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2. Homogeneous Sets in Graphs and a Chromatic Multisymmetric Function

Author

Crew, Logan, Haithcock, Evan, Reynes, Josephine, and Spirkl, Sophie

Subjects
Mathematics - Combinatorics, 05E05, 05C15
Abstract

In this paper, we extend the chromatic symmetric function $X$ to a chromatic $k$-multisymmetric function $X_k$, defined for graphs equipped with a partition of their vertex set into $k$ parts. We demonstrate that this new function retains the basic properties and basis expansions of $X$, and we give a method for systematically deriving new linear relationships for $X$ from previous ones by passing them through $X_k$. In particular, we show how to take advantage of homogeneous sets of $G$ (those $S \subseteq V(G)$ such that each vertex of $V(G) \backslash S$ is either adjacent to all of $S$ or is nonadjacent to all of $S$) to relate the chromatic symmetric function of $G$ to those of simpler graphs. Furthermore, we show how extending this idea to homogeneous pairs $S_1 \sqcup S_2 \subseteq V(G)$ generalizes the process used by Guay-Paquet to reduce the Stanley-Stembridge conjecture to unit interval graphs.

Published
2022

6. Biconed graphs, weighted forests, and h-vectors of matroid complexes

Author

Cranford, Preston, Dochtermann, Anton, Haithcock, Evan, Marsh, Joshua, Oh, Suho, and Truman, Anna

Subjects
Mathematics - Combinatorics, 05E45, 05B35, 13F55
Abstract

A well-known conjecture of Richard Stanley posits that the $h$-vector of the independence complex of a matroid is a pure ${\mathcal O}$-sequence. The conjecture has been established for various classes but is open for graphic matroids. A biconed graph is a graph with two specified `coning vertices', such that every vertex of the graph is connected to at least one coning vertex. The class of biconed graphs includes coned graphs, Ferrers graphs, and complete multipartite graphs. We study the $h$-vectors of graphic matroids arising from biconed graphs, providing a combinatorial interpretation of their entries in terms of `$2$-weighted forests' of the underlying graph. This generalizes constructions of Kook and Lee who studied the M\"obius coinvariant (the last nonzero entry of the $h$-vector) of graphic matroids of complete bipartite graphs. We show that allowing for partially $2$-weighted forests gives rise to a pure multicomplex whose face count recovers the $h$-vector, establishing Stanley's conjecture for this class of matroids. We also discuss how our constructions relate to a combinatorial strengthening of Stanley's Conjecture (due to Klee and Samper) for this class of matroids., Comment: 15 pages, 3 figures; V2: added omitted author to metadata; V3: added Section 5 involving a worked example, added Section 6 connecting our work to that of Klee and Samper, small change to title, other corrections and edits as suggested by referees

Published
2020

8. $\beta$-Packing Sets in Graphs

Author

Case, Benjamin M., Haithcock, Evan M., and Laskar, Renu C.

Subjects
Mathematics - Combinatorics
Abstract

A set $S\subseteq V$ is $\alpha$-dominating if for all $v\in V-S$, $|N(v) \cap S | \geq \alpha |N(v)|.$ The $\alpha$-domination number of $G$ equals the minimum cardinality of an $\alpha$-dominating set $S$ in $G$. Since being introduced by Dunbar, et al. in 2000, $\alpha$-domination has been studied for various graphs and a variety of bounds have been developed. In this paper, we propose a new parameter derived by flipping the inequality in the definition of $\alpha$-domination. We say a set $S \subset V$ is a $\beta$-packing set of a graph $G$ if $S$ is a proper, maximal set having the property that for all vertices $v \in V-S$, $|N(v) \cap S| \leq \beta |N(v)|$ for some $0 < \beta \leq 1.$ The $\beta$-packing number of $G$ ($\beta$-pack($G$)) equals the maximum cardinality of a $\beta$-packing set in $G$. In this research, we determine $\beta$-pack($G$) for several classes of graphs, and we explore some properties of $\beta$-packing sets. Keywords: $\beta$-packing, $\alpha$-domination, graph theory, graph parameters, Comment: First presented at the 50th Southeastern International Conference on Combinatorics, Graph Theory & Computing March 2019

Published
2019

15. Enhanced recovery after thoracic surgery: Systematic review and meta-analysisCentral MessagePerspective

Author

Audrey L. Khoury, MD, MPH, Katharine L. McGinigle, MD, MPH, Nikki L. Freeman, MA, Helal El-Zaatari, BS, Cynthia Feltner, MD, MPH, Jason M. Long, MD, MPH, Lavinia M. Kolarczyk, MD, Emily G. Teeter, MD, Benjamin E. Haithcock, MD, and Gita N. Mody, MD, MPH

Subjects
enhanced recovery after surgery, lung resection, systematic review, meta-analysis, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Published
2021
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16. Three dimensional modeling of biologically relevant fluid shear stress in human renal tubule cells mimics in vivo transcriptional profiles

Author

Emily J. Ross, Emily R. Gordon, Hanna Sothers, Roshan Darji, Oakley Baron, Dustin Haithcock, Balabhaskar Prabhakarpandian, Kapil Pant, Richard M. Myers, Sara J. Cooper, and Nancy J. Cox

Subjects
Medicine, Science
Abstract

Abstract The kidney proximal tubule is the primary site for solute reabsorption, secretion and where kidney diseases can originate, including drug-induced toxicity. Two-dimensional cell culture systems of the human proximal tubule cells (hPTCs) are often used to study these processes. However, these systems fail to model the interplay between filtrate flow, fluid shear stress (FSS), and functionality essential for understanding renal diseases and drug toxicity. The impact of FSS exposure on gene expression and effects of FSS at differing rates on gene expression in hPTCs has not been thoroughly investigated. Here, we performed RNA-sequencing of human RPTEC/TERT1 cells in a microfluidic chip-based 3D model to determine transcriptomic changes. We measured transcriptional changes following treatment of cells in this device at three different fluidic shear stress. We observed that FSS changes the expression of PTC-specific genes and impacted genes previously associated with renal diseases in genome-wide association studies (GWAS). At a physiological FSS level, we observed cell morphology, enhanced polarization, presence of cilia, and transport functions using albumin reabsorption via endocytosis and efflux transport. Here, we present a dynamic view of hPTCs response to FSS with increasing fluidic shear stress conditions and provide insight into hPTCs cellular function under biologically relevant conditions.

Published
2021
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20. The Role of Immunotherapy in the Management of Esophageal Cancer in Patients Treated with Neoadjuvant Chemoradiation: An Analysis of the National Cancer Database.

Author

Tasoudis, Panagiotis, Manaki, Vasiliki, Iwai, Yoshiko, Buckeridge, Steven A., Khoury, Audrey L., Agala, Chris B., Haithcock, Benjamin E., Mody, Gita N., and Long, Jason M.

Subjects
ADENOCARCINOMA, IMMUNOTHERAPY, ESOPHAGEAL tumors, CHEMORADIOTHERAPY, RETROSPECTIVE studies, DESCRIPTIVE statistics, KAPLAN-Meier estimator, COMBINED modality therapy, PROPORTIONAL hazards models
Abstract

Simple Summary: Esophageal cancer is a severe disease with a high mortality rate. Recent advancements in treatments have improved outcomes, but survival rates remain low. This study investigates the use of immunotherapy, a treatment that helps the immune system fight cancer, in combination with standard chemoradiation and surgery for patients with locally advanced esophageal cancer. By analyzing data from the National Cancer Database, we found that patients who received adjuvant immunotherapy had better survival rates than those who did not receive immunotherapy or who received neoadjuvant immunotherapy. These findings suggest that adjuvant immunotherapy could be a beneficial addition to existing treatment protocols, and further research is needed to confirm these results and optimize patient outcomes. Background: The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation. Methods: Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan–Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Results: Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model. Conclusions: In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Contributors

Author

Abbruzzese, James L., primary, Abdel-Wahab, Omar, additional, Abou-Alfa, Ghassan K., additional, Abrahm, Janet L., additional, Abrams, Jeffrey S., additional, Abramson, Jeremy S., additional, Aisner, Dara L., additional, Alonso-Basanta, Michelle, additional, Anampa, Jesus, additional, Anderson, Megan E., additional, Antonarakis, Emmanuel S., additional, Aplenc, Richard, additional, Appelbaum, Frederick R., additional, Araujo, Luiz H., additional, Asban, Ammar, additional, Ashwood, Edward, additional, Awan, Farrukh T., additional, Aylward, Juliet L., additional, Balar, Arjun V., additional, Balentine, Courtney J., additional, Barta, Stefan K., additional, Bartlett, Nancy, additional, Basen-Engquist, Karen, additional, Beaupin, Lynda Kwon, additional, Berkowitz, Ross S., additional, Berry, Donald A., additional, Bevers, Therese, additional, Boggess, John F., additional, Brahmer, Julie R., additional, Brown, Janet, additional, Brown, Karen, additional, Brown, Powel, additional, Browner, Ilene, additional, Bunn, Paul A., additional, Burns, William R., additional, Byrd, John C., additional, Cadoo, Karen, additional, Carbone, David P., additional, Carter, H. Ballentine, additional, Castillo, Jorge J., additional, Chang, Alfred E., additional, Chang, Eric, additional, Chanock, Stephen J., additional, Chapuy, Claudia I., additional, Chauhan, Vikash P., additional, Chen, Herbert, additional, Chen, Ronald C., additional, Cheung, Nai-Kong V., additional, Choe, Jennifer H., additional, Christian, Michaele C., additional, Cinciripini, Paul M., additional, Clarke, Michael F., additional, Coleman, Robert E., additional, Coleman, Robert L., additional, Coletta, Adriana M., additional, Collins, Jerry M., additional, Connors, Jean M., additional, Cools, Michael, additional, Coombes, Kevin R., additional, Cortes, Jorge, additional, Costa, Mauro W., additional, Covey, Anne, additional, Cowan, Kenneth H., additional, Crane, Christopher H., additional, Crawford, Jeffrey, additional, Crooks, Kristy, additional, Culkin, Daniel J., additional, Czito, Brian G., additional, Dalerba, Piero, additional, Dalmau, Josep, additional, Dang, Mai, additional, D'Angelica, Michael, additional, Davies, Kurtis D., additional, Davis, Myrtle, additional, Dea, Nicolas, additional, De Jesus-Acosta, Ana, additional, DeMarzo, Angelo M., additional, DeWeese, Theodore L., additional, Diehn, Maximilian, additional, Digumarthy, Subba R., additional, Dispenzieri, Angela, additional, Do, Khanh T., additional, Dobrenkov, Konstantin, additional, Dome, Jeffrey S., additional, Doroshow, James H., additional, Dorsey, Jay F., additional, Dubard-Gault, Marianne, additional, DuBois, Steven G., additional, Duda, Dan G., additional, Dunlop, Malcolm, additional, Duska, Linda R., additional, Duvic, Madeleine, additional, El Dika, Imane, additional, El-Serag, Hashem, additional, Engelmann, Jeffrey M., additional, Ettinger, David S., additional, Fashoyin-Aje, Lola A., additional, Fearon, Eric R., additional, Ford, James M., additional, Franklin, Wilbur A., additional, Freer, Phoebe E., additional, Freidlin, Boris, additional, Freifeld, Alison G., additional, Friedlander, Terence W., additional, Friedman, Debra L., additional, Fuller, Arian F., additional, Galluzzi, Lorenzo, additional, Gebhardt, Mark C., additional, George, Daniel J., additional, Geyer, Mark B., additional, Giaccia, Amato J., additional, Gilbert, Mark R., additional, Goldner, Whitney, additional, Goldstein, Donald P., additional, Goodman, Annekathryn, additional, Goodman, Karyn A., additional, Gordon, Kathleen, additional, Graeff-Armas, Laura, additional, Greenstein, Alexander J., additional, Grossman, Stuart A., additional, Grupp, Stephan, additional, Gupta, Arjun, additional, Haider, Irfanullah, additional, Haigentz, Missak, additional, Hainsworth, John D., additional, Haithcock, Benjamin E., additional, Hallemeier, Christopher L., additional, Hanash, Samir, additional, Hanrahan, Aphrothiti J., additional, Harding, James, additional, Harrison, Michael R., additional, Hasham, Muneer G., additional, Hawk, Ernest, additional, Hayman, Jonathan, additional, Heinlen, Jonathan E., additional, Henry, N. Lynn, additional, Herman, Joseph, additional, Hobbs, Brian P., additional, Holen, Ingunn, additional, Horn, Leora, additional, Horowitz, Neil S., additional, Horwitz, Steven M., additional, Houghton, Odette, additional, Howard, Scott C., additional, Hudis, Clifford A., additional, Hunger, Stephen P., additional, Hurria, Arti, additional, Ilson, David H., additional, Im, Annie, additional, Iyer, Gopa, additional, Jaffee, Elizabeth M., additional, Jagsi, Reshma, additional, Jain, Rakesh K., additional, Jarnagin, William, additional, Jatoi, Aminah, additional, Jhingran, Anuja, additional, Johnson, David H., additional, Johnston, Brian, additional, Johnston, Patrick G., additional, Judy, Kevin D., additional, Kachnic, Lisa A., additional, Kaidar-Person, Orit, additional, Kalva, Sanjeeva, additional, Kamin, Deborah Y., additional, Kantarjian, Hagop, additional, Karakousis, Giorgos, additional, Karam-Hage, Maher, additional, Kaskas, Nadine M., additional, Kastan, Michael B., additional, Katabi, Nora, additional, Kaul, Daniel R., additional, Kelley, Scott R., additional, Kemeny, Nancy, additional, Kent, Erin E., additional, Kepp, Oliver, additional, Khagi, Simon, additional, Kilgore, Joshua E., additional, Kim, D. Nathan, additional, Kleinschmidt-DeMasters, Bette K., additional, Korn, Edward L., additional, Kroemer, Guido, additional, Ku, Geoffrey Y., additional, Kummar, Shivaani, additional, Ky, Bonnie, additional, Laheru, Daniel A., additional, Lambert, Paul F., additional, Lawler, Mark, additional, Le-Rademacher, Jennifer G., additional, Lee, John Y.K., additional, Lee, Nancy Y., additional, Lee, Susanna L., additional, Leeman, Jonathan E., additional, Linkermann, Andreas, additional, Liu, Jinsong, additional, Lo, Simon, additional, Locasale, Jason W., additional, Loprinzi, Charles L., additional, Lowery, Maeve, additional, Ludwig, Emmy, additional, Lunning, Matthew A., additional, Lustig, Robert A., additional, Machtay, Mitchell, additional, Mackall, Crystal, additional, Mahvi, David A., additional, Mahvi, David M., additional, Maity, Amit, additional, Majithia, Neil, additional, Malumbres, Marcos, additional, Maresso, Karen Colbert, additional, Martin, John D., additional, Matsuo, Koji, additional, Matthews, Natalie H., additional, Mauro, Lauren, additional, Mayer, R. Samuel, additional, McCaskill-Stevens, Worta, additional, McNamara, Megan A., additional, Mehta-Shah, Neha, additional, Merritt, Robert E., additional, Milowsky, Matthew I., additional, Minasian, Lori M., additional, Mitchell, Tara C., additional, Mitsis, Demytra, additional, Mollica, Michelle, additional, Mooney, Margaret, additional, Moustafa, Farah, additional, Nabati, Lida, additional, Naidoo, Jarushka, additional, Narang, Amol, additional, Nelson, Heidi, additional, Nelson, William G., additional, Nesbit, Suzanne, additional, Niglas, Mark, additional, O'Connor, Tracey, additional, Offit, Kenneth, additional, Onciu, Mihaela, additional, O’Reilly, Eileen M., additional, Ostrander, Elaine A., additional, Pappas-Taffer, Lisa, additional, Pardoll, Drew, additional, Park, Jae H., additional, Patel, Anery, additional, Patel, Anish J., additional, Patierno, Steven R., additional, Pavletic, Steven Z., additional, Phillips, Peter C., additional, Post, Miriam D., additional, Pruitt, Amy A., additional, Querfeld, Christiane, additional, Rabius, Vance A., additional, Rajkumar, S. Vincent, additional, Ramadan, Mohammad O., additional, Rankin, Erinn B., additional, Reddy, Sushanth, additional, Reid, Michael A., additional, Reznik, Scott, additional, Rizack, Tina, additional, Robinson, Jason D., additional, Robinson-Bostom, Leslie, additional, Rodriguez-Galindo, Carlos, additional, Romesser, Paul B., additional, Rosen, Steven T., additional, Rosenfeld, Myrna R., additional, Rosenthal, Nadia, additional, Ross, Meredith, additional, Rowland, Julia H., additional, Russell, Anthony H., additional, Sabel, Michael S., additional, Sahgal, Arjun, additional, Salinas, Ryan D., additional, Salo-Mullen, Erin E., additional, Salto-Tellez, Manuel, additional, Sanderson, Sydney M., additional, Sandlund, John T., additional, Santana, Victor M., additional, Savage, Michelle, additional, Schreiber, Eric C., additional, Schuchter, Lynn, additional, Schultz, Liora, additional, Seiden, Michael V., additional, Sellers, Morgan M., additional, Shah, Payal D., additional, Shia, Jinru, additional, Shilo, Konstantin, additional, Small, Eric, additional, Smith, Angela B., additional, Snow, Stephen N., additional, Solit, David B., additional, Sood, Anil K., additional, Soto-Perez-de-Celis, Enrique, additional, Sparano, Joseph A., additional, Spiegelman, Vladimir S., additional, Spunt, Sheri L., additional, Stadler, Zsofia K., additional, Steensma, David P., additional, Stone, Richard M., additional, Stranne, Steven Kent, additional, Stratton, Kelly, additional, Sugden, Bill, additional, Swanson, Andrew M., additional, Tallman, Martin S., additional, Talmadge, James E., additional, Teachey, David T., additional, Teba, Catalina V., additional, Tefferi, Ayalew, additional, Teh, Bin Tean, additional, Teng, Joyce M.C., additional, Tepper, Joel E., additional, Thaker, Premal H., additional, Thrift, Aaron P., additional, Tran, Arthur-Quan, additional, Triska, Grace, additional, Trump, Donald, additional, Tsai, Kenneth, additional, Tseng, Chia-Lin, additional, Tseng, Diane, additional, Van Schaeybroeck, Sandra, additional, Van Tine, Brian A., additional, Vanness, Erin R., additional, Varadhachary, Gauri, additional, Varella-Garcia, Marileila, additional, Wahl, Richard L., additional, Walsh, Michael F., additional, Wang, Thomas, additional, Weiss, Jared, additional, Weissman, Irving L., additional, Westin, Shannon N., additional, White, Jeffrey D., additional, Wilson, Richard, additional, Wong, Richard J., additional, Wood, Gary S., additional, Xu, Yaohui G., additional, Xu-Welliver, Meng, additional, Yust-Katz, Shlomit, additional, Zagar, Timothy, additional, Zeman, Elaine M., additional, Zhang, Tian, additional, and Zwiebel, James A., additional

Published
2020
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29. Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillators: The RAID Trial

Author

Zareba, W., Pyykkonen, K., Buttaccio, A., Perkins, E., DeGrey, D., Robertson, S., Moss, A.J., Brown, M., Lansing, R., Oberer, A., Polonsky, B., Ross, V., Papernov, A., Schleede, S., Beck, C., Oakes, D., Feng, C., McNitt S, S., Hall, W.J., Moss, A., Daubert, J., Huang, D., Winters, S., Schuger, C., Haigney, M., Piccini, J., Alexis, J., Chen, L., Miller, A., Richeson, J.F., Rosero, S., Kutyifa, V., Shah, A., Lamas, G., Cohn, F., Harrell, F., Jr., Piña, I., Poole, J., Sullivan, M., Lathrop, D., Geller, N., Boineau, R., Trondell, J., Cooper, L., Itturiaga, E., Gottlieb, C., Greer, S., Perzanowski, C., McPherson, C., Hedgepeth, C., Assal, C., Salam, T., Woollett, I., Tomassoni, G., Ayala-Paredes, F., Russo, A., Punnam, S., Sangrigoli, R., Sloan, S., Kutalek, S., Sun, A., Lustgarten, D., Monir, G., Haithcock, D., Sorrentino, R., Cannom, D., Kluger, J., Varanasi, S., Rashtian, M., Philippon, F., Berger, R., Mazzella, M., Lessmeier, T., Silver, J., Worley, S., Bernabei, M., Esberg, D., Dixon, M., LeLorier, P., Greenberg, Y., Essebag, V., Venkataraman, G., Shinn, T., Dubuc, M., Turitto, G., Henrikson, C., Mirro, M., Raitt, M., Baranchuk, A., O'Neill, G., Lockwood, E., Vloka, M., Hurwitz, J., Mead, R.H., Somasundarum, P., Aziz, E., Rashba, E., Budzikowski, A., Cox, M., Natale, A., Chung, E., Ziv, O., McGrew, F., III, Tamirisa, K., Greenspon, A., Estes, M., Taylor, S., Janardhanan, R., Mitchell, L.B., Burke, M., Attari, M., Mikaelian, B., Hsu, S., Conti, J., Mazur, A., Shorofsky, S., Rosenthal, L., Sakaguchi, S., Wolfe, D., Flaker, G., Saba, S., Aktas, M., Mason, P., Shalaby, A., Musat, D., Abraham, R., Ellenbogen, K., Fellows, C., Kavesh, N., Thomas, G., Hemsworth, D., Williamson, B., Zareba, Wojciech, Daubert, James P., Beck, Christopher A., Huang, David T., Alexis, Jeffrey D., Brown, Mary W., Pyykkonen, Kathryn, McNitt, Scott, Oakes, David, Feng, Changyong, Aktas, Mehmet K., Ayala-Parades, Felix, Baranchuk, Adrian, Dubuc, Marc, Haigney, Mark, Mazur, Alexander, McPherson, Craig A., Mitchell, L. Brent, Natale, Andrea, Piccini, Jonathan P., Raitt, Merritt, Rashtian, Mayer Y., Schuger, Claudio, Winters, Stephen, Worley, Seth J., Ziv, Ohad, and Moss, Arthur J.

Published
2018
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32. Label-free enrichment of human adipose-derived stem cells using a continuous microfluidic sorting cascade

Author

Lap Man Lee, George J. Klarmann, Dustin W. Haithcock, Yi Wang, Ketan H. Bhatt, Balabhaskar Prabhakarpandian, Kapil Pant, Luis M. Alvarez, and Eva Lai

Subjects
Biomedical Engineering, Bioengineering, General Chemistry, Biochemistry
Abstract

Combining inertial and deterministic lateral displacement (DLD) microfluidic sorting to isolate mesenchymal stem cells (MSCs) from human adipose tissue for regenerative medicine applications.

Published
2023
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40. Post-discharge symptom monitoring with electronic patient-reported outcomes (ePROs): A qualitative study on implementation after thoracic surgery (Preprint)

Author

Boisson, Alex, primary, Cox, Chase, additional, Shrestha, Sachita, additional, Bright, Annie, additional, Carr, Philip, additional, Hill, Lauren, additional, Newsome, Bernice, additional, Long, Jason, additional, Haithcock, Ben, additional, Stover, Angela, additional, Basch, Ethan, additional, Leeman, Jennifer, additional, and Mody, Gita, additional

Published
2023
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41. Gallstone Ectopia: A Rare Clinical Entity

Author

Khoury, Audrey L., primary, J. Kumar, Rashmi, additional, Khoury, Audrey L., additional, Merlo, Aurelie, additional, Haase, Conner, additional, B. Stitzenberg, Karyn, additional, and E. Haithcock, Benjamin, additional

Published
2023
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44. Post-discharge monitoring with electronic patient-reported outcomes (ePROs): a qualitative study on implementation after thoracic surgery (Preprint)

Author

Alex Boisson, Chase Cox, Sachita Shrestha, Annie Bright, Philip Carr, Lauren Hill, Bernice Newsome, Jason Long, Ben Haithcock, Angela Stover, Ethan Basch, Jennifer Leeman, and Gita Mody

Abstract

BACKGROUND Thoracic surgery is a mainstay of therapy for lung cancer and other chronic pulmonary conditions, but recovery is often complicated. Digital systems to monitor postoperative symptom burden have been developed; however, barriers to routine clinical implementation remain, particularly in complex and vulnerable populations. This study sought to determine end-user (patient) barriers and facilitators of using an electronic patient-reported outcome (ePRO) monitoring platform designed to detect complications from thoracic surgery post-discharge. OBJECTIVE To determine the barriers to electronic patient-reported outcomes use after discharge from surgery METHODS Patients planned for thoracic surgery were recruited to participate in web-based ePRO monitoring. Participants experienced in ePRO use (n=16) underwent semi-structured interviews, which were analyzed by deductive team-based coding. Themes were mapped onto the three domains of the COM-B model of behavior framework (Capability, Opportunity, and Motivation). ePRO design and implementation improvements to respond to these themes were identified. RESULTS Analysis demonstrated seven dominant themes reported by ePRO participants. These included barriers (postoperative patient physical and mental health, lack of access to email and poor internet connectivity, lack of clarity on ePRO use in routine clinical care, and symptom item redundancy) and facilitators (ease of the ePRO assessment completion, engagement with the surgical care team on ePRO use, and increased awareness of symptom experience through ePRO use). The following ePRO intervention design improvements were identified: offering alternatives to web-based completion, tailoring symptom assessments to individual patients, and the need for patient-facing materials linking ePROs to other systems for perioperative care. CONCLUSIONS ePROs have the promise of improved care outcomes for postoperative patients. Addressable barriers and facilitators to implementation in the thoracic surgical patient population have been identified. Future work on testing the impact of intervention design improvements on implementation outcomes of feasibility and acceptability is ongoing. CLINICALTRIAL ClinicalTrials.gov NCT04342260

Published
2023
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46. The Prevalence of Benign Pathology Following Major Pulmonary Resection for Suspected Malignancy

Author

Gita N. Mody, Lauren Dawson, Jason M. Long, Joshua Herb, Brittney Williams, and Benjamin E. Haithcock

Subjects
medicine.medical_specialty, Lung Neoplasms, Thoracic Surgery, Video-Assisted, business.industry, Solitary Pulmonary Nodule, Nodule (medicine), Perioperative, Middle Aged, medicine.disease, Malignancy, Benign pathology, Cardiothoracic surgery, Thoracic Oncology, Prevalence, medicine, Humans, Surgery, Radiology, medicine.symptom, Pneumonectomy, Lung cancer, business, Early Detection of Cancer, Lung cancer screening, Retrospective Studies
Abstract

Background In the era of lung cancer screening with low-dose computed tomography, there is concern that high false-positive rates may lead to an increase in nontherapeutic lung resection. The aim of this study is to determine the current rate of major pulmonary resection for ultimately benign pathology. Materials and Methods A single-institution, retrospective analysis of all patients > 18 y who underwent major pulmonary resection between 2013 and 2018 for suspected malignancy and had benign final pathology was performed. Results Of 394 major pulmonary resections performed for known or presumed malignancy, 10 (2.5%) were benign. Of these 10, the mean age was 61.1 y (SD 14.6). Most were current or former smokers (60%). Ninety percent underwent a fluorodeoxyglucose positron emission tomography scan. Median nodule size was 27 mm (IQR 21-35) and most were in the right middle lobe (50%). Preoperative biopsy was performed in four (40%) but were nondiagnostic. Video-assisted thoracoscopic lobectomy (70%) was the most common surgical approach. Final pathology revealed three (30%) infectious, three (30%) inflammatory, two (20%) fibrotic, and two (20%) benign neoplastic nodules. Two (20%) patients had perioperative complications, both of which were prolonged air leaks, one (10%) patient was readmitted within 30 d, and there was no mortality. Conclusions A small percentage of patients (2.5% in our series) may undergo major pulmonary resection for unexpectedly benign pathology. Knowledge of this rate is useful to inform shared decision-making models between surgeons and patients and evaluation of thoracic surgery program performance.

Published
2021
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47. Donation after circulatory death donors in lung transplantation

Author

John Jacob Requard, Benjamin E. Haithcock, Jason Lobo, John Espey, Gita N. Mody, Mir Ali, Thomas M. Egan, and Robert B. Love

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, medicine.medical_treatment, Donation, Review Article on Lung Transplantation: Past, Present, and Future, Medicine, Lung transplantation, business, Intensive care medicine, Circulatory death
Abstract

Transplantation of any organ into a recipient requires a donor. Lung transplant has a long history of an inadequate number of suitable donors to meet demand, leading to deaths on the waiting list annually since national data was collected, and strict listing criteria. Before the Uniform Determination of Death Act (UDDA), passed in 1980, legally defined brain death in the U.S., all donors for lung transplant came from sudden death victims [uncontrolled Donation after Circulatory Death donors (uDCDs)] in the recipient's hospital emergency department. After passage of the UDDA, uDCDs were abandoned to Donation after Brain Death donors (DBDs)-perhaps prematurely. Compared to livers and kidneys, many DBDs have lungs that are unsuitable for transplant, due to aspiration pneumonia, neurogenic pulmonary edema, trauma, and the effects of brain death on lung function. Another group of donors has become available-patients with a devastating irrecoverable brain injury that do not meet criteria for brain death. If a decision is made by next-of-kin (NOK) to withdraw life support and allow death to occur by asphyxiation, with NOK consent, these individuals can have organs recovered if death occurs relatively quickly after cessation of mechanical ventilation and maintenance of their airway. These are known as controlled Donation after Circulatory Death donors (cDCDs). For a variety of reasons, in the U.S., lungs are recovered from cDCDs at a much lower rate than kidneys and livers. Ex-vivo lung perfusion (EVLP) in the last decade has had a modest impact on increasing the number of lungs for transplant from DBDs, but may have had a larger impact on lungs from cDCDs, and may be indispensable for safe transplantation of lungs from uDCDs. In the next decade, DCDs may have a substantial impact on the number of lung transplants performed in the U.S. and around the world.

Published
2021
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48. Barriers and facilitators to early-stage lung cancer care in the USA: a qualitative study

Author

Joshua, Herb, Hannah, Friedman, Sachita, Shrestha, Erin E, Kent, Karyn, Stitzenberg, Benjamin, Haithcock, and Gita N, Mody

Subjects
Adult, Lung Neoplasms, Oncology, Carcinoma, Non-Small-Cell Lung, Humans, Female, Patient Advocacy, Middle Aged, Ambulatory Care Facilities, United States, Qualitative Research
Abstract

Improved outcomes in lung cancer treatment are seen in high-volume academic centers, making it important to understand barriers to accessing care at such institutions. Few qualitative studies examine the barriers and facilitators to early-stage lung cancer care at US academic institutions.Adult patients with suspected or diagnosed early-stage non-small cell lung cancer presenting to a multidisciplinary lung cancer clinic at a US academic institution over a 6-month period beginning in 2019 were purposively sampled for semi-structured interviews. Semi-structured interviews were conducted and a qualitative content analysis was performed using the framework method. Themes relating to barriers and facilitators to lung cancer care were identified through iterative team-based coding.The 26 participants had a mean age of 62 years (SD: 8.4 years) and were majority female (62%), white (77%), and urban (85%). We identified 6 major themes: trust with providers and health systems are valued by patients; financial toxicity negatively influenced the diagnostic and treatment experience; social constraints magnified other barriers; patient self-advocacy as a facilitator of care access; provider advocacy could overcome other barriers; care coordination and good communication were important to patients.We have identified several barriers and facilitators to lung cancer care at an academic center in the US. These factors need to be addressed to improve quality of care among lung cancer patients. Further work will examine our findings in a community setting to understand if our findings are generalizable to patients who do not access a tertiary cancer care center.

Published
2022
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