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Eshak TB, Hobkirk AL, Whitener CJ, Conyers LM, Hwang W, Sznajder KK. Syndemic of Substance Abuse, Depression, and Type 2 Diabetes and Their Association with Retention in Care Among People Living with HIV. AIDS Behav 2024; 28:1612-1620. [PMID: 38281250 DOI: 10.1007/s10461-024-04275-5] [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] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
Substance abuse (SA), depression, and type 2 diabetes (DM2) often co-occur among people living with HIV (PLHIV). Guided by a syndemic framework, this cross-sectional retrospective study examined the cumulative and interaction effects of SA, depression, and DM2 on retention in HIV care (RIC) among 621 PLHIV receiving medical care in central Pennsylvania. We performed logistic regression analysis to test the associations between SA, depression, and DM2 and RIC. To test the "syndemic" model, we assessed additive and multiplicative interactions. In an unadjusted model, a dose-response pattern between the syndemic index (total number of health conditions) and RIC was detected (OR for 1 syndemic factor vs. none: 1.01, 95% CI: 0.69-1.47; 2 syndemic factors: 1.59, 0.89-2.84; 3 syndemic factors: 1.62, 0.44-5.94), but no group reached statistical significance. Interactions on both additive and multiplicative scales were not significant, demonstrating no syndemic effect of SA, depression, and DM2 on RIC among our study sample. Our findings highlight that comorbid conditions may, in some populations, facilitate RIC rather than act as barriers, which may be due to higher levels of engagement with medical care.
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Affiliation(s)
- Tarek B Eshak
- Department of Public Health, College of Health Professions, Slippery Rock University, Slippery Rock, PA, USA.
| | - Andrea L Hobkirk
- Department of Psychiatry and Behavioral Health, Penn State University, Hershey, PA, USA
| | - Cynthia J Whitener
- Department of Medicine, Penn State University, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Liza M Conyers
- Department of Educational Psychology, Counseling, and Special Education, Penn State University, University Park, PA, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
| | - Kristin K Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, PA, USA
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Edmonston D, Mulder H, Lydon E, Chiswell K, Lampron Z, Shay C, Marsolo K, Jones WS, Butler J, Shah RC, Chamberlain AM, Ford DE, Gordon HS, Hwang W, Chang A, Rao A, Bosworth HB, Pagidipati N. Kidney and Cardiovascular Effectiveness of Empagliflozin Compared With Dipeptidyl Peptidase-4 Inhibitors in Patients With Type 2 Diabetes. Am J Cardiol 2024; 221:S0002-9149(24)00268-6. [PMID: 38641191 DOI: 10.1016/j.amjcard.2024.04.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/13/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
Placebo-controlled trials of sodium-glucose co-transporter-2 inhibitors demonstrate kidney and cardiovascular benefits for patients with type 2 diabetes and chronic kidney disease (CKD). We used real-world data to compare the kidney and cardiovascular effectiveness of empagliflozin to dipeptidyl peptidase-4 inhibitors (DPP4is), a commonly prescribed antiglycemic medication, in a diverse population with and without CKD. Using electronic health record data from 20 large US health systems, we leveraged propensity overlap weighting to compare the outcomes for empagliflozin and DPP4i initiators with type 2 diabetes between 2016 and 2020. The primary composite kidney outcome included 40% estimated glomerular filtration rate decrease, incident end-stage kidney disease, or all-cause mortality through 2 years or censoring. We also assessed cardiovascular and safety outcomes. Of 62,197 new users, 20,279 initiated empagliflozin and 41,918 initiated DPP4i. Over a median follow-up of 1.1 years, empagliflozin prescription was associated with a lower risk of the primary outcome (hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.65 to 0.87) than DPP4is. The risks for mortality (HR 0.76, 95% CI 0.62 to 0.92) and a cardiovascular composite of stroke, myocardial infarction, or all-cause mortality (HR 0.81, 95% CI 0.70 to 0.95) were also lower for empagliflozin initiators. No difference in heart failure hospitalization risk between groups was observed. Genital mycotic infections were more common in patients prescribed empagliflozin (HR 1.72, 95% CI 1.58 to 1.88). Empagliflozin was associated with a lower risk of the primary outcome in patients with CKD (HR 0.68, 95% CI 0.53 to 0.88) and those without CKD (HR 0.79, 95% CI 0.67 to 0.94). In conclusion, the initiation of empagliflozin was associated with a significantly lower risk of kidney and cardiovascular outcomes than DPP4is over a median of just over 1 year. The association with a lower risk for clinical outcomes was apparent even for patients without known CKD at baseline.
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Affiliation(s)
- Daniel Edmonston
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Hillary Mulder
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth Lydon
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Zachary Lampron
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Keith Marsolo
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas
| | - Raj C Shah
- Department of Family & Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel E Ford
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Howard S Gordon
- University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Wenke Hwang
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Alexander Chang
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Ajaykumar Rao
- Department of Endocrinology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hayden B Bosworth
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Boehringer Ingelheim Pharmaceuticals Inc., XX, XX; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina; Duke University School of Nursing, Durham, North Carolina
| | - Neha Pagidipati
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Sullivan LM, Weist EM, Barrington WE, Fairchild AL, Hwang W, Kiviniemi MT, Mohammed SD, Wyant VA, Alexander LA, Magaña L. Education for public health 2030: transformation to meet health needs in a changing world. Front Public Health 2023; 11:1269272. [PMID: 38162596 PMCID: PMC10757328 DOI: 10.3389/fpubh.2023.1269272] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Education for public health is at a critical inflection point, and either transforms for success or fails to remain relevant. In 2020, the Association for Schools and Programs of Public Health launched an initiative, Framing the Future 2030: Education for Public Health (FTF 2030) to develop a resilient educational system for public health that promotes scientific inquiry, connects research, education, and practice, eliminates inequities, incorporates anti-racism principles, creates and sustains diverse and inclusive teaching and learning communities, and optimizes systems and resources to prepare graduates who are clearly recognizable for their population health perspectives, knowledge, skills, attitudes, and practices. Three expert panels: (1) Inclusive excellence through an anti-racism lens; (2) Transformative approaches to teaching and learning; and (3) Expanding the reach, visibility, and impact of the field of academic public health are engaged in ongoing deliberations to generate recommendations to implement the necessary change. The article describes the panels' work completed thus far, a "Creating an Inclusive Workspace" guide, and work planned, including questions for self-evaluation, deliberation, and reflection toward actions that support academe in developing a resilient education system for public health, whether beginning or advancing through a process of change. The FTF 2030 steering committee asserts its strong commitment to structural and substantial change that strengthens academic public health as an essential component of a complex socio-political system. Lastly, all are called to join the effort as collaboration is essential to co-develop an educational system for public health that ensures health equity for all people, everywhere.
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Affiliation(s)
- Lisa M. Sullivan
- Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth M. Weist
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Wendy E. Barrington
- Center for Anti-Racism and Community Health, Health Systems and Population Health Epidemiology, University of Washington School of Public Health, Seattle, WA, United States
| | - Amy L. Fairchild
- Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, United States
| | - Wenke Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Marc T. Kiviniemi
- Department of Health, Behavior and Society, University of Kentucky College of Public Health, Lexington, KY, United States
| | - Shan D. Mohammed
- DEI Educational and Student Initiatives, Northeastern University Bouvé College of Health Sciences, Boston, MA, United States
| | - Victoria A. Wyant
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Linda A. Alexander
- Association of Schools and Programs of Public Health, Washington, DC, United States
| | - Laura Magaña
- Association of Schools and Programs of Public Health, Washington, DC, United States
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Kelsey MD, Mulder H, Chiswell K, Lampron ZM, Nilles E, Kulinski JP, Joshi PH, Jones WS, Chamberlain AM, Leucker TM, Hwang W, Milks MW, Paranjape A, Obeid JS, Linton MF, Kent ST, Peterson ED, O'Brien EC, Pagidipati NJ. Contemporary patterns of lipoprotein(a) testing and associated clinical care and outcomes. Am J Prev Cardiol 2023; 14:100478. [PMID: 37025553 PMCID: PMC10070377 DOI: 10.1016/j.ajpc.2023.100478] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective Elevated lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular disease, yet little is known about Lp(a) testing patterns in real-world practice. The objective of this analysis was to determine how Lp(a) testing is used in clinical practice in comparison with low density lipoprotein cholesterol (LDL-C) testing alone, and to determine whether elevated Lp(a) level is associated with subsequent initiation of lipid-lowering therapy (LLT) and incident cardiovascular (CV) events. Methods This is an observational cohort study, based on lab tests administered between Jan 1, 2015 and Dec 31, 2019. We used electronic health record (EHR) data from 11 United States health systems participating in the National Patient-Centered Clinical Research Network (PCORnet). We created two cohorts for comparison: 1) the Lp(a) cohort, of adults with an Lp(a) test and 2) the LDL-C cohort, of 4:1 date- and site-matched adults with an LDL-C test, but no Lp(a) test. The primary exposure was the presence of an Lp(a) or LDL-C test result. In the Lp(a) cohort, we used logistic regression to assess the relationship between Lp(a) results in mass units (< 50, 50-100, and > 100mg/dL) and molar units (<125, 125-250, > 250nmol/L) and initiation of LLT within 3 months. We used multivariable adjusted Cox proportional hazards regression to evaluate these Lp(a) levels and time to composite CV hospitalization, including hospitalization for myocardial infarction, revascularization and ischemic stroke. Results Overall, 20,551 patients had Lp(a) test results and 2,584,773 patients had LDL-C test results (82,204 included in the matched LDL-C cohort). Compared with the LDL-C cohort, the Lp(a) cohort more frequently had prevalent ASCVD (24.3% vs. 8.5%) and multiple prior CV events (8.6% vs. 2.6%). Elevated Lp(a) was associated with greater odds of subsequent LLT initiation. Elevated Lp(a) reported in mass units was also associated with subsequent composite CV hospitalization [aHR (95% CI): Lp(a) 50-100mg/dL 1.25 (1.02-1.53), p<0.03, Lp(a) > 100mg/dL 1.23 (1.08-1.40), p<0.01]. Conclusion Lp(a) testing is relatively infrequent in health systems across the U.S. As new therapies for Lp(a) emerge, improved patient and provider education is needed to increase awareness of the utility of this risk marker.
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Affiliation(s)
- Michelle D. Kelsey
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Ester Nilles
- Duke Clinical Research Institute, Durham, NC, USA
| | - Jacquelyn P. Kulinski
- Department of Medicine, Division of Cardiology, Medical College of Wisconsin, Milwaukee, USA
| | - Parag H. Joshi
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - W. Schuyler Jones
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Alanna M. Chamberlain
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Thorsten M. Leucker
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Penn State Hershey Medical Center, The Pennsylvania State University, PA, USA
| | - M. Wesley Milks
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anuradha Paranjape
- Department of Medicine, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Jihad S. Obeid
- Division of Biomedical Informatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - MacRae F. Linton
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shia T. Kent
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - Eric D. Peterson
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Neha J. Pagidipati
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Chamberlain AM, Cooper-DeHoff RM, Fontil V, Nilles EK, Shaw KM, Smith M, Lin F, Vittinghoff E, Maeztu C, Todd JV, Carton T, O'Brien EC, Faulkner Modrow M, Wozniak G, Rakotz M, Sanchez E, Smith SM, Polonsky TS, Ahmad FS, Liu M, McClay JC, VanWormer JJ, Taylor BW, Chrischilles EA, Wu S, Viera AJ, Ford DE, Hwang W, Knowlton KU, Pletcher MJ. Disruption in Blood Pressure Control With the COVID-19 Pandemic: The PCORnet Blood Pressure Control Laboratory. Mayo Clin Proc 2023; 98:662-675. [PMID: 37137641 PMCID: PMC9874044 DOI: 10.1016/j.mayocp.2022.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To explore trends in blood pressure (BP) control before and during the COVID-19 pandemic. PATIENTS AND METHODS Health systems participating in the National Patient-Centered Clinical Research Network (PCORnet) Blood Pressure Control Laboratory Surveillance System responded to data queries, producing 9 BP control metrics. Averages of the BP control metrics (weighted by numbers of observations in each health system) were calculated and compared between two 1-year measurement periods (January 1, 2019, through December 31, 2019, and January 1, 2020, through December 31, 2020). RESULTS Among 1,770,547 hypertensive persons in 2019, BP control to <140/<90 mm Hg varied across 24 health systems (range, 46%-74%). Reduced BP control occurred in most health systems with onset of the COVID-19 pandemic; the weighted average BP control was 60.5% in 2019 and 53.3% in 2020. Reductions were also evident for BP control to <130/<80 mm Hg (29.9% in 2019 and 25.4% in 2020) and improvement in BP (reduction of 10 mm Hg in systolic BP or achievement of systolic BP <140 mm Hg; 29.7% in 2019 and 23.8% in 2020). Two BP control process metrics exhibited pandemic-associated disruption: repeat visit in 4 weeks after a visit with uncontrolled hypertension (36.7% in 2019 and 31.7% in 2020) and prescription of fixed-dose combination medications among those with 2 or more drug classes (24.6% in 2019 and 21.5% in 2020). CONCLUSION BP control decreased substantially during the COVID-19 pandemic, with a corresponding reduction in follow-up health care visits among persons with uncontrolled hypertension. It is unclear whether the observed decline in BP control during the pandemic will contribute to future cardiovascular events.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - Rhonda M Cooper-DeHoff
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville; Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville
| | - Valy Fontil
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco; UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA
| | | | - Kathryn M Shaw
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Myra Smith
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Carlos Maeztu
- Citizen Scientist, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville
| | | | | | - Emily C O'Brien
- Duke Clinical Research Institute, Duke University, Durham, NC
| | | | | | | | | | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, IL
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mei Liu
- Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City
| | - James C McClay
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha
| | - Jeffrey J VanWormer
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI
| | | | | | - Shenghui Wu
- Department of Health and Exercise Science, Appalachian State University, Boone, NC
| | - Anthony J Viera
- Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Daniel E Ford
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD
| | - Wenke Hwang
- Penn State University College of Medicine, Hershey, PA
| | - Kirk U Knowlton
- Cardiovascular Department, Intermountain Heart Institute, Salt Lake City, UT
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco
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Abedi V, Lambert C, Chaudhary D, Rieder E, Avula V, Hwang W, Li J, Zand R. Defining the Age of Young Ischemic Stroke Using Data-Driven Approaches. J Clin Med 2023; 12:jcm12072600. [PMID: 37048683 PMCID: PMC10095415 DOI: 10.3390/jcm12072600] [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] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction: The cut-point for defining the age of young ischemic stroke (IS) is clinically and epidemiologically important, yet it is arbitrary and differs across studies. In this study, we leveraged electronic health records (EHRs) and data science techniques to estimate an optimal cut-point for defining the age of young IS. Methods: Patient-level EHRs were extracted from 13 hospitals in Pennsylvania, and used in two parallel approaches. The first approach included ICD9/10, from IS patients to group comorbidities, and computed similarity scores between every patient pair. We determined the optimal age of young IS by analyzing the trend of patient similarity with respect to their clinical profile for different ages of index IS. The second approach used the IS cohort and control (without IS), and built three sets of machine-learning models—generalized linear regression (GLM), random forest (RF), and XGBoost (XGB)—to classify patients for seventeen age groups. After extracting feature importance from the models, we determined the optimal age of young IS by analyzing the pattern of comorbidity with respect to the age of index IS. Both approaches were completed separately for male and female patients. Results: The stroke cohort contained 7555 ISs, and the control included 31,067 patients. In the first approach, the optimal age of young stroke was 53.7 and 51.0 years in female and male patients, respectively. In the second approach, we created 102 models, based on three algorithms, 17 age brackets, and two sexes. The optimal age was 53 (GLM), 52 (RF), and 54 (XGB) for female, and 52 (GLM and RF) and 53 (RF) for male patients. Different age and sex groups exhibited different comorbidity patterns. Discussion: Using a data-driven approach, we determined the age of young stroke to be 54 years for women and 52 years for men in our mainly rural population, in central Pennsylvania. Future validation studies should include more diverse populations.
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Affiliation(s)
- Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Clare Lambert
- Department of Neurology, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Emily Rieder
- Geisinger Commonwealth, School of Medicine, Scranton, PA 18509, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence: ; Tel.: +1-(717)-531-1804; Fax: +1-(717)-531-0384
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Ahn S, Hwang W, Cho S, Lee H, Kim J, Park H, Moon D, Oh M. Do changes in metabolic health and obesity affect the incidence of urolithiasis? A nationally representative cohort study. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00429-3] [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: 02/12/2023]
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Jo S, Ahn S, Hwang W, Lee H, Kim J, Oh M, Moon D, Park H. Differences in the composition of urinary stone in metabolically healthy and unhealthy obese patients. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00436-0] [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: 02/12/2023]
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Brawley AM, Schaefer EW, Lucarelli E, Ural SH, Chuang CH, Hwang W, Paul IM, Daymont C. Differing prevalence of microcephaly and macrocephaly in male and female fetuses. Front Glob Womens Health 2023; 4:1080175. [PMID: 36911049 PMCID: PMC9998507 DOI: 10.3389/fgwh.2023.1080175] [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: 10/25/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To compare the proportion of female and male fetuses classified as microcephalic (head circumference [HC] < 3rd percentile) and macrocephalic (>97th percentile) by commonly used sex-neutral growth curves. Methods For fetuses evaluated at a single center, we retrospectively determined the percentile of the first fetal HC measurement between 16 and 0/7 and 21-6/7 weeks using the Hadlock, Intergrowth-21st, and NICHD growth curves. The association between sex and the likelihood of being classified as microcephalic or macrocephalic was evaluated with logistic regression. Results Female fetuses (n = 3,006) were more likely than male fetuses (n = 3,186) to be classified as microcephalic using the Hadlock (0.4% male, 1.4% female; odds ratio female vs. male 3.7, 95% CI [1.9, 7.0], p < 0.001), Intergrowth-21st (0.5% male, 1.6% female; odds ratio female vs. male 3.4, 95% CI [1.9, 6.1], p < 0.001), and NICHD (0.3% male, 1.6% female; odds ratio female vs. male 5.6, 95% CI [2.7, 11.5], p < 0.001) curves. Male fetuses were more likely than female fetuses to be classified as macrocephalic using the Intergrowth-21st (6.0% male, 1.5% female; odds ratio male vs. female 4.3, 95% CI [3.1, 6.0], p < 0.001) and NICHD (4.7% male, 1.0% female; odds ratio male vs. female 5.1, 95% CI [3.4, 7.6], p < 0.001) curves. Very low proportions of fetuses were classified as macrocephalic using the Hadlock curves (0.2% male, < 0.1% female; odds ratio male vs. female 6.6, 95% CI [0.8, 52.6]). Conclusion Female fetuses were more likely to be classified as microcephalic, and male fetuses were more likely to be classified as macrocephalic. Sex-specific fetal head circumference growth curves could improve interpretation of fetal head circumference measurements, potentially decreasing over- and under-diagnosis of microcephaly and macrocephaly based on sex, therefore improving guidance for clinical decisions. Additionally, the overall prevalence of atypical head size varied using three growth curves, with the NICHD and Intergrowth-21st curves fitting our population better than the Hadlock curves. The choice of fetal head circumference growth curves may substantially impact clinical care.
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Affiliation(s)
- Amalia M Brawley
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Elizabeth Lucarelli
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Serdar H Ural
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Cynthia H Chuang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Wenke Hwang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Ian M Paul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Carrie Daymont
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
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Hong J, Seo K, Hwang W, Moon M. 303P Long-term oncologic outcomes for patients undergoing volatile versus intravenous anesthesia for non-small cell lung cancer surgery. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.331] [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: 12/07/2022] Open
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Sznajder KK, Kjerulff KH, Wang M, Hwang W, Ramirez SI, Gandhi CK. Covid-19 vaccine acceptance and associated factors among pregnant women in Pennsylvania 2020. Prev Med Rep 2022; 26:101713. [PMID: 35127367 PMCID: PMC8800167 DOI: 10.1016/j.pmedr.2022.101713] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 07/15/2021] [Revised: 01/06/2022] [Accepted: 01/23/2022] [Indexed: 01/10/2023] Open
Abstract
Data on factors associated with vaccine acceptance among pregnant women are critical to the rapid scale up of interventions to improve vaccine uptake. When COVID-19 vaccines were still in the testing phases of research, we surveyed pregnant women accessing prenatal care at an academic medical institution in Central Pennsylvania, United States to examine factors associated with vaccine acceptance. Willingness to receive a COVID-19 vaccine once a vaccine became available was asked as part of an ongoing study on the COVID-19 pandemic and pregnancy (n = 196). Overall, 65% of women reported they would be willing or somewhat willing to receive the COVID-19 vaccine. Women who had received an influenza vaccine within the past year were more likely to be willing to receive the COVID-19 vaccine than women who had never received an influenza vaccine or those who received it over one year ago (aOR 4.82; 95% CI 2.17, 10.72). Similarly, women who were employed full-time were more willing to receive the COVID-19 vaccine than women who were not employed full time (aOR 2.22; 95% CI 1.02, 4.81), and women who reported feeling overloaded were more willing to receive the COVID-19 vaccine than women who did not feel overloaded (aOR 2.18; 95% CI 1.02, 4.68). Our findings support the need to increase vaccination education among pregnant women before vaccines are rolled out, especially those who have not received an influenza vaccine within the past year. Improved understanding of willingness to vaccinate among pregnant women will improve future pandemic responses and current vaccination efforts.
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Affiliation(s)
- Kristin K. Sznajder
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
- Corresponding author at: Department of Public Health Sciences, Pennsylvania State University College of Medicine, 90 Hope Drive, Hershey, PA 17033, USA.
| | - Kristen H. Kjerulff
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Ming Wang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Sarah I. Ramirez
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
| | - Chintan K. Gandhi
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Nirmal A, Kuzmik A, Sznajder K, Lengerich E, Fredrick NB, Chen M, Hwang W, Patil R, Shaikh B. 'If not for this support, I would have left the treatment!': Qualitative study exploring the role of social support on medication adherence among pulmonary tuberculosis patients in Western India. Glob Public Health 2021; 17:1945-1957. [PMID: 34459366 DOI: 10.1080/17441692.2021.1965182] [Citation(s) in RCA: 3] [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: 10/20/2022]
Abstract
Social support has been identified as a significant factor in addressing treatment barriers and facilitating treatment adherence. Using a descriptive design, this qualitative study aims at sharing personal feelings and social support-related experiences among pulmonary tuberculosis (TB) patients in Western India. A semi-structured interview guide was designed, and thirty-seven in-depth interviews were conducted. Descriptive thematic analysis was employed for reporting the themes and the results. The participants highlighted diverse social support experiences like empathy, compassion, trust, neglect, tangible aid, strained relationships with in-laws, health provider's support, strength, and motivation which influences their treatment adherent behaviour. Contrasting differences of social support experiences among adherent and non-adherent TB patients were also reported. The study has important ramifications for developing patient-centric social support intervention strategies, TB policy, and practice. The study has shown, 'if not for this support', patients would have left the treatment, and it is mainly because this debilitating disease robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. However, we resonate that addressing social support is not the only way, and TB elimination overall will require an optimal mix of enhanced biomedical, social, economic, and policy interventions.
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Affiliation(s)
- Ahuja Nirmal
- Population Health Sciences Department, Harrisburg University of Science and Technology, Harrisburg, USA
| | - Ashley Kuzmik
- Department of Nursing, Penn State College of Nursing, University Park, USA
| | - Kristin Sznajder
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - Eugene Lengerich
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | - N Benjamin Fredrick
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, USA
| | - Michael Chen
- Global Health Center and Department of Opthalmology, Penn State College of Medicine, Hershey, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, USA
| | | | - Bushra Shaikh
- Revised National Tuberculosis Control Program of India, Indira Gandhi Memorial Hospital, Bhiwandi, India
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Herman MA, Aiello BR, DeLong JD, Garcia-Ruiz H, González AL, Hwang W, McBeth C, Stojković EA, Trakselis MA, Yakoby N. A Unifying Framework for Understanding Biological Structures and Functions Across Levels of Biological Organization. Integr Comp Biol 2021; 61:2038-2047. [PMID: 34302339 DOI: 10.1093/icb/icab167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
The relationship between structure and function is a major constituent of the rules of life. Structures and functions occur across all levels of biological organization. Current efforts to integrate conceptual frameworks and approaches to address new and old questions promise to allow a more holistic and robust understanding of how different biological functions are achieved across levels of biological organization. Here, we provide unifying and generalizable definitions of both structure and function that can be applied across all levels of biological organization. However, we find differences in the nature of structures at the organismal level and below as compared to above the level of the organism. We term these intrinsic and emergent structures, respectively. Intrinsic structures are directly under selection, contributing to the overall performance (fitness) of the individual organism. Emergent structures involve interactions among aggregations of organisms and are not directly under selection. Given this distinction, we argue that while the functions of many intrinsic structures remain unknown, functions of emergent structures are the result of the aggregate of processes of individual organisms. We then provide a detailed and unified framework of the structure-function relationship for intrinsic structures to explore how their unknown functions can be defined. We provide examples of how these scalable definitions applied to intrinsic structures provide a framework to address questions on structure-function relationships that can be approached simultaneously from all subdisciplines of biology. We propose that this will produce a more holistic and robust understanding of how different biological functions are achieved across levels of biological organization.
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Affiliation(s)
- M A Herman
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE 68588-0118
| | - B R Aiello
- Schools of Physics and Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332
| | - J D DeLong
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE 68588-0118
| | - H Garcia-Ruiz
- Department of Plant Pathology, Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68503
| | - A L González
- Department of Biology & Center for Computational and Integrative Biology, Rutgers University, Camden, NJ
| | - W Hwang
- Departments of Biomedical Engineering, Materials Science & Engineering, and Physics & Astronomy, Texas A&M University, College Station, TX 77843-3127
| | - C McBeth
- Fraunhofer USA CMI and Boston University, Boston, MA
| | - E A Stojković
- Department of Biology, Northeastern Illinois University, Chicago, IL 60641, USA
| | - M A Trakselis
- Department of Chemistry and Biochemistry, Baylor University, One Bear Place #97348, Waco, TX 76798
| | - N Yakoby
- Department of Biology & Center for Computational and Integrative Biology, Rutgers University, Camden, NJ
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Xie B, Alismail S, Masood S, Lei X, Le M, Niu Z, Cordola Hsu AR, Li Y, Hwang W. Psychosocial adjustment mediates impacts of playmate positive support on body mass index and overweight risk in adolescents. Public Health 2021; 196:223-228. [PMID: 34280750 DOI: 10.1016/j.puhe.2021.05.036] [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: 11/19/2020] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We examined the mediation effects of psychosocial adjustment on the impact of playmate positive support throughout childhood and early adolescence (from age 54 months to 11 years) on later body mass index (BMI) and overweight risk in middle adolescence (age 15 years). STUDY DESIGN This was a prospective cohort study. METHODS Among 844 children and their families, positive support between child-playmate dyads was repeatedly assessed from child's age 54 months to Grade 5. Long-term positive support between child-playmate dyads throughout childhood and early adolescence was prospectively linked to child's BMI and overweight/obesity status at age 15 years. The average scores of repeated assessments of internalizing and externalizing behavior problems from Grades 3 to 6 were used as mediators. RESULTS Significant mediations of internalizing and externalizing behavior problems were observed on pathways from positive support between child-playmate dyads to later BMI and overweight/obesity status at age 15 years. The observed mediations were mainly sustained with pronounced magnitudes in girls, but not in boys. CONCLUSIONS Our findings demonstrated a significant mediating role of psychosocial adjustment. Future research efforts are highly encouraged to replicate our findings and further explore this underlying mediation mechanism.
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Affiliation(s)
- B Xie
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA.
| | - S Alismail
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA
| | - S Masood
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA; School of Medicine, California University of Science and Medicine, San Bernardino, CA, 92408, USA
| | - X Lei
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - M Le
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA
| | - Z Niu
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, 14260
| | - A R Cordola Hsu
- School of Community and Global Health, Claremont Graduate University, Claremont, CA, 91711, USA; Heart Disease Prevention Program, Division of Cardiology, Department of Medicine, University of California at Irvine School of Medicine, Irvine, CA, 92617, USA
| | - Y Li
- School of Social Work, San Diego State University, San Diego, CA, 92182, USA
| | - W Hwang
- Department of Psychological Science, Claremont McKenna College, Claremont, CA, 91711, USA
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Lim F, Guo D, Chen J, Law A, Poon ZY, Cheung A, Tan JC, Kong SL, Loh AHL, Tan MGK, Li S, Lim KH, Thumboo J, Ng CT, Hwang W, Low A, Fan X. POS0417 EXOGENOUS CXCL5 RESTORES ENDOGENOUS BLOOD-TISSUE CHEMOKINE GRADIENT TO IMPROVE SURVIVAL IN MURINE LUPUS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disease that is potentially fatal. There is an unmet need to improve current therapies. In patients with SLE, we observed that serum CXCL5 levels were significantly lower than healthy control subjects and negatively correlated with disease activity(1-9).Objectives:The aim of this study is to elucidate the effect of supplemental serum CXCL5 in abrogating the pathological processes of SLE.Methods:Ten doses of exogenous CXCL5 (3µg/kg) was administered to 16-week-old Faslpr mice weekly by intravenous injection. Mice were monitored for 10 weeks. Splenic immune profile was measured by flow cytometry. Circulating cytokine and immunoglobulin profile were detected by Luminex technology. Renal function was evaluated by urinary spot albumin creatinine ratio. In situ renal immune cell infiltration and complement 3 deposition were detected by Haematoxylin and Eosin (H&E) and immunohistochemistry staining. The molecular pathways involved were examined by RNA sequencing.Results:In Faslpr mice, intravenous administration of exogenous CXCL5 significantly improved mouse survival with concomitant reduction of autoantibody secretion, proteinuria, complement 3 deposition, neutrophil infiltration and lupus nephritis classes. Through evaluating the changes of immune profile, cytokine profile and molecular pathways, we found that intravenous CXCL5 reduced inflammation via an orchestral effect of regulating neutrophil trafficking and modulating helper T cell-mediated immune response. Pharmacokinetic and real-time Polymerase Chain Reaction studies further demonstrated that this orchestration was triggered by a cascade reaction - restoring vascular under-expressed CXCL5 by an exogenous stimulation, re-establishing the normal serum levels of endogenous CXCL5 and reverting the CXCL5 chemokine gradient between inflamed tissues and blood circulation.Conclusion:Managing the dysregulation of CXCL5 by exogenous supplement may provide a new option for SLE therapy.References:[1]Dufies M, Grytsai O, Ronco C, et al. New CXCR1/CXCR2 inhibitors represent an effective treatment for kidney or head and neck cancers sensitive or refractory to reference treatments. Theranostics. 2019;9(18):5332-5346. doi:10.7150/thno.34681[2]Yildirim K, Colak E, Aktimur R, et al. Clinical Value of CXCL5 for Determining of Colorectal Cancer. Asian Pac J Cancer Prev. Sep 26 2018;19(9):2481-2484. doi:10.22034/apjcp.2018.19.9.2481[3]Wu K, Yu S, Liu Q, Bai X, Zheng X. The clinical significance of CXCL5 in non-small cell lung cancer. Onco Targets Ther. 2017;10:5561-5573. doi:10.2147/ott.s148772[4]Zhao J, Ou B, Han D, et al. Tumor-derived CXCL5 promotes human colorectal cancer metastasis through activation of the ERK/Elk-1/Snail and AKT/GSK3beta/beta-catenin pathways. Mol Cancer. Mar 29 2017;16(1):70. doi:10.1186/s12943-017-0629-4[5]Han KQ, Han H, He XQ, et al. Chemokine CXCL1 may serve as a potential molecular target for hepatocellular carcinoma. Cancer Med. Oct 2016;5(10):2861-2871. doi:10.1002/cam4.843[6]Pappa CA, Tsirakis G, Kanellou P, et al. Monitoring serum levels ELR+ CXC chemokines and the relationship between microvessel density and angiogenic growth factors in multiple myeloma. Cytokine. Dec 2011;56(3):616-20. doi:10.1016/j.cyto.2011.08.034[7]Zhang L, Li H, Ge C, et al. CXCL3 contributes to CD133(+) CSCs maintenance and forms a positive feedback regulation loop with CD133 in HCC via Erk1/2 phosphorylation. Sci Rep. Jun 3 2016;6:27426. doi:10.1038/srep27426[8]Matsubara J, Honda K, Ono M, et al. Reduced plasma level of CXC chemokine ligand 7 in patients with pancreatic cancer. Cancer Epidemiol Biomarkers Prev. Jan 2011;20(1):160-71. doi:10.1158/1055- 9965.epi-10-0397[9]Ma Y, Ren Y, Dai ZJ, Wu CJ, Ji YH, Xu J. IL-6, IL-8 and TNF-alpha levels correlate with disease stage in breast cancer patients. Adv Clin Exp Med. May-Jun 2017;26(3):421-426. doi:10.17219/acem/62120Disclosure of Interests:None declared
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Guo J, Hoffman H, Hwang P, Kim D, Alshalalfa M, Mahal B, Hong T, Hwang W. Pan-cancer Transcriptomic Determinants Of Perineural Invasion And Lymphovascular Invasion. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1609] [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: 11/24/2022]
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Sahu N, Chuang C, Lehman E, Hwang W, Bascom R. DISCORDANT OUTPATIENT AND INPATIENT OSA DIAGNOSES ON A GENERAL INTERNAL MEDICINE SERVICE. Chest 2020. [DOI: 10.1016/j.chest.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fan X, Guo D, Ng CT, Law A, Poon ZY, Cheung A, Lim KH, Thumboo J, Hwang W, Low A. AB0128 CXCL5 DAMPENS INFLAMMATION IN THE PRE-CLINICAL MODEL OF SYSTEMIC LUPUS ERYTHEMATOSUS VIA THE ORCHESTRAL EFFECT OF REGULATING NEUTROPHIL TRAFFICKING AND SUPPRESSING HELPER T CELL-MEDIATED IMMUNE RESPONSE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Patients with systemic lupus erythematosus (SLE) suffer from severe morbidity and mortality1-4, either from the disease itself or from side effects of immunosuppression5. Discovery of novel effective therapies with less toxicity is an urgent need.Objectives:The aim of this study is to elucidate the therapeutic potential and working mechanism of cytokine CXCL5 in lupus mice.Methods:Treatment with CXCL5, bone marrow (BM)-MSCs, standard of care (SOC) with combination of methylprednisolone and cyclophosphamide was given to 16-week-old Faslprmice. Mice were monitored for 10 weeks. Splenic immune cell subsets were measured by flow cytometry. Circulating cytokine and immunoglobulin were detected by Luminex technology. Renal function was evaluated by urinary spot albumin creatinine ratio. In situ renal immune cell infiltration and complement 3 deposition were detected by Haematoxylin and Eosin (H&E) staining and immunohistochemistry.Results:CXCL5 demonstrated consistent and potent immunosuppressive capacity in suppressing SLE with reduced autoantibody secretion, lymphoproliferation and preserved kidney function. With further exploration, we proved that CXCL5 reduced the proliferation of helper T cells (TH1 and TH2) in thein vitrofunctional assay. When we administrated CXCL5 to lupus mice, it promoted the proliferation of regulatory T cells and reduced the proliferation of TH17 cells, macrophages and neutrophils. Multiple proinflammatory cytokines including IL-2, IL-6, IL-12, IL-17A, KC/CXCL1, MIP-1β/CCL4 and TNF-α were also reduced. When combined with SOC, CXCL5 boosted its therapeutic effect and reduced the relevant indices of disease activity. When we correlated the effect of four different treatment groups (CXCL5, BM-MSCs, SOC, and CXCL5 plus SOC) on mice survival and target cell changes, we found that TH17 cells were the key effector cells involved in the pathogenesis of SLE.Conclusion:These findings demonstrated that CXCL5 dampens inflammation in the pre-clinical model of systemic lupus erythematosus via the orchestral effect of regulating neutrophil trafficking and suppressing helper T cell-mediated immune response. Administrating exogenous CXCL5 might be an attractive option to treat patients with lupus.References:[1]Ji S, Guo Q, Han Y, Tan G, Luo Y, Zeng F. Mesenchymal stem cell transplantation inhibits abnormal activation of Akt/GSK3beta signaling pathway in T cells from systemic lupus erythematosus mice.Cell Physiol Biochem.2012;29(5-6):705-712.[2]Peng SL. Altered T and B lymphocyte signaling pathways in lupus.Autoimmun Rev.2009;8(3):179-183.[3]Ferucci ED, Johnston JM, Gaddy JR, et al. Prevalence and incidence of systemic lupus erythematosus in a population-based registry of American Indian and Alaska Native people, 2007-2009.Arthritis Rheumatol.2014;66(9):2494-2502.[4]Jakes RW, Bae SC, Louthrenoo W, Mok CC, Navarra SV, Kwon N. Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality.Arthritis Care Res (Hoboken).2012;64(2):159-168.[5]Sattwika PD, Mustafa R, Paramaiswari A, Herningtyas EH. Stem cells for lupus nephritis: a concise review of current knowledge.Lupus.2018;27(12):1881-1897.Acknowledgments:The work was supported by SMART II Centre Grant (NMRC/CG/M011/2017_SGH) and SingHealth Foundation (SHF/FG638P/2016).Disclosure of Interests:None declared
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Hwang W, Pleskow H, Czapla JAA, Fisher R, Kamran S, Lee R, Saylor P, Zietman A, Silvia B, Ting D, Maheswaran S, Haber D, Efstathiou J, Miyamoto D. Integrated Gene Expression Score in Circulating Tumor Cells to Predict Treatment Response in Muscle-Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lim J, Huang D, Tang T, Cai Q, Tan D, Laurensia Y, Chia B, Rou-Jun P, Pang W, Cheah D, Ng C, Hong H, Tan J, Feng L, Chen J, Han B, Guo Y, Goh Y, Rötzschke O, Cheng C, Au-Yeung R, Chan T, Ng S, Kwong Y, Hwang W, Chng W, Tousseyn T, Tan P, Teh B, Khor C, Rozen S, Bei J, Lin T, Lim S, Ong C. WHOLE-GENOME SEQUENCING REVEALS IMMUNOTHERAPEUTIC OPTIONS FOR NATURAL-KILLER/T CELL LYMPHOMA PATIENTS. Hematol Oncol 2019. [DOI: 10.1002/hon.19_2630] [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: 11/11/2022]
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Jeong DE, Kim JW, Kim BM, Hwang W, Kim DJ. Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy. AJNR Am J Neuroradiol 2019; 40:840-844. [PMID: 30948374 DOI: 10.3174/ajnr.a6031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/28/2018] [Accepted: 03/07/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy with proximal flow control and forced aspiration may improve the outcome of endovascular revascularization therapy for patients with acute stroke. The purpose of this study was to compare the impact of balloon-guiding catheter locations in patients treated for anterior circulation acute ischemic stroke using mechanical thrombectomy. MATERIALS AND METHODS The influence of the balloon-guiding catheter location (proximal, balloon-guiding catheter tip proximal to C1 vertebral body; distal, between the skull base and the C1 vertebral body) was analyzed in patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. The baseline angiographic/clinical characteristics, time intervals, recanalization rates, and clinical outcomes were compared. RESULTS The clinical analysis included 102 patients (mean age, 69.5 ± 12.8 years; male/female ratio = 52:50). The balloon-guiding catheter was located distally in 49 patients and proximally in 53 patients for flow control and forced aspiration during stent retrieval. The puncture-to-recanalization time was shorter in the distal group than in the proximal group (40 versus 56 minutes, P = .02). Successful and complete recanalizations were more frequently achieved in the distal group compared with the proximal group (98.0% versus 75.5%. P = .003; 67.3% versus 45.3%, P = .04, respectively). Multivariate analysis showed that the distal catheterization location was independently associated with successful recanalization (adjusted OR, 13.4; 95% CI, 2.4-254.8; P = .02). CONCLUSIONS Location of the balloon-guiding catheter has a significant impact on recanalization in patients with acute stroke. The balloon-guiding catheter should be positioned as distally as safely possible in the cervical ICA for maximally effective thrombectomy.
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Affiliation(s)
- D E Jeong
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
- Department of Neurology (D.E.J.), YeongNam University College of Medicine, Daegu, South Korea
| | - J W Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - B M Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - W Hwang
- Department of Mechanical and Aerospace Engineering (W.H.), Seoul National University, Seoul, South Korea
| | - D J Kim
- From the Department of Radiology (D.E.J., J.W.K., B.M.K., D.J.K.), Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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Hwang W, Lamba N, Kim D, Marciscano A, Stemmer-Rachamimov A, Curry W, Barker F, Martuza R, Santagata S, Dunn I, Claus E, Bi W, Aizer A, Alexander B, Oh K, Loeffler J, Shih H. Atypical Histopathological Features and the Risk of Progression/Recurrence in WHO Grade I-II Meningiomas. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.773] [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: 11/26/2022]
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Marmarelis M, Bange E, Bagley S, Hwang W, Yang Y, Thompson J, Bauml J, Ciunci C, Alley E, Morrissette J, Cohen R, Langer C, Carpenter E, Aggarwal C. P1.01-64 Impact of STK11 Co-Mutation on Outcomes Following Immunotherapy Among Patients with TP53 and KRAS Mutated Stage IV NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hwang W, Tendulkar R, Niemierko A, Agrawal S, Stephans K, Spratt D, Hearn J, Koontz B, Lee W, Michalski J, Pisansky T, Liauw S, Abramowitz M, Pollack A, Moghanaki D, Anscher M, Den R, Zietman A, Stephenson A, Efstathiou J. Multi-institutional Outcomes of Postprostatectomy Adjuvant Versus Early Salvage Radiation Therapy in Prostate Cancer Patients With Adverse Pathologic Features. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.232] [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: 11/25/2022]
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Hwang W, Niemierko A, Willers H, Gainor J, Keane F. Incidence of Pneumonitis in Metastatic Lung Cancer Patients Receiving Immune Checkpoint Inhibitors With or Without Thoracic Radiation Therapy. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hwang W, Silverstein M, Brown M. STEPPARENT-CHILD INTERGENERATIONAL SOLIDARITY IN 11 YEARS: MODERATING ROLE OF RELIGIOUS DISCORDANCE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3888] [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: 11/14/2022] Open
Affiliation(s)
- W. Hwang
- Syracuse University, Syracuse, New York
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Fan X, Guo D, Yap C, Cheung A, Poon Z, Bari S, Li S, Hwang W. Application of a mesenchymal stromal cell-derived two-factor cocktail in graft versus host disease therapy. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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AbdelRazek M, Hwang W, Abdelmaksoud M, Louie J, Kothary N, Kunz P, Sze D. Selection between locoregional embolotherapies for hepatic metastases from neuroendocrine tumor: Stratification by tumor burden. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kim D, Niemierko A, Hwang W, Stemmer-Rachamimov A, Curry W, Barker F, Martuza R, Loeffler J, Oh K, Shih H. Histopathologic Prognostic Factors of Recurrence Following Surgery and Radiation Therapy for Atypical and Malignant Meningiomas. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kim K, Sikora A, Nakazawa H, Umetsu M, Hwang W, Teizer W. Isomorphic coalescence of aster cores formed in vitro from microtubules and kinesin motors. Phys Biol 2016; 13:056002. [PMID: 27652512 DOI: 10.1088/1478-3975/13/5/056002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report fluorescence microscopy studies of the formation of aster-like structures emerging from a cellular element-based active system and a novel analysis of the aster condensation. The system consists of rhodamine labeled microtubules which are dynamically coupled by functionalized kinesin motor proteins cross-linked via streptavidin-coated quantum dots (QDs). The aster-shaped objects contain core structures. The cores are aggregates of the QD-motor protein complexes, and result from the dynamic condensation of sub-clusters that are connected to each other randomly. The structural specificity of the aster core reflects a configuration of the initial connectivity between sub-clusters. Detailed image analysis allows us to extract a novel correlation between the condensation speed and the sub-cluster separation. The size of the core is scaled down during the condensation process, following a power law dependence on the distance between sub-clusters. The exponent of the power law is close to two, as expected from a geometric model. This single exponent common to all the contractile lines implies that there exists a time regime during which an isomorphic contraction of the aster core continues during the condensation process. We analyze the observed contraction by using a model system with potential applicability in a wide range of emergent phenomena in randomly coupled active networks, which are prevalent in the cellular environment.
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Affiliation(s)
- K Kim
- WPI-Advanced Institute for Materials Research (WPI-AIMR), Tohoku University, Japan
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Ahn E, Kwon H, Hwang W, Lee E, Lee E, Song Y, Park J. FRI0487 Association between Fever Pattern and Clinical Manifestations in Adult Onset of Still's Disease: Unbiased Analysis of Fever Pattern Using Hierarchical Clustering. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4067] [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: 11/03/2022]
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Aelion CM, Airhihenbuwa CO, Alemagno S, Amler RW, Arnett DK, Balas A, Bertozzi S, Blakely CH, Boerwinkle E, Brandt-Rauf P, Buekens PM, Chandler GT, Chang RW, Clark JE, Cleary PD, Curran JW, Curry SJ, Diez Roux AV, Dittus R, Ellerbeck EF, El-Mohandes A, Eriksen MP, Erwin PC, Evans G, Finnegan JR, Fried LP, Frumkin H, Galea S, Goff DC, Goldman LR, Guilarte TR, Rivera-Gutiérrez R, Halverson PK, Hand GA, Harris CM, Healton CG, Hennig N, Heymann J, Hunter D, Hwang W, Jones RM, Klag MJ, Klesges LM, Lahey T, Lawlor EF, Maddock J, Martin WJ, Mazzaschi AJ, Michael M, Mohammed SD, Nasca PC, Nash D, Ogunseitan OA, Perez RA, Perri M, Petersen DJ, Peterson DV, Philbert M, Pinto-Martin J, Raczynski JM, Raskob GE, Rimer BK, Rohrbach LA, Rudkin LL, Siminoff L, Szapocznik J, Thombs D, Torabi MR, Weiler RM, Wetle TF, Williams PL, Wykoff R, Ying J. The US Cancer Moonshot initiative. Lancet Oncol 2016; 17:e178-80. [PMID: 27301041 DOI: 10.1016/s1470-2045(16)30054-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022]
Affiliation(s)
- C Marjorie Aelion
- University of Massachusetts-Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | | | - Sonia Alemagno
- Kent State University College of Public Health, Kent, OH, USA
| | - Robert W Amler
- School of Health Sciences and Practice and Institute of Public Health, New York Medical College, Valhalla, NY, USA
| | - Donna K Arnett
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - Andrew Balas
- College of Allied Health Sciences, Augusta University, Augusta, GA, USA
| | - Stefano Bertozzi
- University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Craig H Blakely
- University of Louisville School of Public Health and Information Sciences, Louisville, KY, USA
| | - Eric Boerwinkle
- University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Paul Brandt-Rauf
- University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Pierre M Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - G Thomas Chandler
- University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Rowland W Chang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane E Clark
- University of Maryland School of Public Health, College Park, MD, USA
| | | | - James W Curran
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Susan J Curry
- University of Iowa College of Public Health, Iowa City, IA, USA
| | - Ana V Diez Roux
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Robert Dittus
- Vanderbilt University Institute for Medicine and Public Health, Nashville, TN, USA
| | | | | | | | - Paul C Erwin
- Department of Public Health, University of Tennessee-Knoxville, Knoxville TN, USA
| | - Gregory Evans
- Georgia Southern University Jiann-Ping Hsu College of Public Health, Statesboro, GA, USA
| | - John R Finnegan
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Linda P Fried
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Howard Frumkin
- University of Washington School of Public Health, Seattle, WA, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - David C Goff
- Colorado School of Public Health, Aurora, CO, USA
| | - Lynn R Goldman
- Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Tomas R Guilarte
- Florida International University Robert Stempel College of Public Health and Social Work, Miami, FL, USA
| | | | - Paul K Halverson
- Indiana University Richard M Fairbanks School of Public Health - Indianapolis, Indianapolis, IN, USA
| | - Gregory A Hand
- West Virginia University School of Public Health, Morgantown, WV, USA
| | - Cynthia M Harris
- Institute of Public Health, Florida A&M University, Tallahassee, FL, USA
| | - Cheryl G Healton
- New York University College of Global Public Health, New York, NY, USA
| | - Nils Hennig
- Graduate Program in Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jody Heymann
- UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA
| | - David Hunter
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Wenke Hwang
- Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Resa M Jones
- Virginia Commonwealth University, Richmond, VA, USA
| | - Michael J Klag
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa M Klesges
- University of Memphis School of Public Health, Memphis, TN, USA
| | - Tim Lahey
- Dartmouth-Geisel School of Medicine, Hanover, NH, USA
| | - Edward F Lawlor
- Washington University in St Louis Brown School Public Health Programs, St Louis, MO, USA
| | - Jay Maddock
- Texas A&M School of Public Health, College Station, TX, USA
| | - William J Martin
- The Ohio State University College of Public Health, Columbus, OH, USA
| | | | - Max Michael
- University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Shan D Mohammed
- MPH Program in Urban Health, Northeastern University, Boston, MA, USA
| | - Philip C Nasca
- University at Albany SUNY School of Public Health, Albany, NY, USA
| | - David Nash
- Jefferson College of Population Health, Philadelphia, PA, USA
| | - Oladele A Ogunseitan
- Department of Population Health and Disease Prevention, University of California, Irvine, CA, USA
| | - Ronald A Perez
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael Perri
- University of Florida College of Public Health and Health Professions, Gainsville, FL, USA
| | | | | | - Martin Philbert
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - James M Raczynski
- University of Arkansas for Medical Sciences Fay W Boozman College of Public Health, Little Rock, AR, USA
| | - Gary E Raskob
- University of Oklahoma Health Sciences Center College of Public Health, Oklahoma City, OK, USA
| | - Barbara K Rimer
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Laura L Rudkin
- University of Texas Medical Branch at Galveston Graduate Program in Public Health, Galveston, TX, USA
| | - Laura Siminoff
- Temple University College of Public Health, Philadelphia, PA, USA
| | - José Szapocznik
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Dennis Thombs
- University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
| | - Mohammad R Torabi
- Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Robert M Weiler
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | | | | | - Randy Wykoff
- East Tennessee State University College of Public Health, Johnson City, TN, USA
| | - Jun Ying
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Crites JS, Chuang C, Dimmock A, Hwang W, Johannes B, Paranjape A, Wu AW. PROs in the Balance: Ethical Implications of Collecting Patient Reported Outcome Measures in the Electronic Health Record. Am J Bioeth 2016; 16:67-68. [PMID: 26982933 DOI: 10.1080/15265161.2016.1146543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Fleming ST, Mackley HB, Camacho F, Yao N, Gusani NJ, Seiber EE, Matthews SA, Yang TC, Hwang W. Patterns of Care for Metastatic Colorectal Cancer in Appalachia, and the Clinical, Sociodemographic, and Service Provider Determinants. J Rural Health 2015; 32:113-24. [PMID: 26241785 DOI: 10.1111/jrh.12132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/25/2022]
Abstract
BACKGROUND Appalachia has high colorectal cancer (CRC) incidence and mortality, at least in part due to screening disparities. This paper examines patterns and determinants of metastatic colorectal cancer care. METHODS CRC patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009.) The final sample after exclusions included 855 stage IV and 590 stages I-III patients with metachronous or synchronous metastases. We estimate bivariate and multivariate analyses for several surgical and chemotherapeutic strategies of care using clinical, sociodemographic, and contextual determinants. RESULTS Among 1,445 CRC patients, 84% had primary tumor resection and 44% received chemotherapy. Of the chemotherapy patients, 44% received newer systemic agents for at least 75% of the cycles. One year survivors with liver or lung metastases were more likely to have their primary tumor resected immediately (86.1% vs 69.5% for liver, and 78.2% vs 64.9% for lung) and have their metastases resected/ablated (15.7% vs 2.6% for liver and 15.0% vs 0.5% for lung). Patients with stages I-III primary tumors (versus IV) were much more likely to be resected, but they were less likely to receive chemotherapy. Patients with comorbidities (congestive heart failure, dementia, or respiratory disease) had lower odds of chemotherapy. Smaller hospital size and surgical volume had higher odds of immediate versus delayed surgery. The newer chemotherapeutic agents were more common with higher surgical volume. CONCLUSIONS Metastatic colorectal cancer has clinical, sociodemographic, and service provider determinants.
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Affiliation(s)
- Steven T Fleming
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Heath B Mackley
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Nengliang Yao
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Niraj J Gusani
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Eric E Seiber
- College of Public Health, Ohio State University, Columbus, Ohio
| | - Stephen A Matthews
- Department of Sociology, The Pennsylvania State University, University Park, Pennsylvania
| | - Tse-Chuan Yang
- Department of Sociology, University at Albany, SUNY, Albany, New York
| | - Wenke Hwang
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Ursem CJ, Bosworth HB, Shelby RA, Hwang W, Anderson RT, Kimmick GG. Adherence to adjuvant endocrine therapy for breast cancer: importance in women with low income. J Womens Health (Larchmt) 2015; 24:403-8. [PMID: 25884292 DOI: 10.1089/jwh.2014.4982] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are wide disparities in breast cancer-specific survival by patient sociodemographic characteristics. Women of lower income, for instance, have higher relapse and death rates from breast cancer. One possible contributing factor for this disparity is low use of adjuvant endocrine therapy-an extremely efficacious therapy in women with early stage, hormone receptor positive breast cancer, the most common subtype of breast cancer. Alone, adjuvant endocrine therapy decreases breast cancer recurrence by 50% and death by 30%. Data suggest that low use of adjuvant endocrine therapy is a potentially important and modifiable risk factor for poor outcome in low-income breast cancer patients.
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Affiliation(s)
- Carling J Ursem
- 1 Department of Hematology and Oncology, UCSF , San Francisco, California
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Hwang W, LaClair M, Camacho F, Paz H. Persistent high utilization in a privately insured population. Am J Manag Care 2015; 21:309-316. [PMID: 26014469] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe individuals characterized as persistent high users--that is, individuals who are in the top 10% of users every year over the 3-year study period. STUDY DESIGN Retrospective cohort study of 4 groups in a privately insured population. Groups were defined by the number of years an enrollee was in the top 10% of the spending group (top decile) for the period from 2009 to 2011: persistent high-user group (3 out of 3 years in the top decile spending group); frequent high-user group (2 out of 3 years in top decile); incidental high-user group (1 out of 3 years in top decile); and never high user group (0 out of 3 years in top decile). METHODS This study used insurance claims data to examine enrollees with persistently high health service utilization. Data for the year 2008 were utilized to assess baseline individual characteristics. Annual data for 2009 to 2011 were used to examine healthcare expenditures, utilization patterns, and specific clinical conditions among the 4 groups of the study sample. RESULTS Among 42,038 enrollees, 1216 (2.9%) met the criteria as persistent high users. Over a 3-year period, this group accounted for 21% of total healthcare expenditure. Compared with the other groups, persistent high users had higher overall disease burden due to multiple chronic conditions and incurred significantly higher expenses in medication and professional services (including primary and specialty care). CONCLUSIONS This study highlights the need to proactively engage employees and their dependents for primary and secondary prevention of common chronic diseases before an individual's health status, healthcare utilization, and medical cost become difficult to manage.
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Affiliation(s)
- Wenke Hwang
- Penn State University College of Medicine, Department of Public Health Sciences, 90 Hope Dr, Ste 2200, Hershey, PA 17033. E-mail:
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Affiliation(s)
- Wenke Hwang
- Penn State University College of Medicine, Hershey, PA
| | - Jordan Derk
- Penn State University College of Medicine, Hershey, PA
| | | | - Harold Paz
- Penn State University College of Medicine, Hershey, PA
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Abstract
PURPOSE The objective was to examine the impact of regular primary care encounters (PCE) on early breast cancer detection in an Appalachian sample of Medicare beneficiaries diagnosed 2006-2008. Determinants of PCE were investigated and a mediation analysis was conducted where PCE was a mediator to cancer stage. METHODS A total of 3,589 cases were identified from Appalachian areas in Pennsylvania, Kentucky, Ohio, and North Carolina, and health care services were examined 2 months to 2 years prior to diagnosis. A regular care PCE variable was constructed with 4 ordinal levels: none, any, "annual," and "semi-annual." Association of PCE with stage, mortality and covariables was conducted using ordinal logistic regressions and Cox Proportional Hazards survival models. RESULTS Sixty-eight percent of the cases had semi-annual PCE. Regular PCE was strongly associated with late-stage cancer rates (39%-13% by increasing PCE level, P < .0001) and 5-year all-cause mortality (42%-24%, P < .0001). Subgroup analysis revealed variations by hypertension and urban status, with nonhypertensives with no PCE being at particularly increased risk. Significant determinants of PCE included age, rural/urban status, comorbidity, dual Medicaid insurance, Appalachian region economic classification, state, select comorbidities, hypertension, and minimum distance to provider. Mediation analysis results were consistent with lower number of comorbidities leading to increased late cancer detection due to patients having a decreased PCE. CONCLUSION PCE is an important determinant of cancer detection, with a dose-response relationship. Variations exist by geography and hypertension. Comorbidity may influence both PCE and late-stage rates with partial mediation through PCE.
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Affiliation(s)
- Fabian Camacho
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Wenke Hwang
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Teresa Kern
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Roger T Anderson
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Kimmick GG, Camacho F, Mackley HB, Kern T, Yao N, Matthews SA, Fleming S, Lipscomb J, Liao J, Hwang W, Anderson RT. Individual, Area, and Provider Characteristics Associated With Care Received for Stages I to III Breast Cancer in a Multistate Region of Appalachia. J Oncol Pract 2014; 11:e9-e18. [PMID: 25228530 DOI: 10.1200/jop.2014.001397] [Citation(s) in RCA: 12] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We describe individual, area, and provider characteristics associated with care patterns for early-stage breast cancer in Appalachian counties of Kentucky, North Carolina, Ohio, and Pennsylvania. METHODS Cases of stages I to III breast cancer from 2006 to 2008 were linked to Medicare claims occurring within 1 year of diagnosis. Rates of guideline-concordant endocrine therapy (n = 1,429), chemotherapy (n = 1,480), and radiation therapy (RT) after breast-conserving surgery were studied; RT was studied in women age ≥ 70 years with stage I estrogen receptor (ER) -positive/progesterone receptor (PR) -positive cancer, for whom RT was optional (n = 1,108), and in all others, for whom RT was guideline concordant (n = 1,422). Univariable and multivariable analyses were performed. Independent variables included age, race, county-level economic status, state, surgeon graduation year and volume, comorbidity, diagnosis year, Medicaid/Medicare dual status, histology, tumor size, tumor sequence, positive lymph nodes, ER/PR status, stage, trastuzumab use, and surgery type. RESULTS Population mean age was 74 years; 97% were white. For endocrine therapy, chemotherapy, and RT, guideline concordance was 76%, 48%, and 83%, respectively. Where it was optional, 77% received RT. Guideline-concordant endocrine therapy was lower in North Carolina versus Pennsylvania (odds ratio [OR], 0.60; 95% CI, 0.41 to 0.88) and higher if surgeon graduated between 1984 and 1988 versus ≥ 1989 (OR, 1.58; 95% CI, 1.06 to 2.34). Guideline-concordant chemotherapy varied significantly by state, county-level economic status, and surgeon volume. In guideline-concordant RT, lower surgeon volume (v highest) predicted RT use (OR, 1.63; 95% CI, 1.61 to 2.36). In optional RT, North Carolina residence (v Pennsylvania; OR, 0.29; 95% CI, 0.17 to 0.48) and counties with higher economic status (OR, 0.61; 95% CI, 0.40 to 0.94) predicated RT omission. CONCLUSION Notable variation in care by geographic and surgical provider characteristics provides targets for further research in underserved areas.
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Affiliation(s)
- Gretchen G Kimmick
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Fabian Camacho
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Heath B Mackley
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Teresa Kern
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Nengliang Yao
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Stephen A Matthews
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Steven Fleming
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Joseph Lipscomb
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Jason Liao
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Wenke Hwang
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
| | - Roger T Anderson
- Duke University Medical Center, Durham, NC; Penn State College of Medicine, State College, PA; Virginia Commonwealth University School of Medicine, Richmond, VA; University of Kentucky College of Public Health, Lexington, KY; and Emory University, Atlanta, GA
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Amin W, Tsui FR, Borromeo C, Chuang CH, Espino JU, Ford D, Hwang W, Kapoor W, Lehmann H, Martich GD, Morton S, Paranjape A, Shirey W, Sorensen A, Becich MJ, Hess R. PaTH: towards a learning health system in the Mid-Atlantic region. J Am Med Inform Assoc 2014; 21:633-6. [PMID: 24821745 PMCID: PMC4078296 DOI: 10.1136/amiajnl-2014-002759] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 03/19/2014] [Accepted: 03/25/2014] [Indexed: 12/02/2022] Open
Abstract
The PaTH (University of Pittsburgh/UPMC, Penn State College of Medicine, Temple University Hospital, and Johns Hopkins University) clinical data research network initiative is a collaborative effort among four academic health centers in the Mid-Atlantic region. PaTH will provide robust infrastructure to conduct research, explore clinical outcomes, link with biospecimens, and improve methods for sharing and analyzing data across our diverse populations. Our disease foci are idiopathic pulmonary fibrosis, atrial fibrillation, and obesity. The four network sites have extensive experience in using data from electronic health records and have devised robust methods for patient outreach and recruitment. The network will adopt best practices by using the open-source data-sharing tool, Informatics for Integrating Biology and the Bedside (i2b2), at each site to enhance data sharing using centrally defined common data elements, and will use the Shared Health Research Information Network (SHRINE) for distributed queries across the network.
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Affiliation(s)
- Waqas Amin
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fuchiang Rich Tsui
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles Borromeo
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cynthia H Chuang
- Department of Medicine and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jeremy U Espino
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel Ford
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Wenke Hwang
- Department of Public Health Sciences, Division of Health Services Research, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Wishwa Kapoor
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Harold Lehmann
- Department of Medicine, Division of Health Science Informatics, John Hopkins School of Medicine, Baltimore, Maryland, USA
| | - G Daniel Martich
- Department of Critical Care Medicine, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sally Morton
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anuradha Paranjape
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - William Shirey
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Aaron Sorensen
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael J Becich
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachel Hess
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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kim C, Yang T, Chang S, Kim H, Lee H, Kim J, Jang H, Han G, Park D, Hwang W, Kim G. SU-E-T-594: Preliminary Active Scanning Results of KHIMA. Med Phys 2014. [DOI: 10.1118/1.4888930] [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: 11/07/2022] Open
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Hwang W, Derk J, LaClair M, Paz H. In response to "It's safety, not the score, that needs improvement". J Hosp Med 2014; 9:275. [PMID: 24585421 DOI: 10.1002/jhm.2178] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/06/2014] [Accepted: 02/08/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Wenke Hwang
- Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania
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Kimmick G, Fleming ST, Sabatino SA, Wu XC, Hwang W, Wilson JF, Lund MJ, Cress R, Anderson RT. Comorbidity burden and guideline-concordant care for breast cancer. J Am Geriatr Soc 2014; 62:482-8. [PMID: 24512124 DOI: 10.1111/jgs.12687] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 12/29/2022]
Abstract
OBJECTIVES To explore the relationship between level and type of comorbidity and guideline-concordant care for early-stage breast cancer. DESIGN Cross-sectional. SETTING National Program of Cancer Registry (NPCR) Breast and Prostate Cancer Patterns of Care study, which re-abstracted medical records from 2004 in seven cancer registries. PARTICIPANTS Individuals with stage 0-III breast cancer. MEASUREMENTS Multicomponent guideline-concordant management was modeled based on tumor size, node status, and hormone receptor status, according to consensus guidelines. Comorbid conditions and severity were measured using the Adult Comorbidity Evaluation Index (ACE-27). Multivariate logistic regression models determined factors associated with guideline-concordant care and included overall ACE-27 scores and 26 separate ACE comorbidity categories, age, race, stage, and source of payment. RESULTS The study sample included 6,439 women (mean age 58.7, range 20-99; 76% white; 44% with no comorbidity; 70% estrogen- or progesterone-receptor positive, or both; 31% human epidermal growth factor receptor 2 positive). Care was guideline concordant in 60%. Guideline concordance varied according to overall comorbidity burden (70% for none; 61% for minor; 58% for moderate, 43% for severe; P < .05). In multivariate analysis, the presence of hypertension (odds ratio (OR) = 1.15, 95% confidence interval (CI) = 1.01-1.30) predicted guideline concordance, whereas dementia (OR = 0.45, 95% CI = 0.24-0.82) predicted lack of guideline concordance. Older age (≥ 50) and black race were associated with less guideline concordance, regardless of comorbidity level. CONCLUSION When reporting survival outcomes in individuals with breast cancer with comorbidity, adherence to care guidelines should be among the covariates.
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Affiliation(s)
- Gretchen Kimmick
- Department of Internal Medicine, Division of Oncology, Duke University Medical Center, Durham, North Carolina
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Hwang W, Derk J, LaClair M, Paz H. Hospital patient safety grades may misrepresent hospital performance. J Hosp Med 2014; 9:111-5. [PMID: 24420641 DOI: 10.1002/jhm.2139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 09/10/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Abstract
Nationally, there is strong interest in measuring hospital performance in patient safety. The Leapfrog Group uses a survey, along with other data sources, to calculate patient safety scores for 2600 hospitals across the United States. Under this methodology, every hospital is assigned 1 of 5 letter grades (A, B, C, D, F) depending on how the hospital stands in safety performance relative to all other hospitals. The results have been widely marketed and disseminated to employers, payors, and the public. Leapfrog strongly encourages employers and payors to negotiate hospital reimbursement rates based on the safety grade the hospital receives. Leapfrog's effort to develop a standardized method to provide patient safety information should be commended. However, less than one-half of the 2600 hospitals participated in the Leapfrog survey. For those nonparticipating hospitals, certain safety measures were absent and alternative measures were used to calculate the safety score. A sample of the nation's most prestigious hospitals (n = 35) was drawn from the U.S. News & World Report's "Best Hospitals." Overall, the group of participating hospitals (n = 18) received an average grade of A (mean safety score = 3.165), whereas the group of nonparticipating hospitals received an average grade of B (mean safety score = 3.012). These nonparticipating hospitals were rescored using the methodology for participating hospitals. The results show that the majority of nonparticipating hospitals would have received a better safety grade. This demonstrates a potential shortcoming of Leapfrog's method and its tendency to discriminate against nonparticipating hospitals.
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Affiliation(s)
- Wenke Hwang
- Department of Public Health Sciences, Division of Health Services Research, Penn State University College of Medicine, Hershey, Pennsylvania
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Deville C, Hwang W, Both S, Thomas C, Chapman C. United States Radiation Oncology Residency Diversity Over the Past 20 Years. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1331] [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: 10/26/2022]
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Berman A, Hwang W, Grover S, O'Grady E, Baffic C, Vapiwala N. Standardizing the Radiation Oncology Medical Student Elective: A Novel Curriculum and Evaluation of Student Satisfaction. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1290] [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: 11/16/2022]
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Shaw BE, Chapman J, Fechter M, Foeken L, Greinix H, Hwang W, Phillips-Johnson L, Korhonen M, Lindberg B, Navarro WH, Szer J. Towards a global system of vigilance and surveillance in unrelated donors of haematopoietic progenitor cells for transplantation. Bone Marrow Transplant 2013; 48:1506-9. [PMID: 23892330 DOI: 10.1038/bmt.2013.104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 11/09/2022]
Abstract
Safety of living donors is critical to the success of blood, tissue and organ transplantation. Structured and robust vigilance and surveillance systems exist as part of some national entities, but historically no global systems are in place to ensure conformity, harmonisation and the recognition of rare adverse events (AEs). The World Health Assembly has recently resolved to require AE/reaction (AE/R) reporting both nationally and globally. The World Marrow Donor Association (WMDA) is an international organisation promoting the safety of unrelated donors and progenitor cell products for use in haematopoietic progenitor cell (HPC) transplantation. To address this issue, we established a system for collecting, collating, analysing, distributing and reacting to serious adverse events and reactions (SAE/R) in unrelated HPC donors. The WMDA successfully instituted this reporting system with 203 SAE/R reported in 2011. The committee generated two rapid reports, reacting to specific SAE/R, resulting in practice changing policies. The system has a robust governance structure, formal feedback to the WMDA membership and transparent information flows to other agencies, specialist physicians and transplant programs and the general public.
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Affiliation(s)
- B E Shaw
- 1] Anthony Nolan Research Institute, Royal Free Hospital, UCL Cancer Centre, London, UK [2] Royal Marsden NHS Foundation Trust, London, UK
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Fleming ST, Mackley HB, Camacho F, Seiber EE, Gusani NJ, Matthews SA, Liao J, Yang TC, Hwang W, Yao N. Clinical, sociodemographic, and service provider determinants of guideline concordant colorectal cancer care for Appalachian residents. J Rural Health 2013; 30:27-39. [PMID: 24383482 DOI: 10.1111/jrh.12033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Colorectal cancer represents a significant cause of morbidity and mortality, particularly in Appalachia where high mortality from colorectal cancer is more prevalent. Adherence to treatment guidelines leads to improved survival. This paper examines determinants of guideline concordance for colorectal cancer. METHODS Colorectal cancer patients diagnosed in 2006-2008 from 4 cancer registries (Kentucky, Ohio, Pennsylvania, and North Carolina) were linked to Medicare claims (2005-2009). Final sample size after exclusions was 2,932 stage I-III colon, and 184 stage III rectal cancer patients. The 3 measures of guideline concordance include adjuvant chemotherapy (stage III colon cancer, <80 years), ≥12 lymph nodes assessed (resected stage I-III colon cancer), and radiation therapy (stage III rectal cancer, <80 years). Bivariate and multivariate analyses with clinical, sociodemographic, and service provider covariates were estimated for each of the measures. RESULTS Rates of chemotherapy, lymph node assessment, and radiation were 62.9%, 66.3%, and 56.0%, respectively. Older patients had lower rates of chemotherapy and radiation. Five comorbidities were significantly associated with lower concordance in the bivariate analyses: myocardial infarction, congestive heart failure, respiratory diseases, dementia with chemotherapy, and diabetes with adequate lymph node assessment. Patients treated by hospitals with no Commission on Cancer (COC) designation or lower surgical volumes had lower odds of adequate lymph node assessment. CONCLUSIONS Clinical, sociodemographic, and service provider characteristics are significant determinants of the variation in guideline concordance rates of 3 colorectal cancer measures.
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Affiliation(s)
- Steven T Fleming
- Departments of Epidemiology & Health Services Management, University of Kentucky College of Public Health, Lexington, Kentucky
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Kim C, Yang T, Han G, Lee H, Kim H, Jang H, Kim J, Park D, Chang S, Hwang W, Kim G. SU-E-T-318: A Simulation Study for Active Scanning Nozzle Design Using Beam Optic Parameters. Med Phys 2013. [DOI: 10.1118/1.4814752] [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: 11/07/2022] Open
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