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Yellowlees PM, Burke MM, Gonzalez AD, Fisher A, Chan SR, Hilty DM, McCarron RM, Scher LM, Sciolla AF, Shore J, Xiong G, Fine J, Bannister J, Iosif AM. Patient and Provider Satisfaction with Asynchronous Versus Synchronous Telepsychiatry in Primary Care: A Secondary Mixed-Methods Analysis of a Randomized Controlled Trial. Telemed J E Health 2024; 30:e1049-e1063. [PMID: 38011623 PMCID: PMC11035926 DOI: 10.1089/tmj.2023.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Asynchronous telepsychiatry (ATP) consultations are a novel form of psychiatric consultation. Studies comparing patient and provider satisfaction for ATP with that for synchronous telepsychiatry (STP) do not exist. Methods: This mixed-methods study is a secondary analysis of patients' and primary care providers' (PCPs) satisfaction from a randomized clinical trial of ATP compared with STP. Patients and their PCPs completed satisfaction surveys, and provided unstructured feedback about their experiences with either ATP or STP. Differences in patient satisfaction were assessed using mixed-effects logistic regression models, and the qualitative data were analyzed using thematic analysis with an inductive coding framework. Results: Patient satisfaction overall was high with 84% and 97% of respondents at 6 months reported being somewhat or completely satisfied with ATP and STP, respectively. Patients in the STP group were more likely to report being completely satisfied, to recommend the program to a friend, and to report being comfortable with their care compared with ATP (all p < 0.05). However, there was no difference between the patients in ATP and STP in perceived change in clinical outcomes (p = 0.51). The PCP quantitative data were small, and thus only summarized descriptively. Conclusions: Patients expressed their overall satisfaction with both STP and ATP. Patients in ATP reported more concerns about the process, likely because feedback after ATP was slower than that after STP consultations. PCPs had no apparent preference for STP or ATP, and reported implementing the psychiatrists' recommendations for both groups when such recommendations were made, which supports our previous findings. Trial Registration: ClinicalTrials.gov NCT02084979; https://clinicaltrials.gov/ct2/show/NCT02084979.
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Affiliation(s)
- Peter M. Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Michelle M. Burke
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alvaro D. Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Alice Fisher
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Steven R. Chan
- Stanford University School of Medicine, Stanford, California, USA
- Veterans Administration Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Robert M. McCarron
- Department of Psychiatry, University of California, Irvine, California, USA
| | - Lorin M. Scher
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Andres F. Sciolla
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Glen Xiong
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, University of California, Davis, California, USA
| | - Jennifer Bannister
- Department of Psychiatry and Behavioral Sciences, University of California, Sacramento, California, USA
| | - Ana-Maria Iosif
- Department of Public Health Sciences, University of California, Davis, California, USA
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McCann C, Kamiyama N, Burgess D, Usher AE, Fine J, Wilson M, Iannucci A, Leiserowitz GS, Malogolowkin M. Documentation of Infertility Risk Discussion in Cancer Patients Receiving Cancer-Directed Therapy: The UC Davis Cancer Center Experience. J Adolesc Young Adult Oncol 2024; 13:288-292. [PMID: 37610879 DOI: 10.1089/jayao.2023.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Purpose: A complication of cancer-directed therapy that often goes undiscussed is infertility. Although guidelines recommend addressing the possibility of infertility and fertility preservation approaches before initiating treatment, an internal review at our institution showed only 49% of female patients had infertility risk counseling documented. As a result, a fertility assessment communication was added into all oncology treatment plans to improve rates of fertility discussion and documentation. Methods: This retrospective observational study included newly diagnosed patients of childbearing potential who initiated cancer-directed therapy between January 1, 2020, and October 31, 2021. Patients who were no longer of childbearing potential due to age or surgery were excluded. Patients were divided into pre- and post-implementation groups to assess the impact of the fertility assessment communication implemented on November 1, 2020. Results: A total of 152 patients met inclusion criteria, with 80 patients in the pre-implementation group and 72 patients in the post-implementation group. The primary outcome of documentation of infertility risk discussion was 47.5% in the pre-implementation group and 86.1% in the post-implementation group (p < 0.0001). Discussion of fertility preservation options was documented in 28.7% of the pre-implementation group and 43.1% in the post-implementation group (p = 0.13). In the pre-implementation group, 5% underwent fertility preservation versus 27.8% in the post-implementation group (p = 0.0001). Of the 27 patients who received fertility preservation, 13 received hormonal therapy, 11 sperm banking, and 3 egg harvesting. Conclusion: This intervention significantly increased rates of infertility risk discussion and fertility preservation approaches received. There are opportunities to help patients receive fertility preservation, especially sperm banking and egg harvesting.
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Affiliation(s)
- Colleen McCann
- Department of Pharmacy Services, University of California Davis Health, Sacramento, California, USA
| | - Natalie Kamiyama
- Department of Pharmacy Services, University of California Davis Health, Sacramento, California, USA
| | - Debra Burgess
- UC Davis Comprehensive Cancer Center, University of California Davis Health, Sacramento, California, USA
| | - Angela E Usher
- UC Davis Comprehensive Cancer Center, University of California Davis Health, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Services, Division of Biostatistics, University of California Davis Health, Sacramento, California, USA
| | - Machelle Wilson
- Department of Public Health Services, Division of Biostatistics, University of California Davis Health, Sacramento, California, USA
| | - Andrea Iannucci
- Department of Pharmacy Services, University of California Davis Health, Sacramento, California, USA
| | - Gary S Leiserowitz
- Department of Obstetrics and Gynecology, University of California Davis Health, Sacramento, California, USA
| | - Marcio Malogolowkin
- Department of Pediatrics, University of California Davis Health, Sacramento, California, USA
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Payne ML, Young S, Heard J, Bernardy S, Duby JJ, Fine J, Wilson M, Louie E. Effect of dexmedetomidine on fluid resuscitation in burn-injured patients. J Burn Care Res 2024:irae038. [PMID: 38459902 DOI: 10.1093/jbcr/irae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 03/11/2024]
Abstract
Fluid creep occurs when resuscitation after extensive burn injury reaches volumes higher than predicted. Since this has been described in patients with high opioid requirements, continuous analgesics and sedatives, including dexmedetomidine, have been avoided during resuscitation. This study sought to describe the impact of dexmedetomidine on fluid resuscitation requirements. This retrospective cohort study included adult patients with burns greater than 20% total body surface area (TBSA) resuscitated between January 2017 and June 2022 at a regional burn center. Patients deceased within 48 hours of burn were excluded. Primary outcome was volume of fluid required in the first 24 and 48 hours post-burn. Secondary outcomes were the incidence of fluid-related adverse events within 7 days post-burn. A total of 170 patients were included: 55 in the dexmedetomidine cohort and 115 in the control cohort. After propensity matching for variables associated with fluid creep, the dexmedetomidine cohort required 4.2 ± 1.7 mL/kg/%TBSA in the first 24 hours compared to 3.6 ± 1.1 mL/kg/%TBSA in the control cohort (p=0.03). The difference was no longer significant at 48 hours (p=0.11). There were no differences in the incidence of acute respiratory distress syndrome, delayed escharotomy/fasciotomy, intraabdominal hypertension, or renal replacement therapy. Dexmedetomidine exposure during acute resuscitation resulted in increased fluid requirements in the first 24 hours, suggesting it is independently associated with fluid creep; however, this increase was not sustained at 48 hours. Clinical significance of this finding is unclear as there was no increase in adverse events related to excessive fluid resuscitation between cohorts.
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Affiliation(s)
- Michelle L Payne
- Rhode Island Hospital, Providence, Rhode Island, USA
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Sierra Young
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Jason Heard
- University of California, Davis Medical Center, Sacramento, California, USA
- Firefighters Burn Institute Regional Burn Center, Sacramento, California, USA
| | - Sarah Bernardy
- University of California, Davis Medical Center, Sacramento, California, USA
- Firefighters Burn Institute Regional Burn Center, Sacramento, California, USA
| | - Jeremiah J Duby
- University of California, Davis Medical Center, Sacramento, California, USA
| | - Jeffrey Fine
- University of California, Davis Health, Sacramento, California, USA
| | - Machelle Wilson
- University of California, Davis Health, Sacramento, California, USA
| | - Erin Louie
- University of California, Davis Medical Center, Sacramento, California, USA
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Reddy L, Thompson III GR, Tuznik N, Zolfaghari TA, Dray JV, Ames J, Ho D, Crabtree S, Fine J, Wilson MD, Alnimri M, Cohen SH, Koff A. Safety of fluconazole in kidney transplant recipients for prevention of coccidioidomycosis. Med Mycol 2024; 62:myae017. [PMID: 38425102 PMCID: PMC10941972 DOI: 10.1093/mmy/myae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Coccidioides is an endemic fungus that causes infections ranging from mild respiratory illness to life-threatening disease, and immunocompromised hosts such as solid organ transplant recipients are at higher risk for disseminated infection and mortality. Our center administers fluconazole prophylaxis to kidney transplant recipients residing in geographic areas with higher incidences of coccidioidomycosis. However, because drug-drug interactions occur between triazoles and immunosuppressants used in transplant medicine, we undertook a study to ascertain whether fluconazole prophylaxis was associated with any important safety outcomes in kidney transplant recipients. This retrospective study evaluated patients who had undergone kidney transplantation between 2016 and 2019. Data on patient demographics, transplant-related clinical information, use of fluconazole prophylaxis (200 mg daily for 6-12 months post-transplant), and patient outcomes were obtained. The primary outcome was mean estimated glomerular filtration rate (eGFR) at 12 months, comparing those who received fluconazole prophylaxis to those who did not. Secondary outcomes included mean eGFR at 3 months, 6 months, and 9 months post-transplant, patient survival, biopsy-proven graft rejection, graft loss, or a new requirement for post-transplant dialysis, all within 12 months post-transplant. The mean eGFR at 12 months was similar between both groups, with 66.4 ml/min/1.73 m² in the fluconazole prophylaxis group vs. 64.3 ml/min/1.73 m² in the non-fluconazole prophylaxis group (P = 0.55). Secondary outcomes were similar across both groups. Multivariable linear regression found no significant association between fluconazole use and graft function. Fluconazole prophylaxis for prevention of coccidioidomycosis was not associated with adverse graft outcomes in kidney transplant recipients.
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Affiliation(s)
- Laya Reddy
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - George R Thompson III
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA, USA
| | - Natascha Tuznik
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - Tina A Zolfaghari
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Joy Vongspanich Dray
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Janneca Ames
- Department of Pharmacy Services, University of California Davis Medical Center, Sacramento, CA, USA
| | - Daniel Ho
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Scott Crabtree
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Machelle D Wilson
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis Medical Center, Sacramento, CA, USA
| | - Muna Alnimri
- Department of Internal Medicine, Division of Nephrology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Stuart H Cohen
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
- Department of Medical Microbiology and Immunology, University of California-Davis, Davis, CA, USA
| | - Alan Koff
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, CA, USA
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Sadovnikova A, Fine J, Tartar DM. Differences in Diagnosis and Treatment of Nipple Conditions of Reproductive-Age Women at a Tertiary Health System. J Womens Health (Larchmt) 2023; 32:1388-1393. [PMID: 37917916 PMCID: PMC10712359 DOI: 10.1089/jwh.2023.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background: Nipple-areolar complex (NAC) conditions affect reproductive-age women, yet it is not known how care of NAC complaints is distributed among medical specialties. There is a need to characterize all NAC conditions, including their treatment and the care team involved in their clinical management, of nonlactating and lactating patients to determine care gaps. Materials and Methods: This was a retrospective cohort study of reproductive-age females who presented to a large tertiary health system with an NAC complaint between 2015 and 2020. Data about the symptoms, diagnosis, specialty providing care, diagnostic considerations, and treatments were collected. Results: Nipple pain, dermatitis, and thrush were the most common diagnoses among 407 encounters (215 patients). Lactating patients represented half (204, 50%) of the study sample. Benign breast conditions like obstructed ductal openings, accessory nipples, nipple growth, inverted nipples, and chronic and bacterial infections represented a third of all encounters. Primary care physicians (167, 41%) and obstetricians (105, 26%) provided most of the care and referred a third and quarter of patients, respectively, to another provider. Conclusion: The care of patients with NAC complaints is not limited to obstetricians. Internal medicine, family medicine, emergency medicine, and obstetrician-gynecology, dermatology, and surgery resident physicians should receive training in benign breast conditions and clinical lactation.
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Affiliation(s)
- Anna Sadovnikova
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Danielle M. Tartar
- Department of Dermatology, University of California Davis, Sacramento, California, USA
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Sadovnikova A, Wong MD, Fine J, Tran DT, Kapa N. Comparison of Breastfeeding Practices in Mothers With Chronic Kidney Disease With or Without Kidney Transplantation. Breastfeed Med 2023; 18:849-854. [PMID: 37856117 DOI: 10.1089/bfm.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Introduction: Existing literature on pregnant patients with chronic kidney disease (CKD) with or without kidney transplantation focuses mainly on their pregnancy outcomes, but there are scant data on their lactation outcomes. Our objective was to characterize the lactation outcomes of patients with CKD with or without kidney transplantation. Methods: This is a single-institution retrospective cohort study of female-identifying patients with CKD with or without kidney transplantation who had a birth hospitalization at a tertiary health system between 2010 and 2020. Maternal and pediatric data on medical history, pregnancy, delivery, neonatal, and lactation outcomes, medications, and care team involved were collected. Primary outcome measures were breastfeeding initiation within 24-hour postpartum, breastfeeding 8 or more times per day during hospitalization, and any breastfeeding beyond 1 month. Health professionals' comments related to lactation and medications were extracted for qualitative data analysis. Results: Patients with and without kidney transplantation had similar comorbidities, pregnancy, delivery, and neonatal outcomes, and hospital length of stay (p > 0.05). Patients without kidney transplantation were more likely to initiate breastfeeding in the first 24 hours (p = 0.03) after delivery and continue breastfeeding beyond 1 month postpartum. There was a lack of consistency between specialties regarding medication compatibility with lactation. Patients on immunosuppression were more likely to exclusively formula feed (p = 0.02) or to initiate breastfeeding and then switch to formula (p = 0.0004) because of their immunosuppressive medications versus patients on any other medication. Conclusion: Patients with CKD but without a kidney transplantation were more likely to initiate breastfeeding or provide breast milk to their infant within 24 hours of delivery, breastfeed >8 times per day during their hospital stay, and breastfeed beyond a month postpartum than those with a transplanted kidney. Lactation support and pharmacology should be incorporated into graduate medical education.
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Affiliation(s)
| | - Melinda D Wong
- School of Medicine, UC Davis, Sacramento, California, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, UC Davis, Sacramento, California, USA
| | - Darlene T Tran
- School of Medicine, UC Davis, Sacramento, California, USA
| | - Nandakishor Kapa
- Division of Nephrology, Department of Internal Medicine, UC Davis, Sacramento, California, USA
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Rath C, Yoo C, Cheplowitz H, Lo M, Young R, Guglielmo J, Saunders IM, Banerjee R, Young R, Kumar A, Chung A, Rosenberg AS, Costello C, Fine J, Wilson M, Patel N, Banez MT. Predictors of lenalidomide maintenance duration after autologous stem cell transplant in patients with multiple myeloma. J Oncol Pharm Pract 2023; 29:1715-1724. [PMID: 36731514 DOI: 10.1177/10781552221150935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND For patients with multiple myeloma (MM) who have undergone autologous stem cell transplant (auto-SCT), the immunomodulatory agent lenalidomide is a first-line option for maintenance therapy. Because longer durations of lenalidomide maintenance are associated with improved survival, identifying strategies to avoid premature cessation of maintenance is an important priority in the post-transplant setting. OBJECTIVES The primary objective of this analysis was to identify specific clinical predictors of lenalidomide treatment duration that could guide optimal medication management. Key secondary objectives included predictors of intolerable toxicity, rationale for lenalidomide dose reduction/discontinuation, and characterization of dose adjustments. STUDY DESIGN This retrospective, multi-center cohort study included adults with MM who underwent auto-SCT and initiated maintenance lenalidomide between 01/01/2012 and 02/28/2021. Variables assessed as potential predictors of maintenance duration or intolerable toxicity included age, body mass index (BMI), Eastern Cooperative Oncology Group (ECOG) performance status at time of auto-SCT, renal function, initial lenalidomide dose, use of combination maintenance therapy, and cytogenetic risk category. RESULTS Among 299 patients included, the median age at time of auto-SCT was 62 years (range 30-77). The majority of patients had standard-risk cytogenetics (64%) and an ECOG performance status of 0 or 1 (72%). In the overall population, the median duration of maintenance was 1.3 years (range 0.3-8.6 years). The median initial dose of lenalidomide was 10 mg daily (range 2.5-25 mg). During the study period, 35% of patients had a dose reduction due to toxicity, 21% stopped lenalidomide due to disease progression, and 19% stopped due to toxicity. Multivariate linear regression analyses did not identify any significant predictors of lenalidomide duration or discontinuation due to intolerable toxicity. The most frequently reported toxicities leading to discontinuation were cytopenias, rash, and fatigue. CONCLUSION This analysis did not identify any significant risk factors to predict the duration of lenalidomide maintenance or discontinuation for toxicity following auto-SCT in patients with MM. While limited by the retrospective design and relatively small sample size, our findings suggest that a priori lenalidomide dose reductions based on patient co-morbidities or performance status may not substantially affect the duration of lenalidomide maintenance.
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Affiliation(s)
- Carolyn Rath
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Claude Yoo
- Department of Pharmacy Services, University of California, Davis, Sacramento, CA, USA
| | - Halle Cheplowitz
- Department of Pharmacy Services, University of California, San Diego, La Jolla, CA, USA
| | - Mimi Lo
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca Young
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
| | - Julie Guglielmo
- Department of Pharmacy Services, University of California, Davis, Sacramento, CA, USA
| | - Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Rahul Banerjee
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Hematology and Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Richard Young
- Division of Hematology and Oncology, University of California, Davis, Sacramento, CA, USA
| | - Anupama Kumar
- Division of Hematology and Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Alfred Chung
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Aaron Seth Rosenberg
- Division of Hematology and Oncology, University of California, Davis, Sacramento, CA, USA
| | - Caitlin Costello
- Division of Hematology and Oncology and Bone Marrow Transplantation, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Machelle Wilson
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Nimish Patel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Marisela Tan Banez
- Department of Pharmaceutical Services, University of California, San Francisco, San Francisco, CA, USA
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Piña D, Kalistratova V, Boozé Z, Voort WV, Conry K, Fine J, Holland J, Wick J, Ortega B, Javidan Y, Roberto R, Klineberg E, Lipa S, Le H. Sociodemographic Characteristics of Patients Undergoing Surgery for Metastatic Disease of the Spine. J Am Acad Orthop Surg 2023; 31:e675-e684. [PMID: 37311424 DOI: 10.5435/jaaos-d-22-01147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/11/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Some patients, particularly those who are socioeconomically deprived, are diagnosed with primary and/or metastatic cancer only after presenting to the emergency department. Our objective was to determine sociodemographic characteristics of patients undergoing surgery for metastatic spine disease at our institution. METHODS This retrospective case series included patients 18 years and older who presented to the emergency department with metastatic spine disease requiring surgery. Demographics and survival data were collected. Sociodemographic characteristics were estimated using the Social Deprivation Index (SDI) and Area Deprivation Index (ADI) for the state of California. Univariate log-rank tests and Kaplan-Meier curves were used to assess differences in survival for predictors of interest. RESULTS Between 2015 and 2021, 64 patients underwent surgery for metastatic disease of the spine. The mean age was 61.0 ± 12.5 years, with 60.9% being male (n = 39). In this cohort, 89.1% of patients were non-Hispanic (n = 57), 71.9% were White (n = 46), and 62.5% were insured by Medicare/Medicaid (n = 40). The mean SDI and ADI were 61.5 ± 28.0 and 7.7 ± 2.2, respectively. 28.1% of patients (n = 18) were diagnosed with primary cancer for the first time while 39.1% of patients (n = 25) were diagnosed with metastatic cancer for the first time. During index hospitalization, 37.5% of patients (n = 24) received palliative care consult. The 3-month, 6-month, and all-time mortality rates were 26.7% (n = 17), 39.5% (n = 23), and 50% (n = 32), respectively, with 10.9% of patients (n = 7) dying during their admission. Payor plan was significant at 3 months ( P = 0.02), and palliative consultation was significant at 3 months ( P = 0.007) and 6 months ( P = 0.03). No notable association was observed with SDI and ADI in quantiles or as continuous variables. DISCUSSION In this study, 28.1% of patients were diagnosed with cancer for the first time. Three-month and 6-month mortality rates for patients undergoing surgery were 26.7% and 39.5%, respectively. Furthermore, mortality was markedly associated with palliative care consultation and insurance status, but not with SDI and ADI. LEVEL OF EVIDENCE Retrospective case series, Level III evidence.
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Affiliation(s)
- Dagoberto Piña
- From the University of California, Davis School of Medicine, Sacramento, CA (Piña, Kalistratova, and Boozé), University of Louisville, School of Medicine, Louisville, KY (Holland), Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, CA (Piña, Voort, Conry, Wick, Ortega, Javidan, Roberto, Klineberg, and Le), Department of Public Health Sciences, University of California, Davis, Sacramento, CA (Fine), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Lipa)
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Sadovnikova A, Fine J, Tartar DM. Nipple thrush or dermatitis: A retrospective cohort study of nipple-areolar complex conditions and call for coordinated, multidisciplinary care. J Am Acad Dermatol 2023; 88:1383-1384. [PMID: 36754089 DOI: 10.1016/j.jaad.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Affiliation(s)
- Anna Sadovnikova
- School of Medicine, University of California Davis, Sacramento, California.
| | - Jeffrey Fine
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California
| | - Danielle M Tartar
- Department of Dermatology, University of California Davis, Sacramento, California
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Tang SJ, Mor S, Fine J, Shahlaie K. 804 The Association Between Hyperoxia after TBI and Degree of Disability in Pediatric Patients. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Bonilla H, Peluso MJ, Rodgers K, Aberg JA, Patterson TF, Tamburro R, Baizer L, Goldman JD, Rouphael N, Deitchman A, Fine J, Fontelo P, Kim AY, Shaw G, Stratford J, Ceger P, Costantine MM, Fisher L, O’Brien L, Maughan C, Quigley JG, Gabbay V, Mohandas S, Williams D, McComsey GA. Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative. Front Immunol 2023; 14:1129459. [PMID: 36969241 PMCID: PMC10034329 DOI: 10.3389/fimmu.2023.1129459] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.
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Affiliation(s)
- Hector Bonilla
- Department of Medicine and Infectious Diseases, Stanford University, Palo Alto, CA, United States
| | - Michael J. Peluso
- Department of Medicine and Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Judith A. Aberg
- Department of Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, Chief, Division of Infectious Disease, New York, NY, United States
| | - Thomas F. Patterson
- Department of Medicine, Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Robert Tamburro
- Division of Intramural Research, National Institute of Health, Bethesda, MD, United States
| | - Lawrence Baizer
- National Heart Lung and Blood Institute, Division of Lung Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jason D. Goldman
- Department of Medicine, Organ Transplant and Liver Center, Swedish Medical Center, Seattle, WA, United States
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Amelia Deitchman
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey Fine
- Department of Rehabilitation Medicine at New York University (NYU) Grossman School of Medicine, Physical Medicine and Rehabilitation Service, New York University (NYU), New York University Medical Center, New York, NY, United States
| | - Paul Fontelo
- Applied Clinical Informatics Branch, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Arthur Y. Kim
- Department of Medicine at Harvard Medical School, Division of Infectious Disease, Boston, MA, United States
| | - Gwendolyn Shaw
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Jeran Stratford
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Patricia Ceger
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
| | - Liza Fisher
- Long COVID Families, Houston, TX, United States
| | - Lisa O’Brien
- Utah Covid-19 Long Haulers, Salt Lake City, UT, United States
| | | | - John G. Quigley
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Vilma Gabbay
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Sindhu Mohandas
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Williams
- Department of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace A. McComsey
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH, United States
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Berkley E, Takhar S, Wilson M, Fine J, Ho T, Dray J. Effectiveness of an Opioid Stewardship Guideline in Renal Transplant Recipients Post-Discharge. J Pain Palliat Care Pharmacother 2023; 37:44-51. [PMID: 36519299 DOI: 10.1080/15360288.2022.2149672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Previous literature suggests that kidney transplant recipients (KTRs) do not use the majority of opioid tablets prescribed after transplant surgery. This study analyzed the effectiveness of a new pain management guidance in KTRs after discharge from transplant surgery at a renal transplant center. The single center pre-, post- study compared the number of opioid refill requests, patient-reported pain control, multimodal analgesic agents, and opioid tablets prescribed at discharge in both pre- and post- cohorts. A total of 127 patients were included. Data was collected through standardized patient interviews and chart review from electronic medical records. The pre-guidance and post-guidance cohorts had no detectable difference in refill requests (p = 0.365) nor pain control (p = 0.324) post-discharge. The post-group had a significant reduction in opioid tablets prescribed at discharge (22 tablets ± 10 vs 10 tablets ± 2, p = <0.0001) with a significant increase in acetaminophen (p = 0.005) and lidocaine patches (p = <0.0001) prescribed at discharge. Both groups used a mean of three opioid tablets within the first week after discharge. The guidance resulted in 700 fewer opioid tablets in the community during the study time frame, with no difference in pain control nor refill requests after discharge.
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Somani ST, Firestone RL, Donnelley MA, Sanchez L, Hatfield C, Fine J, Wilson MD, Duby JJ. Impact of Vaccination on Cost and Course of Hospitalization Associated with COVID-19 Infection. Antimicrob Steward Healthc Epidemiol 2023; 3:e19. [PMID: 36714292 PMCID: PMC9879923 DOI: 10.1017/ash.2022.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Examine the impact of vaccination status on hospital cost and course for patients admitted with COVID-19 infection. DESIGN Retrospective cohort study characterizing vaccinated and unvaccinated individuals hospitalized for COVID-19 between April 2021 to January 2022. SETTING Large academic medical center. METHODS Patients were included if they were greater than 18 years old, fully vaccinated or unvaccinated against COVID-19, and admitted for COVID-19 infection. PATIENTS 437 consecutively admitted patients for COVID-19 infection met inclusion criteria. Of these, 79 were excluded for unknown or partial vaccination status, transfer from an outside hospital, or multiple COVID-19 related admissions. RESULTS Overall, 279 (77.9%) unvaccinated patients compared to 79 (22.1%) vaccinated patients were hospitalized with a diagnosis of COVID-19. Average length of stay was significantly lower in the vaccinated group (6.47 days versus 8.92 days, P = 0.03). Vaccinated patients experienced a 70.6% lower risk of ICU admission (OR = 0.29, 95% CI 0.12-0.71, P = 0.006). The unadjusted cost of hospitalization was not found to be statistically significant ($119,630 versus $191,146, P = 0.06). After adjusting for age and comorbidities, vaccinated patients experienced a 26% lower cost of hospitalization compared to unvaccinated patients (P = 0.004). Unvaccinated patients incurred a significantly higher cost of hospitalization per day ($29,425 vs $13,845 P < 0.0001). Unvaccinated patients (n = 118, 42.9%) were more likely than vaccinated patients (n = 16, 20.3%) to require high-flow oxygen or mechanical ventilation (OR = 2.95, 95% CI 1.62-5.38, P = 0.0004). CONCLUSION Vaccinated patients experienced a lower cost of hospitalization after adjusting for age and comorbidities and shorter length of stay compared to unvaccinated patients admitted for COVID-19.
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Affiliation(s)
- Selina T. Somani
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Rachelle L. Firestone
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Monica A. Donnelley
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Luciano Sanchez
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Chad Hatfield
- Department of Pharmacy, University of California Davis Health, Sacramento, California
| | - Jeffrey Fine
- Division of Biostatistics, University of California Davis, Sacramento, California
| | - Machelle D. Wilson
- Division of Biostatistics, University of California Davis, Sacramento, California
| | - Jeremiah J. Duby
- Department of Pharmacy, University of California Davis Health, Sacramento, California
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Bradford W, Donnelley M, Fine J, Crabtree S. 331. Blood Culture Identification (BCID) Performance in Polymicrobial Bacteremia. Open Forum Infect Dis 2022. [PMCID: PMC9752303 DOI: 10.1093/ofid/ofac492.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The rapid multiplex PCR (rmPCR)-based FilmArray® blood culture identification (BCID) assay reduces time from positive blood culture to organism identification. Polymicrobial bacteremia is a known area of reduced diagnostic fidelity for BCID and remains incompletely characterized. Methods All cases of clinically confirmed polymicrobial bacteremia at a large academic single center from a 23-month period were evaluated in a retrospective cohort analysis (figure 1). Samples were assorted into BCID/blood culture concordant and BCID/blood culture discordant groups. Clinical characteristics of the two groups were compared, missed organisms were characterized, and changes in antimicrobial regimen in response to BCID results were characterized.
![]() Screening and exclusion process. 207 cultures were included in final analysis from a number screened of 2750 (constituting all positive blood cultures over a 23-month period from February 2019 to January 2021). Microbiologic inclusion criteria were as follows: evidence on final phenotypic culture of at least two separate microorganisms from the same blood culture specimen as long as both organisms were species other than coagulase negative staphylococci. Results A total of 207 samples were identified and studied. Overall, 49.3% (N=102) of polymicrobial cultures were incompletely identified by FilmArray® result. There were no significant group differences in comorbidity status, length of stay, mortality, or source between patients with polymicrobial bacteremia who had complete versus incomplete BCID identification (see table 1). Some 29.9% (38 of 127 total) of species identified corresponded to an organism potentially requiring time-sensitive treatment (relative numbers of each shown in table 2). De-escalation from adequate empiric to inadequate step-down antibiotic coverage following incomplete BCID result occurred in only 8.8% (N=9) of cases (shown in table 3).
![]() Comparison of the characteristics of the BCID/blood culture (BCx) concordant and BCID/BCx discordant groups. Abbreviations: BCx, blood culture; IQR, interquartile range; ICU, intensive care unit; ER, emergency room; TPN, total parenteral nutrition.
![]() Discrepant organisms typically requiring timely treatment identified on blood culture phenotyping but not on BCID. A complete list can be found in supplemental table S1.
![]() Among patients with inaccurate BCIDs, antimicrobial changes and outcomes following return of BCID result are shown below. P-values comparing the four groups are shown. There was no significant association that could be seen in mortality and time to discharge and patient’s empiric therapy and de-escalation therapy status. Abbreviations: IQR, interquartile range; N/A, not applicable. Conclusion BCID frequently results in incomplete identification of blood culture results in patients with polymicrobial bacteremia, but clinical characteristics and outcomes were similar to those of patients with accurate BCID identification. Clinical team de-escalation to inappropriate antibiotic coverage following return the BCID assay was uncommon and was not clearly associated with inferior outcomes. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- William Bradford
- University of California Davis Medical Center, Sacramento, California
| | - Monica Donnelley
- University of California Davis Medical Center, Sacramento, California
| | - Jeffrey Fine
- University of California, Davis, Davis, California
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Panakkal S, Falkenstein B, Tosun AB, Campbell B, Becich M, Fine J, Taylor DL, Chennubhotla SC, Pullara F. Abstract 454: TumorMapr™ analytical software platform: Unbiased spatial analytics and explainable AI (xAI) platform for generating data, extracting information, and creating knowledge from multi to hyperplexed fluorescence and/or mass spectrometry image datasets. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The current computational analyses of multi to hyperplexed fluorescence and/or mass spectrometry image datasets from patient pathology samples are not powerful enough to extract the maximum amount of information or to create the detailed knowledge that is required to advance precision medicine in pathology, including the development of personalized therapeutic strategies, identification of potential novel targets for drug discovery, selection of optimal patient cohorts for clinical trials, and improvement of the predictive power of prognostics/diagnostics.
Methods: TumorMapr harnesses the computational power of proprietary, unbiased spatial analytics, spatial systems pathology, and explainable artificial intelligence (xAI) to extract information and to create knowledge from patient primary disease pathology samples imaged on any of the existing fluorescence and/or mass spectrometry imaging platforms.
Results: To demonstrate the generalizability and utility of the TumorMapr platform, we apply it on two different datasets: hyperplexed immunofluorescence-based colorectal cancer data (51 biomarkers, 431 patients) and imaging mass cytometry-based breast cancer data (35 biomarkers, 281 patients). The TumorMapr platform (i) unlike the biased intensity thresholding approaches, the unbiased and automated functional cell phenotyping discovers a continuum of cell types and cell states, including transitional, multi-transitional cell states and fusion cell types that are critical for disease progression; (ii) derives microdomains with tumor promoting and tumor suppressing properties that are highly predictive of disease progression and response to therapy; (iii) spatial systems pathology analysis taps into the current network biology knowledge databases to derive pathway interactions and signaling networks, identify novel biomarkers and potential molecular targets and drugs, in the spatial context of each microdomain; (iv) xAI application guide, for example, in the case of predicting 5-year risk of recurrence in CRC patients, provides explanations in the form of microdomain-specific networks that are driving disease progression. Using the TumorMapr pipeline we created a prognostic test that shows a vastly superior performance over current approaches in predicting 5-yr risk of recurrence in CRC patients. Further, the TumorMapr platform enables building a rich outcome-specific library of microdomains to directly apply on prospective tissue samples for a companion diagnostic test that predicts disease outcomes.
Citation Format: Samantha Panakkal, Brian Falkenstein, Akif Burak Tosun, Bruce Campbell, Michael Becich, Jeffrey Fine, D. Lansing Taylor, S. Chakra Chennubhotla, Filippo Pullara. TumorMapr™ analytical software platform: Unbiased spatial analytics and explainable AI (xAI) platform for generating data, extracting information, and creating knowledge from multi to hyperplexed fluorescence and/or mass spectrometry image datasets [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 454.
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Ackerman-Barger K, London M, Yi A, Wilson M, Fine J, Kayingo G. Understanding Early Admission Processes: Implications for Physician Assistant Workforce Diversity and Healthcare Equity. J Physician Assist Educ 2022; 33:119-121. [PMID: 35511468 DOI: 10.1097/jpa.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Increasing diversity in the physician assistant (PA) workforce has been identified as a key priority by national PA organizations and PA programs alike. This study aimed to understand why certain applicants did not progress in PA program admissions by exploring common reasons for nonprogression and identifying any demographic trends. METHODS We conducted a retrospective review of applicants over the last 5 consecutive admission cycles at the University of California Davis Physician Assistant program. RESULTS The most common reasons for denial, starting with the most prevalent, were low application score, bachelor's GPA <3.0, missing prerequisite(s), late application, and science GPA <2.7. Several associations between demographic groups and reasons for nonprogression were identified. CONCLUSIONS The findings from a multicohort study might help programs consider these issues in their own programs and identify interventions to support underrepresented applicants.
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Affiliation(s)
- Kupiri Ackerman-Barger
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
| | - Maya London
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
| | - Amanda Yi
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
| | - Machelle Wilson
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
| | - Jeffrey Fine
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
| | - Gerald Kayingo
- Kupiri Ackerman-Barger, PhD, RN , is an associate dean for Health Equity, Diversity, and Inclusion at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Maya London, BS , is a junior specialist at the Center for a Diverse Healthcare Workforce, University of California Davis School of Medicine, Sacramento, California
- Amanda Yi, BA , is admissions coordinator for the Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California
- Machelle Wilson, PhD , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Jeffrey Fine, MPH , is a senior biostatistician for the Clinical and Translational Science Center, University of California Davis, Sacramento, California
- Gerald Kayingo, PhD, PA-C , is assistant dean, executive director, and a professor for the Physician Assistant Leadership and Learning Academy, Graduate School, University of Maryland Baltimore in Baltimore, Maryland
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Zeiderman MR, Fine J, Asserson DB, Davé DR, Bascone CM, Li AI, Pereira CT. Sensorimotor Outcomes of Upper Extremity End-to-Side Nerve Transfers: A Meta-analysis. Ann Plast Surg 2022; 88:S337-S342. [PMID: 35180756 DOI: 10.1097/sap.0000000000003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND End-to-side nerve transfer (ETSNT) for treatment of peripheral nerve injuries is controversial given the myriad anatomic locations, injury types, and indications. Efficacy of ETSNT remains debated. We hypothesized differences in age, sex, transfer location, and time to surgery influence outcomes. METHODS We performed a search of the PubMed database for ETSNT in the upper extremity from 1988 to 2018. Age, sex, transfer location, time to surgery, donor and recipient axons, and strength and sensation outcomes as measured by Medical Research Council scale were extracted from articles. Meaningful recovery was classified as Medical Research Council Grade 3 or greater. Association between meaningful recovery and younger (<25) and older (≥25) patients, injury mechanism, sex, transfer location, donor axons, and recipient axons were calculated using a χ 2 or Fisher exact test. A logistic mixed effect model was used with time to surgery, age (categorical), transfer location, and injury type as a fixed effect, and a random paper effect was included to account for correlation among patients from the same paper. RESULTS One hundred fifteen patients from 11 studies were included. Neither age (continuous variable, P = 0.68) nor time to surgery ( P = 0.28) affected meaningful recovery. Injury mechanism, sex, and younger age (<25 vs ≥25 years) were not associated with meaningful recovery. Within the brachial plexus ETSNT demonstrated median M4 ± 1 postoperative strength, with trunks/cords as the primary axon donor ( P = 0.03). The musculocutaneous nerve demonstrated promising but variable results in 31 patients with median strength M3 ± 4. Digital nerves consistently demonstrated meaningful sensory recovery as both donor and recipient axons (15 of 15, 100%). Logistic regression analysis demonstrated that odds of meaningful recovery after ETSNT are significantly greater for transfers within the brachial plexus compared with the distal arm (odds ratio, 41.9; 95% CI, 1.1-1586.7, P = 0.04), but location does not significantly affect meaningful recovery ( P = 0.22). CONCLUSIONS Patients undergoing ETSNT for digital nerve injury demonstrated meaningful recovery. End-to-side nerve transfer seems to be more efficacious when performed within the brachial plexus. This study did not find sex, injury mechanism, or time to surgery to significantly affect meaningful recovery. Additional study is needed to better evaluate the effectiveness of ETSNT in the upper extremity.
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Affiliation(s)
- Matthew R Zeiderman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Jeffrey Fine
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | | | - Dattesh R Davé
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Corey M Bascone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Andrew I Li
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Clifford T Pereira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
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18
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Kaur M, Black D, Fine J, Wise BL. Referrals for physical therapy for osteoarthritis during the COVID-19 pandemic: A retrospective analysis. PLoS One 2021; 16:e0259679. [PMID: 34739521 PMCID: PMC8570525 DOI: 10.1371/journal.pone.0259679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability among Americans. Physical therapy (PT) is recommended per the 2019 ACR /Arthritis Foundation Guideline for Treatment of OA of the Hand, Hip, and Knee. During COVID-19, access to healthcare has been altered in a variety of clinical settings, with the pandemic creating delays in healthcare, with an unknown impact on access to PT care for OA. Objectives We sought to determine whether referrals to PT for OA were reduced in 2020 during the COVID-19 pandemic compared to 2019. Methods A retrospective analysis was done of 3586 PT referrals placed by the University of California, Davis for 206 OA ICD-10 codes from January to November 2019 and from January to November 2020. The numbers of PT referrals per month of each year were compared using both descriptive statistics and Poisson Regression analysis. Results A total of 1972 PT referrals for OA were placed from January to November 2019. Only 1614 referrals for OA were placed from January to November 2020, representing a significant decrease (p = 0.001). Month-by-month analysis of 2020 compared to 2019 revealed statistically significant drops in PT referrals for OA in April (p = 0.001), May (p = 0.001), and August (p = 0.001). Conclusions These findings reveal a significant reduction in the number of referrals for PT for OA placed in 2020 during the first year of the COVID-19 pandemic. These reductions were particularly evident in the months following state-mandated actions and closures. Factors associated with this outcome may include decreased access to primary care providers, perceptions of PT availability by health care providers, decreased mobility limiting access to both clinic and PT appointments, and/or willingness to engage in PT by patients during the pandemic.
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Affiliation(s)
- Manmeet Kaur
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, United States of America
- * E-mail:
| | - Daniel Black
- Division of Clinical Affairs Division of Quality and Safety, Department of Medicine, University of California, Davis, Sacramento, CA, United States of America
| | - Jeffrey Fine
- Department of Public Health Sciences, University of California, Davis, Sacramento, CA, United States of America
| | - Barton L. Wise
- Division of Rheumatology, Department of Orthopaedic Surgery, Department of Medicine, University of California, Davis, Sacramento, CA, United States of America
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Yu A, Wilkes M, Iosif AM, Rea M, Fisher A, Fine J, Perry R, Rice E, Jandrey K, Griffin E, Sciolla A. Exploring the Relationships Between Resilience and News Monitoring with COVID Distress in Health Profession Students. Acad Psychiatry 2021; 45:566-574. [PMID: 33928535 PMCID: PMC8083098 DOI: 10.1007/s40596-021-01444-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/22/2021] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Alarming rates of anxiety and burnout in pre-clinical health profession trainees are now challenged by additional COVID-19 stressors. This study explored COVID-related stressors among first-year medical, physician assistant, nurse practitioner, and veterinary medical students. The authors examined associations between resilience, news monitoring, and COVID stress. METHODS Students completed an online questionnaire that included the Brief Resilience Scale at their matriculation in August 2019. Survey results were linked to demographic information collected by all schools. A follow-up survey in May 2020 included original questions on COVID-19 stressors and news monitoring. Statistical analyses included descriptive statistics and multivariable linear regression models. RESULTS Across schools, 74% (266/360) provided consent for the 2019 survey, and 76% (201/264) responded to COVID-19 questions in the follow-up 2020 survey. Students were "extremely" or "very" concerned about family members getting infected (n = 71, 76% School of Medicine (SOM); n = 31, 76% School of Nursing (SON); n = 50, 75% School of Veterinary Medicine (SVM)) and curriculum schedule changes (n = 72, 78%, SOM; n = 28, 68% SON; n = 52, 79% SVM). Greater frequency of COVID news monitoring was associated with greater COVID-related stress (p = 0.02). Higher resilience at matriculation was associated with lower COVID-related stress ten months later (p < 0.001). CONCLUSIONS Amid COVID-19 uncertainty, health science schools should address the immense student stress regarding curriculum disruptions. The results of this study underscore the powerful role of resilience in protecting against stress not only during the known academic rigor of health professions training but also during unprecedented crises.
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Affiliation(s)
- Allison Yu
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Michael Wilkes
- University of California, Davis School of Medicine, Sacramento, CA, USA.
| | - Ana-Maria Iosif
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Margaret Rea
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Alice Fisher
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Jeffrey Fine
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Ross Perry
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Elizabeth Rice
- University of California, Davis School of Nursing, Sacramento, CA, USA
| | - Karl Jandrey
- University of California, Davis School of Veterinary Medicine, Davis, CA, USA
| | - Erin Griffin
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Andres Sciolla
- University of California, Davis School of Medicine, Sacramento, CA, USA
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20
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Ereth MH, Fine J, Stamatatos F, Mathew B, Hess D, Simpser E. Healthcare-associated infection impact with bioaerosol treatment and COVID-19 mitigation measures. J Hosp Infect 2021; 116:69-77. [PMID: 34302883 PMCID: PMC8295046 DOI: 10.1016/j.jhin.2021.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The real-world impact of breathing zone air purification and coronavirus disease 2019 (COVID-19) mitigation measures on healthcare-associated infections is not well documented. Engineering solutions to treat airborne transmission of disease may yield results in controlled test chambers or single rooms, but have not been reported on hospital-wide applications, and the impact of COVID-19 mitigation measures on healthcare-associated infection rates is unknown. AIM To determine the impact of hospital-wide bioaerosol treatment and COVID-19 mitigation measures on clinical outcomes. METHODS The impact of the step-wise addition of air disinfection technology and COVID-19 mitigation measures to standard multi-modal infection control on particle counts, viral and bacterial bioburden, and healthcare-associated infection rates was investigated in a 124-bed hospital (>100,000 patient-days over 30 months). FINDINGS AND CONCLUSION The addition of air disinfection technology and COVID-19 mitigation measures reduced airborne ultrafine particles, altered hospital bioburden, and reduced healthcare-associated infections from 11.9 to 6.6 (per 1000 patient-days) and from 6.6 to 1.0 (per 1000 patient-days), respectively (P<0.0001, R2=0.86). No single technology, tool or procedure will eliminate healthcare-associated infections, but the addition of a ubiquitous facility-wide engineering solution at limited expense and with no alteration to patient, visitor or staff traffic or workflow patterns reduced infections by 45%. A similar impact was documented with the addition of comprehensive, restrictive, and labour- and material-intensive COVID-19 mitigation measures. To the authors' knowledge, this is the first direct comparison between traditional infection control, an engineering solution and COVID-19 mitigation measures.
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Affiliation(s)
- M H Ereth
- Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - J Fine
- St. Mary's Hospital for Children, Bayside, NY, USA
| | | | - B Mathew
- St. Mary's Hospital for Children, Bayside, NY, USA
| | - D Hess
- SecureAire, Inc, Dunedin, FL, USA
| | - E Simpser
- St. Mary's Hospital for Children, Bayside, NY, USA
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21
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Abstract
Aim Compare glycemic control in human immunodeficiency (HIV)-positive patients on antiretroviral therapy to HIV-negative patients following pharmacist interventions. Methods/Results This retrospective observational cohort study conducted at a Federally Qualified Health Center included adults with type II diabetes mellitus who attended at least two clinical pharmacy appointments between January 1, 2018 and July 31, 2019. Exclusion criteria included missing pre- or post-hemoglobin A1c (HgbA1c) values, type 1 diabetes, pregnancy, breastfeeding, deceased, or untreated HIV. The primary endpoint was change in HgbA1c from baseline to month 3. Secondary endpoints were change in HgbA1c at 6, 9, and 12 months, and time to goal. Additional endpoints included changes in number of anti-diabetic agents, blood pressure, body mass index, hypoglycemic events, percent of patients on a sodium-glucose co-transporter-2 (SGLT-2) inhibitor or glucagon-like peptide (GLP-1) agonist. This study was exempt from the University of California, Davis Institutional Review Board as a continuous quality improvement study.Seventy-eight patients were included, 17 of whom were HIV-positive. At 3 months, HgbA1c was reduced by -1.7% and -1.2% (p =0.31) for HIV-positive and -negative patients, respectively. In the pooled cohort, HgbA1c was reduced from baseline at all time points, and 24% of patients achieved HgbA1c below 7.0%. The number of antidiabetic medications remained unchanged or was decreased in 60% of patients. Conclusion The study demonstrated clinically important HgbA1c reductions without increasing the medication burden in most patients. There was no significant difference in glycemic management between HIV-positive and HIV-negative patients.
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Affiliation(s)
- Noelle E Nelson
- University of California, Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Machelle Wilson
- University of California, Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Jeffrey Fine
- University of California, Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817
| | - Rebecca M Hluhanich
- University of California, Davis Health, 2315 Stockton Blvd, Sacramento, CA 95817
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22
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Bunde S, Baskota SU, Fine J, Khader S. Educational Case: High-Grade Serous Carcinoma of the Ovary. Acad Pathol 2021; 8:23742895211032339. [PMID: 34471668 PMCID: PMC8404665 DOI: 10.1177/23742895211032339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Sophia Bunde
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | | | - Jeffrey Fine
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samer Khader
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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23
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Haffner MR, Le HV, Saiz AM, Han G, Fine J, Wolinsky P, Klineberg EO. Postoperative In-Hospital Morbidity and Mortality of Patients With COVID-19 Infection Compared With Patients Without COVID-19 Infection. JAMA Netw Open 2021; 4:e215697. [PMID: 33844002 PMCID: PMC8042521 DOI: 10.1001/jamanetworkopen.2021.5697] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This cohort study uses the Vizient Clinical Data Base to compare the postoperative in-hospital morbidity and mortality of surgical patients with COVID-19 infection with patients without COVID-19 infection.
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Affiliation(s)
- Max R. Haffner
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | - Hai V. Le
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | - Augustine M. Saiz
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | - Gloria Han
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | - Jeffrey Fine
- Division of Biostatistics, University of California, Davis, Davis
| | - Philip Wolinsky
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | - Eric O. Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
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24
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Seldon C, Shrivastava G, Jarboe J, Fine J, Conway S, Pretell J, Freedman L, Wolfson A, Zhao W, Kwon D, Rosenberg A, Trent J, Yechieli R. Tumor Necrosis Following Multi-Modality Neoadjuvant Therapy for Sarcoma: A Single Institution Series. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Maghsoudipour M, Bosompra N, Jen R, Li Y, Moore S, DeYoung P, Fine J, Edwards B, Gilbertson D, Owens R, Morgan T, Malhotra A. 0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes.
Methods
Sixty five patients with OSA (AHI>10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI>10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT).
Results
Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs.
Conclusion
Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear.
Support
R01HL085188-05A1 (U.S. NIH Grant/Contract)
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Affiliation(s)
| | - N Bosompra
- University of California San Diego, La Jolla, CA
| | - R Jen
- University of California San Diego, La Jolla, CA
| | - Y Li
- University of California San Diego, La Jolla, CA
| | - S Moore
- University of California San Diego, La Jolla, CA
| | - P DeYoung
- University of California San Diego, La Jolla, CA
| | - J Fine
- University of California San Diego, La Jolla, CA
| | - B Edwards
- University of California San Diego, La Jolla, CA
| | - D Gilbertson
- University of California San Diego, La Jolla, CA
| | - R Owens
- University of California San Diego, La Jolla, CA
| | - T Morgan
- University of California San Diego, La Jolla, CA
| | - A Malhotra
- University of California San Diego, La Jolla, CA
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26
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Del Vecchio A, Germer CM, Elias LA, Fu Q, Fine J, Santello M, Farina D. The human central nervous system transmits common synaptic inputs to distinct motor neuron pools during non-synergistic digit actions. J Physiol 2019; 597:5935-5948. [PMID: 31605381 PMCID: PMC6972516 DOI: 10.1113/jp278623] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022] Open
Abstract
Key points Neural connectivity between distinct motor neuronal modules in the spinal cord is classically studied through electrical stimulation or multi‐muscle EMG recordings. We quantified the strength of correlation in the activity of two distinct populations of motor neurons innervating the thenar and first dorsal interosseous muscles during tasks that required the two hand muscles to exert matched or un‐matched forces in different directions. We show that when the two hand muscles are concurrently activated, synaptic input to the two motor neuron pools is shared across all frequency bandwidths (representing cortical and spinal input) associated with force control. The observed connectivity indicates that motor neuron pools receive common input even when digit actions do not belong to a common behavioural repertoire.
Abstract Neural connectivity between distinct motor neuronal modules in the spinal cord is classically studied through electrical stimulation or multi‐muscle EMG recordings. Here we quantify the strength of correlation in the activity of two distinct populations of motor neurons innervating the thenar and first dorsal interosseous muscles in humans during voluntary contractions. To remove confounds associated with previous studies, we used a task that required the two hand muscles to exert matched or un‐matched forces in different directions. Despite the force production task consisting of uncommon digit force coordination patterns, we found that synaptic input to motor neurons is shared across all frequency bands, reflecting cortical and spinal inputs associated with force control. The coherence between discharge timings of the two pools of motor neurons was significant at the delta (0–5 Hz), alpha (5–15 Hz) and beta (15–35 Hz) bands (P < 0.05). These results suggest that correlated input to motor neurons of two hand muscles can occur even during tasks not belonging to a common behavioural repertoire and despite lack of common innervation. Moreover, we show that the extraction of activity from motor neurons during voluntary force control removes cross‐talk associated with global EMG recordings, thus allowing direct in vivo interrogation of spinal motor neuron activity. Neural connectivity between distinct motor neuronal modules in the spinal cord is classically studied through electrical stimulation or multi‐muscle EMG recordings. We quantified the strength of correlation in the activity of two distinct populations of motor neurons innervating the thenar and first dorsal interosseous muscles during tasks that required the two hand muscles to exert matched or un‐matched forces in different directions. We show that when the two hand muscles are concurrently activated, synaptic input to the two motor neuron pools is shared across all frequency bandwidths (representing cortical and spinal input) associated with force control. The observed connectivity indicates that motor neuron pools receive common input even when digit actions do not belong to a common behavioural repertoire.
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Affiliation(s)
- A Del Vecchio
- Neuromechanics & Rehabilitation Technology Group, Department of Bioengineering, Faculty of Engineering, Imperial College London, UK
| | - C M Germer
- Neural Engineering Research Laboratory, Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, Sao Paulo, Brazil
| | - L A Elias
- Neural Engineering Research Laboratory, Department of Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas, Sao Paulo, Brazil.,Center for Biomedical Engineering, University of Campinas, Sao Paulo, Brazil
| | - Q Fu
- Neuromechanical Systems Laboratory, Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, USA
| | - J Fine
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Pheonix, AZ, USA
| | - M Santello
- Neural Control of Movement Laboratory, School of Biological and Health Systems Engineering, Arizona State University, Pheonix, AZ, USA
| | - D Farina
- Neuromechanics & Rehabilitation Technology Group, Department of Bioengineering, Faculty of Engineering, Imperial College London, UK
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27
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Ryan T, Wexler D, Wawrzonek A, Mahdavi S, Westdal J, Fine J. C-64 The Verbal Shift Social Assessment: Examining Differences in Emotion Recognition, Attention, and Event Prediction Between Children with HFASD, ADHD, and Typically Developing Peers. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
A pilot study of an experimental instrument extending the ‘verbal shift’ hypothesis indicating HFASD bias towards language over nonverbal cues (Grossman, Klin, Carter & Volkmar, 2000). We hypothesized HFASD differentiates from ADHD in social video interpretation in the degree of reliance on semantic content for correct responses.
Method
68 children ages 7-13 were recruited from the community (21 HFASD, 20 ADHD, 27 Control). Children viewed video pairs of social interaction. A “masked” version preserved prosody and visual cues, but not words. An “unmasked” version was naturalistic, with interpretable spoken language. Three questions were asked following each video scene (masked presented first): 1) the emotion of an actor, 2) a question to verify child was attending, 3) prediction about what might happen next. MANCOVA with post-hoc analysis was used to examine the between-group differences on performance as measured by the number of correct responses gained when the videos were unmasked.
Results
There were no group differences in age, gender, and WASI PRI. With WASI VCI controlled, emotion recognition and prediction questions differed significantly between groups (F = 3.907, p = .025, pEta2 = .109; F = 4.725, p = .012, pEta2 = .129), with ASD having the largest unmasked>masked correct gain compared to ADHD (p = .05; p = .029) and controls (p = .009; p = .004) There were no differences between ADHD and controls. The attention question did not differ among groups; focus on the details of the videos was similar in participants regardless of diagnosis.
Conclusions
Results of this pilot study indicate that emotion recognition and event prediction may be useful diagnostic predictors when differentiating HFASD from ADHD using naturalistic video stimuli.
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28
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Patel A, Fine J, Pai R, Naghavi M, Budoff M. SCREENING FOR CORONARY ARTERY CALCIUM IN ASYMPTOMATIC ADULTS BASED ON THE 10-YEAR FRAMINGHAM RISK SCORE IN THE SOCIETY FOR HEART ATTACK PREVENTION AND ERADICATION (SHAPE) COHORT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Wells WA, Thrall M, Sorokina A, Fine J, Krishnamurthy S, Haroon A, Rao B, Shevchuk MM, Wolfsen HC, Tearney GJ, Hariri LP. In Vivo and Ex Vivo Microscopy: Moving Toward the Integration of Optical Imaging Technologies Into Pathology Practice. Arch Pathol Lab Med 2018; 143:288-298. [PMID: 30525931 DOI: 10.5858/arpa.2018-0298-ra] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The traditional surgical pathology assessment requires tissue to be removed from the patient, then processed, sectioned, stained, and interpreted by a pathologist using a light microscope. Today, an array of alternate optical imaging technologies allow tissue to be viewed at high resolution, in real time, without the need for processing, fixation, freezing, or staining. Optical imaging can be done in living patients without tissue removal, termed in vivo microscopy, or also in freshly excised tissue, termed ex vivo microscopy. Both in vivo and ex vivo microscopy have tremendous potential for clinical impact in a wide variety of applications. However, in order for these technologies to enter mainstream clinical care, an expert will be required to assess and interpret the imaging data. The optical images generated from these imaging techniques are often similar to the light microscopic images that pathologists already have expertise in interpreting. Other clinical specialists do not have this same expertise in microscopy, therefore, pathologists are a logical choice to step into the developing role of microscopic imaging expert. Here, we review the emerging technologies of in vivo and ex vivo microscopy in terms of the technical aspects and potential clinical applications. We also discuss why pathologists are essential to the successful clinical adoption of such technologies and the educational resources available to help them step into this emerging role.
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Affiliation(s)
- Wendy A Wells
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael Thrall
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Anastasia Sorokina
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jeffrey Fine
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Savitri Krishnamurthy
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Attiya Haroon
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Babar Rao
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria M Shevchuk
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Herbert C Wolfsen
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Guillermo J Tearney
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Lida P Hariri
- From the Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (Dr Wells); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Thrall); the Department of Pathology, University of Illinois at Chicago, Chicago (Dr Sorokina); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Fine); the Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston (Dr Krishnamurthy); the Department of Dermatology, Rutgers-Robert Wood Johnson Medical School, Somerset, New Jersey (Drs Haroon and Rao); the Department of Pathology, Weill Cornell Medical College, New York, New York (Dr Shevchuk); the Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida (Dr Wolfsen); and the Wellman Center for Photomedicine (Dr Tearney) and the Department of Pathology (Drs Tearney and Hariri), Massachusetts General Hospital, Harvard Medical School, Boston
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Sharma A, Bansal-Travers M, Celestino P, Fine J, Reid ME, Hyland A, O'Connor R. Using a Smoking Cessation Quitline to Promote Lung Cancer Screening. Am J Health Behav 2018; 42:85-100. [PMID: 30158004 DOI: 10.5993/ajhb.42.6.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective We assessed whether in-depth messaging delivered via a smoking cessation quitline results in participants: (1) speaking to their physician, or (2) insurance company regarding lung cancer screening (LCS). MethodsEligible participants lived in New York State and met the United States Preventive Services Task Force eligibility criteria for LCS (N = 1000). A randomized trial was conducted among New York State Smokers' Quitline participants to assess the impact of a brochure containing information on risks, benefits, and costs associated with LCS (control group) versus the brochure supplemented with phone-based in-depth messaging (treatment group). ResultsAfter a 4-month telephone survey (N = 431), associations between the study groups were examined for: (1) speaking with a physician regarding LCS, and (2) speaking with an insurance company about LCS coverage. Multivariate logistic regression models adjusted for demographics, insurance status, emphysema/COPD, and past 30-day cigarette use found no significant associations. However, sensitivity analyses among control participants found significant associations, including for speaking with a physician (p < .05) by receipt of the study brochure. Analyses repeated in the treatment group also had statistically significant findings emerge, including for speaking with insurance company (p < .05). ConclusionsThe educational brochure may be an effective and low-cost way to deliver information about LCS.
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Patel AA, Fine J, Naghavi M, Budoff MJ. Radiation exposure and coronary artery calcium scans in the society for heart attack prevention and eradication cohort. Int J Cardiovasc Imaging 2018; 35:179-183. [PMID: 30084106 DOI: 10.1007/s10554-018-1431-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 01/30/2023]
Abstract
Coronary artery calcium (CAC) scoring is used in asymptomatic patients to improve their clinically predicted risk for future cardiovascular events. Current CT protocols seek to reduce radiation exposure without diminishing image quality. Reported radiation exposure remains widely variable (0.8-5 mSv) depending on the type of protocol. In this study, we report the radiation exposure of CAC scoring from the Society for Heart Attack Prevention and Eradication (SHAPE) early detection program cohort sites, which spanned multiple centers using 64-MDCT (multi-detector computed tomography) scanners. We reviewed radiation exposure in milliSieverts (mSv) for 82,214 participants from the SHAPE early detection program cohort who underwent CAC scoring. This occurred over a 2.5-year period (2012-2014) divided among 33 sites in 7 countries with four different types 64-MDCT scanners. The effective radiation dose was reported as mSv. Mean radiation dosing amongst all 82,214 participants was 1.03 mSv, a median dose of 0.94 mSv. The mean radiation dose ranged from 0.76 to 1.31 mSv across the 33 sites involved with the SHAPE program cohort. Subgroup analysis by age, gender or body mass index (BMI) less than 30 kg/m2 showed no variability. Radiation dose in patients with BMI > 30 kg/m2 were significantly greater than other subgroups (µ = 1.96 mSv, p < 0.001). The use of 64-MDCT scanners and protocols provide the effective radiation dose for CAC scoring, which is approximately 1 mSv. This is consistently lower than previously reported for CAC scanning, regardless of scanner type, age or gender. In contrast, a greater BMI influenced mean radiation doses.
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Affiliation(s)
- Amish A Patel
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.,Riverside School of Medicine Department of Cardiovascular Medicine, University of California, Riverside, CA, USA
| | - Jeffrey Fine
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Morteza Naghavi
- Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA. .,Society for Heart Attack Prevention and Eradication Program, Palo Alto, CA, USA.
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Abstract
Abstract:Advances in electronic image recording and computer technologyhave resulted in a remarkable increase in the power and flexibility of interactive computer-video teaching systems. The University of Washington Health Science Videodisc Development Group first demonstrated a laser videodisc controlled by a remote central computer in 1980. Even this rudimentary unit highlighted basic medical informatics principles including: rapid accessibility; a “generic” or multi-purposed format; ease of computer control; and large collections of valid, rigorously reviewed images. Advances in medical informatics have led to the development of the following previously undescribed series of teaching units:1. The hypertext programs Hypercard, Linkway, and Guide have been used with videodiscs to develop easy-to-use instructional and reference materials. These materials demonstrate the ease with which a computer-naive instructor may develop new programs and the advantage that the intuitive nature of these programs brings to student users.2. Patient simulations using single and double screens plus pre-defined knowledge structures;3. Interactive single topic tutorials using preset knowledge structures;4. A key-word-based disc searching system;5. Electronic video microscopy;6. A series of programs developed independently by health science faculty who have purchased multi-purpose videodiscs that demonstrate the flexibility of the multi-purpose or “generic”: collection concept.
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Wexler D, Fine J. B-34A Review of Phonological Processing and Rapid Naming in Children with High-Functioning Autism Spectrum Disorder. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Spagnolo DM, Gyanchandani R, Al-Kofahi Y, Stern AM, Lezon TR, Gough A, Meyer DE, Ginty F, Sarachan B, Fine J, Lee AV, Taylor DL, Chennubhotla SC. Pointwise mutual information quantifies intratumor heterogeneity in tissue sections labeled with multiple fluorescent biomarkers. J Pathol Inform 2016; 7:47. [PMID: 27994939 PMCID: PMC5139455 DOI: 10.4103/2153-3539.194839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/09/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Measures of spatial intratumor heterogeneity are potentially important diagnostic biomarkers for cancer progression, proliferation, and response to therapy. Spatial relationships among cells including cancer and stromal cells in the tumor microenvironment (TME) are key contributors to heterogeneity. METHODS We demonstrate how to quantify spatial heterogeneity from immunofluorescence pathology samples, using a set of 3 basic breast cancer biomarkers as a test case. We learn a set of dominant biomarker intensity patterns and map the spatial distribution of the biomarker patterns with a network. We then describe the pairwise association statistics for each pattern within the network using pointwise mutual information (PMI) and visually represent heterogeneity with a two-dimensional map. RESULTS We found a salient set of 8 biomarker patterns to describe cellular phenotypes from a tissue microarray cohort containing 4 different breast cancer subtypes. After computing PMI for each pair of biomarker patterns in each patient and tumor replicate, we visualize the interactions that contribute to the resulting association statistics. Then, we demonstrate the potential for using PMI as a diagnostic biomarker, by comparing PMI maps and heterogeneity scores from patients across the 4 different cancer subtypes. Estrogen receptor positive invasive lobular carcinoma patient, AL13-6, exhibited the highest heterogeneity score among those tested, while estrogen receptor negative invasive ductal carcinoma patient, AL13-14, exhibited the lowest heterogeneity score. CONCLUSIONS This paper presents an approach for describing intratumor heterogeneity, in a quantitative fashion (via PMI), which departs from the purely qualitative approaches currently used in the clinic. PMI is generalizable to highly multiplexed/hyperplexed immunofluorescence images, as well as spatial data from complementary in situ methods including FISSEQ and CyTOF, sampling many different components within the TME. We hypothesize that PMI will uncover key spatial interactions in the TME that contribute to disease proliferation and progression.
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Affiliation(s)
- Daniel M Spagnolo
- Program in Computational Biology, Joint Carnegie Mellon University-University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rekha Gyanchandani
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yousef Al-Kofahi
- GE Global Research Center, Diagnostics, Imaging and Biomedical Technologies, Niskayuna, NY, USA
| | - Andrew M Stern
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; Drug Discovery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy R Lezon
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; Drug Discovery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Albert Gough
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; Drug Discovery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dan E Meyer
- GE Global Research Center, Diagnostics, Imaging and Biomedical Technologies, Niskayuna, NY, USA
| | - Fiona Ginty
- GE Global Research Center, Diagnostics, Imaging and Biomedical Technologies, Niskayuna, NY, USA
| | - Brion Sarachan
- GE Global Research Center, Software Science and Analytics Organization, Niskayuna, NY, USA
| | - Jeffrey Fine
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adrian V Lee
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - D Lansing Taylor
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania; Drug Discovery Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - S Chakra Chennubhotla
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Patel A, Budoff M, Fine J. IDENTIFYING HIGH-RISK ASYMPTOMATIC INDIVIDUALS USING CORONARY ARTERY CALCIUM SCAN IN THE SOCIETY FOR HEART ATTACK PREVENTION AND ERADICATION COHORT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31735-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Blacklock DB, Gordon RM, Fine J, Watson M. Metazoan Immunity: a Report on Recent Investigations. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1930.11684623] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Westdal J, Fine J, Mahdavi S, Constantine K. B-40Relation of Auditory and Visual Sustained Attention to Reading Skills in Low-Skilled Readers. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Smirnova D, Walters J, Fine J, Muchnik-Rozanov Y, Paz M, Lerner V, Belmaker RH, Bersudsky Y. Second language as a compensatory resource for maintaining verbal fluency in bilingual immigrants with schizophrenia. Neuropsychologia 2015; 75:597-606. [PMID: 26162616 DOI: 10.1016/j.neuropsychologia.2015.06.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/08/2015] [Accepted: 06/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Due to the large migrations over the past three decades, large numbers of individuals with schizophrenia are learning a second language and being seen in clinics in that second language. We conducted within-subject comparisons to clarify the contribution of clinical, linguistic and bilingual features in the first and second languages of bilinguals with schizophrenia. METHODS Ten bilingual Russian(L1) and Hebrew(L2) proficient patients, who developed clinical schizophrenia after achieving proficiency in both languages, were selected from 60 candidates referred for the study; they were resident in Israel 7-32 years with 3-10 years from immigration to diagnosis. Clinical, linguistic and fluency markers were coded in transcripts of clinical interviews. RESULTS There was a trend toward more verbal productivity in the first language (L1) than the second language (L2). Clinical speech markers associated with thought disorder and cognitive impairment (blocking and topic shift) were similar in both languages. Among linguistic markers of schizophrenia, Incomplete syntax and Speech role reference were significantly more frequent in L2 than L1; Lexical repetition and Unclear reference demonstrated a trend in the same direction. For fluency phenomena, Discourse markers were more prevalent in L1 than L2, and Codeswitching was similar across languages, showing that the patients were attuned to the socio-pragmatics of language use. CONCLUSIONS More frequent linguistic markers of schizophrenia in L2 show more impairment in the syntactic/semantic components of language, reflecting greater thought and cognitive dysfunction. Patients are well able to acquire a second language. Nevertheless, schizophrenia finds expression in that language. Finally, more frequent fluency markers in L1 suggests motivation to maintain fluency, evidenced in particular by codeswitched L2 lexical items, a compensatory resource.
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Affiliation(s)
- D Smirnova
- Samara State Medical University, Department of Psychiatry, Samara, Russia
| | - J Walters
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - J Fine
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - Y Muchnik-Rozanov
- Bar-Ilan University, Department of English Literature and Linguistics, Ramat Gan, Israel
| | - M Paz
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel
| | - V Lerner
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel
| | | | - Y Bersudsky
- Ben-Gurion University of the Negev, Ministry of Health Mental Health Center, Beer-Sheba, Israel.
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Smirnova D, Walters J, Fine J, Muchnik-Rozanov Y, Paz M, Lerner V, Belmaker H, Bersudsky Y. Schizophrenia in Bilingual Immigrants: is Verbal Fluency Preserved in Second Language Acquisition? Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31288-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kamani AA, Smith EL, Fine J, Reich LM. Physical Medicine Rehabilitation Consults and 30 Day Readmissions: A Retrospective Chart Review. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Constantine K, Fine J, Palejwala M, Mahdavi S, daCruz K, Westdal J. B-86 * Mental Rotation in Children. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martinez J, Francis G, Liu W, Pradzinsky N, Fine J, Wilson M, Hanson L, Frey W, Zochodne D, Gordon T, Toth C. RETRACTION NOTICE TO “INTRANASAL DELIVERY OF INSULIN AND A NITRIC OXIDE SYNTHASE INHIBITOR IN AN EXPERIMENTAL MODEL OF AMYOTROPHIC LATERAL SCLEROSIS” [NEUROSCIENCE 157 (2008) 908–925]. Neuroscience 2014; 275:549. [DOI: 10.1016/j.neuroscience.2014.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fine J, Mahdavi S, Kara C, daCruz K, Westdal J, Palejwala M. B-26 * Visual Sequencing and Global Attention Influences on Mathematics Learning. Arch Clin Neuropsychol 2014. [DOI: 10.1093/arclin/acu038.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Parke E, Hart J, Baldock D, Barchard K, Etcoff L, Allen D, Stolberg P, Nardi N, Cohen J, Jones W, Loe S, Etcoff L, Delgaty L, Tan A, Bunner M, Delgaty L, Tan A, Bunner M, Tan A, Delgaty L, Bunner M, Tan A, Delgaty L, Bunner M, Goodman G, Kim W, Nolty A, Marion S, Davis A, Finch W, Piehl J, Moss L, Nogin R, Dean R, Davis J, Lindstrom W, Poon M, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fonseca F, Bure-Reyes A, Stewart J, Golden C, Fields K, Hill B, Corley E, Russ K, Boettcher A, Musso M, Rohling M, Rowden A, Downing K, Benners M, Miller D, Maricle D, Dugbartey T, Anum A, Anderson J, Daniel M, Hoskins L, Gillis K, Khen S, Carter K, Ayers C, Neeland I, Cullum M, Weiner M, Rossetti H, Buddin W, Mahal S, Schroeder R, Baade L, Macaluso M, Phelps K, Evans C, Clark J, Vickery C, Chow J, Stokic D, Phelps K, Evans C, Watson S, Odom R, Clark J, Clark J, Odom R, Evans C, Vickery C, Thompson J, Noggle C, Kane C, Kecala N, Lane E, Raymond M, Woods S, Iudicello J, Dawson M, Ghias A, Choe M, Yudovin S, McArthur D, Asarnow R, Giza C, Babikian T, Tun S, O'Neil M, Ensley M, Storzbach D, Ellis R, O'Neil M, Carlson K, Storzbach D, Brenner L, Freeman M, Quinones A, Motu'apuaka M, Ensley M, Kansagara D, Brickell T, Grant I, Lange R, Kennedy J, Ivins B, Marshall K, Prokhorenko O, French L, Brickell T, Lange R, Bhagwat A, French L, Weber E, Nemeth D, Songy C, Gremillion A, Lange R, Brubacher J, Shewchuk J, Heran M, Jarrett M, Rauscher A, Iverson G, Woods S, Ukueberuwa D, Medaglia J, Hillary F, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Levan A, Gale S, Atkinson J, Boettcher A, Hill B, Rohling M, Stolberg P, Hart J, Allen D, Mayfield J, Ellis M, Marion SD, Houshyarnejad A, Grant I, Akarakian R, Kernan C, Babikian T, Asarnow R, Bens M, Fisher M, Garrett C, Vinogradov S, Walker K, Torstrick A, Uderman J, Wellington R, Zhao L, Fromm N, Dahdah M, Salisbury D, Monden K, Lande E, Wanlass R, Fong G, Smith K, Miele A, Novakovic-Agopian T, Chen A, Rome S, Rossi A, Abrams G, Murphy M, Binder D, Muir J, Carlin G, Loya F, Rabinovitz B, Bruhns M, Adler M, Schleicher-Dilks S, Messerly J, Babika C, Ukpabi C, Golden C, Schleicher-Dilks S, Coad S, Messerly J, Schaffer S, Babika C, Golden C, Cowad S, Paisley S, Fontanetta R, Messerly J, Golden C, Holder C, Kloezeman K, Henry B, Burns W, Patt V, Minassian A, Perry W, Cooper L, Allen D, Vogel S, Woolery H, Ciobanu C, Simone A, Bedard A, Olivier T, O'Neill S, Rajendran K, Halperin J, Rudd-Barnard A, Steenari M, Murry J, Le M, Becker T, Mucci G, Zupanc M, Shapiro E, Santos O, Cadavid N, Giese E, Londono N, Osmon D, Zamzow J, Culnan E, D'Argenio D, Mosti C, Spiers M, Schleicher-Dilks S, Kloss J, Curiel A, Miller K, Olmstead R, Gottuso A, Saucier C, Miller J, Dye R, Small G, Kent A, Andrews P, Puente N, Terry D, Faraco C, Brown C, Patel A, Siegel J, Miller L, Lee B, Joan M, Thaler N, Fontanetta R, Carla F, Allen D, Nguyen T, Glass L, Coles C, Julie K, May P, Sowell E, Jones K, Riley E, Demsky Y, Mattson S, Allart A, Freer B, Tiersky L, Sunderaraman P, Sylvester P, Ang J, Schultheis M, Newton S, Holland A, Burns K, Bunting J, Taylor J, Muetze H, Coe M, Harrison D, Putnam M, Tiersky L, Freer B, Holland A, Newton S, Sakamoto M, Bunting J, Taylor J, Coe M, Harrison D, Musso M, Hill B, Barker A, Pella R, Gouvier W, Davis J, Woods S, Wall J, Etherton J, Brand T, Hummer B, O'Shea C, Segovia J, Thomlinson S, Schulze E, Roskos P, Gfeller J, Loftis J, Fogel T, Barrera K, Sherzai A, Chappell A, Harrison A, Armstrong I, Flaro L, Pedersen H, Shultz LS, Roper B, Huckans M, Basso M, Silk-Eglit G, Stenclik J, Miele A, Lynch J, McCaffrey R, Silk-Eglit G, Stenclik J, Miele A, Lynch J, Musso M, McCaffrey R, Martin P, VonDran E, Baade L, Heinrichs R, Schroeder R, Hunter B, Calloway J, Rolin S, Akeson S, Westervelt H, Mohammed S, An K, Jeffay E, Zakzanis K, Lynch A, Drasnin D, Ikanga J, Graham O, Reid M, Cooper D, Long J, Lange R, Kennedy J, Hopewell C, Lukaszewska B, Pachalska M, Bidzan M, Lipowska M, McCutcheon L, Kaup A, Park J, Morgan E, Kenton J, Norman M, Martin P, Netson K, Woods S, Smith M, Paulsen J, Hahn-Ketter A, Paxton J, Fink J, Kelley K, Lee R, Pliskin N, Segala L, Vasilev G, Bozgunov K, Naslednikova R, Raynov I, Gonzalez R, Vassileva J, Bonilla X, Fedio A, Johnson K, Sexton J, Blackstone K, Weber E, Moore D, Grant I, Woods S, Pimental P, Welch M, Ring M, Stranks E, Crowe S, Jaehnert S, Ellis C, Prince C, Wheaton V, Schwartz D, Loftis J, Fuller B, Hoffman W, Huckans M, Turecka S, McKeever J, Morse C, Schultheis M, Dinishak D, Dasher N, Vik P, Hachey D, Bowman B, Van Ness E, Williams C, Zamzow J, Sunderaraman P, Kloss J, Spiers M, Swirsky-Sacchetti T, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stricker N, Kimmel C, Grant I, Alhassoon O, Taylor M, Sorg S, Schweinsburg B, Stephan R, Stricker N, Grant I, Hertza J, Tyson K, Northington S, Loughan A, Perna R, Davis A, Collier M, Schroeder R, Buddin W, Schroeder R, Moore C, Andrew W, Ghelani A, Kim J, Curri M, Patel S, Denney D, Taylor S, 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Steed A, Kark S, Lafleche G, Brown T, Bogdanova Y, Strongin E, Spickler C, Drasnin D, Strongin C, Poreh A, Houshyarnejad A, Ellis M, Babikian T, Kernan C, Asarnow R, Didehbani N, Cullum M, Loneman L, Mansinghani S, Hart J, Fischer J. POSTER SESSIONS SCHEDULE. Arch Clin Neuropsychol 2013. [DOI: 10.1093/arclin/act054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Amin M, Radkay L, Pantanowitz L, Fine J, Parwani A. Tumor-to-tumor metastasis (TTM) of breast carcinoma within a solitary renal angiomyolipoma: a case report. Pathol Res Pract 2013; 209:605-8. [PMID: 23891136 DOI: 10.1016/j.prp.2013.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 06/01/2013] [Accepted: 06/25/2013] [Indexed: 12/21/2022]
Abstract
Angiomyolipomas of the kidney have been known to harbor malignant neoplasms including renal cell carcinoma. We report a case of a tumor-to-tumor metastasis (TTM) involving metastatic breast carcinoma and angiomyolipoma. The patient was a 67-year-old female with a history of invasive ductal carcinoma of the breast. Follow-up positron emission tomography 9 years later revealed a left renal mass, suspicious for a primary renal neoplasm, as well as a suspicious subpectoral lymph node. An ultrasound-guided needle biopsy of the lymph node demonstrated metastatic breast carcinoma. The patient underwent a left radical nephrectomy. Pathologic examination demonstrated an ill-defined 2cm estrogen receptor (ER)-positive metastatic breast carcinoma within a 6cm angiomyolipoma. To our knowledge, this is the first reported case of metastatic breast carcinoma to a solitary renal angiomyolipoma. This case highlights the importance of a patient's prior history of malignancy, as well as appropriate sampling of renal neoplasms.
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Affiliation(s)
- Milon Amin
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
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Fine J, Diri K, Krylov A, Nemirow C, Lu Z, Wittig C. Electronic structure of tris(2-phenylpyridine)iridium: electronically excited and ionized states. Mol Phys 2012. [DOI: 10.1080/00268976.2012.685899] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Waite L, Fine J, Veres G, Radovits T, Karck M, Szabó G. A lumped-parameter model of mitral valve blood flow for assessment of diastolic left ventricular filling. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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