6 Main St
Durham CT 06422
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: 049342
Request Appointment Information
Awards & Recognitions
Medical Malpractice Cases
Medical Board Sanctions
Environmental Stress Induces Trinucleotide Repeat Mutagenesis in Human Cells by Alt-Nonhomologous End Joining Repair. - Journal of molecular biology
Multiple pathways modulate the dynamic mutability of trinucleotide repeats (TNRs), which are implicated in neurodegenerative disease and evolution. Recently, we reported that environmental stresses induce TNR mutagenesis via stress responses and rereplication, with more than 50% of mutants carrying deletions or insertions-molecular signatures of DNA double-strand break repair. We now show that knockdown of alt-nonhomologous end joining (alt-NHEJ) components-XRCC1, LIG3, and PARP1-suppresses stress-induced TNR mutagenesis, in contrast to the components of homologous recombination and NHEJ, which have no effect. Thus, alt-NHEJ, which contributes to genetic mutability in cancer cells, also plays a novel role in environmental stress-induced TNR mutagenesis.Copyright Â© 2016. Published by Elsevier Ltd.
Effectiveness of a Self-Administered Intervention for Criminal Thinking: Taking a Chance on Change. - Psychological services
The current study tested the effectiveness of a self-administered, cognitive-behavioral intervention targeting criminal thinking for inmates in segregated housing: Taking a Chance on Change (TCC). Participants included 273 inmates in segregated housing at state correctional institutions. Reductions in criminal thinking, as assessed by the Psychological Inventory of Criminal Styles-Simplified Version, were found in the general criminal thinking score as well as the proactive and reactive composite scores. Examination of demographic predictors of change (i.e., age, years of education, length of sentence) revealed older and more educated participants decreased in criminal thinking more than younger and less educated participants. For a subset of 48 inmates, completion of TCC was associated with significant reduction of disciplinary infractions. Reductions in reactive criminal thinking predicted reductions in disciplinary infractions. Although further research is needed to determine the effectiveness of TCC in reducing recidivism, the reductions in criminal thinking and disordered conduct suggest this is a promising intervention and mode of treatment delivery. By utilizing self-directed study at an accessible reading level, the intervention is uniquely suited to a correctional setting where staff and monetary resources are limited and security and operational issues limit the feasibility of traditional cognitive-behavioral group treatment. (PsycINFO Database Record(c) 2016 APA, all rights reserved).
Border control for stowaway alien species should be prioritised based on variations in establishment debt. - Journal of environmental management
Border control is one of the major approaches used by countries to limit the number of organisms introduced as stowaways. However, it is not feasible to inspect all passengers, cargo and vehicles entering a country, and so efforts need to be prioritised. Here we use South Africa as a case study to assess, based on tourism and trade data and climate matching techniques, the number of stowaway species that might be introduced ('colonisation pressure') and the likelihood that once introduced, these organisms will establish ('likelihood of establishment'). These results were used to explore how the number of species that are likely to establish ('establishment debt') varies across donor regions and seasons. A simple theoretical model was then used to compare four strategies for prioritising border control inspections: no prioritisation; based on colonisation pressure; based on likelihood of establishment; and based on both colonisation pressure and likelihood of establishment. Establishment debt was greatest in southern hemisphere spring and autumn when South Africa is climatically similar to northern hemisphere countries with which there are strong, consistent trade and tourism links (i.e. colonisation pressure varied little seasonally, but likelihood of establishment did vary across the seasons). Prioritising inspections based on both colonisation pressure and the likelihood of establishment was clearly the most effective strategy, with this strategy detecting at least 6% more potential invaders than the other strategies. While there are many practical limitations to the implementation of such prioritised inspection strategies, the results highlight the importance of national and regional studies of establishment debt.Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Advances in Anesthesia Delivery in the Deployed Setting. - U.S. Army Medical Department journal
Lessons learned over the past decade and a half of combat casualty management has brought about numerous advances in trauma anesthesia practice. In the post-Vietnam era, deployable anesthesia equipment centered on the capability to provide a balanced anesthetic technique, utilizing a combination of volatile gas and intravenous anesthetic adjuncts. The evolution of the modern battlefield has forced anesthesia providers across the military to adapt to mission requirements that often dictate a surgical capability that is more rapidly mobile and less reliant on logistical support. Institutional medical equipment development has focused on fielding a lighter, more mobile volatile gas delivery method. Despite numerous advances in anesthetic gas delivery, many veteran anesthesia providers have come to recognize the value of alternative anesthetic techniques in the deployed setting. One of the most appealing advances in combat anesthesia practice is the emergence of total intravenous anesthetics (TIVA) for trauma management and resuscitation. Although there have been numerous developments in anesthetic equipment for use in the deployed setting, TIVA has many advantages over volatile gas administration. Future research, development, and education should focus on TIVA and the ability to provide this as an alternative safe anesthetic for patients in austere environments. It is imperative to retain the lessons we have learned in order to adapt more effectively in future conflicts. This accumulation of knowledge must inform future innovative solutions to the challenges of casualty management in a deployed setting.
Twenty years of human immunodeficiency virus care at the Mayo Clinic: Past, present and future. - World journal of virology
The Mayo human immunodeficiency virus (HIV) Clinic has been providing patient centered care for persons living with HIV in Minnesota and beyond for the past 20 years. Through multidisciplinary engagement, vital clinical outcomes such as retention in care, initiation of antiretroviral therapy and virologic suppression are maximized. In this commentary, we describe the history of the Mayo HIV Clinic and its best practices, providing a "Mayo Model" of HIV care that exceeds national outcomes and may be applicable in other settings.
Mapping fires and American Red Cross aid using demographic indicators of vulnerability. - Disasters
Social vulnerability indicators can assist with informing disaster relief preparation. Certain demographic segments of a population may suffer disproportionately during disaster events, and a geographical understanding of them can help to determine where to place strategically logistical assets and to target disaster-awareness outreach endeavours. Records of house fire events and American Red Cross aid provision over a five-year period were mapped for the County of Los Angeles, California, United States, to examine the congruence between actual events and expectations of risk based on vulnerability theory. The geographical context provided by the data was compared with spatially-explicit indicators of vulnerability, such as age, race, and wealth. Fire events were found to occur more frequently in more vulnerable areas, and Red Cross aid was found to have an even stronger relationship to those places. The findings suggest that these indicators speak beyond vulnerability and relate to patterns of fire risk.Â© 2016 The Author(s). Disasters Â© Overseas Development Institute, 2016.
Mismatch repair enhances convergent transcription-induced cell death at trinucleotide repeats by activating ATR. - DNA repair
Trinucleotide repeat (TNR) expansion beyond a certain threshold results in some 20 incurable neurodegenerative disorders where disease anticipation positively correlates with repeat length. Long TNRs typically display a bias toward further expansion during germinal transmission from parents to offspring, and then are highly unstable in somatic tissues of affected individuals. Understanding mechanisms of TNR instability will provide insights into disease pathogenesis. Previously, we showed that enhanced convergent transcription at long CAG repeat tracks induces TNR instability and cell death via ATR activation. Components of TC-NER (transcription-coupled nucleotide excision repair) and RNaseH enzymes that resolve RNA/DNA hybrids oppose cell death, whereas the MSH2 component of MMR (mismatch repair) enhances cell death. The exact role of the MMR pathway during convergent transcription-induced cell death at CAG repeats is not well understood. In this study, we show that siRNA knockdowns of MMR components-MSH2, MSH3, MLHI, PMS2, and PCNA-reduce DNA toxicity. Furthermore, knockdown of MSH2, MLH1, and PMS2 significantly reduces the frequency of ATR foci formation. These observations suggest that MMR proteins activate DNA toxicity by modulating ATR foci formation during convergent transcription.Published by Elsevier B.V.
Plasticity and Aggregation of Juvenile Porcine Islets in Modified Culture: Preliminary Observations. - Cell transplantation
Diabetes is a major health problem worldwide and there is substantial interest in developing xenogeneic islet transplantation as a potential treatment. The potential to relieve the demand on an inadequate supply of human pancreata is dependent upon the efficiency of techniques for isolating and culturing islets from the source pancreata. Porcine islets are favored for xenotransplantation, but mature pigs (>2 years) present logistic and economic challenges and young pigs (3-6 months) have not yet proven to be an adequate source. In this study, islets were isolated from 20 juvenile porcine pancreata (~3 months; 25 kg Yorkshire pigs) immediately following procurement, or after 24 hours of hypothermic machine perfusion preservation. The resulting islet preparations were characterized using a battery of tests during culture in silicone rubber membrane flasks. Islet biology assessment included oxygen consumption, insulin secretion, histopathology and in vivo function. Islet yields were highest from HMP preserved pancreata (2242Â±449 IEQ/g). All preparations comprised a high proportion (>90%) of small islets (<100 Âµm), and purity was on average 63Â±6%. Morphologically, islets appeared as clusters on day-0, loosely disaggregated structures at day-1, and transitioned to aggregated structures comprising both exocrine and endocrine cells by day-6. Histopathology confirmed both insulin and glucagon staining in cultures and grafts excised after transplantation in mice. Nuclear staining (Ki67) confirmed mitotic activity consistent with the observed plasticity of these structures. Metabolic integrity was demonstrated by oxygen consumption rates = 175Â±16 nmol/min/mgDNA and physiological function was intact by glucose stimulation after 6-8 days in culture. In vivo function was confirmed with blood glucose control achieved in nearly 50% (8/17) transplants. Preparation and culture of juvenile porcine islets as a source for islet transplantation requires specialized conditions. These immature islets undergo plasticity in culture and form fully functional multi-cellular structures. Further development of this method for culturing immature porcine islets is expected to generate small pancreatic tissuederived organoids termed "pancreatites," as a therapeutic product from juvenile pigs for xenotransplantation and diabetes research.
Gabapentin for the Management of Chronic Pelvic Pain in Women (GaPP1): A Pilot Randomised Controlled Trial. - PloS one
An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain. - PloS one
Chronic pelvic pain (CPP) affects 5.7-26.6% women worldwide. 55% have no obvious pathology and 40% have associated endometriosis. Neuropathic pain (NeP) is pain arising as a consequence of a lesion/disease affecting the somatosensory system. The prevalence of NeP in women with CPP is not known. The diagnosis of NeP is challenging because there is no gold-standard assessment. Questionnaires have been used in the clinical setting to diagnose NeP in other chronic pain conditions and quantitative sensory testing (QST) has been used in a research setting to identify abnormal sensory function. We aimed to determine if women with chronic pelvic pain (CPP) have a neuropathic pain (NeP) component to their painful symptoms and how this is best assessed. We performed an exploratory prospective cohort study of 72 pre-menopausal women with a diagnosis of CPP. They underwent a clinician completed questionnaire (DN4) and completed the S-LANSS and PainDETECTâ„¢ questionnaires. Additionally QST testing was performed by a clinician. They also completed a patient acceptability questionnaire. Clinical features of NeP were identified by both questionnaires and QST. Of the women who were NeP positive, 56%, 35% and 26% were identified by the S-LANSS, DN4 and PainDETECTâ„¢ respectively. When NeP was identified by questionnaire, the associated laparoscopy findings were similar irrespective of which questionnaire was used. No subject had entirely unchanged QST parameters. There were distinct loss and gain subgroups, as well as mixed alteration in function, but this was not necessarily clinically significant in all patients. 80% of patients were confident that questionnaires could diagnose NeP, and 90% found them easy to complete. Early identification of NeP in women with CPP with a simple questionnaire could facilitate targeted therapy with neuromodulators, which are cheap, readily available, and have good safety profiles. This approach could prevent unnecessary or fertility-compromising surgery and prolonged treatment with hormones.
Map & Directions
6 Main St Durham, CT 06422