Faculty Bibliography

Paraneoplastic cerebellar degeneration (PCD) is a rare disorder that is associated with lung or gynecological malignancies and Hodgkin lymphoma. Neurologic symptoms are commonly the initial presenting sign leading to the diagnosis of an underlying malignancy. We are presenting an Asian male with progressive lower extremity weakness with EBV-positive nasopharyngeal carcinoma (NPC) and anti-Yo antibodies. Peculiarly, transient diffuse leptomeningeal enhancement is seen on MR imaging. This is the first report of PCD associated with NPC and thus illustrates that PCD embodies a boarder set of disease than previously described.

OBJECTIVES/OBJECTIVE:Assess Staphylococcus aureus (S. aureus) colonization in healthy Australian adults receiving an investigational S. aureus 3-antigen vaccine (SA3Ag). METHODS:In this phase 1, double-blind, sponsor-unblinded study, participants were randomized to receive a single dose (1 of 3 dose levels) of SA3Ag or placebo and a booster dose or placebo at 6 months. S. aureus isolates from nasal, perineal, and oropharyngeal swabs before and through 12 months post-vaccination were identified. RESULTS:Baseline S. aureus colonization prevalence was 30.6% (any site), with nasal carriage (27.0%) more common than oropharyngeal/perineal (3.2% each). Following initial vaccination (low-dose:102; mid-dose:101; high-dose:101; placebo:102) and booster (low-dose:45; mid-dose:44; high-dose:27; placebo:181), placebo and SA3Ag groups showed similar S. aureus carriage through 12 months. Most colonized participants (74.0%) were colonized by single spa types. Placebo and SA3Ag groups had similar persistence of colonization, with 19.6-30.7% due to single spa types. Acquisition was observed in mid- and high-dose recipients (∼20%) and low-dose and placebo recipients (∼12%). Vaccination resulted in substantial increases in antibodies to all 3 antigens, irrespective of carriage status. CONCLUSIONS:Based on descriptive analyses of this small study, SA3Ag vaccination did not impact S. aureus acquisition or carriage. Carriage status did not impact antibody responses to SA3Ag.

OBJECTIVE:Chinese-Americans are a fast growing immigrant group with more severe rheumatic disease manifestations than Caucasians and often a strong cultural preference for Traditional Chinese Medicine (TCM). We aimed to examine TCM use patterns and association with patientreported outcomes (PROs) among Chinese-American rheumatology patients. METHODS:Chinese-Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics. Data on sociodemographics, acculturation, clinical factors, and TCM use (11 modalities) were gathered. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System (PROMIS®) short forms. TCM users and non-users were compared. Factors independently associated with TCM use were identified using multivariable logistic regression. RESULTS:Among 230 participants, median age was 55 (range 20-97), 65% were female, 71% had ≤ high school education, 70% were on Medicaid, 47% lived in the US for ≥20 years, and 22% spoke English fluently. Half used TCM in the past year; these participants had worse selfreported anxiety, depression, fatigue, and ability to participate in social roles and activities compared with non-users. In multivariable analysis, TCM use was associated with belief in TCM, female gender, ≥20 years' US residency, reporting western medicine as ineffective, and shorter rheumatic disease duration. CONCLUSION/CONCLUSIONS:Among these Chinese-American rheumatology patients, TCM users had worse PROs in many physical and mental health domains. TCM use may be a proxy for unmet therapeutic needs. Asking about TCM use could help providers identify patients with suboptimal health-related quality of life who may benefit from targeted interventions.

OBJECTIVE:To determine if World Trade Center (WTC) exposure is associated with hearing loss. METHODS:Logistic regression to evaluate the immediate impact of WTC exposure and parametric survival analysis to assess longitudinal outcomes. RESULTS:Those arriving on the morning of 9/11/2001 had elevated odds of low-frequency (odds ratio [OR]: 1.24;95%CI:1.04-1.47) and high-frequency (OR:1.16;95%CI:1.02-1.31) hearing loss at their first post-9/11/2001 exam. Longitudinally, participants arriving before 9/13/2001 and spending ≥6 months at the WTC-site had greater risk of hearing loss in the low frequencies (risk ratio [RR]:1.31;95%CI:1.05-1.60) and high frequencies (RR:1.37;95%CI:1.22-1.54). By 2016, 3,194 (37%) had abnormal hearing sensitivity in either ear and 1,751 (20%) in both ears. CONCLUSIONS:More heavily WTC-exposed workers were at increased risk of hearing loss, and group differences persisted for at least 15 years. Those with abnormal hearing sensitivity may benefit from interventions such as hearing aids and other rehabilitation.

Curricular revision efforts have resulted in learner-centered programs that value content integration and active learning. Yet, less attention has been placed on assessment methods that are learner-centered and promote assessment for learning. The use of context rich short answer question (CR-SAQ) exams in the preclinical years of medical school was evaluated to determine if this format aligns with the criteria for assessment for learning. Medical students and preclinical faculty members were sent a survey comprised of closed and open-ended questions about their experience using CR-SAQ exams. Data were analyzed using a mixed-method design. Open-ended responses were evaluated using thematic analysis within the framework of criteria for assessment for learning. A total of 274 students (94%) and 24 faculty (75%) completed the survey. Fifty four percent of students reported preferring a CR-SAQ exam format over multiple choice questions (MCQ) format. Quantitative data and qualitative comments by students supported that CR-SAQ exams aligned with criteria for assessment for learning, including acceptability, authenticity, educational effect, and the cueing effect. Student concerns included preparation for USMLE Step 1 exam, as well as the validity and reproducibility of CR-SAQ assessments. Faculty largely agreed with the benefits of the CR-SAQ, but were concerned about feasibility, acceptability and reproducibility. The CR-SAQ exam format assessment strategy supports assessment for learning in an undergraduate medical education setting. Both benefits and drawbacks of this method are presented, however students and faculty describe a broader impact that this assessment method has on their development as a physician.

BACKGROUND/OBJECTIVE/OBJECTIVE:The connection between gout and various cancers remains unclear. We assessed the relationship between gout and colorectal cancer in a population of veterans. METHODS:We reviewed the Computerized Patient Record System of the VA New York Harbor Health Care System to assess the 10-year occurrence of colorectal cancer in patients with gout undergoing colonoscopy, versus patients with osteoarthritis but no gout. RESULTS:Gout and osteoarthritis subjects were similar in age, ethnicity, body mass index, and smoking history. Among 581 gout and 598 osteoarthritis subjects with documented colonoscopies, the 10-year prevalence of colorectal cancer was significantly lower in gout (0.8%) versus osteoarthritis (3.7%) (p = 0.0008) patients. Differences in colorectal cancer rates remained significant after stratifying for nonsteroidal anti-inflammatory drug use. Among gout subjects, use of colchicine and/or allopurinol, as well as the presence/absence of concomitant osteoarthritis, did not influence colorectal cancer occurrence. On subanalysis, differences in colorectal cancer occurrence between gout and osteoarthritis subjects persisted among those who underwent diagnostic (0.5% in gout vs 4.6% in osteoarthritis subjects, p < 0.001) but not screening (0.9% in gout subjects vs 1% in osteoarthritis subjects, p = 1.0) colonoscopy. There was no significant difference in nonmalignant colorectal polyp occurrence between gout and osteoarthritis subjects. CONCLUSIONS:Subjects with gout had decreased colonoscopy-documented occurrence of colorectal cancer compared with osteoarthritis subjects, suggesting a possible protective effect.

BACKGROUND:The relationship of gestational diabetes mellitus (GDM), exclusive breastfeeding (EBF), and sugar-sweetened beverages (SSBs) on obesity prevalence in children has rarely been evaluated. OBJECTIVE:This study examined the association of GDM status, EBF, and SSB with obesity prevalence in children (1-5 y). METHODS:Data are from the 2014 Los Angeles County WIC Survey, which included 3707 mothers and their children (1-5 y). RESULTS:Compared with GDM offspring who were not EBF, GDM offspring who were EBF had lower odds of obesity, as did non-GDM offspring who were and were not EBF. Compared with GDM offspring with high-concurrent SSB intake (>3 servings/d) and no EBF, GDM offspring with high SSB intake and EBF did not have lower odds of obesity, whereas those with GDM, low SSB (≤1 serving/d), and EBF had lower odds of obesity. Using non-GDM, EBF, and low SSB as referent, non-GDM offspring who were not EBF, with either high or low SSB, had approximately a fourfold increase in odds of obesity. CONCLUSIONS:In GDM offspring, EBF is only associated with lower obesity levels if later SSB intake is also low, whereas EBF is protective against obesity in non-GDM offspring regardless of high or low later SSBs intake.