Faculty Bibliography

PURPOSE/OBJECTIVE:The aim of this study was to identify successful recruitment strategies and obstacles reported by principal investigators (PIs) of the Zoster Eye Disease Study (ZEDS). METHODS:A web-based survey was created by a subset of ZEDS PIs and distributed to ZEDS PIs after study enrollment was closed. The survey queried investigators about recruitment strategies and obstacles, use of prophylactic oral antiviral medication, electronic medical records, telemedicine, COVID-19 effect, turnover of research staff, and recruitment outreach to minority and underserved populations. The survey allowed objective measures and free-text options. Analysis from centers with higher enrollment was compared with centers with lower enrollment to identify successful strategies and common obstacles. RESULTS:The most frequently cited helpful strategies were participation from ophthalmologists within the PI's institution (33/63, 52%), ophthalmology resident referrals (23/63, 37%), and chart review (23/63, 37%). Travel to participating clinical center (42/63, 67%) and ongoing prophylactic use of oral systemic antiviral medication (39/63, 62%) were common obstacles. Research coordinator turnover was identified as a contributor to reduced recruitment success by 49% (31/63) of PIs and made recruitment much harder for 22% (14/63). A small number of investigators used telemedicine (18/63, 29%) and few made efforts to recruit from minority and underserved populations (10/63, 16%). CONCLUSIONS:Our survey highlights the importance of internal ophthalmologist referral, chart review, and research coordinator commitment for successful clinical trial recruitment. We discuss the impact of prophylactic use of oral antiviral medication on recruitment. Future randomized clinical trials should mobilize the helpful recruitment strategies and improve outreach to underserved populations.

Around 5% of the children and teenagers worldwide are affected by Attention-Deficit/Hyperactivity Disorder [ADHD], making it a major public health concern. Recently, demand for assessments has substantially increased, putting strain on healthcare and waiting lists. There is concern that pressure to clear service bottlenecks is leading to variable quality and reliability of ADHD assessments in this population. The ADHD Assessment Quality Assurance Standard for Children and Teenagers [CAAQAS] aims to address this by proposing a quality framework for ADHD assessments in this population. CAAQAS is intended to complement formal training, provide support to clinicians, inform commissioners, and empower children, teenagers, and caregivers on what to expect from an assessment and assessment report. Our goal is to promote evidence-based high-quality assessments, improve diagnostic accuracy, and reduce the risks of overdiagnosis, misdiagnosis, and underdiagnosis. Seven key topics were identified by authors which guided the development of this expert consensus statement. It was agreed that a high-quality diagnostic assessment of ADHD in this population commences with advance preparation to facilitate engagement of the child or teenager and caregivers. The consensus agreed that the minimum/essential standards for assessing and diagnosing ADHD adopt a systematic approach from pre-assessment through assessment to post-diagnostic stage, enabling ADHD to be disentangled from differential diagnoses. The process applies multi-source information to inform an assessment of development history and early risk factors, history of physical, mental health and other neurodevelopmental conditions, family, educational, and social histories. Assessment of core ADHD symptoms should include specific developmentally appropriate examples of associated difficulties and impairments. Neuropsychiatric and physical comorbidities should be assessed and identified. Recommendations for report writing are intended to facilitate effective communication between ADHD specialists and other services, and we highlight the importance of linking the diagnosis to an appropriate post-diagnostic discussion. Further, we discuss core competencies required to conduct a diagnostic assessment of ADHD in children and teenagers.

BACKGROUND:Acute myocardial injury is associated with poor outcomes in patients with acute ischemic stroke, but its prognostic significance in patients with spontaneous intracerebral hemorrhage remains unclear. We investigated whether acute myocardial injury and the direction of the cardiac troponin I (cTnI) change (rising versus falling) affect post-intracerebral hemorrhage outcomes. METHODS AND RESULTS/RESULTS:We re-analyzed the FAST (Factor-Seven-for-Acute-Hemorrhagic-Stroke) trial. Acute myocardial injury was defined as at least 1 cTnI value above the upper reference limit with a rise/fall of >20%. Logistic regression tested for associations (1) between acute myocardial injury (presence versus absence) and poor outcome (modified Rankin Scale 4-6) and mortality at 15 and 90 days; (2) among 3 groups (rising versus falling versus no acute myocardial injury) and outcomes. Among the 841 FAST participants, 785 patients were included. Acute myocardial injury was detected in 29% (n=227); 170 had rising cTnI. At 15 and 90 days, respectively, those with acute myocardial injury had higher odds of poor outcome (adjusted odds ratio) ([aOR] 2.3 [95% CI, 1.3-3.9]); and adjusted odds ratio 2.5 [95% CI, 1.6-3.9];, and higher odds of mortality (adjusted odds ratio 2.4 [95% CI, 1.4-4.3]; and adjusted odds ratio 2.2 [CI, 1.3-3.6]) than patients without. There was no interaction between FAST group assignment and myocardial injury, and associations between myocardial injury and outcomes were consistent across group assignments. Rising cTnI was associated with the highest risk of poor outcomes and mortality. CONCLUSIONS:In this secondary analysis of the FAST trial, acute myocardial injury was common and associated with poor outcomes. The direction of the cTnI change might provide additional risk stratification after intracerebral hemorrhage.

OBJECTIVE:To evaluate whether functional, clinical, and self-reported tests reflect lumbar spinal stenosis patients' decisions to undergo or defer surgery. METHODS:Among 108 participants, 77 chose surgery (SG), and 31 opted to wait and see (WaSG) whether they got better spontaneously. Both groups were assessed at baseline (t0) and 3 months (t1), with additional self-reported measures at 6 (t2) and 12 months (t3). Key outcomes included corridor walk distance, chair sit-to-stand repetitions, grip strength, and various pain and disability indices. RESULTS:At baseline, SG reported higher leg pain (NPRS-leg: Δ = 1.66, P = 0.002) and poorer functional outcomes across multiple tests. By t1, both groups improved in disability, but SG showed greater reductions in the Oswestry Disability Index (Δ = 7.85, P = 0.001) and sustained improvements in leg pain at subsequent assessments. WaSG consistently engaged in more walking (mean Δ = 123.5 minutes, P < 0.001). Regression analyses indicated that surgery status, flexibility, and strength significantly predicted improvements in disability (adjusted R² = 0.296). Logistic regression identified predictors for surgery choice, including biological sex, leg pain intensity, walking performance, and weekly walking hours. CONCLUSION/CONCLUSIONS:Functional status, self-reported disability, and fear-avoidance beliefs in lumbar spinal stenosis patients reflect their subjective decision regarding surgery and highlight the importance of baseline leg pain, calf strength, walking-related parameters, and physical function in recovery. STUDY DESIGN/METHODS:Observational prospective cohort.

BACKGROUND/OBJECTIVE/UNASSIGNED:Genetic causes of hypertriglyceridemia like familial chylomicronemia syndrome can be overlooked in everyday practice. We report a patient with a rare genetic mutation, highlighting the importance of genetic testing for timely diagnosis and prevention of complications. CASE REPORT/UNASSIGNED:A 45-year-old Hispanic female presented with serum triglyceride levels of 749 mg/dL, refractory to rosuvastatin 10 mg daily and omega-3 ethyl esters 2 g daily. Initial studies showed total cholesterol of 278 mg/dL and high-density lipoprotein of 38 mg/dL. Physical examination was negative for hepatosplenomegaly and xanthoma, with no reported history of acute pancreatitis. Despite treatment escalation with gemfibrozil, fenofibrate, and icosapent ethyl, her triglyceride levels remained elevated, peaking at 4300 mg/dL. Seven years after presentation, genetic testing revealed homozygosity for c.11delC of the apolipoprotein A5 gene, confirming the diagnosis of familial chylomicronemia syndrome. Postdiagnosis, the patient adhered to a strict low-fat diet with daily fat intake of less than 15-20 g, limited simple sugars, refined carbohydrates, and alcohol, leading to a nadir of serum triglycerides of 197 mg/dL. DISCUSSION/UNASSIGNED:The identified mutation is exceedingly rare (<0.01%), as most associated mutations involve the lipoprotein lipase gene. There are no approved therapies for genetic hypertriglyceridemia. The mainstay of treatment is a very low-fat diet to prevent complications. CONCLUSION/UNASSIGNED:We underscore the importance of genetic testing in refractory hypertriglyceridemia despite a lack of clinical signs. A definitive diagnosis can alleviate patient burden, improve therapeutic adherence, and enhance the patient-physician relationship.

BACKGROUND:by Philips Healthcare). A multi-specialty group of physician POCUS experts (n = 35) acquired three standard ultrasound views (abdominal right upper quadrant, cardiac apical 4-chamber, and superficial neck and lung views) in random order on the same standardized patients and rated the image quality. Afterward, a final survey of the overall ease of use, image quality, and satisfaction of each handheld was completed. RESULTS:. The 5 most desirable characteristics of handhelds were image quality, ease of use, portability, probe size, and battery life. Ultimately, all 6 handhelds had notable advantages and disadvantages, with no single device having all desired qualities or features. CONCLUSIONS:was rated highest for overall ease of use and was the most preferred handheld for purchase by POCUS experts.

Achieving a sustained virologic response (SVR) through direct-acting antivirals for hepatitis C virus (HCV) infection significantly reduces the long-term risk of hepatocellular carcinoma (HCC), particularly in patients with advanced fibrosis (F3) or cirrhosis (F4). However, despite this improvement, the risks associated with HCC and the optimal surveillance strategies for patients who have achieved SVR remain topics of debate. This controversy is compounded by challenges in reliably staging liver fibrosis non-invasively, especially at advanced fibrosis (F3), and the unclear cost-effectiveness, modality, frequency, and duration of HCC surveillance in individuals with SVR but without cirrhosis. These factors contribute to significant variations in surveillance guidelines recommended by different professional societies. Therefore, there is a pressing need for an optimal surveillance strategy that is both simplified and cost-effective to facilitate wider adoption by clinicians. This review article evaluates the existing data, addresses ongoing controversies, and aims to provide new perspectives on HCC surveillance strategies for patients who have achieved SVR from HCV.

BACKGROUND/UNASSIGNED:Spontaneous coronary artery dissection (SCAD) is a disease entity that often occurs in young, healthy women and can cause life-threatening ventricular arrhythmias and sudden cardiac arrest. However, the characteristics and outcomes of SCAD with cardiac arrest are not well characterized. METHODS/UNASSIGNED:This study investigated the baseline characteristics of SCAD patients with cardiac arrest using the National Inpatient Sample (NIS) database between 2016 and 2020. In addition, we also sought to determine the potential impact that implantable cardioverter defibrillator (ICD) therapy had on morbidity and mortality in SCAD patients presenting with cardiac arrest. RESULTS/UNASSIGNED:Our findings showed that the SCAD with cardiac arrest population had significantly higher comorbidities, including cardiac arrhythmias, congestive heart failure, pulmonary circulation disorders, liver diseases, solid tumors, coagulopathy, fluid disorders, chronic kidney disease (CKD), anemia secondary to deficiency, psychosis, neurological disorders, carotid artery disease, atrial fibrillation, ventricular arrhythmias (ventricular tachycardia (VT), ventricular fibrillation (VF)), and acute myocardial infarction (AMI), compared to the SCAD without cardiac arrest population. Likewise, for SCAD patients who did not have an ICD in place, we found increasing age, fluid and electrolyte disorders, uncomplicated diabetes, neurological disorders, peripheral vascular disease, pulmonary circulatory disorders, cardiac arrhythmias, and congestive heart failure to be associated with greater mortality. CONCLUSIONS/UNASSIGNED:SCAD patients with certain comorbidities (e.g., pulmonary diseases, liver diseases, cancers, coagulopathy, and CKD) who presented with AMI or congestive heart failure should be monitored closely for ventricular arrhythmias as they have a higher chance of progressing to cardiac arrest. ICD therapy can be considered for these patients, but data on the success of this treatment option are limited, and more research needs to be performed to determine whether the benefits of this outweigh the risks.

Technological advancements in liquid chromatography (LC) electrospray ionization (ESI) high-resolution mass spectrometry (HRMS) have made it an increasingly popular analytical technique in non-targeted analysis (NTA) of environmental and biological samples. One critical limitation of current methods in NTA is the lack of available analytical standards for many of the compounds detected in biological and environmental samples. Computational approaches can provide estimates of concentrations by modeling the relative response factor of a compound (RRF) expressed as the peak area of a given peak divided by its concentration. In this paper, we explore the application of molecular dynamics (MD) in the development of a computational workflow for predicting RRF. We obtained measurements of RRF for 48 compounds with LC - quadrupole time-of-flight (QTOF) MS and calculated their RRF. We used the CGenFF force field to generate the topologies and GROMACS to conduct the (MD) simulations. We calculated the Lennard-Jones and Coulomb interactions between the analytes and all other molecules in the ESI droplet, which were then sampled to construct a multilinear regression model for predicting RRF using Monte Carlo simulations. The best performing model showed a coefficient of determination (R ²) of 0.82 and a mean absolute error (MAE) of 0.13 log units. This performance is comparable to other predictive models including machine learning models. While there is a need for further evaluation of diverse chemical structures, our approach showed promise in predictions of RRF.