Digital Commons Network^™

Potential Scenarios And Hazards In The Work Of The Future: A Systematic Review Of The Peer-Reviewed And Gray Literatures, Sarah A Felknor, James Grosch, Robert Sala

Faculty, Staff and Student Publications

It would be useful for researchers, practitioners, and decision-makers to anticipate the hazards that workers will face in the future. The focus of this study is a systematic review of published information to identify and characterize scenarios and hazards in the future of work. Eleven bibliographic databases were systematically searched for papers and reports published from 1999 to 2019 that described future of work scenarios or identified future work-related hazards. to compile a comprehensive collection of views of the future, supplemental and ad hoc searches were also performed. After screening all search records against a set of predetermined criteria, the …

Feasibility And Potential Efficacy Of Commercial Mhealth/Ehealth Tools For Weight Loss In African American Breast Cancer Survivors: Pilot Randomized Controlled Trial, Pamela A Ohman-Strickland

Faculty, Staff and Student Publications

Weight management after breast cancer (BC) treatment in African American (AA) women is crucial to reduce comorbid conditions and health disparities. We examined feasibility and potential efficacy of commercial eHealth/mHealth tools for weight management in AA BC survivors in New Jersey. Participants (N = 35) were randomized to an intervention (SparkPeople) plus activity tracker, Fitbit Charge (n = 18), or wait-list active control group (Fitbit only, n = 17). Anthropometric, behavioral, and quality of life (QOL) outcomes were collected at baseline, 3, 6, and 12 months. Differences in outcomes were assessed using intent-to-treat analysis. Retention was 97.1%. Both groups lost …

Risk Prediction Rule For Advanced Neoplasia On Screening Colonoscopy For Average-Risk Individuals, Natalia Khalaf, Fayez S Sarkis, Mustapha M El-Halabi, Nabil M Mansour, Ahmad Malli, Robert Habib

Faculty, Staff and Students Publications

BACKGROUND: In resource-limited countries, risk stratification can be used to optimize colorectal cancer screening. Few prospective risk prediction models exist for advanced neoplasia (AN) in true average-risk individuals.

AIM: To create and internally validate a risk prediction model for detection of AN in average-risk individuals.

METHODS: Prospective study of asymptomatic individuals undergoing first screening colonoscopy. Detailed characteristics including diet, exercise and medications were collected. Multivariate logistic regression was used to elucidate risk factors for AN (adenoma ≥1 cm, villous histology, high-grade dysplasia or carcinoma). The model was validated through bootstrapping, and discrimination and calibration of the model were assessed.

RESULTS: …

Details Matter: A Quality Improvement Study On Screening For Intimate Partner Violence At A Labor And Delivery Hospital, Nancy P. Correa

Journal of Applied Research on Children: Informing Policy for Children at Risk

Background: It is estimated that one in three women will experience intimate partner violence (IPV) in their life time. It is recommended that healthcare professional screen patients for IPV, but screening rates and positive disclosure rates remain low. Best practices for screening for IPV in the healthcare setting include screening alone, showing compassion and non-judgement, asking specific and direct questions, and using a framing statement before the screening occurs.

Methods: A review of the screening protocol for IPV at a labor and delivery hospital revealed high screening rates (88%), low positive disclosure rates (0.43%), and that some best practices were …

The Implementation And Scaling Of An Early Education Program, April Crawford, Phd, Cheryl Varghese, Phd, Pauline Monsegue-Bailey, Phd

Journal of Applied Research on Children: Informing Policy for Children at Risk

The current paper discusses the implementation and scaling of an early education program (Texas School Ready; TSR). Implementation and scaling of the TSR program was initially met with challenges such as participant/site recruitment, participant retention, and staff training. The three challenges are highlighted along with the ways in which delivery and support systems were used to address and mitigate these challenges. Additionally, we highlight several key continuous quality improvement measures (for administrators, coaches/coordinators, teachers, and students) that are used to monitor and improve the implementation of the TSR program across the state. Collectively, the delivery and support systems along with …

Should Nurses Screen Pediatric Medical Inpatients For Suicide Risk? Perspectives From Nurses And Their Patients, Abigail M. Ross, Elizabeth Wharff, Lisa Horowitz

Journal of Applied Research on Children: Informing Policy for Children at Risk

Background: Suicide is the second leading cause of death among adolescents; age-adjusted suicide rate increased 30% from 2000-2016. Medical illnesses are a known risk factor for suicide, establishing medical settings as a key venue for detecting suicide risk. Nurses have the potential to play a critical role in early detection of medically ill patients at elevated risk for suicide. Conducted in tandem with a larger instrument validation study, this study examines nurses’ awareness of pediatric medical inpatients’ experiences with being asked about suicide, their opinions about whether nurses should screen for suicide risk in the medical inpatient setting, and perceived …

Adopting And Growing A Community-Based Early Language Program: Challenges And Solutions For Implementation Success, Cary M. Cain, Kimberly Kay Lopez, Lynda Chima Aririguzo, Angela Cummings

Journal of Applied Research on Children: Informing Policy for Children at Risk

The number of interventions focused on early language development in young children has increased over the past decade. There is a paucity of research on the adoption and implementation of these programs in real-world community settings. This study presents findings from qualitative interviews with leadership, staff, and past participants of a community-based early language development intervention. Themes related to program implementation challenges and solutions are presented. Previous program participants (n=16) identified facilitators and barriers to successful program implementation and provided specific recommendations for program improvements. Interviews with the program leadership and staff (n=6) revealed two main themes: Servant leadership and …

Factors Influencing The Implementation Of Social Determinants Of Health Screening And Referral Processes In Pediatric Settings Serving Medically Complex Patients, Katelyn K. Jetelina, Patricia Rodriguez, Oluwaseun K. Oke, M. Sunil Mathew, Susan Schoppa, Quiera Booker-Nubie, Sarah E. Messiah

Journal of Applied Research on Children: Informing Policy for Children at Risk

Background: Equitable healthcare outcomes are compromised in the absence of strong medical care and social services linkages. In May 2019, Children’s Health, the largest health system for pediatric care in North Texas, initiated a three-pronged social determinants of health (SDOH) quality improvement (QI) project that included: 1) baseline and ongoing clinical team training; 2) implementation of an electronic health record (EHR)-embedded SDOH screening tool; and 3) patient referrals to community resources in three inpatient hospital units and one outpatient specialty clinic serving medically complex patients. The purpose of the study is to identify hospital unit/clinic-level implementation factors associated with …

Transcutaneous Energy Transmission: Can We Do It Now?, Yuriy Pya

The VAD Journal

The percutaneous driveline used in contemporary LVADs presents a continuous risk of infection for the duration of support. Minimizing infection in durable mechanical circulatory support systems requires total implantation of all components and energy transfer by means other than percutaneous drivelines. A novel coplanar energy transfer (CET) system, similar to the original transcutaneous energy transfer (TET) design, is unique by incorporating two large rings with coil-within-the-coil topology to ensure strong resonance power. The CET system consists of an internal integrated controller, a battery coupled with an internal thoracic coil ring, and the LVAD pump. External equipment includes a power transmission …

Predoctoral Periodontal Education And Covid-19: Challenges, Actions, And Learned Lessons

Faculty, Staff and Student Publications

No abstract provided.

Angiotensin Inhibition And Gastrointestinal Bleeding Prevention In Patients With Left Ventricular Assist Devices, Phillip A. Weeks

The VAD Journal

Gastrointestinal bleeding remains a common complication in advanced heart failure patients following implantation of continuous-flow left ventricular assist devices. While the cause is likely multifactorial, development of arterial venous malformations in the gastrointestinal mucosa are a key factor. Inhibition of angiotensin II activity has been postulated to disrupt the signaling that promotes angiogenesis in these patients. We aim to review the theoretical basis for angiotensin receptor blockade, which has been proposed and explore the published evidence regarding this therapy and gastrointestinal bleeding in LVAD patients.

Determining The Utility Of Hl7® Fast Healthcare Interoperability Resources (Fhir®) Standards In Supporting Ehr And Edc-Agnostic Esource Implementations For Clinical Research, Maryam Garza

Dissertations and Theses (Open Access)

Advances in efficiency while maintaining or improving quality are immediately needed in clinical research, specifically for multicenter clinical studies. Though recent evidence points toward electronic health record (EHR) to electronic data capture (EDC) system (EHR to EDC) data collection as a viable contribution, there are many unanswered process and outcome-level questions regarding quality, site burden, and cost within the context of multicenter clinical trials. Direct extraction and use of EHR data in multicenter clinical studies is a long-term and multifaceted endeavor that includes design, development, implementation and evaluation of methods and tools for semi-automating tasks in the research data collection …

Versatile Phenotype-Activated Cell Sorting, John F Ahrens, Shujuan Lai, Xiaoyu Lu, Sihui Guan, François St-Pierre

Faculty, Staff and Students Publications

Unraveling the genetic and epigenetic determinants of phenotypes is critical for understanding and re-engineering biology and would benefit from improved methods to separate cells based on phenotypes. Here, we report SPOTlight, a versatile high-throughput technique to isolate individual yeast or human cells with unique spatiotemporal profiles from heterogeneous populations. SPOTlight relies on imaging visual phenotypes by microscopy, precise optical tagging of single target cells, and retrieval of tagged cells by fluorescence-activated cell sorting. To illustrate SPOTlight's ability to screen cells based on temporal properties, we chose to develop a photostable yellow fluorescent protein for extended imaging experiments. We screened 3 …

An Autism-Linked Missense Mutation In Shank3 Reveals The Modularity Of Shank3 Function, Carolyn J Adamski, Wei Wang, Lingjie He, Jason K Lai, Vitaliy V Bondar, Joseph G Duman, Ronald Richman, Kimberley F Tolias, Patrick Barth, Timothy Palzkill, Zhandong Liu, J Lloyd Holder, Huda Y Zoghbi

Faculty, Staff and Students Publications

Genome sequencing has revealed an increasing number of genetic variations that are associated with neuropsychiatric disorders. Frequently, studies limit their focus to likely gene-disrupting mutations because they are relatively easy to interpret. Missense variants, instead, have often been undervalued. However, some missense variants can be informative for developing a more profound understanding of disease pathogenesis and ultimately targeted therapies. Here we present an example of this by studying a missense variant in a well-known autism spectrum disorder (ASD) causing gene SHANK3. We analyzed Shank3's in vivo phosphorylation profile and identified S685 as one phosphorylation site where one ASD-linked variant has …

Aaim Recommendations For The 2020-2021 Internal Medicine Residency Application Cycle In Response To The Covid-19 Pandemic, Paul Aronowitz, Donna J Astiz, Shobhina G Chheda, Ernie L Esquivel, Maria M Garcia, Nadia Ismail, Susan Lane, Suzanne E Mclaughlin, Anne Pereira, Amy W Shaheen, Abby L Spencer, Kimberly M Tartaglia, Lisa L Willett

Faculty, Staff and Students Publications

This statement was released in June 2020 by the Alliance for Academic Internal Medicine to provide guidance for the 2020-2021 residency application cycle in light of the COVID-19 pandemic. While many of the recommendations are specific to this cycle, others, such as the Department Summary Letter of Evaluation, are meant to be an enduring change to the internal medicine residency application process. AAIM realizes that some schools may not yet have the tools or resources to implement the template fully this cycle and look toward collaboration within the internal medicine education community to facilitate adoption in the cycles to come.

Human Genes Differ By Their Uv Sensitivity Estimated Through Analysis Of Uv-Induced Silent Mutations In Melanoma, Colin Begg, Eva Hernando, Chao Cheng, Ronglai Shen, Irene Orlow, Li Luo, Marc S Ernstoff, Joel Parker, Nancy E Thomas, Olga Y Gorlova, Marianne Berwick

Faculty, Staff and Students Publications

We hypothesized that human genes differ by their sensitivity to ultraviolet (UV) exposure. We used somatic mutations detected by genome-wide screens in melanoma and reported in the Catalog Of Somatic Mutations In Cancer. As a measure of UV sensitivity, we used the number of silent mutations generated by C>T transitions in pyrimidine dimers of a given transcript divided by the number of potential sites for this type of mutations in the transcript. We found that human genes varied by UV sensitivity by two orders of magnitude. We noted that the melanoma-associated tumor suppressor gene CDKN2A was among the top …

Low-Shot Deep Learning Of Diabetic Retinopathy With Potential Applications To Address Artificial Intelligence Bias In Retinal Diagnostics And Rare Ophthalmic Diseases, Neil Joshi, Katia D Pacheco, Neil M Bressler

Faculty, Staff and Students Publications

IMPORTANCE: Recent studies have demonstrated the successful application of artificial intelligence (AI) for automated retinal disease diagnostics but have not addressed a fundamental challenge for deep learning systems: the current need for large, criterion standard-annotated retinal data sets for training. Low-shot learning algorithms, aiming to learn from a relatively low number of training data, may be beneficial for clinical situations involving rare retinal diseases or when addressing potential bias resulting from data that may not adequately represent certain groups for training, such as individuals older than 85 years.

OBJECTIVE: To evaluate whether low-shot deep learning methods are beneficial when using …

Ampk Regulation Of Raptor And Tsc2 Mediate Metformin Effects On Transcriptional Control Of Anabolism And Inflammation, Eric L Van Nostrand, Alina Dayn, Jingting Yu, Maxim N Shokhirev, Yelena Dayn, Gene W Yeo, Reuben J Shaw

Faculty, Staff and Students Publications

Despite being the frontline therapy for type 2 diabetes, the mechanisms of action of the biguanide drug metformin are still being discovered. In particular, the detailed molecular interplays between the AMPK and the mTORC1 pathway in the hepatic benefits of metformin are still ill defined. Metformin-dependent activation of AMPK classically inhibits mTORC1 via TSC/RHEB, but several lines of evidence suggest additional mechanisms at play in metformin inhibition of mTORC1. Here we investigated the role of direct AMPK-mediated serine phosphorylation of RAPTOR in a new

Targeted Fgfr Blockade For The Treatment Of Tumor-Induced Osteomalacia

Faculty, Staff and Student Publications

No abstract provided.

The Post Hurricane Harvey Respiratory Protection Training Program, Joel Adekanye, Kai Zhang, Elaine Symanski, William B Perkison

Faculty, Staff and Student Publications

OBJECTIVES: This study evaluated the effectiveness of an outreach program which included safety training and the distribution of personal protection kits in the Houston area in the aftermath of Hurricane Harvey.

METHODS: Outreach: 71 volunteers conducted training sessions at 19 different sites and distributed a total of 1187 kits. Follow-up study: We conducted telephonic interviews to collect data on respiratory symptoms and obtain perceptions of the quality of the safety training provided among 83 participants.

RESULTS: Participants reported an increase in airway symptoms four weeks after Hurricane Harvey. Outreach efforts were felt to be effective by a majority of participants. …

Evidence For Craniofacial Enhancer Variation Underlying Nonsyndromic Cleft Lip And Palate

Faculty, Staff and Student Publications

Nonsyndromic cleft lip with or without cleft palate (NSCLP) is a common birth defect for which only ~ 20% of the underlying genetic variation has been identified. Variants in noncoding regions have been increasingly suggested to contribute to the missing heritability. In this study, we investigated whether variation in craniofacial enhancers contributes to NSCLP. Candidate enhancers were identified using VISTA Enhancer Browser and previous publications. Prioritization was based on patterning defects in knockout mice, deletion/duplication of craniofacial genes in animal models and results of whole exome/whole genome sequencing studies. This resulted in 20 craniofacial enhancers to be investigated. Custom amplicon-based …

Social Determinants Of Health-Related Needs During Covid-19 Among Low-Income Households With Children, Nalini Ranjit

Faculty, Staff and Student Publications

INTRODUCTION: Little is known about the social needs of low-income households with children during the coronavirus-2019 (COVID-19) pandemic. Our objective was to conduct a cross-sectional quantitative and qualitative descriptive analysis of a rapid-response survey among low-income households with children on social needs, COVID-19-related concerns, and diet-related behaviors.

METHODS: We distributed an electronic survey in April 2020 to 16,435 families in 4 geographic areas, and 1,048 responded. The survey asked families enrolled in a coordinated school-based nutrition program about their social needs, COVID-19-related concerns, food insecurity, and diet-related behaviors during the pandemic. An open-ended question asked about their greatest concern. We …

Representation Of Ehr Data For Predictive Modeling: A Comparison Between Umls And Other Terminologies, Cui Tao, Hua Xu, Degui Zhi

Faculty, Staff and Student Publications

OBJECTIVE: Predictive disease modeling using electronic health record data is a growing field. Although clinical data in their raw form can be used directly for predictive modeling, it is a common practice to map data to standard terminologies to facilitate data aggregation and reuse. There is, however, a lack of systematic investigation of how different representations could affect the performance of predictive models, especially in the context of machine learning and deep learning.

MATERIALS AND METHODS: We projected the input diagnoses data in the Cerner HealthFacts database to Unified Medical Language System (UMLS) and 5 other terminologies, including CCS, CCSR, …

Representation Of Ehr Data For Predictive Modeling: A Comparison Between Umls And Other Terminologies, Laila Rasmy, Firat Tiryaki, Yujia Zhou, Yang Xiang, Cui Tao, Degui Zhi

Faculty, Staff and Student Publications

OBJECTIVE: Predictive disease modeling using electronic health record data is a growing field. Although clinical data in their raw form can be used directly for predictive modeling, it is a common practice to map data to standard terminologies to facilitate data aggregation and reuse. There is, however, a lack of systematic investigation of how different representations could affect the performance of predictive models, especially in the context of machine learning and deep learning.

MATERIALS AND METHODS: We projected the input diagnoses data in the Cerner HealthFacts database to Unified Medical Language System (UMLS) and 5 other terminologies, including CCS, CCSR, …

Canakinumab To Reduce Deterioration Of Cardiac And Respiratory Function In Sars-Cov-2 Associated Myocardial Injury With Heightened Inflammation (Canakinumab In Covid-19 Cardiac Injury: The Three C Study), Tom Kai Ming Wang, Prabalini Rajendram, Abhijit Duggal, A Michael Lincoff, Steven E Nissen, Venu Menon, Paul C Cremer

Faculty, Staff and Student Publications

BACKGROUND: In patients with Covid-19, myocardial injury and increased inflammation are associated with morbidity and mortality. We designed a proof-of-concept randomized controlled trial to evaluate whether treatment with canakinumab prevents progressive respiratory failure and worsening cardiac dysfunction in patients with SARS-CoV2 infection, myocardial injury, and high levels of inflammation.

HYPOTHESIS: The primary hypothesis is that canakiumab will shorten time to recovery.

METHODS: The three C study (canakinumab in Covid-19 Cardiac Injury, NCT04365153) is a double-blind, randomized controlled trial comparing canakinumab 300 mg IV, 600 mg IV, or placebo in a 1:1:1 ratio in hospitalized Covid-19 patients with elevations in troponin …

The Multiple Waves Of Covid-19 In Patients With Inflammatory Bowel Disease: A Temporal Trend Analysis, Julio Charles, Lila Pourzand, Philip J Clements, Daniel E Furst, Dinesh Khanna, Robert M Elashoff, Shervin Assassi

Faculty, Staff and Student Publications

OBJECTIVE: To investigate the prevalence of the MUC5B promoter variant rs35705950 in patients with systemic sclerosis-interstitial lung disease (SSc-ILD) and whether its presence predicts response to immunosuppression with cyclophosphamide (CYC) and mycophenolate (MMF).

METHODS: SSc-ILD patients who participated in Scleroderma Lung Study (SLS) II (MMF versus CYC) were included in this study (N = 142). TaqMan Genotyping Assays were used to determine the MUC5B rs35705950 single nucleotide polymorphism. Joint models were created to examine how the presence of this variant affected the course of the forced vital capacity (FVC) over 2 years. Linear regression models were used to investigate the …

Anesthetic Drugs And Cancer Progression

Faculty, Staff and Student Publications

No abstract provided.

Estrogen/Progesterone Receptor And Her2 Discordance Between Primary Tumor And Brain Metastases In Breast Cancer And Its Effect On Treatment And Survival, Ayal Aizer, Jason Chan, Steve Braunstein, Jessica Lee, John P Kirkpatrick, Will Breen, Paul D Brown, Diana Shi, Helen A Shih, Hany Soliman, Arjun Sahgal, Ryan Shanley, William Sperduto, Emil Lou, Ashlyn Everett, Drexell Hunter Boggs, Laura Masucci, David Roberge, Jill Remick, Kristin Plichta, John M Buatti, Supriya Jain, Laurie E Gaspar, Cheng-Chia Wu, Tony J C Wang, John Bryant, Michael Chuong, James Yu, Veronica Chiang, Toshimichi Nakano, Hidefumi Aoyama, Minesh P Mehta

Faculty, Staff and Student Publications

BACKGROUND: Breast cancer treatment is based on estrogen receptors (ERs), progesterone receptors (PRs), and human epidermal growth factor receptor 2 (HER2). At the time of metastasis, receptor status can be discordant from that at initial diagnosis. The purpose of this study was to determine the incidence of discordance and its effect on survival and subsequent treatment in patients with breast cancer brain metastases (BCBM).

METHODS: A retrospective database of 316 patients who underwent craniotomy for BCBM between 2006 and 2017 was created. Discordance was considered present if the ER, PR, or HER2 status differed between the primary tumor and the …

Implementation Of A Hospital Medicine Rotation And Curriculum For Internal Medicine Residents, Cory Ritter, Lindsey Gay

Faculty, Staff and Students Publications

INTRODUCTION: Hospital medicine is a growing field that focuses not only on expertise in inpatient medicine but also on knowledge of nonclinical health system topics. The traditional model for resident education does not lend itself to learning these topics. We developed a unique ward rotation with a dedicated curriculum called the Resident Inpatient Training Experience (RITE) to address this deficiency.

METHODS: The RITE rotation was initially implemented in the 2013-2014 academic year. The curriculum accompanying the rotation contained four case-based modules that included content on patient safety, quality improvement, cost-conscious care, hospital metrics/reimbursement, physician billing and coding, and transitions of …

When Patients Die: Patient Memorials And Group Reflection In An Internal Medicine Residency Program, Holland Kaplan, Stephanie Sherman

Faculty, Staff and Students Publications

Patient death is a formative and emotional experience for physicians. Medical trainees are particularly susceptible to the emotional impact of patient death. However, few studies have examined how trainees process patient death. This study describes annual patient memorials organized at a large multisite academic graduate medical education program. Peer-led, 1-hour patient memorial services were organized for internal medicine residents, including large and small group reflection, a moment of silence, and collective art projects. At the conclusion of each memorial, participants completed a 10-question survey regarding their experience during the memorial and their prior experiences with patient death. Ninety-nine surveys were …