Ashley Winter | Weill Cornell Medicine (original) (raw)

Papers by Ashley Winter

Research paper thumbnail of Influence of clomiphene citrate on BMI and cholesterol levels in the treatment of hypogonadism

Fertility and Sterility, 2014

Research paper thumbnail of Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study

Sexual Medicine

Introduction: Ospemifene, an oral selective estrogen receptor modulator approved for the treatmen... more Introduction: Ospemifene, an oral selective estrogen receptor modulator approved for the treatment of mild to moderate dyspareunia from menopause, has been shown to moderate sexual pain and vaginal epithelial cell characteristics. However, no prospective vulvoscopic studies have been performed. Aim: To examine, in menopausal women taking ospemifene 60 mg daily, changes to the vulva, vestibule, urethral meatus, and vaginal region over 20 weeks using vulvoscopy in a prospective open-label pilot study. Methods: Vulvoscopic photographs taken at screening and the end of therapy assessed for changes in the appearance of the vulva, vestibule, urethral meatus, and vagina rated by a single reviewer using a 10-parameter Likert rating scale, the Vulvoscopic Genital Tissue Appearance Scale (VGTA). In addition, the cotton-tipped swab test and subject diary scores were assessed over the 20-week treatment period and compared before and after the intervention using Wilcoxon signed-rank test. Main Outcome Measure: Changes in VGTA score from baseline to end of study. Results: 8 subjects (age ¼ 59 ± 4.7 years) completed all visits and were included in the analysis of vulvoscopic photographs (n ¼ 258). There were significant changes during the study period for urethral meatal prominence, introital stenosis, vestibular pallor, vestibular erythema, mucosal moisture, vaginal rugation, and anterior wall prominence (P < .05). Total pain score during cotton-tipped swab testing decreased from 11 (interquartile range ¼ 10e16) before the intervention to 1 (interquartile range ¼ 0e3) at the end of the study. Quantitative diary analysis indicated an increase in the number of sexual events, decrease in rates of pain during foreplay and intercourse, and decrease in use of lubricant at study completion (P < .05). Conclusions: Ospemifene 60 mg daily for 20 weeks showed improvement in physical examination findings in this prospective study of menopausal women with dyspareunia, as documented on vulvoscopic photography. These changes were consistent with improvements in subject-reported pain and sexual function. Goldstein SW, Winter AG, Goldstein I. Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study. Sex Med 2018;6:154e161.

Research paper thumbnail of Biopsychosocial Management of Female Sexual Dysfunction: A Pilot Study of Patient Perceptions From 2 Multi-Disciplinary Clinics

Sexual medicine, Jan 19, 2018

Sexual dysfunction is often complex and biopsychosocial. Traditional sexual health care managemen... more Sexual dysfunction is often complex and biopsychosocial. Traditional sexual health care management involves individual providers not in a multi-disciplinary setting. A multi-disciplinary team may consist of a medical provider, pelvic floor physical therapist, and sex therapist. The aim was to explore the patient perceptions of benefit from management of their sexual dysfunction by a biopsychosocial multi-disciplinary team. A survey was e-mailed to women patients seen by multi-disciplinary teams at 2 different settings: San Diego Sexual Medicine or Mayo Clinic Women's Health Clinic during a 27-month period. Data are reported using summary statistics for age and count for remaining survey responses. Cochran-Armitage tests for trend were used to compare pre- and post-comfort levels. Main outcome measures included perceived benefit of being managed in a team-based model of care, level of benefit and satisfaction from each provider, and difference from pre-conceived level of comfort ...

Research paper thumbnail of PD45-08 Comparison of Clomiphene Citrate and Transdermal Testosterone Replacement Therapy in Their Influence on Hormonal and Metabolic Changes in the Treatment of Hypogonadism

The Journal of Urology, 2015

Research paper thumbnail of STAT3 inhibition in prostate and pancreatic cancer lines by STAT3 binding sequence oligonucleotides: differential activity between 5′ and 3′ ends

Molecular cancer …, 2008

Prostate cancer is the most diagnosed adenocarcinoma in American men, with over 186,000 cases est... more Prostate cancer is the most diagnosed adenocarcinoma in American men, with over 186,000 cases estimated for 2008 (1). Due at least in part to its intrinsic chemoresistant nature, prostate cancer is the second leading cause of cancer death for American men, accounting for ...

Research paper thumbnail of Automated Camera-Phone Experience with the Frequency of Imaging Necessary to Capture Diet

Journal of the American Dietetic Association, 2010

Camera-enabled cell phones provide an opportunity to strengthen dietary recall through automated ... more Camera-enabled cell phones provide an opportunity to strengthen dietary recall through automated imaging of foods eaten during a specified period. To explore the frequency of imaging needed to capture all foods eaten, we examined the number of images of individual foods consumed in a pilot study of automated imaging using camera phones set to an image-capture frequency of one snapshot every 10 seconds. Food images were tallied from 10 young adult subjects who wore the phone continuously during the work day and consented to share their images. Based on the number of images received for each eating experience, the pilot data suggest that automated capturing of images at a frequency of once every 10 seconds is adequate for recording foods consumed during regular meals, whereas a greater frequency of imaging is necessary to capture snacks and beverages eaten quickly.

Research paper thumbnail of Eight Self-Administered 24-Hour Dietary Recalls Using the Internet Are Feasible in African Americans and Whites: The Energetics Study

Journal of the American Dietetic Association, 2010

Objective To support research and to provide food and nutrition practitioners with a strong found... more Objective To support research and to provide food and nutrition practitioners with a strong foundation for nutrient-based counseling, there is a need for affordable automated 24-hour dietary recalls. Multiple days of intake, along with repeated reports over time, are needed to achieve stable indicators of individual intakes and to support evaluation of success in meeting dietary goals because of intraindividual intake variability. Little information has been published on subject responses, participation rates, and the perceived subject burden of repeated 24-hour recalls. Our aim was to determine the willingness of subjects to conduct eight 24-hour recalls via the Internet. Design A study to validate a Web-based, automated, selfadministered 24-hour recall (DietDay, Centrax Corporation, Chicago, IL). Subjects/setting Two-hundred and sixty-one white and African-American subjects within 50 miles of the University of California-Los Angeles participated in the study. Subjects completed 3 DietDays at the study visits and another 5 days on their own. The last 2 DietDays were completed 1 and 2 months after the final clinic visit. Subjects were notified by automatic e-mail of the need for DietDay completion, and nonresponders were followed up with personalized e-mails and phone calls. Results The perceived subject burden was minimal and, even after completing six recalls, 92% were willing to continue reporting their daily diets 1 and 2 months later.

Research paper thumbnail of Using the web for recruitment, screen, tracking, data management, and quality control in a dietary assessment clinical validation trial

Contemporary Clinical Trials, 2010

Screening and tracking subjects and data management in clinical trials require significant invest... more Screening and tracking subjects and data management in clinical trials require significant investments in manpower that can be reduced through the use of web-based systems. To support a validation trial of various dietary assessment tools that required multiple clinic visits and eight repeats of online assessments, we developed an interactive web-based system to automate all levels of management of a biomarker-based clinical trial. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Energetics System&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; was developed to support 1) the work of the study coordinator in recruiting, screening and tracking subject flow, 2) the need of the principal investigator to review study progress, and 3) continuous data analysis. The system was designed to automate web-based self-screening into the trial. It supported scheduling tasks and triggered tailored messaging for late and non-responders. For the investigators, it provided real-time status overviews on all subjects, created electronic case reports, supported data queries and prepared analytic data files. Encryption and multi-level password protection were used to insure data privacy. The system was programmed iteratively and required six months of a web programmer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s time along with active team engagement. In this study the enhancement in speed and efficiency of recruitment and quality of data collection as a result of this system outweighed the initial investment. Web-based systems have the potential to streamline the process of recruitment and day-to-day management of clinical trials in addition to improving efficiency and quality. Because of their added value they should be considered for trials of moderate size or complexity.

Research paper thumbnail of PD45-08 COMPARISON OF CLOMIPHENE CITRATE AND TRANSDERMAL TESTOSTERONE REPLACEMENT THERAPY IN THEIR INFLUENCE ON HORMONAL AND METABOLIC CHANGES IN THE TREATMENT OF HYPOGONADISM

The Journal of Urology, 2015

Research paper thumbnail of Influence of clomiphene citrate on BMI and cholesterol levels in the treatment of hypogonadism

Fertility and Sterility, 2014

Research paper thumbnail of Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study

Sexual Medicine

Introduction: Ospemifene, an oral selective estrogen receptor modulator approved for the treatmen... more Introduction: Ospemifene, an oral selective estrogen receptor modulator approved for the treatment of mild to moderate dyspareunia from menopause, has been shown to moderate sexual pain and vaginal epithelial cell characteristics. However, no prospective vulvoscopic studies have been performed. Aim: To examine, in menopausal women taking ospemifene 60 mg daily, changes to the vulva, vestibule, urethral meatus, and vaginal region over 20 weeks using vulvoscopy in a prospective open-label pilot study. Methods: Vulvoscopic photographs taken at screening and the end of therapy assessed for changes in the appearance of the vulva, vestibule, urethral meatus, and vagina rated by a single reviewer using a 10-parameter Likert rating scale, the Vulvoscopic Genital Tissue Appearance Scale (VGTA). In addition, the cotton-tipped swab test and subject diary scores were assessed over the 20-week treatment period and compared before and after the intervention using Wilcoxon signed-rank test. Main Outcome Measure: Changes in VGTA score from baseline to end of study. Results: 8 subjects (age ¼ 59 ± 4.7 years) completed all visits and were included in the analysis of vulvoscopic photographs (n ¼ 258). There were significant changes during the study period for urethral meatal prominence, introital stenosis, vestibular pallor, vestibular erythema, mucosal moisture, vaginal rugation, and anterior wall prominence (P < .05). Total pain score during cotton-tipped swab testing decreased from 11 (interquartile range ¼ 10e16) before the intervention to 1 (interquartile range ¼ 0e3) at the end of the study. Quantitative diary analysis indicated an increase in the number of sexual events, decrease in rates of pain during foreplay and intercourse, and decrease in use of lubricant at study completion (P < .05). Conclusions: Ospemifene 60 mg daily for 20 weeks showed improvement in physical examination findings in this prospective study of menopausal women with dyspareunia, as documented on vulvoscopic photography. These changes were consistent with improvements in subject-reported pain and sexual function. Goldstein SW, Winter AG, Goldstein I. Improvements to the Vulva, Vestibule, Urethral Meatus, and Vagina in Women Treated With Ospemifene for Moderate to Severe Dyspareunia: A Prospective Vulvoscopic Pilot Study. Sex Med 2018;6:154e161.

Research paper thumbnail of Biopsychosocial Management of Female Sexual Dysfunction: A Pilot Study of Patient Perceptions From 2 Multi-Disciplinary Clinics

Sexual medicine, Jan 19, 2018

Sexual dysfunction is often complex and biopsychosocial. Traditional sexual health care managemen... more Sexual dysfunction is often complex and biopsychosocial. Traditional sexual health care management involves individual providers not in a multi-disciplinary setting. A multi-disciplinary team may consist of a medical provider, pelvic floor physical therapist, and sex therapist. The aim was to explore the patient perceptions of benefit from management of their sexual dysfunction by a biopsychosocial multi-disciplinary team. A survey was e-mailed to women patients seen by multi-disciplinary teams at 2 different settings: San Diego Sexual Medicine or Mayo Clinic Women's Health Clinic during a 27-month period. Data are reported using summary statistics for age and count for remaining survey responses. Cochran-Armitage tests for trend were used to compare pre- and post-comfort levels. Main outcome measures included perceived benefit of being managed in a team-based model of care, level of benefit and satisfaction from each provider, and difference from pre-conceived level of comfort ...

Research paper thumbnail of PD45-08 Comparison of Clomiphene Citrate and Transdermal Testosterone Replacement Therapy in Their Influence on Hormonal and Metabolic Changes in the Treatment of Hypogonadism

The Journal of Urology, 2015

Research paper thumbnail of STAT3 inhibition in prostate and pancreatic cancer lines by STAT3 binding sequence oligonucleotides: differential activity between 5′ and 3′ ends

Molecular cancer …, 2008

Prostate cancer is the most diagnosed adenocarcinoma in American men, with over 186,000 cases est... more Prostate cancer is the most diagnosed adenocarcinoma in American men, with over 186,000 cases estimated for 2008 (1). Due at least in part to its intrinsic chemoresistant nature, prostate cancer is the second leading cause of cancer death for American men, accounting for ...

Research paper thumbnail of Automated Camera-Phone Experience with the Frequency of Imaging Necessary to Capture Diet

Journal of the American Dietetic Association, 2010

Camera-enabled cell phones provide an opportunity to strengthen dietary recall through automated ... more Camera-enabled cell phones provide an opportunity to strengthen dietary recall through automated imaging of foods eaten during a specified period. To explore the frequency of imaging needed to capture all foods eaten, we examined the number of images of individual foods consumed in a pilot study of automated imaging using camera phones set to an image-capture frequency of one snapshot every 10 seconds. Food images were tallied from 10 young adult subjects who wore the phone continuously during the work day and consented to share their images. Based on the number of images received for each eating experience, the pilot data suggest that automated capturing of images at a frequency of once every 10 seconds is adequate for recording foods consumed during regular meals, whereas a greater frequency of imaging is necessary to capture snacks and beverages eaten quickly.

Research paper thumbnail of Eight Self-Administered 24-Hour Dietary Recalls Using the Internet Are Feasible in African Americans and Whites: The Energetics Study

Journal of the American Dietetic Association, 2010

Objective To support research and to provide food and nutrition practitioners with a strong found... more Objective To support research and to provide food and nutrition practitioners with a strong foundation for nutrient-based counseling, there is a need for affordable automated 24-hour dietary recalls. Multiple days of intake, along with repeated reports over time, are needed to achieve stable indicators of individual intakes and to support evaluation of success in meeting dietary goals because of intraindividual intake variability. Little information has been published on subject responses, participation rates, and the perceived subject burden of repeated 24-hour recalls. Our aim was to determine the willingness of subjects to conduct eight 24-hour recalls via the Internet. Design A study to validate a Web-based, automated, selfadministered 24-hour recall (DietDay, Centrax Corporation, Chicago, IL). Subjects/setting Two-hundred and sixty-one white and African-American subjects within 50 miles of the University of California-Los Angeles participated in the study. Subjects completed 3 DietDays at the study visits and another 5 days on their own. The last 2 DietDays were completed 1 and 2 months after the final clinic visit. Subjects were notified by automatic e-mail of the need for DietDay completion, and nonresponders were followed up with personalized e-mails and phone calls. Results The perceived subject burden was minimal and, even after completing six recalls, 92% were willing to continue reporting their daily diets 1 and 2 months later.

Research paper thumbnail of Using the web for recruitment, screen, tracking, data management, and quality control in a dietary assessment clinical validation trial

Contemporary Clinical Trials, 2010

Screening and tracking subjects and data management in clinical trials require significant invest... more Screening and tracking subjects and data management in clinical trials require significant investments in manpower that can be reduced through the use of web-based systems. To support a validation trial of various dietary assessment tools that required multiple clinic visits and eight repeats of online assessments, we developed an interactive web-based system to automate all levels of management of a biomarker-based clinical trial. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Energetics System&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; was developed to support 1) the work of the study coordinator in recruiting, screening and tracking subject flow, 2) the need of the principal investigator to review study progress, and 3) continuous data analysis. The system was designed to automate web-based self-screening into the trial. It supported scheduling tasks and triggered tailored messaging for late and non-responders. For the investigators, it provided real-time status overviews on all subjects, created electronic case reports, supported data queries and prepared analytic data files. Encryption and multi-level password protection were used to insure data privacy. The system was programmed iteratively and required six months of a web programmer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s time along with active team engagement. In this study the enhancement in speed and efficiency of recruitment and quality of data collection as a result of this system outweighed the initial investment. Web-based systems have the potential to streamline the process of recruitment and day-to-day management of clinical trials in addition to improving efficiency and quality. Because of their added value they should be considered for trials of moderate size or complexity.

Research paper thumbnail of PD45-08 COMPARISON OF CLOMIPHENE CITRATE AND TRANSDERMAL TESTOSTERONE REPLACEMENT THERAPY IN THEIR INFLUENCE ON HORMONAL AND METABOLIC CHANGES IN THE TREATMENT OF HYPOGONADISM

The Journal of Urology, 2015