific. Additionally, the warm SST anomalies in the equatorial central Pacific extend farther westward for El Niño Modoki II than for El Niño Modoki I. Similar to the canonical El Niñ o, El Niño Modoki I is associated with an anomalous anticyclone in the Philippine Sea that induces southwesterly wind anomalies along the south coast of China and carries the moisture for increasing rainfall in southern China. For El NiñoModoki II, an anomalous cyclone resides east of the Philippines, associated with northerly wind anomalies and a decrease in rainfall in southern China. The canonical El Niñ o and El Niñ o Modoki I are associated with a westward extension of the western North Pacific subtropical high (WNPSH), whereas El Niño Modoki II shifts the WNPSH eastward. Differing from canonical El Niño and El Niñ o Modoki I, El Niño Modoki II corresponds to northwesterly anomalies of the typhoon steering flow, which are unfavorable for typhoons to make landfall in China. © 2013 American Meteorological Society.

Painemal D.,NASA | Zuidema P.,University of Miami
Atmospheric Chemistry and Physics | Year: 2013

The first aerosol indirect effect (1AIE) is investigated using a combination of in situ and remotely-sensed aircraft (NCAR C-130) observations acquired during VOCALS-REx over the southeast Pacific stratocumulus cloud regime. Satellite analyses have previously identified a high albedo susceptibitility to changes in cloud microphysics and aerosols over this region. The 1AIE was broken down into the product of two independently-estimated terms: the cloud aerosol interaction metric ACI τ Combining double low linτ Na|LWP , and the relative albedo (A) susceptibility S Rτ Combining double low line A/3dτ|LWP, with τ/and N a denoting retrieved cloud optical thickness and in situ aerosol concentration respectively and calculated for fixed intervals of liquid water path (LWP). ACI τ was estimated by combining in situ N/a sampled below the cloud, with τ and LWP derived from, respectively, simultaneous upward-looking broadband irradiance and narrow field-of-view millimeter-wave radiometer measurements, collected at 1 Hz during four eight-hour daytime flights by the C-130 aircraft. ACIτ values were typically large, close to the physical upper limit (0.33), with a modest increase with LWP. The high ACI τ values slightly exceed values reported from many previous in situ airborne studies in pristine marine stratocumulus and reflect the imposition of a LWP constraint and simultaneity of aerosol and cloud measurements. S Rτ increased with LWP and τ, reached a maximum SR τ (0.086) for LWP (τ) of 58 g m-2 (∼14), and decreased slightly thereafter. The 1AIE thus increased with LWP and is comparable to a radiative forcing of-3.2-3.8 W m-2 for a 10% increase in Na, exceeding previously-reported global-range values. The aircraft-derived values are consistent with satellite estimates derived from instantaneous, collocated Clouds and the Earth's Radiant Energy System (CERES) albedo and MOderate resolution Imaging Spectroradiometer (MODIS)-retrieved droplet number concentrations at 50 km resolution. The consistency of the airborne and satellite estimates, despite their independent approaches, differences in observational scales, and retrieval assumptions, is hypothesized to reflect the ideal remote sensing conditions for these homogeneous clouds. We recommend the southeast Pacific for regional model assessments of the first aerosol indirect effect on this basis. This airborne remotely-sensed approach towards quantifying 1AIE should in theory be more robust than in situ calculations because of increased sampling. However, although the technique does not explicitly depend on a remotely-derived cloud droplet number concentration (Nd), the at-times unrealistically-high Nd values suggest more emphasis on accurate airborne radiometric measurements is needed to refine this approach. © 2013 Author(s).

Peak monsoon rainfall (PMR) data have been examined 135 years for five rainfall regions of the Indian subcontinent. S-transform analysis was used to analyse the non-stationarity in the periodicity of rainfall patterns over the study period. The results of the analyses revealed the presence of a 2-3 year cycle corresponding to the El Niño cycle, with periodic strengthening at the decadal scale across most of the regions as well as at the all India level. Further examination revealed that the 2-3 year cycle usually strengthened a few years before the beginning of the cold phase of the Pacific Decadal Oscillation (PDO), and this cycle continued through most of the cold phase. This 2-3 year cycle, however, was almost negligible during the subsequent warm phase of PDO for all regions except the central northeast region. Such a periodic strengthening of the periodicity in PMR during the cool phase of PDO is possibly caused by the differences in temperatures in different parts of the Pacific Ocean. © 2010 Royal Meteorological Society.

Wu X.,University of Miami
Ocean Dynamics | Year: 2011

Using 1-year simulated data from extended Prince William Sound (PWS) nowcast/forecast system, both barotropic and baroclinic transports through two-strait, semi-enclosed PWS are examined. With major tidal constituents removed, hourly time series of volume transports through two straits are significantly correlated with net transport well balanced by the time rate of change of the PWS spatial-mean sea level. A transition frequency band occurs within the coherence function of hourly volume transports, which is characterized by a nearly 180° phase shift between low-frequency (>30 h) and high-frequency (<6 h) bands. The transition band is implicitly related to the horizontally divergent and horizontally non-divergent flows inside the Sound. Further investigation of monthly and annual mean volume transports indicates strong seasonal variability of flows through two straits. On the other hand, baroclinic transport through PWS demonstrates the transition between a two-layered flow structure during the wintertime and a well-defined three-layered structure, i.e., inflow in both the surface and bottom layer with outflow in the intermediate layer, in the remainder of the year. This three-layer exchange flow is determined to be mainly buoyancy-driven, geostrophic flow, and thus largely affected by seasonal variability of buoyancy over the shelf and PWS. © 2011 Springer-Verlag.

There is a consistent positive and significant association between secondhand smoke exposure and mental health outcomes in the literature. There are potential genetic and behavioral confounders (e.g., psychological stress, maternal depression, and family functioning) were discussed, as well as potential causal neurobiological pathways (e.g., dopamine system).Further neurobiological research to establish causal pathways is needed as well as the integration of positive observational findings into clinical and public health prevention practices. © 2011 Elsevier Ltd.

Soden B.J.,University of Miami | Vecchi G.A.,National Oceanic and Atmospheric Administration
Geophysical Research Letters | Year: 2011

We assess the vertical distribution of cloud feedbacks in coupled climate models, taking care to distinguish between cloud feedbacks and a change in cloud forcing. We show that the effect of cloud changes on the longwave fluxes provides a strong positive feedback that is broadly consistent across models. In contrast, the effect of cloud changes on the shortwave fluxes ranges from a modest negative to a strong positive feedback, and is responsible for most of the intermodel spread in net cloud feedback. The feedback from high clouds is positive in all models, and is consistent with that anticipated by the Proportionately Higher Anvil Temperature hypothesis over the tropics. In contrast, low cloud cover is responsible for roughly three-quarters of the difference in global mean net cloud feedback among models, with the largest contributions from regions associated with low-level subtropical marine cloud systems. Copyright 2011 by the American Geophysical Union.

Cai X.,University of Miami | Bazerque J.A.,University of Minnesota | Giannakis G.B.,University of Minnesota
PLoS Computational Biology | Year: 2013

Integrating genetic perturbations with gene expression data not only improves accuracy of regulatory network topology inference, but also enables learning of causal regulatory relations between genes. Although a number of methods have been developed to integrate both types of data, the desiderata of efficient and powerful algorithms still remains. In this paper, sparse structural equation models (SEMs) are employed to integrate both gene expression data and cis-expression quantitative trait loci (cis-eQTL), for modeling gene regulatory networks in accordance with biological evidence about genes regulating or being regulated by a small number of genes. A systematic inference method named sparsity-aware maximum likelihood (SML) is developed for SEM estimation. Using simulated directed acyclic or cyclic networks, the SML performance is compared with that of two state-of-the-art algorithms: the adaptive Lasso (AL) based scheme, and the QTL-directed dependency graph (QDG) method. Computer simulations demonstrate that the novel SML algorithm offers significantly better performance than the AL-based and QDG algorithms across all sample sizes from 100 to 1,000, in terms of detection power and false discovery rate, in all the cases tested that include acyclic or cyclic networks of 10, 30 and 300 genes. The SML method is further applied to infer a network of 39 human genes that are related to the immune function and are chosen to have a reliable eQTL per gene. The resulting network consists of 9 genes and 13 edges. Most of the edges represent interactions reasonably expected from experimental evidence, while the remaining may just indicate the emergence of new interactions. The sparse SEM and efficient SML algorithm provide an effective means of exploiting both gene expression and perturbation data to infer gene regulatory networks. An open-source computer program implementing the SML algorithm is freely available upon request. © 2013 Cai et al.

Kollias P.,McGill University | Albrecht B.,University of Miami
Journal of Climate | Year: 2010

Fair-weather cumuli are fundamental in regulating the vertical structure of water vapor and entropy in the lowest 2-3 km of the earth's atmosphere over vast areas of the oceans. In this study, a long record of profiling cloud radar observations at the Atmospheric Radiation Measurement Program (ARM) Climate Research Facility (ACRF) at Nauru Island is used to investigate cloud vertical air motion statistics over an 8-yr observing period. Appropriate processing of the observed low radar reflectivities provides radar volume samples that contain only small cloud droplets; thus, the Doppler velocities are used as air motion tracers. The technique is applied to shallow boundary layer clouds (less than 1000 m thick) during the 1999-2007 period when radar data are available. Using the boundary layer winds from the soundings obtained at the Nauru ACRF, the fair-weather cumuli fields are classified in easterly and westerly boundary layer wind regimes. This distinction is necessary to separate marine-forced (westerlies) from land-forced (easterlies) shallow clouds because of a well-studied island effect at the Nauru ACRF. The two regimes exhibit large diurnal differences in cloud fraction and cloud dynamics as manifested by the analysis of the hourly averaged vertical air motion statistics. The fair-weather cumuli fields associated with easterlies exhibit a strong diurnal cycle in cloud fraction and updraft strength and fraction, indicating a strong influence of land-forced clouds. In contrast over the fair-weather cumuli with oceanic origin, land-forced clouds are characterized by uniform diurnal cloudiness and persistent updrafts at the cloud-base level. This study provides a unique observational dataset appropriate for testing fair-weather cumulus mass flux and turbulence parameterizations in numerical models. © 2010 American Meteorological Society.

Nolan D.S.,University of Miami
Journal of the Atmospheric Sciences | Year: 2013

A number of studies in recent years have used wind fields derived from portable Doppler radars in combination with the ground-based velocity track display (GBVTD) technique to diagnose the primary (tangential) and secondary (radial and vertical) circulations in tornadoes. These analyses indicate very strong vertical motions in the vortex core, in some cases with updrafts and downdrafts exceeding 100 m s-1. In addition, many of the analyses indicate strong radial outflow at low levels and in the vicinity of the low-level tangential wind maximum. This paper shows that strong outward motion at this location cannot be consistent with a tornado circulation that lasts more than a few minutes. In addition, using data from numerical simulations as truth, it is shown that using observed radial velocities to diagnose vertical velocities greatly overestimates the intensity of downward motion in the core for two reasons: neglect of the mass flux into the core through the swirling boundary layer, and the likely positive bias in low-level radial velocities due to the centrifuging of debris. Possible methods for accounting for these errors are briefly discussed. © 2013 American Meteorological Society.

Roper S.D.,University of Miami
Pflugers Archiv European Journal of Physiology | Year: 2015

Solutions of table salt (NaCl) elicit several tastes, including of course saltiness but also sweet, sour, and bitter. This brief review touches on some of the mileposts concerning what is known about taste transduction for the Na+ ion, the main contributor to saltiness. Electrophysiological recordings, initially from single gustatory nerve fibers, and later, integrated impulse activity from gustatory nerves led researchers to predict that Na+ ions interacted with a surface molecule. Subsequent studies have resolved that this molecule is likely to be an epithelial sodium channel, ENaC. Other Na+ transduction mechanisms are also present in taste buds but have not yet been identified. The specific type(s) of taste cells responsible for salt taste also remains unknown. © 2015, Springer-Verlag Berlin Heidelberg.

Oncogenic RAS-induced reactive oxygen species (ROS) trigger barriers to cell transformation and cancer progression through tumor-suppressive responses such as cellular senescence or cell death. We have recently shown that oncogenic RAS-induced DNA damage and attendant premature senescence can be prevented by overexpressing human MutT Homolog 1 (MTH1), the major mammalian detoxifier of the oxidized DNA precursor, 8-oxo-dGTP. Paradoxically, RAS-induced ROS are also able to participate in tumor progression via transformative processes such as mitogenic signaling, the epithelial-mesenchymal transition (EMT), anoikis inhibition and PI3K/Akt-mediated survival signaling. Here we provide a preliminary insight into the influence of MTH1 levels on the EMT phenotype and Akt activation in RAS-transformed HMLE breast epithelial cells. Within this context, we will discuss the implications of MTH1 upregulation in oncogenic RAS-sustaining cells as a beneficial adaptive change that inhibits ROS-mediated cell senescence and participates in the maintenance of ROS-associated tumor-promoting mechanisms. Accordingly, targeting MTH1 in RAS-transformed tumor cells will not only induce proliferative defects but also potentially enhance therapeutic cytotoxicity by shifting cellular response away from pro-survival mechanisms. © 2012 Landes Bioscience.

Typically, explanation/interpretation of observed light scattering and absorption properties of marine particles is based on assuming a spherical shape and homogeneous composition. We examine the influence of shape and homogeneity by comparing the optics of randomly-oriented cylindrically-shaped particles with those of equal-volume spheres, in particular the influence of aspect ratio (AR = length/diameter) on extinction and backscattering. Our principal finding is that the when AR > ∼3-5 and the diameter is of the order of the wavelength, the extinction efficiency and the backscattering probability are close to those of an infinite cylinder. In addition, we show the spherical-based interpretation of extinction and absorption can lead to large error in predicted backscattering. © 2011 Optical Society of America.

Assaf R.R.,University of Miami
Clinical Therapeutics | Year: 2014

Trans fats, also known as partially hydrogenated oils, have long been associated with cardiovascular disease. In 2003, the Food and Drug Administration mandated that trans fat content of ≥0.5 g be listed on food labeling; the next year, the World Health Organization released a recommended daily limit on trans fat intake. During the following decade, legislatures in different municipal and state governments moved trans fat regulation forward, whereas many food companies decided to independently phase out trans fat in their products. The advancement of these parallel processes suggests an emerging best practices phenomenon, integrating public health, law, and the food industry. With both legislation and markets seemingly favoring a limitation on trans fat content in foods, attention has once again shifted to the Food and Drug Administration for a ruling on the safety of trans fats. © 2014 Elsevier HS Journals, Inc.

Hernandez-Aya L.F.,University of Miami | Gonzalez-Angulo A.M.,United Medical Systems
Oncologist | Year: 2011

The phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) network plays a key regulatory function in cell survival, proliferation, migration, metabolism, angiogenesis, and apoptosis. Genetic aberrations found at different levels, either with activation of oncogenes or inactivation of tumor suppressors, make this pathway one of the most commonly disrupted in human breast cancer. The PI3K-dependent phosphorylation and activation of the serine/threonine kinase AKT is a key activator of cell survival mechanisms. The activation of the oncogene PIK3CA and the loss of regulators of AKT including the tumor suppressor gene PTEN are mutations commonly found in breast tumors. AKT relieves the negative regulation ofmTORto activate protein synthesis and cell proliferation through S6K and 4EBP1. The common activation of the PI3K pathway in breast cancer has led tothe development of compounds targeting the effector mechanisms of the pathway including selective and pan-PI3K/pan-AKT inhibitors, rapamycin analogs for Mtor inhibition, and TOR-catalytic subunit inhibitors. The influences of other oncogenic pathways such as Ras-Raf-Mek on the PI3K pathway and the known feedback mechanisms of activation have prompted the use of compounds with broader effect at multiple levels and rational combination strategies to obtain a more potent antitumor activity and possibly a meaningful clinical effect. Here, we review the biology of the network, its role in the development and progression of breast cancer, and the evaluation of targeted therapies in clinical trials. © AlphaMed Press.

Pulgaron E.R.,University of Miami
Clinical Therapeutics | Year: 2013

Background: Worldwide estimates of childhood overweight and obesity are as high as 43 million, and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities. Objective: The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally. Methods: PubMed and PsychINFO searches were conducted on childhood obesity and comorbidities. Results: The initial search of the terms obesity and comorbidity yielded >5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, attention-deficit hyperactivity disorder, and sleep problems. Conclusions: The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut-off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, attention-deficit hyperactivity disorder, and decreased health-related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that might be associated with childhood obesity are warranted and intervention research in this area is critical. © 2013 Elsevier HS Journals, Inc.

Oncogenic RAS-induced reactive oxygen species (ROS) trigger barriers to cell transformation and cancer progression through tumor-suppressive responses such as cellular senescence or cell death. We have recently shown that oncogenic RAS-induced DNA damage and attendant premature senescence can be prevented by overexpressing human MutT Homolog 1 (MTH1), the major mammalian detoxifier of the oxidized DNA precursor, 8-oxo-dGTP. Paradoxically, RAS-induced ROS are also able to participate in tumor progression via transformative processes such as mitogenic signaling, the epithelial-mesenchymal transition (EMT), anoikis inhibition, and PI3K/Akt-mediated survival signaling. Here we provide a preliminary insight into the influence of MTH1 levels on the EMT phenotype and Akt activation in RAS-transformed HMLE breast epithelial cells. Within this context, we will discuss the implications of MTH1 upregulation in oncogenic RAS-sustaining cells as a beneficial adaptive change that inhibits ROS-mediated cell senescence and participates in the maintenance of ROS-associated tumor-promoting mechanisms. Accordingly, targeting MTH1 in RAS-transformed tumor cells will not only induce proliferative defects but also potentially enhance therapeutic cytotoxicity by shifting cellular response away from pro-survival mechanisms.

Stuebing E.A.,University of Miami | Miner T.J.,Brown University
Archives of Surgery | Year: 2011

Objective: To determine whether simply being made continually aware of the hospital costs of daily phlebotomy would reduce the amount of phlebotomy ordered for nonintensive care unit surgical patients. Design: Prospective observational study. Setting: Tertiary care hospital in an urban setting. Participants: All nonintensive care unit patients on 3 general surgical services. Intervention: A weekly announcement to surgical house staff and attending physicians of the dollar amount charged to nonintensive care unit patients for laboratory services during the previous week. Main Outcome Measure: Dollars charged per patient per day for routine blood work. Results: At baseline, the charges for daily phlebotomy were $147.73/patient/d. After 11 weeks of residents being made aware of the daily charges for phlebotomy, the charges dropped as low as $108.11/patient/d. This had a correlation coefficient of -0.76 and significance of P=.002. Over 11 weeks of intervention, the dollar amount saved was $54 967. Conclusion: Health care providers being made aware of the cost of phlebotomy can decrease the amount of these tests ordered and result in significant savings for the hospital. ©2011 American Medical Association. All rights reserved.

Brogaard B.,University of Miami
Consciousness and Cognition | Year: 2015

Blindsight is a kind of residual vision found in people with lesions to V1. Subjects with blindsight typically report no visual awareness, but they are nonetheless able to make above-chance guesses about the shape, location, color and movement of visual stimuli presented to them in their blind field. A different kind of blindsight, sometimes called type 2 blindsight, is a kind of residual vision found in patients with V1 lesions in the presence of some residual awareness. Type 2 blindsight differs from ordinary visual experience in lacking the particularity, transparency and fine-grainedness often taken to be essential to visual experience, at least in veridical cases. I argue that the case of type 2 blindsight provides a counterexample to the view that these characteristics are essential to veridical visual experience and that this gives us reason to resist the view that visual experience is essentially a perceptual relation to external objects. In the second part of the paper I argue that the case of type 2 blindsight yields important insights into the effects of attentional modulation on perceptual content and that cases of attentional modulation of appearance are not at odds with the view that the phenomenology of visual experience flows from its content. © 2014 Elsevier Inc.

Mei Z.,Huzhou Teachers College | Korotkova O.,University of Miami
Optics Letters | Year: 2013

Two classes of scalar, stochastic sources are introduced, each capable of producing far fields with intensities forming rings. Although the Bessel-Gaussian and the Laguerre-Gaussian Schell-model sources are described by two different math models, the behavior of their degrees of coherence and, hence, the shapes of their far fields are qualitatively similar. The new beams are of importance for optical methods of particle manipulation. © 2013 Optical Society of America.

Maiguel D.,University of Miami
Science signaling | Year: 2011

The integrin CD11b/CD18 (also known as Mac-1), which is a heterodimer of the α(M) (CD11b) and β(2) (CD18) subunits, is critical for leukocyte adhesion and migration and for immune functions. Blocking integrin-mediated leukocyte adhesion, although beneficial in experimental models, has had limited success in treating inflammatory diseases in humans. Here, we used an alternative strategy of inhibiting leukocyte recruitment by activating CD11b/CD18 with small-molecule agonists, which we term leukadherins. These compounds increased the extent of CD11b/CD18-dependent cell adhesion of transfected cells and of primary human and mouse neutrophils, which resulted in decreased chemotaxis and transendothelial migration. Leukadherins also decreased leukocyte recruitment and reduced arterial narrowing after injury in rats. Moreover, compared to a known integrin antagonist, leukadherins better preserved kidney function in a mouse model of experimental nephritis. Leukadherins inhibited leukocyte recruitment by increasing leukocyte adhesion to the inflamed endothelium, which was reversed with a blocking antibody. Thus, we propose that pharmacological activation of CD11b/CD18 offers an alternative therapeutic approach for inflammatory diseases.

Freshwater M.F.,University of Miami
Aesthetic Surgery Journal | Year: 2015

September 2014 marked the bicentennial of the birth of modern plastic surgery. It was then that Carpue began a prospective observational study of nasal reconstruction that culminated in his 1816 monograph, which caused an explosion of interest in reconstructive surgery throughout Europe. In conducting his study, Carpue demonstrated ethical standards and the power of planning a procedure. His methods to document his results accurately would remain unsurpassed until photography was adopted at the end of the 19th century. Carpue took an apocryphal story of surgery performed in India more than twenty years earlier and transformed it into the beginning of modern plastic surgery. He succeeded in a number of unrecognized tasks that are themselves landmarks not only in plastic surgical history, but surgical history: devising the first prospective observational study, using exclusion criteria, maintaining appropriate patient confidentiality, setting a standard for preoperative disclosure and ethical approval over a century before these measures were codified, having independent documentation of his preoperative and postoperative findings, devising a method to objectively monitor and document the forehead flap, and describing the potential value of tissue expansion. He shared his experience by publishing his results and by lecturing in Europe. His contemporaries recognized him for his contributions and he was honored by election to the Royal Society. Carpue launched the modern era of plastic surgery in an ethical, logical, and objective manner. While plastic surgery has changed in the last two centuries, the principles that Carpue followed remain valid. © 2015 The American Society for Aesthetic Plastic Surgery, Inc.

Mei Z.,Huzhou Teachers College | Korotkova O.,University of Miami
Optics Letters | Year: 2013

We introduce a new class of partially coherent sources of Schell type with cosine-Gaussian spectral degree of coherence and confirm that such sources are physically genuine. Further, we derive the expression for the cross-spectral density function of a beam generated by the novel source propagating in free space and analyze the evolution of the spectral density and the spectral degree of coherence. It is shown that at sufficiently large distances from the source the degree of coherence of the propagating beam assumes Gaussian shape while the spectral density takes on the dark-hollow profile. © 2013 Optical Society of America.

Quittner A.L.,University of Miami
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation | Year: 2012

The psychometric properties of a health-related quality of life (HRQOL) instrument, the Cystic Fibrosis Questionnaire-Revised (CFQ-R), were evaluated in a national, US sample of patients with cystic fibrosis (CF). This is the first psychometric evaluation of the revised version of this instrument. The Epidemiologic Study of CF is a national, US multicenter longitudinal cohort study containing CFQ-R and health outcomes data. Developmentally appropriate versions of the CFQ-R were available from 7,330 patients aged 6-70 years and a proxy version from 2,728 parents of school-age children. The CFQ-R was completed during a "stable" or "sick" visit before recording health outcomes such as weight, lung function, and pulmonary exacerbations. There were few floor and ceiling effects and strong internal consistency (Cronbach alpha ≥0.70) for most scales. The CFQ-R consistently discriminated between patients seen for sick-versus-well visits, and among stages of disease severity based on lung function. As predicted, women with CF reported worse HRQOL than men on scales not related to body image and weight. Strong parent-child agreement was found on scales measuring observable behaviors (respiratory symptoms). Convergence between CFQ-R scales and health outcomes provided evidence of construct validity. The CFQ-R demonstrated robust psychometric properties and consistent associations with health outcomes in a large national, US sample. Normative data are available to aid in interpretation.

Ascherman D.P.,University of Miami
Current Rheumatology Reports | Year: 2012

The idiopathic inflammatory myopathies (IIMs) represent a heterogeneous group of disorders characterized by mononuclear cell infiltration of muscle and varying degrees of muscle dysfunction. To better understand the pathogenesis of these diseases, investigators have devised a number of infectious, genetic, and antigen-induced animal models that replicate different aspects of muscle involvement. Although the underlying heterogeneity of disorders encompassed by IIM precludes development of a single unifying model, several recently developed experimental systems have provided tremendous insight regarding the contributions of both immune- and non-immune-mediated disease pathways in various subsets of IIM. In turn, by elucidating the pathogenic roles of such disparate factors as endoplasmic reticulum stress and innate immune signaling, these models have established the foundation for more novel, targeted therapeutic intervention. © Springer Science+Business Media, LLC 2012.

Atkins C.M.,University of Miami
Translational Stroke Research | Year: 2011

There are more than 3. 17 million people coping with long-term disabilities due to traumatic brain injury (TBI) in the United States. The majority of TBI research is focused on developing acute neuroprotective treatments to prevent or minimize these long-term disabilities. Therefore, chronic TBI survivors represent a large, underserved population that could significantly benefit from a therapy that capitalizes on the endogenous recovery mechanisms occurring during the weeks to months following brain trauma. Previous studies have found that the hippocampus is highly vulnerable to brain injury, in both experimental models of TBI and during human TBI. Although often not directly mechanically injured by the head injury, in the weeks to months following TBI, the hippocampus undergoes atrophy and exhibits deficits in long-term potentiation (LTP), a persistent increase in synaptic strength that is considered to be a model of learning and memory. Decoding the chronic hippocampal LTP and cell signaling deficits after brain trauma will provide new insights into the molecular mechanisms of hippocampal-dependent learning impairments caused by TBI and facilitate the development of effective therapeutic strategies to improve hippocampal-dependent learning for chronic survivors of TBI. © 2011 Springer Science+Business Media, LLC.

Sharkey M.,University of Miami
Current Opinion in HIV and AIDS | Year: 2013

Purpose of review: In this review, methods with which investigators detect and monitor HIV persistence will be described. In particular, we will focus on the work that provides evidence that low-level virus replication persists despite the suppressive effects of therapy and the approaches that can be employed to measure and characterize the ongoing virus replication in apparently aviremic individuals. RECENT FINDINGS: With the effectiveness of antiretroviral therapy, there is a need for assays to probe the nature of reservoirs that are maintained despite therapy and to assess the impact of intensification on their stability. Detection and quantitation of surrogate markers for ongoing replication (two long terminal repeat circles) have recently been used to monitor the effects of therapy intensification, source of viral rebound, and characterization of viral variants that contribute to treatment failure. SUMMARY: With successful antiviral therapy, increasingly more attention has turned to the ultimate goal of virus eradication. In order to assess the effectiveness of new therapies and eradication strategies, an assay that can be broadly applied is needed. Amplification of unintegrated DNA is an approach that should be considered to study the effects of therapy intensification and protocols designed to eliminate the reservoirs that persist in HIV-infected individuals. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Kaifer A.E.,University of Miami
Accounts of Chemical Research | Year: 2014

ConspectusThe cucurbit[n]uril (CBn) host family consists of a group of rigid macrocyclic hosts with barrel-like shapes and limited solubility in aqueous media. These hosts are capable of reaching high binding affinities with positively charged hydrophobic guests. In optimum cases, equilibrium association constant (K) values as high as 1017 M-1 have been reported, exceeding the binding affinity of the avidin-biotin host-guest pair. The synthetic CBn receptors have shattered the notion that highly stable noncovalent complexes can form only when one of the partners is a molecule of biological origin.The work described in this Account is concerned with the development of methods geared toward the reversible modulation of the binding affinity of CBn inclusion complexes under mild conditions. A good fraction of the research work has dealt with redox active guests, such as 4,4′-bipyridinium (viologen), ferrocene, and cobaltocenium derivatives. Our experimental results show that the thermodynamics and kinetics of the electron transfer reactions of these compounds can be substantially altered by complexation with CBn hosts, and therefore, electron transfer reactions can be used to exert a measure of control on the overall binding affinity of the CBn complexes. We have also developed systems in which proton transfer reactions have a strong effect on the binding affinity. With more structurally elaborate guests containing more than one adjacent binding sites, proton transfer reactions may affect the average location of the CBn host within the complexes.A series of guest compounds containing paramagnetic 2,2,6,6- tetramethylpiperidine-1-oxyl (TEMPO) residues also exhibit interesting binding properties with CB7 and CB8. The latter host forms a very stable host-guest pair with TEMPO subunits, in which the nitroxide group resides inside the host cavity. Finally, with suitable ditopic guests, we have detected distinct microscopic complexes using experimental techniques with relatively slow time scales, such as NMR spectroscopy. These unusual findings are the result of the considerable thermodynamic and kinetic stability of CBn inclusion complexes. © 2014 American Chemical Society.

Berman B.,University of Miami
Skin therapy letter | Year: 2012

Imiquimod 3.75% cream has recently been approved by both the U.S. Federal Drug Administration and Health Canada for the treatment of external genital warts. Herein, we provide an overview of external genital warts, review the phase 3 clinical trials leading to the approval of imiquimod 3.75% cream, and compare its efficacy and clinical use with imiquimod 5% cream. Moreover, therapeutic options have further expanded with the relatively recent introduction of sinecatechins 15% ointment, an extract of green tea leaves.

Kanner A.M.,University of Miami
Nature Reviews Neurology | Year: 2016

The treatment of epileptic seizure disorders is not restricted to the achievement of seizure-freedom, but must also include the management of comorbid medical, neurological, psychiatric and cognitive comorbidities. Psychiatric and neurological comorbidities are relatively common and often co-exist in people with epilepsy (PWE). For example, depression and anxiety disorders are the most common psychiatric comorbidities in PWE, and they are particularly common in PWE who also have a neurological comorbidity, such as migraine, stroke, traumatic brain injury or dementia. Moreover, psychiatric and neurological comorbodities often have a more severe impact on the quality of life in patients with treatment-resistant focal epilepsy than do the actual seizures. Epilepsy and psychiatric and neurological comorbidities have a complex relationship, which has a direct bearing on the management of both seizures and the comorbidities: the comorbidities have to be factored into the selection of antiepileptic drugs, and the susceptibility to seizures has to be considered when choosing the drugs to treat comorbidities. The aim of this Review is to highlight the complex relationship between epilepsy and common psychiatric and neurological comorbidities, and provide an overview of how treatment strategies for epilepsy can positively and negatively affect these comorbidities and vice versa. © 2016 Macmillan Publishers Limited.

Hutchinson P.,University of Cambridge | O'Phelan K.,University of Miami
Neurocritical Care | Year: 2014

Microdialysis is a powerful technique, which enables the chemistry of the extracellular space to be measured directly. Applying this technique to patients in neurointensive care has increased our understanding of the pathophysiology of traumatic brain injury and spontaneous hemorrhage. In parallel, it is important to determine the place of microdialysis in assisting in the management of patients on an individual intention to treat basis. This is made possible by the availability of analyzers which can measure the concentration of glucose, pyruvate, lactate, and glutamate at the bedside. Samples can then be stored for later analysis of other substrate and metabolites e.g., other amino acids and cytokines. The objective of this paper is to review the fundamental literature pertinent to the clinical application of microdialysis in neurointensive care and to give recommendations on how the technique can be applied to assist in patient management and contribute to outcome. A literature search detected 1,933 publications of which 55 were used for data abstraction and analysis. The role of microdialysis was evaluated in three conditions (traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage) and recommendations focused on three fundamental areas (relationship to outcome, application of microdialysis to guide therapy, and the ability of microdialysis to predict secondary deterioration). © 2014, Springer Science+Business Media New York.

Mezincescu L.,University of Miami | Townsend P.K.,University of Cambridge
Physical Review Letters | Year: 2010

The Nambu-Goto string in a three-dimensional (3D) Minkowski spacetime is quantized preserving Lorentz invariance and parity. The spectrum of massive states contains anyons. An ambiguity in the ground state energy is resolved by the 3D N=1 Green-Schwarz superstring, which has massless ground states describing a dilaton and dilatino, and first-excited states of spin 1/4. © 2010 The American Physical Society.

Prilleltensky I.,University of Miami
American Journal of Community Psychology | Year: 2010

Participatory Action Research (PAR) with children and youth is at the intersection of child wellness and social inclusion. Exclusion and marginalization detract from personal and collective health. Inclusion, on the contrary, contributes to wellness. Hence, we should study inclusion and exclusion in the overall context of child wellness. This special issue offers a wealth of methodologies and lessons for fostering inclusion of young people through PAR. In an effort to synthesize my concerns with child wellness, inclusion, and the scholarly work of this special issue, this paper will (a) articulate the values underpinning the philosophy of social inclusion and child wellness, (b) suggest roles and responsibilities for putting these values into action, and (c) integrate the contributions of this special issue into the emerging framework for social inclusion and child wellness. © 2010 Society for Community Research and Action.

Kanner A.M.,University of Miami
Epilepsia | Year: 2013

One of every three patients with epilepsy (PWE) will experience a depressive disorder in the course of their life, often associated with anxiety symptoms or a full blown anxiety disorder. Clearly, the high prevalence of these psychiatric comorbidities calls for their early identification and management. This article provides practical strategies in the management of depressive episodes in PWE. Contrary to long-held beliefs, the use of antidepressant drugs are safe in PWE when used at therapeutic doses. Antidepressant drugs of the selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) families are the first line of therapy in depressive disorders, and failure to achieve complete symptom remission after a trial of an SSRI or SNRI at optimal doses should be followed by a second trial with a drug from the other antidepressant family. In developing countries, antidepressant drugs of these two antidepressant families are not always available, and tricyclic antidepressants (TCAs) are the drugs of choice. Although there are no differences in efficacy among the three families of antidepressants, TCAs have a lower tolerability and higher toxicity, with greater mortality risk associated with cardiotoxic effects in overdoses. Cognitive behavior therapy is another treatment modality that has been shown to be effective in the treatment of depressive disorders in patients with and without epilepsy. Its use should be considered together with pharmacotherapy or by itself. © Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

Donaldson K.E.,University of Miami
Journal of Cataract and Refractive Surgery | Year: 2013

Femtosecond laser-assisted cataract surgery provides surgeons an exciting new option to potentially improve patient outcomes and safety. Over the past 2 years, 4 unique laser platforms have been introduced into the marketplace. The introduction of this new technology has been accompanied by a host of new clinical, logistical, and financial challenges for surgeons. This article describes the evolution of femtosecond laser technology for use in cataract surgery. It reviews the available laser platforms and discusses the necessary modifications in cataract surgery technique and the logistics of incorporating a femtosecond laser into one's practice. Financial Disclosure Dr. Davidson is on the advisory board for Alcon Laboratories, Inc. (Lensx). Dr. Hamilton is on the speakers bureau for Alcon Laboratories, Inc., Abbott Medical Optics, Inc., Reichert Technologies, and Ziemer USA, Inc. Dr. Jackson is a consultant to Bausch & Lomb and on the speakers bureau for Alcon Laboratories, Inc. Dr. Stonecipher is a consultant to Alcon Laboratories, Inc., and Bausch & Lomb and on the medical advisory board for Alcon Laboratories, Inc. (Lensx). Dr. Yoo is a consultant to Alcon Laboratories, Inc. and Optimedica Corp. No other author has a financial or proprietary interest in any material or method mentioned. © 2013 ASCRS and ESCRS.

Olascoaga M.J.,University of Miami
Nonlinear Processes in Geophysics | Year: 2010

Analysis of year-long drifter trajectories and records of simulated surface Lagrangian Coherent Structures (LCSs) have suggested the presence of a resilient Cross-Shelf Transport Barrier (CSTB) on the West Florida Shelf (WFS). The CSTB was conjectured to provide a large degree of isolation, which is consequential for the fueling of red tides on the southern WFS by nutrients possibly released by rivers and canals directly on the region. Here this conjecture is thoroughly tested by identifying LCSs as well as performing tracer advection calculations based on seven-year-long records of surface and subsurface currents produced by a HYbrid-Coordinate Ocean Model (HYCOM) simulation of the Gulf of Mexico (GoM). The identified LCSs suggest that the CSTB extends downward in the water column. The tracer calculations suggest that, while the majority of the nutrients possibly released by rivers and canals directly on the southern WFS are retained within the region for long times, only a small fraction of the nutrients possibly released by rivers outside the WFS reach the southern WFS, mainly accompanying shoreward excursions of the CSTB. These results add importance to the role played by the CSTB in controlling red tide development on the WFS. Implications of the results for the dispersal of pollutants, such as oil, in the GoM are discussed. © Author(s) 2010.

Lewis P.J.,University of Miami
Studies in History and Philosophy of Science Part B - Studies in History and Philosophy of Modern Physics | Year: 2013

In 1994, Maudlin proposed an objection to retrocausal approaches to quantum mechanics in general, and to the transactional interpretation (TI) in particular, involving an absorber that changes location depending on the trajectory of the particle. Maudlin considered this objection fatal. However, the TI did not die; rather, a number of responses were developed, some attempting to accommodate Maudlin's example within the existing TI, and others modifying the TI. I argue that none of these responses is fully adequate. The reason, I submit, is that there are two aspects to Maudlin's objection; the more readily soluble aspect has received all the attention, but the more problematic aspect has gone unnoticed. I consider the prospects for developing a successful retrocausal quantum theory in light of this second aspect of the objection. © 2013 Elsevier Ltd.

Berman B.,University of Miami | Cockerell C.J.,Dermpath Diagnostics Dermatopathology Laboratories | Zografos P.,LEO Pharma Inc.
Journal of the American Academy of Dermatology | Year: 2013

Actinic keratoses are proliferations of transformed neoplastic keratinocytes in the epidermis that are the result of cumulative ultraviolet (UV) radiation from sun exposure. They are commonly found on sites of sun-exposed skin such as the face, balding scalp, and back of the hand. Although UV exposure does exert certain beneficial effects on the skin, excessive exposure to UV radiation induces multiple cascades of molecular signaling events at the cellular level that produce inflammation, immunosuppression, failure of apoptosis, and aberrant differentiation. Cumulatively, these actions result in mutagenesis and, ultimately, carcinogenesis. This article provides a brief overview of the key mediators that are implicated in the pathobiology of actinic keratosis. Three evolutionary possibilities exist for these keratoses in the absence of treatment: (1) spontaneous remission, which can be common; (2) remaining stable, without further progression; or (3) transformation to invasive squamous cell carcinoma, which may metastasize. Because the effects of UV radiation on the skin are complex, it is not yet fully clear how all of the mediators of actinic keratosis progression are interrelated. Nonetheless, some represent potential therapeutic targets, because it is clear that directing therapy to the effects of UV radiation at a number of different levels could interrupt and possibly reverse the mechanisms leading to malignant transformation. © 2012 by the American Academy of Dermatology, Inc.

Wang M.Y.,University of Miami
Minimally Invasive Surgery | Year: 2012

Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws. Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body. Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation. Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs. © 2012 Michael Y. Wang.

Meneghini L.F.,University of Miami
American Journal of Medicine | Year: 2013

The progressive nature of type 2 diabetes (T2D) requires practitioners to periodically evaluate patients and intensify therapy when glycemic targets become unattainable with their current treatment regimen. Traditional first- and second-line antidiabetic agents such as metformin and the sulfonylureas do not prevent the characteristic decline in beta-cell function associated with T2D; insulin replacement therapy can therefore quickly become a necessity in some patients. Basal insulin initiation provides an excellent platform to which rapid-acting prandial insulin doses can easily be added, potentially in a stepwise manner, as disease progresses. Premix insulin regimens are another effective intensification option following basal insulin initiation, but are most effective in insulin-naïve patients. The use of insulin in combination with modern T2D agents, such as the incretin-based therapies, has the potential to improve glycemic control while limiting insulin-associated weight gain and hypoglycemia. Further clinical data and approval are required before practitioners can fully endorse this novel approach. © 2013 Published by Elsevier Inc.

Gao Y.,University of Miami
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye | Year: 2012

To determine whether the volumes of macular layers before and after epiretinal membrane (ERM) peeling as measured by spectral-domain optical coherence tomography (SD-OCT) correlated with best-corrected visual acuity (BCVA) or ERM location. Thirty-six eyes with idiopathic ERM and 12 control eyes were imaged preoperatively and postoperatively using SD-OCT. The inner, middle, and outer retinal layers were measured in the temporal and nasal half of the central 1,500 μm of the macula for each of the SD-OCT five raster scans and used to estimate the volumes for each group. The inner layer volumes were larger in cases compared with control eyes. The nasal inner and temporal inner layer volumes decreased after ERM removal in the nasal dominant, macular dominant, and temporal dominant groups. The inner layer volume decreased more temporally than nasally in the macular dominant and temporal dominant groups but not in the nasal dominant group. The volume decreased more in the temporal middle than the nasal middle layer for the temporal dominant group. The BCVA improvement correlated with nasal inner layer volume decrease and nasal outer and temporal outer layer volume increase. The volume of the inner perifoveal retinal sections decreases after ERM peeling, possibly representing resolution of edema or reorganization of the nerve fiber layer on release of mechanical traction. Visual improvement correlated with volume increase of the outer retinal layers and may represent photoreceptor cell recovery after ERM peeling. Copyright 2012, SLACK Incorporated.

Korotkova O.,University of Miami | Shchepakina E.,Samara State Aerospace University
Optics Express | Year: 2014

Analytical models for random sources producing far fields with frame-like intensity profiles are introduced. The frames can have polar and Cartesian symmetry and adjustable sharpness of the inner and outer edges. The frames are shape invariant throughout the far zone but expand due to diffraction with growing distance from the source. The generalization to multiple nested frames is also discussed. The applications of the frames are envisioned in material surface processing and particle trapping. © 2014 Optical Society of America.

Gordon H.R.,University of Miami
Optics Express | Year: 2014

A simple, surprisingly accurate, method for estimating the influence of Raman scattering on the upwelling light field in natural waters is developed. The method is based on the single (or quasi-single) scattering solution of the radiative transfer equation with the Raman source function. Given the light field at the excitation wavelength, accurate estimates (∼1-10%) of the contribution of Raman scattering to the light field at the emission wavelength are obtained. The accuracy is only slightly degraded when typically measured aspects of the light field at the excitation are available. © 2014 Optical Society of America.

The United States excels at treating the most complex medical conditions, but our low-ranking health statistics (relative to other countries) do not match our high-end health care spending. One way to understand this paradox is to examine the history of federal children's health programs. In the 1800s, children's health advocates confronted social determinants of health to reduce infant mortality. Over the past 100 years, however, physicians have increasingly focused on individual doctor-patient encounters; public health professionals, meanwhile, have maintained a population health perspective but struggled with the politics of addressing root causes of disease. Political history and historical demography help explain some salient differences with European nations that date to the founding of federal children's health programs in the early 20th century. More recently, federal programs for children with intellectual disability illustrate technical advances in medicine, shifting children's health epidemiology, and the politics of public health policy.

Nave G.,California Institute of Technology | Camerer C.,California Institute of Technology | McCullough M.,University of Miami
Perspectives on Psychological Science | Year: 2015

Behavioral neuroscientists have shown that the neuropeptide oxytocin (OT) plays a key role in social attachment and affiliation in nonhuman mammals. Inspired by this initial research, many social scientists proceeded to examine the associations of OT with trust in humans over the past decade. To conduct this work, they have (a) examined the effects of exogenous OT increase caused by intranasal administration on trusting behavior, (b) correlated individual difference measures of OT plasma levels with measures of trust, and (c) searched for genetic polymorphisms of the OT receptor gene that might be associated with trust. We discuss the different methods used by OT behavioral researchers and review evidence that links OT to trust in humans. Unfortunately, the simplest promising finding associating intranasal OT with higher trust has not replicated well. Moreover, the plasma OT evidence is flawed by how OT is measured in peripheral bodily fluids. Finally, in recent large-sample studies, researchers failed to find consistent associations of specific OT-related genetic polymorphisms and trust. We conclude that the cumulative evidence does not provide robust convergent evidence that human trust is reliably associated with OT (or caused by it). We end with constructive ideas for improving the robustness and rigor of OT research. © 2015, The Author(s) 2015.

Molnar-Szakacs I.,University of California at Los Angeles | Uddin L.Q.,Stanford University | Uddin L.Q.,University of Miami
Frontiers in Human Neuroscience | Year: 2013

Recent evidence for the fractionation of the default mode network (DMN) into functionally distinguishable subdivisions with unique patterns of connectivity calls for a reconceptualization of the relationship between this network and self-referential processing. Advances in resting-state functional connectivity analyses are beginning to reveal increasingly complex patterns of organization within the key nodes of the DMN - medial prefrontal cortex and posterior cingulate cortex - as well as between these nodes and other brain systems. Here we review recent examinations of the relationships between the DMN and various aspects of self-relevant and social-cognitive processing in light of emerging evidence for heterogeneity within this network. Drawing from a rapidly evolving social-cognitive neuroscience literature, we propose that embodied simulation and mentalizing are processes which allow us to gain insight into another's physical and mental state by providing privileged access to our own physical and mental states. Embodiment implies that the same neural systems are engaged for self- and other-understanding through a simulation mechanism, while mentalizing refers to the use of high-level conceptual information to make inferences about the mental states of self and others. These mechanisms work together to provide a coherent representation of the self and by extension, of others. Nodes of the DMN selectively interact with brain systems for embodiment and mentalizing, including the mirror neuron system, to produce appropriate mappings in the service of social-cognitive demands. © 2013 Molnar-Szakacs and Uddin.

Goldstein L.J.,University of Miami
Dermatologic Therapy | Year: 2013

Hyperbaric oxygen therapy (HBOT), the administration of pressurized 100% oxygen, is used as an adjunct to aid healing in selected chronic wounds. Though the therapy has had a controversial history, research is now elucidating the mechanisms by which HBOT helps to heal wounds. HBOT increases growth factors and local wound signaling, while also promoting a central stem cell release of endothelial progenitor cells from the bone marrow via nitric oxide pathways. The clinical data continue to accumulate in support of HBOT to help hasten wound healing, and reduce the amputation rate in diabetic ulcers. In appropriate patients, HBOT is an effective, noninvasive, adjunct modality that can be used to hasten chronic wound healing. © 2013 Wiley Periodicals, Inc.

Koch S.,University of Miami
Translational Stroke Research | Year: 2010

Ischemic preconditioning has evolved as one of the most powerful strategies for cerebral protection in laboratory models of ischemia. Translating the success of laboratory studies to human cerebral protection will necessitate an approximation of laboratory conditions. This would require a practical, easily implemented method of preconditioning and clinical settings in which cerebral ischemia is anticipated, thereby allowing cerebral preconditioning prior to ischemia onset. Remote limb ischemic preconditioning is readily instituted and used in several ongoing cardiac studies for ischemic myocardial protection. It is a potentially promising intervention for brain protection as well. Suitable clinical settings, in which a preliminary study of ischemic preconditioning in neurological disorders appears feasible, include carotid endarterectomy or stenting, cardiac surgery, and subarachnoid hemorrhage with the accompanying risk of vasospasm. These are settings, in which there is substantial risk of brain ischemia, which occurs over a short and predictable period, allowing for preconditioning to be implemented prior to ischemia onset. © 2010 Springer Science+Business Media, LLC.

Goldberg R.B.,University of Miami | Mather K.,Indiana University
Arteriosclerosis, Thrombosis, and Vascular Biology | Year: 2012

This review describes the effect of lifestyle change or metformin compared with standard care on incident type 2 diabetes and cardiometabolic risk factors in the Diabetes Prevention Program and its Outcome Study. The Diabetes Prevention Program was a randomized controlled clinical trial of intensive lifestyle and metformin treatments versus standard care in 3234 subjects at high risk for type 2 diabetes. At baseline, hypertension was present in 28% of subjects, and 53% had metabolic syndrome with considerable variation in risk factors by age, sex, and race. Over 2.8 years, type 2 diabetes incidence fell by 58% and 31% in the lifestyle and metformin groups, respectively, and metabolic syndrome prevalence fell by one-third with lifestyle change but was not reduced by metformin. In placebo-and metformin-treated subjects, the prevalence of hypertension and dyslipidemia increased during the Diabetes Prevention Program, whereas lifestyle intervention slowed these increases significantly. During long-term follow-up using modified interventions, type 2 diabetes incidence decreased to ∼5% per year in all groups. This was accompanied by significant improvement in cardiovascular disease risk factors over time in all treatment groups, in part associated with increasing use of lipid-lowering and antihypertensive medications. Thus a program of lifestyle change significantly reduced type 2 diabetes incidence and metabolic syndrome prevalence in subjects at high risk for type 2 diabetes. Metformin had more modest effects. © 2012 American Heart Association, Inc.

Aref A.A.,University of Miami
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye | Year: 2010

Spectral domain optical coherence tomography (SD-OCT) is a relatively new imaging technology that is being used for the diagnosis and management of glaucoma. This article presents a review of the specific parameters analyzed by SD-OCT and the diagnostic capability, reproducibility, and limitations of the device. SD-OCT parameters useful for diagnosis of glaucoma include retinal nerve fiber layer analysis, optic nerve head analysis, and ganglion cell complex analysis. These parameters have proven to be at least as equivalent to time-domain technology in terms of diagnostic capability and superior in terms of reproducibility. SD-OCT technology may be limited by signal quality, image artifact, and confounding ocular disease. Copyright 2010, SLACK Incorporated.

Cherniack E.P.,University of Miami
Forschende Komplementarmedizin | Year: 2010

Cellular senescence is characterized by cellular hypertrophy: cell growth in the absence of cell division. The genes that regulate this process can be activated or inactivated by numerous plant polyphenols such as resveratrol, quercetin, butein, fistein, piceatannol, curcumin. Many of these substances have been shown to lengthen the lifespan of invertebrates. Many of these compounds have other potential beneficial effects on lifespan as antiatherogenic or antineoplastic agents. Challenges to human testing of such substances on lifespan include determination of dosage, low bioavailability, time and resources necessary to conduct tests, and understanding which formulation of substances to use. © 2010 S. Karger AG.

Skyler J.S.,University of Miami
Diabetes Care | Year: 2015

Over the past three decades there have been a number of clinical trials directed at interdicting the type 1 diabetes (T1D) disease process in an attempt to prevent the development of the disease in those at increased risk or to stabilize-potentially even reverse-the disease in people with T1D, usually of recent onset. Unfortunately, to date there has been no prevention trial that has resulted in delay or prevention of T1D. And, trials in people with T1D have had mixed results with some showing promise with at least transient improvement in β-cell function compared with randomized control groups, while others have failed to slow the decline in β-cell function when compared with placebo. This Perspective will assess the past and present challenges in this effort and provide an outline for potential future opportunities. ©2015 by the American Diabetes Association.

Jellinger P.S.,University of Miami
Postgraduate Medicine | Year: 2011

Glucose homeostasis is regulated by a complex interaction of hormones, principally including insulin, glucagon, amylin, and the incretins. Glucagon, cortisol, catecholamines, and growth hormone serve as the classic glucose counterregulatory hormones. The incretins are hormones released by enteroendocrine cells in the intestine in response to a meal. Classically, type 2 diabetes mellitus (T2DM) has been considered to be a triad of insulin resistance, increased hepatic gluconeogenesis, and progressive β-cell exhaustion/failure. However, disordered enteroendocrine physiology, specifically the reduced activity of glucagon-like peptide-1 (GLP-1), is also a principal pathophysiologic abnormality of the disease. Glucagon-like peptide-1 receptor agonists that have been studied include exenatide and liraglutide, which have been approved by the US Food and Drug Administration for use in patients with T2DM. Sitagliptin and saxagliptin, both approved for use in the United States, modulate incretin physiology by inhibiting degradation of GLP-1 by the enzyme dipeptidyl peptidase-4 (DPP-4). Modulators of incretin physiology have been shown to improve glycemic control with a low risk for hypoglycemia and beneficially affect β-cell function. Unlike the DPP-4 inhibitors, GLP-1 receptor agonist therapy also produces weight loss, an important consideration given the close association among T2DM, overweight/obesity, and cardiovascular disease. The GLP-1 receptor agonists have also demonstrated beneficial effects on cardiovascular risk factors other than hyperglycemia and excess body weight, such as lipid concentrations and blood pressure. This article describes incretin physiology and studies of pharmacologic therapy designed to address the blunted incretin response in patients with T2DM. Information was obtained by a search of the PubMed and MEDLINE databases for articles published from January 1, 1995 to June 1, 2009. © Postgraduate Medicine.

Lin B.,University of Miami
Central Nervous System Agents in Medicinal Chemistry | Year: 2013

Post ischemic/hypoxic encephalopathy is a progressive and widespread damage syndrome in human brain, which includes production of new ischemic foci as well as neurodegeneration associated with accumulation of amyloid protein (Aβ), which emerges within days after the primary ischemic or hypoxic ictus. Patients may suddenly suffer severe dementia and Parkinson's syndrome after a symptom-free period averaging 2 weeks following resuscitation. Death of neurons in the cortex, limbic system, globus pallidus (GP) and substantia nigra (SN) and damage to white matter are responsible. From experimental studies in animals evidence is obtained to reveal the mechanisms. Injured endothelia and activated platelets lead to secondary injury via thrombosis and vasoconstriction resulting in infarction and new foci of necrosis. Blood-brain barrier (BBB) breakdown allows penetration of blood-borne toxic substances into brain resulting in neuronal degeneration and enhanced inflammatory destruction. These secondary injuries happen within two weeks after moderate global ischemia. As these pathological changes cycle between the vascular and neuronal compartments, the damage expands and worsens. Aβ, β amyloid precursor protein (βAPP) and the inflammation mediator cyclooxygenase-2 (COX2) as well as γ-aminobutyric acid (GABA) system degeneration participate in producing secondary injury. Thus, implementing multi-targeted prophylaxis before or at the brain-at-risk stage is desirable. A combination of protecting endothelia, inhibiting platelet activity and improving cerebral circulation is a fundamental strategy to block this vicious cascade, thereby ameliorating or preventing the encephalopathy. © 2013 Bentham Science Publishers.

Distributions of pathogen counts in treated water over time are highly skewed, power-law-like, and discrete. Over long periods of record, a long tail is observed, which can strongly determine the long-term mean pathogen count and associated health effects. Such distributions have been modeled with the Poisson lognormal (PLN) computed (not closed-form) distribution, and a newdiscrete growth distribution(DGD), also computed, recently proposed and demonstrated for microbial counts in water (Risk Analysis29, 841-856). In this article, an error in the original theoretical development of the DGD is pointed out, and the approach is shown to support the closed-form discrete Weibull (DW). Furthermore, an information-theoretic derivation of the DGD is presented, explaining the fit shown for it to the original nine empirical and three simulated (n= 1,000) long-term waterborne microbial count data sets. Both developments result from a theory of multiplicative growth of outcome size from correlated, entropy-forced cause magnitudes. The predicted DW and DGD are first borne out in simulations of continuous and discrete correlated growth processes, respectively. Then the DW and DGD are each demonstrated to fit 10 of the original 12 data sets, passing the chi-square goodness-of-fit test (α= 0.05, overallp= 0.1184). The PLN was not demonstrated, fitting only 4 of 12 data sets (p= 1.6 × 10-8), explained by cause magnitude correlation. Results bear out predictions of monotonically decreasing distributions, and suggest use of the DW for inhomogeneous counts correlated in time or space. A formula for computing the DW mean is presented. © 2010 Society for Risk Analysis.

Harbour J.W.,University of Miami
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting | Year: 2013

Uveal melanoma (UM) is the second-most common form of melanoma and the most common primary intraocular malignancy. Up to one-half of patients are at risk for fatal metastatic disease. The metastatic potential of an individual tumor can be accurately determined by analysis of a fine-needle aspirate with gene expression profiling assay that is available for routine clinical use through a commercial Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory. The test renders one of two results-class 1 (low metastatic risk) or class 2 (high metastatic risk)-and has been extensively validated in multiple centers. Until recently, the genetic mutations and signaling aberrations in UM were largely unknown. With the advent of new genomic sequencing technologies, however, the molecular landscape of UM is rapidly emerging. Mutations in the Gq alpha subunits GNAQ and GNA11 are mutually exclusive and represent early or initiating events that constitutively activate the MAPK pathway. Mutations in BRCA1-associated protein-1 (BAP1) and splicing factor 3B subunit 1 (SF3B1) also appear to be largely mutually exclusive, and they occur later in tumor progression. BAP1 mutations are strongly associated with metastasis, whereas SF3B1 mutations are associated with a more favorable outcome. BAP1 mutations can arise in the germ line, leading to a newly described BAP1 familial cancer syndrome. These discoveries have led to new clinical trials to assess several classes of compounds, including MEK, protein kinase C, and histone deacetylase inhibitors, in the adjuvant setting for high-risk patients identified as class 2, as well as in the setting of advanced disseminated disease.

Over the last 10 years there has been a dramatic increase in the number of patients identified and treated with testosterone replacement therapy (TRT) for late-onset hypogonadism (LOH). By virtue of age, race, and family history, many of these patients are concurrently at risk for harboring indolent prostate cancer. Other men are at increased risk for prostate cancer as a result of an elevated serum PSA level or having had a prior prostate biopsy showing prostatic intraepithelial neoplasia (PIN) or atypical small acinar proliferation (ASAP). The clinician is often challenged with the decision whether to initiate TRT in these patients. This review presents a contemporary overview of the rationale for TRT, as well as the relationship between testosterone (endogenous and exogenous) and premalignant and malignant lesions of the prostate. We will discuss preliminary data from several recent series demonstrating that TRT may be safely administered in select patients with certain premalignant and bona fide malignant tumors of the prostate. In the absence of a large randomized clinical trial with long-term outcome data evaluating TRT, we hope that this overview will provide clinicians with an evidence-based approach to managing these anxiety-provoking - and often frustrating - clinical scenarios. © 2014 Springer Science+Business Media.

Johnson S.L.,University of California at Berkeley | Carver C.S.,University of Miami
Journal of Affective Disorders | Year: 2012

The dominance behavioral system has been conceptualized as a biologically based system comprising motivation to achieve social power and self-perceptions of power. Biological, behavioral, and social correlates of dominance motivation and self-perceived power have been related to a range of psychopathological tendencies. Preliminary evidence suggests that mania and risk for mania (manic temperament) relate to the dominance system. Method: Four studies examine whether manic temperament, measured with the Hypomanic Personality Scale (HPS), is related to elevations in dominance motivation, self-perceptions of power, and engagement in socially dominant behavior across multiple measures. In Study 1, the HPS correlated with measures of dominance motivation and the pursuit of extrinsically-oriented ambitions for fame and wealth among 454 undergraduates. In Study 2, the HPS correlated with perceptions of power and extrinsically-oriented lifetime ambitions among 780 undergraduates. In Study 3, the HPS was related to trait-like tendencies to experience hubristic (dominance-related) pride, as well as dominance motivation and pursuit of extrinsically-oriented ambitions. In Study 4, we developed the Socially Dominant Behavior Scale to capture behaviors reflecting high power. The scale correlated highly with the HPS among 514 undergraduates. Limitations: The studies rely on self-ratings of manic temperament and dominance constructs, and findings have not yet been generalized to a clinical sample. Conclusions: Taken together, results support the hypothesis that manic temperament is related to a focus on achieving social dominance, ambitions related to achieving social recognition, perceptions of having achieved power, tendencies to experience dominance-related pride, and engagement in social behaviors consistent with this elevated sense of power. © 2012 Elsevier B.V.

Buchwald P.,University of Miami
Theoretical Biology and Medical Modelling | Year: 2011

Background: Because insulin is the main regulator of glucose homeostasis, quantitative models describing the dynamics of glucose-induced insulin secretion are of obvious interest. Here, a computational model is introduced that focuses not on organism-level concentrations, but on the quantitative modeling of local, cellular-level glucose-insulin dynamics by incorporating the detailed spatial distribution of the concentrations of interest within isolated avascular pancreatic islets. Methods. All nutrient consumption and hormone release rates were assumed to follow Hill-type sigmoid dependences on local concentrations. Insulin secretion rates depend on both the glucose concentration and its time-gradient, resulting in second-and first-phase responses, respectively. Since hypoxia may also be an important limiting factor in avascular islets, oxygen and cell viability considerations were also built in by incorporating and extending our previous islet cell oxygen consumption model. A finite element method (FEM) framework is used to combine reactive rates with mass transport by convection and diffusion as well as fluid-mechanics. Results: The model was calibrated using experimental results from dynamic glucose-stimulated insulin release (GSIR) perifusion studies with isolated islets. Further optimization is still needed, but calculated insulin responses to stepwise increments in the incoming glucose concentration are in good agreement with existing experimental insulin release data characterizing glucose and oxygen dependence. The model makes possible the detailed description of the intraislet spatial distributions of insulin, glucose, and oxygen levels. In agreement with recent observations, modeling also suggests that smaller islets perform better when transplanted and/or encapsulated. Conclusions: An insulin secretion model was implemented by coupling local consumption and release rates to calculations of the spatial distributions of all species of interest. The resulting glucose-insulin control system fits in the general framework of a sigmoid proportional-integral- derivative controller, a generalized PID controller, more suitable for biological systems, which are always nonlinear due to the maximum response being limited. Because of the general framework of the implementation, simulations can be carried out for arbitrary geometries including cultured, perifused, transplanted, and encapsulated islets. © 2011 Buchwald; licensee BioMed Central Ltd.

Perez V.L.,University of Miami | Caspi R.R.,U.S. National Institutes of Health
Trends in Immunology | Year: 2015

It has recently been recognized that pathology of age-associated degenerative eye diseases such as adult macular degeneration (AMD), glaucoma and diabetic retinopathy, have strong immunological underpinnings. Attempts have been made to extrapolate to age-related degenerative disease insights from inflammatory processes associated with non-infectious uveitis, but these have not yet been sufficiently informative. Here we review recent findings on the immune processes underlying uveitis and those that have been shown to contribute to AMD, discussing in this context parallels and differences between overt inflammation and para-inflammation in the eye. We propose that mechanisms associated with ocular immune privilege, in combination with paucity of age-related antigen(s) within the target tissue, dampen what could otherwise be overt inflammation and result in the para-inflammation that characterizes age-associated neurodegenerative disease. © 2015.

Weiss S.C.,University of Miami
Dermatologic Therapy | Year: 2011

Effective dermatologic therapy depends on both the active drug and the properties of the delivery system. A topical delivery system, or vehicle, is defined as the substance that carries a specific drug into contact with and through the skin. The challenge to topical drug delivery is the transport across the skin barrier. Depending on the delivery system, penetration of the active drug can be quite variable and this is largely due to the physiochemical properties of the constituent components of that vehicle. Selection of the appropriate drug delivery system will depend on the active, anatomic site of disease and patient preferences © 2012 Wiley Periodicals, Inc.

Cherniack E.P.,University of Miami
Complementary Therapies in Clinical Practice | Year: 2011

Lack of adherence to medications is a potential cause of hospitalizations, morbidity, and mortality in the elderly. Medication adherence decreases with polypharmacy. Older persons commonly use complementary medicine, therefore complementary medicine use might pose an increase risk of loss of medication adherence with conventional medications, but this has not been previously investigated. A chart review was conducted of 300 patients at least sixty-five years of age who used at least three medications each who attended a university geriatrics clinic in Florida, USA to obtain information about medication adherence and complementary medicine use. However, no association was found between use of at least one complementary medicine and adherence to conventional medications. © 2010.

Juola F.A.,University of Miami | Dearborn D.C.,Bates College
Proceedings of the Royal Society B: Biological Sciences | Year: 2011

The major histocompatibility complex (MHC) is a polymorphic gene family associated with immune defence, and it can play a role in mate choice. Under the genetic compatibility hypothesis, females choose mates that differ genetically from their own MHC genotypes, avoiding inbreeding and/or enhancing the immunocompetence of their offspring. We tested this hypothesis of disassortative mating based on MHC genotypes in a population of great frigatebirds (Fregata minor) by sequencing the second exon of MHC class II B. Extensive haploid cloning yielded two to four alleles per individual, suggesting the amplification of two genes. MHC similarity between mates was not significantly different between pairs that did (n 1/4 4) or did not (n 1/4 42) exhibit extra-pair paternity. Comparing all mated pairs to a distribution based on randomized re-pairings, we observed the following (i): no evidence for mate choice based on maximal or intermediate levels of MHC allele sharing (ii), significantly disassortative mating based on similarity of MHC amino acid sequences, and (iii) no evidence for mate choice based on microsatellite alleles, as measured by either allele sharing or similarity in allele size. This suggests that females choose mates that differ genetically from themselves at MHC loci, but not as an inbreeding-avoidance mechanism. © 2012 The Royal Society.

Rossi G.A.,Pulmonary and Allergy Disease Paediatric Unit | Colin A.A.,University of Miami
European Respiratory Journal | Year: 2015

There is evidence that respiratory viruses play a key role in the development and exacerbation of obstructive respiratory diseases in children. This review attempts to juxtapose the separate profiles and prototypes of pathogenenetic mechanisms represented by the two most common amongst such viruses: respiratory syncytial virus (RSV) and human rhinovirus (HRV). RSV represents the most common agent of severe airway disease in infants and young children, and is predominant in winter months. Large epidemiological studies have revealed an unequivocal relationship between RSV infection and subsequent wheezing into childhood, thought to be related to long-term changes in neuroimmune control of the airways rather than allergic sensitisation. HRV is a highly diverse group of viruses that affect subjects of all ages, is ubiquitous and occurs yearround. In contrast to RSV, infections with HRV cause minimal cytotoxicity but induce a rapid production of cytokines and chemokines with amplification of the inflammatory response. The susceptibility to HRV-induced bronchiolitis and subsequent wheezing appears to be linked to individual predisposition since it is often associated with a family or personal history of asthma/atopy. Thus, RSV probably serves as an "inducer" rather than a "trigger" . Conversely, HRVs seem to serve as a "trigger" rather than an "inducer" in predisposed individuals. Copyright ©ERS 2015.

Li W.,University of Miami
Ageing Research Reviews | Year: 2013

Immunologically-silent phagocytosis of apoptotic cells is critical to maintaining tissue homeostasis and innate immune balance. Aged phagocytes reduce their functional activity, leading to accumulation of unphagocytosed debris, chronic sterile inflammation and exacerbation of tissue aging and damage. Macrophage dysfunction plays an important role in immunosenescence. Microglial dysfunction has been linked to age-dependent neurodegenerations. Retinal pigment epithelial (RPE) cell dysfunction has been implicated in the pathogenesis of age-related macular degeneration (AMD). Despite several reports on the characterization of aged phagocytes, the role of phagocyte dysfunction in tissue aging and degeneration is yet to be fully appreciated. Lack of knowledge of molecular mechanisms by which aging reduces phagocyte function has hindered our capability to exploit the therapeutic potentials of phagocytosis for prevention or delay of tissue degeneration. This review summarizes our current knowledge of phagocyte dysfunction in aged tissues and discusses possible links to age-related diseases. We highlight the challenges to decipher the molecular mechanisms, present new research approaches and envisage future strategies to prevent phagocyte dysfunction, tissue aging and degeneration. © 2013 Elsevier B.V.

Ascherman D.P.,University of Miami
Current Rheumatology Reports | Year: 2015

Histidyl-tRNA synthetase (HRS = Jo-1) represents a key autoantibody target in the anti-synthetase syndrome that is marked by myositis as well as extra-muscular organ complications including interstitial lung disease (ILD). Over the last 25 years, a wealth of clinical, epidemiological, genetic, and experimental data have collectively supported a role for Jo-1 in mediating deleterious cell-mediated, adaptive immune responses contributing to the disease phenotype of the anti-synthetase syndrome. Complementing these studies, more recent work suggests that unique, non-enzymatic functional properties of Jo-1 also endow this antigen with the capacity to activate components of the innate immune system, particularly cell surface as well as endosomal Toll-like receptors and their downstream signaling pathways. Combining these facets of Jo-1-mediated immunity now supports a more integrated model of disease pathogenesis that should lead to improved therapeutic targeting in the anti-synthetase syndrome and related subsets of idiopathic inflammatory myopathy. © 2015, Springer Science+Business Media New York.

Barber G.N.,University of Miami
Immunological Reviews | Year: 2011

The innate immune system is responsible for detecting microbial invasion of the cell and for stimulating host defense countermeasures. These anti-pathogen procedures include the transcriptional activation of powerful antiviral genes such as the type I interferons (IFNs) or the triggering of inflammatory responses through interleukin-1 (IL-1) production. Over the past decade, key cellular sensors responsible for triggering innate immune signaling pathways and host defense have started to be resolved and include the Toll-like receptor (TLR), RIG-I-like helicase, and the cytoplasmic nucleotide-binding oligermerization domain-like receptor families. These sensors recognize non-self pathogen-associated molecular patterns such as microbial lipopolysaccharides and nucleic acids. For example, TLR9 has evolved to detect CpG DNA commonly found in bacteria and viruses and to initiate the production of IFN and other cytokines. In contrast, AIM2 (absent in melanoma 2) has been shown to be essential for mediating inflammatory responses involving IL-1β following the sensing of microbial DNA. Recently, a molecule referred to as STING (stimulator of IFN genes) was demonstrated as being vital for recognizing cytoplasmic DNA and for activating the production of innate immune genes in response to a variety of DNA pathogens and even certain RNA viruses. Comprehending the mechanisms of intracellular DNA-mediated innate immune signaling may lead to the design of new adjuvant concepts that will facilitate vaccine development and may provide important information into the origins of autoimmune disease. © 2011 John Wiley & Sons A/S.

Monteith T.S.,University of Miami | Borsook D.,Harvard University
Current Neurology and Neuroscience Reports | Year: 2014

Despite the growing awareness of mild traumatic brain injury in military and civilian populations, understanding of the acute and chronic effects of concussion on central nervous system structure and function is limited. Even less is understood about the underpinnings of the cardinal postconcussive symptom, post-traumatic headache (PTH). Here, we review recent advances in PTH, with special emphasis on the migraine-like phenotype, the most disabling form. Considerations for future research in PTH are discussed, including diagnostic classification, and applications with advanced neuroimaging techniques, biomarkers, and treatments. © Springer Science+Business Media 2014.

Tien J.M.,University of Miami
Journal of Systems Science and Systems Engineering | Year: 2012

The outputs or products of an economy can be divided into services products and goods products (due to manufacturing, construction, agriculture and mining). To date, the services and goods products have, for the most part, been separately mass produced. However, in contrast to the first and second industrial revolutions which respectively focused on the development and the mass production of goods, the next - or third - industrial revolution is focused on the integration of services and/or goods; it is beginning in this second decade of the 21st Century. The Third Industrial Revolution (TIR) is based on the confluence of three major technological enablers (i. e., big data analytics, adaptive services and digital manufacturing); they underpin the integration or mass customization of services and/or goods. As detailed in an earlier paper, we regard mass customization as the simultaneous and real-time management of supply and demand chains, based on a taxonomy that can be defined in terms of its underpinning component and management foci. The benefits of real-time mass customization cannot be over-stated as goods and services become indistinguishable and are co-produced - as "servgoods" - in real-time, resulting in an overwhelming economic advantage to the industrialized countries where the consuming customers are at the same time the co-producing producers. © 2012 Systems Engineering Society of China and Springer-Verlag Berlin Heidelberg.

Skyler J.S.,University of Miami
Diabetic Medicine | Year: 2013

Since type 1 diabetes is an immunologically mediated disease, immune intervention should alter the natural history of the disease. This article reviews prevention studies undertaken either prior to any evidence of autoimmunity (primary prevention) or after the development of islet autoantibodies (secondary prevention). Most immune intervention studies have been conducted in recent-onset type 1 diabetes (tertiary prevention), and these are not reviewed herein. The goal of primary and secondary intervention is to arrest the immune process and thus prevent or delay clinical disease. Primary prevention studies have been conducted in infants with high genetic risk. Interventions tested include several dietary manipulations, including infant formulas free of either cow's milk or of bovine insulin, infant formula supplemented with the omega-3-fatty acid docosahexaenoic acid, delayed introduction of gluten-containing foods, and vitamin D supplementation. Secondary prevention studies have been conducted in both children and adults with diabetes autoantibodies. Interventions tested include nicotinamide, insulin injections, oral insulin, nasal insulin, glutamic acid decarboxylase, and cyclosporine. Underway are secondary prevention studies with teplizumab and with abatacept. © 2012 The Author. Diabetic Medicine © 2012 Diabetes UK.

Epstein M.,University of Miami | Vaziri N.D.,University of California at Irvine
Nature Reviews Nephrology | Year: 2012

The cause of death in the majority of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is accelerated cardiovascular disease and not renal failure per se, suggesting a role for statin therapy in this setting. During the past 6 years three large, randomized, placebo-controlled studies of three different statins have been conducted in the dialysis population - but two of these studies did not demonstrate any benefits of statin therapy, and the third study showed only marginally positive results. To understand why statins have failed to reduce cardiovascular events in patients with ESRD, the basic mechanisms underlying the pathogenesis of dyslipidemia in CKD must be critically examined. The observed negative results in the clinical trials of statin therapy might also reflect the biomarkers and targets that were chosen to be evaluated. The characteristics of dyslipidemia in patients with CKD not yet requiring dialysis treatment differ markedly from those of individuals with established ESRD and form the basis for therapeutic recommendations. The potential adverse effects associated with statin therapy are important to consider in the management of dyslipidemia in patients with CKD. © 2012 Macmillan Publishers Limited. All rights reserved.

Tobin J.M.,University of Maryland, Baltimore | Varon A.J.,University of Miami
Anesthesia and Analgesia | Year: 2012

The management of trauma patients has matured significantly since a systematic approach to trauma care was introduced nearly a half century ago. The resuscitation continuum emphasizes the effect that initial therapy has on the outcome of the trauma patient. The initiation of this continuum begins with prompt field medical care and efficient transportation to designated trauma centers, where lifesaving procedures are immediately undertaken. Resuscitation with packed red blood cells and plasma, in parallel with surgical or interventional radiologic source control of bleeding, are the cornerstones of trauma management. Adjunctive pharmacologic therapy can assist with resuscitation. Tranexamic acid is used in Europe with good results, but the drug is slowly being added to the pharmacy formulary of trauma centers in United States. Recombinant factor VIIa can correct abnormal coagulation values, but its outcome benefit is less clear. Vasopressin shows promise in animal studies and case reports, but has not been subjected to a large clinical trial. The concept of "early goal-directed therapy" used in sepsis may be applicable in trauma as well. An early, appropriately aggressive resuscitation with blood products, as well as adjunctive pharmacologic therapy, may attenuate the systemic inflammatory response of trauma. Future investigations will need to determine whether this approach offers a similar survival benefit. Copyright © 2012 International Anesthesia Research Society.

Rowe C.L.,University of Miami
Child and Adolescent Psychiatric Clinics of North America | Year: 2010

Adolescent substance abuse rarely occurs without other psychiatric and developmental problems, but it is often treated and researched as if it can be isolated from comorbid conditions. Few comprehensive interventions are available that effectively address the range of co-occurring problems associated with adolescent substance abuse. This article reviews the clinical interventions and research evidence supporting the use of Multidimensional Family Therapy (MDFT) for adolescents with substance abuse and co-occurring problems. MDFT is uniquely suited to address adolescent substance abuse and related disorders given its comprehensive interventions that systematically target the multiple interacting risk factors underlying many developmental disruptions of adolescence. © 2010 Elsevier Inc.

Wolf M.,University of Miami
Kidney International | Year: 2012

Chronic kidney disease (CKD) is a public health epidemic that affects millions of people worldwide. Presence of CKD predisposes individuals to high risks of end-stage renal disease (ESRD), cardiovascular disease, and premature death. Disordered phosphate homeostasis with elevated circulating levels of fibroblast growth factor 23 (FGF23) is an early and pervasive complication of CKD. CKD is likely the most common cause of chronically elevated FGF23 levels, and the clinical condition in which levels are most markedly elevated. Although increases in FGF23 levels help maintain serum phosphate in the normal range in CKD, prospective studies in populations of pre-dialysis CKD, incident and prevalent ESRD, and kidney transplant recipients demonstrate that elevated FGF23 levels are independently associated with progression of CKD and development of cardiovascular events and mortality. It was originally thought that these observations were driven by elevated FGF23 levels acting as a highly sensitive biomarker of toxicity due to phosphate. However, FGF23 itself has now been shown to mediate off-target, direct, end-organ toxicity in the heart, which suggests that elevated FGF23 levels may be a novel mechanism of adverse outcomes in CKD. This report reviews recent advances in FGF23 biology relevant to CKD, the classical effects of FGF23 on mineral homeostasis, and the studies that established FGF23 excess as a biomarker and novel mechanism of cardiovascular disease. The report concludes with a critical review of the effects of different therapeutic strategies targeting FGF23 reduction and how these might be leveraged in a future randomized trial aimed at improving outcomes in CKD. © 2012 International Society of Nephrology.

Beron-Vera F.J.,University of Miami
Journal of Geophysical Research: Oceans | Year: 2010

The nature of mixing near the ocean's surface is investigated by considering passive tracer advection by currents derived geostrophically using sea surface height fields that differ in their spatiotemporal resolution. One is a low-resolution field that can be thought of as being derived using current-generation groundtrack altimetric measurements. The other is a high-resolution field that may be envisioned as derived using hypothetical next-generation wideswath altimetric measurements. The investigation is carried out in two world ocean regions with quite distinct characteristics and which have been the focus of recent studies on mixing by altimetry-derived currents. One region corresponds to an ample domain in the South Atlantic, which is traversed by vortices shed from the Agulhas current. The other region corresponds to a portion of the Pacific sector of the Southern Ocean, which is dominated by multiple zonal jets associated with the Antarctic Circumpolar Current. It is argued that while altimetry-derived currents capture the most salient characteristics of surface ocean mixing, deterministic Lagrangian calculations may be improved by considering surface geostrophic currents with greater spatiotemporal resolution. This is supported on analysis of probability distribution functions of finite-time Lyapunov exponents (FTLEs); inspection of Lagrangian coherent structures (or LCSs), which constitute distinguished material fluid curves that organize mixing; computation of kinetic energy and FTLE variance spectra; and realization of explicit passive tracer advection experiments. Copyright 2010 by the American Geophysical Union.

The ability to abstract and symbolize ideas and knowledge as simplified schematic constructs is an important element of scientific creativity and communication. Availability of such generalized symbolic constructs may be particularly important when addressing a complex adaptive system such as a marine ecosystem. Various examples have appeared in the climate-fisheries literature, each more or less effectively integrating hypothesized effects of several interacting environmental and/or biological processes in controlling population dynamics of exploited fish species. A selection of these are herein presented and reviewed, including match-mismatch, connectivity, school trap, loopholes, ocean triads, stable ocean hypothesis, several classes of nonlinear feedback loops (e.g., 'P2P', school-mix feedback, predator pit), as well as several prominent large-scale integrative climatic index series (SOI, NAO, PDO). The importance of considering the potential for adaptation and/or rapid evolution is stressed. An argument is offered for the potential utility of such widely recognizable schematic concepts in offering relatively well-understood, fairly well-defined frameworks for comparative identification and elaboration of important mechanistic linkages between climate variability and fishery dynamics, as well as in easing effective communication among scientists from different regions and disciplinary backgrounds. Certain difficulties in the application of the comparative method are discussed. It is suggested that alleviation of such difficulties may be one of the major benefits of international collaborative programs such as GLOBEC and IMBER. © 2009 Elsevier B.V. All rights reserved.

Filler G.,University of Western Ontario | Lipshultz S.E.,University of Miami
Pediatric Nephrology | Year: 2012

In adults, strong evidence indicates that slowing progression of chronic kidney disease (CKD) requires an integrated, multidisciplinary approach. In children, however, this approach has not been studied. This editorial commentary to the study by Ajarmeh et al in this volume of Pediatric Nephrology highlights how a dedicated, multidisciplinary team of physicians, nurses, pharmacists, dieticians, social workders and clinic data managers slowed the progression of CKD in children to a remarkable degree. We discuss the strengths and limitations of the study and its cost implications, as well as the issue of determining the optional complement of physicians and allied health care professionals in such clinics. Our calculations indicate that the additional costs of such clinics would be recovered in one year, even if the progession of CKD were to be delayed by 1 year in only 2% of affected children. Here, we call on the international pediatric nephrology community to establihs guidelines for forming multidisciplinary clinics throughout the world. © IPNA 2012.

Zhang J.A.,University of Miami
Journal of the Atmospheric Sciences | Year: 2010

Data collected in the low-level atmospheric boundary layer in five hurricanes by NOAA research aircraft are analyzed to measure turbulence with scales small enough to retrieve the rate of dissipation. A total of 49 flux runs suitable for analysis are identified in the atmospheric boundary layer within 200 m above the sea surface. Momentum fluxes are directly determined using the eddy correlation method, and drag coefficients are also calculated. The dissipative heating is estimated using two different methods: 1) integrating the rate of dissipation in the surface layer and 2) multiplying the drag coefficient by the cube of surface wind speed. While the latter method has been widely used in theoretical models as well as several numerical models simulating hurricanes, these analyses show that using this method would significantly overestimate the magnitude of dissipative heating. Although the dataset used in this study is limited by the surface wind speed range <30 m s-1, this work highlights that it is crucial to understand the physical processes related to dissipative heating in the hurricane boundary layer for implementing it into hurricane models. © 2010 American Meteorological Society.

Raskin M.M.,University of Miami
Journal of the American College of Radiology | Year: 2010

Failure to communicate is one of the greatest problems facing radiologists today. The courts have consistently held that timely communication may be as important as the diagnosis itself. One of the major driving forces that directly affects our failure to communicate is IT. Not only does IT provide patients with up-to-date information about medical conditions and diagnoses, it also allows the public to instantly communicate with one another, something they expect physicians to do as well. The paradox is that we are so advanced in imaging technology, but not in communicating imaging findings. This article addresses some of the most pressing issues in communicating unexpected findings and their possible solutions. Information technology can be a facilitator but not the substitute for direct communication with ordering physicians. © 2010 American College of Radiology.

Verma A.,University of Miami
Annals of Indian Academy of Neurology | Year: 2014

Over 70 different Charcot-Marie-Tooth disease (CMT)-associated genes have now been discovered and their number is growing. Conventional genetic testing for all CMT genes is cumbersome, expensive, and impractical in an individual patient. Next-generation sequencing (NGS) technology allows cost-effective sequencing of large scale DNA, even entire exome (coding sequences) or whole genome and thus, NGS platform can be employed to effectively target a large number or all CMT-related genes for accurate diagnosis. This overview discusses how NGS can be strategically used for genetic diagnosis in patients with CMT or unexplained neuropathy. A comment is made to combine simple clinical and electrophysiological algorithm to assign patients to major CMT subtypes and then employ NGS to screen for all known mutations in the subtype-specific CMT gene panel.

Kanner A.M.,University of Miami
Current Opinion in Neurology | Year: 2013

Purpose of Review: Psychiatric comorbidities are relatively frequent in people with epilepsy (PWE) occurring in one of every three patients, with a predominance of mood and anxiety disorders. Their relation with epilepsy is very complex as not only are patients with epilepsy at greater risk of developing psychiatric disorders, but also those with primary psychiatric disorders are at greater risk of developing epilepsy. The purpose of this review is to identify the implications that this bidirectional relation has on the management of the actual seizure disorder. Purpose of Review: Psychiatric comorbidities are associated with a worse response to the pharmacologic and surgical treatment of the seizure disorder. In addition, comorbid mood and anxiety disorders have been associated with a worse tolerance of antiepileptic drugs. Furthermore, the complexity between psychiatric comorbidities and epilepsy can also be appreciated in patients with treatment-resistant focal epilepsy who are treated with surgery, as some may experience a remission of presurgical mood and anxiety disorders after surgery, particularly when complete seizure freedom is achieved, whereas others experience an exacerbation in severity during the first 12 months after surgery and others may experience the development of de-novo psychiatric disorders. Summary: Psychiatric comorbidities are relatively frequent in PWE and have a bidirectional relation, the consequence of which are reflected in a worse response to the pharmacologic and surgical treatment of the seizure disorder. In addition, the variable changes of presurgical psychiatric comorbidities following epilepsy surgery may be another expression of this complex relation. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Brosco J.P.,University of Miami
Perspectives in Biology and Medicine | Year: 2016

Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists’ arguing against child’s rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine’s focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that “rights language” has hindered progress on child health and well-being in the United States. In today’s political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right’s perspective) are less likely to improve child health than robust advocacy on behalf of children’s unique needs, especially as novel models of health-care financing emerge. © 2016 by Johns Hopkins University Press.

Yehoshua Z.,University of Miami
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye | Year: 2010

Spectral domain optical coherence tomography is a useful new technology for imaging and measuring geographic atrophy (GA) and drusen, the hallmarks of dry age-related macular degeneration (AMD). The advantage of using this novel technique over other imaging modalities for dry AMD is that the same scan pattern can be used to image both drusen and GA while obtaining reproducible, quantitative data on both the area of GA and the morphologic features of drusen. Moreover, this strategy enables the clinician to follow the disease as it progresses from drusen to both GA and choroidal neovascularization. No other imaging modality is able to quantitatively assess all forms of AMD. This unique feature of spectral domain optical coherence tomography makes it the ideal imaging modality for clinical trials designed to assess new drugs for the treatment of dry AMD. Copyright 2010, SLACK Incorporated.

Schmid A.,University of Miami
Sub-cellular biochemistry | Year: 2011

A thin layer of airway surface liquid (ASL) lines the entire surface of the lung and is the first point of contact between the lung and the environment. Surfactants contained within this layer are secreted in the alveolar region and are required to maintain a low surface tension and to prevent alveolar collapse. Mucins are secreted into the ASL throughout the respiratory tract and serve to intercept inhaled pathogens, allergens and toxins. Their removal by mucociliary clearance (MCC) is facilitated by cilia beating and hydration of the ASL by active ion transport. Throughout the lung, secretion, ion transport and cilia beating are under purinergic control. Pulmonary epithelia release ATP into the ASL which acts in an autocrine fashion on P2Y(2) (ATP) receptors. The enzymatic network describes in Chap. 2 then mounts a secondary wave of signaling by surface conversion of ATP into adenosine (ADO), which induces A(2B) (ADO) receptor-mediated responses. This chapter offers a comprehensive description of MCC and the extensive ramifications of the purinergic signaling network on pulmonary surfaces.

Millero F.J.,University of Miami
Marine and Freshwater Research | Year: 2010

Intensive studies have been made on the carbonate system in seawater. The thermodynamic constants needed to examine the components of the carbonate system have been developed by several authors. The thermodynamic constants for the dissociation of carbonic acid in seawater have been determined on different pH scales. The two most popular pH scales are the total scale: [H +] T ≤ [H +] F{1 + [SO 4 2] T/K HSO4}) and the seawater scale: [H +] SWS ≤ [H +] F {1 + HSO4[SO 4 2] T/K HSO4 + HF[F -] T/K HF}, where the brackets denote concentrations and the subscripts F and T are for free and total concentrations. The values of K HSO4 and K HF are the dissociation constants for HSO 4 - and HF: As long as the same pH scale and constants for seawater are used, one can evaluate the components of the carbonate system in seawater. Unfortunately, not all the measured and fitted constants have been made for dilute seawater, and thus cannot be used in estuarine waters. In this paper, the measured constants from S ≤ 1 to 50 and t ≤ 0 to 50C have been determined on the total, seawater and free scale (pH F ≤ log[H +] F). These stoichiometric constants can now be used to examine the carbonate system in most estuarine waters. © 2010 CSIRO.

Babcock E.A.,University of Miami | Maccall A.D.,Southwest Fisheries Science Center
Canadian Journal of Fisheries and Aquatic Sciences | Year: 2011

A management strategy evaluation (based on five species in the California, USA, nearshore fishery) of control rules that reduce relative fishing effort as a function of the ratio of fish density outside versus inside no-take marine reserves (as a measure of depletion) showed that although the control rules allowed effort to increase at first, in the long term, they were effective at maintaining spawning stock biomass and yield for all simulated species, including depleted ones. Scenarios with fish movement, illegal fishing in the reserve, or post-dispersal density dependence in recruitment required higher density ratio targets, such as 60% of mature fish or 80% of all fish, to avoid stock depletion. The effort allowed by multispecies density-ratio control rules depended on the relative weight given to more or less depleted species. High variability in recruitment or in monitoring data caused the allowable effort to fluctuate. Density-ratio control rules have the advantages that they require no historical data, they can be used at local spatial scales, and they adjust to changing environmental conditions.

Litosch I.,University of Miami
Biochemical and Biophysical Research Communications | Year: 2012

Cellular response to G q-linked agonists is shaped by regulatory inputs which determine signal strength and duration. Stimulation of phospholipase C-β (PLC-β) lipase activity results in an increase in the levels of diacylglycerol (DAG) and activation of protein kinase C (PKC) activity. PKC has been implicated in the feedback regulation of G q signaling through actions on PLC-β and phospholipase D (PLD) lipase activity. As PKC activity is modulated by multiple layers of regulation, the physiological impact of PKC on G q signaling is unclear. PKC signaling can be terminated by diacylglycerol kinases (DGKs) which are regulated in a cell-specific manner. The present studies investigated the contribution of the ubiquitously expressed DGKζ isoform in the regulation of PKC signaling and G q response in transfected COS-7 cells. Genetic depletion of DGKζ protein with antisense oligonucleotides dramatically reduced DAG metabolism. The sustained increase in PKC signaling was associated with a pronounced inhibition of carbachol-stimulated lipase activity in cells co-transfected with m1 muscarinic receptor, Gα q and either with or without PLC-β 1. The data also reveal that sustained activation of PKC alone does not increase cellular PLD1 activity. Therefore, G 12-activated RhoA is physiologically important for adequate stimulation of PLD1 activity. These data show that the impact of PKC on G q signal transduction is determined by the background of cell-specific processes. © 2011 Elsevier Inc.

Schimel A.M.,University of Miami
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye | Year: 2011

Optical coherence tomography (OCT) is an important imaging modality in the setting of diabetic macular edema (DME). Its use allows more precise evaluation of retinal pathology in DME, including retinal thickness and edema, vitreomacular interface abnormalities, subretinal fluid, and foveal microstructural changes. Additional advantages include its ability to quantitatively monitor response to treatment of DME by laser, intravitreal pharmacotherapies, and vitreoretinal surgery. OCT measurements are now used in all major clinical studies of DME treatment as critical endpoints. This article presents a review of both time-domain and spectral-domain OCT in the diagnosis and management of DME. The authors discuss the various parameters evaluated by the OCT systems and provide an evidence-based evaluation of their accuracy, significance, reliability, and limitations. As the capability of OCT continues to advance, it appears that its use will play an increasingly important role in the understanding, evaluation, and treatment of DME. Copyright 2011, SLACK Incorporated.

Yoneyama K.,Japan Agency for Marine - Earth Science and Technology | Zhang C.,University of Miami | Long C.N.,Pacific Northwest National Laboratory
Bulletin of the American Meteorological Society | Year: 2013

A field campaign in the Indian Ocean region collected unprecedented observations during October 2011'March 2012 to help advance knowledge of physical processes of the Madden-Julian oscillation (MJO). Studies on the MJO mean seasonal cycle indicated that main MJO initiation activity takes place in the central IO from October to March, with the highest occurrence probability near the equator in October-January. The special observing period (SOP) was designed to obtain high-resolution data to capture the diurnal cycle of convective activity with the maximum observing capacity. All other instruments continued to operate after the SOP until the end of the intensive observing period (IOP). Accompanying the sounding arrays and equally essential to the field campaign was a radar network. The 2011-12 MJO field campaign provided observations that are unique in several aspects in comparison to previous tropical field campaigns that aimed at interactions between atmospheric convection and its large-scale environment and between the atmosphere and ocean.

Hansell D.A.,University of Miami
Annual Review of Marine Science | Year: 2013

Marine dissolved organic carbon (DOC) exhibits a spectrum of reactivity, from very fast turnover of the most bioavailable forms in the surface ocean to long-lived materials circulating within the ocean abyss. These disparate reactivities group DOC by fractions with distinctive functions in the cycling of carbon, ranging from support of the microbial loop to involvement in the biological pump to a hypothesized major source/sink of atmospheric CO2 driving paleoclimate variability. Here, the major fractions constituting the global ocean's recalcitrant DOC pool are quantitatively and qualitatively characterized with reference to their roles in carbon biogeochemistry. A nomenclature for the fractions is proposed based on those roles. © 2013 by Annual Reviews. All rights reserved.

Shah N.H.,University of Miami | Roos K.L.,Indiana University
Current Opinion in Neurology | Year: 2013

Purpose of Review: The incidence of spinal epidural abscess is increasing, and the understanding of the pathophysiology is evolving. Better understanding of the pathophysiology, specifically the role of ischemia, warrants a change in therapy. Recent Findings: Paralysis in spinal epidural abscess may be the result of spinal cord compression, spinal cord arterial and/or venous ischemia and thrombophlebitis or a combination of these. Summary: Recent evidence indicates the following areas of investigation and management can improve outcome in spinal epidural abscess: minimally invasive surgery early versus medical management when there are no significant neurological deficits, neuroradiologic arterial evaluation with therapies directed at vascular ischemia and thrombosis, and aggressive rehabilitation. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Rincon F.,Thomas Jefferson University | Wright C.B.,University of Miami
Current Opinion in Neurology | Year: 2013

PURPOSE OF REVIEW: Clinically apparent and subclinical forms of vascular disease including stroke are important causes of cognitive dysfunction. In this review, we will describe the current nomenclature for vascular cognitive impairment (VCI) from the histopathological and clinical perspectives to raise awareness among practitioners about the interaction between conventional and novel vascular risk factors and VCI, with an emphasis on the prevention and risk factor modification. RECENT FINDINGS: There is substantial evidence from observational studies and clinical trials that conventional risk factors such as hypertension, diabetes, dyslipidemia, smoking, and atrial fibrillation play a role in the development of VCI. Additional novel risk factors such as the metabolic syndrome have been associated with cognitive dysfunction as well. Targeting these risk factors will minimize the burden of VCI in our aging population. SUMMARY: The concept of VCI has evolved to describe a continuum of cognitive disorders in which vascular brain injury plays a role, ranging from mild cognitive impairment to dementia. Future research is needed to clarify the role of risk factor modification in limiting vascular brain injury to prevent VCI and progression to dementia. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Roper S.D.,University of Miami
Seminars in Cell and Developmental Biology | Year: 2013

Taste buds are peripheral chemosensory organs situated in the oral cavity. Each taste bud consists of a community of 50-100. cells that interact synaptically during gustatory stimulation. At least three distinct cell types are found in mammalian taste buds - Type I cells, Receptor (Type II) cells, and Presynaptic (Type III) cells. Type I cells appear to be glial-like cells. Receptor cells express G protein-coupled taste receptors for sweet, bitter, or umami compounds. Presynaptic cells transduce acid stimuli (sour taste). Cells that sense salt (NaCl) taste have not yet been confidently identified in terms of these cell types. During gustatory stimulation, taste bud cells secrete synaptic, autocrine, and paracrine transmitters. These transmitters include ATP, acetylcholine (ACh), serotonin (5-HT), norepinephrine (NE), and GABA. Glutamate is an efferent transmitter that stimulates Presynaptic cells to release 5-HT. This chapter discusses these transmitters, which cells release them, the postsynaptic targets for the transmitters, and how cell-cell communication shapes taste bud signaling via these transmitters. © 2012 Elsevier Ltd.

Cross J.H.,University College London | Duchowny M.,University of Miami
Epilepsia | Year: 2014

Children with intractable epilepsy benefit from early surgical treatment when possible to reduce long-term morbidity. Issues for transition are variable according to type and timing of surgery, and the outcome. When surgery is successful, cognitive and behavioral improvements may not be apparent for several years. The value of continuing antiepileptic drug (AED) treatment after successful surgery remains unclear, and the adjustment to a life without seizures may be challenging. © 2014 International League Against Epilepsy.

Fernandez C.A.,University of Miami
Investigative ophthalmology & visual science | Year: 2013

To evaluate whether veterans with posttraumatic stress disorder (PTSD) or depression have differences in dry eye symptoms and signs compared to a population without these conditions. Male patients aged ≥50 years with normal eyelid, conjunctival, and corneal anatomy were recruited from the Miami Veterans Affairs Eye Clinic (N = 248). We compared dry eye symptoms (determined by the Dry Eye Questionnaire 5 [DEQ5] score) to tear film indicators obtained by clinical examination (i.e., tear osmolarity, corneal staining, tear breakup time, Schirmer's, meibomian gland quality, orifice plugging, lid vascularity) between patients with PTSD or depression and those without these conditions. Student's t-tests, χ(2) analyses, and linear and logistic regressions were used to assess differences between the groups. DEQ5 scores were higher in the PTSD (mean = 13.4; standard error [SE] = 1.1; n = 22) and depression (mean = 12.0; SE = 0.8; n = 40) groups compared to the group without these conditions (mean = 9.8; SE = 0.4; n = 186; P < 0.01 and P = 0.02, respectively). More patients in the PTSD and depression groups had severe dry eye symptoms, defined as a DEQ5 score ≥ 12 (77% and 63% vs. 41%; P < 0.01 and P = 0.02, respectively). No significant differences in tear film indicators were found among the three groups. Multivariable logistic regression indicated that a PTSD diagnosis (odds ratio [OR] = 4.08; 95% confidence interval [CI] = 1.10-15.14) and use of selective serotonin reuptake inhibitors (OR = 2.66; 95% CI = 1.01-7.00) were significantly associated with severe symptoms. Patients with PTSD have ocular surface symptoms that are not solely explained by tear indicators. Identifying underlying conditions associated with ocular discomfort is essential to better understand the mechanisms behind ocular pain in dry eye syndrome.

1300 each) showed high VEGF expression, was prognostic of poor outcome and strongly associated with STAT3 and MYC expression, supporting the link between VEGF and CSC self-renewal. High-VEGF tumors may be most likely to escape anti-angiogenics by upregulating VEGF, driving CSC self-renewal to re-populate post-treatment. Our work highlights the need to better define VEGF-driven cancer subsets and supports further investigation of combined therapeutic blockade of VEGF or VEGFR-2 and JAK2/STAT3.Oncogene advance online publication, 25 August 2014; doi:10.1038/onc.2014.257.

De Sa D.C.,University of Sao Paulo | Tosti A.,University of Miami
American Journal of Clinical Dermatology | Year: 2014

Introduction: Onychomycosis is a very common fungal infection of the nail apparatus; however, it is very hard to treat, even when the causative agent is identified, and usually requires prolonged systemic antifungal therapy. Until the 1990s, oral treatment options included only griseofulvin and ketoconazole, and the cure rate was very low. New generations of antimycotics, such as fluconazole, itraconazole and terbinafine have improved treatment success. Methods: Literature was identified by performing a PubMed Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) search. Prospective and randomized clinical trials were chosen to be included in this review. Forty-six trials were included. Results: Fluconazole, itraconazole and terbinafine are effective in the treatment of onychomycosis and have a good safety profile. When a dermatophyte is the pathogen, terbinafine produces the best results. For Candida and nondermatophyte infections, the azoles, mainly itraconazole, are the recommended therapy. Conclusion: In the majority of the studies, terbinafine treatment showed a higher cure ratio than the other drugs for dermatophyte onychomycosis. © 2013 Springer International Publishing Switzerland.

Siegel Y.,University of Miami
The American journal of emergency medicine | Year: 2013

Acute aortic syndrome is a spectrum of diseases that have similar presentation and clinical background and include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Presented here is an 82-year-old woman with a medical history of diabetes, hypertension, nephrectomy, and chronic renal failure who complained of sudden abdominal pain radiating to epigastrium and back. At presentation, the patient was hemodynamically stable with a hemoglobin level of 10.2 and white blood cell count of 12. Chest x-ray showed a right pleural effusion and lung opacity with interstitial pulmonary edema. Computed tomography demonstrated an aortic penetrating atherosclerotic ulcer that ruptured into the right pleural space resulting in right hemothorax. A percutaneous endostent was placed with subsequent discharge of the patient 10 days after admission.

Meneghini L.F.,University of Miami
Endocrine | Year: 2013

Insulin therapy provides effective glycemic control in patients with diabetes who have deficient beta-cell function and insulin secretion. Subjects with type 2 diabetes not adequately controlled on oral agents or incretin therapies can initiate basal insulin replacement to correct fasting hyperglycemia. While all basal insulin preparations have similar efficacy in lowering fasting plasma glucose and improving A1C, the newer basal insulin analogs are associated with a lower risk of hypoglycemia than NPH insulin. Patients whose A1C levels remain above goal despite adequate basal insulin replacement need to evaluate and correct post-prandial hyperglycemia. With progressive beta-cell deficiency, rapid-acting insulin preparations can be introduced before one or more meals and titrated to achieve post-prandial glycemic control. For many patients requiring full basal/bolus insulin replacement, a strategy of fixed prandial insulin doses can yield acceptable glycemic control when compared to a more sophisticated approach utilizing carbohydrate counting and matching to insulin. Concentrated insulin preparations such as U-500 have also been of value in patients with resistant type 2 diabetes. Regardless of the type of insulin replacement used, the blood glucose lowering effects of insulin need to be carefully balanced with the increasing risk of hypoglycemia, and the weight gain associated with insulin intensification. © 2012 Springer Science+Business Media New York.

Niemesh G.T.,University of Miami
Journal of Human Resources | Year: 2015

Iron deficiency reduces productive capacity in adults and impairs cognitive development in children. In 1943, the United States government required the fortification of bread with iron to reduce iron deficiency in the workingage population during World War II. This nationwide fortification of grain products increased per capita consumption of iron by 16 percent. I find that areas with lower levels of iron consumption prior to the mandate experienced greater increases in income and school enrollment in the 1940s. A long- term followup suggests that adults in 1970 with more exposure to fortification during childhood earned higher wages. © 2015 by the Board of Regents of the University of Wisconsin System.

Klofstad C.A.,University of Miami
Proceedings. Biological sciences / The Royal Society | Year: 2012

It is well known that non-human animals respond to information encoded in vocal signals, and the same can be said of humans. Specifically, human voice pitch affects how speakers are perceived. As such, does voice pitch affect how we perceive and select our leaders? To answer this question, we recorded men and women saying 'I urge you to vote for me this November'. Each recording was manipulated digitally to yield a higher- and lower-pitched version of the original. We then asked men and women to vote for either the lower- or higher-pitched version of each voice. Our results show that both men and women select male and female leaders with lower voices. These findings suggest that men and women with lower-pitched voices may be more successful in obtaining positions of leadership. This might also suggest that because women, on average, have higher-pitched voices than men, voice pitch could be a factor that contributes to fewer women holding leadership roles than men. Additionally, while people are free to choose their leaders, these results clearly demonstrate that these choices cannot be understood in isolation from biological influences.

Eming S.A.,University of Cologne | Martin P.,University of Bristol | Martin P.,University of Cardiff | Tomic-Canic M.,University of Miami
Science Translational Medicine | Year: 2014

The cellular and molecular mechanisms underpinning tissue repair and its failure to heal are still poorly understood, and current therapies are limited. Poor wound healing after trauma, surgery, acute illness, or chronic disease conditions affects millions of people worldwide each year and is the consequence of poorly regulated elements of the healthy tissue repair response, including inflammation, angiogenesis, matrix deposition, and cell recruitment. Failure of one or several of these cellular processes is generally linked to an underlying clinical condition, such as vascular disease, diabetes, or aging, which are all frequently associated with healing pathologies. The search for clinical strategies that might improve the body's natural repair mechanisms will need to be based on a thorough understanding of the basic biology of repair and regeneration. In this review, we highlight emerging concepts in tissue regeneration and repair, and provide some perspectives on how to translate current knowledge into viable clinical approaches for treating patients with wound-healing pathologies. © 2014, American Association for the Advancement of Science. All rights reserved.

Persons with epilepsy (PWE) have a higher risk of developing depressive disorders (DDs), and people with primary DD have an increased risk of developing epilepsy. Furthermore, a lifetime history of DD has been associated with a worse response of the seizure disorder to pharmacotherapy and epilepsy surgery. The first part of this article reviews the literature of this problem with the intention of highlighting the neurobiologic pathogenic mechanisms operant in DD with a potential to facilitate the epileptogenic process and/or cortical hyperexcitability in humans and experimental animal studies of depression. They include the following: (i) a hyperactive hypothalamic-pituitary-adrenal axis and the associated structural and functional abnormalities of limbic structures, (ii) increased glutamatergic activity and decreased GABAergic and serotonergic activity, and (iii) immunologic disturbances. In the second part of this article, we suggest research strategies to test the hypothesis of whether depression worsens the course of epilepsy and identify the pathogenic mechanisms operant in this process. This article is part of a Special Issue entitled "NEWroscience 2013". © 2014.

Figueiredo B.,University of Minho | Canario C.,University of Minho | Field T.,University of Miami
Psychological Medicine | Year: 2014

Background. This prospective cohort study explored the effects of prenatal and postpartum depression on breastfeeding and the effect of breastfeeding on postpartum depression. Method. The Edinburgh Postpartum Depression Scale (EPDS) was administered to 145 women at the first, second and third trimester, and at the neonatal period and 3 months postpartum. Self-report exclusive breastfeeding since birth was collected at birth and at 3, 6 and 12 months postpartum. Data analyses were performed using repeated-measures. ANOVAs and logistic and multiple linear regressions. Results Depression scores at the third trimester, but not at 3 months postpartum, were the best predictors of exclusive breastfeeding duration (β =-0.30, t =-2.08, p < 0.05). A significant decrease in depression scores was seen from childbirth to 3 months postpartum in women who maintained exclusive breastfeeding for ≥3 months (F1,65 = 3.73, p < 0.10, ηp 2 = 0.05). Conclusions. These findings suggest that screening for depression symptoms during pregnancy can help to identify women at risk for early cessation of exclusive breastfeeding, and that exclusive breastfeeding may help to reduce symptoms of depression from childbirth to 3 months postpartum. Copyright © Cambridge University Press 2013.

Shembade N.,University of Miami | Harhaj E.W.,Sidney Kimmel Comprehensive Cancer Center
Cellular and Molecular Immunology | Year: 2012

The NF-κB transcription factor is a central mediator of inflammatory and innate immune signaling pathways. Activation of NF-κB is achieved by K63-linked polyubiquitination of key signaling molecules which recruit kinase complexes that in turn activate the Iδ °B kinase (IKK). Ubiquitination is a highly dynamic process and is balanced by deubiquitinases that cleave polyubiquitin chains and terminate downstream signaling events. The A20 deubiquitinase is a critical negative regulator of NF-κB and inflammation, since A20-deficient mice develop uncontrolled and spontaneous multi-organ inflammation. Furthermore, specific polymorphisms in the A20 genomic locus predispose humans to autoimmune disease. Recent studies also indicate that A20 is an important tumor suppressor that is inactivated in B-cell lymphomas. Therefore, targeting A20 may form the basis of novel therapies for autoimmune disease and lymphomas. © 2012 CSI and USTC. All rights reserved.

Harhaj E.W.,University of Miami | Dixit V.M.,Genentech
Immunological Reviews | Year: 2012

The nuclear factor-κB (NF-κB) pathway is a critical regulator of innate and adaptive immunity. Noncanonical K63-linked polyubiquitination plays a key regulatory role in NF-κB signaling pathways by functioning as a scaffold to recruit kinase complexes containing ubiquitin-binding domains. Ubiquitination is balanced by deubiquitinases that cleave polyubiquitin chains and oppose the function of E3 ubiquitin ligases. Deubiquitinases therefore play an important role in the termination of NF-κB signaling and the resolution of inflammation. In this review, we focus on NF-κB regulation by deubiquitinases with an emphasis on A20 and CYLD. Deubiquitinases and the ubiquitin/proteasome components that regulate NF-κB may serve as novel therapeutic targets for inflammatory diseases and cancer. © 2012 John Wiley & Sons A/S.

This review presents some of the major historical events that advanced the body of knowledge of the anatomy of the inner ear and its sensory receptors as well as the biology of these receptors that underlies the sensory functions of hearing and balance. This knowledge base of the inner ear's structure/function has been an essential factor for the design and construction of prosthetic devices to aid patients with deficits in their senses of hearing and balance. Prosthetic devices are now available for severely hearing impaired and deaf patients to restore hearing and are known as cochlear implants and auditory brain stem implants. A prosthetic device for patients with balance disorders is being perfected and is in an animal model testing phase with another prosthetic device for controlling intractable dizziness in Meniere's patients currently being evaluated in clinical testing. None of this would have been possible without the pioneering studies and discoveries of the investigators mentioned in this review and with the work of many other talented investigators to numerous to be covered in this review. © 2012 Wiley Periodicals, Inc.

Dinets V.,University of Miami
Animal Behaviour | Year: 2011

All crocodilians use long-distance signals, composed of vocal sounds, head slaps or jaw slaps and infrasound in various combinations. These signal components differ in their ability to carry information about the animal's location and status through air and water. It can be predicted that animals living in fragmented aquatic habitats should predominantly use vocal sounds combined with infrasound, while those living in continuous aquatic habitats should predominantly use head slaps combined with infrasound. To test this prediction, I sampled signals of adult male American alligators, Alligator mississippiensis, and Nile crocodiles, Crocodylus niloticus, in geographical areas where each species inhabited only one type of habitat during the mating season. I found that American alligators used head slaps more often in areas with continuous aquatic habitat, but they bellowed frequently in all habitats. Nile crocodiles frequently used head slaps in all habitats, but they roared more often in fragmented aquatic habitats, whereas in areas with continuous aquatic habitat, their roars were reduced to quiet coughs and seldom used. This discrepancy might be due to some signal components having additional functions, such as bellows attracting participants to bellowing choruses in alligators. The ability of crocodilians to optimize their signalling to habitat parameters by adjusting signal composition might account for the evolutionary stability of their signalling systems, which are still very similar between crocodiles and alligators even after more than 70 million years of separation between these two lineages. © 2011 The Association for the Study of Animal Behaviour.

Elewski B.E.,University of Alabama at Birmingham | Tosti A.,University of Miami
Expert Opinion on Pharmacotherapy | Year: 2014

Introduction: Onychomycosis causes approximately one-half of all nail disorders and its prevalence has been steadily increasing. It is difficult to treat, partly due to the subungual location and the inability of both oral and topical antifungals to reach the site of infection. Published cure rates with oral drugs are < 50% and even lower with topical drugs. Pathogenic factors include the diversity of fungal organisms and the difficulty of drugs penetrating the nail plate. Tavaborole is a broad-spectrum oxaborole antifungal agent with low molecular weight, permitting optimal nail plate penetration. In vitro and ex vivo studies have demonstrated the superior nail-penetrating properties of tavaborole compared to existing topical antifungal medications approved for the treatment of onychomycosis.Areas covered: The clinical characteristics and prevalence of onychomycosis, currently available treatments, and the chemistry, safety and pharmacokinetic properties of tavaborole for the treatment of onychomycosis.Expert opinion: Tavaborole is a novel, topical antifungal pharmaceutical agent pending FDA approval for the treatment of toenail onychomycosis due to dermatophytes. Efficacy has been demonstrated by a clinical development program including in vitro data and two large Phase III trials that enrolled ∼ 1200 patients. When approved, tavaborole topical solution, 5% may become a safe and effective option for the treatment of onychomycosis. © 2014 Informa UK, Ltd.

Kaifer A.E.,University of Miami
ChemPhysChem | Year: 2013

Stick it to them! Underwater adhesion becomes possible by taking advantage of highly stable host-guest complexes formed between cucurbit[7]uril hosts and ferrocenyl residues. The formation of multiple noncovalent complexes between the two complementary surfaces gives rise to strong adhesive forces resulting in a "supramolecular velcro" system that operates efficiently in the presence of water. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Raval A.P.,University of Miami
Journal of Addictive Diseases | Year: 2011

Nicotine addiction produces diverse physiological effects common to both men and women because of activation of the nicotinic acetylcholine receptors. In addition to these effects, nicotine reduces circulating estrogen (the female sex hormone) levels and leads to early onset of menopause in women. Nicotine's effect on estrogen metabolism has potential far-reaching consequences because endogenous circulating estrogen helps prevent cerebrovascular diseases in premenopausal women. In this article, the author presents a survey of literature showing that nicotine addiction causes unique deleterious effects in women's brains by inhibiting estrogen signaling, which makes the brain more susceptible to ischemic brain damage. Copyright © Taylor & Francis Group, LLC.

Velazquez O.C.,University of Miami | Velazquez O.C.,Holtz Center
Annals of Surgery | Year: 2011

Despite the dramatically increased entry of women into general surgery and surgical subspecialties, traditionally male-dominated fields, there remains a gross under-representation of women in the leadership positions of these departments. Women begin their careers with fewer academic resources and tend to progress through the ranks slower than men. Female surgeons also receive significantly lower salaries than their male counterparts and are more vulnerable to discrimination, both obvious and covert. Although some argue that female surgeons tend to choose their families over careers, studies have actually shown that women are as eager as men to assume leadership positions, are equally qualified for these positions as men, and are as good as men at leadership tasks.Three major constraints contribute to the glass-ceiling phenomenon: traditional gender roles, manifestations of sexism in the medical environment, and lack of effective mentors. Gender roles contribute to unconscious assumptions that have little to do with actual knowledge and abilities of an individuals and they negatively influence decision-making when it comes to promotions. Sexism has many forms, from subtle to explicit forms, and some studies show that far more women report being discriminately against than do men. There is a lack of same-sex mentors and role models for women in academic surgery, thereby isolating female academicians further. This review summarizes the manifestation of the glass-ceiling phenomenon, identifies some causes of these inequalities, and proposes different strategies for continuing the advancement of women in academic surgery and to shatter the glass ceiling. © 2011 Lippincott Williams & Wilkins.

Lin G.,University of Miami | Thurber C.H.,University of Wisconsin - Madison
Journal of Geophysical Research: Solid Earth | Year: 2012

We revisit the rupture zone of the 1989 Mw6.9 Loma Prieta earthquake, central California, by developing high-resolution three-dimensional (3-D) V p and Vp/Vs models. We apply the simul2000 inversion method and algorithm to a set of "composite" events, which have greater number of picks per event and reduced random picking errors compared with traditional master events. Our final P-wave velocity model generally agrees with previous studies, showing a high velocity body of above 6.7km/s in the southeast rupture zone of the main shock. The 3-D V p/Vs model, however, has different features, with low Vp/Vs in the upper crust and high Vp/V s anomalies in deeper layers of the rupture zone. We interpret the low Vp/Vs at shallow depths to be granitic rocks, whereas at greater depths the areas of higher Vp/Vs (around 1.725-1.75) presumably are mafic rocks. The resulting 3-D velocity model was used to improve absolute locations for all local events between 1984 and 2010 in our study area. We then applied a similar event cluster analysis, waveform cross-correlation, and differential time relocation methods to improve relative event location accuracy. Over 88% of the seismicity falls into similar event clusters. A dramatic sharpening of seismicity patterns is obtained after using these methods. The medians of the relative location uncertainties calculated by using the bootstrap approach are 5m for horizontal and 8m for vertical. Differential times from cross-correlation are used to estimate in situ near-source Vp/Vs ratio within each event cluster. The high-resolution Vp/Vs method confirms the trend of the velocity variations from the tomographic results, although absolute values are slightly different. © 2012. American Geophysical Union. All Rights Reserved.

Fotino C.,University of Miami
The review of diabetic studies : RDS | Year: 2010

The bone marrow is an invaluable source of adult pluripotent stem cells, as it gives rise to hematopoietic stem cells, endothelial progenitor cells, and mesenchymal cells, amongst others. The use of bone marrow-derived stem cell (BMC) transplantation (BMT) may be of assistance in achieving tissue repair and regeneration, as well as in modulating immune responses in the context of autoimmunity and transplantation. Ongoing clinical trials are evaluating the effects of BMC to preserve functional beta-cell mass in subjects with type 1 and type 2 diabetes, and to favor engraftment and survival of transplanted islets. Additional trials are evaluating the impact of BMT (i.e., mesenchymal stem cells) on the progression of diabetes complications. This article reviews the progress in the field of BMC for the treatment of subjects with insulin-dependent diabetes, and summarizes clinical data of pilot studies performed over the last two decades at our research center by combining allogeneic islet transplantation with donor-specific BMC. Clinical data is summarized from pilot studies performed at our research center over the last two decades.

Lanzoni G.,University of Miami | Cardinale V.,University of Rome La Sapienza | Carpino G.,Foro Italico University of Rome
Hepatology | Year: 2016

Stem/progenitors for liver, biliary tree, and pancreas exist at early stages of development in the definitive ventral endoderm forming the foregut. In humans, they persist postnatally as part of a network, with evidence supporting their contributions to hepatic and pancreatic organogenesis throughout life. Multiple stem cell niches persist in specific anatomical locations within the human biliary tree and pancreatic ducts. In liver and pancreas, replication of mature parenchymal cells ensures the physiological turnover and the restoration of parenchyma after minor injuries. Although actively debated, multiple observations indicate that stem/progenitor cells contribute to repair pervasive, chronic injuries. The most primitive of the stem/progenitor cells, biliary tree stem cells, are found in peribiliary glands within extrahepatic and large intrahepatic bile ducts. Biliary tree stem cells are comprised of multiple subpopulations with traits suggestive of maturational lineage stages and yet capable of self-replication and multipotent differentiation, being able to differentiate to mature liver cells (hepatocytes, cholangiocytes) and mature pancreatic cells (including functional islet endocrine cells). Hepatic stem cells are located within canals of Hering and bile ductules and are capable of differentiating to hepatocyte and cholangiocyte lineages. The existence, phenotype, and anatomical location of stem/progenitors in the adult pancreas are actively debated. Ongoing studies suggest that pancreatic stem cells reside within the biliary tree, primarily the hepatopancreatic common duct, and are rare in the pancreas proper. Pancreatic ducts and pancreatic duct glands harbor committed pancreatic progenitors. Conclusion: The hepatic, biliary, and pancreatic network of stem/progenitor cell niches should be considered as a framework for understanding liver and pancreatic regeneration after extensive or chronic injuries and for the study of human chronic diseases affecting these organs. (Hepatology 2016;64:277-286). © 2015 by the American Association for the Study of Liver Diseases

Physical ecosystem engineers often make major, durable physical constructs that can provide living space for other species and can structure local animal communities over evolutionary time. In Florida, a medium sized chelonian, the Gopher Tortoise (Gopherus polyphemus) will excavate extensive subterranean chambers that can endure for long periods of time. The tortoise starts a 'burrowing cascade', by first excavating a larger burrow that may extend 10. m, which is then re-engineered by Florida Mice (Podomys floridanus) and other rodents that dig smaller side-burrows and pockets. This sequence is often followed by an invertebrate, the camel cricket (Ceuthophilus labibuli) which is reported to excavate even smaller chambers. Our first aim was to quantify the zoogeomorphic impact of this burrowing cascade by measuring the amount of soil excavated in a large sample of burrows in two communities. Secondly, we hypothesized that the high biodiversity reported for these structures might be related to the quasi-fractal nature of the geometry, following the work of Frontier (1987). To visualize this underground geometry, we used high-resolution 3D Ground Penetrating Radar (GPR), which provided images and insights previously unobtainable using excavations or 2D GPR. Our images verified that the active tortoise burrow had a spiraling shape, but also showed splits in the larger burrow apparently dug by tortoises. For the first time, the smaller Florida Mouse burrows were imaged, showing side loops that exit and re-renter the tortoise burrow. This study also presents new information by making the discovery of numerous remnants of past tortoise burrows underground in the sampling grid surrounding the active burrow. Our third aim was to interpret our field results with previous ecological field studies to evaluate the strength of evidence that this species ranks as an ecosystem engineer. © 2011 Elsevier B.V.

Hotz G.A.,University of Miami
American journal of disaster medicine | Year: 2012

Prior to the devastating earthquake in Haiti, January 12, 2010, a group of Haitian physicians, leaders and members of Project Medishare for Haiti, a Non-governmental Organization, had developed plans for a Trauma Critical Care Network for Haiti. One year after the earthquake stands a 50-bed trauma critical care and rehab hospital that employs more than 165 Haitian doctors, nurses and allied healthcare professionals, and administrative and support staff in Port-Au-Prince. Hospital Bernard Mevs Project Medishare (HBMPM) has been operating with the following two primary goals: 1) to provide critical-care- and trauma-related medical and rehabilitation services and 2) to provide clinical education and training to Haitian healthcare professionals.(1) These goals have been successfully accomplished, with more than 43,000 outpatients seen, 6,500 emergency room visits, and about 2,300 surgical procedures performed. Daily patient care has been managed by Haitian medical staff as well as more than 2,400 international volunteers including physicians, nurses, and allied healthcare professionals. With the continued assistance of weekly volunteers, many programs and services have been developed; however, many challenges remain. This article highlights the development and progress of HBMPM over the last year with emphasis on developing inpatient and outpatient services, which include surgical, clinical laboratory, wound care, radiology, rehabilitation, and prosthesis/orthotics programs. Some of the challenges faced and how they were managed will be discussed as well as future plans to conduct more training and education to increase the building of medical capacity for Haiti.

Raymo F.M.,University of Miami
Physical Chemistry Chemical Physics | Year: 2013

Photoactivatable fluorophores switch from a nonemissive state to an emissive one under irradiation at an activation wavelength and then emit light in the form of fluorescence upon illumination at an excitation wavelength. Such a concatenation of activation and excitation events translates into the possibility of switching fluorescence on within a defined region of space at a given interval of time. In turn, the spatiotemporal control of fluorescence offers the opportunity to monitor dynamic processes in real time as well as to reconstruct images with resolution at the nanometer level. As a result, these photoresponsive molecular switches are becoming invaluable analytical tools to probe the structures and dynamics of a diversity of materials relying on the noninvasive character of fluorescence imaging. © the Owner Societies 2013.

Tregear S.J.,MANILA Consulting Group Inc. | Gavin L.E.,Office of Population Affairs | Williams J.R.,University of Miami
American Journal of Preventive Medicine | Year: 2015

From 2010 to 2014, CDC and the Office of Population Affairs at the USDHHS collaborated on the development of clinical recommendations for providing quality family planning services. A high priority was placed on the use of existing scientific evidence in developing the recommendations, in accordance with IOM guidelines for how to develop "trustworthy" clinical practice guidelines. Consequently, a series of systematic reviews were developed using a transparent and reproducible methodology aimed at ensuring that the clinical practice guidelines would be based on evidence collected in the most unbiased manner possible. This article describes the methodology used in conducting these systematic reviews, which occurred from mid-2011 through 2012. © 2015 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Cherniack E.P.,University of Miami
Nutrition | Year: 2011

Greater understanding about the pathogenesis of metabolic syndrome and potential causes suggests that plant polyphenols might be useful as a treatment. Dietary excess energy can be stored in adipocytes, leading to the release of proinflammatory cytokines and adipose-related hormones that cause vascular injury. Plant polyphenols, organic compounds found in numerous plant species and their fruits, are being actively studied as potential treatments for components of the metabolic syndrome. Individual polyphenols that have been examined include resveratrol, quercetin, epigallocathechin-3-gallate, and curcumin. Resveratrol lowers weight, blood pressure, glucose, and insulin resistance in rodents, and a human trial is currently underway. Quercetin decreases lipid and glucose levels in obese rats, and in a human investigation of subjects with the metabolic syndrome has lowered blood pressure without significant alteration of lipids. Epigallocathechin-3-gallate-induced weight loss has attenuated glucose levels and insulin resistance in rodents and improved hemoglobin A1c and lipid in human studies. Plant extracts also can be used. Grape seed and chokeberry extracts have decreased blood pressure and lipid levels in small human trials. Other human investigations have shown the beneficial effects of cocoa, coffee, carob, and Momordica charantia. Thus far, most studies have involved a small number of subjects and have been of short duration. Future studies should be designed to account for a disease process in which the pathogenic factors may take place for years before disease manifestations take place, the possibly limited bioavailability of polyphenols, and the potential need to provide combinations or modifications of polyphenols. © 2011.

Endothelial progenitor cells (EPCs) contribute to the regeneration of endothelium. Aging-associated senescence results in reduced number and function of EPCs, potentially contributing to increased cardiac risk, reduced angiogenic capacity, and impaired cardiac repair effectiveness. The mechanisms underlying EPC senescence are unknown. Increasing evidence supports the role of microRNAs in regulating cellular senescence. We aimed to determine whether microRNAs regulated EPC senescence and, if so, what the underlying mechanisms are. To map the microRNA/gene expression signatures of EPC senescence, we performed microRNA profiling and microarray analysis in lineage-negative bone marrow cells from young and aged wild-type and apolipoprotein E-deficient mice. We identified 2 microRNAs, microRNA-10A* (miR-10A*), and miR-21, and their common target gene Hmga2 as critical regulators for EPC senescence. Overexpression of miR-10A* and miR-21 in young EPCs suppressed Hmga2 expression, caused EPC senescence, as evidenced by senescence-associated β-galactosidase upregulation, decreased self-renewal potential, increased p16(Ink4a)/p19(Arf) expression, and resulted in impaired EPC angiogenesis in vitro and in vivo, resembling EPCs derived from aged mice. In contrast, suppression of miR-10A* and miR-21 in aged EPCs increased Hmga2 expression, rejuvenated EPCs, resulting in decreased senescence-associated β-galactosidase expression, increased self-renewal potential, decreased p16(Ink4a)/p19(Arf) expression, and improved EPC angiogenesis in vitro and in vivo. Importantly, these phenotypic changes were rescued by miRNA-resistant Hmga2 cDNA overexpression. miR-10A* and miR-21 regulate EPC senescence via suppressing Hmga2 expression and modulation of microRNAs may represent a potential therapeutic intervention in improving EPC-mediated angiogenesis and vascular repair.

Li J.,University of Miami
Circulation research | Year: 2013

Cardiac myocyte hypertrophy is the main compensatory response to chronic stress on the heart. p90 ribosomal S6 kinase (RSK) family members are effectors for extracellular signal-regulated kinases that induce myocyte growth. Although increased RSK activity has been observed in stressed myocytes, the functions of individual RSK family members have remained poorly defined, despite being potential therapeutic targets for cardiac disease. To demonstrate that type 3 RSK (RSK3) is required for cardiac myocyte hypertrophy. RSK3 contains a unique N-terminal domain that is not conserved in other RSK family members. We show that this domain mediates the regulated binding of RSK3 to the muscle A-kinase anchoring protein scaffold, defining a novel kinase anchoring event. Disruption of both RSK3 expression using RNA interference and RSK3 anchoring using a competing muscle A-kinase anchoring protein peptide inhibited the hypertrophy of cultured myocytes. In vivo, RSK3 gene deletion in the mouse attenuated the concentric myocyte hypertrophy induced by pressure overload and catecholamine infusion. Taken together, these data demonstrate that anchored RSK3 transduces signals that modulate pathologic myocyte growth. Targeting of signaling complexes that contain select kinase isoforms should provide an approach for the specific inhibition of cardiac myocyte hypertrophy and for the development of novel strategies for the prevention and treatment of heart failure.

Yim E.,University of Miami
Current Opinion in Endocrinology, Diabetes and Obesity | Year: 2014

PURPOSE OF REVIEW: The authors will review the current literature on efficacy and safety of 5-alpha reductase inhibitors (5αRIs) for androgenetic alopecia (AGA).RECENT FINDINGS: The 5αRI finasteride and dutasteride are effective in treating AGA and promoting hair regrowth. 5αRI can be given orally, topically and more recently through mesotherapy. However, there has been an increasing concern about permanent sexual adverse events such as impotence and infertility. Most of these reports are published as case reports, and two studies reporting persistent sexual side-effects after discontinuation of finasteride had serious method limitations, as patients were recruited from a website. To our knowledge, permanent sexual adverse events have yet to be published in higher quality studies, such as randomized controlled trials. Although patients treated with 5αRIs have an increased incidence of sexual adverse events, these events decrease if discontinued or over time with continued therapy.SUMMARY: Sexual side-effects are uncommon and resolve spontaneously in most patients even without discontinuing therapy. Significant effort is underway to find delivery systems that optimize delivery and reduce systemic absorption of topical 5αRs including hydroxypropyl chitosan and liposomal and nanoparticulate systems. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

As it becomes ever clearer that on longer time scales marine ecosystems function as non-linear "complex adaptive systems", potential consequences of global change become obscured within a maze of multiple possibilities. This essay attempts to route one pathway to a potentially more robust conceptual synthesis, employing the globally important example of anchovies and sardines as a model. Expressly, the anchovy emerges as an efficient specialist of neritic origin. In contrast, the sardine's oceanic-based adaptations equip it to deal with intermittent episodes of poorly productive conditions and to take advantage of associated reduction in predation pressure on early life stages of their offspring. Based on the overall synthesis, the nimble, wide-ranging, actively opportunistic sardine appears notably well equipped to deal with climate-related disruptions and dislocations and even to profit from their adverse effects on predators and competitors. Global-scale multispecies population synchronies in the 1970s to the mid-1980s suggest that a variety of different species types might be flagged for investigation as perhaps embodying similar "active opportunist" attributes. If so, events and anecdotes might, as global changes proceed, be viewed within a developing universal framework that could support increasingly effective transfers of experience and predictive foresight across different species groups and regional ecosystems. © 2014 International Council for the Exploration of the Sea. All rights reserved.

Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy. To determine clinical, radiological, and patient satisfaction outcomes between expansile cervical laminoplasty (ECL) and cervical laminectomy and fusion (CLF). We performed a prospective, randomized study of ECL vs CLF in patients suffering from cervical spondylotic myelopathy. End points included the Short Form-36, Neck Disability Index, Visual Analog Scale, modified Japanese Orthopedic Association score, Nurick score, and radiographic measures. A survey of academic North American spine surgeons (n = 30) demonstrated that CLF is the most commonly used (70%) posterior procedure to treat multilevel spondylotic cervical myelopathy. A total of 16 patients were randomized: 7 to CLF and 9 to ECL. Both groups showed improvements in their Nurick grade and Japanese Orthopedic Association score postoperatively, but only the improvement in the Nurick grade for the ECL group was statistically significant (P < .05). The cervical range of motion between C2 and C7 was reduced by 75% in the CLF group and by only 20% in the ECL group in a comparison of preoperative and postoperative range of motion. The overall increase in canal area was significantly (P < .001) greater in the CLF group, but there was a suggestion that the adjacent level was more narrowed in the CLF group in as little as 1 year postoperatively. In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.

Kirk-Sanchez N.J.,University of Miami | McGough E.L.,University of Washington
Clinical Interventions in Aging | Year: 2014

In an aging population with increasing incidence of dementia and cognitive impairment, strategies are needed to slow age-related decline and reduce disease-related cognitive impairment in older adults. Physical exercise that targets modifiable risk factors and neuroprotective mechanisms may reduce declines in cognitive performance attributed to the normal aging process and protect against changes related to neurodegenerative diseases such as Alzheimer's disease and other types of dementia. In this review we summarize the role of exercise in neuroprotection and cognitive performance, and provide information related to implementation of physical exercise programs for older adults. Evidence from both animal and human studies supports the role of physical exercise in modifying metabolic, structural, and functional dimensions of the brain and preserving cognitive performance in older adults. The results of observational studies support a dose-dependent neuroprotective relationship between physical exercise and cognitive performance in older adults. Although some clinical trials of exercise interventions demonstrate positive effects of exercise on cognitive performance, other trials show minimal to no effect. Although further research is needed, physical exercise interventions aimed at improving brain health through neuroprotective mechanisms show promise for preserving cognitive performance. Exercise programs that are structured, individualized, higher intensity, longer duration, and multicomponent show promise for preserving cognitive performance in older adults. © 2014 Kirk-Sanchez and McGough.

Ramamurthy V.,University of Miami
Accounts of Chemical Research | Year: 2015

Conspectus Photochemistry along with life as we know it originated on earth billions of years ago. Supramolecular Photochemistry had its beginning when plants that sustain life began transforming water into oxygen by carrying out light initiated reactions within highly organized assemblies. Prompted by the efforts of J. Priestly (photosynthesis), F. Sestini, S. Cannizaro, and C. Liebermann (solid-state photochemistry of santonin, quinones, and cinnamic acid), orderly scientific investigations of the link between light absorption by matter and molecules and the chemical and physical consequences began in the mid-1700s. By 1970 when Molecular Photochemistry had matured, it was clear that controlling photochemical reactions by conventional methods of varying reaction parameters like temperature and pressure would be futile due to the photoreactions' very low activation energies and enthalpies.During the last 50 years, the excited state behavior of molecules has been successfully manipulated with the use of confining media and weak interactions between the medium and the reactant molecule. In this context, with our knowledge from experimentation with micelles, cyclodextrins (CD), cucurbitruils (CB), calixarenes (CA), Pd nanocage, crystals, and zeolites as media, we began about a decade ago to explore the use of a new water-soluble synthetic organic cavitand, octa acid (OA) as a reaction container. The uniqueness of OA as an organic cavitand lies in that two OA molecules form a closed hydrophobic capsule to encapsulate water-insoluble guest molecule(s). The ability to include a large number of guest molecules in OA has provided an opportunity to examine the excited state chemistry of organic molecules in a hydrophobic, confined environment. OA distinguishes itself from the well-known cavitands CD and CB by its active reaction cavity absorbing UV-radiation between 200 and 300 nm and serving as energy, electron, and hydrogen donor. The freedom of guest molecules in OA, between that in crystals and isotropic solution can be transformed into photoproducts selectivity. The results of our photochemical investigations elaborated in this Account demonstrate that OA with a medium sized cavity exerts better control on excited state processes than the more common and familiar organic hosts such as CD, CB, CA, and micelles. By examining the photochemistry of a number of molecules (olefins, carbonyls, aromatics and singlet oxygen) that undergo varied reactions (cleavage, cycloaddition, cis-trans isomerization, oxidation and cyclization) within OA capsule, we have demonstrated that the free space within the container, the capsule influenced conformation and preorientation of guest molecules, supramolecular steric control, and capsular dynamics contribute to the altered excited state behavior.In this Account, we have shown that photochemistry based on concepts of physical organic and supramolecular chemistry continues to be a discipline with unlimited potential. The future of supramolecular photochemistry lies in synthetic, materials, medicinal, and biological chemistries. Success in these areas depends on synthesizing well-designed water-soluble hosts that can emulate complex biological assemblies, organizing and examining the behavior of supramolecular assemblies on solid surfaces, rendering the photoreactions catalytic, and delivering encapsulated drugs in a targeted fashion. © 2015 American Chemical Society.

Capobianco E.,University of Miami | Capobianco E.,CNR Institute of Clinical Physiology | Lio' P.,University of Cambridge
Trends in Molecular Medicine | Year: 2013

Comorbidity represents an extremely complex domain of research. An individual entity, the patient, is the center of gravity of a system characterized by multiple, complex, and interrelated conditions, disorders, or diseases. Such complexity is influenced by uncertainty that is difficult to decipher and is proportional to the number of associated morbidities. Computational scientists usually provide meta-analysis studies aimed at integrating various types of evidence, but in our opinion they may help reformulate comorbidity by emphasizing, in particular, two aspects: (i) a systems approach, which allows for an ensemble view of comorbidity, and offers a model representation generalizable to multimorbidity; and (ii) a dynamic network inference approach, which is indicated for the analysis of links among morbidities and evaluation of risk. Notably, the main question remains whether such instruments suggest a shift of paradigm providing prospective impact on medical practice. We have identified in the simultaneous consideration of multiple dimensions linked to comorbidity complexity the rationale for such translation. © 2013 Elsevier Ltd.

Rogers R.,National Oceanic and Atmospheric Administration | Reasor P.,National Oceanic and Atmospheric Administration | Lorsolo S.,University of Miami
Monthly Weather Review | Year: 2013

Differences in the inner-core structure of intensifying [IN; intensity increase of at least 20 kt (24 h)1, where 1 kt 5 0.51ms1] and steady-state [SS; intensity remaining between 610 kt (24 h)1] tropical cyclones (TCs) are examined using composites of airborneDoppler observations collected from NOAAP-3 aircraft missions. The IN dataset contains 40 eyewall passes from 14 separate missions, while the SS dataset contains 53 eyewall passes from 14 separate missions. Intensifying TCs have a ringlike vorticity structure inside the radius of maximum wind (RMW); lower vorticity in the outer core; a deeper, stronger inflow layer; and stronger axisymmetric eyewall upward motion compared with steady-state TCs. There is little difference in the vortex tilt between 2 and 7 km, and both IN and SS TCs show an eyewall precipitation and updraft asymmetry whose maxima are located in the downshear and downshear-left region. The azimuthal coverage of eyewall and outer-core precipitation is greater for IN TCs. There is little difference in the distribution of downdrafts and weak to moderate updrafts in the eyewall. The primary difference is seen at the high end of the vertical velocity spectrum, where IN TCs have a larger number of convective bursts. These bursts accomplish more vertical mass flux, but they compose such a small portion of the total vertical velocity distribution that there is little difference in the shape of the net mass flux profile. The radial location of convective bursts for IN TCs is preferentially located inside the RMW, where the axisymmetric vorticity is generally higher, whereas for SS TCs the bursts are located outside the RMW.

Field T.,University of Miami | Field T.,Fielding Graduate University
Complementary Therapies in Clinical Practice | Year: 2014

Moderate pressure massage has contributed to many positive effects including increased weight gain in preterm infants, reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis, enhanced attentiveness, reduced depression and enhanced immune function (increased natural killer cells and natural killer cell activity).Surprisingly, these recent studies have not been reviewed, highlighting the need for the current review. When moderate and light pressure massage have been compared in laboratory studies, moderate pressure massage reduced depression, anxiety and heart rate, and it altered EEG patterns, as in a relaxation response. Moderate pressure massage has also led to increased vagal activity and decreased cortisol levels. Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex, all areas involved in stress and emotion regulation. Further research is needed to identify underlying neurophysiological and biochemical mechanisms associated with moderate pressure massage. © 2014 Elsevier Ltd.

Maderal A.D.,University of Miami
Hospital practice (1995) | Year: 2012

Diabetic foot ulcers (DFUs) are a common complication of diabetes and present a significant health risk to patients, as well as impose a large economic burden. Evaluation for contributory factors that may impact general health or healing, such as hyperglycemia, peripheral artery disease, neuropathy, and nutritional status, is of the utmost importance. Management of DFUs requires involvement of a multidisciplinary team and a standardized approach to patient care. Standard therapy for DFUs includes offloading and debridement. Assessment and control of infection are critical, including determining the severity of the infection, which may drive therapeutic approaches. For recalcitrant ulcers, adjuvant therapies are used to hasten the healing process, and newer therapies are under investigation.

Cushman R.,University of Miami
Journal of biomedical informatics | Year: 2010

Robert Wood Johnson Foundation's Project HealthDesign included funding of an ethical, legal and social issues (ELSI) team, to serve in an advisory capacity to the nine design projects. In that capacity, the authors had the opportunity to analyze the personal health record (PHR) and personal health application (PHA) implementations for recurring themes. PHRs and PHAs invert the long-standing paradigm of health care institutions as the authoritative data-holders and data-processors in the system. With PHRs and PHAs, the individual is the center of his or her own health data universe, a position that brings new benefits but also entails new responsibilities for patients and other parties in the health information infrastructure. Implications for law, policy and practice follow from this shift. This article summarizes the issues raised by the first phase of Project HealthDesign projects, categorizing them into four topics: privacy and confidentiality, data security, decision support, and HIPAA and related legal-regulatory requirements. Discussion and resolution of these issues will be critical to successful PHR/PHA implementations in the years to come. Copyright © 2010 Elsevier Inc. All rights reserved.

Claypool H.M.,University of Miami | Bernstein M.J.,Pennsylvania State University
Journal of Personality and Social Psychology | Year: 2014

Exclusion triggers a desire to re-capture connections with others. To facilitate this goal, excluded individuals typically process social information especially carefully. One implication of this is that exclusion may foster judgments of others that are reliant on a careful consideration of their idiosyncratic behaviors rather than on more superficial features. We predicted, therefore, that excluded individuals should individuate more and stereotype less than non-excluded individuals and that such effects should be in service of identifying appropriate re-affiliation candidates. In 3 replications of Experiment 1, excluded (compared to non-excluded) individuals rendered less stereotypic judgments of occupational and racial group members described with mildly or ambiguously counter-stereotypic information. Confirming such processes aid with re-affiliation, Experiments 2 and 3 showed that these effects occurred for social targets that represented reasonable sources of re-affiliation, but not for offensive social targets (i.e., Skinheads) or non-social agents. Experiment 4 underscored that excluded participants process presented social information more carefully (individuate), showing greater differentiation in judgments of highly stereotype-consistent and stereotype-inconsistent targets. Implications for the social exclusion literature are discussed. © 2014 American Psychological Association.

Lencastre A.,Centro Hospitalar Of Lisbon Central Lisbon | Tosti A.,University of Miami
Pediatric Dermatology | Year: 2013

Hair and scalp disorders in children may originate from the hair itself, scalp skin, or infectious causes and be congenital or acquired. The most common sign is alopecia, frequently brought on by tinea capitis, patchy alopecia areata, or trichotillomania. Sometimes less frequent and clinically more elusive conditions such as initial androgenetic alopecia, congenital triangular alopecia, or alopecia areata incognita may be responsible for hair loss. The noninvasive technique known as trichoscopy is being used more frequently, aiding in the prompt differential diagnosis and follow-up of many of these diseases, oftentimes providing further examination before a treatment decision is made. This review of trichoscopy of the main scalp and hair disorders afflicting children and adolescents discusses the most important dermoscopic criteria and the usefulness of this technique. © 2013 Wiley Periodicals, Inc.

Hevia O.,University of Miami
Journal of Drugs in Dermatology | Year: 2010

Background: Prior international clinical experience and domestic controlled clinical trials provide useful guidance for dosing of a new botulinum toxin type A, abobotulinumtoxinA. Nonetheless, aftermarket experience is paramount in providing confirmatory "real world" information on any recently introduced drug. This report describes the incorporation of abobotulinumtoxinA into an established clinical practice that previously only utilized onabotulinumtoxinA for facial rejuvenation Description: Retrospective review of 500 patients who received abobotulinumtoxinA injections. Results: A total of 736 abobotulinumtoxinA treatments were administered to 500 patients. The most common areas treated were corrugators, "crow's feet," frontalis, brow and platysma, respectively. A dose conversion ratio of 1:2.67 (onabotulinumtoxinA : abobotulinumtoxinA) was determined. The majority of adverse events were considered to be mild and self-limiting. There were three (0.6%) cases of ptosis. Conclusion: Since its recent approval by the U.S. Food and Drug Administration (FDA), experience with abobotulinumtoxinA is evolving. Utilizing a dose conversion ratio of 1:2.67 units (onabotulinumtoxinA: abobotulinumtoxinA) and the same injection techniques, one can safely and effectively incorporate this new neurotoxin into his or her practice. Copyright © 2010 Journal of Drugs in Dermatology.

Ridley D.A.,Massachusetts Institute of Technology | Heald C.L.,Massachusetts Institute of Technology | Prospero J.M.,University of Miami
Atmospheric Chemistry and Physics | Year: 2014

Dust from Africa strongly perturbs the radiative balance over the Atlantic, with emissions that are highly variable from year to year. We show that the aerosol optical depth (AOD) of dust over the mid-Atlantic observed by the AVHRR satellite has decreased by approximately 10% per decade from 1982 to 2008. This downward trend persists through both winter and summer close to source and is also observed in dust surface concentration measurements downwind in Barbados during summer. The GEOS-Chem model, driven with MERRA re-analysis meteorology and using a new dust source activation scheme, reproduces the observed trend and is used to quantify the factors contributing to this trend and the observed variability from 1982 to 2008. We find that changes in dustiness over the east mid- Atlantic are almost entirely mediated by a reduction in surface winds over dust source regions in Africa and are not directly linked with changes in land use or vegetation cover. The global mean all-sky direct radiative effect (DRE) of African dust is -0.18Wm-2 at top of atmosphere, accounting for 46% of the global dust total, with a regional DRE of -7.4±1.5Wm-2 at the surface of the mid-Atlantic, varying by over 6.0Wm-2 from year to year, with a trend of +1.3Wm-2 per decade. These large interannual changes and the downward trend highlight the importance of climate feedbacks on natural aerosol abundance. Our analysis of the CMIP5 models suggests that the decreases in the indirect anthropogenic aerosol forcing over the North Atlantic in recent decades may be responsible for the observed climate response in African dust, indicating a potential amplification of anthropogenic aerosol radiative impacts in the Atlantic via natural mineral dust aerosol. © Author(s) 2014.

Sobel A.E.K.,University of Miami
Computer | Year: 2013

Today's educators must wear multiple hats-entertainer, personal coach, emergency responder, gizmo wizard, and social media guru-to be judged as informed and effective. © 1970-2012 IEEE.

Wilson A.,University of Miami
Journal of Medicine and Philosophy (United Kingdom) | Year: 2013

Lung cancer is the leading cause of cancer deaths, yet research funding is by far the lowest for lung cancer than for any other cancer compared with respective death rates. Although this discrepancy should appear alarming, one could argue that lung cancer deserves less attention because it is more attributable to poor life choices than other common cancers. Accordingly, the general question that I ask in this article is whether victims of more avoidable diseases, such as lung cancer, deserve to have their needs taken into less consideration than those of less avoidable diseases, on the grounds of either retributive or distributive justice. Such unequal treatment may be the "penalty" one incurs for negligent or reckless behavior. However, I hope to show that such unequal treatment cannot be supported by any coherent accounts of retributive or distributive justice. © 2013 Published by Oxford University Press on behalf of the Journal of Medicine and Philosophy Inc. 2013.

Rosen M.R.,Columbia University | Myerburg R.J.,University of Miami | Francis D.P.,Imperial College London | Cole G.D.,Imperial College London | Marban E.,Cedars Sinai Heart Institute
Journal of the American College of Cardiology | Year: 2014

Over the past 2 decades, there have been numerous stem cell studies focused on cardiac diseases, ranging from proof-of-concept to phase 2 trials. This series of papers focuses on the legacy of these studies and the outlook for future treatment of cardiac diseases with stem cell therapies. The first section by Drs. Rosen and Myerburg is an independent review that analyzes the basic science and translational strategies supporting the rapid advance of stem cell technology to the clinic, the philosophies behind them, trial designs, and means for going forward that may impact favorably on progress. The second and third sections were collected as responses to the initial section of this review. The commentary by Drs. Francis and Cole discusses the review by Drs. Rosen and Myerburg and details how trial outcomes can be affected by noise, poor trial design (particularly the absence of blinding), and normal human tendencies toward optimism and denial. The final, independent paper by Dr. Marbán takes a different perspective concerning the potential for positive impact of stem cell research applied to heart disease and future prospects for its clinical application. (Compiled by the JACC editors). © 2014 by the American College of Cardiology Foundation.

Baim S.,University of Miami
Rheumatic Disease Clinics of North America | Year: 2011

Osteoporosis-related fractures are associated with significant morbidity, mortality, and health care expenditure worldwide. The low sensitivity of bone density testing alone to predict fractures has led to the development of a variety of fracture assessment tools that use the combination of bone density and clinical risk factors to improve the prediction of low-trauma fractures. These fracture assessment tools quantitatively predict the 10-year probability of hip and major osteoporosis-related fractures, and can be used with various intervention strategies to effectively intervene with cost-effective therapies to prevent future fractures. © 2011 Elsevier Inc.

O'Brien T.P.,University of Miami
Current Opinion in Allergy and Clinical Immunology | Year: 2013

PURPOSE OF REVIEW: The focus of this review is to provide a logical paradigm for the diagnosis and treatment of ocular allergies, with a focus on seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). RECENT FINDINGS: Several classes of topical medications are currently available for the management of ocular allergies, including: lubricating agents, vasoconstrictors, antihistamines, mast cell stabilizers, and topical corticosteroids. SUMMARY: SAC and PAC make up the vast majority of ocular allergy cases. A proactive approach to these diseases, anticipating the regional spring and fall allergen spikes, is needed for optimally managing these disorders. A multifaceted treatment regimen comprising patient education, lifestyle modification, and topical medications (such as antihistamines and/or mast cell stabilizers and corticosteroids) may be required in order to manage ocular allergies effectively. The appropriate treatment paradigm is based on the severity of the patients' signs and symptoms. For moderate-to-severe cases, especially chronic vernal keratoconjunctivitis, atopic keratoconjunctivitis, and giant papillary conjunctivitis, comanagement with an ophthalmologist is recommended. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Zingg J.-M.,University of Miami
Annual Review of Nutrition | Year: 2015

Vitamin E modulates the activity of several signal transduction enzymes with consequent alterations of gene expression. At the molecular level, vitamin E may directly bind to these enzymes and compete with their substrates, or it may change their activity by redox regulation. The translocation of several of these enzymes to the plasma membrane is regulated by vitamin E, suggesting the modulation of protein-membrane interactions as a common mechanism for vitamin E action. Enzyme-membrane interactions can be affected by vitamin E by interference with binding to specific membrane lipids or by altering cellular structures such as membrane microdomains (lipid rafts). Moreover, competition by vitamin E for common binding sites within lipid transport proteins may alter the traffic of lipid mediators and thus affect their signaling and enzymatic conversion. In this review, the main effects of vitamin E on enzymes involved in signal transduction are summarized and possible molecular mechanisms leading to enzyme modulation are evaluated. Copyright ©2015 by Annual Reviews. All rights reserved.

Marine teleost fish osmoregulation involves seawater ingestion and intestinal fluid absorption. Solute coupled fluid absorption by the marine teleost fish intestine has long been believed to be the product of Na(+) and Cl(-) absorption via the Na(+) :K(+) :2Cl(-) co-transporter (NKCC2). However, the past decade has revealed that intestinal anion exchange contributes significantly to Cl(-) absorption, in exchange for HCO(3) (-) secretion, and that this process is important for intestinal water absorption. In addition to contributing to solute coupled water absorption intestinal anion exchange results in luminal precipitation of CaCO(3) which acts to reduce luminal osmotic pressure and thus assist water absorption. Most recently, activity of apical H(+) -pumps, especially in distal segments of the intestine have been suggested to not only promote anion exchange, but also to reduce luminal osmotic pressure by preventing excess HCO(3)(-) concentrations from accumulating in intestinal fluids, thereby aiding water absorption. The present review summarizes and synthesizes the most recent advances in our view of marine teleosts osmoregulation, including our emerging understanding of epithelial transport of acid-base equivalents in the intestine, the consequences for whole organism acid-base balance and finally the impact of piscine CaCO(3) formation on the global oceanic carbon cycle. © 2011 The Author. Acta Physiologica © 2011 Scandinavian Physiological Society.

Porciatti V.,University of Miami
Experimental Eye Research | Year: 2015

The function of retinal ganglion cells (RGCs) can be non-invasively assessed in experimental and genetic models of glaucoma by means of variants of the ERG technique that emphasize the activity of inner retina neurons. The best understood technique is the Pattern Electroretinogram (PERG) in response to contrast-reversing gratings or checkerboards, which selectively depends on the presence of functional RGCs. In glaucoma models, the PERG can be altered before histological loss of RGCs; PERG alterations may be either reversed with moderate IOP lowering or exacerbated with moderate IOP elevation. Under particular luminance-stimulus conditions, the Flash-ERG displays components that may reflect electrical activity originating in the proximal retina and be altered in some experimental glaucoma models (positive Scotopic Threshold response, pSTR; negative Scotopic Threshold Response, nSTR; Photopic Negative Response, PhNR; Oscillatory Potentials, OPs; multifocal ERG, mfERG). It is not yet known which of these components is most sensitive to glaucomatous damage. Electrophysiological assessment of RGC function appears to be a necessary outcome measure in experimental glaucoma models, which complements structural assessment and may even predict it. Neuroprotective strategies could be tested based on enhancement of baseline electrophysiological function that results in improved RGC survival. The use of electrophysiology in glaucoma models may be facilitated by specifically designed instruments that allow high throughput, robust assessment of electrophysiological function. © 2015 Elsevier Ltd.

Composite dropsonde profiles are analyzed for developing and nondeveloping tropical waves in an attempt to improve the understanding of tropical cyclogenesis. These tropical waves were sampled by 25 reconnaissance missions during the 2010 Pre-Depression Investigation of Cloud-Systems in the Tropics (PREDICT) field campaign. Comparisons are made between mean profiles of temperature, mixing ratio, relative humidity, radial and tangential winds, relative vorticity, and virtual convective available potential energy (CAPE) for genesis and nongenesis cases. Genesis soundings are further analyzed in temporal progression to investigate whether significant changes in the thermodynamic or wind fields occur during the transition from tropical wave to tropical cyclone. Significant results include the development of positive temperature anomalies from 500 to 200 hPa 2 days prior to genesis in developing waves. This is not observed in the nongenesis mean. Progressive mesoscale moistening of the column is observed within 150 km of the center of circulation prior to genesis. The genesis composite is found to be significantly moister than the nongenesis composite at the middle levels, while comparatively drier at low levels, suggesting that dry air is more detrimental to genesis when located at the middle levels. Time-varying tangential wind profiles reveal an initial delay in intensification, followed by an increase in organization 24 h pregenesis. The vertical evolution of relative vorticity, in addition to a warmover-cold thermal structure, is more consistent with a top-down than a bottom-up genesis mechanism. Last, CAPE values are much greater for nongenesis than genesis profiles, indicating that greater instability does not necessarily favor genesis. ©2013 American Meteorological Society.

Gluck P.A.,University of Miami
Obstetrics and Gynecology | Year: 2012

Progress in patient safety has been exceedingly slow, hampered by lack of both clarity regarding the definition and standard methodology to assess iatrogenic patient harm in obstetrics and gynecology. Understanding the causes of medical error and strategies to reduce harm is simple compared with the complexity of clinical practice. On the other hand, patient safety interventions will not be successful without a receptive culture of safety. This culture can only occur with engaged organizational and individual leaders who understand the importance of patient safety. Transforming groups of individual experts into expert teams is central to this cultural transformation. Strategic pathways to accelerate future improvement in patient safety include fundamental changes in health care education, patient engagement, transparency, care coordination, and improving health care providers' morale. © 2012 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.

Elgart G.W.,University of Miami
Seminars in cutaneous medicine and surgery | Year: 2014

Fungal infection is a common clinical problem in dermatology. While most cases in practice are superficial infections, invasive subcutaneous mycoses are important to recognize and treat, as these conditions often have significant morbidity and mortality. Deep fungi demonstrate species-specific syndromes and may be identified by clinical and histological features in addition to serological evaluation and culture. Identification of the common innoculation subcutaneous mycoses, as well as those associated with pulmonary primary infection and dissemination to the skin is important, as treatments vary by organism and clinical setting. This overview will help to identify the key dermatological presentations of subcutaneous fungal infection, and the clues they give to cause.

Evenepoel P.,University Hospitals Leuven | Wolf M.,University of Miami
Kidney International | Year: 2013

The association of abnormalities of calcium and phosphate homeostasis with adverse clinical outcomes in chronic kidney disease (CKD) has generated interest in developing therapeutic strategies to target mineral metabolism early in the course of CKD. Hill et al. present results from a classic balance study of CKD stage 3-4 patients that challenge existing paradigms and suggest a need to rethink our understanding of calcium and phosphate homeostasis in CKD. © 2013 International Society of Nephrology.

Sutcliffe G.,University of Miami
AI Communications | Year: 2013

The CADE ATP System Competition (CASC) is an annual evaluation of fully automatic, classical logic Automated Theorem Proving (ATP) systems. CASC-J6 was the seventeenth competition in the CASC series. Thirty-two ATP systems and system variants competed in the various competition and demonstration divisions. An outline of the competition design, and a commentated summary of the results, are presented. © 2013-IOS Press and the authors. All rights reserved.

Hooton T.M.,University of Miami | Roberts P.L.,University of Washington | Stapleton A.E.,University of Washington
JAMA - Journal of the American Medical Association | Year: 2012

Context: Although fluoroquinolones remain the most reliable urinary antimicrobial, resistance rates have increased and effective fluoroquinolone-sparing antimicrobials are needed. Objective: To determine whether cefpodoxime is noninferior to ciprofloxacin for treatment of acute cystitis. Design, Setting, and Patients: Randomized, double-blind trial of 300 women aged 18 to 55 years with acute uncomplicated cystitis comparing ciprofloxacin (n=150) with cefpodoxime (n=150); patients were from a student health center in Seattle, Washington, and a referral center in Miami, Florida. The study was conducted from 2005 to 2009 and outcomes were assessed at 5 to 9 days and 28 to 30 days after completion of therapy. Intent-to-treat and per-protocol analyses were performed; 15 women in the ciprofloxacin group and 17 women in the cefpodoxime group were lost to follow-up. Interventions: Patients were given 250 mg of ciprofloxacin orally twice daily for 3 days or 100 mg of cefpodoxime proxetil orally twice daily for 3 days. Main Outcome Measures: Overall clinical cure (defined as not requiring antimicrobial treatment during follow-up) at the 30-day follow-up visit. Secondary outcomes were clinical and microbiological cure at the first follow-up visit and vaginal Escherichia coli colonization at each follow-up visit. The hypothesis that cefpodoxime would be noninferior to ciprofloxacin by a 10% margin (ie, for the difference in the primary outcome for ciprofloxacin minus cefpodoxime, the upper limit of the confidence interval would be <10%) was formulated prior to data collection. Results: The overall clinical cure rate at the 30-day visit with the intent-to-treat approach in which patients lost to follow-up were considered as having clinical cure was 93% (139/150) for ciprofloxacin compared with 82% (123/150) for cefpodoxime (difference of 11%; 95% CI, 3%-18%); and for the intent-to-treat approach in which patients lost to follow-up were considered as having not responded to treatment, the clinical cure rate was 83% (124/150) for ciprofloxacin compared with 71% (106/150) for cefpodoxime (difference of 12%; 95% CI, 3%-21%). The microbiological cure rate was 96% (123/128) for ciprofloxacin compared with 81% (104/129) for cefpodoxime (difference of 15%; 95% CI, 8%-23%). At first follow-up, 16% of women in the ciprofloxacin group compared with 40% of women in the cefpodoxime group had vaginal E coli colonization. Conclusions: Among women with uncomplicated cystitis, a 3-day regimen of cefpodoxime compared with ciprofloxacin did not meet criteria for noninferiority for achieving clinical cure. These findings, along with concerns about possible adverse ecological effects associated with other broad-spectrum β-lactams, do not support the use of cefpodoxime as a first-line fluoroquinolone-sparing antimicrobial for acute uncomplicated cystitis. Trial Registration: clinicaltrials.gov Identifier: NCT00194532 ©2012 American Medical Association. All rights reserved.

Stevenson M.,University of Miami
Topics in Antiviral Medicine | Year: 2014

In the HIV basic science categories of the 2014 Conference on Retroviruses and Opportunistic Infections, research examining obstacles to viral eradication continued to be a major component. This research encompassed areas of activity from the identification of where virus resides in individuals on suppressive antiretroviral therapy to studies aimed at eliminating long-lived viral reservoirs that persist in the face of therapy. In the area of antiviral restrictions, a number of presentations highlighted the ability of host factors to profoundly shape the interplay between virus and host and, in particular, how innate immune response opposes viral infection through the induction of antiviral restrictions. © 2014, IAS-USA. All rights reserved.

Previously, recipients of a simultaneous pancreas-kidney transplant versus a kidney transplant alone were thought to have higher fracture risk. Using a large US registry, Nikkel et al. observed lower rates of fracture hospitalization among patients with type 1 diabetes after simultaneous pancreas-kidney compared with kidney transplantation alone, particularly among men. It is not known whether the apparent benefit of simultaneous pancreas-kidney transplantation is due to improved bone strength or fewer falls, but these findings may influence transplant decision making. © 2012 International Society of Nephrology.

The increasing presence of contaminants in water streams is an emerging concern with regards to detection, cost-effective treatments, and analytical methods of addressing the resulting pollution, especially for emerging contaminants. The application of reverse osmosis (RO) is one method used to improve water quality, but few researchers have investigated the specific contaminants found in water, including emerging contaminants generated from the RO process. The present study focused on this issue to investigate a potential method for treating RO concentrates. The method involves a composition system with both chemical and physical treatment effects; this system consists of radical generators and adsorbents in soil. Contaminants from RO concentrates were effectively removed through the combined physical and chemical processes. The proposed composition system has several benefits, including a relatively low cost, no separate equipment, and simplicity of use. This new system may offer a wide range of applications for environmental remediation. © 2014 Elsevier B.V.

In Neotropical forests, mammals act as seed dispersers and predators. To prevent seed predation and promote dispersal, seeds exhibit physical or chemical defenses. Collared peccaries (Pecari tajacu) cannot eat some hard seeds, but can digest chemically defended seeds. Central American agoutis (Dasyprocta punctata) gnaw through hard-walled seeds, but cannot consume chemically defended seeds. The objectives of this study were to determine relative peccary and agouti abundances within a lowland forest in Costa Rica and to assess how these two mammals affect the survival of large seeds that have no defenses (Iriartea deltoidea, Socratea exorrhiza), physical defenses (Astrocaryum alatum, Dipteryx panamensis), or chemical defenses (Mucuna holtonii) against seed predators. Mammal abundances were determined over 3 yrs from open-access motion-detecting camera trap photos. Using semi-permeable mammal exclosures and thread-marked seeds, predation and dispersal by mammals for each seed species were quantified. Abundances of peccaries were up to six times higher than those of agoutis over 3 yrs, but neither peccary nor agouti abundances differed across years. Seeds of A. alatum were predominantly dispersed by peccaries, which did not eat A. alatum seeds, whereas non-defended and chemically defended seeds suffered high levels of predation, mostly by peccaries. Agoutis did not eat M. holtonii seeds. Peccaries and agoutis did not differ in the distances they dispersed seeds. This study shows that seed fates are contingent upon many factors such as seed defenses, frugivore-granivore abundances, and seed-handling capabilities. Mammal-seed interactions are complex; the outcomes of these interactions depend on the inherent characteristics of seeds and their potential dispersers. © 2012 The Author(s) Journal compilation © 2012 by The Association for Tropical Biology and Conservation.

Girgis D.O.,University of Miami
Clinical & experimental ophthalmology | Year: 2012

To provide an update on the frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria. Retrospective study of university clinic patients. One hundred thirty-nine patients with culture confirmed non-tuberculous mycobacteria infections seen at Bascom Palmer Eye Institute from January 1980 to July 2007. Chart review of data collected included patients' demographics, risk factors, microbiological profiles and clinical outcomes. Frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non-tuberculous mycobacteria. A total of 183 non-tuberculous mycobacteria isolates from 142 eyes were identified, with a fourfold increase in the number of eyes infected with non-tuberculous mycobacteria from 1980-1989 (13.4%) to 2000-2007 (56.3%). Eighty-three percent of non-tuberculous mycobacteria isolates were identified as M. abscessus/chelonae. The majority (91%) of isolates were recovered within 10 days. Common diagnoses included keratitis (36.6%), scleral buckle infections (14.8%) and socket/implant infections (14.8%). Identifiable risk factors were presence of biomaterials (63.1%), ocular surgery (24.1%) and steroid exposure (77%). The median time from diagnosis of culture positive non-tuberculous mycobacteria infection to resolution was 13 to 24 weeks. Combination therapy was used to treat 80% of infected eyes. In vitro susceptibility of non-tuberculous mycobacteria isolates were: amikacin, 81%; clarithromycin, 93%; and moxifloxacin, 21%. The incidence of ocular infections caused by non-tuberculous mycobacteria has increased within the last 8 years, with a high number of biomaterial associated infections among this group. Clinical diagnosis and microbiological confirmation of non-tuberculous mycobacteria infections remains challenging. Patient outcomes may be improved by early diagnosis, appropriate therapy and removal of biomaterials. © 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists.

Endophthalmitis following intravitreal injections of therapeutic medications is a rare but potentially vision-threatening problem. Infectious agents associated with endophthalmitis following injection of vascular endothelial growth factor (VEGF) inhibitors are typically Gram positive organisms with a predominance of Streptococcal and Staphylococcal microbiologic isolates. Patients with infectious endophthalmitis generally present within the first 72 hours following an intravitreal anti-VEGF injection with complaints of pain, redness, and decreased vision. Prompt treatment with a conventional endophthalmitis management approach may mitigate irreversible vision loss; however, poorer outcomes have been reported with more virulent organisms such as those associated with Streptococcal species. As the number of intravitreal injections performed each year continues to increase, ophthalmologists must maintain a rigorous approach to their injection technique and remain vigilant for the signs and symptoms of endophthalmitis. © 2011 Informa Healthcare USA, Inc.

Lim E.,University of Miami | Glynn P.W.,Stanford University
Operations Research | Year: 2012

Convex regression is concerned with computing the best fit of a convex function to a data set of n observations in which the independent variable is (possibly) multidimensional. Such regression problems arise in operations research, economics, and other disciplines in which imposing a convexity constraint on the regression function is natural. This paper studies a leastsquares estimator that is computable as the solution of a quadratic program and establishes that it converges almost surely to the "true" function as n → ∞ under modest technical assumptions. In addition to this multidimensional consistency result, we identify the behavior of the estimator when the model is misspecified (so that the "true" function is nonconvex), and we extend the consistency result to settings in which the function must be both convex and nondecreasing (as is needed for consumer preference utility functions). © 2012 INFORMS.

The relationship between song sharing among male songbirds and geographic distance between their territories is a function of juvenile dispersal distance and length of the song learning period. I analysed the spatial pattern of syllable sharing in white-throated thrushes (Turdus assimilis) to infer their song learning strategy. Songs of 23 males from three different sites (2.5-21 km) in Puntarenas, Costa Rica, were studied using visual classification, spectrogram correlation and multidimensional scaling analysis. In total, 8505 syllables were classified into 296 syllable types. All males shared syllables but most types were unique to particular males, suggesting that males invent most of their repertoires. Repertoire dissimilarity increased with geographic distance.Within sites, syllable sharing was higher between intermediate than between adjacent neighbours. These results suggest that juvenile dispersal distance is <2.5 km and relatively lower song sharing between adjacent neighbours may result from non-random dispersal or active avoidance by open-ended learners. © 2015 Koninklijke Brill NV, Leiden.

Jose J.,University of Miami
American journal of orthopedics (Belle Mead, N.J.) | Year: 2012

Hypothenar hammer syndrome is a rare, but likely underdiagnosed occupational or recreational malady, resulting from repetitive microtrauma to the ulnar artery at the level of Guyon's canal. Significant diagnostic and treatment delays are associated with high morbidity, therefore early recognition is of the utmost importance. We discuss specific imaging features, emphasizing findings at ultrasound, computed tomography, and magnetic resonance imaging, that favor the diagnosis in the appropriate clinical context. Definitive evaluation is made with catheter directed angiography, which remains the gold standard for diagnosis. The range of management options, which depend on the degree of severity and the presence or absence of ulnar artery aneurysm, are also presented.

The Resource-Based Relative Value Scale (RBRVS) is fundamentally undermined by the following foundational errors: (1) The full range of offi ce-based evaluation and management (E/M) activities are not captured by the Current Procedural Terminology (CPT) code choices, (2) it places relatively high values on procedural services, (3) there is no measure of intensity for complex outpatient E/M care, and (4) its maintenance and update have been delegated to select professional societies. Limitations imposed on the development of the RBRVS dating back to the early 1980s have not been corrected. The repertoire of codes for physician offi ce-based E/M work must be expanded to create a new topology of choices with new outpatient code families with discrete service code levels, such as comprehensive outpatient consultation care, comprehensive outpatient primary care, and limited outpatient consultation care. Service code relative values must be based on representative samples and reliable survey data, draw from the broader literature on work intensity, and be developed with accountable and representative professional engagement.

Kargi A.Y.,University of Miami | Merriam G.R.,University of Washington
Nature Reviews Endocrinology | Year: 2013

The availability of synthetic recombinant human growth hormone (GH) in potentially unlimited quantities since the 1980s has improved understanding of the many nonstatural effects of GH on metabolism, body composition, physical and psychological function, as well as the consequences of GH deficiency in adult life. Adult GH deficiency is now recognized as a distinct if nonspecific syndrome with considerable adverse health consequences. GH replacement therapy in lower doses than those used in children can reverse many of these abnormalities and restore functional capacities toward or even to normal; if dosed appropriately, GH therapy has few adverse effects. Although some doubts remain about possible long-term risks of childhood GH therapy, most registries of adult GH replacement therapy, albeit limited in study size and duration, have not shown an increased incidence of cancers or of cardiovascular morbidity or mortality. © 2013 Macmillan Publishers Limited.

Volkov D.L.,University of Miami | Volkov D.L.,National Oceanic and Atmospheric Administration
Geophysical Research Letters | Year: 2014

The Gravity Recovery and Climate Experiment (GRACE) satellites have observed coherent and nearly uniform nonseasonal fluctuations of bottom pressure throughout the Arctic Ocean and the Nordic Seas. Strong correlation between the nonseasonal GRACE and satellite altimetry data is found in the Nordic and Barents Seas, which suggests a possibility of using the longer altimetry records in these areas as a proxy for the nonseasonal sea level variability over the entire Arctic. This study identifies the dominant pattern of the nonseasonal atmospheric pressure variability that drives strong zonal wind anomalies over the northeastern North Atlantic associated with the nonseasonal sea level anomalies in the Nordic Seas. Our results show that wind-driven northward Ekman transport anomalies in the northeastern North Atlantic may induce coherent changes of sea level across the entire Arctic Ocean. © 2014. American Geophysical Union. All Rights Reserved.

Barrera I.,University of Miami | Spiegel D.,Stanford University
International Review of Psychiatry | Year: 2014

Depression, ranging from mild to severe, is the most frequently found psychological symptom among individuals with cancer. Depression in cancer patients has been known to mitigate emotional distress, quality of life, adherence to medical treatment, and overall health outcomes. Specifically, depression has been associated with impaired immune response and with poorer survival in patients with cancer. Various studies have found that psychotherapeutic interventions are effective in reducing symptoms of depression, which in turn could affect disease progression and mortality. This paper provides updated information on psychotherapeutic interventions geared towards cancer patients suffering from depressive disorders, and its impact on disease progression. PubMed, Cochrane Library database, PsycINFO and PsycARTICLES databases were searched from January 1980 through August 2013 using key words: psychotherapy, treatment, oncology, cancer, psycho-oncology, psychosocial issues, psychosocial stress, depression, mood disorder, and psychoneuroimmunology. © 2014 Institute of Psychiatry.

When cells (including Schwann cells; SCs) of the peripheral nervous system (PNS) could be purified and expanded in number in tissue culture, Richard Bunge in 1975 envisioned that the SCs could be introduced to repair the central nervous system (CNS), as SCs enable axons to regenerate after PNS injury. Importantly, autologous human SCs could be transplanted into injured human spinal cord. Availability of the new culture systems to study interactions between sensory neurons, SCs and fibroblasts increased our knowledge of SC biology in the 1970s and '80s. Joining the Miami Project to Cure Paralysis in 1989 brought the opportunity to use this knowledge to initiate spinal cord repair studies. Development of a rat complete spinal cord transection/SC bridge model allowed the demonstration that axons regenerate into the SC bridge. Together with study of contused rat spinal cord, it was concluded that implanted SCs reduce cavitation, protect tissue around the lesion, support axon regeneration and form myelin. SC transplantation efficacy was improved when combined with neurotrophins, elevation of cyclic AMP levels, olfactory ensheathing cells, a steroid or chondroitinase. Increased efficacy meant higher numbers of axons, particularly from the brainstem, and more SC-myelinated axons in the implants and improvement in hindlimb movements. Human SCs support axon regeneration as do rat SCs. Astrocytes at the SC bridge-host spinal cord interfaces play a key role in determining whether axons enter the SC milieu. The SC work described here contributed to gaining approval from the FDA for an initial autologous human SC clinical trial (at the Miami Project) that has been completed and found to be safe. Journal compilation © 2016 The Physiological Society.

Culture influences people's information processing and attitude formation. This study examined the effects of using social networking sites from a cultural perspective, based on the culture learning model in the acculturation literature. A total of 251 Chinese individuals residing in the U.S. participated in the experiment. They were randomly assigned to one of four product package conditions with different cultural symbols (either American cultural symbols or Chinese cultural symbols, or both, or neither). Their usage intensity of two social networking sites, U.S.-based Facebook and China-based Renren ("the Facebook of China"), was measured. It was found that participants' usage intensity of Facebook and Renren reflected their cultural orientation, language proficiency, and length of stay in the U.S. It was also discovered that more intensive Renren usage led to more favorable attitudes toward packages carrying Chinese cultural symbols. However, participants' willingness to pay for the products with different packages was not affected by their usage intensity of social networking sites, due to the country-of-origin effect. © 2013 Elsevier Ltd. All rights reserved.

Hansell D.A.,University of Miami | Carlson C.A.,University of California at Santa Barbara
Global Biogeochemical Cycles | Year: 2013

The global ocean holds one of Earth's major carbon reservoirs as dissolved organic matter (662 ± 32 PgC). Most of this material (>95%) is termed refractory dissolved organic carbon (RDOC) as Williams and Druffel (1987) found it to be old relative to the circulation time of the ocean. While RDOC within the modern ocean is thus perceived as vast and only slowly renewed, its mobilization has been implicated by Sexton et al. (2011) to explain Earth's transient warming events (i.e., hyperthermals) of the Paleocene and Eocene epochs (65-34 million years ago). Assessing this proposed function of RDOC as a rapidly (~5-10 kyr) exchangeable carbon reservoir is presently limited by insufficient knowledge of the responsible processes. Here we investigate the dynamics of RDOC in the deep Pacific Ocean, previously characterized by concentration gradients thought to be established by slow but systematic RDOC removal with circulation and aging of the water masses. We demonstrate that RDOC is instead conserved during much of its circulation, but that there exist localized sinks in the deep, far North Pacific and at mid depth in the subtropical South Pacific. Water mass mixing into these sink regions creates the observed RDOC gradients. Together, the Pacific sinks remove 7-29% of the 43 Tg RDOC added to the deep global ocean each year with overturning circulation, and point to an important but still unidentified control on the RDOC inventory of deep marine systems. ©2013. American Geophysical Union. All Rights Reserved.

Lin G.,University of Miami
Bulletin of the Seismological Society of America | Year: 2014

I present a frequency-independent 3D seismic attenuation model (indicated by Q−1 P) for the crust of the Salton trough and the adjacent regions in southeastern southern California. The simul2000 tomographic algorithm was used to invert the frequency-independent attenuation operator t* values measured from amplitude spectra of 23,378 P-wave arrivals of 1203 events through a recently developed 3D velocity model. The QP model has a uniform horizontal grid spacing of 5 km, and the vertical-node intervals range between 2 and 5 km down to 27 km depth. In general, the QP values increase with depth and agree with the surface geology in the shallow depth layers. Low QP values are observed in the Imperial Valley, California, which are consistent with the sedimentary deposits and may also reflect the presence of pore fluid in the active fault zones, whereas greatly elevated QP values are shown in the surrounding crystalline ranges. The new QP model provides an important complement to the existing velocity models for interpreting structural heterogeneity and fluid saturation of rocks in the study area. © 2014, Seismological Society of America. All rights reserved.

Uy J.A.C.,University of Miami | Safran R.J.,University of Colorado at Boulder
Behavioral Ecology and Sociobiology | Year: 2013

The use of signals across multiple sensory modalities in communication is common in animals and plants. Determining the information that each signal component conveys has provided unique insights into why multimodal signals evolve. However, how these complex signals are assessed by receivers will also influence their evolution, a hypothesis that has received less attention. Here, we explore multimodal signal assessment in a closely related complex of island flycatchers that have diverged in visual and acoustic signals. Using field experiments that manipulated song and plumage colour, we tested if song, a possible long-range signal, is assessed before plumage colour in conspecific recognition. We find that divergent song and colour are assessed in sequence, and this pattern of sequential assessment is likely mediated by habitat structure and the extent of differences in signal characteristics. A broad survey of the literature suggests that many organisms from a wide range of taxa sequentially assess multimodal signals, with long-range signals attracting conspecifics for further assessment of close-range signals. Our results highlight the need to consider how signals are assessed when understanding multimodal signal evolution. Finally, given the results of our field experiments indicating sequential assessment of divergent song and colour in the recognition of conspecifics, we discuss the consequences of multimodal signal divergence for the origin of species, as changes in signals across different sensory modalities may influence the evolution of premating reproductive isolation. © 2013 Springer-Verlag Berlin Heidelberg.

Caralis P.,University of Miami
Patient Education and Counseling | Year: 2010

Objective: This study evaluated the use of a telephone triage system in an academic primary care clinic and its impact on communication, patient management and satisfaction. Methods: A " telephone clinic" was created using a triage nurse to answer patients' calls to an academic primary care clinic, staffed by house staff physicians. Chart reviews were conducted of all medical records of patients who called and were referred to the telephone clinic during a six month period. A total of 1135 patient calls were monitored. Using a random selection process, 366 patient calls were studied and 42% of these patients were called back two weeks after the initial call and were interviewed. Results: Of the 336 calls, 68% of the calls were serious enough to be referred to a house staff physician. Symptom complaints accounted for 64% of the telephone calls; 4% of patients were sent to the emergency room or admitted to the hospital directly based on the information from the call. Telephone calls enhanced patients' access to specialty care consultative services and 14% of patients who called received a new medication prescription. Patients' satisfaction with the communication and the overall care provided by the " telephone clinic" was highly rated. Conclusion: The telephone contact initiated by the patients resulted in expedited access for patients whose symptoms were serious enough to require immediate referral to the emergency room or direct hospital admission. Practice implications: In a primary care practice, the telephone can be a major source of communication for practitioners, office staff and patients. The creation of a " telephone clinic" which utilizes nurses and house staff physicians trained and dedicated to telephone communication directly with patients resulted in more efficient management and greater satisfaction for patients. © 2010.

Berloff P.,Imperial College London | Kamenkovich I.,University of Miami
Journal of Physical Oceanography | Year: 2013

Several turbulent flow regimes of an idealized ocean circulation model are systematically analyzed in physical and spectral domains. Zonal dispersion properties of transient mesoscale eddies are described by the zonal wavenumber/temporal frequency spectra. The eddy patterns and the corresponding nonlinear eddy forcing exerted on the jets are examined by filtering different parts of the spectra. Comparison of the outcome of this nonlinear analysis with the properties of the linearized solutions (obtained in Part I of this paper) demonstrates that a very substantial part of the flow dynamics is controlled by the underlying linear dynamics. This result supports the hypothesis that it is possible to describe most of the oceanic mesoscale eddies as a wave turbulence phenomenon. © 2013 American Meteorological Society.

Berloff P.,Imperial College London | Kamenkovich I.,University of Miami
Journal of Physical Oceanography | Year: 2013

This study aims to understand the ocean's circulation, which is characterized by the presence of multiple alternating zonal jets and transient mesoscale eddies, by systematic analysis of the underlying linear dynamics of this system. For this purpose, properties of the linear normal modes such as growth rates, dispersion, spatial structure, and nonlinear self-interactions are explored for a hierarchy of idealized, vertically, and horizontally sheared flows with increasing complexity. The authors find that large-scale background vertical shear, alternating multiple zonal jets, bottom friction, and the Reynolds number have important effects on these modes. This study hypothesizes that when these effects are taken into account, the linear results can be used to predict many properties of nonlinear mesoscale eddies. This hypothesis is confirmed in Part II of this paper. © 2013 American Meteorological Society.

Valente Duarte De Sousa I.C.,Private Practice | Tosti A.,University of Miami
Expert Opinion on Investigational Drugs | Year: 2013

Introduction: Androgenetic alopecia (AGA) is the most common form of hair loss, however current treatment options are limited and moderately effective. In the past few years, there has been an increased interest in deciphering the molecular mechanisms responsible for this disorder, which has opened the possibility of novel treatments that promise to not only stimulate hair growth, but also to induce formation of new hair follicles. Areas covered: The future holds more effective topical treatments with less systemic side effects (such as topical 5-alfa-reductase inhibitors), prostaglandin analogs and antagonists, medications which act through the Wnt signaling pathway, stem cells for hair regeneration, platelet-rich plasma (PRP) and more effective ways of transplanting hair. A comprehensive search was made using PubMed, GoogleScholar and Clinicaltrial.gov using different combination of key words, which included AGA treatment, new treatments for AGA, Wnt pathway, prostaglandins, PRP and stem cells for hair regrowth. Expert opinion: In the near future, treatments with topical 5-alfa-reductase inhibitors and prostaglandin agonists or antagonists are expected. More evidence is needed to verify the efficacy of PRP. Although hair follicle bioengineering and multiplication is a fascinating and promising field, it is still a long way from being available to clinicians. © 2013 Informa UK, Ltd.

Koch S.,University of Miami
Translational Stroke Research | Year: 2013

The large volume of preclinical investigations begets the question of whether to proceed with clinical trials in preconditioning for neurological disorders, particularly for treatment of human cerebral ischemia. This important question was discussed during the 2nd Translational Preconditioning Meeting held at the University of Miami. While recommendations for proceeding to clinical trials have been devised in other fields of stroke therapy, such as neuroprotection, no such guidelines exist for preconditioning. During the discussion, the general opinion was to proceed with clinical preconditioning trials, with the understanding that initial trials be exploratory in nature and focus on the development of biomarkers, assessing the elicitability of the preconditioning response. © 2012 Springer Science+Business Media New York.

Colin A.A.,University of Miami | McEvoy C.,Oregon Health And Science University | Castile R.G.,Ohio State University
Pediatrics | Year: 2010

Normal lung development follows a series of orchestrated events. Premature birth interrupts normal in utero lung development, which results in significant alterations in lung function and physiology. Increasingly, there are reports documenting the broad range of complications experienced by infants aged 34 to 36 weeks' gestational age (GA). Our objective was to summarize the evidence demonstrating respiratory system vulnerability in infants aged 34 to 36 weeks' GA and to review the developmental and physiologic principles that underlie this vulnerability. A comprehensive search for studies that reported epidemiologic data and respiratory morbidity was conducted on the PubMed, Medline, Ovid Biosis, and Embase databases from 2000 to 2009 by using medical subject headings "morbidity in late preterm infants," "preterm infants and lung development," "prematurity and morbidity," and "prematurity and lung development." Because the number of studies exclusive to infants aged 34 to 36 weeks' GA was limited, selected studies also included infants aged 32 to 36 weeks' GA. Of the 24 studies identi-fied, 16 were retrospective population-based cohort studies; 8 studies were observational. These studies consistently revealed that infants born at 32 to 36 weeks' GA, including infants of 34 to 36 weeks' GA, experience substantial respiratory morbidity compared with term infants. Levels of morbidity were, at times, comparable to those observed in very preterm infants. The developmental and physiologic mechanisms that underlie the increased morbidity rate and alterations in respiratory function are discussed. We also present evidence to demonstrate that the immaturity of the respiratory system of infants 34 to 36 weeks' GA at birth results in increased morbidity in infancy and leads to deficits in lung function that may persist into adulthood. Copyright © 2010 by the American Academy of Pediatrics.

Abreu M.T.,University of Miami | Peek Jr. R.M.,Vanderbilt University
Gastroenterology | Year: 2014

Microbial species participate in the genesis of a substantial number of malignancies - in conservative estimates, at least 15% of all cancer cases are attributable to infectious agents. Little is known about the contribution of the gastrointestinal microbiome to the development of malignancies. Resident microbes can promote carcinogenesis by inducing inflammation, increasing cell proliferation, altering stem cell dynamics, and producing metabolites such as butyrate, which affect DNA integrity and immune regulation. Studies in human beings and rodent models of cancer have identified effector species and relationships among members of the microbial community in the stomach and colon that increase the risk for malignancy. Strategies to manipulate the microbiome, or the immune response to such bacteria, could be developed to prevent or treat certain gastrointestinal cancers. © 2014 by the AGA Institute.

Anwar Z.,University of Miami
American journal of ophthalmology | Year: 2013

To determine the value of anterior chamber paracentesis with polymerase chain reaction (PCR) in patients with anterior uveitis. Retrospective observational case series. Bascom Palmer Eye Institute. Fifty-three patients with a diagnosis of anterior uveitis who underwent anterior chamber paracentesis with PCR. Anterior chamber paracentesis with PCR of aqueous fluid. Diagnostic utility and frequency of management change based on anterior chamber paracentesis and PCR. There were 15 of 53 (28%) acute and 35 of 53 (65%) chronic anterior uveitis patients. PCR positivity of herpes simplex virus, cytomegalovirus, varicella zoster virus, and Epstein-Barr virus in our population were 4 of 53 (8%), 1 of 47 (2%), 1 of 35 (3%), and 1 of 18 (6%). Overall, 7 of 53 patients (13%) had a change in management because of PCR results from anterior chamber paracentesis. Four patients encountered paracentesis complications (4/53, 7.5%), 1 with long-term sequelae. Anterior chamber paracentesis with PCR had a relatively low diagnostic utility and resulted in few management changes in patients with suspected infectious anterior uveitis. Copyright © 2013 Elsevier Inc. All rights reserved.

Nowicki S.,Duke University | Searcy W.A.,University of Miami
Current Opinion in Neurobiology | Year: 2014

Vocal learning, in which animals modify their vocalizations to imitate those of others, has evolved independently in scattered lineages of birds and mammals. Comparative evidence supports two hypotheses for the selective advantages leading to the origin of vocal learning. The sexual selection hypothesis proposes that vocal learning evolves to allow expansion of vocal repertoires in response to mating preferences for more complex vocalizations. The information-sharing hypothesis also proposes that vocal learning evolves to allow expansion of vocal repertoires, but in this case in response to kin selection favoring sharing of information among relatives. © 2014 Elsevier Ltd.

Pugliese A.,University of Miami
Discovery Medicine | Year: 2014

Type 1 diabetes (T1D) is an insulin-dependent form of diabetes resulting from the autoimmune destruction of pancreatic beta cells. The past few decades have seen tremendous progress in our understanding of the molecular basis of the disease, with the identification of susceptibility genes and autoantigens, the demonstration of several abnormalities affecting various cell types and functions, and the development of improved assays to detect and monitor autoimmunity and beta cell function. New findings about the disease pathology and pathogenesis are emerging from extensive studies of organ donors with T1D promoted by the JDRF nPOD (Network for the Pancreatic Organ Donor with Diabetes). Furthermore, the establishment of extensive collaborative projects including longitudinal follow-up studies in relatives and clinical trials are setting the stage for a greater understanding of the role of environmental factors, the natural history of the disease, and the discovery of novel biomarkers for improved prediction, which will positively impact future clinical trials. Recent studies have highlighted the chronicity of islet autoimmunity and the persistence of some beta cell function for years after diagnosis, which could be exploited to expand therapeutic options and the time window during which a clinical benefit can be achieved. © Discovery Medicine.

Fine R.A.,University of Miami
Annual Review of Marine Science | Year: 2011

An advantage of using chlorofluorocarbons (CFCs) and sulfur hexafluoride (SF 6) as tracers of ocean circulation is that the time-dependent source functions permit calculation of rates for ocean processes. These compounds are also sensitive indicators highlighting interior ocean regions where surface-derived anomalies can be transported on timescales of decades. Significant applications for CFCs have been for the deep limb of the Atlantic meridional overturning circulation, upper ocean ventilation, and biogeochemical rates, including apparent oxygen utilization rates and anthropogenic CO 2 inventories. Although CFCs have started to decrease in the atmosphere, SF 6 continues to increase. There are benefits to measuring both CFCs and SF 6: A large global CFC data set exists; CFCs are still increasing in older waters; SF 6 expands estimates of age; and calculations of anthropogenic CO 2 inventory are enhanced. Thus, the outlook for using CFCs as tracers for oceanic processes, and in particular in concert with SF 6, remains very positive. Copyright © 2011 by Annual Reviews. All rights reserved.

Blonska M.,University of Miami
Blood | Year: 2016

In this issue of Blood, Juilland and colleagues reveal the expression pattern and the role of different members of the activating transcription factor (ATF) family in survival of diffuse large B-cell lymphoma (DLBCL) cells. © 2016 by The American Society of Hematology.

Juppner H.,Massachusetts General Hospital | Wolf M.,University of Miami | Salusky I.B.,University of California at Los Angeles
Journal of Bone and Mineral Research | Year: 2010

Fibroblast growth factor 23 (FGF-23) is likely to be the most important regulator of phosphate homeostasis, which mediates its functions through FGF receptors and the coreceptor Klotho. Besides reducing expression of the sodium-phosphate cotransporters NPT2a and NPT2c in the proximal tubules, FGF-23 inhibits the renal 1α-hydroxylase and stimulates the 24-hydroxylase, and it appears to reduce parathyroid hormone (PTH) secretion in short-term studies. FGF-23 synthesis and secretion by osteocytes and osteoblasts is upregulated through 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] and through an increased dietary phosphate intake. FGF-23 levels are elevated or inappropriately normal in patients with tumor-induced osteomalacia and several inherited hypophosphatemic disorders, but the most significant increases are found in patients with chronic kidney disease (CKD). During the early stages of CKD, increased FGF-23 production enhances urinary phosphate excretion and thus prevents the development of hyperphosphatemia, reduces the circulating levels of 1,25(OH)2D3, and therefore contributes to the development of secondary hyperparathyroidism. In patients with end-stage renal disease (ESRD), FGF-23 levels can be extremely high and were shown to be predictors of bone mineralization, left ventricular hypertrophy, vascular calcification, and mortality. It remains to be determined, however, whether FGF-23 represents simply a sensitive biomarker of an abnormal phosphate homeostasis or has, independent of serum phosphate levels, potentially negative "off- target" effects. Nonetheless, reducing the production and/or the biologic activity of FGF-23 may be an important therapeutic goal for this patient population. © 2010 American Society for Bone and Mineral Research.

Zarbin M.A.,The New School | Rosenfeld P.J.,University of Miami
Retina | Year: 2010

Purpose: To review treatments under development for age-related macular degeneration (AMD) in the context of current knowledge of AMD pathogenesis. Methods: Review of the scientific literature published in English. Results: Steps in AMD pathogenesis that appear to be good targets for drug development include 1) oxidative damage; 2) lipofuscin accumulation; 3) chronic inflammation; 4) mutations in the complement pathway; and 5) noncomplement mutations that influence chronic inflammation and/or oxidative damage (e.g., mitochondria and extracellular matrix structure). Steps in neovascularization that can be targeted for drug development and combination therapy include 1) angiogenic factor production; 2) factor release; 3) binding of factors to extracellular receptors (and activation of intracellular signaling after receptor binding); 4) endothelial cell activation (and basement membrane degradation); 5) endothelial cell proliferation; 6) directed endothelial cell migration; 7) extracellular matrix remodeling; 8) tube formation; and 9) vascular stabilization. Conclusion: The era of pathway-based therapy for the early and late stages of AMD has begun. At each step in the pathway, a new treatment could be developed, but complete inhibition of disease progression will likely require a combination of the various treatments. Combination therapy will likely supplant monotherapy as the treatment of choice because the clinical benefits (visual acuity and frequency of treatment) will likely be superior to monotherapy in preventing the late-stage complications of AMD. Copyright © by Ophthalmic Communications Society, Inc.

Kanner A.M.,University of Miami | Mazarati A.,University of California at Los Angeles | Koepp M.,University College London
Neurotherapeutics | Year: 2014

The last decade has witnessed a significant shift on our understanding of the relationship between psychiatric disorders and epilepsy. While traditionally psychiatric disorders were considered as a complication of the underlying seizure disorder, new epidemiologic data, supported by clinical and experimental research, have suggested the existence of a bidirectional relation between the two types of conditions: not only are patients with epilepsy at greater risk of experiencing a psychiatric disorder, but patients with primary psychiatric disorders are at greater risk of developing epilepsy. Do these data suggest that some of the pathogenic mechanisms operant in psychiatric comorbidities play a role in epileptogenesis? The aim of this article is to review the epidemiologic data that demonstrate that primary psychiatric disorders are more frequent in people who develop epilepsy, before the onset of the seizure disorder than among controls. The next question looks at the available data of pathogenic mechanisms of primary mood disorders and their potential for facilitating the development and/or exacerbation in the severity of epileptic seizures. Finally, we review data derived from experimental studies in animal models of depression and epilepsy that support a potential role of pathogenic mechanisms of mood disorders in the development of epileptic seizures and epileptogenesis. The data presented in this article do not yet establish conclusive evidence of a pathogenic role of psychiatric comorbidities in epileptogenesis, but raise important research questions that need to be investigated in experimental, clinical, and population-based epidemiologic research studies. © 2014 The American Society for Experimental NeuroTherapeutics, Inc.

Sanchez J.J.,University of Miami
Acta neurochirurgica. Supplement | Year: 2013

Neuromonitoring with microdialysis has the potential for early detection of metabolic derangements associated with TBI. 1,260 microdialysis samples from 12 TBI patients were analyzed for glucose, -lactate, pyruvate, lactate/pyruvate ratio (LPR), and lactate/glucose ratio (LGR). Analytes were correlated with the Glasgow Coma Scale (GCS) before surgery and with the Glasgow Outcome Scale (GOS) at the time of discharge. The patients were divided into two groups for GCS: 3-6 and 7-9, and for GOS 1-3 and 4-5. Chi-squared test was performed for correlations. Glucose, lactate levels, and LGR were high in TBI patients with GCS 3-6 (p < 0.0001). Pyruvate level was lower in patients with GCS 7-9 (p < 0.001). LPR was higher in patients with GCS 3-6 (p < 0.05). High glucose, lactate level (p < 0.001), and LPR (p < 0.01) was observed in patients with GOS 1-3. Pyruvate level was low in patients with GOS 1-3 (p < 0.001). LGR was higher in patient with better outcome (GOS 4-5). After craniotomy extracellular glucose and lactate were good "biomarkers" of cerebral damage in TBI patients. We consider that high extracellular lactate and low glucose is an indicator of severe neurological damage and poor outcome, because of impaired brain metabolism.

Oellers P.,University of Miami
The British journal of ophthalmology | Year: 2014

An 83-year-old man presented with a 1-month history of a rapidly enlarging conjunctival mass. On examination, slit lamp biomicroscopy revealed a leukoplakic tumour at the temporal limbus. The lesion was excised with cryotherapy application to the limbus and conjunctival margins. Histopathology revealed a keratoacanthoma (KA). KA typically occurs on sun-exposed areas of the skin. Conjunctival KA is very rare, and differentiation between conventional squamous cell carcinoma (SCCA) and KA can be challenging. The present case highlights the indication for excisional surgery in patients with conjunctival KA using the no touch technique, cryotherapy, amniotic membrane and the histopathological differentiation between KA and SCCA.

Wahlestedt C.,University of Miami
Nature Reviews Drug Discovery | Year: 2013

The majority of currently available drugs and tool compounds exhibit an inhibitory mechanism of action and there is a relative lack of pharmaceutical agents that are capable of increasing the activity of effectors or pathways for therapeutic benefit. Indeed, the upregulation of many genes, including tumour suppressors, growth factors, transcription factors and genes that are deficient in various genetic diseases, would be desired in specific situations. Recently, key roles for regulatory long non-coding RNAs (lncRNAs) in the regulation of gene expression have begun to emerge. lncRNAs can positively or negatively regulate gene expression and chromatin architecture. Here, we review the current understanding of the mechanisms of action of lncRNAs and their roles in disease, focusing on recent work in the design of inhibitors of the natural antisense transcript (NAT) class of lncRNAs, known as antagoNAT oligonucleotides, and the issues associated with their potential therapeutic application.

Endovascular embolization is the preferred treatment for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of tortuosity, hypoplasia, or stenosis of the normal venous routes. In these cases, direct operative cannulation of the arterialized superior ophthalmic vein (SOV) offers an excellent alternative approach. We reviewed the records of patients who underwent surgical cannulation of the SOV in preparation for embolization and identified 10 patients with indirect CCF, all of whom presented with ocular signs and symptoms. All had previously undergone unsuccessful endovenous attempts at treatment at our institution. In the operating room, the SOV was catheterized under microscopic magnification through an eyelid or eyebrow incision, and the patients were taken directly to the angiographic suite for embolization. In 9 of 10 patients, embolization of the CCF was complete with clinical improvement. In 1 case, navigation of the catheter into the SOV proved difficult, and the procedure was aborted because of contrast extravasation after partial embolization. One patient required a small orbital osteotomy to localize the SOV. There were no clinical complications and no known recurrences. Cosmetic results were excellent in all patients. Surgical access to the superior ophthalmic vein for embolization of a CCF is an excellent and definitive alternative treatment when traditional endovenous routes are inaccessible. The operative approach to the SOV is straightforward and can be performed safely and expeditiously by the neurovascular team.

Wolf M.,University of Miami
Clinical Journal of the American Society of Nephrology | Year: 2012

Background and objectives Levels of fibroblast growth factor 23 (FGF23) and inflammatory markers are commonly elevated in CKD, and each is associated with adverse clinical outcomes. This study tested the hypothesis that FGF23 is independently associated with inflammation in CKD. Design, setting, participants, & measurements The association between levels of FGF23 and the inflammatory markers IL-6, C-reactive protein (CRP), TNF-a, and fibrinogen was assessed in a cross-sectional analysis of 3879 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study between June 2003 and September 2008. Results FGF23 correlated directly with IL-6 (r=0.4), CRP (r=0.2), TNF-a (r=0.4), and fibrinogen (r=0.3; P,0.001 for each). In univariate and multivariable-adjusted linear regression analyses, natural log (ln) transformed FGF23 was significantly associated with lnIL-6, lnCRP, lnTNF-α, and fibrinogen (P,0.001 for each). Each unit higher lnFGF23 was associated with severe inflammation, defined as levels of all inflammatory markers in the highest 25th percentile, in univariate (odds ratio [OR], 2.4 [95%confidence interval (CI), 2.0-2.9]) and multivariable-adjusted (OR, 2.0 [95% CI, 1.6-2.5]) logistic regression analyses. Ascending FGF23 quartiles were independently associated with severe inflammation (OR, 5.6 for the highest versus lowest FGF23 quartile [95% CI, 2.3-13.9]; P for trend, 0.001). Conclusions Higher FGF23 levels are independently associated with higher levels of inflammatory markers in patients with CKD and with significantly greater odds of severe inflammation. Future studies should evaluate whether inflammation modifies the association between FGF23 and adverse outcomes in CKD. © 2012 by the American Society of Nephrology.

Harhaj E.W.,University of Miami | Dixit V.M.,Genentech
Cell Research | Year: 2011

Nuclear factor-kappa B (NF-κB) is a critical regulator of multiple biological functions including innate and adaptive immunity and cell survival. Activation of NF-κB is tightly regulated to preclude chronic signaling that may lead to persistent inflammation and cancer. Ubiquitination of key signaling molecules by E3 ubiquitin ligases has emerged as an important regulatory mechanism for NF-κB signaling. Deubiquitinases (DUBs) counteract E3 ligases and therefore play a prominent role in the downregulation of NF-κB signaling and homeostasis. Understanding the mechanisms of NF-κB downregulation by specific DUBs such as A20 and CYLD may provide therapeutic opportunities for the treatment of chronic inflammatory diseases and cancer. © 2011 IBCB, SIBS, CAS All rights reserved.

Cherniack E.P.,University of Miami
Nutrition | Year: 2012

Ergogenic dietary aids might be useful adjunctive therapy to enhance the effects of exercise in the elderly, who lose physical function with age. Many such aids have been tested in athletes and untrained younger persons in laboratory and athletic performance settings, with positive results, although not all studies have demonstrated benefit. Some substances have been tested in the elderly, including creatine, caffeine, β-hydroxy-β-methylbutyrate, ubiquinone, and carnitine. The published medical evidence for the use of these substances is considered in this review article. All studies have involved a few subjects for a short period. Studies of creatine alone or together with exercise in old persons have yielded mixed results. These studies have confirmed that creatine in older individuals, as in younger individuals, can increase the short-term capacity to perform quick, repeated episodes of intense activity. An investigation of caffeine has suggested that in older as in younger individuals, caffeine increases endurance but may not improve other parameters of exercise capacity. Evidence has implied β-hydroxy-β-methylbutyrate can increase the ability to perform certain short-term activities requiring strength, but not others. Carnitine has been reported to decrease fatigue and increase endurance in older persons. An investigation of ubiquinone has shown no benefit. Further testing has involved the combinations of agents, such as creatine and caffeine, and combinations of β-hydroxy-β-methylbutyrate, showing some small improvements in physical function. Future research with these and potentially other combinations over a longer duration will be needed to establish the safety and efficacy of ergogenic dietary aids. © 2012.

Tien J.M.,University of Miami
Journal of Systems Science and Systems Engineering | Year: 2011

Manufacturing and services constitute two of the five sectors of every country's economy; depending on the maturity of the economy, they are - in terms of employment - typically the two largest sectors. The outputs or products of an economy can also be divided into goods products (due to manufacturing, construction, agriculture and mining) and services products. To date, the goods and services products have, for the most part, been mass produced; it is the premise of this paper that recent technological advances - including flexible manufacturing, cloud computing, nanotechnology and smart sensing - can better enable the transformation from mass production to mass customization. We regard mass customization as the simultaneous and real time management of supply and demand chains, based on a taxonomy that can be defined in terms of its underpinning component and management foci. From a components perspective, we first consider the value chain of supplier, manufacturer, assembler, retailer, and customer, and then develop a consistent set of definitions for supply and demand chains based on the location of the customer order penetration point. From a management perspective, we classify the methods that are employed in the management of these chains, based on whether supply and/or demand are flexible or fixed. Interestingly, our management taxonomy highlights a very critical research area at which both supply and demand are flexible, thus manageable. Simultaneous management of supply and demand chains sets the stage for mass customization which is concerned with meeting the needs of an individualized customer market. Simultaneous and real time management of supply and demand chains set the stage for real time mass customization (e. g., wherein a tailor first laser scans an individual's upper torso and then delivers a uniquely fitted jacket within a reasonable period, while the individual is waiting). The benefits of real time mass customization cannot be over-stated as goods and services become indistinguishable and are co-produced - as "servgoods" - in real time, resulting in an overwhelming economic advantage. © 2011 Systems Engineering Society of China and Springer-Verlag Berlin Heidelberg.

Toselli I.,Fraunhofer Institute for Optronics, System Technologies and Image Exploitation | Toselli I.,University of Miami
Journal of the Optical Society of America A: Optics and Image Science, and Vision | Year: 2014

In this paper, the concept of anisotropy at different atmospheric turbulence scales is introduced. A power spectrum and its associated structure function with inner and outer scale effects and anisotropy are also shown. The power spectrum includes an effective anisotropic parameter ζeff to describe anisotropy, which is useful for modeling optical turbulence when a non-Kolmogorov power law and anisotropy along the direction of propagation are present. © 2014 Optical Society of America.

O'Brien T.P.,University of Miami
Advances in Therapy | Year: 2012

Acute bacterial conjunctivitis, the most common cause of conjunctivitis, is responsible for approximately 1% of all primary-care consultations. Of the topical ophthalmic antibiotics used to treat acute bacterial conjunctivitis, fluoroquinolones are especially useful because they possess a broad antibacterial spectrum, are bactericidal in action, are generally well tolerated, and have been less prone to development of bacterial resistance. Besifloxacin, the latest advanced fluoroquinolone approved for treating bacterial conjunctivitis, is the first fluoroquinolone developed specifically for topical ophthalmic use. It has a C-8 chlorine substituent and is known as a chloro-fluoroquinolone. Besifloxacin possesses relatively balanced dual-targeting activity against bacterial topoisomerase IV and DNA gyrase (topoisomerse II), two essential enzymes involved in bacterial DNA replication, leading to increased potency and decreased likelihood of bacterial resistance developing to besifloxacin. Microbiological data suggest a relatively high potency and rapid bactericidal activity for besifloxacin against common ocular pathogens, including bacteria resistant to other fluoroquinolones, especially resistant staphylococcal species. Randomized, doublemasked, controlled clinical studies demonstrated the clinical efficacy of besifloxacin ophthalmic suspension 0.6% administered three-times daily for 5 days to be superior to the vehicle alone and similar to moxifloxacin ophthalmic solution 0.5% for bacterial conjunctivitis. In addition, besifloxacin ophthalmic suspension 0.6% administered two-times daily for 3 days was clinically more effective than the vehicle alone for bacterial conjunctivitis. Besifloxacin has also been shown in preclinical animal studies to be potentially effective for the "off- label" treatment of infections following ocular surgery, prophylaxis of endophthalmitis, and the treatment of bacterial keratitis. Taken together, clinical and preclinical animal studies indicate that besifloxacin is an important new option for the treatment of ocular infections. © Springer Healthcare 2012.

Prilleltensky I.,University of Miami
American Journal of Community Psychology | Year: 2012

I argue that distinct conditions of justice lead to diverse wellness outcomes through a series of psychosocial processes. Optimal conditions of justice, suboptimal conditions of justice, vulnerable conditions of injustice, and persisting conditions of injustice lead to thriving, coping, confronting, and suffering, respectively. The processes that mediate between optimal conditions of justice and thriving include the promotion of responsive conditions, the prevention of threats, individual pursuit, and avoidance of comparisons. The mechanisms that mediate between suboptimal conditions of justice and coping include resilience, adaptation, compensation, and downward comparisons. Critical experiences, critical consciousness, critical action, and righteous comparisons mediate between vulnerable conditions of injustice and confrontation with the system. Oppression, internalization, helplessness, and upward comparisons mediate between persisting conditions of injustice and suffering. These psychosocial processes operate within and across personal, interpersonal, organizational and community contexts. Different types of justice are hypothesized to influence well-being within each context. Intrapersonal injustice operates at the personal level, whereas distributive, procedural, relational, and developmental justice impact interpersonal well-being. At the organizational level, distributive, procedural, relational and informational justice influence well-being. Finally, at the community level, distributive, procedural, retributive, and cultural justice support community wellness. Data from a variety of sources support the suggested connections between justice and well-being. © 2011 Society for Community Research and Action.

Harvey P.D.,University of Miami | Bowie C.R.,Queens University
Psychiatric Clinics of North America | Year: 2012

This article discusses the measurement of cognition in schizophrenia, its role as a determinant of disability, and treatment efforts to date, including pharmacological and behavioral interventions as well as effective treatments that lead to improved outcomes. The measurement of functioning when patients with schizophrenia receive treatment in the office is addressed. The review focuses on new developments in the creation and adoption of a consensus method for the assessment of cognitive functioning in treatment studies, on the increased appreciation for assessment of functional skills in the prediction of everyday outcomes, and on developments in the basic neuroscience of cognition. © 2012 Elsevier Inc.

Deregulation of microRNAs (miRs) contributes to progression and metastasis of prostate and other cancers. miR-23b and -27b, encoded in the same miR cluster (miR-23b/-27b), are downregulated in human metastatic prostate cancer compared with primary tumors and benign tissue. Expression of miR-23b/-27b decreases prostate cancer cell migration, invasion and results in anoikis resistance. Conversely, antagomiR-mediated miR-23b and -27b silencing produces the opposite result in a more indolent prostate cancer cell line. However, neither miR-23b/-27b expression or inhibition impacts prostate cancer cell proliferation suggesting that miR-23b/-27b selectively suppresses metastasis. To examine the effects of miR-23b/-27b on prostate cancer metastasis in vivo, orthotopic prostate xenografts were established using aggressive prostate cancer cells transduced with miR-23b/-27b or non-targeting control miRNA. Although primary tumor formation was similar between miR-23b/-27b-transduced cells and controls, miR-23b/-27b expression in prostate cancer cells decreased seminal vesicle invasion and distant metastases. Gene-expression profiling identified the endocytic adaptor, Huntingtin-interacting protein 1-related (HIP1R) as being downregulated by miR-23b/-27b. Increased HIP1R expression in prostate cancer cells inversely phenocopied the effects of miR-23b/-27b overexpression on migration, invasion and anchorage-independent growth. HIP1R rescued miR-23b/-27b-mediated repression of migration in prostate cancer cells. HIP1R mRNA levels were decreased in seminal vesicle tissue from mice bearing miR-23b/-27b-transduced prostate cancer cell xenografts compared with scrambled controls, suggesting HIP1R is a key functional target of miR-23b/-27b. In addition, depletion of HIP1R led to a more rounded, less mesenchymal-like cell morphology, consistent with decreased metastatic properties. Together, these data demonstrate that the miR-23b/-27b cluster functions as a metastasis-suppressor by decreasing HIP1R levels in pre-clinical models of prostate cancer.Oncogene advance online publication, 22 February 2016; doi:10.1038/onc.2016.6. © 2016 Macmillan Publishers Limited

Hamid H.,Yale University | Kanner A.M.,University of Miami
Epilepsy and Behavior | Year: 2013

For a long time, there has been a misconception that all antidepressant drugs have proconvulsant effects. Yet, antidepressants of the selective serotonin reuptake inhibitor (SSRI) family not only have been shown to be safe when used in patients with epilepsy (PWE) but also have been found to possess antiepileptic properties in animal models of epilepsy. In humans randomized to SSRIs vs. placebo for the treatment of major depressive episodes, the incidence of epileptic seizures was significantly lower among those treated with the antidepressants. These data raise the question of whether there is enough evidence that would support a randomized placebo-controlled trial to test antiepileptic effect of SSRIs in PWE. This article reviews the preclinical and clinical data to address this question.This article is part of a Special Issue entitled "The Future of Translational Epilepsy Research". © 2012 Elsevier Inc.

Shigenobu S.,Japan National Institute for Basic Biology | Shigenobu S.,Japan Science and Technology Agency | Wilson A.C.C.,University of Miami
Cellular and Molecular Life Sciences | Year: 2011

The symbiosis of the pea aphid Acyrthosphion pisum with the bacterium Buchnera aphidicola APS represents the best-studied insect obligate symbiosis. Here we present a refined picture of this symbiosis by linking pre-genomic observations to new genomic data that includes the complete genomes of the eukaryotic and prokaryotic symbiotic partners. In doing so, we address four issues central to understanding the patterns and processes operating at the A. pisum/Buchnera APS interface. These four issues include: (1) lateral gene transfer, (2) host immunity, (3) symbiotic metabolism, and (4) regulation. © 2011 The Author(s).

Ossification of the posterior longitudinal ligament (OPLL) is a disorder afflicting as many as 2% of East Asians. However, reports of OPLL in non-Asians have been sporadic in the medical literature. This study describes clinical and radiographic findings with OPLL in non-Asians at a tertiary care center treating a diverse multiethnic population. Over a 6-year period, 43 patients not of East Asian descent presented to an urban tertiary medical center with OPLL. Patient data, including ethnicity, spinal cord function, Nurick grade, radiographic findings, OPLL subtype, and degree of cervical stenosis, were recorded. The average patient age was 59 years (range 32-92 years) with 18 women and 25 men. There were 22 Caucasian patients, 17 Hispanic patients, and 4 Black patients. With respect to the radiographic findings, OPLL morphology was continuous in 19, segmental in 17, mixed in 6, and other in 1. Average canal diameter was 7.6 mm (range 4.2-9.0 mm) at the most stenotic points. The mean Nurick grade was 2.95 at presentation, but 7 of the patients had OPLL identified incidentally and with early or minimal symptoms and signs of myelopathy. Ossification of the posterior longitudinal ligament in non-Asians demonstrates similar demographic and radiographic characteristics as in East Asians. The representation of different ethnic groups mirrors the demographics of the medical center population in general, showing no specific predilection for particular ethnic groups. Surgical decompression in appropriately selected patients results in similar rates of improvement when compared with the Japanese literature.

Pugliese A.,University of Miami
Pediatric Diabetes | Year: 2016

Type 1 diabetes (T1D) is a chronic autoimmune disease in which autoreactive T-cells and inflammation cause severe loss of pancreatic beta cells. Insulitis, the pathologic hallmark of T1D, is an inflammatory lesion consisting of immune cell infiltrates around and within the islets. New research initiatives and methodologies are advancing our understanding of pancreas pathology. Studies have revealed the predominant cellular types that infiltrate the islets, novel molecular aspects associated with insulitis, and the coexistence of additional pathological abnormalities. While insulitis is a critical element of T1D pathology and pathogenesis, it is typically present only in a modest proportion of islets at any given time, even at diagnosis, with overall limited relation to disease duration. Thus, the relative importance of insulitis as a determining factor of diabetes symptoms at disease onset appears to have been overestimated; growing evidence also shows that beta cell loss at diagnosis is more modest than previously thought. Thus, the sole targeting of the immune system may not afford full therapeutic efficacy if dysfunction affects beta cells that are not under immune attack and this is a key contributor to symptoms. Combination therapies that promote both immunoregulation and address beta cell dysfunction should be more effective in treating this chronic disease process. It remains a major goal to clarify the relation of insulitis with the dynamics of beta cell loss and coexisting mechanisms of dysfunction, according to clinical stage; such improved understanding is key to design therapeutic strategies that target multiple pathogenic mechanisms. © 2016 The Authors. Pediatric Diabetes published by John Wiley & Sons Ltd.

Deutscher M.P.,University of Miami
FEMS Microbiology Reviews | Year: 2015

Ribonucleases (RNases) play an essential role in essentially every aspect of RNA metabolism, but they also can be destructive enzymes that need to be regulated to avoid unwanted degradation of RNA molecules. As a consequence, cells have evolved multiple strategies to protect RNAs against RNase action. They also utilize a variety of mechanisms to regulate the RNases themselves. These include post-transcriptional regulation, post-translational modification, trans-acting inhibitors, cellular localization, as well as others that are less well studied. In this review, I will briefly discuss how RNA molecules are protected and then examine in detail our current understanding of the mechanisms known to regulate individual RNases. © 2015 FEMS.

Bogdan Allemann I.,Universitatsspital Zurich | Kaufman J.,University of Miami
Lasers in Medical Science | Year: 2010

The novel concept of non-ablative fractional photothermolysis was introduced to the market in 2003 as an answer to the need for effective, yet low risk, resurfacing techniques. Unlike conventional ablative and non-ablative lasers, fractional ablative and non-ablative photothermolysis treats only a fraction of the skin, leaving up to a maximum of 95% of the skin uninvolved. The undamaged surrounding tissue allows for a reservoir of viable tissue, permitting rapid epidermal repair. Non-ablative fractional photothermolysis is currently approved by the US Food and Drug Administration (FDA) for the treatment of pigmented lesions, periorbital rhytides, skin resurfacing, melasma and soft tissue coagulation, acne and surgical scars, and actinic keratoses. However, its off-label use is clearly more extended. In 2007 the concept was further developed, and ablative fractional photothermolysis was introduced, using an erbium yttrium aluminium garnet (Er:YAG) or carbon dioxide laser. These devices are FDA cleared to treat wrinkles, rhytides, furrows, fine lines, textural irregularities, pigmented lesions and vascular dyschromia. In this review we discuss the two concepts, their technical details and clinical indications, and we describe the current literature available. © 2009 Springer-Verlag London Ltd.

Bonasio R.,University of Pennsylvania | Shiekhattar R.,University of Miami
Annual Review of Genetics | Year: 2014

Over the past decade there has been a greater understanding of genomic complexity in eukaryotes ushered in by the immense technological advances in high-throughput sequencing of DNA and its corresponding RNA transcripts. This has resulted in the realization that beyond protein-coding genes, there are a large number of transcripts that do not encode for proteins and, therefore, may perform their function through RNA sequences and/or through secondary and tertiary structural determinants. This review is focused on the latest findings on a class of noncoding RNAs that are relatively large (>200 nucleotides), display nuclear localization, and use different strategies to regulate transcription. These are exciting times for discovering the biological scope and the mechanism of action for these RNA molecules, which have roles in dosage compensation, imprinting, enhancer function, and transcriptional regulation, with a great impact on development and disease. © 2014 by Annual Reviews. All rights reserved.

Moraes C.T.,University of Miami
EMBO Molecular Medicine | Year: 2014

When mitochondrial diseases result from mutations found in the mitochondrial DNA, engineered mitochondrial-targeted nucleases such as mitochondrial-targeted zinc finger nucleases are shown to specifically eliminate the mutated molecules, leaving the wild-type mitochondrial DNA intact to replicate and restore normal copy number. In this issue, Gammage and colleagues successfully apply this improved technology on patients' cells with two types of genetic alterations responsible for neuropathy ataxia and retinitis pigmentosa (NARP) syndrome and Kearns Sayre syndrome and progressive external ophthalmoplegia (PEO). In this issue of EMBO Molecular Medicine, mitochondrial-targeted zinc finger nucleases (mtZFN) are used to alter the mitochondrial DNA (mtDNA) heteroplasmy balance in cells derived from patients with mitochondrial diseases. © 2014 The Author.

Radko T.,Naval Postgraduate School, Monterey | Kamenkovich I.,University of Miami
Journal of Physical Oceanography | Year: 2011

An analytical model of the Atlantic deep stratification and meridional overturning circulation is presented that illustrates the dynamic coupling between the Southern Ocean and the midlatitude gyres. The model, expressed here in terms of the two-and-a-half-layer framework, predicts the stratification and meridional transport as a function of the mechanical and thermodynamic forcing at the sea surface. The approach is based on the classical elements of large-scale circulation theory-ideal thermocline, inertial western boundary currents, and eddy-controlled Antarctic Circumpolar Current (ACC) models-which are combined to produce a consistent three-dimensional view of the global overturning. The analytical tractability is achieved by assuming and subsequently verifying that the pattern of circulation in the model is largely controlled by adiabatic processes: the time-mean and eddy-induced isopycnal advection of buoyancy. The mean stratification of the lower thermocline is determined by the surface forcing in the ACC and, to a lesser extent, by the North Atlantic Deep Water formation rate. Although the vertical small-scale mixing and the diapycnal eddyflux components can substantially influence the magnitude of overturning, their effect on the net stratification of the midlatitude ocean is surprisingly limited. The analysis in this paper suggests the interpretation of the ACC as an active lateral boundary layer that does not passively adjust to the prescribed large-scale solution but instead forcefully controls the interior pattern. © 2011 American Meteorological Society.

Bossart G.D.,Georgia Aquarium | Bossart G.D.,University of Miami
Veterinary Pathology | Year: 2011

The long-term consequences of climate change and potential environmental degradation are likely to include aspects of disease emergence in marine plants and animals. In turn, these emerging diseases may have epizootic potential, zoonotic implications, and a complex pathogenesis involving other cofactors such as anthropogenic contaminant burden, genetics, and immunologic dysfunction. The concept of marine sentinel organisms provides one approach to evaluating aquatic ecosystem health. Such sentinels are barometers for current or potential negative impacts on individual- and population-level animal health. In turn, using marine sentinels permits better characterization and management of impacts that ultimately affect animal and human health associated with the oceans. Marine mammals are prime sentinel species because many species have long life spans, are long-term coastal residents, feed at a high trophic level, and have unique fat stores that can serve as depots for anthropogenic toxins. Marine mammals may be exposed to environmental stressors such as chemical pollutants, harmful algal biotoxins, and emerging or resurging pathogens. Since many marine mammal species share the coastal environment with humans and consume the same food, they also may serve as effective sentinels for public health problems. Finally, marine mammals are charismatic megafauna that typically stimulate an exaggerated human behavioral response and are thus more likely to be observed. © The American College of Veterinary Pathologists 2011.

Multiple evolutionary phenomena require individual animals to assess conspecifics based on behaviors, morphology, or both. Both behavior and morphology can provide information about individuals and are often used as signals to convey information about quality, motivation, or energetic output. In certain cases, conspecific receivers of this information must rank these signaling individuals based on specific traits. The efficacy of information transfer associated within a signal is likely related to the type of trait used to signal, though few studies have investigated the relative effectiveness of contrasting signaling systems. I present a set of models that represent a large portion of signaling systems and compare them in terms of the ability of receivers to rank signalers accurately. Receivers more accurately assess signalers if the signalers use traits that do not require non-food resources; similarly, receivers more accurately ranked signalers if all the signalers could be observed simultaneously, similar to leks. Surprisingly, I also found that receivers are only slightly better at ranking signaler effort if the effort results in a cumulative structure. This series of findings suggests that receivers may attend to specific traits because the traits provide more information relative to others; and similarly, these results may explain the preponderance of morphological and behavioral display signals. © 2014 Gavin M. Leighton.

Li W.,University of Miami
Journal of Cellular Physiology | Year: 2012

Hundreds of billions of cells undergo apoptosis in our body everyday and are removed by immunologically silent phagocytosis to maintain tissue homeostasis. Impairments in phagocytosis result in autoimmune and/or degenerative diseases. Eat-me signals are the key to the recognition of extracellular cargos and the initiation of the phagocytosis process by activating phagocytic receptors and signaling cascades, and are convenient targets for therapeutic modulation. Despite their importance, eat-me signals and other phagocytosis players are mostly identified on case-by-case basis with daunting challenges. This Commentary focuses on our latest knowledge of the extracellular players, highlights our approaches to systematically map unknown pathways by functional genetic and proteomic technologies, and discusses future direction to unravel the mystery of molecular phagocyte biology. © 2011 Wiley Periodicals, Inc.

Palte H.D.,University of Miami
Local and Regional Anesthesia | Year: 2015

In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon’s block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma. © 2015 Palte.

Recent studies have reported a large gap between the forceful and assertive recommendations in the guidelines and real-world practice in the use of renin-angiotensin-aldosterone inhibitors (RAASi) therapies. A comprehensive, retrospective analysis of a large database of electronic medical records (>7 million patients) was undertaken to evaluate 3 pivotal concerns: (i) whether RAASi are being prescribed according to treatment guidelines, (ii) what happens to RAASi prescriptions after hyperkalemia events, and (iii) what the clinical outcomes are in patients whose RAASi are discontinued or who are prescribed at doses lower than the guidelines recommend. The results indicate that a substantial gap exists between guideline recommendations and real-world prescribing patterns for RAASi. Among patients with cardiorenal comorbidities for which RAASi are recommended by the guidelines, more than one-half were prescribed lower-than-recommended doses, and approximately 14% to 16% discontinued RAASi therapy. RAASi prescribing patterns may be altered by the development of hyperkalemia. Moderate-to-severe hyperkalemia events were followed by down-titration or discontinuation of RAASi therapy in nearly one-half of all patients on maximal dose and by discontinuation in nearly one-third of patients on submaximal dose. This analysis highlights the challenge behind RAASi prescribing decisions, balancing the risk of provoking hyperkalemia with the benefits to reducing cardiorenal morbidity and mortality. Patients who are known to derive the greatest benefit from these drugs (chronic kidney disease patients with concomitant diabetes mellitus or heart failure) are the same patients who are at highest risk of developing hyperkalemia. These observations constitute a "call to action" to develop newer treatment modalities to lower serum potassium and to achieve and sustain normokalemia long-term. © 2016 International Society of Nephrology.

Wu J.,University of Miami | Wells M.L.,University of Maine, United States | Rember R.,University of Alaska Fairbanks
Geochimica et Cosmochimica Acta | Year: 2011

Dissolved iron profiles along a north-south transect along 158°W in the tropical Pacific show evidence of two deepwater anomalies. The first extends from Station ALOHA (22.78°N) to the equator at ∼1000-1500m and lies below the maximum apparent oxygen utilization and nutrient (N, P) concentrations. The feature is not supported by vertical export processes, but instead corresponds with the lateral dilution field of δ 3He derived from the Loihi seamount, Hawaii, though a sediment source associated with the Hawaiian Island Chain cannot be entirely ruled out. The second, deeper (2000-3000m) anomaly occurs in tropical South Pacific waters (7°S) and also does not correlate with the depths of maximum nutrient concentrations or apparent oxygen utilization, but it does coincide closely with δ 3He emanating from the East Pacific Rise, more than 5000km to the east. We hypothesize that these anomalies represent the long-range (>2000km) transport of hydrothermal iron residuals, stabilized against scavenging by complexation with excess organic ligands in the plume source regions. Such trace leakage of hydrothermal iron to distal plume regions would have been difficult to identify in most hydrothermal vent mapping studies because low analytical detection limits were not needed for the proximal plume regions. These findings suggest that hydrothermal activity may represent a major source of dissolved iron throughout the South Pacific deep basin today, as well as other regions having high mid-ocean spreading rates in the geologic past. In particular, we hypothesize that high spreading rates along the South Atlantic and Southern Ocean mid-oceanic ridges, combined with the upwelling ventilation of these distal hydrothermal plumes, may have increased ocean productivity and carbon export in the Southern Ocean. Assessing the magnitude and persistence of dissolved hydrothermal iron in basin scale deep waters will be important for understanding the marine biogeochemistry of iron and, potentially, on ocean productivity and climate change during the geologic past. © 2010 Elsevier Ltd.

Hoffer M.E.,University of Miami
Current Opinion in Neurology | Year: 2015

Purpose of review: The purpose of this review is to examine recent advances in the diagnosis and treatment of mild traumatic brain injury with attention to the neurosensory sequelae. Recent findings: There has been a great deal of work done in this area over the last 18 months. Much of the work focuses on diagnosing the disorder. The neurosensory sequelae can be difficult to diagnose with headache relying on subjective information and cognitive effects and fatigue being very difficult to accurately measure. Dizziness is a very common disorder and probably the easiest effect to measure objectively and evidence is mounting that diagnosing and treating dizziness is very important in this patient group. Advances in treatment have occurred in the last 18 months but there is still a great deal of work necessary in this area. There is one reported pharmaceutical countermeasure and it is vital that this medicine be further tested and developed. Therapies remain the mainstay of treatment and work in this area needs to be supported. Summary: It is clear from this review that mild traumatic brain injury is a rapidly growing public health issue and it vital for those who see these patients to be well versed in the neurosensory manifestations so that appropriate diagnosis and treatment are provided and accurate prognostic implications can be provided for patients and their families. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Millero F.J.,University of Miami
Oceanography | Year: 2010

As one of few who have been involved in the equation of state of seawater over the last 40 years, I was invited to review some of the history behind its early development and also the more recent thermodynamic equation of state. The article first reviews early (late 1800s) work by Knudsen and others in defining the concept of salinity. This summary leads into the development of the practical salinity scale. Our studies at the University of Miami Rosenstiel School, along with the work of Alain Poisson's group at Laboratoire de Physique et Chimie, Université Pierre et Marie Curie, and that of Alvin Bradshaw and Karl Schleicher at Woods Hole Oceanographic Institution, were instrumental in deriving the 1980 equation of state (EOS-80) that has been used for 30 years. The fundamental work of Ranier Feistel at Leibniz Institute for Baltic Sea Research led to the development of a Gibbs free energy function that is the backbone of the new thermodynamic equation of state (TEOS-10). It can be used to determine all of the thermodynamic properties of seawater. The salinity input to the TEOS-10 Gibbs function requires knowledge of the absolute salinity of seawater (SA), which is based upon the reference salinity of seawater (SR). The reference salinity is our best estimate of the absolute salinity of the seawater that was used to develop the practical salinity scale (SP), the equation of state, and the other thermodynamic properties of seawater. Reference salinity is related to practical salinity by SR = SP (35.16504/35.000) g kg-1 and absolute salinity is related to reference salinity by SA = SR + δSA, where δSA is due to the added solutes in seawater in deep waters resulting from the dissolution of CaCO3(s) and SiO2(s), CO2, and nutrients like NO3 and PO4 from the oxidation of plant material. The δSA values due to the added solutes are estimated from the differences between the measured densities of seawater samples compared with the densities calculated from the TEOS-10 equation of state (Δρ) at the same reference salinity, temperature, and pressure, using δSA = Δρ/0.75179 g kg-1. The values of δSA in the ocean can be estimated for waters at given longitude, latitude, and depth using correlations of δSA and the concentration of Si(OH)4 in the waters. The SA values can then be used to calculate all the thermodynamic properties of seawater in the major oceans using the new TEOS-10. It will be very useful to modelers examining the entropy and enthalpy of seawater. © 2010 by The Oceanography Society.

Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression. HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up. Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline. A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.

Cosner C.,University of Miami
Mathematical Biosciences | Year: 2015

Host and/or vector movement patterns have been shown to have significant effects in both empirical studies and mathematical models of vector-borne diseases. The processes of economic development and globalization seem likely to make host movement even more important in the future. This article is a brief survey of some of the approaches that have been used to study the effects of host movement in analytic mathematical models for vector-borne diseases. It describes the formulation and interpretation of various types of spatial models and describes a few of the conclusions that can be drawn from them. It is not intended to be comprehensive but rather to provide sufficient background material and references to the literature to serve as an entry point into this area of research for interested readers. © 2015 Elsevier Inc..

Atypical spitzoid tumors are a morphologically diverse group of rare melanocytic lesions most frequently seen in children and young adults. As atypical spitzoid tumors bear striking resemblance to Spitz nevus and spitzoid melanomas clinically and histopathologically, it is crucial to determine its malignant potential and predict its clinical behavior. To date, many researchers have attempted to differentiate atypical spitzoid tumors from unequivocal melanomas based on morphological, immonohistochemical, and molecular diagnostic differences. A diagnostic algorithm is proposed here to assess the malignant potential of atypical spitzoid tumors by using a combination of immunohistochemical and cytogenetic/molecular tests. Together with classical morphological evaluation, this algorithm includes a set of immunohistochemistry assays (p16 Ink4a, a dual-color Ki67/MART-1, and HMB45), fluorescence in situ hybridization (FISH) with five probes (6p25, 8q24, 11q13, CEN9, and 9p21), and an array-based comparative genomic hybridization. This review discusses details of the algorithm, the rationale of each test used in the algorithm, and utility of this algorithm in routine dermatopathology practice. This algorithmic approach will provide a comprehensive diagnostic tool that complements conventional histological criteria and will significantly contribute to improve the diagnosis and prediction of the clinical behavior of atypical spitzoid tumors. © 2016 USCAP, Inc All rights reserved.

Papapetropoulos S.S.,University of Miami
CNS Neuroscience and Therapeutics | Year: 2012

Parkinson's disease (PD) is the second most common neurodegenerative disorder with an estimated 4 million patients worldwide. L-dopa is standard, and often initial, therapy for patients with this condition; however, with continued dopaminergic treatment and as the disease progresses, the majority of patients experience complications such as "wearing-off" symptoms, dyskinesias, and other motor complications. These complications may become disabling and profoundly affect quality of life. Treatment modification and combination therapies with L-dopa, dopamine agonists, monoamine oxidase type B inhibitors, and catechol-O-methyltransferase inhibitors are commonly used to manage complications. In recent years regulatory agencies, clinical researchers, and sponsors have widely accepted and utilized changes in "ON" and "OFF" time measured by Patient Hauser Diaries as endpoints for measuring efficacy of therapeutics seeking approval for symptomatic treatment of PD. Successful antiparkinsonian medications have been associated with treatment effects of more than 1 h in either reduction of "OFF" time of increase in "ON" time. Accurate "ON" and "OFF" time registration during clinical studies requires rigorous patient training. Reduced compliance, recall bias and diary fatigue are common problems seen with patient diary reported measures. Electronic diaries may help reducing some of these problems but may be associated with other challenges in large, multicenter studies. © 2011 Blackwell Publishing Ltd.