Kessler C.S.,Jesse Brown Medical Center |
Leone K.A.,Oregon Health And Science University
Academic Emergency Medicine | Year: 2012
In 2012, the Accreditation Council for Graduate Medical Education (ACGME) introduced the Next Accreditation System (NAS) for residency program accreditation. With implementation of the NAS, residents are assessed according to a series of new emergency medicine (EM)-specific performance milestones, and the frequency of assessment reporting is increased. These changes are driving the development of new assessment tools for the NAS that can be feasibly implemented by EM residency programs and that produce valid and reliable assessment data. This article summarizes the recommendations of the writing group on assessment of observable learner performance at the 2012 Academic Emergency Medicine consensus conference on education research in EM that took place on May 9, 2012, in Chicago, Illinois. The authors define an agenda for future assessment tool research and development that was arrived at by consensus during the conference. © 2012 by the Society for Academic Emergency Medicine.
Beauchamp E.M.,Northwestern University |
Platanias L.C.,Northwestern University |
Platanias L.C.,Jesse Brown Medical Center
Oncogene | Year: 2013
The target of rapamycin (TOR) pathway is highly conserved among eukaryotes and has evolved to couple nutrient sensing to cellular growth. TOR is found in two distinct signaling complexes in cells, TOR complex 1 (TORC1) and TOR complex 2 (TORC2). These complexes are differentially regulated and act as effectors for the generation of signals that drive diverse cellular processes such as growth, proliferation, protein synthesis, rearrangement of the cytoskeleton, autophagy, metabolism and survival. Mammalian TOR (mTOR) is very important for development in embryos, while in adult organisms it is linked to aging and lifespan effects. In humans, the mTOR pathway is implicated in the tumorigenesis of multiple cancer types and its deregulation is associated with familial cancer syndromes. Because of its high biological relevance, different therapeutic strategies have been developed to target this signaling cascade, resulting in the emergence of unique pharmacological inhibitors that are either already approved for use in clinical oncology or currently under preclinical or clinical development. Multimodal treatment strategies that simultaneously target multiple nodes of the pathway and/or negative feedback regulatory loops may ultimately provide the best therapeutic advantage in targeting this pathway for the treatment of malignancies. © 2013 Macmillan Publishers Limited All rights reserved.
Macnamara A.,University of Illinois at Chicago |
Phan K.L.,University of Illinois at Chicago |
Phan K.L.,Jesse Brown Medical Center
Psychophysiology | Year: 2016
NIMH's Research Domain Criteria (RDoC) project seeks to advance the diagnosis, prevention, and treatment of mental disorders by promoting psychobiological research on dimensional constructs that might cut across traditional diagnostic boundaries (Kozak & Cuthbert, ). At the core of this approach is the notion that these dimensional constructs can be assessed across different units of analysis (e.g., genes, physiology, behavior), enriching the constructs and providing more complete explanations of clinical problems. While the conceptual aspects of RDoC have been discussed in several prior papers, its methodological aspects have received comparatively less attention. For example, how to integrate data from different units of analysis has been relatively unclear. Here, we discuss one means of psychobiologically operationalizing RDoC constructs across different units of analysis (the psychoneurometric approach; Yancey et al., ), highlighting ways in which this approach might be refined in future iterations. We conclude that there is much to be learned from this technique; however, greater attention to scale-development methods and to psychometrics will likely benefit this and other methodological approaches to combining measurements across multiple units of analysis. © 2016 Society for Psychophysiological Research.
Hay N.,University of Illinois at Chicago |
Hay N.,Jesse Brown Medical Center
Nature Reviews Cancer | Year: 2016
In recent years there has been a growing interest among cancer biologists in cancer metabolism. This Review summarizes past and recent advances in our understanding of the reprogramming of glucose metabolism in cancer cells, which is mediated by oncogenic drivers and by the undifferentiated character of cancer cells. The reprogrammed glucose metabolism in cancer cells is required to fulfil anabolic demands. This Review discusses the possibility of exploiting the reprogrammed glucose metabolism for therapeutic approaches that selectively target cancer cells. © 2016 Macmillan Publishers Limited.
Weisenbach S.L.,University of Illinois at Chicago |
Weisenbach S.L.,Jesse Brown Medical Center |
Kumar A.,University of Illinois at Chicago
Current Psychiatry Reports | Year: 2014
Late life depression is a complex disease associated with a number of contributing neurobiological factors, including cerebrovascular disease, neurodegeneration, and inflammation, which also contribute to its longitudinal prognosis and course. These factors create a context in which the brain is more vulnerable to the impact of stress, and thus, to depression. At the same time, some individuals are protected from late life depression and its consequences, even in the face of neurobiological vulnerability, through benefitting from one or more attributes associated with resilience, including social support, engagement in physical and cognitive activities, and brain reserve. Enhanced understanding of how neurobiological and environmental factors interact in predicting vulnerability and resilience is needed to predict onset and course of depression in late life and develop more effective interventions. © 2014, Springer Science+Business Media New York.
Merkel O.M.,Wayne State University |
Rubinstein I.,University of Illinois at Chicago |
Rubinstein I.,Jesse Brown Medical Center |
Kissel T.,University of Marburg
Advanced Drug Delivery Reviews | Year: 2014
RNA interference (RNAi) has been thought of as the general answer to many unmet medical needs. After the first success stories, it soon became obvious that short interfering RNA (siRNA) is not suitable for systemic administration due to its poor pharmacokinetics. Therefore local administration routes have been adopted for more successful in vivo RNAi. This paper reviews nucleic acid modifications, nanocarrier chemistry, animal models used in successful pulmonary siRNA delivery, as well as clinical translation approaches. We summarize what has been published recently and conclude with the potential problems that may still hamper the efficient clinical application of RNAi in the lung. © 2014 Elsevier B.V.
Patra K.C.,Harvard University |
Hay N.,University of Illinois at Chicago |
Hay N.,Jesse Brown Medical Center
Trends in Biochemical Sciences | Year: 2014
The pentose phosphate pathway (PPP), which branches from glycolysis at the first committed step of glucose metabolism, is required for the synthesis of ribonucleotides and is a major source of NADPH. NADPH is required for and consumed during fatty acid synthesis and the scavenging of reactive oxygen species (ROS). Therefore, the PPP plays a pivotal role in helping glycolytic cancer cells to meet their anabolic demands and combat oxidative stress. Recently, several neoplastic lesions were shown to have evolved to facilitate the flux of glucose into the PPP. This review summarizes the fundamental functions of the PPP, its regulation in cancer cells, and its importance in cancer cell metabolism and survival. © 2014 Elsevier Ltd.
Bilimoria K.Y.,Northwestern University |
Chung J.,Northwestern University |
Ju M.H.,Northwestern University |
Haut E.R.,Johns Hopkins University |
And 4 more authors.
JAMA - Journal of the American Medical Association | Year: 2013
IMPORTANCE: Postoperative venous thromboembolism (VTE) rates are widely reported quality metrics soon to be used in pay-for-performance programs. Surveillance bias occurs when some clinicians use imaging studies to detect VTE more frequently than other clinicians. Because they look more, they find more VTE events, paradoxically worsening their hospital's VTE quality measure performance. A surveillance bias may influence VTE measurement if (1) greater hospital VTE prophylaxis adherence fails to result in lower measured VTE rates, (2) hospitals with characteristics suggestive of higher quality (eg, more accreditations) have greater VTE prophylaxis adherence rates but worse VTE event rates, and (3) higher hospital VTE imaging utilization use rates are associated with higher measured VTE event rates. OBJECTIVE: To examine whether a surveillance bias influences the validity of reported VTE rates. DESIGN, SETTING, AND PARTICIPANTS: 2010 Hospital Compare and American Hospital Association data from 2838 hospitals were merged. Next, 2009-2010 Medicare claims data for 954 926 surgical patient discharges from 2786 hospitals who were undergoing 1 of 11 major operations were used to calculate VTE imaging (duplex ultrasonography, chest computed tomography/magnetic resonance imaging, and ventilation-perfusion scans) and VTE event rates. MAIN OUTCOMES AND MEASURES: The association between hospital VTE prophylaxis adherence and risk-adjusted VTE event rates was examined. The relationship between a summary score of hospital structural characteristics reflecting quality (hospital size, numbers of accreditations/quality initiatives) and performance on VTE prophylaxis and risk-adjusted VTE measures was examined. Hospital-level VTE event rates were compared across VTE diagnostic imaging rate quartiles and with a quantile regression. RESULTS: Greater hospital VTE prophylaxis adherence rates were weakly associated with worse risk-adjusted VTE event rates (r2 = 4.2%; P = .03). Hospitals with increasing structural quality scores had higher VTE prophylaxis adherence rates (93.3% vs 95.5%, lowest vs highest quality quartile; P < .001) but worse risk-adjusted VTE rates (4.8 vs 6.4 per 1000, lowest vs highest quality quartile; P < .001). Mean VTE diagnostic imaging rates ranged from 32 studies per 1000 in the lowest imaging use quartile to 167 per 1000 in the highest quartile (P < .001). Risk-adjusted VTE rates increased significantly with VTE imaging use rates in a stepwise fashion, from 5.0 per 1000 in the lowest quartile to 13.5 per 1000 in the highest quartile (P < .001). CONCLUSIONS AND RELEVANCE: Hospitals with higher quality scores had higher VTE prophylaxis rates but worse risk-adjusted VTE rates. Increased hospital VTE event rates were associated with increasing hospital VTE imaging use rates. Surveillance bias limits the usefulness of the VTE quality measure for hospitals working to improve quality and patients seeking to identify a high-quality hospital.
Daros A.R.,University of Toronto |
Ruocco A.C.,University of Toronto |
Reilly J.L.,Northwestern University |
Harris M.S.H.,Jesse Brown Medical Center |
Sweeney J.A.,Southwestern University
Schizophrenia Research | Year: 2014
Patients with schizophrenia and bipolar disorder have difficulties recognizing facial expressions of emotion. Differences in deficits between these disorders and the effects of treating acute symptoms of illness with antipsychotic medication on these deficits are not well characterized. First-episode patients with schizophrenia (n= 24) and psychotic bipolar I disorder (n= 16) were compared to a healthy control group (n= 32) on the Penn Emotional Acuity Test. Patients were studied during an acute psychotic episode and after seven weeks of treatment with antipsychotic medication. During acute psychosis, bipolar patients showed deficits recognizing subtle facial expressions of happiness and sadness, and this deficit did not resolve with treatment. Schizophrenia patients similarly had difficulty recognizing subtle happy faces during acute illness that also did not resolve with treatment. In addition, problems recognizing subtle expressions of sadness among schizophrenia patients were apparent after treatment. Poorer emotion recognition at follow-up was related to negative symptom severity for schizophrenia patients. These findings highlight the severity and persistence of emotion recognition deficits early in the course of psychotic bipolar disorder and schizophrenia, and demonstrate an association of emotion processing deficits to negative symptoms in schizophrenia during periods of relative clinical stability. © 2014 Elsevier B.V.
Hayes J.,Clement blocki Va Medical Center |
Jackson J.L.,Clement blocki Va Medical Center |
McNutt G.M.,William S Middleton Memorial Veterans Hospital |
Hertz B.J.,Hines Medical Center |
And 2 more authors.
JAMA - Journal of the American Medical Association | Year: 2014
IMPORTANCE: American Board of Internal Medicine (ABIM) initiatives encourage internists with time-unlimited certificates to recertify. However, there are limited data evaluating differences in performance between internists with time-limited or time-unlimited board certification. OBJECTIVE: To determine whether there are differences in primary care quality between physicians holding time-limited or time-unlimited certification. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of performance data from 1 year (2012-2013) at 4 Veterans Affairs (VA) medical centers. Participants were internists with time-limited (n = 71) or time-unlimited (n = 34) ABIM certification providing primary care to 68 213 patients. Median physician panel size was 610 patients (range, 19-1316), with no differences between groups (P = .90). MAIN OUTCOMES AND MEASURES: Ten primary care performance measures: colorectal screening rates; diabetes with glycated hemoglobin (HbA1c level) less than 9.0%; diabetes with blood pressure less than 140/90mmHg; diabetes with low-density lipoprotein cholesterol (LDL-C) level less than 100mg/dL; hypertension with blood pressure less than 140/90mmHg; thiazide diuretics used in multidrug hypertensive regimen; atherosclerotic coronary artery disease and LDL-C level less than 100mg/dL; post-myocardial infarction use of aspirin; post-myocardial infarction use of β-blockers; congestive heart failure (CHF) with use of angiotensin-converting enzyme (ACE) inhibitor. RESULTS: After adjustment for practice site, panel size, years since certification, and clustering by physician, there were no differences in outcomes for patients cared for by internists with time-limited or time-unlimited certification for any performance measure: colorectal screening (odds ratio [OR], 0.95 [95%CI, 0.89-1.01]); diabetes with HbA1c level less than 9.0% (OR, 0.96 [95%CI, 0.74-1.2]); blood pressure control (OR, 0.99 [95%CI, 0.69-1.4]); LDL-C level less than 100mg/dL (OR, 1.1 [95%CI, 0.79-1.5]); hypertension with blood pressure less than 140/90mmHg (OR, 1.0 [95%CI, 0.92-1.2]); thiazide use (OR, 1.0 [95%CI, 0.8-1.3]); atherosclerotic coronary artery disease with LDL-C level less than 100mg/dL (OR, 1.1 [95%CI, 0.75-1.7]); post-myocardial infarction use of aspirin (OR, 0.98 [95%CI, 0.58-1.68]) or β-blockers (OR, 1.0 [95%CI, 0.57-1.9]); CHF with use of ACE inhibitor (OR, 0.98 [95%CI, 0.61-1.6]). CONCLUSIONS AND RELEVANCE: Among internists providing primary care at 4 VA medical centers, there were no significant differences between those with time-limited ABIM certification and those with time-unlimited ABIM certification on 10 primary care performance measures. Additional research to examine the difference in patient outcomes among holders of time-limited and time-unlimited certificates in non-VA and nonacademic settings and the association with other ABIM goals may help clarify the potential benefit of Maintenance of Certification participation. Copyright 2014 American Medical Association. All rights reserved.