Faculty Bibliography

Background Coronary artery calcium (CAC) predicts cardiovascular disease (CVD) events; however, less is known about how its prognostic implications vary by race/ethnicity. Methods and Results A total of 38 277 whites, 1621 Asians, 977 blacks, and 1349 Hispanics from the CAC Consortium (mean age 55 years, 35% women) were followed over a median of 11.7 years. Modeling CAC in continuous and categorical (CAC=0; CAC 1-99; CAC 100-399; CAC ≥400) forms, we assessed its predictive value for all-cause and CVD mortality by race/ethnicity using Cox proportional hazards and Fine and Gray competing-risk regression, respectively. We also assessed the impact of race/ethnicity on risk within individual CAC strata, using whites as the reference. Models were adjusted for traditional cardiovascular risk factors. Increased CAC was associated with higher total and CVD mortality risk in all race/ethnicity groups, including Asians. However, the risk gradient with increasing CAC was more pronounced in blacks and Hispanics. In Fine and Gray subdistribution hazards models adjusted for traditional cardiovascular risk factors and CAC (continuous), blacks (subdistribution hazard ratio 3.4, 95% confidence interval, 2.5-4.8) and Hispanics (subdistribution hazard ratio 2.3, 95% confidence interval, 1.6-3.2) showed greater risk of CVD mortality when compared with whites, while Asians had risk similar to whites. These race/ethnic differences persisted when CAC=0. Conclusions CAC predicts all-cause and CVD mortality in all studied race/ethnicity groups, including Asians and Hispanics, who may be poorly represented by the Pooled Cohort Equations. Blacks and Hispanics may have greater mortality risk compared with whites and Asians after adjusting for atherosclerosis burden, with potential implications for US race/ethnic healthcare disparities research.

BACKGROUND:We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has two main components: (1) A novel online curriculum addressing core SUD research topics, to reach a large number of students. (2) A mentored summer research experience for in-depth exposure. METHODS:Modules were integrated into the curricula of the lead institution, and of five external schools. We assessed the number of web modules completed and their effect on students' interest in SUD research. We also assessed the impact of the mentorship experience on participants' attitudes and early career trajectories, including current involvement in SUD research. RESULTS:Since 2008, over 24,000 modules have been completed by approximately 9,700 individuals. In addition to integration of the modules into curricula at the lead institution, all five health-professional partner schools integrated at least one module and approximately 5,500 modules were completed by individuals outside the lead institution. We found an increase in interest in SUD research after completion of the modules for students in all four disciplines. From 2008-2015, 76 students completed summer mentorships; 8 students completed year-long mentorships; 13 published in SUD-related journals, 18 presented at national conferences, and 3 are actively engaged in SUD-related research. Mentorship participants reported a positive influence on their attitudes towards SUD-related clinical care, research, and inter-professional collaboration, leading in some cases to changes in career plans. CONCLUSIONS:A modular curriculum that stimulates clinical and research interest in SUD can be successfully integrated, into medical, dental, nursing, and social work curricula. The SARET program of mentored research participation fostered early research successes and influenced career choice of some participants. Longer-term follow-up will enable us to assess more distal careers of the program.

OBJECTIVES/OBJECTIVE:Following a diagnosis of cancer, the detailed assessment of prognostic stage by radiology is a crucial determinant of initial therapeutic strategy offered to patients. Pretherapeutic stage by imaging is known to be inconsistently documented. We tested whether the completeness of cancer staging radiology reports could be improved through a nationally introduced pilot of proforma-based reporting for a selection of six common cancers. DESIGN/METHODS:Prospective interventional study comparing the completeness of radiology cancer staging reports before and after the introduction of proforma reporting. SETTING/METHODS:Twenty-one UK National Health Service hospitals. PARTICIPANTS/METHODS:1283 cancer staging radiology reports were submitted. MAIN OUTCOME MEASURES/METHODS:Radiology staging reports across the six cancers types were evaluated before and after the implementation of proforma-based reporting. Report completeness was assessed using scoring forms listing the presence or absence of predetermined key staging data. Qualitative data regarding proforma implementation and usefulness were collected from questionnaires provided to radiologists and end-users. RESULTS:Electronic proforma-based reporting was successfully implemented in 15 of the 21 centres during the evaluation period. A total of 787 preproforma and 496 postproforma staging reports were evaluated. In the preproforma group, only 48.7% (5586/11 470) of key staging items were present compared with 87.3% (6043/6920) in the postproforma group. Thus, the introduction of proforma reporting produced a 78% improvement in staging completeness . This increase was seen across all cancer types and centres. The majority of participants found proforma reporting improved cancer reporting quality for their clinical practice . CONCLUSION/CONCLUSIONS:The implementation of proforma reporting results in a significant improvement in the completeness of cancer staging reports. Proforma-based assessment of cancer stage enables objective comparisons of patient outcomes across centres. It should therefore become an auditable quality standard for cancer care.

INTRODUCTION/BACKGROUND:Oxytocin, while classically known for its role in parturition, lactation and social behavior, also has been implicated in the control of sodium homeostasis in animal models. To improve our understanding of oxytocin physiology in humans, we measured basal oxytocin levels under low and liberal dietary sodium conditions and following a peripheral Angiotensin II (Ang II) infusion. METHODS:Ten healthy individuals underwent a 6-day standardized low sodium diet and a 6-day liberal sodium diet. Each diet was followed by a graded Ang II infusion for 30 minute sequential intervals at doses of 0.3, 1.0, 3.0 ng/kg/min. Fasting serum oxytocin was assessed before and after Ang II infusion. RESULTS:Basal oxytocin levels (1498.5{plus minus}94.7 vs. 1663.3{plus minus}213.9 pg/mL, P=0.51) did not differ after the low and liberal sodium diets. Following the Ang II infusion, Ang II levels and mean arterial pressure significantly increased as expected. In contrast, the Ang II infusion significantly lowered oxytocin levels from 1498.5{plus minus}94.7 vs. 1151.7{plus minus}118.1 pg/mL (P<0.001) on the low sodium diet and from 1663.3{plus minus}213.9 vs. 1095.2{plus minus}87.4 pg/mL (P=0.03) on the liberal sodium diet. The percent change in oxytocin following the Ang II infusion did not differ by sodium diet (-25{plus minus}5% vs. -28{plus minus}7% low vs. liberal sodium conditions, P>0.99). CONCLUSIONS:Dietary sodium intake did not affect circulating oxytocin levels among healthy individuals. Systemic oxytocin levels were significantly suppressed following a peripheral Ang II infusion independent of dietary sodium conditions.

Objective/UNASSIGNED:Fatty liver disease is increased among individuals with HIV. We sought to explore how aldosterone, a key hormone linked to insulin resistance and inflammation, relates to liver fat in the large population of individuals with HIV and metabolic abnormalities. Methods/UNASSIGNED:Forty-six individuals with HIV and increased waist circumference and dysglycemia were assessed for liver fat using proton magnetic resonance spectroscopy. Serum aldosterone level was obtained following strictly controlled posture conditions and a standardized sodium diet and was related to liver fat. Results/UNASSIGNED:= 0.002). Conclusion/UNASSIGNED:These data highlight a robust association between aldosterone and liver fat among individuals with HIV and metabolic dysregulation. Increased aldosterone may be a risk factor for liver fat accumulation among the population with HIV.

The inconsistent findings from epidemiologic studies relating total sugars (TS) consumption to cardiovascular disease (CVD) or type 2 diabetes (T2D) risk may be partly due to measurement error (ME) in self-reported intake. Using regression calibration equations developed based on the predictive biomarker for TS and recovery biomarker for energy, we examined the association of TS with T2D and CVD risk, before and after dietary calibration, in 82,254 postmenopausal women of the Women's Health Initiative-Observational Study. After up to 16 years of follow-up (1993-2010), 6,621 T2D and 5,802 CVD incident cases were identified. The hazard ratio (HR) for T2D per 20% increase in calibrated TS was 0.94 (95% CI: 0.77, 1.15) in multivariable energy substitution (ES), and 1.00 (0.85, 1.18) in energy partition (EP) models. Multivariable HRs for total CVD were 0.97 (0.87, 1.09) from ES, and 0.91 (0.80, 1.04) from EP models. Uncalibrated TS generated a statistically significant inverse association with T2D and total CVD risk in both multivariable ES and EP models. The lack of conclusive findings from our calibrated analyses may be due to the low explanatory power of the calibration equations for TS, which could have led to incomplete deattenuation of the risk estimates.