482 results on '"S. McCullough"'
Search Results
2. Uncertainty quantification of the lattice Boltzmann method focussing on studies of human-scale vascular blood flow
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Jon W. S. McCullough and Peter V. Coveney
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Lattice Boltzmann method ,Uncertainty quantification ,Blood flow simulation ,Medicine ,Science - Abstract
Abstract Uncertainty quantification is becoming a key tool to ensure that numerical models can be sufficiently trusted to be used in domains such as medical device design. Demonstration of how input parameters impact the quantities of interest generated by any numerical model is essential to understanding the limits of its reliability. With the lattice Boltzmann method now a widely used approach for computational fluid dynamics, building greater understanding of its numerical uncertainty characteristics will support its further use in science and industry. In this study we apply an in-depth uncertainty quantification study of the lattice Boltzmann method in a canonical bifurcating geometry that is representative of the vascular junctions present in arterial and venous domains. These campaigns examine how quantities of interest—pressure and velocity along the central axes of the bifurcation—are influenced by the algorithmic parameters of the lattice Boltzmann method and the parameters controlling the values imposed at inlet velocity and outlet pressure boundary conditions. We also conduct a similar campaign on a set of personalised vessels to further illustrate the application of these techniques. Our work provides insights into how input parameters and boundary conditions impact the velocity and pressure distributions calculated in a simulation and can guide the choices of such values when applied to vascular studies of patient specific geometries. We observe that, from an algorithmic perspective, the number of time steps and the size of the grid spacing are the most influential parameters. When considering the influence of boundary conditions, we note that the magnitude of the inlet velocity and the mean pressure applied within sinusoidal pressure outlets have the greatest impact on output quantities of interest. We also observe that, when comparing the magnitude of variation imposed in the input parameters with that observed in the output quantities, this variability is particularly magnified when the input velocity is altered. This study also demonstrates how open-source toolkits for validation, verification and uncertainty quantification can be applied to numerical models deployed on high-performance computers without the need for modifying the simulation code itself. Such an ability is key to the more widespread adoption of the analysis of uncertainty in numerical models by significantly reducing the complexity of their execution and analysis.
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- 2024
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3. High resolution simulation of basilar artery infarct and flow within the circle of Willis
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Jon W. S. McCullough and Peter V. Coveney
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Medicine ,Science - Abstract
Abstract On a global scale, cerebro- and cardiovascular diseases have long been one of the leading causes of death and disability and their prevalence appears to be increasing in recent times. Understanding potential biomarkers and risk factors will help to identify individuals potentially at risk of suffering an ischemic stroke. However, the widely variable construction of the cerebral vasculature makes it difficult to provide a specific assessment without the knowledge of a patient’s physiology. In this paper we use the 3D blood flow simulator HemeLB to study flow within three common structural variations of the circle of Willis during and in the moments after a blockage of the basilar artery. This tool, based on the lattice Boltzmann method, allows the 3D flow entering the basilar artery to be finely controlled to replicate the cessation of blood feeding this particular vessel—we demonstrate this with several examples including a sudden halt to flow and a gradual loss of flow over three heartbeat cycles. In this work we start with an individualised 3D representation of a full circle of Willis and then construct two further domains by removing the left or right posterior communicating arteries from this geometry. Our results indicate how, and how quickly, the circle of Willis is able to redistribute flow following such a stroke. Due to the choice of infarct, the greatest reduction in flow was observed in the posterior cerebral arteries where flow was reduced by up to 70% in some cases. The high resolution domains used in this study permit the velocity magnitude and wall shear stress to be analysed at key points during and following the stroke. The model we present here indicates how personalised vessels are required to provide the best insight into stroke risk for a given individual.
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- 2023
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4. Histidine Phosphorylation: Protein Kinases and Phosphatases
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Jia Ning, Margaux Sala, Jeffrey Reina, Rajasree Kalagiri, Tony Hunter, and Brandon S. McCullough
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NME ,histidine kinase ,phosphorylation ,histidine phosphatase ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Phosphohistidine (pHis) is a reversible protein post-translational modification (PTM) that is currently poorly understood. The P-N bond in pHis is heat and acid-sensitive, making it more challenging to study than the canonical phosphoamino acids pSer, pThr, and pTyr. As advancements in the development of tools to study pHis have been made, the roles of pHis in cells are slowly being revealed. To date, a handful of enzymes responsible for controlling this modification have been identified, including the histidine kinases NME1 and NME2, as well as the phosphohistidine phosphatases PHPT1, LHPP, and PGAM5. These tools have also identified the substrates of these enzymes, granting new insights into previously unknown regulatory mechanisms. Here, we discuss the cellular function of pHis and how it is regulated on known pHis-containing proteins, as well as cellular mechanisms that regulate the activity of the pHis kinases and phosphatases themselves. We further discuss the role of the pHis kinases and phosphatases as potential tumor promoters or suppressors. Finally, we give an overview of various tools and methods currently used to study pHis biology. Given their breadth of functions, unraveling the role of pHis in mammalian systems promises radical new insights into existing and unexplored areas of cell biology.
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- 2024
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5. Gold(I) ion and the phosphine ligand are necessary for the anti-Toxoplasma gondii activity of auranofin
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C. I. Ma, J. A. Tirtorahardjo, S. S. Schweizer, J. Zhang, Z. Fang, L. Xing, M. Xu, D. A. Herman, M. T. Kleinman, B. S. McCullough, A. M. Barrios, and R. M. Andrade
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auranofin ,Toxoplasma ,repurposing ,drug discovery ,gold ,Microbiology ,QR1-502 - Abstract
ABSTRACTAuranofin, an FDA-approved drug for rheumatoid arthritis, has emerged as a promising antiparasitic medication in recent years. The gold(I) ion in auranofin is postulated to be responsible for its antiparasitic activity. Notably, aurothiomalate and aurothioglucose also contain gold(I), and, like auranofin, they were previously used to treat rheumatoid arthritis. Whether they have antiparasitic activity remains to be elucidated. Herein, we demonstrated that auranofin and similar derivatives, but not aurothiomalate and aurothioglucose, inhibited the growth of Toxoplasma gondii in vitro. We found that auranofin affected the T. gondii biological cycle (lytic cycle) by inhibiting T. gondii’s invasion and triggering its egress from the host cell. However, auranofin could not prevent parasite replication once T. gondii resided within the host. Auranofin treatment induced apoptosis in T. gondii parasites, as demonstrated by its reduced size and elevated phosphatidylserine externalization (PS). Notably, the gold from auranofin enters the cytoplasm of T. gondii, as demonstrated by scanning transmission electron microscopy-energy dispersive X-ray spectroscopy (STEM-EDS) and Inductively Coupled Plasma-Mass Spectrometry (ICP-MS).IMPORTANCEToxoplasmosis, caused by Toxoplasma gondii, is a devastating disease affecting the brain and the eyes, frequently affecting immunocompromised individuals. Approximately 60 million people in the United States are already infected with T. gondii, representing a population at-risk of developing toxoplasmosis. Recent advances in treating cancer, autoimmune diseases, and organ transplants have contributed to this at-risk population's exponential growth. Paradoxically, treatments for toxoplasmosis have remained the same for more than 60 years, relying on medications well-known for their bone marrow toxicity and allergic reactions. Discovering new therapies is a priority, and repurposing FDA-approved drugs is an alternative approach to speed up drug discovery. Herein, we report the effect of auranofin, an FDA-approved drug, on the biological cycle of T. gondii and how both the phosphine ligand and the gold molecule determine the anti-parasitic activity of auranofin and other gold compounds. Our studies would contribute to the pipeline of candidate anti-T. gondii agents.
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- 2024
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6. Parametric analysis of an efficient boundary condition to control outlet flow rates in large arterial networks
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Sharp C. Y. Lo, Jon W. S. McCullough, and Peter V. Coveney
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Medicine ,Science - Abstract
Abstract Substantial effort is being invested in the creation of a virtual human—a model which will improve our understanding of human physiology and diseases and assist clinicians in the design of personalised medical treatments. A central challenge of achieving blood flow simulations at full-human scale is the development of an efficient and accurate approach to imposing boundary conditions on many outlets. A previous study proposed an efficient method for implementing the two-element Windkessel model to control the flow rate ratios at outlets. Here we clarify the general role of the resistance and capacitance in this approach and conduct a parametric sweep to examine how to choose their values for complex geometries. We show that the error of the flow rate ratios decreases exponentially as the resistance increases. The errors fall below 4% in a simple five-outlets model and 7% in a human artery model comprising ten outlets. Moreover, the flow rate ratios converge faster and suffer from weaker fluctuations as the capacitance decreases. Our findings also establish constraints on the parameters controlling the numerical stability of the simulations. The findings from this work are directly applicable to larger and more complex vascular domains encountered at full-human scale.
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- 2022
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7. Association between vitamin D supplementation and COVID-19 infection and mortality
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Jason B. Gibbons, Edward C. Norton, Jeffrey S. McCullough, David O. Meltzer, Jill Lavigne, Virginia C. Fiedler, and Robert D. Gibbons
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Medicine ,Science - Abstract
Abstract Vitamin D deficiency has long been associated with reduced immune function that can lead to viral infection. Several studies have shown that Vitamin D deficiency is associated with increases the risk of infection with COVID-19. However, it is unknown if treatment with Vitamin D can reduce the associated risk of COVID-19 infection, which is the focus of this study. In the population of US veterans, we show that Vitamin D2 and D3 fills were associated with reductions in COVID-19 infection of 28% and 20%, respectively [(D3 Hazard Ratio (HR) = 0.80, [95% CI 0.77, 0.83]), D2 HR = 0.72, [95% CI 0.65, 0.79]]. Mortality within 30-days of COVID-19 infection was similarly 33% lower with Vitamin D3 and 25% lower with D2 (D3 HR = 0.67, [95% CI 0.59, 0.75]; D2 HR = 0.75, [95% CI 0.55, 1.04]). We also find that after controlling for vitamin D blood levels, veterans receiving higher dosages of Vitamin D obtained greater benefits from supplementation than veterans receiving lower dosages. Veterans with Vitamin D blood levels between 0 and 19 ng/ml exhibited the largest decrease in COVID-19 infection following supplementation. Black veterans received greater associated COVID-19 risk reductions with supplementation than White veterans. As a safe, widely available, and affordable treatment, Vitamin D may help to reduce the severity of the COVID-19 pandemic.
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- 2022
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8. Short‐Term Safety of Repeated Acetaminophen Use in Patients With Compensated Cirrhosis
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Mitchell R. McGill, Laura P. James, Sandra S. McCullough, Jeffery H. Moran, Samuel E. Mathews, Eric C. Peterson, Davis P. Fleming, Morgan E. Tripod, Joel H. Vazquez, Stefanie Kennon‐McGill, Horace J. Spencer, and Jonathan A. Dranoff
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Current guidelines recommend restricting acetaminophen (APAP) use in patients with cirrhosis, but evidence to support that recommendation is lacking. Prior studies focused on pharmacokinetics (PK) of APAP in cirrhosis but did not rigorously examine clinical outcomes, sensitive biomarkers of liver damage, or serum APAP‐protein adducts, which are a specific marker of toxic bioactivation. Hence, the goal of this pilot study was to test the effects of regularly scheduled APAP dosing in a well‐defined compensated cirrhosis group compared to control subjects without cirrhosis, using the abovementioned outcomes. After a 2‐week washout, 12 subjects with and 12 subjects without cirrhosis received 650 mg APAP twice per day (1.3 g/day) for 4 days, followed by 650 mg on the morning of day 5. Patients were assessed in‐person at study initiation (day 1) and on days 3 and 5. APAP‐protein adducts and both conventional (alanine aminotransferase) and sensitive (glutamate dehydrogenase [GLDH], full‐length keratin 18 [K18], and total high‐mobility group box 1 protein) biomarkers of liver injury were measured in serum on the mornings of days 1, 3, and 5, with detailed PK analysis of APAP, metabolites, and APAP‐protein adducts throughout day 5. No subject experienced adverse clinical outcomes. GLDH and K18 were significantly different at baseline but did not change in either group during APAP administration. In contrast, clearance of APAP‐protein adducts was dramatically delayed in the cirrhosis group. Minor differences for other APAP metabolites were also detected. Conclusion: Short‐term administration of low‐dose APAP (650 mg twice per day,
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- 2022
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9. An efficient, localised approach for the simulation of elastic blood vessels using the lattice Boltzmann method
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J. W. S. McCullough and P. V. Coveney
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Medicine ,Science - Abstract
Abstract Many numerical studies of blood flow impose a rigid wall assumption due to the simplicity of its implementation compared to a full coupling with a solid mechanics model. In this paper, we present a localised method for incorporating the effects of elastic walls into blood flow simulations using the lattice Boltzmann method implemented by the open-source code HemeLB. We demonstrate that our approach is able to more accurately capture the flow behaviour expected in elastic walled vessels than ones with rigid walls. Furthermore, we show that this can be achieved with no loss of computational performance and remains strongly scalable on high performance computers. We finally illustrate that our approach captures the same trends in wall shear stress distribution as those observed in studies using a rigorous coupling between fluid dynamics and solid mechanics models to solve flow in personalised vascular geometries. These results demonstrate that our model can be used to efficiently and effectively represent flows in elastic blood vessels.
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- 2021
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10. Exogenous phosphatidic acid reduces acetaminophen-induced liver injury in mice by activating hepatic interleukin-6 signaling through inter-organ crosstalk
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Melissa M. Clemens, Stefanie Kennon-McGill, Joel H. Vazquez, Owen W. Stephens, Erich A. Peterson, Donald J. Johann, Felicia D. Allard, Eric U. Yee, Sandra S. McCullough, Laura P. James, Brian N. Finck, and Mitchell R. McGill
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Acute liver injury ,Acute liver failure ,Adipokine ,Cytokine ,Dietary supplement ,Drug-induced liver injury ,Therapeutics. Pharmacology ,RM1-950 - Abstract
We previously demonstrated that endogenous phosphatidic acid (PA) promotes liver regeneration after acetaminophen (APAP) hepatotoxicity. Here, we hypothesized that exogenous PA is also beneficial. To test that, we treated mice with a toxic APAP dose at 0 h, followed by PA or vehicle (Veh) post-treatment. We then collected blood and liver at 6, 24, and 52 h. Post-treatment with PA 2 h after APAP protected against liver injury at 6 h, and the combination of PA and N-acetyl-l-cysteine (NAC) reduced injury more than NAC alone. Interestingly, PA did not affect canonical mechanisms of APAP toxicity. Instead, transcriptomics revealed that PA activated interleukin-6 (IL-6) signaling in the liver. Consistent with that, serum IL-6 and hepatic signal transducer and activator of transcription 3 (Stat3) phosphorylation increased in PA-treated mice. Furthermore, PA failed to protect against APAP in IL-6-deficient animals. Interestingly, IL-6 expression increased 18-fold in adipose tissue after PA, indicating that adipose is a source of PA-induced circulating IL-6. Surprisingly, however, exogenous PA did not alter regeneration, despite the importance of endogenous PA in liver repair, possibly due to its short half-life. These data demonstrate that exogenous PA is also beneficial in APAP toxicity and reinforce the protective effects of IL-6 in this model.
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- 2021
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11. Rates and types of infections in left ventricular assist device recipients: A scoping reviewCentral MessagePerspective
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Michael Pienta, MD, MS, Supriya Shore, MBBS, MSc, MSc, Francis D. Pagani, MD, PhD, Donald S. Likosky, PhD, Ashraf Shaaban, Abdel Aziz Abou El Ela, MB, BCH, Paul C. Tang, MD, PhD, Michael P. Thompson, PhD, Keith Aaronson, MD, MS, Supriya Shore, MBBS, Thomas Cascino, MD, MSc, Katherine B. Salciccioli, MD, Min Zhang, PhD, Jeffrey S. McCullough, PhD, Michelle Hou, MS, Allison M. Janda, MD, Michael R. Mathis, MD, Tessa M.F. Watt, MD, MSc, Michael J. Pienta, MD, MS, Alexander Brescia, MD, MSc, Austin Airhart, Daniel Liesman, and Khalil Nassar
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left ventricular assist device ,infection ,adverse events ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Published
- 2021
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12. The Role of Social Support in Telehealth Utilization Among Older Adults in the United States During the COVID-19 Pandemic
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Grace S. Chung, Chad S. Ellimoottil, and Jeffrey S. McCullough
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telehealth ,social support ,COVID-19 ,aging ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Background: Older adults may experience a significant digital divide and need support with using technology to transition to telehealth. This study examines the role of social support for telehealth utilization among older adults during the COVID-19 pandemic. Materials and Methods: We used data from the COVID-19 Sample Person Interview to the National Health and Aging Trends Study. Using logistic regression, we measured the association between telehealth utilization and social support. Results: Nearly one in five respondents used telehealth during the COVID-19 pandemic (weighted %: 20.6 [585/3188]). Currently living with family or friends and receipt of technical support were associated with telehealth utilization. Among residents of an assisted living facility, those who received communications technology support from the facility were more likely to use telehealth. Conclusion: Health care providers and policies should aim to reduce barriers to telehealth among older adults, with efforts such as digital literacy support and training.
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- 2021
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13. High fidelity blood flow in a patient-specific arteriovenous fistula
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J. W. S. McCullough and P. V. Coveney
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Medicine ,Science - Abstract
Abstract An arteriovenous fistula, created by artificially connecting segments of a patient’s vasculature, is the preferred way to gain access to the bloodstream for kidney dialysis. The increasing power and availability of supercomputing infrastructure means that it is becoming more realistic to use simulations to help identify the best type and location of a fistula for a specific patient. We describe a 3D fistula model that uses the lattice Boltzmann method to simultaneously resolve blood flow in patient-specific arteries and veins. The simulations conducted here, comprising vasculatures of the whole forearm, demonstrate qualified validation against clinical data. Ongoing research to further encompass complex biophysics on realistic time scales will permit the use of human-scale physiological models for basic and clinical medicine.
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- 2021
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14. Development and performance of a HemeLB GPU code for human-scale blood flow simulation.
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Ioannis Zacharoudiou, Jon W. S. McCullough, and Peter V. Coveney
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- 2023
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15. Development and performance of a HemeLB GPU code for human-scale blood flow simulation.
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Ioannis Zacharoudiou, Jon W. S. McCullough, and Peter V. Coveney
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- 2022
16. Investigation of local and non-local lattice Boltzmann models for transient heat transfer between non-stationary, disparate media.
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Jon W. S. McCullough, Christopher R. Leonardi, Bruce David Jones, Saiied M. Aminossadati, and John R. Williams
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- 2020
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17. Pre-treatment twice with liposomal clodronate protects against acetaminophen hepatotoxicity through a pre-conditioning effect
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Melissa M. Clemens, Joel H. Vazquez, Stefanie Kennon-McGill, Sandra S. McCullough, Laura P. James, and Mitchell R. McGill
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Acetaminophen (APAP) ,Acute liver failure (ALF) ,Damage-associated molecular patterns (DAMPs) ,Drug-induced liver injury ,Liposomal clodronate (LC) ,Kupffer cells ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and aim: Acetaminophen (APAP) overdose is a major cause of acute liver injury, but the role of macrophages in the propagation of the hepatotoxicity is controversial. Early research revealed that macrophage inhibitors protect against APAP injury. However, later work demonstrated that macrophage ablation by acute pre-treatment with liposomal clodronate (LC) exacerbates the toxicity. To our surprise, during other studies, we observed that pre-treatment twice with LC seemed to protect against APAP hepatotoxicity, in contrast to acute pre-treatment. The aim of this study was to confirm that observation and to explore the mechanisms. Methods: We treated mice with empty liposomes (LE) or LC twice per week for 1 week before APAP overdose and collected blood and liver tissue at 0, 2, and 6 h post-APAP. We then measured liver injury (serum alanine aminotransferase activity, histology), APAP bioactivation (total glutathione, APAP-protein adducts), oxidative stress (oxidized glutathione (GSSG)), glutamate-cysteine ligase subunit c (Gclc) mRNA, and nuclear factor erythroid 2-related factor (Nrf2) immunofluorescence. We also confirmed the ablation of macrophages by F4/80 immunohistochemistry. Results: Pre-treatment twice with LC dramatically reduced F4/80 staining, protected against liver injury, and reduced oxidative stress at 6 h post-APAP, without affecting APAP bioactivation. Importantly, Gclc mRNA was higher in the LC group at 0 h and total glutathione was higher at 2 h, indicating accelerated glutathione re-synthesis after APAP overdose due to greater basal glutamate-cysteine ligase. Oxidative stress was lower in the LC groups at both time points. Finally, total Nrf2 immunofluorescence was higher in the LC group. Conclusions: We conclude that multiple pre-treatments with LC protect against APAP by accelerating glutathione re-synthesis through glutamate-cysteine ligase. Investigators using twice or possibly more LC pre-treatments to deplete macrophages, including peritoneal macrophages, should be aware of this possible confounder.
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- 2020
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18. Center Variability in Medicare Claims–Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures
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Michael P. Thompson, Hechuan Hou, Alexander A. Brescia, Francis D. Pagani, Devraj Sukul, Jeffrey S. McCullough, and Donald S. Likosky
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hospital profiling ,outcomes ,transcatheter aortic valve replacement ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Public reporting of transcatheter aortic valve replacement (TAVR) claims–based outcome measures is used to identify high‐ and low‐performing centers. Whether claims‐based TAVR outcomes can reliably be used for center‐level comparisons is unknown. In this study, we sought to evaluate center variability in claims‐based TAVR outcomes used in public reporting. Methods and Results The study sample included 119 554 Medicare beneficiaries undergoing TAVR between January 2014 and October 2018 based on procedure codes in 100% Medicare inpatient claims. Multivariable hierarchical logistic regression was used to estimate center‐specific adjusted rates and reliability (R) of 30‐day mortality, discharge not to home/self‐care, 30‐day stroke, and 30‐day readmission. Reliability was defined as the ratio of between‐hospital variation to the sum of the between‐ and within‐hospital variation. The median (interquartile range [IQR]) center‐level adjusted outcome rates were 3.1% (2.9%–3.4%) for 30‐day mortality, 41.4% (31.3%–53.4%) for discharge not to home, 2.5% (2.3%–2.7%) for 30‐day stroke, and 14.9% (14.4%–15.5%) for 30‐day readmission. Median reliability was highest for the discharge not to home measure (R=0.95; IQR, 0.94–0.97), followed by the 30‐day stroke (R=0.92; IQR, 0.87–0.94), 30‐day mortality (R=0.86; IQR, 0.81–0.91), and 30‐day readmission measures (R=0.42; IQR, 0.35–0.51). Across outcomes, there was an inverse relationship between center volume and measure reliability. Conclusions Claims‐based TAVR outcome measures for mortality, discharge not to home, and stroke were reliable measures for center‐level comparisons, but readmission measures were unreliable. Stakeholders should consider these findings when evaluating claims‐based measures to compare center‐level TAVR performance.
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- 2021
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19. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions
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Maximilian A. Fliegner, Devraj Sukul, Michael P. Thompson, Nirav J. Shah, Reza Soroushmehr, Jeffrey S. McCullough, and Donald S. Likosky
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TAVR ,SAVR ,Aortic Stenosis ,Valvular heart disease ,Wearable Devices ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods: Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results: The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions: While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment.
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- 2021
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20. Rescuing the right ventricle: A conceptual framework to target new interventions for patients receiving a durable left ventricular assist device
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Michael J. Pienta, Pierre-Emmanuel Noly, Allison M. Janda, Paul C. Tang, Abbas Bitar, Michael R. Mathis, Keith D. Aaronson, Francis D. Pagani, Donald S. Likosky, Ashraf Shaaban Abdel Aziz Abou El Ela, Michael P. Thompson, Robert B. Hawkins, Peter Sassalos, Keith Aaronson, Supriya Shore, Thomas Cascino, Min Zhang, Jeffrey S. McCullough, Grace Chung, Michelle Hou, Tessa M.F. Watt, Alexander Brescia, Gardner L. Yost, James William Stewart, Austin Airhart, Daniel Liesman, and Khalil Nassar
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
21. Evaluation of osteopenia and osteoporosis in younger breast cancer survivors compared with cancer-free women: a prospective cohort study
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Cody Ramin, Betty J. May, Richard B. S. Roden, Mikiaila M. Orellana, Brenna C. Hogan, Michelle S. McCullough, Dana Petry, Deborah K. Armstrong, and Kala Visvanathan
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Osteopenia ,Osteoporosis ,Bone loss ,Breast cancer survivors ,Cancer-free women ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Osteoporosis, an indicator of significant bone loss, has been consistently reported among older breast cancer survivors. Data are limited on the incidence of osteopenia, an earlier indicator of bone loss, and osteoporosis in younger breast cancer survivors compared with cancer-free women. Methods We prospectively examined bone loss in 211 breast cancer survivors (mean age at breast cancer diagnosis = 47 years) compared with 567 cancer-free women in the same cohort with familial risk for breast cancer. Multivariable-adjusted Cox proportional hazards models were used to estimate HRs and 95% CIs of osteopenia and/or osteoporosis incidence based on physician diagnosis. Results During a mean follow-up of 5.8 years, 66% of breast cancer survivors and 53% of cancer-free women reported having a bone density examination, and 112 incident cases of osteopenia and/or osteoporosis were identified. Breast cancer survivors had a 68% higher risk of osteopenia and osteoporosis compared to cancer-free women (HR = 1.68, 95% CI = 1.12–2.50). The association was stronger among recent survivors after only 2 years of follow-up (HR = 2.74, 95% CI = 1.37–5.47). A higher risk of osteopenia and osteoporosis was also observed among survivors aged ≤ 50 years, estrogen receptor-positive tumors, and those treated with aromatase inhibitors alone or chemotherapy plus any hormone therapy relative to cancer-free women. Conclusions Younger breast cancer survivors are at higher risk for osteopenia and osteoporosis compared to cancer-free women. Studies are needed to determine effective approaches to minimize bone loss in this population.
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- 2018
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22. Interhospital variability in health care–associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries
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Donald S. Likosky, Guangyu Yang, Min Zhang, Preeti N. Malani, Michael D. Fetters, Raymond J. Strobel, Carol E. Chenoweth, Hechuan Hou, Francis D. Pagani, Ashraf Shaaban Abdel Aziz Abou El Ela, Paul C. Tang, Michael P. Thompson, Keith Aaronson, Supriya Shore, Thomas Cascino, Katherine B. Salciccioli, Jeffrey S. McCullough, Michelle Hou, Allison M. Janda, Michael R. Mathis, Tessa M.F. Watt, Michael J. Pienta, Alexander Brescia, Austin Airhart, Daniel Liesman, and Khalil Nassar
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,media_common.quotation_subject ,Psychological intervention ,030204 cardiovascular system & hematology ,Medicare ,Health care associated ,Article ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Registries ,Aged ,Retrospective Studies ,media_common ,Heart Failure ,Cross Infection ,business.industry ,Incidence (epidemiology) ,Medicare beneficiary ,Payment ,Patient Discharge ,United States ,Confidence interval ,Treatment Outcome ,030228 respiratory system ,Ventricular assist device ,Emergency medicine ,Surgery ,Heart-Assist Devices ,Implant ,Health Expenditures ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVE: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of healthcare-associated infections associated with durable ventricular assist device implant, few studies have examined inter-hospital variation and associated costs. METHODS: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n=120) were merged with post-implant 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implant and Medicare payments. RESULTS: There were 3982 infections identified among 27.8% (2,417/8,688) of patients developing an infection. The median (25(th), 75(th) percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied by hospital (range 0.0 – 35.6). Total Medicare payments from implant to 90-days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals, p
- Published
- 2022
23. Inhibitor Screen Identifies Covalent Inhibitors of the Protein Histidine Phosphatase PHPT1
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Brandon S. McCullough, Hanfei Wang, and Amy M. Barrios
- Subjects
Organic Chemistry ,Drug Discovery ,Biochemistry - Abstract
The protein histidine phosphatase PHPT1 is implicated in a variety of cellular signaling pathways. However, little is known about the precise biological roles of this enzyme and a dearth of chemical tools for studying histidine phosphorylation and dephosphorylation has hampered progress in the field. With the goal of identifying the first inhibitors of PHPT1 activity, we carried out an inhibitor screen using a facile fluorogenic assay for PHPT1 activity recently developed in our laboratory. From a panel of approximately 4000 compounds obtained from the Microsource Spectrum Collection and the NCI Diversity Set IV, we identified several potential hits with significant selectivity for inhibiting PHPT1 activity over other phosphatases. Of these, norstictic acid was the most potent inhibitor of PHPT1 activity with an IC
- Published
- 2022
24. What Strategies Are Recommended for Potential Implementation of a National Lung Cancer Screening in Australia?
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N. Rankin, R.H. Dodd, K.L.A. Dunlop, E. Stone, M.L. Yap, J. Rhee, A.R. Sharman, S. McCullough, and H.M. Marshall
- Published
- 2023
25. Trifluoperazine inhibits acetaminophen-induced hepatotoxicity and hepatic reactive nitrogen formation in mice and in freshly isolated hepatocytes
- Author
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Sudip Banerjee, Stepan B. Melnyk, Kimberly J. Krager, Nukhet Aykin-Burns, Sandra S. McCullough, Laura P. James, and Jack A. Hinson
- Subjects
Toxicology. Poisons ,RA1190-1270 - Abstract
The hepatotoxicity of acetaminophen (APAP) occurs by initial metabolism to N-acetyl-p-benzoquinone imine which depletes GSH and forms APAP-protein adducts. Subsequently, the reactive nitrogen species peroxynitrite is formed from nitric oxide (NO) and superoxide leading to 3-nitrotyrosine in proteins. Toxicity occurs with inhibited mitochondrial function. We previously reported that in hepatocytes the nNOS (NOS1) inhibitor NANT inhibited APAP toxicity, reactive nitrogen and oxygen species formation, and mitochondrial dysfunction. In this work we examined the effect of trifluoperazine (TFP), a calmodulin antagonist that inhibits calcium induced nNOS activation, on APAP hepatotoxicity and reactive nitrogen formation in murine hepatocytes and in vivo. In freshly isolated hepatocytes TFP inhibited APAP induced toxicity, reactive nitrogen formation (NO, GSNO, and 3-nitrotyrosine in protein), reactive oxygen formation (superoxide), loss of mitochondrial membrane potential, decreased ATP production, decreased oxygen consumption rate, and increased NADH accumulation. TFP did not alter APAP induced GSH depletion in the hepatocytes or the formation of APAP protein adducts which indicated that reactive metabolite formation was not inhibited. Since we previously reported that TFP inhibits the hepatotoxicity of APAP in mice without altering hepatic APAP-protein adduct formation, we examined the APAP treated mouse livers for evidence of reactive nitrogen formation. 3-Nitrotyrosine in hepatic proteins and GSNO were significantly increased in APAP treated mouse livers and decreased in the livers of mice treated with APAP plus TFP. These data are consistent with a hypothesis that APAP hepatotoxicity occurs with altered calcium metabolism, activation of nNOS leading to increased reactive nitrogen formation, and mitochondrial dysfunction. Keywords: Acetaminophen, Neuronal nitric oxide, Oxidative stress, Mitochondria
- Published
- 2017
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26. A challenge to equity in transplantation: Increased center-level variation in short-term mechanical circulatory support use in the context of the updated U.S. heart transplant allocation policy
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Jeffrey S. McCullough, Alexander A. Brescia, Josef Stehlik, Francis D. Pagani, Yulin Cheng, Supriya Shore, Min Zhang, Jessica R. Golbus, Donald S. Likosky, Thomas Cascino, Keith D. Aaronson, Tessa M.F. Watt, Michael P. Thompson, and Wida S. Cherikh
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Tissue and Organ Procurement ,medicine.medical_treatment ,Context (language use) ,Interrupted Time Series Analysis ,Interquartile range ,Internal medicine ,Humans ,Medicine ,skin and connective tissue diseases ,Aged ,Retrospective Studies ,Heart transplantation ,Transplantation ,Health Equity ,business.industry ,Health Policy ,Middle Aged ,United States ,Organ procurement ,Circulatory system ,cardiovascular system ,Cardiology ,Heart Transplantation ,Female ,Surgery ,Heart-Assist Devices ,sense organs ,Waitlist mortality ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND The United States National Organ Procurement Transplant Network (OPTN) implemented changes to the adult heart allocation system to reduce waitlist mortality by improving access for those at greater risk of pre-transplant death, including patients on short-term mechanical circulatory support (sMCS). While sMCS increased, it is unknown whether the increase occurred equitably across centers. METHODS The OPTN database was used to assess changes in use of sMCS at time of transplant in the 12 months before (pre-change) and after (post-change) implementation of the allocation system in October 2018 among 5,477 heart transplant recipients. An interrupted time series analysis comparing use of bridging therapies pre- and post-change was performed. Variability in the proportion of sMCS use at the center level pre- and post-change was determined. RESULTS In the month pre-change, 9.7% of patients were transplanted with sMCS. There was an immediate increase in sMCS transplant the following month to 32.4% - an absolute and relative increase of 22.7% and 312% (p < 0.001). While sMCS use was stable pre-change (monthly change 0.0%, 95% CI [-0.1%,0.1%]), there was a continuous 1.2%/month increase post-change ([0.6%,1.8%], p < 0.001). Center-level variation in sMCS use increased substantially after implementation, from a median (interquartile range) of 3.85% (10%) pre-change to 35.7% (30.6%) post-change (p < 0.001). CONCLUSIONS Use of sMCS at time of transplant increased immediately and continued to expand following heart allocation policy changes. Center-level variation in use of sMCS at the time of transplant increased compared to pre-change, which may have negatively impacted equitable access to heart transplantation.
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- 2022
27. The Role of Social Support in Telehealth Utilization Among Older Adults in the United States During the COVID-19 Pandemic
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Jeffrey S. McCullough, Chad Ellimoottil, and Grace S. Chung
- Subjects
Gerontology ,2019-20 coronavirus outbreak ,Social support ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pandemic ,Telehealth ,Sociology ,Digital divide - Abstract
Background: Older adults may experience a significant digital divide and need support with using technology to transition to telehealth. This study examines the role of social support for telehealt...
- Published
- 2021
28. Vocal Minority and Silent Majority: How Do Online Ratings Reflect Population Perceptions of Quality?
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Guodong Gordon Gao, Brad N. Greenwood, Ritu Agarwal, and Jeffrey S. McCullough
- Published
- 2015
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29. A 3D LBM-DEM study of sheared particle suspensions under the influence of temperature-dependent viscosity
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Łukasz Łaniewski-Wołłk, Christopher R. Leonardi, Saiied M. Aminossadati, and Jon W. S. McCullough
- Subjects
Work (thermodynamics) ,Range (particle radiation) ,Materials science ,General Chemical Engineering ,Relative viscosity ,Lattice Boltzmann methods ,02 engineering and technology ,Mechanics ,021001 nanoscience & nanotechnology ,Condensed Matter::Soft Condensed Matter ,020401 chemical engineering ,Volume (thermodynamics) ,Thermal ,Coupling (piping) ,Particle ,0204 chemical engineering ,0210 nano-technology - Abstract
Particle suspensions form a fundamental yet complex component of many scientific and engineering endeavours. This paper proposes a numerical coupling between the lattice Boltzmann and discrete element methods that resolves particle suspensions exposed to thermal influences due to temperature-dependent fluid viscosity and conjugate heat transfer between components. Validation of the model was performed via the study of the relative viscosity of suspensions. This numerically corroborated the proposed temperature-dependence of the relative viscosity of suspensions. The model was finally used to interrogate the macroscopic behaviour of sheared suspensions at a range of solid volume fractions. This demonstrated changes in suspension flow behaviour due to temperature related effects. Future work based on these results would examine how particle properties could be modified to exacerbate and control temperature-based phenomena potentially leading to improvements in domains such as industrial material processing and manufacture.
- Published
- 2021
30. Racial and Sex Inequities in the Use of and Outcomes After Left Ventricular Assist Device Implantation Among Medicare Beneficiaries
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Thomas M. Cascino, Sriram Somanchi, Monica Colvin, Grace S. Chung, Alexander A. Brescia, Michael Pienta, Michael P. Thompson, James W. Stewart, Devraj Sukul, Daphne C. Watkins, Francis D. Pagani, Donald S. Likosky, Keith D. Aaronson, and Jeffrey S. McCullough
- Subjects
Cohort Studies ,Heart Failure ,Male ,Humans ,Female ,General Medicine ,Heart-Assist Devices ,Medicare ,United States ,Article ,Aged ,Retrospective Studies - Abstract
While left ventricular assist devices (LVADs) increase survival for patients with advanced heart failure (HF), racial and sex access and outcome inequities remain and are poorly understood.To assess risk-adjusted inequities in access and outcomes for both Black and female patients and to examine heterogeneity in treatment decisions among patients for whom clinician discretion has a more prominent role.This retrospective cohort study of 12 310 Medicare beneficiaries used 100% Medicare Fee-for-Service administrative claims. Included patients had been admitted for heart failure from 2008 to 2014. Data were collected from July 2007 to December 2015 and analyzed from August 23, 2020, to May 15, 2022.Beneficiary race and sex.The propensity for LVAD implantation was based on clinical risk factors from the 6 months preceding HF admission using XGBoost and the synthetic minority oversampling technique. Beneficiaries with a 5% or greater probability of receiving an LVAD were included. Logistic regression models were estimated to measure associations of race and sex with LVAD receipt adjusting for clinical characteristics and social determinants of health (eg, distance from LVAD center, Medicare low-income subsidy, neighborhood deprivation). Next, 1-year mortality after LVAD was examined.The analytic sample included 12 310 beneficiaries, of whom 22.9% (n = 2819) were Black and 23.7% (n = 2920) were women. In multivariable models, Black beneficiaries were 3.0% (0.2% to 5.8%) less likely to receive LVAD than White beneficiaries, and women were 7.9% (5.6% to 10.2%) less likely to receive LVAD than men. Individual poverty and worse neighborhood deprivation were associated with reduced use, 2.9% (0.4% to 5.3%) and 6.7% (2.9% to 10.5%), respectively, but these measures did little to explain observed disparities. The racial disparity was concentrated among patients with a low propensity score (propensity score0.52). One-year survival by race and sex were similar on average, but Black patients with a low propensity score experienced improved survival (7.2% [95% CI, 0.9% to 13.5%]).In this cohort study of Medicare beneficiaries hospitalized for HF, disparities in LVAD use by race and sex existed and were not explained by clinical characteristics or social determinants of health. The treatment and post-LVAD survival by race were equivalent among the most obvious LVAD candidates. However, there was differential use and outcomes among less clear-cut LVAD candidates, with lower use but improved survival among Black patients. Inequity in LVAD access may have resulted from differences in clinician decision-making because of systemic racism and discrimination, implicit bias, or patient preference.
- Published
- 2022
31. Failure to rescue: A candidate quality metric for durable left ventricular assist device implantation
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Michael J. Pienta, Thomas M. Cascino, Donald S. Likosky, Amir A. Ghaferi, Keith D. Aaronson, Francis D. Pagani, Michael P. Thompson, Ashraf Shaaban Abdel Aziz Abou El Ela, Paul C. Tang, Keith Aaronson, Supriya Shore, Thomas Cascino, Katherine B. Salciccioli, Min Zhang, Jeffrey S. McCullough, Michelle Hou, Allison M. Janda, Michael R. Mathis, Tessa M.F. Watt, Alexander Brescia, Austin Airhart, Daniel Liesman, and Khalil Nassar
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Failure to rescue ,business.industry ,Mortality rate ,medicine.medical_treatment ,media_common.quotation_subject ,Prom ,Logistic regression ,Ventricular assist device ,Emergency medicine ,medicine ,Surgery ,Quality (business) ,Metric (unit) ,Cardiology and Cardiovascular Medicine ,Complication ,business ,media_common - Abstract
Failure to rescue (FTR), defined as death after a complication, is recognized as a principal driver of variation in mortality among hospitals. We evaluated FTR as a quality metric in patients who received durable left ventricular assist devices (LVADs) using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support.Data on 13,617 patients who received primary durable LVADs from April 2012 to October 2017 at 131 hospitals that performed at least 20 implants were analyzed from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Rates of major complications and FTR were compared across risk-adjusted in-hospital mortality terciles (low, medium, high) and hospital volume. Logistic regression was used to estimate expected FTR rates on the basis of patient factors for each major complication.The overall unadjusted in-hospital mortality rate was 6.96%. Risk-adjusted in-hospital mortality rates varied 3.1-fold across terciles (low, 3.3%; high, 10.3%; P trend.001). Rates of major complications varied 1.1-fold (low, 34.0%; high, 38.8%; P .0001). Among patients with a major complication, 854 died in-hospital for an FTR rate of 17.7%, with 2.8-fold variation across mortality terciles (low, 8.5%; high, 23.9%; P .0001). FTR rates were highest for renal dysfunction requiring dialysis (45.3%) and stroke (36.5%). Higher average annual LVAD volume was associated with higher rates of major complications (10 per year, 26.7%; 10-20 per year, 34.0%; 20-30 per year, 34.0%;30 per year, 40.1%; P trend.0001) whereas hospitals implanting10 per year had the highest FTR rate (10 per year, 23.5%; 10-20 per year, 16.5%; 20-30 per year, 17.0%;30 per year, 17.9%; P = .03).FTR might serve as an important quality metric for durable LVAD implant procedures, and identifying strategies for successful rescue after complications might reduce hospital variations in mortality.
- Published
- 2023
32. (1163) Tolerability of Posaconazole as Fungal Prophylaxis in Lung Transplant Patients Compared to Voriconazole
- Author
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H. Hixson, S. McCullough, S. Haywood, C. Shoemaker, L. Donohue, S. Floyd, R. Anderson, and H. Mannem
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Pulmonary and Respiratory Medicine ,Transplantation ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
33. Information technology and voluntary quality disclosure by hospitals.
- Author
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Corey M. Angst, Ritu Agarwal, Guodong Gordon Gao, Jiban Khuntia, and Jeffrey S. McCullough
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- 2014
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34. Imposing Ratios of Outlet Flow Rates on Large Arterial Networks with Two-Element Windkessel Model: Parametric Analysis
- Author
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Sharp Chim Yui Lo, J. W. S. McCullough, and P. V. Coveney
- Abstract
Substantial effort is being invested in the creation of a virtual human — a model which will improve our understanding of human physiology and diseases and assist clinicians in the design of personalised medical treatments. A central challenge of achieving blood flow simulations at full-human scale is the development of an efficient and accurate approach to imposing boundary conditions on many outlets. A previous study proposed an efficient method for implementing the two-element Windkessel model to control the flow rate ratios at outlets. However, no study to date has examined the conditions for this approach to hold in complex geometries. Here we clarify the general role of the resistance and capacitance in this approach. We show that the error of the flow rate ratios decreases exponentially as the resistance increases. The errors fall below 4% in a simple five-outlets model and 7% in a human artery model comprising 10 outlets. Moreover, the flow rate ratios converge faster and suffer from weaker fluctuations as the capacitance decreases. Our findings also establish constraints on the parameters controlling the numerical stability of the simulations. The findings from this work are directly applicable to larger and more complex vascular domains encountered at full-human scale.
- Published
- 2022
35. Costs implications of pneumococcal vaccination of adults aged 30–60 with a recent diagnosis of diabetes
- Author
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William H. Herman, Jamison Pike, Wen Ye, Tamara Pilishvili, Ping Zhang, Lisa A. Prosser, David W. Hutton, and Jeffrey S. McCullough
- Subjects
Adult ,Research design ,Pediatrics ,medicine.medical_specialty ,030231 tropical medicine ,Population ,Pneumococcal Infections ,Article ,New diagnosis ,Cohort Studies ,Pneumococcal Vaccines ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Diabetes Mellitus ,Humans ,Medicine ,030212 general & internal medicine ,education ,education.field_of_study ,General Veterinary ,General Immunology and Microbiology ,business.industry ,Vaccination ,Public Health, Environmental and Occupational Health ,Middle Aged ,Pneumonia, Pneumococcal ,medicine.disease ,Pneumococcal polysaccharide vaccine ,Infectious Diseases ,Cohort ,Pneumococcal vaccination ,Molecular Medicine ,business - Abstract
OBJECTIVE: The 23-valent pneumococcal polysaccharide vaccine is routinely recommended for adults with diabetes, but little is known about adherence to this recommendation and how vaccination of these adults affects costs related to pneumococcal disease. RESEARCH DESIGN AND METHODS: We used data from a commercial insurance claims dataset to examine a cohort of non-elderly adults with a new diagnosis of diabetes and adults with no diagnosis of diabetes from 2005–2014. We examined rates of pneumococcal polysaccharide vaccination and the relationship between vaccination and pneumococcal disease costs, comparing results for persons with a diagnosis of diabetes and those with no diagnosis of diabetes. RESULTS: Overall rates of pneumococcal polysaccharide vaccination among adults 30–60 years old were
- Published
- 2021
36. Paradoxical Patterns of Sinusoidal Obstruction Syndrome-Like Liver Injury in Aged Female CD-1 Mice Triggered by Cannabidiol-Rich Cannabis Extract and Acetaminophen Co-Administration
- Author
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Laura E. Ewing, Mitchell R. McGill, Eric U. Yee, Charles M. Quick, Charles M. Skinner, Stefanie Kennon-McGill, Melissa Clemens, Joel H. Vazquez, Sandra S. McCullough, D. Keith Williams, Kristy R. Kutanzi, Larry A. Walker, Mahmoud A. ElSohly, Laura P. James, Bill J. Gurley, and Igor Koturbash
- Subjects
acetaminophen ,cannabidiol ,liver injury ,natural products ,phytochemical ,sinusoidal obstruction syndrome ,Organic chemistry ,QD241-441 - Abstract
The goal of this study was to investigate the potential for a cannabidiol-rich cannabis extract (CRCE) to interact with the most common over-the-counter drug and the major known cause of drug-induced liver injury−acetaminophen (APAP)−in aged female CD-1 mice. Gavaging mice with 116 mg/kg of cannabidiol (CBD) [mouse equivalent dose (MED) of 10 mg/kg of CBD] in CRCE delivered with sesame oil for three consecutive days followed by intraperitoneally (i.p.) acetaminophen (APAP) administration (400 mg/kg) on day 4 resulted in overt toxicity with 37.5% mortality. No mortality was observed in mice treated with 290 mg/kg of CBD+APAP (MED of 25 mg/kg of CBD) or APAP alone. Following CRCE/APAP co-administration, microscopic examination revealed a sinusoidal obstruction syndrome-like liver injury−the severity of which correlated with the degree of alterations in physiological and clinical biochemistry end points. Mechanistically, glutathione depletion and oxidative stress were observed between the APAP-only and co-administration groups, but co-administration resulted in much greater activation of c-Jun N-terminal kinase (JNK). Strikingly, these effects were not observed in mice gavaged with 290 mg/kg CBD in CRCE followed by APAP administration. These findings highlight the potential for CBD/drug interactions, and reveal an interesting paradoxical effect of CBD/APAP-induced hepatotoxicity.
- Published
- 2019
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37. Association Between Primary Care Practice Telehealth Use and Acute Care Visits for Ambulatory Care-Sensitive Conditions During COVID-19
- Author
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Kathleen Y. Li, Sophia Ng, Ziwei Zhu, Jeffrey S. McCullough, Keith E. Kocher, and Chad Ellimoottil
- Subjects
Adult ,Cohort Studies ,Male ,Primary Health Care ,Ambulatory Care ,COVID-19 ,Humans ,Female ,General Medicine ,Pandemics ,Telemedicine ,Retrospective Studies - Abstract
During the COVID-19 pandemic, many primary care practices adopted telehealth in place of in-person care to preserve access to care for patients with acute and chronic conditions. The extent to which this change was associated with their rates of acute care visits (ie, emergency department visits and hospitalizations) for these conditions is unknown.To examine whether a primary care practice's level of telehealth use is associated with a change in their rate of acute care visits for ambulatory care-sensitive conditions (ACSC visits).This retrospective cohort analysis used a difference-in-differences study design to analyze insurance claims data from 4038 Michigan primary care practices from January 1, 2019, to September 30, 2020.Low, medium, or high tertile of practice-level telehealth use based on the rate of telehealth visits from March 1 to August 31, 2020, compared with prepandemic visit volumes.Risk-adjusted ACSC visit rates before (June to September 2019) and after (June to September 2020) the start of the COVID-19 pandemic, reported as an annualized average marginal effect. The study examined overall, acute, and chronic ACSC visits separately and controlled for practice size, in-person visit volume, zip code-level attributes, and patient characteristics.A total of nearly 1.5 million beneficiaries (53% female; mean [SD] age, 40 [22] years) were attributed to 4038 primary care practices. Compared with 2019 visit volumes, median telehealth use was 0.4% for the low telehealth tertile, 14.7% for the medium telehealth tertile, and 39.0% for the high telehealth tertile. The number of ACSC visits decreased in all tertiles, with adjusted rates changing from 24.3 to 14.9 per 1000 patients per year (low), 23.9 to 15.3 per 1000 patients per year (medium), and 27.5 to 20.2 per 1000 patients per year (high). In difference-in-differences analysis, high telehealth use was associated with a higher ACSC visit rate (2.10 more visits per 1000 patients per year; 95% CI, 0.22-3.97) compared with low telehealth practices; practices in the middle tertile did not differ significantly from the low tertile. No difference was found in ACSC visits across tertiles when acute and chronic ACSC visits were examined separately.In this cohort study that used a difference-in-differences analysis, the association between practice-level telehealth use and ACSC visits was mixed. High telehealth use was associated with a slightly higher overall ACSC visit rate than low telehealth practices. The association of telehealth with downstream care use should be closely monitored going forward.
- Published
- 2022
38. Impact of enteral immunonutrition on infectious complications and immune and inflammatory markers in cancer patients undergoing chemotherapy: A systematic review of randomised controlled trials
- Author
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Laura J. Miller, Cara Douglas, Fiona S. McCullough, Simon J. Stanworth, and Philip C. Calder
- Subjects
Adult ,Nutrition and Dietetics ,Nucleotides ,Tumor Necrosis Factor-alpha ,Glutamine ,Malnutrition ,Vitamins ,Critical Care and Intensive Care Medicine ,Arginine ,Neoplasms ,Fatty Acids, Omega-3 ,Humans ,Vitamin A ,Biomarkers ,Randomized Controlled Trials as Topic - Abstract
There is increasing awareness of the importance of nutritional support in cancer treatment including the interaction with immunity. Immunonutrition is the provision of one or more nutrients (e.g. Vitamins A, D, or E, omega-3 fatty acids, arginine and glutamine) known to modulate immune function when given at levels above those normally encountered in the diet in order to support immune system function or modulate its activity, including control of inflammation. We reviewed the role of oral or enteral immunonutrition versus standard nutrition on infection and infection-related biomarkers in adult cancer patients undergoing chemotherapy.A systematic search of oral or enteral immunonutrition versus standard nutrition in adult cancer patients during chemotherapy with or without radiotherapy or haematopoietic stem cell transplant was conducted in MEDLINE, EMBASE and CENTRAL. The search was limited to randomised controlled trials. Our primary outcome was infectious episodes or immune-related biomarkers (e.g. immune cell numbers, inflammatory markers). Secondary outcomes included incidence of malnutrition or cachexia, non-infection related adverse events (AEs), rate of remission, survival, and delays or incomplete cycles of chemotherapy. Risk of bias was assessed using ROB 2.0 and study quality was assessed using CASP for RCTs.The search yielded seven studies involving 521 patients (261 immunonutrition, 260 control) for analysis. All studies enrolled patients with solid tumours (no haematological malignancies). Studies were heterogenous for cancer type (upper gastrointestinal, head and neck, pancreatic and lung), immunonutrient composition (omega-3 fatty acids, vitamin A, E, glutamine, arginine or nucleotides), delivery route (enteral nutrition or oral nutritional supplement) and control used. Intervention period ranged from 4 to 14 weeks. No study reported absolute number of infections. Three studies reported AEs including potential infectious episodes of febrile neutropenia, pneumonitis and mucositis with oral candidiasis. Some studies report a decrease in blood concentrations of CRP and TNF-α with immunonutrition.There is currently insufficient evidence to define a role for immunonutrition on infectious episodes during chemotherapy in adult cancer patients. Further well-defined studies that account for degree of malnutrition, dose, timing and duration of immunonutrition in specific well-defined cancer groups using a standardised outcome framework are needed.
- Published
- 2022
39. Advancing Quality Metrics for Durable Left Ventricular Assist Device Implant: Analysis of the Society of Thoracic Surgeons Intermacs Database
- Author
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Michael J. Pienta, Xiaoting Wu, Thomas M. Cascino, Alexander A. Brescia, Ashraf Abou el Ela, Min Zhang, Jeffrey S. McCullough, Supriya Shore, Keith D. Aaronson, Michael P. Thompson, Francis D. Pagani, and Donald S. Likosky
- Subjects
Pulmonary and Respiratory Medicine ,Heart Failure ,Male ,Surgeons ,Stroke ,Benchmarking ,Treatment Outcome ,Humans ,Surgery ,Female ,Kidney Diseases ,Heart-Assist Devices ,Registries ,Cardiology and Cardiovascular Medicine ,Respiratory Insufficiency ,Retrospective Studies - Abstract
Patients undergoing left ventricular assist device (LVAD) implantation are at risk for death and postoperative adverse outcomes. Interhospital variability and concordance of quality metrics were assessed using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs).A total of 22 173 patients underwent primary, durable LVAD implantation across 160 hospitals from 2012 to 2020, excluding hospitals performing10 implant procedures. Observed and risk-adjusted operative mortality rates were calculated for each hospital. Outcomes included operative and 90-day mortality, a composite of adverse events (operative mortality, bleeding, stroke, device malfunction, renal dysfunction, respiratory failure), and secondarily failure to rescue. Rates are presented as median (interquartile range [IQR]). Hospital performance was evaluated using observed-to-expected (O/E) ratios for mortality and the composite outcome.Interhospital variability existed in observed (median, 7.2% [IQR, 5.1%-9.6%]) mortality. The rates of adverse events varied across hospitals: major bleeding, 15.6% (IQR, 11.4%-22.4%); stroke, 3.1% (IQR, 1.6%-4.7%); device malfunction, 2.4% (IQR, 0.8%-3.7%); respiratory failure, 10.5% (IQR, 4.6%-15.7%); and renal dysfunction, 6.4% (IQR, 3.2%-9.6%). The O/E ratio for operative mortality varied from 0.0 to 6.1, whereas the O/E ratio for the composite outcome varied from 0.28 to 1.99. Hospital operative mortality O/E ratios were more closely correlated with the 90-day mortality O/E ratio (r = 0.74) than with the composite O/E ratio (r = 0.12).This study reported substantial interhospital variability in performance for hospitals implanting durable LVADs. These findings support the need to (1) report hospital-level performance (mortality, composite) and (2) undertake benchmarking activities to reduce unwarranted variability in outcomes.
- Published
- 2022
40. The use of count data models in biomedical informatics evaluation research.
- Author
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Jing Du, Young-Taek Park, Nawanan Theera-Ampornpunt, Jeffrey S. McCullough, and Stuart M. Speedie
- Published
- 2012
- Full Text
- View/download PDF
41. Fluorogenic probes for imaging cellular phosphatase activity
- Author
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Brandon S. McCullough and Amy M. Barrios
- Subjects
0301 basic medicine ,Cell signaling ,Phosphatase ,Cell ,Peptide ,010402 general chemistry ,01 natural sciences ,Biochemistry ,Article ,Analytical Chemistry ,03 medical and health sciences ,medicine ,Animals ,Humans ,Protein phosphorylation ,Enzyme family ,Enzyme Assays ,Fluorescent Dyes ,chemistry.chemical_classification ,biology ,Optical Imaging ,Phosphoric Monoester Hydrolases ,Enzyme assay ,0104 chemical sciences ,030104 developmental biology ,Enzyme ,medicine.anatomical_structure ,Microscopy, Fluorescence ,chemistry ,biology.protein ,Peptides - Abstract
The ability to visualize enzyme activity in a cell, tissue, or living organism can greatly enhance our understanding of the biological roles of that enzyme. While many aspects of cellular signaling are controlled by reversible protein phosphorylation, our understanding of the biological roles of the protein phosphatases involved is limited. Here, we provide an overview of progress toward the development of fluorescent probes that can be used to visualize the activity of protein phosphatases. Significant advances include the development of probes with visible and near-infrared (near-IR) excitation and emission profiles, which provides greater tissue and whole-animal imaging capabilities. In addition, the development of peptide-based probes has provided some selectivity for a phosphatase of interest. Key challenges involve the difficulty of achieving sufficient selectivity for an individual member of a phosphatase enzyme family and the necessity of fully validating the best probes before they can be adopted widely.
- Published
- 2020
42. Thirst as an ingestive behavior: A brief review on physiology and assessment
- Author
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Alexis S McCullough, J D Adams, and Ali I Myatich
- Subjects
Feedback, Physiological ,0301 basic medicine ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Psychotherapist ,Drinking Water ,digestive, oral, and skin physiology ,Drinking ,Medicine (miscellaneous) ,030229 sport sciences ,General Medicine ,Thirst ,03 medical and health sciences ,0302 clinical medicine ,Sensation ,medicine ,Humans ,medicine.symptom ,Psychology - Abstract
Background:Thirst is a sensation normally aroused by a lack of water and associated with a desire to drink more fluid.Aim:The aims of this brief review are twofold: (a) to summarize the thirst mechanism in how it is initiated and diminished, and (b) to describe techniques to assess human thirst accurately in a variety of situations.Discussion:Thirst is maintained via a feedback-controlled mechanism, regulated by central and peripheral factors, as well as social and psychological cues. Most studies of thirst have focused on the initiation of water intake and the neural mechanisms responsible for this vital behavior. Less attention has been paid to the stimuli and mechanisms that terminate a bout of drinking and limit fluid ingestion, such as oropharyngeal and gastric signals, coupled with osmotic sensations. Thirst perception is typically assessed by subjective ratings using a variety of questionnaires, rankings, or visual analog scales. However, the appropriate perceptual tool may not always be used for the correct assessment of thirst perception.Conclusions:In considering the many factors involved in thirst arousal and inhibition, similar questions need to be considered for the correct assessment of this ingestive behavior.
- Published
- 2020
43. Synthesis and PTP Inhibitory Activity of Illudalic Acid and Its Methyl Ether, with Insights into Selectivity for LAR PTP over Other Tyrosine Phosphatases under Physiologically Relevant Conditions
- Author
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Kacey B Hutchinson, Amy M. Barrios, Brandon S. McCullough, Paratchata Batsomboon, and Gregory B. Dudley
- Subjects
Methyl Ethers ,Phosphatase ,Pharmaceutical Science ,Ether ,Protein tyrosine phosphatase ,01 natural sciences ,Analytical Chemistry ,chemistry.chemical_compound ,Coumarins ,Drug Discovery ,Humans ,Enzyme Inhibitors ,Tyrosine ,Receptor ,IC50 ,Pharmacology ,chemistry.chemical_classification ,Dose-Response Relationship, Drug ,010405 organic chemistry ,Spectrum Analysis ,Organic Chemistry ,0104 chemical sciences ,010404 medicinal & biomolecular chemistry ,Enzyme ,Complementary and alternative medicine ,chemistry ,Biochemistry ,Covalent bond ,Molecular Medicine ,Protein Tyrosine Phosphatases - Abstract
The protein tyrosine phosphatase (PTP) family of enzymes includes many attractive therapeutic targets, such as those in the leukocyte common antigen-related (LAR) subfamily of receptor PTPs. Synthesis and PTP inhibitory activity of illudalic acid and its methyl ether are described, with a focus on selective inhibition of LAR PTP relative to a small collection of other representative PTPs. The synthesis comprises 16 steps and provides illudalic acid in up to 12% overall yield from neopentylene-fused benzoate 1 (20 steps from commercial materials). Illudalic acid dose-dependently (measured IC50 = 2.1 ± 0.2 μM) and time-dependently inhibits LAR consistent with previous reports of covalent binding. The kinetics of LAR inhibition by illudalic acid are consistent with a two-step mechanism in which the inhibitor and enzyme first interact noncovalently (KI = 130 ± 50 μM), followed by covalent ligation at a rate kinact = 1.3 ± 0.4 min-1. The kinact/KI ratio of 104 corresponds to a t∞1/2 of 0.5 min, as discussed herein. The phenol methyl ether of illudalic acid was found to be less potent in our dose-response assays (measured IC50 = 55 ± 6 μM) but more selective for LAR, with a weaker initial noncovalent interaction and faster covalent ligation of LAR as compared to illudalic acid itself. A truncated analogue of illudalic acid that lacks the neopentylene ring fusion was found to be devoid of significant activity under our assay conditions, in contrast to previous reports. These observations collectively help inform further development of illudalic acid analogues as potent and selective inhibitors of the LAR subfamily of tyrosine phosphatases.
- Published
- 2019
44. Center Variability in Medicare Claims–Based Publicly Reported Transcatheter Aortic Valve Replacement Outcome Measures
- Author
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Alexander A. Brescia, Michael P. Thompson, Donald S. Likosky, Francis D. Pagani, Jeffrey S. McCullough, Hechuan Hou, and Devraj Sukul
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,hospital profiling ,medicine.medical_treatment ,Medicare ,outcomes ,Transcatheter Aortic Valve Replacement ,Valve replacement ,Risk Factors ,Public reporting ,Outcome Assessment, Health Care ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Aged ,Original Research ,Quality and Outcomes ,business.industry ,Outcome measures ,Reproducibility of Results ,Aortic Valve Stenosis ,United States ,Stroke ,Treatment Outcome ,RC666-701 ,Aortic Valve ,Emergency medicine ,Cardiology and Cardiovascular Medicine ,business ,Health Services and Outcomes Research - Abstract
Background Public reporting of transcatheter aortic valve replacement (TAVR) claims–based outcome measures is used to identify high‐ and low‐performing centers. Whether claims‐based TAVR outcomes can reliably be used for center‐level comparisons is unknown. In this study, we sought to evaluate center variability in claims‐based TAVR outcomes used in public reporting. Methods and Results The study sample included 119 554 Medicare beneficiaries undergoing TAVR between January 2014 and October 2018 based on procedure codes in 100% Medicare inpatient claims. Multivariable hierarchical logistic regression was used to estimate center‐specific adjusted rates and reliability (R) of 30‐day mortality, discharge not to home/self‐care, 30‐day stroke, and 30‐day readmission. Reliability was defined as the ratio of between‐hospital variation to the sum of the between‐ and within‐hospital variation. The median (interquartile range [IQR]) center‐level adjusted outcome rates were 3.1% (2.9%–3.4%) for 30‐day mortality, 41.4% (31.3%–53.4%) for discharge not to home, 2.5% (2.3%–2.7%) for 30‐day stroke, and 14.9% (14.4%–15.5%) for 30‐day readmission. Median reliability was highest for the discharge not to home measure (R=0.95; IQR, 0.94–0.97), followed by the 30‐day stroke (R=0.92; IQR, 0.87–0.94), 30‐day mortality (R=0.86; IQR, 0.81–0.91), and 30‐day readmission measures (R=0.42; IQR, 0.35–0.51). Across outcomes, there was an inverse relationship between center volume and measure reliability. Conclusions Claims‐based TAVR outcome measures for mortality, discharge not to home, and stroke were reliable measures for center‐level comparisons, but readmission measures were unreliable. Stakeholders should consider these findings when evaluating claims‐based measures to compare center‐level TAVR performance.
- Published
- 2021
45. Bridging the gap between attitudes and action: Opportunities for the cancer care workforce to support exercise counselling and referral
- Author
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W. Liauw, J. Phillips, Paul Sharp, M. Agar, Cristina M. Caperchione, R. Lillian, S. McCullough, and C. Harris
- Subjects
Bridging (networking) ,Referral ,business.industry ,Cancer ,Physical Therapy, Sports Therapy and Rehabilitation ,medicine.disease ,Nursing ,Action (philosophy) ,Workforce ,Medicine ,Orthopedics and Sports Medicine ,business ,1106 Human Movement and Sports Sciences, 1116 Medical Physiology, 1117 Public Health and Health Services ,Sport Sciences - Published
- 2021
46. Association Between Buprenorphine Treatment Gaps, Opioid Overdose, and Health Care Spending in US Medicare Beneficiaries With Opioid Use Disorder
- Author
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Jason B, Gibbons, Jeffrey S, McCullough, Kara, Zivin, Zach Y, Brown, and Edward C, Norton
- Subjects
Male ,Opiate Overdose ,Psychiatry and Mental health ,Case-Control Studies ,Humans ,Female ,Middle Aged ,Health Expenditures ,Medicare ,United States ,Aged ,Buprenorphine - Abstract
ImportanceNonadherence to buprenorphine may increase patient risk of opioid overdose and increase health care spending. Quantifying the impacts of nonadherence can help inform clinician practice and policy.ObjectiveTo estimate the association between buprenorphine treatment gaps, opioid overdose, and health care spending.Design, Setting, and ParticipantsThis longitudinal case-control study compared patient opioid overdose and health care spending in buprenorphine-treated months with treatment gap months. Individuals who were US Medicare fee-for-service beneficiaries diagnosed with opioid use disorder who received at least 1 two-week period of continuous buprenorphine treatment between 2010 and 2017 were included. Analysis took place between January 2010 and December 2017.InterventionsA gap in buprenorphine treatment in a month lasting more than 15 consecutive days.Main Outcomes and MeasuresOpioid overdose and total, medical, and drug spending (combined patient out-of-pocket and Medicare spending).ResultsOf 34 505 Medicare beneficiaries (17 927 [520%] male; 16 578 [48.1%] female; mean [SD] age, 49.5 [12.7] years; 168 [0.5%] Asian; 2949 [8.5%] Black; 2089 [6.0%] Hispanic; 266 [0.8%] Native American; 28 525 [82.7%] White; 508 [1.5%] other race), 11 524 beneficiaries (33.4%) experienced 1 or more buprenorphine treatment gaps. Treatment gap beneficiaries, compared with nontreatment gap beneficiaries, were more likely to be younger, be male, have a disability, and be Medicaid dual-eligible while less likely to be White, close to a buprenorphine prescriber, and treated with buprenorphine monotherapy (ie, buprenorphine hydrochloride). Beneficiaries were 2.89 (95% CI, 2.20-3.79) times more likely to experience an opioid overdose during buprenorphine treatment gap months compared with treated months. During treatment gap months, spending was $196.41 (95% CI, $110.53-$282.30) more than in treated months. Patients who continued to take buprenorphine dosages of greater than 8 mg/d and 16 mg/d were 2.61 and 2.84 times more likely to overdose in a treatment gap month, respectively, while patients taking buprenorphine dosages of 8 mg/d or less were 3.62 times more likely to overdose in a treatment gap month (maintenance of >16 mg/d: hazard ratio (HR), 2.64 [95% CI, 1.80-3.87]; maintenance of >8 mg/d: HR, 2.84 [95% CI, 2.13-3.78]; maintenance of ≤8 mg/d: HR, 3.62 [95% CI, 1.54-8.50]). Buprenorphine monotherapy was associated with greater risk of overdose and higher spending during treatment gaps months than buprenorphine/naloxone.Conclusions and RelevanceMedicare patients treated with buprenorphine between 2010 and 2017 had a lower associated opioid overdose risk and spending during treatment months than treatment gap months.
- Published
- 2022
47. Comparison of Evaluations for Heart Transplant Before Durable Left Ventricular Assist Device and Subsequent Receipt of Transplant at Transplant vs Nontransplant Centers
- Author
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Thomas M, Cascino, Jeffrey S, McCullough, Xiaoting, Wu, Michael J, Pienta, James W, Stewart, Robert B, Hawkins, Alexander A, Brescia, Ashraf, Abou El Ala, Min, Zhang, Pierre-Emmanuel, Noly, Jonathan W, Haft, Jennifer A, Cowger, Monica, Colvin, Keith D, Aaronson, Francis D, Pagani, Donald S, Likosky, and Allison M, Janda
- Subjects
Male ,Heart Failure ,Humans ,Heart Transplantation ,Female ,Heart-Assist Devices ,General Medicine ,Middle Aged ,Medicare ,United States ,Aged ,Retrospective Studies - Abstract
ImportanceIn 2020, the Centers for Medicare & Medicaid Services revised its national coverage determination, removing the requirement to obtain review from a Medicare-approved heart transplant center to implant a durable left ventricular assist device (LVAD) for bridge-to-transplant (BTT) intent at an LVAD-only center. The association between center-level transplant availability and access to heart transplant, the gold-standard therapy for advanced heart failure (HF), is unknown.ObjectiveTo investigate the association of center transplant availability with LVAD implant strategies and subsequent heart transplant following LVAD implant before the Centers for Medicare & Medicaid Services policy change.Design, Setting, and ParticipantsA retrospective cohort study of the Society of Thoracic Surgeons Intermacs multicenter US registry database was conducted from April 1, 2012, to June 30, 2020. The population included patients with HF receiving a primary durable LVAD.ExposuresLVAD center transplant availability (LVAD/transplant vs LVAD only).Main Outcomes and MeasuresThe primary outcomes were implant strategy as BTT and subsequent transplant by 2 years. Covariates that might affect listing strategy and outcomes were included (eg, patient demographic characteristics, comorbidities) in multivariable models. Parameters for BTT listing were estimated using logistic regression with center-level random effects and for receipt of a transplant using a Cox proportional hazards regression model with death as a competing event.ResultsThe sample included 22 221 LVAD recipients with a median age of 59.0 (IQR, 50.0-67.0) years, of whom 17 420 (78.4%) were male and 3156 (14.2%) received implants at LVAD-only centers. Receiving an LVAD at an LVAD/transplant center was associated with a 79% increased adjusted odds of BTT LVAD designation (odds ratio, 1.79; 95% CI, 1.35-2.38; P Conclusions and RelevanceReceiving an LVAD at an LVAD-transplant center was associated with increased odds of BTT intent at implant and subsequent transplant receipt for patients at 2 years. The findings of this study suggest that Centers for Medicare & Medicaid Services policy change may have the unintended consequence of further increasing inequities in access to transplant among patients at LVAD-only centers.
- Published
- 2022
48. Evaluating treatment-specific post-discharge quality-of-life and cost-effectiveness of TAVR and SAVR: Current practice & future directions
- Author
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Devraj Sukul, Maximilian A. Fliegner, Reza Soroushmehr, Donald S. Likosky, Jeffrey S. McCullough, Nirav Shah, and Michael P. Thompson
- Subjects
medicine.medical_specialty ,Post discharge ,Cost effectiveness ,medicine.medical_treatment ,Review ,TAVR ,law.invention ,Valve replacement ,Randomized controlled trial ,Quality of life ,Aortic valve replacement ,law ,Wearable Devices ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Intensive care medicine ,Aortic Stenosis ,business.industry ,valvular heart disease ,SAVR ,medicine.disease ,Valvular heart disease ,RC666-701 ,Observational study ,Cardiology and Cardiovascular Medicine ,business - Abstract
Highlights • Post-TAVR HRQOL shows more rapid short-term improvement than SAVR within trials. • Higher TAVR use requires better real-world TAVR/SAVR cost-effectiveness comparisons. • Wearable devices should be used in real-world settings to compare TAVR/SAVR HRQOL., Background Aortic stenosis is a prevalent valvular heart disease that is treated primarily by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), which are common treatments for addressing symptoms secondary to valvular heart disease. This narrative review article focuses on the existing literature comparing recovery and cost-effectiveness for SAVR and TAVR. Methods Major databases were searched for relevant literature discussing HRQOL and cost-effectiveness of TAVR and SAVR. We also searched for studies analyzing the use of wearable devices to monitor post-discharge recovery patterns. Results The literature focusing on quality-of-life following TAVR and SAVR has been limited primarily to single-center observational studies and randomized controlled trials. Studies focused on TAVR report consistent and rapid improvement relative to baseline status. Common HRQOL instruments (SF-36, EQ-5D, KCCQ, MLHFQ) have been used to document that TF-TAVR is advantageous over SAVR at 1-month follow-up, with the benefits leveling off following 1 year. TF-TAVR is economically favorable relative to SAVR, with estimated incremental cost-effectiveness ratio values ranging from $50,000 to $63,000/QALY gained. TA-TAVR has not been reported to be advantageous from an HRQOL or cost-effectiveness perspective. Conclusions While real-world experiences are less described, large-scale trials have advanced our understanding of recovery and cost-effectiveness of aortic valve replacement treatment strategies. Future work should focus on scalable wearable device technology, such as smartwatches and heart-rate monitors, to facilitate real-world evaluation of TAVR and SAVR to support clinical decision-making and outcomes ascertainment.
- Published
- 2021
49. MicroRNA Expression Profiles in Autism Spectrum Disorder: Role for miR-181 in Immunomodulation
- Author
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Sandra S. McCullough, Shannon Rose, Patricia Porter-Gill, Harsh Dweep, Sirish C. Bennuri, Pritmohinder S. Gill, and Richard E. Frye
- Subjects
Genetics ,AKT2 ,AKT3 ,microRNA ,Medicine (miscellaneous) ,autism spectrum disorder ,Biology ,CamKinase II ,medicine.disease ,Article ,Immune system ,Autism spectrum disorder ,miR-181 ,mental disorders ,medicine ,Medicine ,sibling study ,KEGG ,Sibling ,Gene ,TNF alpha - Abstract
Background: MicroRNAs (miRNAs) are important regulators of molecular pathways in psychiatric disease. Here, we examine differential miRNAs expression in lymphoblastoid cell lines (LCLs) derived from 10 individuals with autism spectrum disorder (ASD) and compare them to seven typically developing unrelated age- and gender-matched controls and 10 typically developing siblings. Small RNAseq analysis identified miRNAs, and selected miRNAs were validated using quantitative real-time polymerase reaction (qRT-PCR). KEGG analysis identified target pathways, and selected predicted mRNAs were validated using qRT-PCR. Results: Small RNAseq analysis identified that multiple miRNAs differentiated ASD from unrelated controls and ASD from typically developing siblings, with only one, hsa-miR-451a_R-1, being in common. Verification with qRT-PCR showed that miR-320a differentiated ASD from both sibling and unrelated controls and that several members of the miR-181 family differentiated ASD from unrelated controls. Differential expression of AKT2, AKT3, TNF α and CamKinase II predicted by KEGG analysis was verified by qRT-PCR. Expression of CamKinase II βwas found to be correlated with the severity of stereotyped behavior of the ASD participants. Conclusions: This study provides insight into the mechanisms regulating molecular pathways in individuals with ASD and identifies differentiated regulated genes involved in both the central nervous system and the immune system.
- Published
- 2021
50. Short-Term Safety of Repeated Acetaminophen Use in Patients With Compensated Cirrhosis
- Author
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Laura P. James, Joel H. Vazquez, Eric C. Peterson, Davis P. Fleming, Horace J. Spencer, Jeffery H. Moran, Jonathan A. Dranoff, Samuel E. Mathews, Sandra S. McCullough, Morgan E. Tripod, Stefanie Kennon-McGill, and Mitchell R. McGill
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,Pilot Projects ,RC799-869 ,Gastroenterology ,Keratin 18 ,Drug Administration Schedule ,Young Adult ,Pharmacokinetics ,Glutamate Dehydrogenase ,Internal medicine ,medicine ,Humans ,Dosing ,Prospective Studies ,HMGB1 Protein ,Morning ,Acetaminophen ,Liver injury ,Hepatology ,Keratin-18 ,business.industry ,Glutamate dehydrogenase ,digestive, oral, and skin physiology ,Alanine Transaminase ,Original Articles ,Diseases of the digestive system. Gastroenterology ,Analgesics, Non-Narcotic ,Middle Aged ,medicine.disease ,Female ,Original Article ,business ,Biomarkers ,medicine.drug - Abstract
Current guidelines recommend restricting acetaminophen (APAP) use in patients with cirrhosis, but evidence to support that recommendation is lacking. Prior studies focused on pharmacokinetics (PK) of APAP in cirrhosis but did not rigorously examine clinical outcomes, sensitive biomarkers of liver damage, or serum APAP‐protein adducts, which are a specific marker of toxic bioactivation. Hence, the goal of this pilot study was to test the effects of regularly scheduled APAP dosing in a well‐defined compensated cirrhosis group compared to control subjects without cirrhosis, using the abovementioned outcomes. After a 2‐week washout, 12 subjects with and 12 subjects without cirrhosis received 650 mg APAP twice per day (1.3 g/day) for 4 days, followed by 650 mg on the morning of day 5. Patients were assessed in‐person at study initiation (day 1) and on days 3 and 5. APAP‐protein adducts and both conventional (alanine aminotransferase) and sensitive (glutamate dehydrogenase [GLDH], full‐length keratin 18 [K18], and total high‐mobility group box 1 protein) biomarkers of liver injury were measured in serum on the mornings of days 1, 3, and 5, with detailed PK analysis of APAP, metabolites, and APAP‐protein adducts throughout day 5. No subject experienced adverse clinical outcomes. GLDH and K18 were significantly different at baseline but did not change in either group during APAP administration. In contrast, clearance of APAP‐protein adducts was dramatically delayed in the cirrhosis group. Minor differences for other APAP metabolites were also detected. Conclusion: Short‐term administration of low‐dose APAP (650 mg twice per day, The safety of acetaminophen (APAP) use in cirrhosis is highly controversial. In this study, we compared novel, sensitive biomarkers of liver injury and pharmacokinetics between non‐cirrhotic and cirrhotic subjects with repeated APAP use over 5 days. There was no APAP‐induced liver damage in either group, but there was evidence of greater APAP‐protein binding and reduced APAP‐protein adduct clearance in the cirrhosis group that warrants caution and further study.
- Published
- 2021
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