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Article: Supplements Are Not a Synonym for Safe: Suspected Liver Injury From Ashwagandha.

Vazirani, Sondra / Kothari, Amit / Fujimoto, Jeffrey / Gomez, Mariana

Federal practitioner : for the health care professionals of the VA, DoD, and PHS

2023 Volume 40, Issue 9, Page(s) 315–319

Abstract: Background: As patients look more to alternative herbal and dietary supplements to boost energy and mood, reports are increasing of unintended adverse effects, particularly to the liver.: Case presentation: We report a case of a 48-year-old man with ... ...

Abstract	Background: As patients look more to alternative herbal and dietary supplements to boost energy and mood, reports are increasing of unintended adverse effects, particularly to the liver. Case presentation: We report a case of a 48-year-old man with a history of severe alcohol use disorder who presented to the emergency department with a cholestatic pattern of liver injury in the setting of alcohol and use of a testosterone-boosting supplement containing ashwagandha. Conclusions: Drug-induced liver damage should be considered in patients with alcohol use disorder who present with a cholestatic pattern of liver injury. Although many natural substances are well tolerated, others can have unanticipated and harmful adverse effects and drug interactions. Future research should identify not only potentially harmful substances, but also which patients may be at greatest risk.
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article
ISSN	1078-4497
ISSN	1078-4497
DOI	10.12788/fp.0409
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Article ; Online: Field testing the transferability of behavioural science knowledge on promoting vaccinations.

Saccardo, Silvia / Dai, Hengchen / Han, Maria A / Vangala, Sitaram / Hoo, Juyea / Fujimoto, Jeffrey

Nature human behaviour

2024

Abstract: As behavioural science is increasingly adopted by organizations, there is a growing need to assess the robustness and transferability of empirical findings. Here, we investigate the transferability of insights from various sources of behavioural science ... ...

Abstract	As behavioural science is increasingly adopted by organizations, there is a growing need to assess the robustness and transferability of empirical findings. Here, we investigate the transferability of insights from various sources of behavioural science knowledge to field settings. Across three pre-registered randomized controlled trials (RCTs, N = 314,824) involving a critical policy domain-COVID-19 booster uptake-we field tested text-based interventions that either increased vaccinations in prior field work (RCT1, NCT05586204), elevated vaccination intentions in an online study (RCT2, NCT05586178) or were favoured by scientists and non-experts (RCT3, NCT05586165). Despite repeated exposure to COVID-19 vaccination messaging in our population, reminders and psychological ownership language increased booster uptake, replicating prior findings. However, strategies deemed effective by prediction or intention surveys, such as encouraging the bundling of COVID-19 boosters and flu shots or addressing misconceptions, yielded no detectable benefits over simple reminders. These findings underscore the importance of testing interventions' transferability to real-world settings.
Language	English
Publishing date	2024-03-14
Publishing country	England
Document type	Journal Article
ISSN	2397-3374
ISSN (online)	2397-3374
DOI	10.1038/s41562-023-01813-4
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Article: A 1-Year Review of a Nationally Led Intervention to Improve Suicide Prevention Screening at a Large Homeless Veterans Clinic.

Temblique, Eileen Kay Ramos / Foster, Kayla / Fujimoto, Jeffrey / Kopelson, Kristin / Borthwick, Katharine Maile / Capone-Newton, Peter

Federal practitioner : for the health care professionals of the VA, DoD, and PHS

2022 Volume 39, Issue 1, Page(s) 12–18

Abstract: Background: Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for ... ...

Abstract	Background: Suicide is a national public health concern and veterans are a particularly vulnerable population. The Veterans Health Administration (VHA) Office of Mental Health and Suicide Prevention implemented a national, standardized process for suicide risk screening in October 2018, which was instituted at the West Los Angeles Veterans Affairs Medical Center Homeless Patient Aligned Care Team (HPACT) clinic. Methods: This article examines the results of the screening initiative after implementation, describes difficulties faced in implementation, and suggests strategies that might be used to overcome those challenges. Results: Over 1 fiscal year (October 1, 2018 to September 30, 2019) the HPACT clinic had 2932 unique veterans assigned to its care; 1876 (64%) received a primary screen of suicide risk, 523 (18%) were not screened, and 533 (18%) were exempt from screening by protocol. Of the 523 (18%) unscreened patients, 331 (11%) patients had no HPACT visit and 132 (5%) did not visit any VHA site during the period. There were 192 (7%) patients who visited but were not screened of which 19 (1%) declined screening. Conclusions: Most missed screening opportunities were due to patients being lost to follow-up. There were 5 challenges identified for screening implementation, including health record factors, communication, clinician buy-in, system factors, and patient factors. Thus, promoting interprofessional collaboration, visualizing effective process flows, establishing clear lines of communication and roles for involved staff, and opening avenues for continuous feedback and troubleshooting were all effective in increasing comfort with suicide assessment and screening rates.
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article
ISSN	1078-4497
ISSN	1078-4497
DOI	10.12788/fp.0215
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Article ; Online: Ultrahigh Resolution OCT Markers of Normal Aging and Early Age-related Macular Degeneration.

Chen, Siyu / Abu-Qamar, Omar / Kar, Deepayan / Messinger, Jeffrey D / Hwang, Yunchan / Moult, Eric M / Lin, Junhong / Baumal, Caroline R / Witkin, Andre / Liang, Michelle C / Waheed, Nadia K / Curcio, Christine A / Fujimoto, James G

Ophthalmology science

2023 Volume 3, Issue 3, Page(s) 100277

Abstract: Purpose: Ultrahigh resolution spectral domain-OCT (UHR SD-OCT) enables in vivo visualization of micrometric structural markers which differentially associate with normal aging versus age-related macular degeneration (AMD). This study explores the ... ...

Abstract	Purpose: Ultrahigh resolution spectral domain-OCT (UHR SD-OCT) enables in vivo visualization of micrometric structural markers which differentially associate with normal aging versus age-related macular degeneration (AMD). This study explores the hypothesis that UHR SD-OCT can detect and quantify sub-retinal pigment epithelium (RPE) deposits in early AMD, separating AMD pathology from normal aging. Design: Prospective cross-sectional study. Participants: A total of 53 nonexudative (dry) AMD eyes from 39 patients, and 63 normal eyes from 39 subjects. Methods: Clinical UHR SD-OCT scans were performed using a high-density protocol. Exemplary high-resolution histology and transmission electron microscopy images were obtained from archive donor eyes. Three trained readers evaluated and labeled outer retina morphological features, including the appearance of a hyporeflective split within the RPE-RPE basal lamina (RPE-BL)-Bruch's membrane (BrM) complex on UHR brightness (B)-scans. A semi-automatic segmentation algorithm measured the thickness of the RPE-BL-BrM split/hyporeflective band. Main outcome measures: Qualitative description of outer retinal morphological changes on UHR SD-OCT B-scans; the proportion of the RPE-BL-BrM complex with visible split (%) and the thickness of the resulting hyporeflective band (μm). Results: In young normal eyes, UHR SD-OCT consistently revealed an RPE-BL-BrM split/hyporeflective band. Its visibility and thickness were less in eyes of advanced age. However, the split/hyporeflective band was again visible in early AMD eyes. Both qualitative reading and quantitative thickness measurements showed significantly elevated visibility and thickness of the RPE-BL-BrM split/hyporeflective in early AMD eyes compared to age-matched controls. Conclusions: Our imaging results strongly support the hypothesis that appearance of the RPE-BL-BrM split/hyporeflective band in older subjects is dominated by the BL deposit, an indicator of early AMD well known from histology. Ultrahigh resolution SD-OCT can be used to investigate physiological aging as well as early AMD pathology in clinical imaging studies. Developing quantifiable markers associated with disease pathogenesis and progression can facilitate drug discovery, as well as reduce clinical trial times. Financial disclosures: Proprietary or commercial disclosure may be found after the references.
Language	English
Publishing date	2023-02-02
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-9145
ISSN (online)	2666-9145
DOI	10.1016/j.xops.2023.100277
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Article: Use of Phenobarbital in Delirium Tremens.

Fujimoto, Jeffrey / Lou, Jerry J / Pessegueiro, Antonio M

Journal of investigative medicine high impact case reports

2017 Volume 5, Issue 4, Page(s) 2324709617742166

Abstract: The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium ... ...

Abstract	The standard of care for alcohol withdrawal centers on the use of escalating doses of benzodiazepines until clinical improvement is achieved. However, there is no established standard in the care of patients with severe alcohol withdrawal and delirium tremens that is refractory to benzodiazepine therapy. One potential therapy that is gaining traction is the use of phenobarbital, which may be mechanistically superior to benzodiazepines in treating delirium tremens because of its effects on GABA and N-methyl-D-aspartate receptors. The dosing of phenobarbital and its subsequent taper, however, is still unclear and the side effect profile is not well characterized. In this case report, we present the case of a 37-year-old Hispanic male who presented with alcohol withdrawal and subsequent delirium tremens who was treated with phenobarbital with positive clinical response and minimal side effects.
Language	English
Publishing date	2017-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2710326-2
ISSN	2324-7096
ISSN	2324-7096
DOI	10.1177/2324709617742166
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Article: Eurytemora carolleeae in the Laurentian Great Lakes revealed by phylogenetic and morphological analysis.

Vasquez, Adrian A / Hudson, Patrick L / Fujimoto, Masanori / Keeler, Kevin / Armenio, Patricia M / Ram, Jeffrey L

Journal of Great Lakes research

2016 Volume 42, Issue 4, Page(s) 802–811

Abstract: In the Laurentian Great Lakes, specimens ... ...

Abstract	In the Laurentian Great Lakes, specimens of
Language	English
Publishing date	2016-04-30
Publishing country	Canada
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2163239-X
ISSN	0380-1330 ; 0380-1330
ISSN (online)	0380-1330
ISSN	0380-1330
DOI	10.1016/j.jglr.2016.04.001
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Article: Vascularized drusen: a cross-sectional study.

Or, Chris / Heier, Jeffrey S / Boyer, David / Brown, David / Shah, Sumit / Alibhai, Agha Yasin / Fujimoto, James G / Waheed, Nadia

International journal of retina and vitreous

2019 Volume 5, Page(s) 36

Abstract: Background: To investigate whether neovascularization may arise and be detectable in drusen, as reported in histopathologic studies, by OCTA prior to developing exudation and to assess its prevalence in a cohort of patients with intermediate AMD.: ... ...

Abstract	Background: To investigate whether neovascularization may arise and be detectable in drusen, as reported in histopathologic studies, by OCTA prior to developing exudation and to assess its prevalence in a cohort of patients with intermediate AMD. Methods: Retrospective cross-sectional study of 128 patients with intermediate AMD recruited as part of a separate ongoing clinical trial conducted at multiple large tertiary referral retina clinics. One hundred and twenty-eight consecutive patients with exudative AMD in one eye and intermediate non-exudative AMD in the fellow eye were enrolled and analyzed between September 2015 and March 2017. Results: SD-OCTA identified vascularization within drusen in 7 of 128 eyes, for a prevalence of 5.5%. A total of 12 instances of vascularized drusen were noted. Out of the 12 vascularized drusen noted, 7 were located in the parafoveal region or subfoveal region and 5 was in the extrafoveal region. 9 of 12 instances of vascularized drusen exhibited a uniform sub-RPE hyperreflectivity, whilst 3 of 12 exhibited more heterogenous reflectivity. In all 12 instances, FA images failed to identify the neovascular nature of vascularized drusen. Conclusions: Our results demonstrate the utility of SD-OCTA for the diagnosis of vascularized drusen in patients with intermediate non-exudative AMD. Longitudinal studies are needed to delineate the evolution and conversion risk of these lesions over time, which can be of substantial clinical relevance.
Language	English
Publishing date	2019-08-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2836254-8
ISSN	2056-9920
ISSN	2056-9920
DOI	10.1186/s40942-019-0187-6
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Article ; Online: Evaluation of a primary care-based post-discharge phone call program: keeping the primary care practice at the center of post-hospitalization care transition.

Tang, Ning / Fujimoto, Jeffrey / Karliner, Leah

Journal of general internal medicine

2014 Volume 29, Issue 11, Page(s) 1513–1518

Abstract: Background: The post-hospitalization period is a precarious time for patients. Post-discharge nurse telephone call programs aiming to prevent unnecessary readmissions have had mixed results.: Objective: Describe a primary-care based program to ... ...

Abstract	Background: The post-hospitalization period is a precarious time for patients. Post-discharge nurse telephone call programs aiming to prevent unnecessary readmissions have had mixed results. Objective: Describe a primary-care based program to identify and address problems arising after hospital discharge. Design: A quality improvement program embedding registered nurses in a primary care practice to call patients within 72 h of hospital discharge and route problems within the practice for real-time resolution. Participants: Adult patients with a primary care provider in the general internal medicine practice at the University of California San Francisco who were discharged home from the Medicine service. Main measures: Patients reached directly by phone had a 'full-scripted encounter;' those reached only by voice-mail had a 'message-scripted encounter;' those not reached despite multiple attempts had a 'missed encounter.' Among patients with full-scripted encounters, we identified and cataloged problems arising after hospital discharge and measured the proportion of calls in which a problem was uncovered. For the different encounter types, we compared follow-up appointment attendance and 30-day readmission rates. Key results: Of 790 eligible discharges, 486 had a full-scripted, 229 a message-scripted and 75 a missed encounter. Among the 486 full-scripted encounters, nurses uncovered at least one problem in 371 (76 %) discharges, 25 % of which (n = 94) included new symptoms, and 47 % (n = 173) included medication issues. Discharges with full-scripted and message-scripted encounters were associated with higher follow-up appointment attendance rates compared with those with missed encounters (60.1 %, 58.5 %, 38.5 % respectively p = 0.004). There was no significant difference in 30-day readmission rates (12.8 %, 14.8 %, 14.7 %; p = 0.72). Conclusions: Our results suggest that centering a post-discharge phone call program within the primary care practice improves post-hospital care by identifying clinical and care-coordination problems early. With the new Medicare transitional care payment, such programs could become an important, self-sustaining part of the patient-centered medical home.
MeSH term(s)	Aftercare/organization & administration ; California ; Continuity of Patient Care/organization & administration ; Delivery of Health Care, Integrated/organization & administration ; Hospitalization ; Humans ; Patient Discharge ; Primary Care Nursing ; Primary Health Care/organization & administration ; Program Evaluation ; Quality Improvement ; Telenursing/organization & administration ; Telephone
Language	English
Publishing date	2014-07-24
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-014-2942-6
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Article ; Online: Plasma matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs and aging and lifelong exercise adaptations in ventricular and arterial stiffness.

Carrick-Ranson, Graeme / Spinale, Francis G / Bhella, Paul S / Sarma, Satyam / Shibata, Shigeki / Fujimoto, Naoki / Hastings, Jeffrey L / Levine, Benjamin D

Experimental gerontology

2019 Volume 123, Page(s) 36–44

Abstract: The age-associated increase in cardiac and central arterial stiffness is attenuated with lifelong (>25 years) endurance exercise in a dose-dependent manner. Remodelling of the extracellular matrix of cardiovascular structures may underpin these lifelong ... ...

Abstract	The age-associated increase in cardiac and central arterial stiffness is attenuated with lifelong (>25 years) endurance exercise in a dose-dependent manner. Remodelling of the extracellular matrix of cardiovascular structures may underpin these lifelong exercise adaptations in structural stiffness. The primary aim was to examine whether matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) levels are associated with aging and lifelong exercise-related changes in cardiac and central arterial stiffness. Plasma MMPs and TIMPs, left ventricular (LV) (LV stiffness constant) and central arterial stiffness (pulse wave velocity) were examined in healthy adults stratified into five groups based on age and lifelong weekly exercise frequency: (1) young sedentary adults (28-50 years), and older adults (>60 years) who had performed either: (a) sedentary (0-1 sessions/week), (b) casual (2-3 sessions/week), (c) committed (4-5 sessions/week) or (d) athletic (≥6 sessions/week) frequency of exercise. MMP-1 was significantly lower in young compared to older sedentary (p = 0.049). Except for TIMP-2 (p = 0.018 versus committed) and the ratio of MMP-2/TIMP-4 (p = 0.047 versus committed), MMP and TIMP expression was not significantly different in lifelong exercise groups (≥casual) compared to the older sedentary group. MMP-1, -3 had a weak positive relationship with central PWV (r = 0.17-0.25, p ≤ 0.050) but there were no significant relationships between MMPs or TIMPs and LV stiffness constant (p ≥ 0.148). In conclusion, there was not a clear or consistent difference in plasma MMPs and TIMPs with lifelong exercise dose despite exhibiting lower cardiovascular stiffness at the highest exercise levels.
MeSH term(s)	Adaptation, Physiological ; Aged ; Aging/physiology ; Cardiovascular Physiological Phenomena ; Correlation of Data ; Exercise/physiology ; Extracellular Matrix/physiology ; Female ; Humans ; Male ; Matrix Metalloproteinase Inhibitors/blood ; Matrix Metalloproteinases/blood ; Middle Aged ; Vascular Stiffness/physiology
Chemical Substances	Matrix Metalloproteinase Inhibitors ; Matrix Metalloproteinases (EC 3.4.24.-)
Language	English
Publishing date	2019-05-13
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	390992-x
ISSN	1873-6815 ; 0531-5565
ISSN (online)	1873-6815
ISSN	0531-5565
DOI	10.1016/j.exger.2019.05.004
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Article ; Online: Shared Nearest Neighbors Approach and Interactive Browser for Network Analysis of a Comprehensive Non-Small-Cell Lung Cancer Data Set.

Schmidt, Stephanie T / Akhave, Neal / Knightly, Ryan E / Reuben, Alexandre / Vokes, Natalie / Zhang, Jianhua / Li, Jun / Fujimoto, Junya / Byers, Lauren A / Sanchez-Espiridion, Beatriz / Diao, Lixia / Wang, Jing / Federico, Lorenzo / Forget, Marie-Andree / McGrail, Daniel J / Weissferdt, Annikka / Lin, Shiaw-Yih / Lee, Younghee / Suzuki, Erika /

Kovacs, Jeffrey J / Behrens, Carmen / Wistuba, Ignacio I / Futreal, Andrew / Vaporciyan, Ara / Sepesi, Boris / Heymach, John V / Bernatchez, Chantale / Haymaker, Cara / Cascone, Tina / Zhang, Jianjun / Bristow, Christopher A / Heffernan, Timothy P / Negrao, Marcelo V / Gibbons, Don L

JCO clinical cancer informatics

2022 Volume 6, Page(s) e2200040

Abstract: Purpose: Advances in biological measurement technologies are enabling large-scale studies of patient cohorts across multiple omics platforms. Holistic analysis of these data can generate actionable insights for translational research and necessitate new ...

Abstract	Purpose: Advances in biological measurement technologies are enabling large-scale studies of patient cohorts across multiple omics platforms. Holistic analysis of these data can generate actionable insights for translational research and necessitate new approaches for data integration and mining. Methods: We present a novel approach for integrating data across platforms on the basis of the shared nearest neighbors algorithm and use it to create a network of multiplatform data from the immunogenomic profiling of non-small-cell lung cancer project. Results: Benchmarking demonstrates that the shared nearest neighbors-based network approach outperforms a traditional gene-gene network in capturing established interactions while providing new ones on the basis of the interplay between measurements from different platforms. When used to examine patient characteristics of interest, our approach provided signatures associated with and new leads related to recurrence and TP53 oncogenotype. Conclusion: The network developed offers an unprecedented, holistic view into immunogenomic profiling of non-small-cell lung cancer, which can be explored through the accompanying interactive browser that we built.
MeSH term(s)	Carcinoma, Non-Small-Cell Lung/genetics ; Cluster Analysis ; Gene Expression Profiling ; Humans ; Lung Neoplasms/genetics ; Software
Language	English
Publishing date	2022-08-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2473-4276
ISSN (online)	2473-4276
DOI	10.1200/CCI.22.00040
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