Digital Commons Network^™

Live Usability Testing Of Two Complex Clinical Decision Support Tools: Observational Study, S. Richardson, D. Feldstein, T. Mcginn, L. S. Park, S. Khan, R. Hess, P. D. Smith, R. G. Mishuris, L. Mccullagh, D. Mann

Journal Articles

© 2019 Journal of Medical Internet Research. All rights reserved. Background: Potential of the electronic health records (EHR) and clinical decision support (CDS) systems to improve the practice of medicine has been tempered by poor design and the resulting burden they place on providers. CDS is rarely tested in the real clinical environment. As a result, many tools are hard to use, placing strain on providers and resulting in low adoption rates. The existing CDS usability literature relies primarily on expert opinion and provider feedback via survey. This is the first study to evaluate CDS usability and the provider-computer-patient interaction …

Current Aats Guidelines On Surgical Treatment Of Infective Endocarditis, G. B. Pettersson, S. T. Hussain

Journal Articles

© Annals of Cardiothoracic Surgery. The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, …

Assessing Cognitive Impairment In Sle: Examining Relationships Between Resting Glucose Metabolism And Anti-Nmdar Antibodies With Navigational Performance., E. Ploran, C. Tang, M. Mackay, E. Anderson, C. Aranow, C. Sartori, P. Watson, B. Volpe, B. Diamond, D. Eidelberg, +4 Additional Authors

Journal Articles

Objective: Resting Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) brain imaging and neuropsychological testing were used to investigate the usefulness of a spatial navigation task (SNT) as a performance benchmark for cognitive impairment related to anti-N-methyl D-aspartate (anti-NMDA) receptor antibodies (DNRAb) in SLE.

Methods: Neuropsychological assessments, including a desktop 3-D virtual SNT, were performed on 19 SLE participants and 9 healthy control (HC) subjects. SLE participants had stable disease activity and medication doses and no history of neuropsychiatric illness or current use of mind-altering medications. Resting FDG-PET scans were obtained on all SLE participants and compared with a historical set from …

Neurogenesis In Neurodegenerative Diseases: Role Of Mfg-E8, C. Cheyuo, M. Aziz, P. Wang

Journal Articles

No abstract provided.

Comparison Of The Panther Fusion And Bd Max Gbs Assays For Detection Of Group B Streptococcus In Prenatal Screening Specimens., G. J. Berry, F. Zhang, R. Manji, S. Juretschko

Journal Articles

Streptococcus agalactiae, or Group B Streptococcus (GBS) is the cause of early and late-onset GBS disease in neonates and can present as septicemia, meningitis, and pneumonia. Our objective was to compare the performance of two FDA-approved nucleic acid amplification tests (NAATs), the Panther Fusion and BD MAX™ systems, for detection of group B Streptococcus (GBS) in vaginal-rectal screening specimens. A total of 510 vaginal-rectal prepartum specimens were tested simultaneously in both NAATs following broth enrichment. Assay agreement was calculated using the kappa statistics. Overall agreement between assays was 99.0% (505/510; 95% CI: 0.951 to 0.997; kappa = 0.974). Discordant results …

Performance Evaluation Of The Luminex Aries® C. Difficile Assay In Comparison To Two Other Molecular Assays Within A Multi-Hospital Health Care Center., S. Juretschko, R. Manji, R. Khare, S. Das, S. Dunbar

Journal Articles

Clostridioides difficile infections (CDI) remain a serious issue in the U.S. Both fast and accurate diagnosis of CDI is paramount to achieve immediate infection control initiation, triaging and isolation, as well as appropriate antibiotic treatment. However, both, over- and under-diagnosis can lead to adverse patient outcomes, such as unnecessary administration of antibiotics or unwanted spread of spores in any hospital setting, respectively. In this prospective study, we evaluated the FDA-cleared ARIES® C. difficile Assay and compared its performance and workflow characteristics to the BD MAX Cdiff and Xpert C.difficile/Epi assays. Out of 302 samples tested, 55 (18.2%) samples were positive, …

Quantitative Human Immunodeficiency Virus (Hiv)-1 Antibodies Correlate With Plasma Hiv-1 Rna And Cell-Associated Dna Levels In Children On Antiretroviral Therapy, M. Mcmanus, J. Henderson, A. Gautam, R. Brody, E. R. Weiss, D. Persaud, E. Mick, K. Luzuriaga, V. Bonagura, I. Febo, +22 Additional Authors

Journal Articles

No abstract provided.

Homozygous Nlrp1 Gain-Of-Function Mutation In Siblings With A Syndromic Form Of Recurrent Respiratory Papillomatosis, S. B. Drutman, F. Haerynck, F. L. Zhong, D. Hum, N. J. Hernandez, S. Belkaya, F. Rapaport, S. J. De Jong, V. R. Bonagura, J. Laurent-Casanova, +13 Additional Authors

Journal Articles

© 2019 National Academy of Sciences. All rights reserved. Juvenile-onset recurrent respiratory papillomatosis (JRRP) is a rare and debilitating childhood disease that presents with recurrent growth of papillomas in the upper airway. Two common human papillomaviruses (HPVs), HPV-6 and -11, are implicated in most cases, but it is still not understood why only a small proportion of children develop JRRP following exposure to these common viruses. We report 2 siblings with a syndromic form of JRRP associated with mild dermatologic abnormalities. Whole-exome sequencing of the patients revealed a private homozygous mutation in NLRP1, encoding Nucleotide-Binding Domain Leucine-Rich Repeat Family Pyrin …

Physician Agreement On The Diagnosis Of Sepsis In The Intensive Care Unit: Estimation Of Concordance And Analysis Of Underlying Factors In A Multicenter Cohort, B. K. Lopansri, R. R. Miller, J. P. Burke, M. Levy, S. Opal, M. Narasimhan, A. Tsegaye, S. Hahn, P. Mayo, R. B. Brandon, +19 Additional Authors

Journal Articles

© 2019 The Author(s). Background: Differentiating sepsis from the systemic inflammatory response syndrome (SIRS) in critical care patients is challenging, especially before serious organ damage is evident, and with variable clinical presentations of patients and variable training and experience of attending physicians. Our objective was to describe and quantify physician agreement in diagnosing SIRS or sepsis in critical care patients as a function of available clinical information, infection site, and hospital setting. Methods: We conducted a post hoc analysis of previously collected data from a prospective, observational trial (N = 249 subjects) in intensive care units at seven US hospitals, …

Related Peripheral Blood Stem Cell Donors Experience More Severe Symptoms And Less Complete Recovery At One Year Compared To Unrelated Donors, M. A. Pulsipher, B. R. Logan, D. M. Kiefer, P. Chitphakdithai, M. L. Riches, D. Rizzo, P. Anderlini, R. Bayer, I. Sahdev, B. E. Shaw, +51 Additional Authors

Journal Articles

No abstract provided.

Backward Bifurcation, Oscillations And Chaos In An Eco-Epidemiological Model With Fear Effect, Amar Sha, Sudip Samanta, Maia Martcheva, Joydev Chattopadhyay

Journal Articles

This paper considers an eco-epidemiological model with disease in the prey population. The disease in the prey divides the total prey population into two subclasses, susceptible prey and infected prey. The model also incorporates fear of predator that reduces the growth rate of the prey population. Furthermore, fear of predator lowers the activity of the prey population, which reduces the disease transmission. The model is well-posed with bounded solutions. It has an extinction equilibrium, susceptible prey equilibrium, susceptible prey-predator equilibrium, and coexistence equilibria. Conditions for local stability of equilibria are established. The model exhibits fear- induced backward bifurcation and bistability. …

Adult Onset Immunoglobulin A Vasculitis (Henoch-Schonlein Purpura) With Alveolar Hemorrhage, N. Niknam, L. Ha, P. Gautam-Goyal

Journal Articles

© 2018 The Authors S. pyogenes is the cause of many important human diseases, ranging from mild superficial skin infections to life-threatening systemic diseases. The post streptococcal syndromes are immune mediated phenomena including Immunoglobulin A Vasculitis (Henoch-Schönlein purpura). HSP is more common in children and usually self limited but it can cause skin, joint, renal, gastrointestinal and rarely respiratory involvement. We present a case with Streptococcus pyogenes pneumonia that presented with respiratory failure, pulmonary hemorrhage, extensive rash and renal failure.

Exome Chip Analyses Identify Genes Affecting Mortality After Hla-Matched Unrelated-Donor Blood And Marrow Transplantation, Q. Zhu, L. Yan, Q. Liu, C. Zhang, L. Wei, Q. Hu, L. Preus, A. I. Clay-Gilmour, K. Onel, L. E. Sucheston-Campbell, +10 Additional Authors

Journal Articles

© 2018 by The American Society of Hematology Although survival outcomes have significantly improved, up to 40% of patients die within 1 year of HLA-matched unrelated-donor blood and marrow transplantation (BMT). To identify non-HLA genetic contributors to mortality after BMT, we performed the first exome-wide association study in the DISCOVeRY-BMT cohorts using the Illumina HumanExome BeadChip. This study includes 2473 patients with acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndrome and 2221 10/10 HLA-matched donors treated from 2000 to 2011. Single-variant and gene-level analyses were performed on overall survival (OS), transplantation-related mortality (TRM), and disease-related mortality (DRM). Genotype mismatches …

Microbiota-Sensitive Epigenetic Signature Predicts Inflammation In Crohn's Disease., D. Kelly, M. Kotliar, V. Woo, S. Jagannathan, J. Whitt, J. Moncivaiz, B. J. Aronow, M. C. Dubinsky, J. F. Markowitz, T. Alenghat, +12 Additional Authors

Journal Articles

Altered response to the intestinal microbiota strongly associates with inflammatory bowel disease (IBD); however, how commensal microbial cues are integrated by the host during the pathogenesis of IBD is not understood. Epigenetics represents a potential mechanism that could enable intestinal microbes to modulate transcriptional output during the development of IBD. Here, we reveal a histone methylation signature of intestinal epithelial cells isolated from the terminal ilea of newly diagnosed pediatric IBD patients. Genes characterized by significant alterations in histone H3-lysine 4 trimethylation (H3K4me3) showed differential enrichment in pathways involving immunoregulation, cell survival and signaling, and metabolism. Interestingly, a large subset …

Implementation Of An Emergency Medicine Research Associates Program: Sharing 20 Years Of Experience, B. Abar, V. Derienzo, J. Glick, N. Wood, M. N. Shah, S. Schneider, D. Adler

Journal Articles

© 2018 Abar et al. Introduction: The use of research associates (RA) programs to facilitate study enrollment in the emergency department was initiated during the mid-1990s. The University of Rochester Medical Center (URMC) was an early adopting site for this model, which has experienced considerable growth and development over the past 20 years. Methods: Our goal was to detail the Emergency Department Research Associates (EDRA) program processes developed at the URMC that has led to our program’s sustainability and productivity. These processes, and the lessons learned during their development, can assist institutions seeking to establish an RA program or refine …

Automated Real-Time Collection Of Pathogen-Specific Diagnostic Data: Syndromic Infectious Disease Epidemiology, L. Meyers, C. C. Ginocchio, A. N. Faucett, F. S. Nolte, P. H. Gesteland, A. Leber, D. Janowiak, V. Donovan, S. Juretschko, M. A. Poritz, +23 Additional Authors

Journal Articles

© Lindsay Meyers, Christine C Ginocchio, Aimie N Faucett, Frederick S Nolte, Per H Gesteland, Amy Leber, Diane Janowiak,. Background: Health care and public health professionals rely on accurate, real-time monitoring of infectious diseases for outbreak preparedness and response. Early detection of outbreaks is improved by systems that are comprehensive and specific with respect to the pathogen but are rapid in reporting the data. It has proven difficult to implement these requirements on a large scale while maintaining patient privacy. Objective: The aim of this study was to demonstrate the automated export, aggregation, and analysis of infectious disease diagnostic test …

Strongyloides Stercoralis−Associated Tip Variant Focal Segmental Glomerulosclerosis, M. Merzkani, N. N. Uppal, D. W. Ross, P. Gautam-Goyal, P. Malhotra, H. H. Shah, K. D. Jhaveri, V. D. D'Agati

Journal Articles

No abstract provided.

Severe Maternal Morbidity Associated With Systemic Lupus Erythematosus Flare In The Second Trimester Of Pregnancy., M. J. Blitz, A. Fleischer

Journal Articles

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Here, we present a case of severe maternal morbidity in a 23-year-old primigravida with SLE and secondary Sjögren's syndrome who experienced a life-threatening multisystem flare at 17 weeks of gestational age. She presented to the emergency department complaining of cough with hemoptysis and shortness of breath. She developed hypoxic respiratory failure and was admitted to the intensive care unit. Bronchoscopy confirmed diffuse alveolar hemorrhage. Physical exam and laboratory evaluation were consistent with an active SLE flare, pancytopenia, and new-onset lupus …

Bacterial Spinal Epidural And Psoas Abscess In Pregnancy Associated With Intravenous Drug Use., T. N. Spiegel Strauss, S. L. Pachtman, B. Rochelson

Journal Articles

Spontaneous spinal epidural abscess (SEA) is a rare infection of the central nervous system. We report a case of a 25-year-old G3 P0020 at 36 weeks of gestational age with history of intravenous drug abuse presenting with acute-onset and severe back pain. Despite antibiotic therapy, pain worsened and she developed lower extremity weakness. Magnetic resonance imaging (MRI) revealed an SEA, and cesarean delivery was performed secondary to increasing weakness, followed by laminectomy (T9-12) and decompression of epidural abscess. Postoperative course was complicated by a psoas muscle abscess and persistent SEA refractory to antibiotic therapy, requiring surgical reexploration and extended treatment …

Streptococcus Intermedius Brain And Diverticular Abscesses After Dental Manipulation: A Case Report., H. Al Moussawi, M. Krzyzak, Z. Awada, J. M. Chalhoub

Journal Articles

A brain abscess is defined as a focal intracerebral infection consisting of an encapsulated collection of pus, which can be a life-threatening complication of infections, trauma, or surgery. While immunocompromised patients can have a wide array of causative organisms, bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000, with a high predisposition among immunocompromised patients and in those with disruption of the blood-brain barrier. The most common causative organisms found were Streptococcus species, particularly S. viridians and S. pneumonia, Enterococcus, and Staphylococcus species, mainly S. aurieus and …

Alk-Negative Anaplastic Large Cell Lymphoma Presenting As Disseminated Intravascular Coagulation And Hemophagocytic Lymphohistiocytosis: A Potentially Fatal Presentation., U. Ibrahim, A. Saqib, M. Rehan, J. P. Atallah

Journal Articles

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder that can be familial in etiology or a result of infections, malignancy, and autoimmune or inflammatory disorders. Disseminated intravascular coagulation (DIC) is common in patients admitted to intensive care units and can confound and delay the diagnosis of HLH. We present a case of a 69-year-old female who presented with dyspnea and malaise. Her condition declined rapidly with laboratory parameters consistent with DIC. In addition, she had a ferritin of 32,522 ng/mL, low haptoglobin, and elevated LDH, and bone marrow biopsy showed hemophagocytic lymphohistiocytes. She was started on HLH-directed therapy, and later, a …

High Mobility Group Box 1 Orchestrates Tissue Regeneration Via Cxcr4, M. Tirone, N. L. Tran, C. Ceriotti, A. Gorzanelli, M. Canepari, R. Bottinelli, A. Raucci, M. He, Y. Al-Abed, E. Vénéreau, +17 Additional Authors

Journal Articles

© 2018 Tirone et al. Inflammation and tissue regeneration follow tissue damage, but little is known about how these processes are coordinated. High Mobility Group Box 1 (HMGB1) is a nuclear protein that, when released on injury, triggers inflammation. We previously showed that HMGB1 with reduced cysteines is a chemoattractant, whereas a disulfide bond makes it a proinflammatory cytokine. Here we report that fully reduced HMGB1 orchestrates muscle and liver regeneration via CXCR4, whereas disulfide HMGB1 and its receptors TLR4/MD-2 and RAGE (receptor for advanced glycation end products) are not involved. Injection of HMGB1 accelerates tissue repair by acting on …

Persons With Chronic Spinal Cord Injury Have Decreased Natural Killer Cell And Increased Toll-Like Receptor/Inflammatory Gene Expression, P. Herman, A. Stein, K. Gibbs, I. Korsunsky, P. Gregersen, O. Bloom

Journal Articles

No abstract provided.

Cold-Inducible Rna-Binding Protein Activates Splenic T Cells During Sepsis In A Tlr4-Dependent Manner, A. C. Bolognese, A. Sharma, W. Yang, J. Nicastro, G. F. Coppa, P. Wang

Journal Articles

No abstract provided.

Neonatal Intestinal Dysbiosis In Necrotizing Enterocolitis, N. Denning, J. M. Prince

Journal Articles

No abstract provided.

Noninfectious Manifestations And Complications Of Chronic Granulomatous Disease, S. E. Henrickson, A. M. Jongco, K. F. Thomsen, E. K. Garabedian, I. P. Thomsen

Journal Articles

© The Author(s) 2018. Chronic granulomatous disease (CGD), a primary immunodeficiency characterized by a deficient neutrophil oxidative burst and the inadequate killing of microbes, is well known to cause a significantly increased risk of invasive infection. However, infectious complications are not the sole manifestations of CGD; substantial additional morbidity is driven by noninfectious complications also. These complications can include, for example, a wide range of inflammatory diseases that affect the gastrointestinal tract, lung, skin, and genitourinary tract and overt autoimmune disease. These diseases can occur at any age and are especially problematic in adolescents and adults with CGD. Many of …

Considerations In The Diagnosis Of Chronic Granulomatous Disease, J. E. Yu, A. E. Azar, H. J. Chong, A. M. Jongco, B. T. Prince

Journal Articles

© The Author(s) 2018. Chronic granulomatous disease (CGD) is a rare primary immunodeficiency that is caused by defects in the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. The disease presents in most patients initially with infection, especially of the lymph nodes, lung, liver, bone, and skin. Patients with CGD are susceptible to a narrow spectrum of pathogens, and Staphylococcus aureus, Burkholderia cepacia complex, Serratia marcescens, Nocardia species, and Aspergillus species are the most common organisms implicated in North America. Granuloma formation, most frequently in the gastrointestinal and genitourinary systems, is a common complication of CGD and can be seen even …

Neuro-Immune Interactions In Inflammation And Host Defense: Implications For Transplantation, S. S. Chavan, P. Ma, I. M. Chiu

Journal Articles

© 2017 The American Society of Transplantation and the American Society of Transplant Surgeons Sensory and autonomic neurons of the peripheral nervous system (PNS) play a critical role in regulating the immune system during tissue inflammation and host defense. Recent studies have identified the molecular mechanisms underlying the bidirectional communication between the nervous system and the immune system. Here, we highlight the studies that demonstrate the importance of the neuro-immune interactions in health and disease. Nociceptor sensory neurons detect immune mediators to produce pain, and release neuropeptides that act on the immune system to regulate inflammation. In parallel, neural reflex …

Fine-Mapping And Functional Studies Highlight Potential Causal Variants For Rheumatoid Arthritis And Type 1 Diabetes, H. J. Westra, M. Martínez-Bonet, S. Onengut-Gumuscu, A. Lee, Y. Luo, N. Teslovich, J. Worthington, J. Martin, P. K. Gregersen, S. Raychaudhuri, +9 Additional Authors

Journal Articles

© 2018, The Author(s), under exclusive licence to Springer Nature America, Inc. To define potentially causal variants for autoimmune disease, we fine-mapped1,276 rheumatoid arthritis (11,475 cases, 15,870 controls)3and type 1 diabetes loci (9,334 cases, 11,111 controls)4. After sequencing 799 1-kilobase regulatory (H3K4me3) regions within these loci in 568 individuals, we observed accurate imputation for 89% of common variants. We defined credible sets of ≤5 causal variants at 5 rheumatoid arthritis and 10 type 1 diabetes loci. We identified potentially causal missense variants at DNASE1L3, PTPN22, SH2B3, and TYK2, and noncoding variants at MEG3, CD28–CTLA4, and IL2RA. We also identified potential …

What Is The Risk-Benefit Ratio Of Long-Term Antipsychotic Treatment In People With Schizophrenia?, C. U. Correll, J. M. Rubio, J. M. Kane

Journal Articles

No abstract provided.