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Pigaiani N, McCleskey B, Bortolotti F, De Leo D. Authors reply to "Commentary on - fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice? -". Forensic Sci Med Pathol 2024; 20:293-294. [PMID: 37428293 DOI: 10.1007/s12024-023-00671-w] [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] [Accepted: 06/19/2023] [Indexed: 07/11/2023]
Affiliation(s)
- N Pigaiani
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro, 10 - 37134, Verona, Italy.
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, AL, 35233, Birmingham, USA.
| | - B McCleskey
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, AL, 35233, Birmingham, USA
| | - F Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro, 10 - 37134, Verona, Italy
| | - D De Leo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro, 10 - 37134, Verona, Italy
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Pigaiani N, Barbiero G, Balestro E, Ausania F, McCleskey B, Begni E, Bortolotti F, Brunelli M, De Leo D. Fatal cardiac air embolism after CT-guided percutaneous needle lung biopsy: medical complication or medical malpractice? Forensic Sci Med Pathol 2024; 20:199-204. [PMID: 37160632 PMCID: PMC10944409 DOI: 10.1007/s12024-023-00639-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
Computed tomography (CT)-guided percutaneous needle biopsy of the lung is a well-recognized and relatively safe diagnostic procedure for suspicious lung masses. Systemic air embolism (SAE) is a rare complication of transthoracic percutaneous lung biopsies. Herein, we present a case of an 81-year-old man who underwent CT-guided percutaneous needle biopsy of a suspicious nodule in the lower lobe of the right lung. Shortly after the procedure, the patient coughed up blood which prompted repeat CT imaging. He was found to have a massive cardiac air embolism. The patient became unresponsive and, despite resuscitation efforts, was pronounced dead. The pathophysiology, risk factors, clinical features, radiological evidence, and autopsy findings associated with SAE are discussed, which may, in light of the current literature, assist with the dilemma between assessing procedural complications and medical liability. Given the instances of SAE in the setting of long operative procedures despite careful technical execution, providing accurate and in-depth information, including procedure-related risks, even the rarest but potentially fatal ones, is recommended for informed consent to reduce medicolegal litigation issues.
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Affiliation(s)
- Nicola Pigaiani
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy.
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA.
| | - Giulio Barbiero
- Unit of Radiology, Department of Medicine, University of Padova, University Hospital, 35128, Padua, Italy
| | - Elisabetta Balestro
- Unit of Respiratory Diseases, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, University Hospital, 35128, Padua, Italy
| | - Francesco Ausania
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Brandi McCleskey
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, 1515 6th Avenue South, Room 220, Birmingham, AL, 35233, USA
| | - Erica Begni
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Federica Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Matteo Brunelli
- Unit of Pathology, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
| | - Domenico De Leo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Piazzale L.A. Scuro 10, Verona, 37134, Italy
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Fujihashi A, Yang LC, Haynes W, Patel OU, Burge K, Yadav I, Van Wagoner N, McCleskey B. Evaluating the impact of pass/fail United States Medical Licensing Examination Step 1 scoring on pathology residency selection. Acad Pathol 2023; 10:100083. [PMID: 37168282 PMCID: PMC10164826 DOI: 10.1016/j.acpath.2023.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/14/2023] [Accepted: 03/18/2023] [Indexed: 05/13/2023] Open
Abstract
Beginning 26 January 2022, the United States Medical Licensing Examination Step 1 changed from a numerical score to Pass/Fail. Historically, residency programs have used Step 1 scores as a valuable metric in assessing the competitiveness of applicants. We assessed how residency program criteria will change when evaluating applicants after Step 1 becomes Pass/Fail. A survey was distributed to the program directors of all 144 pathology residency programs accredited by Accreditation Council for Graduate Medical Education. Survey questions evaluated the importance of using Step 1 and Step 2 Clinical Knowledge (CK) scores when assessing applicants. Participants were asked to rank a list of applicant criteria used before and after Step 1 becomes Pass/Fail. Data were analyzed using chi-squared and paired t-tests with significance at P < 0.05. A total of 34 residency program directors (23.6%) responded to the survey. 76.5% (P< 0.001) of responders believed Step 1 scores were able to predict a resident's ability to pass their board exams, while 41.2% believed Step 2 CK could predict a resident's ability to pass board exams and perform clinically in pathology (P = 0.282). 61.8% of responders agreed that an applicant's medical school ranking would become more important (P = 0.001). There were no significant differences in the relative importance of 16 selection criteria after the change of Step 1 to Pass/Fail. It does not appear that Step 2 CK will become more important. Although results are constrained by a 23.6% response rate, it can be a start to guiding future students through residency applications.
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Affiliation(s)
- Ayaka Fujihashi
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Corresponding author. Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Birmingham, AL, 35233, USA
| | - Lydia C. Yang
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Haynes
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Om U. Patel
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaitlin Burge
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ishant Yadav
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas Van Wagoner
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brandi McCleskey
- Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Forensic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
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Mitchell C, McCleskey B. Utility of a Handheld Blood Ketone Meter as a Postmortem Indicator of Diabetic Ketoacidosis. Am J Forensic Med Pathol 2023; 44:17-20. [PMID: 36103404 DOI: 10.1097/paf.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT When investigating a death potentially due to diabetic ketoacidosis (DKA), it is challenging to assess the glucose level in the blood, but β-hydroxybutyrate, the most prevalent ketone body in the blood, is relatively stable after death. The aim of this project is to prove that a commercially available ketone meter can be used on postmortem blood samples to aid the diagnosis of DKA in a novel setting (during coroner/medical examiner examination). Samples with acetone detected via gas chromatography were chosen retrospectively to determine whether the meter could detect ketones in postmortem blood (proof-of-concept). In all of the thawed samples, the meter detected an elevated ketone level. Samples were then obtained in a prospective manner to include those with a possible cause of death from DKA along with controls. We correctly identified 16 cases in which death was due to DKA with use of the ketone manner. The ketone levels ranged from 2.6 to 5.4 mmol/L in those cases. The diagnosis was confirmed with a greatly elevated vitreous glucose concentration or glycated hemoglobin concentration. Detecting the presence of ketones while in the autopsy suite allowed for more accurate preliminary diagnoses and utilization of resources.
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Padilla O, Knollmann-Ritschel B, McCleskey B, Zhang B, Lin A, Koteeswaran R, Dudrey E. Group for Research in Pathology Education at the International Association of Medical Science Educators (GRIPE@IAMSE): Working as a Team for Integration, 51th Annual Meeting, 2022, Denver, CO. Med Sci Educ 2023; 33:317-319. [PMID: 37008436 PMCID: PMC10060601 DOI: 10.1007/s40670-023-01741-y] [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] [Accepted: 01/13/2023] [Indexed: 06/19/2023]
Affiliation(s)
- Osvaldo Padilla
- Department of Pathology and Medical Education, Texas Tech Health Science Center in El Paso, El Paso, TX USA
| | | | - Brandi McCleskey
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Bei Zhang
- Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT USA
| | - Amy Lin
- University of Illinois College of Medicine at Chicago, Chicago, IL USA
| | - Rajasekara Koteeswaran
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA USA
| | - Ellen Dudrey
- Department of Pathology and Medical Education, Texas Tech Health Science Center in El Paso, El Paso, TX USA
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Levy S, Bassler J, Gagnon K, Prados M, Jeziorski M, McCleskey B, Crockett K, Li L, Bradford D, Cropsey K, Eaton E. Methamphetamines and Serious Injection-Related Infections: Opioid Use Care Continuum and Opportunities to End Alabama's Drug Crisis. Open Forum Infect Dis 2022; 10:ofac708. [PMID: 36726543 PMCID: PMC9879754 DOI: 10.1093/ofid/ofac708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Background Increasingly, injection opioid use and opioid use disorder (OUD) are complicated by methamphetamine use, but the impact of stimulant use on the care of people who inject drugs (PWID) with serious injection-related infections (SIRIs) is unknown. The objective of this study was to explore hospital outcomes and postdischarge trends for a cohort of hospitalized PWID to identify opportunities for intervention. Methods We queried the electronic medical record for patients hospitalized at the University of Alabama at Birmingham with injection drug use-related infections between 1/11/2016 and 4/24/2021. Patients were categorized as having OUD only (OUD), OUD plus methamphetamine use (OUD/meth), or injection of other substance(s) (other). We utilized statistical analyses to assess group differences across hospital outcomes and postdischarge trends. We determined the OUD continuum of care for those with OUD, with and without methamphetamine use. Results A total of 370 patients met inclusion criteria-many with readmissions (98%) and high mortality (8%). The majority were White, male, and uninsured, with a median age of 38. One in 4 resided outside of a metropolitan area. There were significant differences according to substance use in terms of sociodemographics and hospital outcomes: patients with OUD/meth were more likely to leave via patient-directed discharge, but those with OUD only had the greatest mortality. Comorbid methamphetamine use did not significantly impact the OUD care continuum. Conclusions The current drug crisis in AL will require targeted interventions to engage a young, uninsured population with SIRI in evidence-based addiction and infection services.
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Affiliation(s)
- Sera Levy
- Correspondence: Sera Levy, MS, Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, UAB, The University of Alabama at Birmingham, L107 Volker Hall, 1670 University Blvd, Birmingham, AL 35233 ()
| | - John Bassler
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kelly Gagnon
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Prados
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Madison Jeziorski
- Division of Infectious Diseases, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandi McCleskey
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kaylee Crockett
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Li
- Department of Psychiatry, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Davis Bradford
- Department of Internal Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen Cropsey
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, UAB, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Cutshall H, Amerson C, Singh N, Hattaway R, Rais-Bahrami S, McCleskey B. Impacts of the Virtual Landscape During the COVID-19 Pandemic on the 2020 Application Cycle. Am J Clin Pathol 2021. [PMCID: PMC8574506 DOI: 10.1093/ajcp/aqab191.246] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction/Objective In response to the COVID-19 pandemic, the 2020 application cycle adapted to a mostly virtual setting. This project focused on the impact of these changes on the 2020 application cycle with the elimination of in- person away rotations and interviews, as well as the implementation of new virtual opportunities for learning and interacting with residents and programs. Methods/Case Report This study was conducted through an anonymous survey sent out to programs that engaged in social media usage in the 2020 application cycle. The survey was made available to program directors, faculty, residents and the matched applicants and focused on their usage and opinion of impact of virtual opportunities, virtual interviews and social media encounters. Results (if a Case Study enter NA) A total of 17 program directors/faculty, 17 residents and 19 matched applicants completed the survey across 91 programs surveyed. Virtual opportunities that were offered across these programs include: open houses, sub-internships, didactic lectures, grand rounds, Q&A sessions, and virtual facility tours. Responses showed that 4 programs (16%) moved applicants up on their rank list based on pre-interview virtual interactions. From the applicant perspective, 13 (76.5%) said virtual opportunities impacted the way they evaluated programs with 13 (68.4%) ranking programs higher and 3 (15.7%) ranking programs they otherwise would not have ranked. On the other hand, 21 faculty/residents (80.7%) felt that applicants missed out on fully experiencing the program due to lack of in person interviews and away rotations. However, 14 programs (56%) interviewed more candidates and offered more interview days during the 2020 application cycle. Applicants also applied to a greater number of programs with 42% of surveyed applicants applying to more than 50 programs, however none attended more than 30 interviews. Conclusion In conclusion, adaptations in response to the COVID-19 pandemic have provided an unexpected opportunity to explore the impact of the virtual landscape on residency recruitment.
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Affiliation(s)
- H Cutshall
- Medical School, University of Alabama at Birmingham School of Medicine, Hoover, Alabama, UNITED STATES
| | - C Amerson
- Medical School, University of Alabama at Birmingham School of Medicine, Hoover, Alabama, UNITED STATES
| | - N Singh
- Medical School, University of Alabama at Birmingham School of Medicine, Hoover, Alabama, UNITED STATES
| | - R Hattaway
- Medical School, University of Alabama at Birmingham School of Medicine, Hoover, Alabama, UNITED STATES
| | - S Rais-Bahrami
- Urology, University of Alabama at Birmingham, Birmingham, Alabama, UNITED STATES
| | - B McCleskey
- Pathology, University of Alabama at Birmingham, Birmingham, Alabama, UNITED STATES
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Cutshall H, Hattaway R, Singh NP, Rais-Bahrami S, McCleskey B. The #Path2Path Virtual Landscape During the COVID-19 Pandemic: Preparing for the 2020 Pathology Residency Recruitment Season. Acad Pathol 2021; 8:23742895211002783. [PMID: 34192133 PMCID: PMC7994921 DOI: 10.1177/23742895211002783] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 11/17/2022] Open
Abstract
On May 11, 2020, the Association of American Medical Colleges released recommendations discouraging in-person activities for away rotations and mandating virtual-only residency recruitment interviews. This paper focuses on how residency programs have attempted to adjust to this vastly different application cycle by using social media to reach their applicants. A total of 138 programs were identified through the Electronic Residency Application Services. The presence of Departmental/Residency program Twitter, Instagram, and Facebook as well as web pages offering virtual opportunities was recorded for each program on October 30, 2020. A total of 132 social media accounts were found; the majority of which were on Twitter, while fewer were on Instagram and Facebook. All 138 pathology residency programs had websites. Sixteen (11.5%) of those advertised virtual open houses and 2 (1.4%) advertised virtual subinternships; social media were more often used for advertisement of these virtual experiences. A total of 58 open house opportunities were advertised on Twitter, 21 on Instagram, and 20 on Facebook. Innovative virtual subinternships ranging from 2 to 4 weeks were developed, but only represented 6% of the usual 126 away rotations available. Pathology programs across the country utilized websites and social media as a method of communication to interact with applicants as part of the #Path2Path in 2020 and to provide virtual opportunities in preparation for a drastically different recruitment cycle.
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Affiliation(s)
- Hannah Cutshall
- School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Reagan Hattaway
- School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Nikhi P Singh
- School of Medicine, University of Alabama, Birmingham, AL, USA
| | | | - Brandi McCleskey
- Department of Pathology, University of Alabama, Birmingham, AL, USA
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Eaton EF, Lee RA, Westfall AO, Mathews RE, McCleskey B, Paddock CS, Lane PS, Cropsey KL. An Integrated Hospital Protocol for Persons With Injection-Related Infections May Increase Medications for Opioid Use Disorder Use but Challenges Remain. J Infect Dis 2021; 222:S499-S505. [PMID: 32877555 DOI: 10.1093/infdis/jiaa005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge. METHODS This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018. The protocol, the intravenous antibiotic and addiction team (IVAT), included Addiction Medicine and Infectious Diseases consultation and a 9-item risk assessment. We quantified MOUD use before and after IVAT and used logistic regression to determine factors associated with MOUD. We explored barriers to MOUD uptake using chart review. RESULTS A total of 37 and 98 patients met criteria in the pre- and post-IVAT periods, respectively. With IVAT, the percentage with OUD receiving MOUD significantly increased (29% pre-IVAT and 37% post-IVAT; P = .026) and MOUD use was higher in "high risk" participants (62%). Clinical and sociodemographic factors were not associated with MOUD receipt. CONCLUSIONS A hospital-based protocol may increase the use of MOUD; however, the uptake of MOUD remains suboptimal (<50%).
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Affiliation(s)
- Ellen F Eaton
- Department of Medicine, Division of Infectious Diseases University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rachael A Lee
- Department of Medicine, Division of Infectious Diseases University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew O Westfall
- Department of Biostatistics, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - R E Mathews
- Department of Medicine, Division of Hospital Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandi McCleskey
- Department of Pathology, Division of Forensics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cayce S Paddock
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter S Lane
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen L Cropsey
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chichester K, Drawve G, Sisson M, McCleskey B, Dye DW, Cropsey K. Examining the neighborhood-level socioeconomic characteristics associated with fatal overdose by type of drug involved and overdose setting. Addict Behav 2020; 111:106555. [PMID: 32717498 DOI: 10.1016/j.addbeh.2020.106555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/07/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fatal drug overdose in the United States is a public health crisis fueled by increased opioid and polysubstance use. Few studies have compared the neighborhood-level socioeconomic characteristics associated with overdoses of various substance classes and, to our knowledge, no investigation has yet assessed these factors in relation to polysubstance overdoses. Further, no study has determined whether socioeconomic conditions predict other contextually relevant aspects of overdoses such as whether they occur at-home or out-of-home. METHODS Overdose data (2015-2018) were obtained from the Coroner/Medical Examiner's Office of Jefferson County, Alabama. The toxicology results of decedents with a known overdose locations (N = 768) were assessed for the presence of synthetic opioids, natural and semi-synthetic opioids, heroin, stimulants, benzodiazepines, and alcohol. Socioeconomic characteristics were obtained from the Unites States Census Bureau at the census tract level. RESULTS Stimulant overdoses occurred in neighborhoods with the highest rates of disadvantage relative to other substance and polysubstance overdose types. The majority of included overdoses occurred at-home (63.7%) and an index of socioeconomic disadvantage predicted overdose rates for both at-home and out-of-home overdoses. Heroin overdose deaths were more likely to occur at-home while polysubstance stimulant-heroin overdoses were more common out-of-home. CONCLUSIONS An index of socioeconomic disadvantage was generally predictive of overdose, regardless of the setting in which the overdose occurred (in-home vs. out-of-home). The associations between neighborhood-level socioeconomic characteristics and fatal overdose can be tailored by substance type to create targeted interventions. Overdose setting may be an important consideration for future policy efforts, as overdoses were nearly twice as likely to occur at-home.
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Chichester K, Drawve G, Giménez-Santana A, Sisson M, McCleskey B, Dye DW, Walker J, Mrug S, Cropsey K. Pharmacies and features of the built environment associated with opioid overdose: A geospatial comparison of rural and urban regions in Alabama, USA. Int J Drug Policy 2020; 79:102736. [PMID: 32278255 DOI: 10.1016/j.drugpo.2020.102736] [Citation(s) in RCA: 8] [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: 08/19/2019] [Revised: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elements of the physical environment have been shown to influence health behaviors including drug use and overdose mortality. Throughout the opioid epidemic in the United States, rural regions have been disproportionately affected by opioid overdose. Although the relationship between the urban built environment and opioid overdose has been established, little is known as to how trends may differ in rural areas. METHODS Risk terrain modeling was used as a spatial analytical approach to assess environmental features that significantly increase the risk of opioid overdose in Jefferson County, Alabama. Spatial risk assessments were conducted for urban and rural regions as well as for the county as a whole. Criminogenic, opioid-related, and community variables were included and compared across spatial risk models. RESULTS The geographic context, rural or urban, influenced the relationship between environmental features and opioid overdose. In rural areas, community features such as bus stops and public schools were related to the occurrence of opioid overdose. In urban areas, inpatient treatment centers, transitional living facilities, express loan establishments, and liquor vendors were significantly related to the locations of opioid overdose. CONCLUSION Risk terrain modeling can be used to locate high-risk areas for opioid overdose while identifying factors that are contributing to the risk of events occurring in communities. The patterns of overdose risk differ in rural and urban contexts and may be used to inform the placement of treatment and prevention resources.
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Affiliation(s)
- Keith Chichester
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Grant Drawve
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, Fayetteville, AR 72701, United States
| | | | - Michelle Sisson
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Brandi McCleskey
- Department of Pathology, University of Alabama at Birmingham, 1515 6th Ave S #220, Birmingham, AL 35233, United States
| | - Daniel W Dye
- Department of Pathology, University of Alabama at Birmingham, 1515 6th Ave S #220, Birmingham, AL 35233, United States
| | - Jeffery Walker
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Sylvie Mrug
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Karen Cropsey
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States.
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Zhou Y, Staley EM, McCleskey B, Taylor B, Lorenz R. Paraneoplastic Panel Orders in the Context of an Existing Utilization Management Strategy. Am J Clin Pathol 2017. [DOI: 10.1093/ajcp/aqw191.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brazelton J, Oster RA, McCleskey B, Fuller J, Adamski J, Marques MB. Increased troponin I is associated with fatal outcome in acquired thrombotic thrombocytopenic purpura. J Clin Apher 2016; 32:311-318. [DOI: 10.1002/jca.21510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Jason Brazelton
- Department of Pathology; University of Alabama at Birmingham (UAB); Birmingham Alabama
| | - Robert A. Oster
- Department of Medicine; University of Alabama at Birmingham (UAB); Birmingham Alabama
| | - Brandi McCleskey
- Department of Pathology; University of Alabama at Birmingham (UAB); Birmingham Alabama
| | - Jessica Fuller
- Department of Pediatrics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Phoenix Arizona
| | - Marisa B. Marques
- Department of Pathology; University of Alabama at Birmingham (UAB); Birmingham Alabama
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14
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Mann SA, McCleskey B, Marques MB, Adamski J. Establishing an institutional therapeutic apheresis registry. J Clin Apher 2016; 31:516-522. [DOI: 10.1002/jca.21443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 12/02/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Steven A. Mann
- Department of Pathology and Laboratory Medicine, Indiana University; Indianapolis Indiana
| | - Brandi McCleskey
- Department of Pathology; University of Alabama at Birmingham (UAB); Birmingham Alabama
| | - Marisa B. Marques
- Department of Pathology; University of Alabama at Birmingham (UAB); Birmingham Alabama
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology; Mayo Clinic Arizona; Phoenix Arizona
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15
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Goyal J, McCleskey B, Adamski J. Peering into the future: hepcidin testing. Am J Hematol 2013; 88:976-8. [PMID: 23798368 DOI: 10.1002/ajh.23519] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/31/2013] [Accepted: 06/17/2013] [Indexed: 11/12/2022]
Abstract
Hepcidin, a small 25 amino acid peptide, has been well established as the iron regulatory hormone. Its expression is upregulated in response to iron and inflammatory cytokines, and downregulated in anemic or hypoxic states. Hepcidin decreases iron export into the plasma by binding to and inducing the degradation of ferroportin, an iron channel located on macrophages and the basolateral surface of enterocytes. This leads to decreased absorption of parental iron by the enterocytes, reduced recycling of erythrocyte iron by macrophages, and increased iron stores in the hepatocytes. Although hepcidin assays are not currently approved for clinical use in the United States, there is much interest in the potential use of this biomarker for management of iron related medical conditions. This review briefly summarizes the current hepcidin test platforms under investigation and the challenges associated with development of a clinical assay for this biomarker. In addition, selected potential future applications hepcidin testing in the clinical setting are addressed.
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Affiliation(s)
- Jatinder Goyal
- Department of Medicine; University of Alabama at Birmingham School of Medicine; Alabama
| | - Brandi McCleskey
- Department of Pathology; University of Alabama at Birmingham School of Medicine; Alabama
| | - Jill Adamski
- Department of Pathology; University of Alabama at Birmingham School of Medicine; Alabama
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McCleskey B, Tracht J, Adamski J. Thrombotic Thrombocytopenic Purpura-like Illness in a Patient With Anti-Glomerular Basement Membrane Antibody Disease. Am J Clin Pathol 2013. [DOI: 10.1093/ajcp/140.suppl1.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Scott JL, McCleskey B, Adamski J, Marques MB. Thrombotic thrombocytopenic purpura does not show seasonal variation in Alabama. Transfusion 2013; 53:1864-5. [DOI: 10.1111/trf.12253] [Citation(s) in RCA: 5] [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] [Indexed: 01/04/2023]
Affiliation(s)
| | | | - Jill Adamski
- University of Alabama at Birmingham; Birmingham; AL
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