Medicine and Health Sciences Commons^™

Just Culture For Medical Students: Understanding Response To Providers In Adverse Events, Brijen J Shah, Bonnie Portnoy, Dennis Chang, Marc Napp

2020-Current year OA Pubs

INTRODUCTION: Individual and organizational response to an adverse event is a key part of the life cycle of a patient safety event. Just culture is a safety concept that emphasizes system drivers of human behavior. We developed a learning activity for medical students to teach and discuss just culture as part of a patient safety curriculum.

METHODS: This small-group, discussion-based learning activity was aimed at third-year medical students. Over 5 years, 628 students participated in it. The session had three components: a presession case-based survey, a didactic lecture, and a facilitated small-group discussion. Participants evaluated the session using our institution's …

Unfriendly Fire: How The Tobacco Industry Is Destroying The Future Of Our Children, Andrew Bush, Thomas Ferkol, Et Al.

2020-Current year OA Pubs

Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned …

The Free And Cued Selective Reminding Test Predicts Braak Stage, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To identify clinical measures that predict pathology, we evaluated the relationships of the picture version of the Free and Cued Selective Reminding Test (pFCSRT + IR), the Mini-Mental State Exam (MMSE), and the Clinical Dementia Rating scale Sum of Boxes (CDR-SB) to Braak stage.

METHODS: 315 cases from the clinicopathologic series at the Knight Alzheimer's Disease Research Center were classified according to Braak stage. Boxplots of each predictor were compared to identify the earliest stage at which decline was observed and …

Stages Of Objective Memory Impairment Predict Alzheimer's Disease Neuropathology: Comparison With The Clinical Dementia Rating Scale-Sum Of Boxes, Ellen Grober, Qi Qi, Lynn Kuo, Jason Hassenstab, Richard J Perrin, Richard B Lipton

2020-Current year OA Pubs

BACKGROUND: The ultimate validation of a clinical marker for Alzheimer's disease (AD) is its association with AD neuropathology.

OBJECTIVE: To examine how well the Stages of Objective Memory Impairment (SOMI) system predicts intermediate/high AD neuropathologic change and extent of neurofibrillary tangle (NFT) pathology defined by Braak stage, in comparison to the Clinical Dementia Rating (CDR) Scale sum of boxes (CDR-SB).

METHODS: 251 well-characterized participants from the Knight ADRC clinicopathologic series were classified into SOMI stage at their last assessment prior to death using the free recall and total recall scores from the picture version of the Free and Cued Selective …

Exploring Intentional Medication Non-Adherence In Patients With Systemic Lupus Erythematosus: The Role Of Physician-Patient Interactions, Jerik Leung, Elizabeth A Baker, Alfred H J Kim

2020-Current year OA Pubs

OBJECTIVE: Medication non-adherence contributes to worse health outcomes among SLE patients. The underlying mechanisms that drive medication non-adherence are poorly understood. The purpose of this study was to explore possible mechanisms of medication non-adherence by eliciting patient experiences.

METHODS: Consented adult patients with ACR- or SLICC-classified SLE were recruited. Ten semi-structured interviews were conducted across six participants. Interviews were audio recorded, transcribed, and analysed using an iterative process. The findings were presented to an interactive public forum with SLE patients, family members and friends of patients, and health-care professionals to assess validity and for elaboration of the concepts developed.

RESULTS: …

A Phase Ii Study Of Laser Interstitial Thermal Therapy Combined With Doxorubicin In Patients With Recurrent Glioblastoma, Omar H Butt, Alice Y Zhou, Jiayi Huang, William A Leidig, Alice E Silberstein, Milan G Chheda, Tanner M Johanns, George Ansstas, Jingxia Liu, Grayson Talcott, Ruth Nakiwala, Joshua S Shimony, Albert H Kim, Eric C Leuthardt, Jian L Campian, Et Al.

2020-Current year OA Pubs

BACKGROUND: The blood-brain barrier (BBB) is a major limiting factor for drug delivery in brain tumors. Laser interstitial thermal therapy (LITT) disrupts the peritumoral BBB. In this study, we examine survival in patients with recurrent glioblastoma (GBM) treated with LITT followed by low-dose doxorubicin, a potent anti-neoplastic drug with poor BBB permeability.

METHODS: Forty-one patients with recurrent GBM were enrolled; thirty patients were evaluable. Participants underwent LITT followed by 6 weekly doxorubicin treatments starting within one week (Early Arm) or at 6-8 weeks (Late Arm) after LITT. The overall survival (OS), local progression-free survival (PFS), and any PFS were compared …

Does Circulating Progesterone Mediate The Associations Of Single Nucleotide Polymorphisms In Progesterone Receptor (Pgr)-Related Genes With Mammographic Breast Density In Premenopausal Women?, Favour A Akinjiyan, Yunan Han, Jingqin Luo, Adetunji T Toriola

2020-Current year OA Pubs

UNLABELLED: Progesterone is a proliferative hormone in the breast but the associations of genetic variations in progesterone-regulated pathways with mammographic breast density (MD) in premenopausal women and whether these associations are mediated through circulating progesterone are not clearly defined. We, therefore, investigated these associations in 364 premenopausal women with a median age of 44 years. We sequenced 179 progesterone receptor (PGR)-related single nucleotide polymorphisms (SNPs). We measured volumetric percent density (VPD) and non-dense volume (NDV) using Volpara. Linear regression models were fit on circulating progesterone or VPD/NDV separately. We performed mediation analysis to evaluate whether the effect of a SNP …

Loss Of Angiotensin Ii Type 2 Receptor Improves Blood Pressure In Elastin Insufficiency, Michelle Lin, Robyn A Roth, Beth A Kozel, Robert P Mecham, Carmen M Halabi

2020-Current year OA Pubs

There is ample evidence supporting a role for angiotensin II type 2 receptor (AT

Effective Connectivity Extracts Clinically Relevant Prognostic Information From Resting State Activity In Stroke, Mohit H Adhikari, Joseph Griffis, Joshua S Siegel, Michel Thiebaut De Schotten, Gustavo Deco, Andrea Instabato, Matthieu Gilson, Maurizio Corbetta

2020-Current year OA Pubs

Recent resting-state functional MRI studies in stroke patients have identified two robust biomarkers of acute brain dysfunction: a reduction of inter-hemispheric functional connectivity between homotopic regions of the same network, and an abnormal increase of ipsi-lesional functional connectivity between task-negative and task-positive resting-state networks. Whole-brain computational modelling studies, at the individual subject level, using undirected effective connectivity derived from empirically measured functional connectivity, have shown a reduction of measures of integration and segregation in stroke as compared to healthy brains. Here we employ a novel method, first, to infer whole-brain directional effective connectivity from zero-lagged and lagged covariance matrices, then, …

Smaller Spared Subcortical Nuclei Are Associated With Worse Post-Stroke Sensorimotor Outcomes In 28 Cohorts Worldwide, Sook-Lei Liew, Catherine E Lang, Anup K Bhattacharya, Et Al.

2020-Current year OA Pubs

Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of spared subcortical nuclei and sensorimotor behaviour at different timepoints after stroke. We pooled high-resolution T

The Next Generation Of Ocular Pathogen Detection, Sharon L. Sabapathypillai, Hayley R. James, Rachael R. L. Lyerla, Lynn Hassman

2020-Current year OA Pubs

Metagenomic next-generation sequencing is a powerful method for pathogen detection that combines advanced genome sequencing technology with cutting-edge bioinformatics to analyze microbial populations. Metagenomic next-generation sequencing has the potential to identify uncommon, unculturable, and even previously unidentified pathogens from a clinical isolate. Of particular interest to ophthalmology, this robust data extraction can occur from very small volume clinical samples. Here we discuss the opportunities and limitations of this technique and their current and future application to ophthalmic diagnostics.

Differentiating Wide Complex Tachycardias: A Historical Perspective, Anthony H Kashou, Christopher M Evenson, Peter A Noseworthy, Thoddi R Muralidharan, Christopher V Desimone, Abhishek J Deshmukh, Samuel J Asirvatham, Adam M May

2020-Current year OA Pubs

One of the most critical and challenging skills is the distinction of wide complex tachycardias into ventricular tachycardia or supraventricular wide complex tachycardia. Prompt and accurate differentiation of wide complex tachycardias naturally influences short- and long-term management decisions and may directly affect patient outcomes. Currently, there are many useful electrocardiographic criteria and algorithms designed to distinguish ventricular tachycardia and supraventricular wide complex tachycardia accurately; however, no single approach guarantees diagnostic certainty. In this review, we offer an in-depth analysis of available methods to differentiate wide complex tachycardias by retrospectively examining its rich literature base - one that spans several decades.

Anabolic Resistance Of Muscle Protein Turnover Comes In Various Shapes And Sizes, Kevin J M Paulussen, Colleen F Mckenna, Joseph W Beals, Kenneth R Wilund, Amadeo F Salvador, Nicholas A Burd

2020-Current year OA Pubs

Anabolic resistance is defined by a blunted stimulation of muscle protein synthesis rates (MPS) to common anabolic stimuli in skeletal muscle tissue such as dietary protein and exercise. Generally, MPS is the target of most exercise and feeding interventions as muscle protein breakdown rates seem to be less responsive to these stimuli. Ultimately, the blunted responsiveness of MPS to dietary protein and exercise underpins the loss of the amount and quality of skeletal muscle mass leading to decrements in physical performance in these populations. The increase of both habitual physical activity (including structured exercise that targets general fitness characteristics) and …

Temozolomide Chronotherapy In Patients With Glioblastoma: A Retrospective Single-Institute Study, Anna R Damato, Jingqin Luo, Ruth G N Katumba, Grayson R Talcott, Joshua B Rubin, Erik D Herzog, Jian L Campian

2020-Current year OA Pubs

BACKGROUND: Chronotherapy is an innovative approach to improving survival through timed delivery of anti-cancer treatments according to patient daily rhythms. Temozolomide (TMZ) is a standard-of-care chemotherapeutic agent for glioblastoma (GBM). Whether timing of TMZ administration affects GBM patient outcome has not previously been studied. We sought to evaluate maintenance TMZ chronotherapy on GBM patient survival.

METHODS: This retrospective study reviewed patients with newly diagnosed GBM from January 1, 2010 to December 31, 2018 at Washington University School of Medicine who had surgery, chemoradiation, and were prescribed TMZ to be taken in the morning or evening. The Kaplan-Meier method and Cox …

Immune Cell Analysis Of Pilocytic Astrocytomas Reveals Sexually Dimorphic Brain Region-Specific Differences In T-Cell Content, Jie Chen, Namita Sinha, Olivia Cobb, Collin Liu, Ayca Ersen, Joanna J Phillips, Tarik Tihan, David H Gutmann, Sonika Dahiya

2020-Current year OA Pubs

No abstract provided.

Salvage Therapies For Radiation-Relapsed Isocitrate Dehydrogenase-Mutant Astrocytoma And 1p/19q Codeleted Oligodendroglioma, Sirui Ma, Soumon Rudra, Jian L Campian, Milan G Chheda, Tanner M Johanns, George Ansstas, Christopher D Abraham, Michael R Chicoine, Eric C Leuthardt, Joshua L Dowling, Gavin P Dunn, Albert H Kim, Jiayi Huang

2020-Current year OA Pubs

BACKGROUND: Optimal management for recurrent IDH-mutant glioma after radiation therapy (RT) is not well-defined. This study assesses practice patterns for managing recurrent IDH-mutant astrocytoma (Astro) and 1p/19q codeleted oligodendroglioma (Oligo) after RT and surveys their clinical outcomes after different salvage approaches.

METHODS: Ninety-four recurrent Astro or Oligo patients after RT who received salvage systemic therapy (SST) between 2001 and 2019 at a tertiary cancer center were retrospectively analyzed. SST was defined as either alkylating chemotherapy (AC) or nonalkylating therapy (non-AC). Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method from the start of SST. Multivariable analysis …

Validation Of Diffusion Mri As A Biomarker For Efficacy Using Randomized Phase Iii Trial Of Bevacizumab With Or Without Vb-111 In Recurrent Glioblastoma, Benjamin M Ellingson, Jian L Campian, Et Al.

2020-Current year OA Pubs

BACKGROUND: Evidence from single and multicenter phase II trials have suggested diffusion MRI is a predictive imaging biomarker for survival benefit in recurrent glioblastoma (rGBM) treated with anti-VEGF therapy. The current study confirms these findings in a large, randomized phase III clinical trial.

METHODS: Patients with rGBM were enrolled in a phase III randomized (1:1), controlled trial (NCT02511405) to compare the efficacy and safety of bevacizumab (BV) versus BV in combination with ofranergene obadenovec (BV+VB-111), an anti-cancer viral therapy. In 170 patients with diffusion MRI available, pretreatment enhancing tumor volume and ADC histogram analysis were used to phenotype patients as …

Profiles Of Hiv Care Disruptions Among Adult Patients Lost To Follow-Up In Zambia: A Latent Class Analysis, Aaloke Mody, Kombatende Sikombe, Laura K. Beres, Sandra Simbeza, Njekwa Mukamba, Ingrid Eshun-Wilson, Sheree Schwartz, Jake Pry, Nancy Padian, Charles B. Holmes, Carolyn Bolton-Moore, Izukanji Sikazwe, Elvin H. Geng

2020-Current year OA Pubs

BACKGROUND: Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles.

METHODS: We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site).

RESULTS: Among 547 patients, we identified …

Going Remote: Implementing Digital Research Methods At An Academic Medical Center During Covid-19, Katie E Keenoy, Eric J Lenze, Ginger E Nicol

2020-Current year OA Pubs

COVID-19 has forced medical research institutions to conduct clinical research remotely. Here, we describe how a university's mHealth Research Core helped facilitate the shift to remote research during the COVID-19 pandemic. In 2019 (pre-pandemic), we conducted stakeholder interviews and leadership group sessions to identify, create, and implement resources and core functions to support investigator-initiated mHealth research. Between April 2019 and February 2020, we identified four investigator needs: 1) a

Health Disparities And Treatment Approaches In Portopulmonary Hypertension And Idiopathic Pulmonary Arterial Hypertension: An Analysis Of The Pulmonary Hypertension Association Registry, Hilary M Dubrock, Murali Chakinala, Et Al.

2020-Current year OA Pubs

Compared to idiopathic pulmonary arterial hypertension (IPAH), patients with portopulmonary hypertension (POPH) have worse survival. Health disparities may contribute to these differences but have not been studied. We sought to compare socioeconomic factors in patients with POPH and IPAH and to determine whether socioeconomic status and/or POPH diagnosis were associated with treatment and health-care utilization. We performed a cross-sectional study of adults enrolled in the Pulmonary Hypertension Association Registry. Patients with IPAH (n = 344) and POPH (n = 57) were compared. Compared with IPAH, patients with POPH were less likely to be college graduates (19.6% vs. 34.9%, p = …

Clinical Challenges In The Management Of Hormone Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Metastatic Breast Cancer: A Literature Review, Gayathri Nagaraj, Cynthia X Ma

2020-Current year OA Pubs

Endocrine therapy (ET) is integral to the treatment of hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). Aromatase inhibitors (AIs; e.g., anastrozole, letrozole, exemestane), selective estrogen receptor modulators (e.g., tamoxifen), and the selective estrogen receptor degrader, fulvestrant, inhibit tumor cell proliferation by targeting ER signaling. However, the efficacy of ET could be limited by intrinsic and acquired resistance mechanisms, which has prompted the development of targeted agents and combination strategies. In recent years, the treatment landscape for HR+, HER2- MBC has evolved rapidly. AIs, historically the first-line treatment for postmenopausal patients with HR+, HER2- …

Gene Therapy Potential For Genetic Disorders Of Surfactant Dysfunction, Ashley L Cooney, Jennifer A Wambach, Patrick L Sinn, Paul B Mccray

2020-Current year OA Pubs

Pulmonary surfactant is critically important to prevent atelectasis by lowering the surface tension of the alveolar lining liquid. While respiratory distress syndrome (RDS) is common in premature infants, severe RDS in term and late preterm infants suggests an underlying genetic etiology. Pathogenic variants in the genes encoding key components of pulmonary surfactant including surfactant protein B (SP-B,

Perceived Barriers To Assessing Understanding And Appreciation Of Informed Consent In Clinical Trials: A Mixed-Method Study, Erin D Solomon, Jessica Mozersky, Kari Baldwin, Matthew P Wroblewski, Meredith V Parsons, Melody Goodman, James M Dubois

2020-Current year OA Pubs

INTRODUCTION: Participants and research professionals often overestimate how well participants understand and appreciate consent information for clinical trials, and experts often vary in their determinations of participant's capacity to consent to research. Past research has developed and validated instruments designed to assess participant understanding and appreciation, but the frequency with which they are utilized is unknown.

METHODS: We administered a survey to clinical researchers working with older adults or those at risk of cognitive impairment (

RESULTS: We found that using a validated assessment of consent is relatively uncommon, being used by only 44% of researchers who had an opportunity. …

Development And Genetics Of Red Coloration In The Zebrafish Relative Danio Albolineatus, Delai Huang, Victor M. Lewis, Tarah N. Foster, Matthew B. Toomey, Joseph C. Corbo, David M. Parichy

Open Access Publications

Animal pigment patterns play important roles in behavior and, in many species, red coloration serves as an honest signal of individual quality in mate choice. Among

A Comprehensive Review Of Tic Disorders In Children, Keisuke Ueda, Kevin J. Black

Open Access Publications

Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities …

Academic Performance Of Children With Sickle Cell Disease In The United States: A Meta-Analysis, Andrew M Heitzer, Latacha Hamilton, Claire Stafford, Jeffrey Gossett, Lara Ouellette, Ana Trpchevska, Allison A King, Guolian Kang, Jane S Hankins

Open Access Publications

No abstract provided.

Context-Responsive Anticoagulation Reduces Complications In Pediatric Extracorporeal Membrane Oxygenation, John C Lin, Lauren M Barron, Adam M Vogel, Ryan M Colvin, Sirine A Baltagi, Allan Doctor, Avihu Z Gazit, Mary Mehegan, Nicole O'Connor, Ahmed S Said, Mark Shepard, Michael Wallendorf, Philip C Spinella

2020-Current year OA Pubs

No abstract provided.

Detection Of Β-Amyloid Positivity In Alzheimer's Disease Neuroimaging Initiative Participants With Demographics, Cognition, Mri And Plasma Biomarkers, Duygu Tosun, James Bollinger, Vitaliy Ovod, Kwasi G Mawuenyega, Randall J Bateman, Et Al.

2020-Current year OA Pubs

No abstract provided.

Veterans Health Administration's Whole Health System Of Care: Supporting The Health, Well-Being, And Resiliency Of Employees, Kavitha P Reddy, Tamara M Schult, Alison M Whitehead, Barbara G Bokhour

2020-Current year OA Pubs

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from …

Immunotherapy As A Treatment Strategy In Advanced Stage And Recurrent Endometrial Cancer: Review Of Current Phase Iii Immunotherapy Clinical Trials, Ramez N Eskander, Matthew A Powell

2020-Current year OA Pubs

The treatment of advanced stage, metastatic or recurrent endometrial cancer remains a clinically difficult scenario. Although combination carboplatin and paclitaxel is an effective standard-of-care regimen, alternate strategies have shown promise, particularly in biomarker select populations. In an effort to improve oncologic outcomes, investigators are exploring novel immunotherapy combinations. In this review, we discuss the clinical rationale and design of current phase III immuno-oncology clinical trials in patients with advanced stage or recurrent endometrial cancer.