Faculty Bibliography

OBJECTIVES: We sought to survey the New Investigators and Trainees Section (NITS) members of the American Headache Society (AHS) to better understand their exposure to headache medicine during training and to determine their perceptions and attitudes about the field and the future of headache medicine. BACKGROUND: Despite the high prevalence of headache disorders in the general population, only about 2% of neurology residents pursue headache medicine fellowships. Furthermore, there is a paucity of United Council of Neurologic Subspecialties headache specialists in the country to meet the population demands. Thus, there needs to be a focus on how to recruit and retain more headache specialists. METHODS: A survey was distributed via SurveyMonkey to the NITS listserv. It remained online for 60 days, during which reminder emails were sent to members of the listserv. In addition, the survey was available on laptops at NITS-related events at an annual AHS meeting. Descriptive analyses were then conducted using SurveyMonkey and Excel. RESULTS: Of the 93 members of NITS, 64 of the 96 (68.8%) clicked to initiate the survey and 52.7% successfully completed it. Attendings made up the majority of respondents (62.5%), followed by fellows (10.9%), and residents (7.8%). Key highlights of the survey included the following: just under 10% reported no exposure to a headache center during any time in their training (medical school, residency, or fellowship); less than 2% had exposure to a headache center during medical school; less than half of participants reported exposure to a headache center in residency (45.3%) and during fellowship (43.4%). Having a mentor in the field, liking the patient population, and working in a headache center, 64.7%, 52.9%, and 41.2%, respectively, were the top ways in which participants became interested in headache. The journal Headache (56.9%), attendings (56.3%), and the AHS/American Academy of Neurology guidelines for migraine management (52.0%) are the resources cited as being used all/most of the time. About 82.4% strongly agree that there needs to be improved headache education for physicians of all specialties (primary care, emergency department, psychiatry); 84.4% feel that they are appreciated by their patients; 68.6% feel that there is strong support in their departments for headache; 56.9% believe that their work schedule leaves enough time for personal and family life; and 60.8% agreed that their professional life will improve in years to come. Participants agreed/strongly agreed that they like to treat the following diseases/symptoms: migraine headache (98.0%), cluster headache (92%), chronic daily headache (84%), and post-concussive syndrome (71.4%). Participants disagreed/strongly disagreed that they like to treat the following comorbid conditions/symptoms: low back pain (66.6%), dizziness (42.9%), sleep apnea (36.7%), depression (32.0%), and anxiety (32.0%). CONCLUSIONS: In this detailed survey on the recruitment and retention of headache specialists, the following themes emerged: mentorship and exposure to a headache center are key foundations in the young investigator/trainee experience. Young headache specialists appear positive about their field of medicine. These specialists like to treat various headache types but not necessarily some of the related comorbidities (sleep disorders, depression, anxiety, back pain, and dizziness). Finally, there was strong agreement that there needs to be improved headache education for physicians of other medical specialties.

Idiopathic demyelinating optic neuritis (ON) most commonly presents as acute unilateral vision loss and eye pain and is frequently associated with multiple sclerosis. Although emphasis is often placed on the good recovery of high-contrast visual acuity, persistent deficits are frequently observed in other aspects of vision, including contrast sensitivity, visual field testing, color vision, motion perception, and vision-related quality of life. Persistent and profound structural and functional changes are often revealed by imaging and electrophysiologic techniques, including optical coherence tomography, visual-evoked potentials, and nonconventional MRI. These abnormalities can impair patients' abilities to perform daily activities (e.g., driving, working) so they have important implications for patients' quality of life. In this article, we review the sequelae from ON, including clinical, structural, and functional changes and their interrelationships. The unmet needs in each of these areas are considered and the progress made toward meeting those needs is examined. Finally, we provide an overview of past and present investigational approaches for disease modification in ON.

The association of cardiovascular risk factors and complexity and severity of coronary artery disease with contrast volume (CV) remains unknown. We assessed the predictive factors of CV use during elective and emergent cardiac catheterization (CC). Electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 708 patients were eligible. On multivariable regression analysis, the presence of obstructed coronary arteries was associated with CV (P = .01, beta = -14.17), with greater CV used in patients with single or double vessel disease compared to those with triple vessel disease. The presence of lesions with >70% stenosis in major epicardial arteries (P = .019, beta = 24.39) and ST-segment elevation myocardial infarction (P = .001, beta = 36.14) was associated with increased CV use. Elevated B-type natriuretic peptide (P = .036, beta = -17.23) and increase in Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score (P = .024, beta = -29.06) were associated with decreased CV use. These aforementioned associations were attenuated after adjusting for percutaneous coronary intervention. Our findings may help predict patient populations who could be exposed to increased CV during CC, thereby possibly increasing their risk of contrast-induced nephropathy.

AIM: We assessed the association of aortic valve sclerosis (AVS) with atherosclerotic risk factors and severity and complexity of coronary artery disease (CAD). METHODS: In this retrospective study, a total of 482 eligible patients were divided into 2 groups: AVS present and AVS absent. All major cardiovascular risk factors and coronary lesion characteristics were included. RESULTS: Age was the only independent predictor of AVS. AVS was not independently associated with the number of obstructive vessels, degree of lesion obstruction and SYNTAX score. CONCLUSION: AVS is probably a benign marker of age-related degenerative changes in the heart independent of the severity and complexity of CAD.

We sought to determine the association of major cardiovascular risk factors and other comorbidities with the presence or absence of coronary collateral (CC) circulation. All electronic medical records from 2010 to 2011 were retrospectively reviewed. A total of 563 patients were divided into 2 groups: CC present (180) and CC absent (383). Smoking (P = .012, odds ratio [OR] 1.58), hypercholesterolemia (P = .001, OR 2.21), and hypertension (P = .034, OR 1.75) were associated with the presence of CC. Increasing body mass index (BMI, P = .001) and decreasing estimated glomerular filtration rate (eGFR, P = .042) were associated with the absence of CC. On multivariable linear regression analysis, hypercholesterolemia (P = .001, OR 2.28), BMI (P = .012, OR 0.77), and eGFR (P = .001, OR 0.70) were found to be independently associated with CC. Our findings will help predict patient populations more likely to have presence or absence of CC circulation.

We assessed the association of mitral annular calcification (MAC) with atherosclerotic risk factors and severity and complexity of coronary artery disease (CAD). Cardiac catheterization reports and electronic medical records from 2010 to 2011 were retrospectively reviewed. A total of 481 patients were divided into 2 groups: MAC present (209) and MAC absent (272). All major cardiovascular risk factors, comorbidities, and coronary lesion characteristics were included. On linear regression analysis, age (P = .001, beta 1.12) and female gender (P = .031, beta 0.50) were the independent predictors of MAC. Mitral annular calcification was not independently associated with the presence of lesions with >70% stenosis (P = .283), number of obstructive vessels (P = .469), lesions with 50% to 70% stenosis (P = .458), and Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score (P = .479). Mitral annular calcification is probably a benign marker of age-related degenerative changes in the heart independent of the severity and complexity of CAD.

Introduction: We performed a more detailed, updated analysis of social media use by AUA members. Specifically we sought to characterize the frequency of and reason for using different social media platforms as well as barriers to social media use. Methods: From November to December 2013 we sent a 21-item survey on social media use to 16,376 AUA members with a valid email address. A total of 1,114 members (6.8%) completed the survey. Responses were tallied and statistical analysis was performed to evaluate use patterns based on demographic characteristics. Results: Overall 71% of AUA members who responded to the survey currently had a social media account. The most popular social media platform was Facebook (89% of respondents), followed by LinkedIn (59%), YouTubeTM (54%), Twitter (48%) and Google+TM (35%). All platforms except LinkedIn were used primarily for personal reasons. Fewer than a third of respondents had viewed an AUA social media site and 35% of physician respondents participated in a physician-only social media community. Among respondents who did not use social media the most common reasons were no perception of added value and privacy concerns. Conclusions: Although most AUA respondents are involved in social media, they primarily use social media for personal reasons. There remains significant potential for growth and education on the usefulness of social media for urologists in the professional setting

OBJECTIVE: Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. STUDY DESIGN: Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. RESULTS: Individual pathologist pair kappa values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. CONCLUSIONS: The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.

BACKGROUND AND OBJECTIVES: Unemployment (5.5% as of 2015) is a serious social and economic problem in our society. Since marijuana use is an important factor related to unemployment, identifying the trajectory of the use of marijuana may aid intervention programs and research on unemployment. METHODS: Six hundred seventy-four participants (53% African-Americans, 47% Puerto Ricans) were surveyed (60% females) from ages 14 to 36. The first data collection was held when the participants were students attending schools in the East Harlem area of New York City. RESULTS: We found that the chronic marijuana use (OR = 4.07, p < .001; AOR = 2.58, p < .05) and the late marijuana quitter (OR = 2.91, p < .05) trajectory groups were associated with an increased likelihood of unemployment compared with the no marijuana use trajectory group. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The results suggest that those who use marijuana chronically are at greater risk for being unemployed. Consequently, these individuals should have access to and participate in marijuana cessation treatment programs in order to reduce their risk of unemployment. Unemployment intervention programs should also consider focusing on the cessation of the use of marijuana to decrease the likelihood of later unemployment. (Am J Addict 2015;24:452 -459).