Faculty Bibliography

With former President George W. Bush having decided to stay largely silent during Mr. [Barack Obama]'s tenure, Mr. Cheney had embraced the role of public critic, accusing the new, young president of rolling back Bush-era policies and undermining the security of the United States. In 2009, Mr. Cheney and Mr. Obama gave dueling speeches on the same day. Mr. Cheney's friends and family say that he is making plans to get out in 2011 and do more speeches. On Jan. 20, he is to fly to Texas for the 20th anniversary of the Gulf War with former President George H.W. Bush, the emir of Kuwait, and a host of alumni of that administration, including the former national security adviser Brent Scowcroft and Colin L. Powell, who was the chairman of the Joint Chiefs of Staff at the time, when Mr. Cheney was defense secretary. Mr. Cheney, who is spending the holidays at his ranch in Wyoming, recently had a class of U.S. Military Academy cadets over to his house in McLean, Virginia, to talk about his experiences working for four of the last five Republican presidents. In Wyoming, he has been seen in local stores, stocking up to make chili and spaghetti sauce, 'as well as walking me through how to cook Christmas dinner,' his daughter Liz Cheney said in an e-mail. But most of all, Ms. Cheney said, her father has been working on his book, which is due out this autumn

Mr. Cheney, as he did at several holiday receptions in Washington, chatted about his new pump. At one cocktail party, he even opened his coat jacket to show off the pump. While Mr. Cheney is noticeably thinner -- his stiff, one-sided grin now shows up on a markedly leaner face -- he is returning, associates say, to his old life, including hunting and socializing. With former President George W. Bush having decided to stay largely silent during Mr. [Barack Obama]'s tenure, Mr. Cheney had embraced the role of public critic, accusing the new, young president of rolling back Bush-era policies and undermining the security of the United States. In 2009, Mr. Cheney and Mr. Obama gave dueling speeches on the same day. Mr. Cheney's friends and family say that he is making plans to get out in 2011 and do more speeches. On Jan. 20, he is to fly to Texas for the 20th anniversary of the Gulf War with former President George H.W. Bush, the emir of Kuwait, and a host of alumni of that administration, including the former national security adviser Brent Scowcroft and Colin L. Powell, who was the chairman of the Joint Chiefs of Staff at the time, when Mr. Cheney was defense secretary

[...] Mr. Cheney has begun resuming his old activities. Besides the Cino fund-raiser, he attended a round of holiday parties in Washington -- leaving whispers in his trail about his weight loss.

The fundraiser for [Maria Cino], held at the Alexandria, Va., home of [Dick Cheney]'s former aide Mary Matalin, was his first major foray into partisan Washington political theater since receiving a mechanical heart pump in July that has, most doctors say, saved Cheney's life by taking on the task of helping to push blood through his arteries. With George W. Bush having decided to stay largely silent during [Barack Obama]'s tenure, Cheney embraced the role of public critic, accusing the new, young president of rolling back Bush-era policies and undermining the nation's security. In 2009, Cheney and Obama gave dueling speeches on the same day. At 69, Cheney's heart will never beat at full strength again, doctors say. His new mechanical pump, a partial artificial heart known as a ventricular assist device, leaves patients without a pulse because it pushes blood continuously instead of mimicking the heart's own beat. Most pulseless patients feel nothing unusual, but the devices do pose significant risks of infection. They are implanted as a last resort either for permanent use or as a bridge to transplant until a donor heart can be found. Cheney, who has participated in some of the nation's toughest decisions for decades, now faces a crucial one of his own: whether to seek a full heart transplant

The foreign-born population is disproportionately affected by tuberculosis (TB). Testing to identify persons with latent TB infection is critical. The aim of this study was to assess clinic-based testing for latent tuberculosis infection among recent Asian and Latino immigrants. A randomized controlled trial of interpreting methods and their impact on medical outcomes was conducted at the primary care clinic of a New York City municipal hospital. This study is a nested cohort of recruited patients with an indication to receive tuberculin testing, based on recent migration to the US from endemic areas. Medical record data were abstracted to determine referral for, and completion of, tuberculin testing. Bivariate analyses were used to test for differences in tuberculin testing between language concordant and discordant groups. Seven hundred and eighty-two patients were enrolled. One hundred and ninety-one had migrated within 5 years of enrollment from endemic areas. None spoke English as a primary language. Seventy percentage of patient-provider encounters were language discordant. Seventeen of 191 were referred for testing. Fifteen (88%) completed testing. Six (40%) had positive results. There were no significant differences between language concordant and discordant patients. In this at-risk population, every patient in clinical care should be considered for testing if indicated by country of origin

While the long-term goal is to develop highly effective AIDS vaccines, first generation vaccines may be only partially effective. Other HIV prevention modalities such as preexposure prophylaxis with antiretrovirals (PrEP) may have limited efficacy as well. The combined administration of vaccine and PrEP (VAXPREP), however, may have a synergistic effect leading to an overall benefit that is greater than the sum of the individual effects. We propose two test-of-concept trial designs for an AIDS vaccine plus oral or topical ARV. In one design, evidence that PrEP reduces the risk of HIV acquisition is assumed to justify offering it to all participants. A two-arm study comparing PrEP alone to VAXPREP is proposed in which 30 to 60 incident infections are observed to assess the additional benefit of vaccination on risk of infection and setpoint viral load. The demonstrated superiority of VAXPREP does not imply vaccine alone is efficacious. Similarly, the lack of superiority does not imply vaccine alone is ineffective, as antagonism could exist between vaccine and PrEP. In the other design, PrEP is assumed not to be in general use. A 2 x 2 factorial design is proposed in which high-risk individuals are randomized to one of four arms: placebo vaccine given with placebo PrEP, placebo vaccine given with PrEP, vaccine given with placebo PrEP, or VAXPREP. Between 60 and 210 infections are required to detect a benefit of vaccination with or without PrEP on risk of HIV acquisition or setpoint viral load, with fewer infections needed when synergy is present

South Asian immigrants are a large, rapidly growing community in the United States. The rate of cardiovascular disease in immigrants from India, Pakistan, and Bangladesh is disproportionately high. We conducted focus groups with diverse South Asian community members in New York City to elucidate hypertension knowledge, and screening and treatment practices. Focus groups were conducted in partnership with community-based organizations. 47 participants across Bangladeshi, Pakistani and Indian immigrants participated in three focus groups. Participants hesitated accessing services because of immigration fears, financial concerns, scheduling constraints, and dissatisfaction with their interactions with doctors. Discussions detailed knowledge about, and barriers to following, advice on diet and exercise. The findings compel further development of culturally- and linguistically-tailored research and interventions to address the specific needs of this large at-risk community. Potential culturally appropriate approaches are discussed to bridge barriers faced by the community.

RATIONALE, AIMS AND OBJECTIVE/OBJECTIVE:Changes in physician behavior are difficult to accomplish. We hypothesized measuring physicians' vitamin D levels would increase measurement of their patients' levels. METHODS:We recruited faculty via e-mail. We measured physicians' serum 25(OH)D levels and asked them to complete a questionnaire created to assess the risk of vitamin D deficiency. Physicians received their vitamin D test results by mail. We monitored physicians' vitamin D testing rate per 100 patient visits in the 12 weeks before and after receipt of their own vitamin D test result. RESULTS:Twenty-eight (22%) of 126 primary care physicians participated in the study; all were Caucasian and 17 (61%) were women. Gender, practic type, and year of graduation from medical school were similar in participants and non-participants. Over half of participants took a multivitamin and a third took a vitamin D supplement. Although 6 (21%) reported a recent fracture, only 1 physician carried a diagnosis of osteopenia or osteoporosis. At baseline, geriatricians ordered 14 vitamin D tests per 100 patient visits, while internists and family practitioners ordered substantially fewer tests (2 and <1 tests per 100 visits, respectively). After study participation, vitamin D testing rates increased significantly among family practitioners (rate ratio 3.27, 95% CI 1.29-8.33) and internists (rate ratio 3.19, 95% CI 1.12-9.07). Physicians with heavier clinic workloads were half as likely (rate ratio 0.50, 95% CI 0.32-0.76) as those with lighter clinic workloads to increase vitamin D testing rates. Surprisingly, physicians with hypovitaminosis D demonstrated no change in vitamin D testing rates. CONCLUSIONS:Physicians with low vitamin D testing rates were receptive to a personal intervention involving measurement of their own vitamin D levels. High workload appeared to attenuate this effect. These novel but preliminary observations require confirmation in future studies.

Congenital tuberculosis (TB) is uncommon, and diagnosis may be delayed. We report a case of congenital TB and the management of exposure in three different neonatal intensive care units. This case demonstrates the need for a high index of suspicion, active communication among maternal and neonatal medical providers, and timely provider reporting of maternal disease, and emphasizes the relatively greater risk of transmission to health care workers versus infants in this setting.