Digital Commons Network^™

Genetic Susceptibility To Chronic Obstructive Pulmonary Disease And Idiopathic Pulmonary Fibrosis: The Missing Link?

Faculty, Staff and Students Publications

No abstract provided.

Harmonizing Ptsd Severity Scales Across Instruments And Sites, Terri Deroon-Cassini, Stefan Du Plessis, Negar Fani, Milissa L Kaufman, Nastassja Koen, Christine L Larson, Sarah Laskowitz, Lauren A M Lebois, Rajendra A Morey, Mary R Newsome, Cori Palermo, Nicholas J Pastorek, Abigail Powers, Randall Scheibel, Soraya Seedat, Antonia Seligowski, Dan J Stein, Jennifer Stevens, Delin Sun, Paul Thompson, Maya Troyanskaya, Sanne J H Van Rooij, Amanda A Watts, Carissa W Tomas, Wright Williams, Frank G Hillary, Mary Jo Pugh, Elisabeth A Wilde, David F Tate

Faculty, Staff and Students Publications

Objective: The variety of instruments used to assess posttraumatic stress disorder (PTSD) allows for flexibility, but also creates challenges for data synthesis. The objective of this work was to use a multisite mega analysis to derive quantitative recommendations for equating scores across measures of PTSD severity.

Method: Empirical Bayes harmonization and linear models were used to describe and mitigate site and covariate effects. Quadratic models for converting scores across PTSD assessments were constructed using bootstrapping and tested on hold out data.

Results: We aggregated 17 data sources and compiled an n = 5,634 sample of individuals who were assessed for …

Gender Bias In Antidepressant Direct-To-Consumer Pharmaceutical Advertising

Faculty, Staff and Students Publications

Background: Direct to consumer pharmaceutical advertising (DTCPA) may have significant impacts on public perception of diseases and treatments. Our objective was to examine whether DTCPA for antidepressants disproportionately portray and hence target women in the United States.

Methods: DTCPA for branded medications for depression, psoriasis and diabetes were analyzed to determine the gender of the main "patient" portrayed, as well as the content of the disease depiction.

Results: DTCPA for antidepressants included only women in 82% of ads, only men in 10.1% of ads, and both genders in 7.8% of ads. There were significantly higher representations of women versus men …

Advances In The Management Of Menopausal Symptoms, Fertility Preservation, And Bone Health For Women With Breast Cancer On Endocrine Therapy, Audrey Messelt, Kristin E Rojas

Faculty, Staff and Students Publications

In patients with hormone receptor-positive early-stage breast cancer, adjuvant endocrine treatment administered for up to 5-10 years after diagnosis significantly reduces the risk of recurrence and death. However, this benefit comes with the cost of short- and long-term side effects that may negatively affect patients' quality of life (QoL) and treatment adherence. Among them, the prolonged estrogen suppression associated with the use of adjuvant endocrine therapy in both premenopausal and postmenopausal women can induce life-altering menopausal symptoms, including sexual dysfunction. Moreover, a decrease in bone mineral density and an increased risk of fractures should be carefully considered and prevented whenever …

Imi-Management And Investigation Of High Myopia In Infants And Young Children, Susan Cotter, Elise Harb, Zi-Bing Jin, Caroline C W Klaver, Anthony T Moore, Ken K Nischal, Kyoko Ohno-Matsui, Evelyn A Paysse, Michael X Repka, Irina Y Smirnova, Martin Snead, Virginie J M Verhoeven, Pavan K Verkicharla

Faculty, Staff and Students Publications

Purpose: The purpose of this study was to evaluate the epidemiology, etiology, clinical assessment, investigation, management, and visual consequences of high myopia (≤-6 diopters [D]) in infants and young children.

Findings: High myopia is rare in pre-school children with a prevalence less than 1%. The etiology of myopia in such children is different than in older children, with a high rate of secondary myopia associated with prematurity or genetic causes. The priority following the diagnosis of high myopia in childhood is to determine whether there is an associated medical diagnosis that may be of greater overall importance to the health …

Practice Efficiency In Dermatology: Enhancing Quality Of Care And Physician Well-Being, Jennifer Li-Wang, Harry Dao

Faculty, Staff and Students Publications

A focus on improved efficiency can impact both patient care and physician well-being. Efficiency is one of the six domains of healthcare quality. It is also recognized as one of the three main pillars of professional fulfillment. Quality improvement measures in the area of efficiency are focused on reducing waste, specifically related to physicians' time, energy, and cognitive demands. Interventions and practices reported in the literature or communicated by dermatologists have documented efforts centered on patient care workflows, documentation, communication, and other areas. Team-based care models maximize the skill sets of other trained providers, while workflow changes encompassing process standardization, …

Beyond Information Design: Designing Health Care Dashboards For Evidence-Driven Decision-Making, Melissa K Knox, Patrick O'Mahen, Laura A Petersen

Faculty, Staff and Students Publications

No abstract provided.

Home Dialysis: Conclusions From A Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference, Cécile Couchoud, Simon J Davies, Rümeyza Kazancioğlu, Scott Klarenbach, Adrian Liew, Daniel E Weiner, Michael Cheung, Michel Jadoul, Wolfgang C Winkelmayer, Martin E Wilkie, For Conference Participants

Faculty, Staff and Students Publications

Home dialysis modalities (home hemodialysis [HD] and peritoneal dialysis [PD]) are associated with greater patient autonomy and treatment satisfaction compared with in-center modalities, yet the level of home-dialysis use worldwide is low. Reasons for limited utilization are context-dependent, informed by local resources, dialysis costs, access to healthcare, health system policies, provider bias or preferences, cultural beliefs, individual lifestyle concerns, potential care-partner time, and financial burdens. In May 2021, KDIGO (Kidney Disease: Improving Global Outcomes) convened a controversies conference on home dialysis, focusing on how modality choice and distribution are determined and strategies to expand home-dialysis use. Participants recognized that expanding …

Impact Of The 2018 Unos Heart Transplant Policy Changes On Patient Outcomes, Andrew B Civitello, Prateeti Khazanie, Joseph G Rogers

Faculty, Staff and Students Publications

In 2018, the United Network for Organ Sharing implemented a 6-tier allocation policy to replace the prior 3-tier system. Given increasing listings of critically ill candidates for heart transplantation and lengthening waitlist times, the new policy aimed to better stratify candidates by waitlist mortality, shorten waiting times for high priority candidates, add objective criteria for common cardiac conditions, and further broaden sharing of donor hearts. There have been significant shifts in cardiac transplantation practices and patient outcomes following the implementation of the new policy, including changes in listing practices, waitlist time and mortality, transplant donor characteristics, post-transplantation outcomes, and mechanical …

Vortioxetine Improves Physical And Cognitive Symptoms In Patients With Post-Covid-19 Major Depressive Episodes, Maria Chiara Spera, Isabella Panaccione, Alessio Simonetti, Gabriele Sani

Faculty, Staff and Students Publications

Major Depressive Episodes (MDE) following COVID-19 are frequent, can have a characteristic clinical picture, and are associated with immune-inflammatory changes. Vortioxetine is known to improve physical and cognitive performance in patients with depression and shows anti-inflammatory and anti-oxidative activities. This study aimed to retrospectively evaluate the effects of vortioxetine after 1 and 3 months of treatment in 80 patients (44.4% males, 54±17.2 years) with post-COVID-19 MDE. The primary outcome was improvement in physical and cognitive symptoms measured by specific items of Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), Short Form-36 Health Survey Questionnaire (SF-36), Digit Symbol …

Midterm Outcomes Of Aortic Root Surgery In Patients With Marfan Syndrome: A Prospective, Multicenter, Comparative Study, Heidi M Connolly, Thoralf M Sundt, Dianna M Milewicz, Harry C Dietz, Hiruni S Amarasekara, Susan Y Green, Qianzi Zhang, Hartzell V Schaff, D Craig Miller

Faculty, Staff and Students Publications

Objective: The objective of this study was to compare midterm outcomes of aortic valve-replacing root replacement (AVR) and aortic valve-sparing root replacement (AVS) operations in patients with Marfan syndrome.

Methods: Patients who met strict Ghent diagnostic criteria for Marfan syndrome and who underwent either AVR or AVS between March 1, 2005 and December 31, 2010 were enrolled in a 3-year follow-up prospective, multicenter, international registry study; the study was subsequently amended to include 20-year follow-up. Enrollees were followed clinically and echocardiographically.

Results: Of the 316 patients enrolled, 77 underwent AVR and 239 underwent AVS; 214 gave reconsent for 20-year follow-up. …

Use, Durability, And Risks For Discontinuation Of Initial And Subsequent Biologics In A Large Pediatric-Onset Ibd Cohort., Jess L. Kaplan, Chunyan Liu, Eileen C. King, Julie A. Bass, Ashish S. Patel, Jeanne Tung, Shiran Chen, Trevor Lissoos, Ninfa Candela, Shehzad Saeed, Richard B. Colletti, Improvecarenow Network

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Biologic medications are recommended for treatment of moderately-to-severely active Crohn disease (CD) or ulcerative colitis (UC) in children. However, many patients require sequential biologic treatment because of nonresponse or loss of response to the initial biologic.

METHODS: We analyzed pediatric inflammatory bowel disease (IBD) data from the ImproveCareNow Network registry between May 2006 and September 2016, including time to biologic initiation, choice of first subsequent biologics, biologic durability, and reasons for discontinuation.

RESULTS: Of 17,649 patients with IBD [CD: 12,410 (70%); UC: 5239 (30%)], 7585 (43%) were treated with a biologic agent before age 18 (CD: 50%; UC: 25%). …

Rationale And Design Of Integrating A Parents First Obesity Intervention With A Pediatric Weight Management Intervention For Rural Families - Evaluating The Ripple Effect., Ann M. Davis, Christie A. Befort, Brittany D. Lancaster, Chris Tuck, Barbara J. Polivka, Jordan A. Carlson, Kandace Fleming, Rebecca Swinburne Romine, Kelsey Dean, Megan Murray

Manuscripts, Articles, Book Chapters and Other Papers

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment …

Rare And Common Variants In Galnt3 May Affect Bone Mass Independently Of Phosphate Metabolism., Neelam Hassan, Celia L. Gregson, Haotian Tang, Marc Van Der Kamp, Paul Leo, Aideen M Mcinerney-Leo, Jie Zheng, Maria Luisa Brandi, Jonathan C Y Tang, William Fraser, Michael D. Stone, Elin Grundberg, Anglo-Australasian Genetics Consortium, Matthew A. Brown, Emma L. Duncan, Jonathan H. Tobias

Manuscripts, Articles, Book Chapters and Other Papers

Anabolic treatment options for osteoporosis remain limited. One approach to discovering novel anabolic drug targets is to identify genetic causes of extreme high bone mass (HBM). We investigated a pedigree with unexplained HBM within the UK HBM study, a national cohort of probands with HBM and their relatives. Whole exome sequencing (WES) in a family with HBM identified a rare heterozygous missense variant (NM_004482.4:c.1657C > T, p.Arg553Trp) in GALNT3, segregating appropriately. Interrogation of data from the UK HBM study and the Anglo-Australasian Osteoporosis Genetics Consortium (AOGC) revealed an unrelated individual with HBM with another rare heterozygous variant (NM_004482.4:c.831 T > A, p.Asp277Glu) …

A Novel Approach To Diagnostic Left And Right Heart Catheterization In A Patient With A Mechanical Prosthetic Tricuspid Valve

Faculty, Staff and Students Publications

A 47-year-old patient was experiencing dyspnea and fatigue concerning for right ventricular hypertension and new heart failure. Because of the risks associated with catheter entrapment, prosthetic valve leaflet damage, and valve thrombosis associated with crossing a mechanical valve, a novel technique was used for diagnostic left and right heart catheterization in a patient with mechanical tricuspid valve replacement and tortuous pulmonary arteries. Using a percutaneous subxiphoid approach to avoid traversing the mechanical valve without discontinuing anticoagulation, a Volcano fractional flow reserve pressure wire (Philips Volcano) was advanced for distal measurements of pressures and saturations.

Dietary Effects On Monocyte Phenotypes In Subjects With Hypertriglyceridemia And Metabolic Syndrome, Xueying Peng, Lu Xu, Jing Ni, Bingqian Zhang, Veronica O'Brien, Anum Saeed, Xiaoming Jia, Aliza Hussain, Bing Yu, Scott I Simon, Frank M Sacks, Ron C Hoogeveen, Christie M Ballantyne, Huaizhu Wu

Faculty, Staff and Students Publications

In patients with hypertriglyceridemia, a short-term low–saturated fat vs high–saturated fat diet induced lower plasma lipids and improved monocyte phenotypes. These findings highlight the role of diet fat content and composition for monocyte phenotypes and possibly cardiovascular disease risk in these patients. (Effects of Dietary Interventions on Monocytes in Metabolic Syndrome; NCT03591588)

Evaluation Of Retinal Nerve Fibre Layer Thickness As A Possible Measure Of Diabetic Retinal Neurodegeneration In The Epic-Norfolk Eye Study, Yao Liu, Praveen J Patel, Paul J Foster, Benjamin J Frankfort, Michael Abramoff, Charles G Minard, Alasdair Warwick, Anthony P Khawaja, Roomasa Channa

Faculty, Staff and Students Publications

BACKGROUND/AIMS: Markers to clinically evaluate structural changes from diabetic retinal neurodegeneration (DRN) have not yet been established. To study the potential role of peripapillary retinal nerve fibre layer (pRNFL) thickness as a marker for DRN, we evaluated the relationship between diabetes, as well as glycaemic control irrespective of diabetes status and pRNFL thickness.

METHODS: Leveraging data from a population-based cohort, we used general linear mixed models (GLMMs) with a random intercept for patient and eye to assess the association between pRNFL thickness (measured using GDx) and demographic, systemic and ocular parameters after adjusting for typical scan score. GLMMs were also …

Effect Of P2y12 Inhibitors On Organ Support-Free Survival In Critically Ill Patients Hospitalized For Covid-19: A Randomized Clinical Trial, Michelle N Gong, Harmony R Reynolds, Mary Cushman, Andrew D Althouse, Patrick R Lawler, Bryan J Mcverry, Keri S Kim, Lisa Baumann Kreuziger, Scott D Solomon, Mikhail N Kosiborod, Scott M Berry, Grant V Bochicchio, Marco Contoli, Michael E Farkouh, Joshua D Froess, Sheetal Gandotra, Yonatan Greenstein, Erinn M Hade, Nicholas Hanna, Kristin Hudock, Robert C Hyzy, Fátima Ibáñez Estéllez, Nicole Iovine, Ashish K Khanna, Pooja Khatri, Bridget-Anne Kirwan, Matthew E Kutcher, Eric Leifer, George Lim, Renato D Lopes, Jose L Lopez-Sendon, James F Luther, Lilia Nigro Maia, John G Quigley, Lana Wahid, Jennifer G Wilson, Ryan Zarychanski, Andrei Kindzelski, Mark W Geraci, Judith S Hochman, Activ-4a Investigators

Faculty, Staff and Students Publications

IMPORTANCE: Platelet activation is a potential therapeutic target in patients with COVID-19.

OBJECTIVE: To evaluate the effect of P2Y12 inhibition among critically ill patients hospitalized for COVID-19.

DESIGN, SETTING, AND PARTICIPANTS: This international, open-label, adaptive platform, 1:1 randomized clinical trial included critically ill (requiring intensive care-level support) patients hospitalized with COVID-19. Patients were enrolled between February 26, 2021, through June 22, 2022. Enrollment was discontinued on June 22, 2022, by the trial leadership in coordination with the study sponsor given a marked slowing of the enrollment rate of critically ill patients.

INTERVENTION: Participants were randomly assigned to receive a P2Y12 …

Leveraging The Electronic Health Record To Implement Emergency Department Delirium Screening, Ilianna Santangelo, Christopher R Carpenter, Shan W Liu, Kyler M Godwin, Aanand D Naik, Hardeep Singh, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVE: The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.

METHODS: We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data …

Neighborhood-Level Factors Contribute To Disparities In Hepatocellular Carcinoma Incidence In Texas, Aaron P Thrift

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Texas has the highest hepatocellular carcinoma (HCC) incidence rates in the continental United States, but these rates vary by race-ethnicity. We examined racial-ethnic disparities through a geospatial analysis of the social determinants of health.

METHODS: Using data from the Texas Cancer Registry, we assembled 11,547 HCC cases diagnosed between 2011 and 2015 into Texas's census tracts geographic units. Twenty-nine neighborhood measures representing demographics and socioeconomic, and employment domains were retrieved from the U.S. Census Bureau. We performed a series of aspatial and spatially weighted regression models to identify neighborhood-level characteristics associated with HCC risk.

RESULTS: We found …

The Prevalence And Determinants Of Nafld And Mafld And Their Severity In The Va Primary Care Setting, Maya Balakrishnan, Fasiha Kanwal, Rohit Loomba, Hao T Duong, David Ramsey, Hashem B El-Serag

Faculty, Staff and Students Publications

BACKGROUND & AIMS: A recent panel of international experts proposed the disease acronym metabolic (dysfunction)-associated fatty liver disease (MAFLD) in lieu of nonalcoholic fatty liver disease (NAFLD). We aimed to estimate the burden of and risk factors for NAFLD and MAFLD, and to examine the concordance between definitions in a Veterans population.

METHODS: We conducted a cross-sectional study among randomly selected patients within primary care at the Houston Veterans Affairs (VA) facility. Participants completed a survey, provided blood, and underwent Fibroscan. In the absence of heavy alcohol, hepatitis C virus and hepatitis B virus, a controlled attenuation parameter median ≥290 …

Spinning A Yarn: Exploring Social Work And Artistry, Cal F. Erasmus Tronson

Graduate Student Portfolios, Professional Papers, and Capstone Projects

No abstract provided.

Environmental Education In Informal Learning Spaces: Integration, Design, And Access, Maya S. Gutierrez

Graduate Student Portfolios, Professional Papers, and Capstone Projects

In this portfolio, I will focus on using learning spaces to facilitate environmental education and promote environmental literacy. I will discuss the incorporation of the framework of environmental education into an experiential and informal learning environment; the creation of a curriculum that fuses formal and informal learning, providing upper elementary students opportunities to participate in hands-on experiential learning opportunities of environmental education; and the direct and indirect benefits nature-based experiences can provide when implemented into a therapeutic group home. Embedded throughout is an environmental education framework that has been adapted for the diverse setting and requirements of the respective organization …

Community Food Security Strategies In Montana: Exploring Practices And Policies, Andrew T. Besser

Graduate Student Portfolios, Professional Papers, and Capstone Projects

No abstract provided.

Oral Manifestations Of Acute Lymphocytic Leukemia, Angela Yepes Dds, Ms, Mba, Juan Yepes Dds, Md, Mph, Ms, Drph, James E. Jones Dmd, Msd, Edd, Phd

The Journal of the Michigan Dental Association

Leukemia is the most prevalent malignancy of leukocytes and can occur in children and adults. Oral manifestations are part of the complexity of signs and symptoms in patients with leukemia and, in some patients, oral manifestations precede systemic manifestations. Oral signs of leukemia include spontaneous bleeding, gingival enlargement, and whiteness of the oral mucosa. Head and neck lymphadenopathy is common in patients with leukemia. Oral manifestations are the result of the direct invasion of immature cells in the oral cavity tissues or indirectly caused by the replacement of the normal blood cells for immature cells causing anemia, leucopenia, and thrombocytopenia. …

10-Minute Ebd: Do Posterior Composite Restorations Have Longer-Term Success Than Glass Ionomer?, Eleni E. Langas Dds, Mridula Manoj Dds, Kelsey Carreras-Simons Dds

The Journal of the Michigan Dental Association

This Ten Minute Evidence Based Dentistry Article provides an example of the implementation of the evidence based dentistry search process with trusted search engines, and identification of the best literature through critical appraisal to answer the clinical question on long-term success of posterior resin vs. posterior glass ionomer restorations.

Finding Calm Amidst Chaos, Lisa Knowles Dds

The Journal of the Michigan Dental Association

This commentary on mindfulness and wellness provides the practitioner with strategies to achieve peace amidst chaos.

The Human Role In Artificial Intelligence, Christopher J. Smiley Dds

The Journal of the Michigan Dental Association

The success of AI requires human involvement to ensure that it is used safely and effectively. Transparency, collaboration, and standardization are necessary.

J Mich Dent Assoc May 2023

The Journal of the Michigan Dental Association

In this issue, the reader will find the following original content:

• A case study on recognizing the oral signs of Acute Lymphatic Leukemia
• A special pull-out section to assist clinicians in identifying and treating common oral lesions
• Advice on personal Wellness: "Finding Calm Amidst Chaos."
• State of Michigan C.E. Requirements for License Renewal of Dentists, Hygienists, and Registered Dental Assistants.
• A 10Minute EBD contrasting clinical success of composite restorations vs. glass ionomers.
• Guest commentary "Pretty Good Dentistry."
• News you need, Editorial, and an Advocacy Spotlight.

First Presentation With Neuropsychiatric Symptoms In Autosomal Dominant Alzheimer's Disease: The Dominantly Inherited Alzheimer's Network Study, Antoinette O'Connor, Helen Rice, Josephine Barnes, Natalie S. Ryan, Kathy Y. Liu, Ricardo Francisco Allegri, Sarah Berman, John M. Ringman, Carlos Cruchaga, Martin R. Farlow, Jason Hassenstab, Jae-Hong Lee, Richard J. Perrin, Chengjie Xiong, Brian Gordon, Allan I. Levey, Alison Goate, Neil Graff-Radford, Johannes Levin, Mathias Jucker, Tammie Benzinger, Eric Mcdade, Hiroshi Mori, James M. Noble, Peter R. Schofield, Ralph N. Martins, Stephen Salloway, Jasmeer Chhatwal, John C. Morris, Randall Bateman, Rob Howard, Suzanne Reeves, Nick C. Fox

Research outputs 2022 to 2026

Behavioural changes and neuropsychiatric symptoms (NPS) commonly occur in Alzheimer’s disease (AD) but may not be recognised as AD-related when they are the presenting feature. NPS are important as they are associated with greater functional impairment, poorer quality of life, accelerated cognitive decline and worsened caregiver burden.1 Autosomal dominant AD (ADAD), although < 1% of total AD cases, provides a valuable opportunity to study the clinical heterogeneity of AD. The young age at onset reduces the prevalence of age-related comorbid pathologies and the near 100% penetrance of pathogenic mutations reduces the likelihood of misdiagnosis.2 Anxiety and depression commonly occur in ADAD family members, with increased levels of depression having been found among predementia female mutation carriers.3 Subsequent studies, however, have shown that anxiety and/or depression are common regardless of mutation status, occurring in almost one in three at-risk individuals, with one study reporting a higher rate of depression in non-carriers (17%) than asymptomatic carriers (5%).4 5 Despite the high frequency of NPS in ADAD families, relatively little is known about the proportion of ADAD cases who present with predominantly behavioural symptoms. Our aims were to assess the first reported clinical change in symptomatic ADAD, to compare presentations across genotypes, and to compare cognitive performance between behavioural and cognitive-led presentations.