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Amin KS, Forman HP, Davis MA. Even with ChatGPT, race matters. Clin Imaging 2024; 109:110113. [PMID: 38552383 DOI: 10.1016/j.clinimag.2024.110113] [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] [Received: 11/03/2023] [Revised: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Applications of large language models such as ChatGPT are increasingly being studied. Before these technologies become entrenched, it is crucial to analyze whether they perpetuate racial inequities. METHODS We asked Open AI's ChatGPT-3.5 and ChatGPT-4 to simplify 750 radiology reports with the prompt "I am a ___ patient. Simplify this radiology report:" while providing the context of the five major racial classifications on the U.S. census: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. To ensure an unbiased analysis, the readability scores of the outputs were calculated and compared. RESULTS Statistically significant differences were found in both models based on the racial context. For ChatGPT-3.5, output for White and Asian was at a significantly higher reading grade level than both Black or African American and American Indian or Alaska Native, among other differences. For ChatGPT-4, output for Asian was at a significantly higher reading grade level than American Indian or Alaska Native and Native Hawaiian or other Pacific Islander, among other differences. CONCLUSION Here, we tested an application where we would expect no differences in output based on racial classification. Hence, the differences found are alarming and demonstrate that the medical community must remain vigilant to ensure large language models do not provide biased or otherwise harmful outputs.
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Affiliation(s)
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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2
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Ismail M, Hanna TN, Davis MA, Rubin E, DeQuesada IM, Miles RC, Pandharipande P. The Remote Academic Radiologist: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024:1-7. [PMID: 37672330 DOI: 10.2214/ajr.23.29601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The importance of developing a robust remote workforce in academic radiology has come to the forefront owing to several converging factors. COVID-19, as well as the abrupt transformation it precipitated in terms of how radiologists work, has been the biggest impetus for change; concurrent factors such as increasing examination volumes and radiologist burnout have also contributed. How to best advance the most desirable and favorable aspects of remote work while preserving an academic environment that fulfills the tripartite mission is a critical challenge that nearly all academic institutions face today. In this AJR Expert Panel Narrative Review, we discuss current challenges in academic radiology, including effects of the COVID-19 pandemic, from three perspectives-those of the radiologist, the learner, and the health system-and address the following topics: productivity, recruitment, wellness, clinical supervision, mentorship and research, educational engagement, radiologist access, investments in technology, and radiologist value. Throughout, we focus on the opportunities and drawbacks of remote work, to help guide its effective and reliable integration into academic radiology practices.
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Affiliation(s)
- Mohammed Ismail
- Department of Radiology, Ohio State University Wexner Medical Center, 450 Faculty Office Tower, 395 W 12th Ave, Columbus, OH 43210
| | - Tarek N Hanna
- Department of Radiology, Emory University, Atlanta, GA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT
| | - Eric Rubin
- Department of Radiology, Crozier Health, Upland, PA
| | - Ivan M DeQuesada
- Radiology Associates of North Texas, TCU School of Medicine, Fort Worth, TX
| | | | - Pari Pandharipande
- Department of Radiology, Ohio State University Wexner Medical Center, 450 Faculty Office Tower, 395 W 12th Ave, Columbus, OH 43210
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Cavallo JJ, Davis MA. Establishing robust governance of clinical artificial intelligence software - Why radiologists should lead. Clin Imaging 2024; 110:110163. [PMID: 38678765 DOI: 10.1016/j.clinimag.2024.110163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Joseph J Cavallo
- Yale Department of Radiology, Yale New Haven Hospital, 330 Cedar Street, TE 2-214, New Haven, CT 06520, United States of America.
| | - Melissa A Davis
- Yale Department of Radiology, Yale New Haven Hospital, 330 Cedar Street, TE 2-214, New Haven, CT 06520, United States of America.
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4
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Davis MA, Wu O, Ikuta I, Jordan JE, Johnson MH, Quigley E. Understanding Bias in Artificial Intelligence: A Practice Perspective. AJNR Am J Neuroradiol 2024; 45:371-373. [PMID: 38123951 DOI: 10.3174/ajnr.a8070] [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] [Received: 08/29/2023] [Accepted: 10/17/2023] [Indexed: 12/23/2023]
Abstract
In the fall of 2021, several experts in this space delivered a Webinar hosted by the American Society of Neuroradiology (ASNR) Diversity and Inclusion Committee, focused on expanding the understanding of bias in artificial intelligence, with a health equity lens, and provided key concepts for neuroradiologists to approach the evaluation of these tools. In this perspective, we distill key parts of this discussion, including understanding why this topic is important to neuroradiologists and lending insight on how neuroradiologists can develop a framework to assess health equity-related bias in artificial intelligence tools. In addition, we provide examples of clinical workflow implementation of these tools so that we can begin to see how artificial intelligence tools will impact discourse on equitable radiologic care. As continuous learners, we must be engaged in new and rapidly evolving technologies that emerge in our field. The Diversity and Inclusion Committee of the ASNR has addressed this subject matter through its programming content revolving around health equity in neuroradiologic advances.
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Affiliation(s)
- Melissa A Davis
- From Yale University (M.A.D., M.H.J.), New Haven, Connecticut
| | - Ona Wu
- Massachusetts General Hospital (O.W.), Charlestown, Massachusetts
| | - Ichiro Ikuta
- Mayo Clinic Arizona, Department of Radiology (I.I.), Phoenix, Arizona
| | - John E Jordan
- Stanford University School of Medicine (J.E.J.), Stanford, California
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5
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Czerminski J, Pahade JK, Davis MA, Mezrich JL. The disproportionate impact of peer learning on emergency radiology. Emerg Radiol 2024; 31:133-139. [PMID: 38261134 DOI: 10.1007/s10140-024-02207-3] [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] [Received: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The use of peer learning methods in radiology continues to grow as a means to constructively learn from past mistakes. This study examined whether emergency radiologists receive a disproportionate amount of peer learning feedback entered as potential learning opportunities (PLO), which could play a significant role in stress and career satisfaction. Our institution offers 24/7 attending coverage, with emergency radiologists interpreting a wide range of X-ray, ultrasound and CT exams on both adults and pediatric patients. MATERIALS AND METHODS Peer learning submissions entered as PLO at a single large academic medical center over a span of 3 years were assessed by subspecialty distribution and correlated with the number of attending radiologists in each section. Total number of studies performed on emergency department patients and throughout the hospital system were obtained for comparison purposes. Data was assessed using analysis of variance and post hoc analysis. RESULTS Emergency radiologists received significantly more (2.5 times) PLO submissions than the next closest subspeciality division and received more yearly PLO submissions per attending compared to other subspeciality divisions. This was found to still be true when normalizing for increased case volumes; Emergency radiologists received more PLO submissions per 1000 studies compared to other divisions in our department (1.59 vs. 0.85, p = 0.04). CONCLUSION Emergency radiologists were found to receive significantly more PLO submissions than their non-emergency colleagues. Presumed causes for this discrepancy may include a higher error rate secondary to wider range of studies interpreted, demand for shorter turn-around times, higher volumes of exams read per shift, and hindsight bias in the setting of follow-up review.
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Affiliation(s)
- Jan Czerminski
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Jay K Pahade
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA
| | - Jonathan L Mezrich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, TE2, New Haven, CT, 06520, USA.
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6
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Moore CL, Baskin A, Cheung D, Davis MA, Fertel BS, Larson DM, Lee RK, McCabe-Kline KB, Mills AM, Nicola GN, Nicola LP. Reply. J Am Coll Radiol 2023; 20:1191-1192. [PMID: 37348746 DOI: 10.1016/j.jacr.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Christopher L Moore
- Professor and Chief, Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
| | | | - Dickson Cheung
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Melissa A Davis
- Associate Professor, Vice Chair of Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Baruch S Fertel
- VP Quality and Patient Safety, New York, Presbyterian Hospital, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - David M Larson
- Department of Emergency Medicine, Ridgeview Medical Center, Waconia, Minnesota
| | - Ryan K Lee
- Department of Diagnostic Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Kristin B McCabe-Kline
- Chief Medical Information Officer, Advent Health Central Florida Division, Orlando, Florida
| | - Angela M Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Gregory N Nicola
- Hackensack Radiology Group, Executive Board and Partner, Clinically Integrated Network Board and Finance Chair, Hackensack Meridian Health Partners, Chief Medical Officer, Neutigers Inc., ACR Board of Chancellors, Economics Chair, Hackensack Radiology Group, River Edge, New Jersey
| | - Lauren Parks Nicola
- Triad Radiology Associates, Partner and CEO, ACR Board of Chancellors, ACR Reimbursement Committee Chair, ACR MACRA Committee Chair, Triad Radiology Associates, Winston Salem, North Carolina
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7
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Amin KS, Davis MA, Doshi R, Haims AH, Khosla P, Forman HP. Accuracy of ChatGPT, Google Bard, and Microsoft Bing for Simplifying Radiology Reports. Radiology 2023; 309:e232561. [PMID: 37987662 DOI: 10.1148/radiol.232561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Kanhai S Amin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Melissa A Davis
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Rushabh Doshi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Andrew H Haims
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Pavan Khosla
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
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8
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Davis MA, Ramakrishnan D, Sala M, Aboian M. Local Economic Considerations in Selecting Artificial Intelligence Tools for Implementation. J Am Coll Radiol 2023; 20:981-984. [PMID: 37604325 DOI: 10.1016/j.jacr.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Melissa A Davis
- Vice Chair of Medical Informatics and Medical Director of Informatics, Yale University, New Haven, Connecticut; Co-Chair of Patient and Family Centered Care - American College of Radiology; and President of SRRO Chapter, National Medical Association.
| | | | | | - Mariam Aboian
- Director, 3D Lab, Yale University, New Haven, Connecticut
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9
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Davis MA, Lim N, Jordan J, Yee J, Gichoya JW, Lee R. Imaging Artificial Intelligence: A Framework for Radiologists to Address Health Equity, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023; 221:302-308. [PMID: 37095660 DOI: 10.2214/ajr.22.28802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/24/2023]
Abstract
Artificial intelligence (AI) holds promise for helping patients access new and individualized health care pathways while increasing efficiencies for health care practitioners. Radiology has been at the forefront of this technology in medicine; many radiology practices are implementing and trialing AI-focused products. AI also holds great promise for reducing health disparities and promoting health equity. Radiology is ideally positioned to help reduce disparities given its central and critical role in patient care. The purposes of this article are to discuss the potential benefits and pitfalls of deploying AI algorithms in radiology, specifically highlighting the impact of AI on health equity; to explore ways to mitigate drivers of inequity; and to enhance pathways for creating better health care for all individuals, centering on a practical framework that helps radiologists address health equity during deployment of new tools.
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Affiliation(s)
- Melissa A Davis
- Department of Diagnostic Radiology, Yale University School of Medicine, 789 Howard Ave, PO Box 20842, New Haven, CT 06520
| | | | - John Jordan
- Stanford University School of Medicine, Stanford, CA
| | - Judy Yee
- Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY
| | | | - Ryan Lee
- Jefferson Health, Philadelphia, PA
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10
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Lee CI, Davis MA, Lexa FJ, Liao JM. JACR Health Policy Expert Panel: Private Equity Investment in Radiology. J Am Coll Radiol 2023; 20:940-942. [PMID: 37011830 DOI: 10.1016/j.jacr.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Christoph I Lee
- Director of the Northwest Screening and Cancer Outcomes Research Enterprise, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; and Deputy Editor, JACR.
| | - Melissa A Davis
- Vice Chair of Informatics, Department of Radiology, Yale University School of Medicine, New Haven, Connecticut. https://twitter.com/MelissaDavis29
| | - Frank J Lexa
- Department of Radiology, University of Pittsburgh School of Medicine and UPMC International, Pittsburgh, Pennsylvania; and Chief Medical Officer and Vice Chair, ACR Radiology Leadership Institute. https://twitter.com/fjlexa
| | - Joshua M Liao
- Director of the Value and Systems Science Lab and Associate Chair for Health Systems, Department of Medicine, University of Washington School of Medicine, Seattle, Washington. https://twitter.com/JoshuaLiaoMD
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11
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Moore CL, Baskin A, Chang AM, Cheung D, Davis MA, Fertel BS, Hans K, Kang SK, Larson DM, Lee RK, McCabe-Kline KB, Mills AM, Nicola GN, Nicola LP. White Paper: Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging. J Am Coll Radiol 2023; 20:422-430. [PMID: 36922265 DOI: 10.1016/j.jacr.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/15/2022] [Revised: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Actionable incidental findings (AIFs) are common in radiologic imaging. Imaging is commonly performed in emergency department (ED) visits, and AIFs are frequently encountered, but the ED presents unique challenges for communication and follow-up of these findings. The authors formed a multidisciplinary panel to seek consensus regarding best practices in the reporting, communication, and follow-up of AIFs on ED imaging tests. METHODS A 15-member panel was formed, nominated by the ACR and American College of Emergency Physicians, to represent radiologists, emergency physicians, patients, and those involved in health care systems and quality. A modified Delphi process was used to identify areas of best practice and seek consensus. The panel identified four areas: (1) report elements and structure, (2) communication of findings with patients, (3) communication of findings with clinicians, and (4) follow-up and tracking systems. A survey was constructed to seek consensus and was anonymously administered in two rounds, with a priori agreement requiring at least 80% consensus. Discussion occurred after the first round, with readministration of questions where consensus was not initially achieved. RESULTS Consensus was reached in the four areas identified. There was particularly strong consensus that AIFs represent a system-level issue, with need for approaches that do not depend on individual clinicians or patients to ensure communication and completion of recommended follow-up. CONCLUSIONS This multidisciplinary collaboration represents consensus results on best practices regarding the reporting and communication of AIFs in the ED setting.
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Affiliation(s)
- Christopher L Moore
- Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
| | | | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dickson Cheung
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Melissa A Davis
- Vice Chair of Informatics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Baruch S Fertel
- Vice President, Quality and Patient Safety, NewYork-Presbyterian Hospital, New York, New York; and Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kristen Hans
- University of Rochester Medical Center, Rochester, New York
| | - Stella K Kang
- Chair, ACR Incidental Findings Steering Committee; Chair, ACR Appropriateness Criteria Expert Panel on Obstetrical and Gynecological Imaging; Associate Chair of Population Health Imaging and Outcomes, Department of Radiology, Department of Population Health, Grossman School of Medicine, New York University, New York, New York
| | - David M Larson
- Department of Emergency Medicine, Ridgeview Medical Center, Waconia, Minnesota
| | - Ryan K Lee
- Department of Diagnostic Radiology, Einstein Healthcare Network, Philadelphia Pennsylvania
| | - Kristin B McCabe-Kline
- Chief Medical Information Officer, Advent Health Central Florida Division, Orlando, Florida
| | - Angela M Mills
- Department of Emergency Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Gregory N Nicola
- Hackensack Radiology Group, River Edge, New Jersey; Clinically Integrated Network Board and Finance Chair, Hackensack Meridian Health Partners; Chief Medical Officer, Neutigers; and Economics Chair, ACR Board of Chancellors
| | - Lauren P Nicola
- CEO, Triad Radiology Associates, Winston-Salem, North Carolina; ACR Board of Chancellors; Chair, ACR Reimbursement Committee; and Chair, ACR MACRA Committee
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12
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Forman HP, Davis MA. Even in Radiology, Race Matters. Radiology 2023; 307:e223330. [PMID: 36809221 DOI: 10.1148/radiol.223330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Tompkins East 2-204, New Haven, CT 06520 (H.P.F., M.A.D.); Yale School of Management, New Haven, Conn (H.P.F.); Yale School of Public Health, New Haven, Conn (H.P.F.); and Economics Department, Yale University, New Haven, Conn (H.P.F.)
| | - Melissa A Davis
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Tompkins East 2-204, New Haven, CT 06520 (H.P.F., M.A.D.); Yale School of Management, New Haven, Conn (H.P.F.); Yale School of Public Health, New Haven, Conn (H.P.F.); and Economics Department, Yale University, New Haven, Conn (H.P.F.)
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13
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Rachh P, Davis MA, Heilbrun ME. Quality Improvement Report: Improving Pre- and Postprocedure Care Area Workflows at a Busy Urban Academic Hospital Using Lean Management Principles. Radiographics 2023; 43:e220089. [PMID: 36563095 DOI: 10.1148/rg.220089] [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: 12/24/2022]
Abstract
Radiology procedure workflow is a summation of individual workflows for scheduling, precertification, preprocedure clinic visits, and day of procedure, representing a complex total process with many opportunities for inefficiencies and waste. At the authors' institution, a lack of standard work and communication gaps in a pre- and postprocedure care area (PPCA) workflow were identified as factors in bottlenecks, waits and delays, and staff and patient frustrations. Using "lean" process improvement tools, these workflows were targeted in a rapid improvement event (RIE). A cross-functional team was formed to work on the PPCA workflow RIE. Using lean management principles, process gaps were identified and changes were instituted to improve patient and information flow. Three projects were implemented over a course of 4 months. These included a 5S, a lean methodology of workplace organization to optimize supply cabinets; standardization of nursing preprocedure documentation and process; and standard work confirmation in daily management system huddles. At baseline, 45% of patients were prepared within 60 minutes of their arrival in the PPCA. After the RIE and instituting the changes from the RIE, 80% of patients were prepared within 60 minutes of their arrival in the PPCA. Implementing lean management strategies, such as daily management systems and huddles, and establishing standard work confirmation help to eliminate waste and create systems and teams that sustain and improve complex workflows. © RSNA, 2022.
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Affiliation(s)
- Pratik Rachh
- From the Department of Radiology and Imaging Sciences, Emory Healthcare, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303
| | - Melissa A Davis
- From the Department of Radiology and Imaging Sciences, Emory Healthcare, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303
| | - Marta E Heilbrun
- From the Department of Radiology and Imaging Sciences, Emory Healthcare, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303
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14
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Banerjee I, Davis MA, Vey BL, Mazaheri S, Khan F, Zavaletta V, Gerard R, Gichoya JW, Patel B. Natural Language Processing Model for Identifying Critical Findings-A Multi-Institutional Study. J Digit Imaging 2023; 36:105-113. [PMID: 36344632 PMCID: PMC9984612 DOI: 10.1007/s10278-022-00712-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/02/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022] Open
Abstract
Improving detection and follow-up of recommendations made in radiology reports is a critical unmet need. The long and unstructured nature of radiology reports limits the ability of clinicians to assimilate the full report and identify all the pertinent information for prioritizing the critical cases. We developed an automated NLP pipeline using a transformer-based ClinicalBERT++ model which was fine-tuned on 3 M radiology reports and compared against the traditional BERT model. We validated the models on both internal hold-out ED cases from EUH as well as external cases from Mayo Clinic. We also evaluated the model by combining different sections of the radiology reports. On the internal test set of 3819 reports, the ClinicalBERT++ model achieved 0.96 f1-score while the BERT also achieved the same performance using the reason for exam and impression sections. However, ClinicalBERT++ outperformed BERT on the external test dataset of 2039 reports and achieved the highest performance for classifying critical finding reports (0.81 precision and 0.54 recall). The ClinicalBERT++ model has been successfully applied to large-scale radiology reports from 5 different sites. Automated NLP system that can analyze free-text radiology reports, along with the reason for the exam, to identify critical radiology findings and recommendations could enable automated alert notifications to clinicians about the need for clinical follow-up. The clinical significance of our proposed model is that it could be used as an additional layer of safeguard to clinical practice and reduce the chance of important findings reported in a radiology report is not overlooked by clinicians as well as provide a way to retrospectively track large hospital databases for evaluating the documentation of the critical findings.
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Affiliation(s)
- Imon Banerjee
- Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
- Arizona State University, SCAI, 6161 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Melissa A Davis
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Brianna L Vey
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Sina Mazaheri
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Fiza Khan
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Vaz Zavaletta
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Roger Gerard
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Judy Wawira Gichoya
- School of Medicine, Emory University, 1364 Clifton Road NE, 30322, Atlanta, USA
| | - Bhavik Patel
- Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
- Arizona State University, SCAI, 6161 E Mayo Blvd, Phoenix, AZ, 85054, USA
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15
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Cox CG, Davis MA, Grill JD, Roberts JS. US Adults' Likelihood to Participate in Dementia Prevention Drug Trials: Results from the National Poll on Healthy Aging. J Prev Alzheimers Dis 2023; 10:34-40. [PMID: 36641608 PMCID: PMC9579667 DOI: 10.14283/jpad.2022.86] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Recruitment to dementia prevention clinical trials is challenging, and participants are not representative of US adults at risk. A better understanding of the general public's interest in dementia prevention research participation is needed to inform future recruitment strategies. OBJECTIVE To examine US adults' characteristics associated with self-reported likelihood to participate in dementia prevention clinical trials. DESIGN We conducted a cross-sectional survey using the October 2018 wave of the University of Michigan National Poll on Healthy Aging. SETTING The National Poll on Healthy Aging is a nationally representative survey of adults using KnowledgePanel (Ipsos Public Affairs LLC), a probability-based panel of the civilian, noninstitutionalized US population. PARTICIPANTS We analyzed data from 1,028 respondents, ages 50 to 64 years, who completed a web survey module on brain health. MEASUREMENTS We used logistic regression models to examine associations between sociodemographic and dementia-related factors (e.g., family history) and self-reported likelihood to participate in a dementia prevention clinical trial of a new medicine ("very" or "somewhat likely" vs. "not likely" survey responses). Among respondents not likely to participate, we examined frequency of reasons endorsed for this decision, stratified by age, sex, and race and ethnicity. RESULTS Of the 1,028 respondents, half were female, 68% Non-Hispanic White, 13% Hispanic, and 12% Non-Hispanic Black. Twelve percent of respondents reported being very likely to participate in a dementia prevention trial, 32% somewhat likely, and 56% not likely. Factors associated with higher likelihood to participate were higher perceived risk of dementia [OR, 2.17 (95% CI, 1.61, 2.93)], a positive family history of dementia [OR, 1.75 (95% CI, 1.27, 2.43)], and having discussed dementia prevention with a doctor [OR, 2.20 (95% CI, 1.10, 4.42)]. There were no differences in likelihood to participate by sociodemographic characteristics. Among 570 respondents not likely to participate, 39% said they did not want to be a guinea pig, 23% thought dementia would not affect them, 22% thought there would be too high a chance for harm, 15% indicated study participation would take too much time, and 5% reported fear of learning information about oneself. There were no differences across age, sex, and racial and ethnic groups. CONCLUSIONS In this study, perceived risk of dementia, family history, and discussion of prevention with a doctor were associated with likelihood to participate in a dementia prevention clinical trial, whereas sociodemographic factors including race and ethnicity were not. Findings suggest that recruitment interventions focused on increasing knowledge of dementia risk and prevention trials and involving healthcare providers may be effective tools to improve enrollment rates, regardless of target community.
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Affiliation(s)
- C G Cox
- Chelsea G. Cox, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA,
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Karandikar A, Solberg A, Fung A, Lee AY, Farooq A, Taylor AC, Oliveira A, Narayan A, Senter A, Majid A, Tong A, McGrath AL, Malik A, Brown AL, Roberts A, Fleischer A, Vettiyil B, Zigmund B, Park B, Curran B, Henry C, Jaimes C, Connolly C, Robson C, Meltzer CC, Phillips CH, Dove C, Glastonbury C, Pomeranz C, Kirsch CFE, Burgan CM, Scher C, Tomblinson C, Fuss C, Santillan C, Daye D, Brown DB, Young DJ, Kopans D, Vargas D, Martin D, Thompson D, Jordan DW, Shatzkes D, Sun D, Mastrodicasa D, Smith E, Korngold E, Dibble EH, Arleo EK, Hecht EM, Morris E, Maltin EP, Cooke EA, Schwartz ES, Lehrman E, Sodagari F, Shah F, Doo FX, Rigiroli F, Vilanilam GK, Landinez G, Kim GGY, Rahbar H, Choi H, Bandesha H, Ojeda-Fournier H, Ikuta I, Dragojevic I, Schroeder JLT, Ivanidze J, Katzen JT, Chiang J, Nguyen J, Robinson JD, Broder JC, Kemp J, Weaver JS, Conyers JM, Robbins JB, Leschied JR, Wen J, Park J, Mongan J, Perchik J, Barbero JPM, Jacob J, Ledbetter K, Macura KJ, Maturen KE, Frederick-Dyer K, Dodelzon K, Cort K, Kisling K, Babagbemi K, McGill KC, Chang KJ, Feigin K, Winsor KS, Seifert K, Patel K, Porter KK, Foley KM, Patel-Lippmann K, McIntosh LJ, Padilla L, Groner L, Harry LM, Ladd LM, Wang L, Spalluto LB, Mahesh M, Marx MV, Sugi MD, Sammer MBK, Sun M, Barkovich MJ, Miller MJ, Vella M, Davis MA, Englander MJ, Durst M, Oumano M, Wood MJ, McBee MP, Fischbein NJ, Kovalchuk N, Lall N, Eclov N, Madhuripan N, Ariaratnam NS, Vincoff NS, Kothary N, Yahyavi-Firouz-Abadi N, Brook OR, Glenn OA, Woodard PK, Mazaheri P, Rhyner P, Eby PR, Raghu P, Gerson RF, Patel R, Gutierrez RL, Gebhard R, Andreotti RF, Masum R, Woods R, Mandava S, Harrington SG, Parikh S, Chu S, Arora SS, Meyers SM, Prabhu S, Shams S, Pittman S, Patel SN, Payne S, Hetts SW, Hijaz TA, Chapman T, Loehfelm TW, Juang T, Clark TJ, Potigailo V, Shah V, Planz V, Kalia V, DeMartini W, Dillon WP, Gupta Y, Koethe Y, Hartley-Blossom Z, Wang ZJ, McGinty G, Haramati A, Allen LM, Germaine P. Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clin Imaging 2023; 93:117-121. [PMID: 36064645 DOI: 10.1016/j.clinimag.2022.07.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alice Fung
- Oregon Health & Science University (OHSU), United States of America
| | - Amie Y Lee
- University of California, San Francisco, United States of America
| | | | - Amy C Taylor
- University of Virginia, Charlottesville, VA, United States of America
| | | | - Anand Narayan
- University of Wisconsin Hospitals and Clinics, Madison, WI, United States of America
| | | | | | | | | | | | | | - Anne Roberts
- University of California San Diego, United States of America
| | | | | | - Beth Zigmund
- Larner College of Medicine at University of Vermont, United States of America
| | - Brian Park
- Oregon Health & Science University (OHSU), United States of America
| | - Bruce Curran
- Virginia Commonwealth University Health System, United States of America
| | - Cameron Henry
- Vanderbilt University Medical Center, United States of America
| | - Camilo Jaimes
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Cara Connolly
- Vanderbilt University Medical Center, United States of America
| | - Caroline Robson
- Boston Children's Hospital and Harvard Medical School, United States of America
| | - Carolyn C Meltzer
- Keck School of Medicine of the University of Southern California, United States of America
| | | | - Christine Dove
- Vanderbilt University Medical Center, United States of America
| | | | | | | | | | - Courtney Scher
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Cristina Fuss
- Oregon Health & Science University (OHSU), United States of America
| | | | - Dania Daye
- Massachusetts General Hospital/Harvard Medical School, United States of America
| | - Daniel B Brown
- Vanderbilt University Medical Center, United States of America
| | - Daniel J Young
- Oregon Health & Science University (OHSU), United States of America
| | | | | | - Dann Martin
- Vanderbilt University Medical Center, United States of America
| | | | - David W Jordan
- University Hospitals Cleveland Medical Center & Case Western Reserve University, United States of America
| | | | - Derek Sun
- University of California, San Francisco, United States of America
| | | | | | - Elena Korngold
- Oregon Health & Science University (OHSU), United States of America
| | - Elizabeth H Dibble
- The Warren Alpert Medical School of Brown University, United States of America
| | | | | | | | | | - Erin A Cooke
- Vanderbilt University Medical Center, United States of America
| | - Erin Simon Schwartz
- Perelman School of Medicine, University of Pennsylvania, United States of America
| | | | - Faezeh Sodagari
- Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Faisal Shah
- Radiology Partners, United States of America
| | | | | | - George K Vilanilam
- Dept of Radiology, University of Arkansas for Medical Sciences, United States of America
| | - Gina Landinez
- University of California, San Francisco, United States of America
| | | | - Habib Rahbar
- University of Washington, United States of America
| | - Hailey Choi
- University of California, San Francisco, United States of America
| | | | | | - Ichiro Ikuta
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | | | | | | | - Jason Chiang
- Ronald Reagan UCLA Medical Center, United States of America
| | - Jeffers Nguyen
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, United States of America
| | | | - Jennifer C Broder
- Lahey Hospital and Medical Center, Burlington, MA, United States of America
| | - Jennifer Kemp
- University of Colorado School of Medicine, United States of America
| | | | | | - Jessica B Robbins
- University of Wisconsin School of Medicine and Public Health, United States of America
| | | | - Jessica Wen
- Stanford University, United States of America
| | - Jocelyn Park
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | | | - Jordan Perchik
- University of Alabama at Birmingham, United States of America
| | | | - Jubin Jacob
- St Lawrence Radiology, United States of America
| | | | | | | | | | | | | | - Kelly Kisling
- University of California San Diego, United States of America
| | | | | | | | | | | | - Kimberly Seifert
- Stanford University School of Medicine, United States of America
| | - Kirang Patel
- University of Texas Southwestern Medical Center, United States of America
| | - Kristin K Porter
- University of Alabama at Birmingham Hospital, United States of America
| | | | | | | | - Laura Padilla
- University of California San Diego, United States of America
| | | | - Lauren M Harry
- Indiana University School of Medicine, United States of America
| | - Lauren M Ladd
- Indiana University School of Medicine, United States of America
| | - Lisa Wang
- Oregon Health & Science University (OHSU), United States of America
| | - Lucy B Spalluto
- Vanderbilt University Medical Center, United States of America
| | - M Mahesh
- Johns Hopkins University School of Medicine, United States of America
| | | | - Mark D Sugi
- University of California, San Francisco, United States of America
| | | | - Maryellen Sun
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | | | | | - Maya Vella
- University of California, San Francisco, United States of America
| | | | | | | | - Michael Oumano
- Rhode Island Hospital (Brown University), Providence, RI, United States of America
| | - Monica J Wood
- Mount Auburn Hospital/Harvard Medical School, Cambridge, MA, United States of America
| | - Morgan P McBee
- Medical University of South Carolina, United States of America
| | | | | | - Neil Lall
- Emory University, Atlanta, GA, United States of America
| | - Neville Eclov
- Duke University, Durham, NC, United States of America
| | | | | | - Nina S Vincoff
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States of America
| | - Nishita Kothary
- Stanford University School of Medicine, United States of America
| | | | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Orit A Glenn
- University of California, San Francisco, United States of America
| | - Pamela K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America
| | | | - Peter R Eby
- Virginia Mason Franciscan Health, United States of America
| | - Preethi Raghu
- University of California, San Francisco, United States of America
| | - Rachel F Gerson
- Northwest Radiologists, Inc, PS, Bellingham, WA, United States of America
| | - Rina Patel
- University of California, San Francisco, United States of America
| | | | - Robyn Gebhard
- The Ohio State University, Columbus, OH, United States of America
| | | | - Rukya Masum
- The Ohio State University, Columbus, OH, United States of America
| | - Ryan Woods
- University of Wisconsin School of Medicine and Public Health, United States of America
| | - Sabala Mandava
- Henry Ford Health, Detroit, MI, United States of America
| | | | - Samir Parikh
- Henry Ford Health, Jackson, MI, United States of America
| | - Sammy Chu
- University of Washington (Seattle, WA), United States of America
| | | | - Sandra M Meyers
- University of California San Diego, United States of America
| | - Sanjay Prabhu
- Boston Children's Hospital, United States of America
| | | | - Sarah Pittman
- Stanford University School of Medicine, United States of America
| | | | | | - Steven W Hetts
- University of California, San Francisco, United States of America
| | - Tarek A Hijaz
- Northwestern Memorial Hospital/Feinberg School of Medicine of Northwestern University, Chicago, IL, United States of America
| | - Teresa Chapman
- University of Washington (Seattle, WA), United States of America
| | - Thomas W Loehfelm
- University of California, Davis, Sacramento, CA, United States of America
| | | | | | | | - Vinil Shah
- University of California, San Francisco, United States of America
| | - Virginia Planz
- Vanderbilt University Medical Center, United States of America
| | - Vivek Kalia
- Texas Scottish Rite for Children Hospital, United States of America
| | - Wendy DeMartini
- Stanford University School of Medicine, United States of America
| | - William P Dillon
- University of California, San Francisco, United States of America
| | - Yasha Gupta
- Memorial Sloan Kettering Cancer Center, United States of America
| | - Yilun Koethe
- Oregon Health & Science University (OHSU), United States of America
| | | | - Zhen Jane Wang
- University of California, San Francisco, United States of America
| | | | - Adina Haramati
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Laveil M Allen
- Vanderbilt University Medical Center, United States of America
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Davis MA. The Catalyst to Revive Healthcare. AR 2022. [DOI: 10.37549/ar2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Booth LE, Lo FJ, Davis MA, Spalluto LB, Yee J, Yong-Hing CJ, Murray N, Alwazzan AB, Khosa F. Gender Disparity in Surgical Device Patents: A 5-year Trend From Canada and the United States. J Surg Res 2022; 280:248-257. [PMID: 36027658 DOI: 10.1016/j.jss.2022.07.016] [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: 01/29/2022] [Revised: 05/25/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite an increasing number of women pursuing careers in science, engineering, and medicine, gender disparities in patents persist. This study sought to analyze trends in inventor's gender for surgical device patents filed and granted in Canada and the United States from 2015 to 2019. METHODS This study analyzed patents filed and granted by the Canadian Intellectual Property Office (CIPO) in the category of "Diagnosis; Surgery; Identification" and the United States Patent and Trademark Office (USPTO) in the category of "Surgery" from 2015 to 2019. The gender of the patent applicants was determined using a gender algorithm that predicts gender based on first names. Gender matches with names having a probability of less than 95% were excluded. RESULTS We identified 14,312 inventors on patents filed and 12,737 inventors on patents granted by the CIPO for "Diagnosis; Surgery; Identification". In the USPTO category of "Surgery," we identified 75,890 inventors on patents filed and 44,842 inventors on patents granted. Female inventors accounted for 7%-10% of inventors from 2015 to 2019 for both patents filed and granted. The proportion of female inventors on patents granted was significantly lower than for patents filed for four of the 5 y analyzed for both the USPTO and CIPO. CONCLUSIONS Female representation in surgical device patenting has stagnated, between 7 and 10%, from 2015 to 2019 in Canada and the United States. This underrepresentation of female inventors in surgical device patenting represents sizable gender disparity.
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Affiliation(s)
- Lindsay E Booth
- Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - Fu Jorden Lo
- Faculty of Medicine, University of British Columbia, Kelowna, British Columbia, Canada
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Lucy B Spalluto
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Judy Yee
- Professor and University Chair, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, New York City, New York
| | - Charlotte J Yong-Hing
- University of British Columbia Radiology, Vancouver, British Columbia, Canada; BC Cancer Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ahmad B Alwazzan
- Department of Obstetrics and Gynecology, King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
| | - Faisal Khosa
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.
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Camacho LE, Davis MA, Kelly AC, Steffens NR, Anderson MJ, Limesand SW. Prenatal Oxygen and Glucose Therapy Normalizes Insulin Secretion and Action in Growth Restricted Fetal Sheep. Endocrinology 2022; 163:6585511. [PMID: 35560217 PMCID: PMC9113332 DOI: 10.1210/endocr/bqac053] [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] [Received: 12/21/2021] [Indexed: 11/19/2022]
Abstract
Placental insufficiency (PI) lowers fetal oxygen and glucose concentrations, which disrupts glucose-insulin homeostasis and promotes fetal growth restriction (FGR). To date, prenatal treatments for FGR have not attempted to correct the oxygen and glucose supply simultaneously. Therefore, we investigated whether a five-day correction of oxygen and glucose concentrations in PI-FGR fetuses would normalize insulin secretion and glucose metabolism. Experiments were performed in near-term FGR fetal sheep with maternal hyperthermia-induced PI. Fetal arterial oxygen tension was increased to normal levels by increasing the maternal inspired oxygen fraction and glucose was infused into FGR fetuses (FGR-OG). FGR-OG fetuses were compared to maternal air insufflated, saline-infused fetuses (FGR-AS) and control fetuses. Prior to treatment, FGR fetuses were hypoxemic and hypoglycemic and had reduced glucose-stimulated insulin secretion (GSIS). During treatment, oxygen, glucose, and insulin concentrations increased, and norepinephrine concentrations decreased in FGR-OG fetuses, whereas FGR-AS fetuses were unaffected. On treatment day 4, glucose fluxes were measured with euglycemic and hyperinsulinemic-euglycemic clamps. During both clamps, rates of glucose utilization and production were greater in FGR-AS than FGR-OG fetuses, while glucose fluxes in FGR-OG fetuses were not different than control rates. After five-days of treatment, GSIS increased in FGR-OG fetuses to control levels and their ex vivo islet GSIS was greater than FGR-AS islets. Despite normalization in fetal characteristics, GSIS, and glucose fluxes, FGR-OG and FGR-AS fetuses weighed less than controls. These findings show that sustained, simultaneous correction of oxygen and glucose normalized GSIS and whole-body glucose fluxes in PI-FGR fetuses after the onset of FGR.
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Affiliation(s)
- Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Nathan R Steffens
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona 85719, USA
- Correspondence: Sean W. Limesand, PhD, Animal and Comparative Biomedical Sciences, The University of Arizona, 1650 E Limberlost Dr, Tucson AZ 85719, USA.
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Davis MA, Flores EJ. Health Equity Is Pursuing Social Justice in Health. J Am Coll Radiol 2022; 19:99-100. [PMID: 35033316 PMCID: PMC8756258 DOI: 10.1016/j.jacr.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Melissa A Davis
- Director of Quality, Emory University School of Medicine, Atlanta, Georgia.
| | - Efren J Flores
- Harvard University, Massachusetts General Hospital, Boston, Massachusetts
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Davis MA, Dupree CH, Meltzer CC. Diversity, Equity, and Inclusion Efforts Are Organizational Change Management Efforts. J Am Coll Radiol 2022; 19:181-183. [PMID: 35033308 DOI: 10.1016/j.jacr.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Davis
- Assistant Professor, Departments of Radiology and Imaging Sciences and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Cydney H Dupree
- Assistant Professor, Management and Organizations, Yale University, School of Management, New Haven, Connecticut
| | - Carolyn C Meltzer
- Professor, Radiology and Imaging Services, Psychiatry and Behavioral Science, and Neurology, Emory University School of Medicine, Atlanta, Georgia
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22
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Davis MA, Gichoya JW, Banerjee I, Sung D, Newsome J, Vey BL, Gerard R, Khan F, Zavaletta V, Mazaheri S, Heilbrun ME. Balancing the Scales: An Analysis of Social Determinants of Health, Radiology Report Acuity, and Radiology Staffing Models in an Academic Health System. J Am Coll Radiol 2022; 19:172-177. [PMID: 35033306 DOI: 10.1016/j.jacr.2021.08.029] [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: 07/26/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Social determinants of health, including race and insurance status, contribute to patient outcomes. In academic health systems, care is provided by a mix of trainees and faculty members. The optimal staffing ratio of trainees to faculty members (T/F) in radiology is unknown but may be related to the complexity of patients requiring care. Hospital characteristics, patient demographics, and radiology report findings may serve as markers of risk for poor outcomes because of patient complexity. METHODS Descriptive characteristics of each hospital in an urban five-hospital academic health system, including payer distribution and race, were collected. Radiology department T/F ratios were calculated. A natural language processing model was used to classify multimodal report findings into nonacute, acute, and critical, with report acuity calculated as the fraction of acute and critical findings. Patient race, payer type, T/F ratio, and report acuity score for hospital 1, a safety net hospital, were compared with these factors for hospitals 2 to 5. RESULTS The fraction of patients at hospital 1 who are Black (79%) and have Medicaid insurance (28%) is significantly higher than at hospitals 2 to 5 (P < .0001), with the exception of hospital 3 (80.1% black). The T/F ratio of 1.37 at hospital 1 as well as its report acuity (28.9%) were significantly higher (P < .0001 for both). CONCLUSIONS T/F ratio and report acuity are highest at hospital 1, which serves the most at-risk patient population. This suggests a potential overreliance on trainees at a site whose patients may require the greatest expertise to optimize care.
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Affiliation(s)
- Melissa A Davis
- Assistant Professor, Director of Quality, Emory University, School of Medicine, Atlanta, Georgia.
| | | | - Imon Banerjee
- Assistant Professor, Emory University, School of Medicine, Atlanta, Georgia
| | | | - Janice Newsome
- Associate Professor, Chief of Interventional Radiology, Emory University, School of Medicine, Atlanta, Georgia
| | - Brianna L Vey
- Resident, Emory University, School of Medicine, Atlanta, Georgia
| | - Roger Gerard
- Resident, Emory University, School of Medicine, Atlanta, Georgia
| | - Fiza Khan
- Resident, Emory University, School of Medicine, Atlanta, Georgia
| | - Vaz Zavaletta
- Fellow, Emory University, School of Medicine, Atlanta, Georgia
| | - Sina Mazaheri
- Resident, Emory University, School of Medicine, Atlanta, Georgia
| | - Marta E Heilbrun
- Associate Professor, Vice-Chair of Quality, Emory University, School of Medicine, Atlanta, Georgia
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23
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Hutchins TA, Peckham M, Shah LM, Parsons MS, Agarwal V, Boulter DJ, Burns J, Cassidy RC, Davis MA, Holly LT, Hunt CH, Khan MA, Moritani T, Ortiz AO, O'Toole JE, Powers WJ, Promes SB, Reitman C, Shah VN, Singh S, Timpone VM, Corey AS. ACR Appropriateness Criteria® Low Back Pain: 2021 Update. J Am Coll Radiol 2021; 18:S361-S379. [PMID: 34794594 DOI: 10.1016/j.jacr.2021.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 01/19/2023]
Abstract
In the United States, acute low back pain, with or without radiculopathy, is the leading cause of years lived with disability and the third ranking cause of disability-adjusted life-years. Uncomplicated acute low back pain and/or radiculopathy is a benign, self-limited condition that does not warrant any imaging studies. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags, raising suspicion for a serious underlying condition, such as cauda equina syndrome, malignancy, fracture, or infection. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Troy A Hutchins
- Chief Value Officer, Department of Radiology, University of Utah Health, Salt Lake City, Utah.
| | - Miriam Peckham
- Research Author, University of Utah Medical Center, Salt Lake City, Utah
| | - Lubdha M Shah
- Panel Chair, University of Utah, Salt Lake City, Utah
| | - Matthew S Parsons
- Panel Vice-Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Vikas Agarwal
- Vice-Chair, Education, Chief, Neuroradiology, and Director, Spine Intervention, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel J Boulter
- Clinical Director, MRI, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Judah Burns
- Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; Executive Board, Kentucky Orthopaedic Society; and American Academy of Orthopaedic Surgeons
| | - Melissa A Davis
- Director of Quality, Department of Radiology, Emory University, Atlanta, Georgia; and ACR YPS Communications Liaison
| | - Langston T Holly
- UCLA Medical Center, Los Angeles, California, Neurosurgery expert
| | | | | | | | - A Orlando Ortiz
- Chairman, Department of Radiology, Jacobi Medical Center, Bronx, New York
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; and Chair, Writing Group - American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Susan B Promes
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania; American College of Emergency Physicians; Editor-in-Chief, AEM Education & Training; and Board Member, Pennsylvania Psychiatric Hospital
| | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; North American Spine Society
| | - Vinil N Shah
- University of California San Francisco, San Francisco, California; Executive Committee, American Society of Spine Radiology; and Board of Directors, Spine Intervention Society
| | - Simranjit Singh
- Indiana University School of Medicine, Indianapolis, Indiana; American College of Physicians; Secretary, SHM, Indiana chapter; and Secretary, SGIM Midwest Region
| | - Vincent M Timpone
- Co-Director, Neuroradiology, Spine Intervention Service, and Director, Stroke and Vascular Imaging, Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Ledbetter LN, Burns J, Shih RY, Ajam AA, Brown MD, Chakraborty S, Davis MA, Ducruet AF, Hunt CH, Lacy ME, Lee RK, Pannell JS, Pollock JM, Powers WJ, Setzen G, Shaines MD, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Cerebrovascular Diseases-Aneurysm, Vascular Malformation, and Subarachnoid Hemorrhage. J Am Coll Radiol 2021; 18:S283-S304. [PMID: 34794589 DOI: 10.1016/j.jacr.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Received: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 11/22/2022]
Abstract
Cerebrovascular disease is a broad topic. This document focuses on the imaging recommendations for the varied clinical scenarios involving intracranial aneurysms, vascular malformations, and vasculitis, which all carry high risk of morbidity and mortality. Additional imaging recommendations regarding complications of these conditions, including subarachnoid hemorrhage and vasospasm, are also covered. While each variant presentation has unique imaging recommendations, the major focus of this document is neurovascular imaging techniques. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Luke N Ledbetter
- Director, Head and Neck Imaging, University of California Los Angeles, Los Angeles, California.
| | - Judah Burns
- Panel Chair and Program Director, Diagnostic Radiology Residency Program, Montefiore Medical Center, Bronx, New York
| | - Robert Y Shih
- Panel Vice-Chair, Uniformed Services University, Bethesda, Maryland
| | - Amna A Ajam
- Ohio State University, Columbus, Ohio; Chief of Neuroradiology & MRI at WRNMMC; and Associate Chief of Neuroradiology for AIRP
| | - Michael D Brown
- Michigan State University, East Lansing, Michigan, American College of Emergency Physicians
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Melissa A Davis
- Director of Quality, Radiology, Emory University, Atlanta, Georgia; ACR YPS Communications Liaison
| | - Andrew F Ducruet
- Barrow Neurological Institute, Phoenix, Arizona, Neurosurgery expert
| | | | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | - Ryan K Lee
- Chair, Department of Radiology, Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology; Chair, Writing Group, American Heart Association/American Stroke Association Guidelines for the Early Management of Patients with Acute Ischemic Stroke, 2016-2019
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York; American Academy of Otolaryngology-Head and Neck Surgery; President, Albany ENT & Allergy Services, PC
| | - Matthew D Shaines
- Associate Chief, Hospital Medicine, Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York; Internal medicine physician
| | - Pallavi S Utukuri
- Clinical Site Director, Department of Radiology, Allen Hospital, New York Presbyterian, New York, New York; and Columbia University Medical Center, New York, New York
| | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Davis MA, Camacho LE, Pendleton AL, Antolic AT, Luna-Ramirez RI, Kelly AC, Steffens NR, Anderson MJ, Limesand SW. Augmented glucose production is not contingent on high catecholamines in fetal sheep with IUGR. J Endocrinol 2021; 249:195-207. [PMID: 33994373 PMCID: PMC8175032 DOI: 10.1530/joe-21-0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 01/04/2023]
Abstract
Fetuses with intrauterine growth restriction (IUGR) have high concentrations of catecholamines, which lowers the insulin secretion and glucose uptake. Here, we studied the effect of hypercatecholaminemia on glucose metabolism in sheep fetuses with placental insufficiency-induced IUGR. Norepinephrine concentrations are elevated throughout late gestation in IUGR fetuses but not in IUGR fetuses with a bilateral adrenal demedullation (IAD) at 0.65 of gestation. Euglycemic (EC) and hyperinsulinemic-euglycemic (HEC) clamps were performed in control, intact-IUGR, and IAD fetuses at 0.87 of gestation. Compared to controls, basal oxygen, glucose, and insulin concentrations were lower in IUGR groups. Norepinephrine concentrations were five-fold higher in IUGR fetuses than in IAD fetuses. During the EC, rates of glucose entry (GER, umbilical + exogenous), glucose utilization (GUR), and glucose oxidation (GOR) were greater in IUGR groups than in controls. In IUGR and IAD fetuses with euglycemia and euinsulinemia, glucose production rates (GPR) remained elevated. During the HEC, GER and GOR were not different among groups. In IUGR and IAD fetuses, GURs were 40% greater than in controls, which paralleled the sustained GPR despite hyperinsulinemia. Glucose-stimulated insulin concentrations were augmented in IAD fetuses compared to IUGR fetuses. Fetal weights were not different between IUGR groups but were less than controls. Regardless of norepinephrine concentrations, IUGR fetuses not only develop greater peripheral insulin sensitivity for glucose utilization but also develop hepatic insulin resistance because GPR was maintained and unaffected by euglycemia or hyperinsulinemia. These findings show that adaptation in glucose metabolism of IUGR fetuses are independent of catecholamines, which implicate that hypoxemia and hypoglycemia cause the metabolic responses.
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Affiliation(s)
- Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Alexander L Pendleton
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Andrew T Antolic
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Rosa I Luna-Ramirez
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Nathan R Steffens
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, USA
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Garg A, Maran I, Vlieks K, Neuschatz K, Coppola A, Poskus K, Johnson J, Davis MA, Minja F, Jasne A, Sansing LH, Schindler JL, Malhotra A, Sharma R. Abstract P136: Feasibility and Safety of an Expedited Emergency Department TIA Evaluation. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p136] [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
Introduction:
Transient ischemic attack (TIA) can portend impending stroke, but it is unclear whether a TIA evaluation necessitates inpatient admission. We assessed feasibility and safety of a TIA protocol in the emergency room for low-risk TIA patients.
Methods:
We studied low-risk TIA patients (ABCD2 score < 4, no significant vessel stenosis) before (January 2018-July 2019) and after (August 2019-March 2020) the implementation of an expedited, emergency room TIA protocol at a comprehensive stroke center. The pre-intervention cohort consisted of TIA patients in the institutional Get-With-The-Guidelines database who met pre-specified criteria (
Figure
) and were admitted. The post-intervention patients met the same criteria and underwent an expedited MRI with selected sequences. If the MRI showed no ischemia, patients were scheduled with rapid, outpatient stroke clinic follow-up and outpatient echocardiogram as indicated. We compared differences in outcomes of interest between the pre-and post-intervention cohorts including length of stay, radiographic and echocardiogram findings, and recurrent neurovascular events within 30 days.
Results:
In total, 120 TIA patients met criteria (71 pre-intervention, 49 patient post-intervention). Demographic and clinical characteristics were similar except the pre-intervention pathway had a higher proportion of patients with a smoking history and presenting symptom of aphasia and dysarthria. Median time from MRI order to completion was 2.3 hours in the post-intervention cohort. Median length of stay was 7.7 hours (IQR 5.2-9.7) in the post-intervention cohort compared to 28.8 hours (IQR 24.4-42.4) pre-intervention. There were no differences in neuroimaging or echocardiographic findings and 30-day re-presentation for stroke, TIA, or mortality.
Conclusions:
Our study demonstrates the feasibility and suggests safety of an expedited TIA protocol. Further study is needed to determine its generalizability.
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Rao B, Zohrabian V, Cedeno P, Saha A, Pahade J, Davis MA. Utility of Artificial Intelligence Tool as a Prospective Radiology Peer Reviewer - Detection of Unreported Intracranial Hemorrhage. Acad Radiol 2021; 28:85-93. [PMID: 32102747 DOI: 10.1016/j.acra.2020.01.035] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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] [Received: 10/16/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES Misdiagnosis of intracranial hemorrhage (ICH) can adversely impact patient outcomes. The increasing workload on the radiologists may increase the chance of error and compromise the quality of care provided by the radiologists. MATERIALS AND METHODS We used an FDA approved artificial intelligence (AI) solution based on a convolutional neural network to assess the prevalence of ICH in scans, which were reported as negative for ICH. We retrospectively applied the AI solution to all consecutive noncontrast computed tomography (CT) head scans performed at eight imaging sites affiliated to our institution. RESULTS In the 6565 noncontrast CT head scans, which met the inclusion criteria, 5585 scans were reported to have no ICH ("negative-by-report" cases). We applied AI solution to these "negative-by-report" cases. AI solution suggested there were ICH in 28 of these scans ("negative-by-report" and "positive-by-AI solution"). After consensus review by three neuroradiologists, 16 of these scans were found to have ICH, which was not reported (missed diagnosis by radiologists), with a false-negative rate of radiologists for ICH detection at 1.6%. Most commonly missed ICH was overlying the cerebral convexity and in the parafalcine regions. CONCLUSION Our study demonstrates that an AI solution can help radiologists to diagnose ICH and thus decrease the error rate. AI solution can serve as a prospective peer review tool for non-contrast head CT scans to identify ICH and thus minimize false negatives.
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Affiliation(s)
- Balaji Rao
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520.
| | - Vahe Zohrabian
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520
| | - Paul Cedeno
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520
| | - Atin Saha
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520
| | - Jay Pahade
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar St. Tompkins East TE-2, New Haven, CT 06520
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Davis MA, Rao B, Cedeno PA, Saha A, Zohrabian VM. Machine Learning and Improved Quality Metrics in Acute Intracranial Hemorrhage by Noncontrast Computed Tomography. Curr Probl Diagn Radiol 2020; 51:556-561. [PMID: 33243455 DOI: 10.1067/j.cpradiol.2020.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The timely reporting of critical results in radiology is paramount to improved patient outcomes. Artificial intelligence has the ability to improve quality by optimizing clinical radiology workflows. We sought to determine the impact of a United States Food and Drug Administration-approved machine learning (ML) algorithm, meant to mark computed tomography (CT) head examinations pending interpretation as higher probability for intracranial hemorrhage (ICH), on metrics across our healthcare system. We hypothesized that ML is associated with a reduction in report turnaround time (RTAT) and length of stay (LOS) in emergency department (ED) and inpatient populations. MATERIALS AND METHODS An ML algorithm was incorporated across CT scanners at imaging sites in January 2018. RTAT and LOS were derived for reports and patients between July 2017 and December 2017 prior to implementation of ML and compared to those between January 2018 and June 2018 after implementation of ML. A total of 25,658 and 24,996 ED and inpatient cases were evaluated across the entire healthcare system before and after ML, respectively. RESULTS RTAT decreased from 75 to 69 minutes (P <0.001) at all facilities in the healthcare system. At the level 1 trauma center specifically, RTAT decreased from 67 to 59 minutes (P <0.001). ED LOS decreased from 471 to 425 minutes (P <0.001) for patients without ICH, and from 527 to 491 minutes for those with ICH (P = 0.456). Inpatient LOS decreased from 18.4 to 15.8 days for those without ICH (P = 0.001) and 18.1 to 15.8 days for those with ICH (P = 0.02). CONCLUSION We demonstrated that utilization of ML was associated with a statistically significant decrease in RTAT. There was also a significant decrease in LOS for ED patients without ICH, but not for ED patients with ICH. Further evaluation of the impact of such tools on patient care and outcomes is needed.
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Affiliation(s)
- Melissa A Davis
- Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT 06520
| | - Balaji Rao
- Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT 06520
| | - Paul A Cedeno
- Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT 06520
| | - Atin Saha
- Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT 06520
| | - Vahe M Zohrabian
- Department of Radiology and Biomedical Imaging ,Yale School of Medicine, Yale University, New Haven, CT 06520..
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Davis MA, Camacho LE, Anderson MJ, Steffens NR, Pendleton AL, Kelly AC, Limesand SW. Chronically elevated norepinephrine concentrations lower glucose uptake in fetal sheep. Am J Physiol Regul Integr Comp Physiol 2020; 319:R255-R263. [PMID: 32667834 PMCID: PMC7509250 DOI: 10.1152/ajpregu.00365.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/23/2019] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022]
Abstract
Fetal conditions associated with placental insufficiency and intrauterine growth restriction (IUGR) chronically elevate plasma norepinephrine (NE) concentrations. Our objective was to evaluate the effects of chronically elevated NE on insulin-stimulated glucose metabolism in normally grown, non-IUGR fetal sheep, which are independent of other IUGR-related reductions in nutrients and oxygen availability. After surgical placement of catheters, near-term fetuses received either a saline (control) or NE intravenous infusion with controlled euglycemia. In NE fetuses, plasma NE concentrations were 5.5-fold greater than controls, and fetal euglycemia was maintained with a maternal insulin infusion. Insulin secretion was blunted in NE fetuses during an intravenous glucose tolerance test. Weight-specific fluxes for glucose were measured during a euinsulinemic-euglycemic clamp (EEC) and a hyperinsulinemic-euglycemic clamp (HEC). Plasma glucose and insulin concentrations were not different between groups within each clamp, but insulin concentrations increased 10-fold between the EEC and the HEC. During the EEC, rates of glucose uptake (umbilical uptake + exogenous infusion) and glucose utilization were 47% and 35% lower (P < 0.05) in NE fetuses compared with controls. During the HEC, rates of glucose uptake were 28% lower (P < 0.05) in NE fetuses than controls. Glucose production was undetectable in either group, and glucose oxidation was unaffected by the NE infusion. These findings indicate that chronic exposure to high plasma NE concentrations lowers rates of net glucose uptake in the fetus without affecting glucose oxidation rates or initiating endogenous glucose production. Lower fetal glucose uptake was independent of insulin, which indicates insulin resistance as a consequence of chronically elevated NE.
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Affiliation(s)
- Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Nathan R Steffens
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Alexander L Pendleton
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
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30
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Pendleton AL, Antolic AT, Kelly AC, Davis MA, Camacho LE, Doubleday K, Anderson MJ, Langlais PR, Lynch RM, Limesand SW. Lower oxygen consumption and Complex I activity in mitochondria isolated from skeletal muscle of fetal sheep with intrauterine growth restriction. Am J Physiol Endocrinol Metab 2020; 319:E67-E80. [PMID: 32396498 PMCID: PMC7468780 DOI: 10.1152/ajpendo.00057.2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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] [Received: 02/19/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 01/25/2023]
Abstract
Fetal sheep with placental insufficiency-induced intrauterine growth restriction (IUGR) have lower hindlimb oxygen consumption rates (OCRs), indicating depressed mitochondrial oxidative phosphorylation capacity in their skeletal muscle. We hypothesized that OCRs are lower in skeletal muscle mitochondria from IUGR fetuses, due to reduced electron transport chain (ETC) activity and lower abundances of tricarboxylic acid (TCA) cycle enzymes. IUGR sheep fetuses (n = 12) were created with mid-gestation maternal hyperthermia and compared with control fetuses (n = 12). At 132 ± 1 days of gestation, biceps femoris muscles were collected, and the mitochondria were isolated. Mitochondria from IUGR muscle have 47% lower State 3 (Complex I-dependent) OCRs than controls, whereas State 4 (proton leak) OCRs were not different between groups. Furthermore, Complex I, but not Complex II or IV, enzymatic activity was lower in IUGR fetuses compared with controls. Proteomic analysis (n = 6/group) identified 160 differentially expressed proteins between groups, with 107 upregulated and 53 downregulated mitochondria proteins in IUGR fetuses compared with controls. Although no differences were identified in ETC subunit protein abundances, abundances of key TCA cycle enzymes [isocitrate dehydrogenase (NAD+) 3 noncatalytic subunit β (IDH3B), succinate-CoA ligase ADP-forming subunit-β (SUCLA2), and oxoglutarate dehydrogenase (OGDH)] were lower in IUGR mitochondria. IUGR mitochondria had a greater abundance of a hypoxia-inducible protein, NADH dehydrogenase 1α subcomplex 4-like 2, which is known to incorporate into Complex I and lower Complex I-mediated NADH oxidation. Our findings show that mitochondria from IUGR skeletal muscle adapt to hypoxemia and hypoglycemia by lowering Complex I activity and TCA cycle enzyme concentrations, which together, act to lower OCR and NADH production/oxidation in IUGR skeletal muscle.
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Affiliation(s)
- Alexander L Pendleton
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona
| | - Andrew T Antolic
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Kevin Doubleday
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, Arizona
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Paul R Langlais
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - Ronald M Lynch
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona
- Department of Physiology, University of Arizona, Tucson, Arizona
| | - Sean W Limesand
- Physiological Sciences Graduate Interdisciplinary Program, University of Arizona, Tucson, Arizona
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
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31
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Yates DT, Camacho LE, Kelly AC, Steyn LV, Davis MA, Antolic AT, Anderson MJ, Goyal R, Allen RE, Papas KK, Hay WW, Limesand SW. Postnatal β2 adrenergic treatment improves insulin sensitivity in lambs with IUGR but not persistent defects in pancreatic islets or skeletal muscle. J Physiol 2019; 597:5835-5858. [PMID: 31665811 PMCID: PMC6911010 DOI: 10.1113/jp278726] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 07/29/2019] [Accepted: 10/28/2019] [Indexed: 12/21/2022] Open
Abstract
Key points Previous studies in fetuses with intrauterine growth restriction (IUGR) have shown that adrenergic dysregulation was associated with low insulin concentrations and greater insulin sensitivity. Although whole‐body glucose clearance is normal, 1‐month‐old lambs with IUGR at birth have higher rates of hindlimb glucose uptake, which may compensate for myocyte deficiencies in glucose oxidation. Impaired glucose‐stimulated insulin secretion in IUGR lambs is due to lower intra‐islet insulin availability and not from glucose sensing. We investigated adrenergic receptor (ADR) β2 desensitization by administering oral ADRβ modifiers for the first month after birth to activate ADRβ2 and antagonize ADRβ1/3. In IUGR lambs ADRβ2 activation increased whole‐body glucose utilization rates and insulin sensitivity but had no effect on isolated islet or myocyte deficiencies. IUGR establishes risk for developing diabetes. In IUGR lambs we identified disparities in key aspects of glucose‐stimulated insulin secretion and insulin‐stimulated glucose oxidation, providing new insights into potential mechanisms for this risk.
Abstract Placental insufficiency causes intrauterine growth restriction (IUGR) and disturbances in glucose homeostasis with associated β adrenergic receptor (ADRβ) desensitization. Our objectives were to measure insulin‐sensitive glucose metabolism in neonatal lambs with IUGR and to determine whether daily treatment with ADRβ2 agonist and ADRβ1/β3 antagonists for 1 month normalizes their glucose metabolism. Growth, glucose‐stimulated insulin secretion (GSIS) and glucose utilization rates (GURs) were measured in control lambs, IUGR lambs and IUGR lambs treated with adrenergic receptor modifiers: clenbuterol atenolol and SR59230A (IUGR‐AR). In IUGR lambs, islet insulin content and GSIS were less than in controls; however, insulin sensitivity and whole‐body GUR were not different from controls. Of importance, ADRβ2 stimulation with β1/β3 inhibition increases both insulin sensitivity and whole‐body glucose utilization in IUGR lambs. In IUGR and IUGR‐AR lambs, hindlimb GURs were greater but fractional glucose oxidation rates and ex vivo skeletal muscle glucose oxidation rates were lower than controls. Glucose transporter 4 (GLUT4) was lower in IUGR and IUGR‐AR skeletal muscle than in controls but GLUT1 was greater in IUGR‐AR. ADRβ2, insulin receptor, glycogen content and citrate synthase activity were similar among groups. In IUGR and IUGR‐AR lambs heart rates were greater, which was independent of cardiac ADRβ1 activation. We conclude that targeted ADRβ2 stimulation improved whole‐body insulin sensitivity but minimally affected defects in GSIS and skeletal muscle glucose oxidation. We show that risk factors for developing diabetes are independent of postnatal catch‐up growth in IUGR lambs as early as 1 month of age and are inherent to the islets and myocytes. Previous studies in fetuses with intrauterine growth restriction (IUGR) have shown that adrenergic dysregulation was associated with low insulin concentrations and greater insulin sensitivity. Although whole‐body glucose clearance is normal, 1‐month‐old lambs with IUGR at birth have higher rates of hindlimb glucose uptake, which may compensate for myocyte deficiencies in glucose oxidation. Impaired glucose‐stimulated insulin secretion in IUGR lambs is due to lower intra‐islet insulin availability and not from glucose sensing. We investigated adrenergic receptor (ADR) β2 desensitization by administering oral ADRβ modifiers for the first month after birth to activate ADRβ2 and antagonize ADRβ1/3. In IUGR lambs ADRβ2 activation increased whole‐body glucose utilization rates and insulin sensitivity but had no effect on isolated islet or myocyte deficiencies. IUGR establishes risk for developing diabetes. In IUGR lambs we identified disparities in key aspects of glucose‐stimulated insulin secretion and insulin‐stimulated glucose oxidation, providing new insights into potential mechanisms for this risk.
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Affiliation(s)
- Dustin T Yates
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Leah V Steyn
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Andrew T Antolic
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Ravi Goyal
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Ronald E Allen
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Klearchos K Papas
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - William W Hay
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
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Pendleton AL, Humphreys LR, Davis MA, Camacho LE, Anderson MJ, Limesand SW. Increased pyruvate dehydrogenase activity in skeletal muscle of growth-restricted ovine fetuses. Am J Physiol Regul Integr Comp Physiol 2019; 317:R513-R520. [PMID: 31314546 PMCID: PMC6842904 DOI: 10.1152/ajpregu.00106.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/15/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022]
Abstract
Fetal sheep with placental insufficiency-induced intrauterine growth restriction (IUGR) have lower fractional rates of glucose oxidation and greater gluconeogenesis, indicating lactate shuttling between skeletal muscle and liver. Suppression of pyruvate dehydrogenase (PDH) activity was proposed because of greater pyruvate dehydrogenase kinase (PDK) 4 and PDK1 mRNA concentrations in IUGR muscle. Although PDK1 and PDK4 inhibit PDH activity to reduce pyruvate metabolism, PDH protein concentrations and activity have not been examined in skeletal muscle from IUGR fetuses. Therefore, we evaluated the protein concentrations and activity of PDH and the kinases and phosphatases that regulate PDH phosphorylation status in the semitendinosus muscle from placenta insufficiency-induced IUGR sheep fetuses and control fetuses. Immunoblots were performed for PDH, phosphorylated PDH (E1α), PDK1, PDK4, and pyruvate dehydrogenase phosphatase 1 and 2 (PDP1 and PDP2, respectively). Additionally, the PDH, lactate dehydrogenase (LDH), and citrate synthase (CS) enzymatic activities were measured. Phosphorylated PDH concentrations were 28% lower (P < 0.01) and PDH activity was 67% greater (P < 0.01) in IUGR fetal muscle compared with control. PDK1, PDK4, PDP1, PDP2, and PDH concentrations were not different between groups. CS and LDH activities were also unaffected. Contrary to the previous speculation, PDH activity was greater in skeletal muscle from IUGR fetuses, which parallels lower phosphorylated PDH. Therefore, greater expression of PDK1 and PDK4 mRNA did not translate to greater PDK1 or PDK4 protein concentrations or inhibition of PDH as proposed. Instead, these findings show greater PDH activity in IUGR fetal muscle, which indicates that alternative regulatory mechanisms are responsible for lower pyruvate catabolism.
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Affiliation(s)
- Alexander L Pendleton
- Physiological Sciences Graduate Interdisciplinary Program, The University of Arizona, Tucson, Arizona
| | - Laurel R Humphreys
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
| | - Sean W Limesand
- Physiological Sciences Graduate Interdisciplinary Program, The University of Arizona, Tucson, Arizona
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona
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Chong ST, Robinson JD, Davis MA, Bruno MA, Roberge EA, Reddy S, Pyatt RS, Friedberg EB. Emergency Radiology: Current Challenges and Preparing for Continued Growth. J Am Coll Radiol 2019; 16:1447-1455. [PMID: 31092353 DOI: 10.1016/j.jacr.2019.03.009] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/14/2019] [Accepted: 03/20/2019] [Indexed: 10/26/2022]
Abstract
The escalation of imaging volumes in the emergency department and intensifying demands for rapid radiology results have increased the demand for emergency radiology. The provision of emergency radiology is essential for nearly all radiology practices, from the smallest to the largest. As our radiology specialty responds to the challenge posed by the triple threat of providing 24-7 coverage, high imaging volumes, and rapid turnaround time, various questions regarding emergency radiology have emerged, including its definition and scope, unique operational demands, quality and safety concerns, impact on physician well-being, and future directions. This article reviews the current challenges confronting the subspecialty of emergency radiology and offers insights into preparing for continued growth.
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Affiliation(s)
- Suzanne T Chong
- Michigan Medicine, University of Michigan, Taubman Center, Ann Arbor, Michigan.
| | | | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Michael A Bruno
- Department of Radiology, The Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Eric A Roberge
- Department of Diagnostic Radiology, Madigan Army Medical Center, Tacoma, Washington
| | - Sravanthi Reddy
- Keck School of Medicine, University of Souther California, Los Angeles, California
| | - Robert S Pyatt
- Department of Radiology, Summit Health, Chambersburg, Pennsylvania
| | - Eric B Friedberg
- Department of Radiology and Imaging Services, Emory University, Johns Creek, Georgia
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Smith KE, Purvis WG, Davis MA, Min CG, Cooksey AM, Weber CS, Jandova J, Price ND, Molano DS, Stanton JB, Kelly AC, Steyn LV, Lynch RM, Limesand SW, Alexander M, Lakey JRT, Seeberger K, Korbutt GS, Mueller KR, Hering BJ, McCarthy FM, Papas KK. In vitro characterization of neonatal, juvenile, and adult porcine islet oxygen demand, β-cell function, and transcriptomes. Xenotransplantation 2018; 25:e12432. [PMID: 30052287 DOI: 10.1111/xen.12432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 01/29/2018] [Revised: 04/20/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is currently a shortage of human donor pancreata which limits the broad application of islet transplantation as a treatment for type 1 diabetes. Porcine islets have demonstrated potential as an alternative source, but a study evaluating islets from different donor ages under unified protocols has yet to be conducted. METHODS Neonatal porcine islets (NPI; 1-3 days), juvenile porcine islets (JPI; 18-21 days), and adult porcine islets (API; 2+ years) were compared in vitro, including assessments of oxygen consumption rate, membrane integrity determined by FDA/PI staining, β-cell proliferation, dynamic glucose-stimulated insulin secretion, and RNA sequencing. RESULTS Oxygen consumption rate normalized to DNA was not significantly different between ages. Membrane integrity was age dependent, and API had the highest percentage of intact cells. API also had the highest glucose-stimulated insulin secretion response during a dynamic insulin secretion assay and had 50-fold higher total insulin content compared to NPI and JPI. NPI and JPI had similar glucose responsiveness, β-cell percentage, and β-cell proliferation rate. Transcriptome analysis was consistent with physiological assessments. API transcriptomes were enriched for cellular metabolic and insulin secretory pathways, while NPI exhibited higher expression of genes associated with proliferation. CONCLUSIONS The oxygen demand, membrane integrity, β-cell function and proliferation, and transcriptomes of islets from API, JPI, and NPI provide a comprehensive physiological comparison for future studies. These assessments will inform the optimal application of each age of porcine islet to expand the availability of islet transplantation.
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Affiliation(s)
- Kate E Smith
- Department of Physiological Sciences, University of Arizona, Tucson, AZ, USA.,Department of Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Catherine G Min
- Department of Physiological Sciences, University of Arizona, Tucson, AZ, USA.,Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Amanda M Cooksey
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Craig S Weber
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Jana Jandova
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Diana S Molano
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Leah V Steyn
- Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ronald M Lynch
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
| | - Michael Alexander
- Department of Surgery, University of California-Irvine, Orange, CA, USA
| | | | - Karen Seeberger
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, AL, Canada
| | - Gregory S Korbutt
- Department of Surgery, Alberta Diabetes Institute, University of Alberta, Edmonton, AL, Canada
| | - Kate R Mueller
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Bernhard J Hering
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Fiona M McCarthy
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, USA
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Harris SE, De Blasio MJ, Davis MA, Kelly AC, Davenport HM, Wooding FBP, Blache D, Meredith D, Anderson M, Fowden AL, Limesand SW, Forhead AJ. Hypothyroidism in utero stimulates pancreatic beta cell proliferation and hyperinsulinaemia in the ovine fetus during late gestation. J Physiol 2017; 595:3331-3343. [PMID: 28144955 PMCID: PMC5451716 DOI: 10.1113/jp273555] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 09/29/2016] [Accepted: 01/11/2017] [Indexed: 12/17/2022] Open
Abstract
Key points Thyroid hormones are important regulators of growth and maturation before birth, although the extent to which their actions are mediated by insulin and the development of pancreatic beta cell mass is unknown. Hypothyroidism in fetal sheep induced by removal of the thyroid gland caused asymmetric organ growth, increased pancreatic beta cell mass and proliferation, and was associated with increased circulating concentrations of insulin and leptin. In isolated fetal sheep islets studied in vitro, thyroid hormones inhibited beta cell proliferation in a dose‐dependent manner, while high concentrations of insulin and leptin stimulated proliferation. The developing pancreatic beta cell is therefore sensitive to thyroid hormone, insulin and leptin before birth, with possible consequences for pancreatic function in fetal and later life. The findings of this study highlight the importance of thyroid hormones during pregnancy for normal development of the fetal pancreas.
Abstract Development of pancreatic beta cell mass before birth is essential for normal growth of the fetus and for long‐term control of carbohydrate metabolism in postnatal life. Thyroid hormones are also important regulators of fetal growth, and the present study tested the hypotheses that thyroid hormones promote beta cell proliferation in the fetal ovine pancreatic islets, and that growth retardation in hypothyroid fetal sheep is associated with reductions in pancreatic beta cell mass and circulating insulin concentration in utero. Organ growth and pancreatic islet cell proliferation and mass were examined in sheep fetuses following removal of the thyroid gland in utero. The effects of triiodothyronine (T3), insulin and leptin on beta cell proliferation rates were determined in isolated fetal ovine pancreatic islets in vitro. Hypothyroidism in the sheep fetus resulted in an asymmetric pattern of organ growth, pancreatic beta cell hyperplasia, and elevated plasma insulin and leptin concentrations. In pancreatic islets isolated from intact fetal sheep, beta cell proliferation in vitro was reduced by T3 in a dose‐dependent manner and increased by insulin at high concentrations only. Leptin induced a bimodal response whereby beta cell proliferation was suppressed at the lowest, and increased at the highest, concentrations. Therefore, proliferation of beta cells isolated from the ovine fetal pancreas is sensitive to physiological concentrations of T3, insulin and leptin. Alterations in these hormones may be responsible for the increased beta cell proliferation and mass observed in the hypothyroid sheep fetus and may have consequences for pancreatic function in later life. Thyroid hormones are important regulators of growth and maturation before birth, although the extent to which their actions are mediated by insulin and the development of pancreatic beta cell mass is unknown. Hypothyroidism in fetal sheep induced by removal of the thyroid gland caused asymmetric organ growth, increased pancreatic beta cell mass and proliferation, and was associated with increased circulating concentrations of insulin and leptin. In isolated fetal sheep islets studied in vitro, thyroid hormones inhibited beta cell proliferation in a dose‐dependent manner, while high concentrations of insulin and leptin stimulated proliferation. The developing pancreatic beta cell is therefore sensitive to thyroid hormone, insulin and leptin before birth, with possible consequences for pancreatic function in fetal and later life. The findings of this study highlight the importance of thyroid hormones during pregnancy for normal development of the fetal pancreas.
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Affiliation(s)
- Shelley E Harris
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK
| | - Miles J De Blasio
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Hailey M Davenport
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - F B Peter Wooding
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Dominique Blache
- School of Animal Biology, University of Western Australia, 6009, Crawley, Australia
| | - David Meredith
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK
| | - Miranda Anderson
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Abigail L Fowden
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, AZ, 85721, USA
| | - Alison J Forhead
- Department of Biological and Medical Sciences, Oxford Brookes University, Oxford, OX3 0BP, UK.,Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EG, UK
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Benjamin JS, Culpepper CB, Brown LD, Wesolowski SR, Jonker SS, Davis MA, Limesand SW, Wilkening RB, Hay WW, Rozance PJ. Chronic anemic hypoxemia attenuates glucose-stimulated insulin secretion in fetal sheep. Am J Physiol Regul Integr Comp Physiol 2017; 312:R492-R500. [PMID: 28100476 PMCID: PMC5407078 DOI: 10.1152/ajpregu.00484.2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 11/10/2016] [Revised: 01/04/2017] [Accepted: 01/11/2017] [Indexed: 01/15/2023]
Abstract
Fetal insulin secretion is inhibited by acute hypoxemia. The relationship between prolonged hypoxemia and insulin secretion, however, is less well defined. To test the hypothesis that prolonged fetal hypoxemia impairs insulin secretion, studies were performed in sheep fetuses that were bled to anemic conditions for 9 ± 0 days (anemic, n = 19) and compared with control fetuses (n = 15). Arterial hematocrit and oxygen content were 34% and 52% lower, respectively, in anemic vs. control fetuses (P < 0.0001). Plasma glucose concentrations were 21% higher in the anemic group (P < 0.05). Plasma norepinephrine and cortisol concentrations increased 70% in the anemic group (P < 0.05). Glucose-, arginine-, and leucine-stimulated insulin secretion all were lower (P < 0.05) in anemic fetuses. No differences in pancreatic islet size or β-cell mass were found. In vitro, isolated islets from anemic fetuses secreted insulin in response to glucose and leucine as well as control fetal islets. These findings indicate a functional islet defect in anemic fetuses, which likely involves direct effects of low oxygen and/or increased norepinephrine on insulin release. In pregnancies complicated by chronic fetal hypoxemia, increasing fetal oxygen concentrations may improve insulin secretion.
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Affiliation(s)
- Joshua S Benjamin
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Christine B Culpepper
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Laura D Brown
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado.,Center for Women's Health Research, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Stephanie R Wesolowski
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado.,Center for Women's Health Research, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Sonnet S Jonker
- Knight Cardiovascular Institute Center for Developmental Health, Oregon Health & Science University, Portland, Oregon; and
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona
| | - Randall B Wilkening
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - William W Hay
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Paul J Rozance
- Perinatal Research Center, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado; .,Center for Women's Health Research, University of Colorado Denver School of Medicine, Aurora, Colorado
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Fowler H, Davis MA, Perkins A, Trufan S, Joy C, Buswell M, McElwain TF, Moore D, Worhle R, Rabinowitz PM. A survey of veterinary antimicrobial prescribing practices, Washington State 2015. Vet Rec 2016; 179:651. [PMID: 27807211 DOI: 10.1136/vr.103916] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2016] [Indexed: 01/18/2023]
Abstract
Antimicrobial resistance is a growing global health issue. It is also a recognised problem in veterinary medicine. Between September and December 2015 the authors administered a cross-sectional survey to licensed veterinarians in Washington State to assess factors affecting antimicrobial prescribing practices among veterinarians in Washington State. Two hundred and three veterinarians completed the survey. The majority of respondents (166, 82 per cent) were engaged in small animal or exotic animal practice. 24 per cent of respondents reported not ordering culture and sensitivity (C/S) testing in practice. Of the 76 per cent of veterinarians who reported ordering C/S tests, 36 per cent reported ordering such testing 'often' or 'always' when treating presumptive bacterial infections. Most respondents (65 per cent) mentioned cost as the most common barrier to ordering a C/S test. Only 16 (10 per cent) respondents reported having access to or utilising a clinic-specific antibiogram. This survey demonstrated that while antimicrobials are commonly used in veterinary practice, and veterinarians are concerned about antimicrobial resistance, cost is a barrier to obtaining C/S tests to guide antimicrobial therapy. Summaries of antimicrobial resistance patterns are rarely available to the practising veterinarian. Efforts to promote antimicrobial stewardship in a 'One Health' manner should address barriers to the judicious use of antimicrobials in the veterinary practice setting.
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Affiliation(s)
- H Fowler
- Department of Occupational and Environmental Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle, Washington, USA
| | - M A Davis
- Washington State One Health Veterinary Workgroup
| | - A Perkins
- Washington State One Health Veterinary Workgroup
| | - S Trufan
- Department of Occupational and Environmental Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle, Washington, USA
| | - C Joy
- Washington State One Health Veterinary Workgroup
| | - M Buswell
- Washington State One Health Veterinary Workgroup
| | - T F McElwain
- Washington State One Health Veterinary Workgroup
| | - D Moore
- Washington State One Health Veterinary Workgroup
| | - R Worhle
- Washington State One Health Veterinary Workgroup
| | - P M Rabinowitz
- Department of Occupational and Environmental Health Sciences, Center for One Health Research (COHR), University of Washington School of Public Health, Seattle, Washington, USA
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Macko AR, Yates DT, Chen X, Shelton LA, Kelly AC, Davis MA, Camacho LE, Anderson MJ, Limesand SW. Adrenal Demedullation and Oxygen Supplementation Independently Increase Glucose-Stimulated Insulin Concentrations in Fetal Sheep With Intrauterine Growth Restriction. Endocrinology 2016; 157:2104-15. [PMID: 26937714 PMCID: PMC4870878 DOI: 10.1210/en.2015-1850] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 11/19/2022]
Abstract
In pregnancies complicated by placental insufficiency and intrauterine growth restriction (IUGR), fetal glucose and oxygen concentrations are reduced, whereas plasma norepinephrine and epinephrine concentrations are elevated throughout the final third of gestation. Here we study the effects of chronic hypoxemia and hypercatecholaminemia on β-cell function in fetal sheep with placental insufficiency-induced IUGR that is produced by maternal hyperthermia. IUGR and control fetuses underwent a sham (intact) or bilateral adrenal demedullation (AD) surgical procedure at 0.65 gestation. As expected, AD-IUGR fetuses had lower norepinephrine concentrations than intact-IUGR fetuses despite being hypoxemic and hypoglycemic. Placental insufficiency reduced fetal weights, but the severity of IUGR was less with AD. Although basal plasma insulin concentrations were lower in intact-IUGR and AD-IUGR fetuses compared with intact-controls, glucose-stimulated insulin concentrations were greater in AD-IUGR fetuses compared with intact-IUGR fetuses. Interestingly, AD-controls had lower glucose- and arginine-stimulated insulin concentrations than intact-controls, but AD-IUGR and AD-control insulin responses were not different. To investigate chronic hypoxemia in the IUGR fetus, arterial oxygen tension was increased to normal levels by increasing the maternal inspired oxygen fraction. Oxygenation of IUGR fetuses enhanced glucose-stimulated insulin concentrations 3.3-fold in intact-IUGR and 1.7-fold in AD-IUGR fetuses but did not lower norepinephrine and epinephrine concentrations. Together these findings show that chronic hypoxemia and hypercatecholaminemia have distinct but complementary roles in the suppression of β-cell responsiveness in IUGR fetuses.
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Affiliation(s)
- Antoni R Macko
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Dustin T Yates
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Xiaochuan Chen
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Leslie A Shelton
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Amy C Kelly
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Leticia E Camacho
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, Arizona 85719
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Davis MA, Macko AR, Steyn LV, Anderson MJ, Limesand SW. Fetal adrenal demedullation lowers circulating norepinephrine and attenuates growth restriction but not reduction of endocrine cell mass in an ovine model of intrauterine growth restriction. Nutrients 2015; 7:500-16. [PMID: 25584967 PMCID: PMC4303851 DOI: 10.3390/nu7010500] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 09/05/2014] [Accepted: 12/25/2014] [Indexed: 12/26/2022] Open
Abstract
Placental insufficiency is associated with fetal hypoglycemia, hypoxemia, and elevated plasma norepinephrine (NE) that become increasingly pronounced throughout the third trimester and contribute to intrauterine growth restriction (IUGR). This study evaluated the effect of fetal adrenal demedullation (AD) on growth and pancreatic endocrine cell mass. Placental insufficiency-induced IUGR was created by exposing pregnant ewes to elevated ambient temperatures during mid-gestation. Treatment groups consisted of control and IUGR fetuses with either surgical sham or AD at 98 days gestational age (dGA; term = 147 dGA), a time-point that precedes IUGR. Samples were collected at 134 dGA. IUGR-sham fetuses were hypoxemic, hypoglycemic, and hypoinsulinemic, and values were similar in IUGR-AD fetuses. Plasma NE concentrations were ~5-fold greater in IUGR-sham compared to control-sham, control-AD, and IUGR-AD fetuses. IUGR-sham and IUGR-AD fetuses weighed less than controls. Compared to IUGR-sham fetuses, IUGR-AD fetuses weighed more and asymmetrical organ growth was absent. Pancreatic β-cell mass and α-cell mass were lower in both IUGR-sham and IUGR-AD fetuses compared to controls, however, pancreatic endocrine cell mass relative to fetal mass was lower in IUGR-AD fetuses. These findings indicate that NE, independently of hypoxemia, hypoglycemia and hypoinsulinemia, influence growth and asymmetry of growth but not pancreatic endocrine cell mass in IUGR fetuses.
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Affiliation(s)
- Melissa A Davis
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ 85721, USA.
| | - Antoni R Macko
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ 85721, USA.
| | - Leah V Steyn
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ 85721, USA.
| | - Miranda J Anderson
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ 85721, USA.
| | - Sean W Limesand
- School of Animal and Comparative Biomedical Sciences, The University of Arizona, Tucson, AZ 85721, USA.
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40
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Pereira RV, Siler JD, Ng JC, Davis MA, Warnick LD. Effect of preweaned dairy calf housing system on antimicrobial resistance in commensal Escherichia coli. J Dairy Sci 2014; 97:7633-43. [PMID: 25306277 PMCID: PMC4351789 DOI: 10.3168/jds.2014-8588] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 07/09/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022]
Abstract
Group housing of preweaned dairy calves is a growing practice in the United States. The objective of this practice is to increase the average daily gain of calves in a healthy and humane environment while reducing labor requirements. However, feeding protocols, commingling of calves, and occurrence of disease in different calf-housing systems may affect the prevalence of antimicrobial drug-resistant bacteria. This study evaluated the effect of a group pen-housing system and individual pen-housing system on antimicrobial resistance trends in fecal Escherichia coli of preweaned dairy calves and on the prevalence of environmental Salmonella. Twelve farms from central New York participated in the study: 6 farms using an individual pen-housing system (IP), and 6 farms using a group pen-housing system (GP). A maximum of 3 fecal E. coli isolates per calf was tested for susceptibility to 12 antimicrobial drugs using a Kirby-Bauer disk diffusion assay. Calves in GP had a significantly higher proportion of E. coli resistant to ciprofloxacin and nalidixic acid, whereas calves in IP had a significantly higher proportion of E. coli resistant to ampicillin, ceftiofur, gentamycin, streptomycin, and tetracycline. Calf-housing system had an effect on resistance to individual antimicrobial drugs in E. coli, but no clear-cut advantage to either system was noted with regard to overall resistance frequency. No outstanding difference in the richness and diversity of resistant phenotypes was observed between the 2 calf-housing systems.
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Affiliation(s)
- R V Pereira
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
| | - J D Siler
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - J C Ng
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - M A Davis
- Veterinary Microbiology and Pathology Department, Washington State University, Pullman 99164-7040
| | - L D Warnick
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
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Pereira RV, Siler JD, Ng JC, Davis MA, Grohn YT, Warnick LD. Effect of on-farm use of antimicrobial drugs on resistance in fecal Escherichia coli of preweaned dairy calves. J Dairy Sci 2014; 97:7644-54. [PMID: 25306279 DOI: 10.3168/jds.2014-8521] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [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: 06/24/2014] [Accepted: 09/04/2014] [Indexed: 11/19/2022]
Abstract
Respiratory disease and diarrhea are the 2 most common diseases that result in the use of antimicrobial drugs in preweaned calves. Because the use of drugs in food animals, including dairy calves, has the potential for generating cross-resistance to drugs used in human medicine, it is vital to propose farm practices that foster the judicious use of antimicrobials while assuring animal health and productivity. The objective of this study was to use dairy farm calf treatment records to identify antimicrobial drug treatments in calves and to evaluate their effects on the prevalence of antimicrobial-resistant Escherichia coli from rectal swabs of preweaned dairy calves. Eight farms from central New York participated in the study, 3 farms using individual pen housing management and 5 farms using group pen housing management. Eligible study farms could not add antimicrobial drugs to the milk fed to preweaned calves and were required to have farm records documenting antimicrobial drug treatment of calves from birth to weaning. Three fecal E. coli isolates per calf were tested for susceptibility to 12 antimicrobial drugs using a Kirby-Bauer disk diffusion assay. A total of 473 calves were sampled, from which 1,423 commensal E. coli isolates were tested. Of the 9 antimicrobial drugs used on study farms, only enrofloxacin was significantly associated with reduced antimicrobial susceptibility of E. coli isolates, although treatment with ceftiofur was associated with reduced susceptibility to ceftriaxone. The median numbers of days from treatment with ceftiofur and enrofloxacin to rectal swab sampling of calves were 16 d (range: 1-39) and 12 d (range: 6-44), respectively. At the isolate level, treatment with enrofloxacin resulted in odds ratios of 2 [95% confidence interval (CI): 1-4] and 3 (95% CI: 2-6), respectively, for isolation of nonsusceptible E. coli to nalidixic acid and ciprofloxacin compared with calves not treated with enrofloxacin. Treatment with ceftiofur resulted in an odds ratio of 3 (95% CI: 0.9-12) for isolation of nonsusceptible E. coli to ceftriaxone compared with calves not treated with ceftiofur. Treatment with enrofloxacin resulted in selection of isolates that presented phenotypic resistance to both ciprofloxacin and ceftriaxone. Treatment with ceftiofur resulted in a higher prevalence of isolates resistant to ≥3 antimicrobial drugs (97%) compared with no treatment with ceftiofur (73%). These findings reinforce the necessity for continued implementation of practices at the dairy farm that support the sustainable and judicious use of antimicrobial drugs in dairy calves.
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Affiliation(s)
- R V Pereira
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853.
| | - J D Siler
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - J C Ng
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - M A Davis
- Veterinary Microbiology and Pathology Department, Washington State University, Pullman 99164-7040
| | - Y T Grohn
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
| | - L D Warnick
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853
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Stukenborg GJ, Blackhall L, Harrison J, Barclay JS, Dillon P, Davis MA, Mallory M, Read P. Cancer patient-reported outcomes assessment using wireless touch screen tablet computers. Qual Life Res 2013; 23:1603-7. [PMID: 24307212 DOI: 10.1007/s11136-013-0595-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the feasibility of collecting patient-reported outcomes data with wireless touch screen tablet computers in the adult oncology palliative care setting. METHODS Patients were provided with tablet computers during scheduled clinic visits and answered online queries about their experience over the past week in the health domains of anxiety, depression, fatigue, pain interference, physical function, instrumental social support, sleep impairment, diarrhea, constipation, nausea, vomiting, anorexia, dyspnea, neuropathy, and spiritual values. RESULTS Content analysis of patient interviews indicates that wireless touch screen tablet computers are a feasible approach for collecting patient-reported outcome measures by palliative care cancer patients presenting in clinic. Most patients indicated that the questionnaire was easy to answer. However, all but one patient requested some form of assistance, and many reported difficulties attributable to a lack of familiarity with the device, interpretation of certain questions, and wireless connectivity-related issues. CONCLUSIONS This feasibility study demonstrates that tablet computers have the potential to efficiently and reliably collect patient-reported health status measures among palliative care cancer patients presenting in clinics. The use of these devices may lead to substantial improvements by making patient-reported outcomes available for clinical decision-making.
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Affiliation(s)
- G J Stukenborg
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA,
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Davis MA, Castillo M. Evaluation of the pituitary gland using magnetic resonance imaging: T1-weighted vs. VIBE imaging. Neuroradiol J 2013; 26:297-300. [PMID: 23859285 DOI: 10.1177/197140091302600307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/23/2013] [Indexed: 11/15/2022] Open
Abstract
Volumetric interpolated breath-hold examination (VIBE) is used for abdominal imaging as a fast and efficient modality. Evaluation of brain lesions using VIBE is not common and its use for the pituitary gland has not yet been addressed. Our goal was to compare coronal T1-weighted (T1W) and VIBE images in patients undergoing studies of the pituitary gland. We hypothesized that, for this purpose, VIBE is superior to T1W images. T1W and VIBE images of the pituitary gland in 32 patients were evaluated. The two sequences were compared with specific attention to: contrast enhancement (gland and cavernous sinuses) and ability to view the anatomy of the cavernous sinuses. In patients with macroadenomas, visualization of the optic chiasm was also assessed. Images were rated as: VIBE being better, equal, or worse in comparison to T1W images. We also compared VIBE and T1W images specifically looking at micro/macro-adenomas and post-surgical patients. Statistical analysis was performed using chi-square statistics. Of the 32 patients, the VIBE sequence showed superior contrast enhancement in 18 patients, six were found as being equal to T1W, and in eight instances VIBE was found to be worse than T1W. These results were statistically significant (p=.02). When looking at micro/macro-adenomas and post-surgical patients specifically, there was a trend to VIBE being superior to T1W but these data were not statistically significant. Visualization of chiasm in macroadenomas was similar for both techniques. VIBE was significantly superior to T1W with respect to pituitary and cavernous sinus contrast enhancement and cavernous sinus anatomy. A trend towards VIBE being superior in the evaluation of adenomas (pre- and post-operative) was seen, but it was not statistically significant. This is likely due to the small population size.
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Affiliation(s)
- M A Davis
- Department of Radiology, University of North Carolina; Chapel Hill, NC, USA.
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Davis MA, Walsh SDC, Saar MO. Statistically reconstructing continuous isotropic and anisotropic two-phase media while preserving macroscopic material properties. Phys Rev E Stat Nonlin Soft Matter Phys 2011; 83:026706. [PMID: 21405929 DOI: 10.1103/physreve.83.026706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/13/2010] [Indexed: 05/30/2023]
Abstract
We propose a method to generate statistically similar reconstructions of two-phase media. As with previous work, we initially characterize the microstructure of the material using two-point correlation functions (a subset of spatial correlation functions) and then generate numerical reconstructions using a simulated annealing method that preserves the geometric relationships of the material's phase of interest. However, in contrast to earlier contributions that consider reconstructions composed of discrete arrays of pixels or voxels alone, we generate reconstructions based on assemblies of continuous, three-dimensional, interpenetrating objects. The result is a continuum description of the material microstructure (as opposed to a discretized or pixelated description), capable of efficiently representing large disparities in scale. Different reconstruction methods are considered based on distinct combinations of two-point correlation functions of varying degrees of complexity. The quality of the reconstruction methods are evaluated by comparing the total pore fraction, specific surface area of the percolating cluster, pore fraction of the percolating cluster, tortuosity, and permeability of the reconstructions to those of a set of reference assemblies. Elsewhere it has been proposed that two-phase media could be statistically reproduced with only two spatial correlation functions: the two-point probability function (the probability that two points lie within the same phase) and the lineal path function (the probability that a line between two points lies entirely within the same phase). We find that methods employing the two-point probability function and lineal path function are improved if the percolating cluster volume is also considered in the reconstruction. However, to reproduce more complicated geometric assemblies, we find it necessary to employ the two-point probability, two-point cluster, and lineal path function in addition to the percolating cluster volume to produce a generally accurate statistical reconstruction.
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Affiliation(s)
- M A Davis
- Department of Geology and Geophysics, University of Minnesota, Twin Cities, Minnesota 55455, USA.
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Hoelzer K, Cummings KJ, Wright EM, Rodriguez-Rivera LD, Roof SE, Switt AIM, Dumas N, Root T, Schoonmaker-Bopp DJ, Grohn YT, Siler JD, Warnick LD, Hancock DD, Davis MA, Wiedmann M. Salmonella Cerro isolated over the past twenty years from various sources in the US represent a single predominant pulsed-field gel electrophoresis type. Vet Microbiol 2011; 150:389-93. [PMID: 21349663 DOI: 10.1016/j.vetmic.2011.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/09/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
Salmonella Cerro prevalence in US dairy cattle has increased significantly during the past decade. Comparison of 237 Salmonella isolates collected from various human and animal sources between 1986 and 2009 using pulsed-field gel electrophoresis, antimicrobial resistance typing, and spvA screening, showed very limited genetic diversity, indicating clonality of this serotype. Improved subtyping methods are clearly needed to analyze the potential emergence of this serotype. Our results thus emphasize the critical importance of population-based pathogen surveillance for the detection and characterization of potentially emerging pathogens, and caution to critically evaluate the adequacy of diagnostic tests for a given study population and diagnostic application.
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Affiliation(s)
- K Hoelzer
- Department of Food Science, Cornell University, Ithaca, NY 14850, USA.
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Davis MA, Evermann JF, Petersen CR, VancerSchalie J, Besser TE, Huckabee J, Daniels JB, Hancock DD, Leslie M, Baer R. Serological survey for antibodies to Leptospira in dogs and raccoons in Washington State. Zoonoses Public Health 2008; 55:436-42. [PMID: 18631236 DOI: 10.1111/j.1863-2378.2008.01137.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A high number of reported canine leptospirosis cases occurred in Washington State from 2004 to 2006. This prompted a serosurvey of healthy dogs from around the state to determine the distribution of exposure risk and to provide insight into serovar epidemiology in the region. In addition, a convenience sample of sera from injured raccoons was also tested, and clinical serological data from the Washington Animal Disease Diagnostic Laboratory were examined. The proportion of dogs with an antibody titre (>or=1:100) to any serovar was 27/158 (17.1%, 95% CI 11.6-23.9), and that proportion among raccoons was 22/115 (19.1%, 95% CI 12.4-27.5) suggesting that the potential for exposure in Washington state is not uncommon. The most frequently detected serovars in healthy dogs were Autumnalis, Icterohemorrhagiae and Canicola, in clinical canine samples Autumnalis, Bratislava and Pomona were more frequent and in sick or injured raccoons Autumnalis, and Pomona were most frequently detected. Clinical canine serology demonstrated a late summer-fall seasonality that was consistent with other reports. An outbreak of canine leptospirosis occurred during 2004-2006 and was located primarily in western Washington counties, as were three reported human cases in 2005. Canine leptospirosis surveillance is an important tool for detecting human risk of exposure and may provide insights into which serovars are currently of clinical importance.
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Affiliation(s)
- M A Davis
- Veterinary Microbiology and Pathology Department, College of Veterinary Medicine, Washington State University, Pullman, WA 99164-7040, USA.
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Chen YC, Davis MA, Lapatra SE, Cain KD, Snekvik KR, Call DR. Genetic diversity of Flavobacterium psychrophilum recovered from commercially raised rainbow trout, Oncorhynchus mykiss (Walbaum), and spawning coho salmon, O. kisutch (Walbaum). J Fish Dis 2008; 31:765-773. [PMID: 18681900 DOI: 10.1111/j.1365-2761.2008.00950.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Flavobacterium psychrophilum is the aetiological agent of rainbow trout fry syndrome and bacterial cold water disease. This study examined the genetic diversity of F. psychrophilum isolates retrieved from multiple epizootics at rainbow trout, Oncorhynchus mykiss, rearing facilities and from spawning coho salmon, O. kisutch. A total of 139 isolates were confirmed as F. psychrophilum by PCR assay and were further typed using pulsed-field gel electrophoresis (PFGE). Multiple epizootics at three proximally located rainbow trout rearing facilities were numerically dominated by three PFGE profiles, which accounted for 76% of all trout isolates. In coho salmon, 19 PFGE profiles were differentiated by PFGE and four numerically dominant PFGE profiles represented 56% of all coho salmon isolates. PFGE analysis also indicated that the average similarity of macrorestriction patterns of F. psychrophilum isolates was greater in rainbow trout than in coho salmon (88% vs. 70%). Furthermore, it was not unusual to isolate multiple PFGE profiles from a single coho salmon sample whereas only two PFGE profiles were shared between two sample dates separated by 1 month. It is clear that the domestic rainbow trout aquaculture facilities studied here were primarily affected by a complex of genetically related strains whereas spawning coho salmon supported a much more genetically diverse collection of F. psychrophilum.
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Affiliation(s)
- Y-C Chen
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman, WA 99164-7040, USA
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Cobbold RN, Davis MA, Rice DH, Szymanski M, Tarr PI, Besser TE, Hancock DD. Associations between bovine, human, and raw milk, and beef isolates of non-O157 Shiga toxigenic Escherichia coli within a restricted geographic area of the United States. J Food Prot 2008; 71:1023-7. [PMID: 18522040 DOI: 10.4315/0362-028x-71.5.1023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A survey for Shiga toxigenic Escherichia coli in raw milk and beef was conducted within a defined geographic region of the United States. Prevalence rates based on detection of Shiga toxin gene (stx) were 36% for retail beef, 23% for beef carcasses, and 21% for raw milk samples, which were significantly higher than were Shiga toxigenic E. coli isolation rates of 7.5, 5.8, and 3.2%, respectively. Seasonal prevalence differences were significant for stx positivity among ground beef and milk samples. Distribution of stx subtypes among isolates varied according to sample type, with stx1 predominating in milk, stx2 on carcasses, and the combination of both stx1 and stx2 in beef. Ancillary virulence markers eae and ehx were evident in 23 and 15% of isolates, respectively. Pulsed-field gel electrophoresis demonstrated associations between food isolates and sympatric bovine fecal, and human clinical isolates. These data demonstrate that non-O157 Shiga toxigenic E. coli is present in the food chain in the Pacific Northwest, and its risk to health warrants critical assessment.
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Affiliation(s)
- R N Cobbold
- Field Disease Investigation Unit, College of Veterinary Medicine, Washington State University, Pullman, Washington 99164-6610, USA.
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Nagurney JT, Huang C, Kulkarni RG, Sane S, Davis MA, Anderson PD, Gaufberg SV, Ciottone GR, Motola I, Chang Y, Setnik G. An attempt to measure the spread of emergency medicine internationally. Intern Emerg Med 2007; 2:302-10. [PMID: 18060470 DOI: 10.1007/s11739-007-0083-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 06/18/2007] [Accepted: 08/20/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the feasibility of using the internet to track the spread of emergency medicine internationally. OVERVIEW This was an attempt to perform a descriptive cross-sectional study employing a web-based survey. SUBJECTS Potential respondents were identified from multiple sources. OBSERVATIONS The primary outcome was the response to 16 questions about EM care and the setting in which it was delivered for acute cardiac, paediatric, obstetrical illnesses and trauma. The questions were divided into six general areas and elicited for urban, semi-urban and rural settings. A series of four e-mails soliciting completion of the survey were sent to potential respondents. ANALYSIS Simple descriptive statistics. RESULTS We identified 358 potential respondents with valid e-mail addresses over a period of three years. Overall, 145 (41%) responded and 117 (33% 95% CI 28-38%) of them were complete and interpretable. There was one response from 54 and two responses from 29 countries, representing an overall response rate by country surveyed of 65% (95% CI 57-73%), but of all existing countries of only 43% (95% CI 36-50%). Based on sparse data, it appears that in urban areas, 47% (obstetrics) to 65% (paediatric) of acutely sick or injured patients are taken to an ED-equivalent. For rural areas, this range was 19% (obstetrical) to 40% (trauma). CT scans are available in 78% of urban ED-equivalents but 12% of rural ones. Haematocrits are available in 72% of rural settings. In 60% of responding nations, some type of EM training was available, and in 42% physicians went abroad to study EM. CONCLUSIONS A survey of international EM is challenging to achieve because of difficulty in both identifying and in contacting potential respondents. Based on sparse data, population density (urban, rural) appears to be related to both the location to which acutely ill patients are taken for their care and to the level of technology available. The specialty of EM is now recognised internationally and education in EM is common.
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Affiliation(s)
- J T Nagurney
- Department of Emergency Medicine Clinics 115, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02115, USA.
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