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1.  Development and Evaluation of an Interactive CD-ROM for Children with Leukemia and Their Families1 
Patient Education and Counseling  2002;46(4):297-307.
To meet the need for an interactive software product to educate children with leukemia, ages 4–11 years, and their families about the disease and its treatment, we developed and evaluated an interactive, comprehensive, multimedia CD-ROM product, Kidz with Leukemia: A Space Adventure. The prototype was tested using a randomized controlled experimental design. Children with leukemia and their parents were randomized to receive either the newly developed CD-ROM or the book You and Leukemia by Lynn Baker. Health care providers (HCPs) and other content/technical experts evaluated only the CD-ROM. Data were collected on children’s health locus of control, their understanding of leukemia, and the satisfaction of participants with their assigned intervention. Children in the CD-ROM group, compared with those in the book group, showed increased feelings of control over their health. Although there was a high level of satisfaction with the CD-ROM among all users, younger children and their parents were most satisfied. In conclusion, the CD-ROM, Kidz with Leukemia: A Space Adventure, was found to be a useful, engaging, and empowering tool for children with leukemia and can serve as a model for developing future health-related educational materials.
PMCID: PMC3307387  PMID: 11932129
Childhood cancer; CD-ROM; Leukemia; Patient education; Pediatrics
2.  Increasing Rates of Breast Cancer and Cardiac Surveillance Among High Risk Survivors of Childhood Hodgkin Lymphoma Following a Mailed, One-Page Survivorship Care Plan 
Pediatric blood & cancer  2010;56(5):818-824.
Hodgkin lymphoma (HL) survivors face substantially elevated risks of breast cancer and cardiovascular disease. They and their physicians are often unaware of these risks and surveillance recommendations.
A prospective one-arm study was conducted among a random sample of 72 HL survivors, ages 27 to 55, participating in the Childhood Cancer Survivor Study (CCSS) who were at increased risk for breast cancer and/or cardiomyopathy and had not had a screening mammogram or echocardiogram, respectively, within the prior two years. A one-page survivorship care plan with recommendations for surveillance was mailed to participants. In addition, survivors’ primary physicians were contacted and provided patient-specific information and a web-based Virtual Information Center was made available for both survivors and physicians. Outcomes were assessed by telephone six months after the intervention.
The survivor participation (62/72; 86%) and six-month retention (56/61; 92%) rates were high. Tension and anxiety, measured by the Profile of Mood States, did not increase following risk notification; 91% of survivors described their reactions to receiving the information in positive terms. At six months, 41% of survivors reported having completed the recommended mammogram; 20% reported having an echocardiogram (females 30%, males 10%). Only 29% of survivors visited the website. Nine physicians enrolled, and none used the study resources.
A mailed, personalized survivorship care plan was effective in communicating risk and increasing compliance with recommended medical surveillance. Internet- and telephone-based strategies to communicate risk were not utilized by survivors or physicians.
PMCID: PMC3749088  PMID: 21370417
cancer survivor; late effects; survivorship care plan
3.  Hospitalized cardiovascular events in patients with diabetic macular edema 
BMC Ophthalmology  2012;12:11.
Microvascular and macrovascular complications in diabetes stem from chronic hyperglycemia and are thought to have overlapping pathophysiology. The aim of this study was to investigate the incidence rate of hospitalized myocardial infarctions (MI) and cerebrovascular accidents (CVA) in patients with diabetic macular edema (DME) compared with diabetic patients without retinal diseases.
This was a retrospective cohort study of a commercially insured population in an administrative claims database. DME subjects (n = 3519) and diabetes controls without retinal disease (n = 10557) were matched by age and gender. Healthcare claims were analyzed for the study period from 1 January 2002 to 31 December 2005. Incidence and adjusted rate ratios of hospitalized MI and CVA events were then calculated.
The adjusted rate ratio for MI was 2.50 (95% CI: 1.83-3.41, p < 0.001) for DME versus diabetes controls. Predictors of MI events were heart disease, history of acute MI, and prior use of antiplatelet or anticoagulant drugs. The adjusted rate ratio for CVA was 1.98 (95% CI: 1.39-2.83, p < 0.001) for DME versus diabetes controls. Predictors of CVA events were cardiac arrhythmia, Charlson comorbidity scores, history of CVA, hyperlipidemia, and other cerebrovascular diseases.
Event rates of MI or CVA were higher in patients with DME than in diabetes controls. This study is one of few with sufficient sample size to accurately estimate the relationship between DME and cardiovascular outcomes.
PMCID: PMC3395554  PMID: 22646811
4.  Development and Evaluation of an Educational Interactive CD-ROM For Teens with Cancer 
Pediatric blood & cancer  2010;55(3):512-519.
PMCID: PMC3324939  PMID: 20533523
cancer; pediatric; adolescent; education; interactive; CD-ROM
5.  Elevated ethyl methanesulfonate (EMS) in nelfinavir mesylate (Viracept®, Roche): overview 
Roche's protease inhibitor nelfinavir mesylate (Viracept®) produced between March 2007-June 2007 was found to contain elevated levels of ethyl methanesulfonate (EMS), a known mutagen (alkylator) – leading to a global recall of the drug. EMS levels in a daily dose (2,500 mg Viracept/day) were predicted not to exceed a dose of ~2.75 mg/day (~0.055 mg/kg/day based on 50 kg patient). As existing toxicology data on EMS did not permit an adequate patient risk assessment, a comprehensive animal toxicology evaluation of EMS was conducted. General toxicity of EMS was investigated in rats over 28 days. Two studies for DNA damage were performed in mice; chromosomal damage was assessed using a micronucleus assay and gene mutations were detected using the MutaMouse transgenic model. In addition, experiments designed to extrapolate animal exposure to humans were undertaken. A general toxicity study showed that the toxicity of EMS occurred only at doses ≥ 60 mg/kg/day, which is far above that received by patients. Studies for chromosomal damage and mutations in mice demonstrated a clear threshold effect with EMS at 25 mg/kg/day, under chronic dosing conditions. Exposure analysis (Cmax) demonstrated that ~370-fold higher levels of EMS than that ingested by patients, are needed to saturate known, highly conserved, error-free, mammalian DNA repair mechanisms for alkylation. In summary, animal studies suggested that patients who took nelfinavir mesylate with elevated levels of EMS are at no increased risk for carcinogenicity or teratogenicity over their background risk, since mutations are prerequisites for such downstream events. These findings are potentially relevant to >40 marketed drugs that are mesylate salts.
PMCID: PMC2731786  PMID: 19660105
7.  Rat liver adenyl cyclase activity in various thyroid states 
Journal of Clinical Investigation  1972;51(9):2498-2501.
Thyroidectomized and euthyroid rats were injected with three doses of triiodothyronine (T3) or of the diluent over a 6 day period, and liver homogenates were assayed for basal, epinephrine-stimulated, and NaF-stimulated adenyl cyclase activity. Based on NaF-stimulated levels, total adenyl cyclase activity, expressed per milligram of liver protein, was increased after thyroidectomy. Administration of T3 to either hypothyroid or euthyroid rats, however, had no effect on the NaF-stimulated levels. Basal and epinephrine-stimulated enzyme activities were the same in hypothyroid, euthyroid, and hyperthyroid (euthyroid + T3) liver homogenates. In contrast, injections of T3 in hypothyroid rats increased the activities of basal and epinephrine-stimulated adenyl cyclase. In view of the findings in euthyroid and hyperthyroid liver, it is possible that this effect is transient. In general, no correlation was found between the effects of thyroid hormone on respiration and on adenyl cyclase activity of the rat liver. These results imply that the hepatic thermogenic response to thyroid hormone is not mediated by stimulation of adenyl cyclase activity with the possible exception of the early effects of T3 in the athyroid rat.
PMCID: PMC292419  PMID: 4639030

Results 1-7 (7)