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Bland K.I.,University of Alabama at Birmingham | Hoyt D.B.,The American College | Hoyt D.B.,University of California at Irvine | Polk Jr. H.C.,University of Louisville | And 2 more authors.
Annals of Surgery | Year: 2011

The surgeon of the future will be required (expected) to engage in leading high performance teams that integrate surgical and nonsurgical skills; he or she will be integral to the evolving systems of health care. Practice will be based on evidence and measured by outcomes that will include some aspect of public reporting. Continuous professional development will be based upon recertification that is founded on practice and objective learning criteria. The processes and goals of CER are of the highest priority and remain in line with the surgeons' practice and professionalism. As we guide the evolution of the health care of the future, our professionalism will be increasingly focused upon accountability. We, as surgeons, must assume this challenge as our legacy, which includes a 100-year history that provides inspiring quality with development of higher standards and improved outcomes for the surgery patient. Copyright © 2011 by Lippincott Williams & Wilkins. Source


Erikson G.A.,Scripps Research Institute | Bodian D.L.,Inova Translational Medicine Institute | Rueda M.,Scripps Research Institute | Molparia B.,Scripps Research Institute | And 7 more authors.
Cell | Year: 2016

Studies of long-lived individuals have revealed few genetic mechanisms for protection against age-associated disease. Therefore, we pursued genome sequencing of a related phenotype-healthy aging-to understand the genetics of disease-free aging without medical intervention. In contrast with studies of exceptional longevity, usually focused on centenarians, healthy aging is not associated with known longevity variants, but is associated with reduced genetic susceptibility to Alzheimer and coronary artery disease. Additionally, healthy aging is not associated with a decreased rate of rare pathogenic variants, potentially indicating the presence of disease-resistance factors. In keeping with this possibility, we identify suggestive common and rare variant genetic associations implying that protection against cognitive decline is a genetic component of healthy aging. These findings, based on a relatively small cohort, require independent replication. Overall, our results suggest healthy aging is an overlapping but distinct phenotype from exceptional longevity that may be enriched with disease-protective genetic factors. Video Abstract: Display Omitted. The genomic characterization of humans that age without developing diseases suggests that healthy aging is a distinct phenotype from exceptional longevity and that it may be enriched with disease-protective genetic factors, such as resistance against cognitive decline. © 2016 Elsevier Inc. Source


Hourigan S.K.,Inova Childrens Hospital | Hourigan S.K.,Johns Hopkins University | Hourigan S.K.,Inova Translational Medicine Institute | Oliva-Hemker M.,Johns Hopkins University
Pediatric Research | Year: 2016

There has been a growing interest in fecal microbiota transplantation (FMT) over recent years, in part due to the increasing prevalence of Clostridium difficile infection (CDI) and expanding association of intestinal dysbiosis with a wide range of human diseases. Many adult studies have shown that FMT is an effective treatment for recurrent CDI and may possibly have applications in other illnesses such as inflammatory bowel disease (IBD); however, there is a paucity of data available in children who may differ from adults for many reasons including having a dynamic developing microbiome compared to adults who have a relatively stable microbiome. Here, we review published studies looking at FMT in children, for CDI and IBD, and discuss special considerations needed when conducting FMT in children. © Copyright 2016 International Pediatric Research Foundation, Inc. Source


Solomon B.D.,Inova Translational Medicine Institute | Solomon B.D.,Virginia Commonwealth University | Solomon B.D.,National Human Genome Research Institute
Molecular Syndromology | Year: 2015

Evolving sequencing technologies allow more accurate, efficient and affordable genomic analysis. As a result, these technologies are increasingly available, especially to provide molecular diagnoses for patients with suspected genetic disorders. However, there are many challenges to using genomic sequencing to benefit patients, including concerns that there is insufficient evidence that identifying an underlying molecular explanation may positively impact a patient's healthcare. This concern has many repercussions, including funding and/or (in some countries and healthcare systems) insurance reimbursement for genomic sequencing. To investigate this concern, all monogenic disorders were analyzed based on the impact of achieving molecular diagnosis. Of the 2,849 individual genes in which germline mutations cause disorders (not including contiguous gene syndromes or what may be categorized as susceptibility alleles), our analyses showed a specific, available intervention related to at least one affected organ system for 1,419 (49.8%) genes. In 95.6% of these genes, the intervention(s) would be recommended during the pediatric time frame. © 2015 S. Karger AG, Basel. Source


Shah P.,Inova Translational Medicine Institute | Cowger J.A.,St Vincent Heart Center
Critical Care Clinics | Year: 2014

Cardiogenic shock is the most common cause of in-hospital mortality for patients who have suffered a myocardial infarction. Mortality exceeds 50% and management is focused on a rapid diagnosis of cardiogenic shock, restoration of coronary blood flow through early revascularization, complication management, and maintenance of end-organ homeostasis. Besides revascularization, inotropes and vasodilators are potent medical therapies to assist the failing heart. Pulmonary arterial catheters are an important adjunctive tool to assess patient hemodynamics, but their use should be limited to select patients in cardiogenic shock. © 2014 Elsevier Inc. Source

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