38 results on '"Peterman N"'
Search Results
2. EP1.01-94 The Role of Neoadjuvant Chemo-Immunotherapy in Unresectable Non-Small Cell Lung Cancer
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Oh, M., primary, Davis, A., additional, Lentz, R., additional, Peterman, N., additional, Robertson, A., additional, Srivas, R., additional, Lambert, N., additional, Wilson, T., additional, Tezcan, H., additional, Bharat, A., additional, and Chae, Y.K., additional
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- 2019
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3. Dynamic changes in whole-genome cell-free DNA (cfDNA) to identify disease progression prior to imaging in advanced solid tumours
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Davis, A.A., primary, Iams, W., additional, Chan, D., additional, Oh, M.S., additional, Lentz, R.W., additional, Peterman, N., additional, Robertson, A., additional, Shah, A., additional, Srivas, R., additional, Lambert, N., additional, Wilson, T., additional, George, P., additional, Wong, B., additional, Close, J., additional, Wood, H., additional, Tezcan, A., additional, Spinosa, J.C., additional, Tezcan, H., additional, and Chae, Y.K., additional
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- 2019
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4. Longitudinal changes in cell-free DNA (cfDNA) methylation levels identify early non-responders to treatment in advanced solid tumours
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Davis, A.A., primary, Iams, W., additional, Chan, D., additional, Oh, M.S., additional, Lentz, R.W., additional, Srivas, R., additional, Lambert, N., additional, Robertson, A., additional, Peterman, N., additional, Shah, A., additional, Wilson, T., additional, Close, J., additional, George, P., additional, Wood, H., additional, Wong, B., additional, Tezcan, A., additional, Spinosa, J.C., additional, Tezcan, H., additional, and Chae, Y.K., additional
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- 2019
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5. Comparison of enzymatic-and bisulfite conversion to map the plasma cell-free methylome in cancer
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Lambert, N., primary, Robertson, A., additional, Srivas, R., additional, Peterman, N., additional, Close, J., additional, Wilson, T., additional, George, P., additional, Wood, H., additional, Wong, B., additional, Tezcan, A., additional, and Tezcan, H., additional
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- 2019
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6. P1.01-49 Serial Changes in Whole-Genome Cell-Free DNA (cfDNA) to Identify Disease Progression Prior to Imaging in Advanced NSCLC
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Davis, A., primary, Iams, W., additional, Chan, D., additional, Oh, M., additional, Lentz, R., additional, Peterman, N., additional, Robertson, A., additional, Shah, A., additional, Srivas, R., additional, Lambert, N., additional, Wilson, T., additional, Tezcan, A., additional, Spinosa, J., additional, Tezcan, H., additional, Mohindra, N., additional, Villaflor, V., additional, and Chae, Y.K., additional
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- 2019
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7. 116P - Longitudinal changes in cell-free DNA (cfDNA) methylation levels identify early non-responders to treatment in advanced solid tumours
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Davis, A.A., Iams, W., Chan, D., Oh, M.S., Lentz, R.W., Srivas, R., Lambert, N., Robertson, A., Peterman, N., Shah, A., Wilson, T., Close, J., George, P., Wood, H., Wong, B., Tezcan, A., Spinosa, J.C., Tezcan, H., and Chae, Y.K.
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- 2019
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- View/download PDF
8. 114P - Dynamic changes in whole-genome cell-free DNA (cfDNA) to identify disease progression prior to imaging in advanced solid tumours
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Davis, A.A., Iams, W., Chan, D., Oh, M.S., Lentz, R.W., Peterman, N., Robertson, A., Shah, A., Srivas, R., Lambert, N., Wilson, T., George, P., Wong, B., Close, J., Wood, H., Tezcan, A., Spinosa, J.C., Tezcan, H., and Chae, Y.K.
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- 2019
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9. 47P - Comparison of enzymatic-and bisulfite conversion to map the plasma cell-free methylome in cancer
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Lambert, N., Robertson, A., Srivas, R., Peterman, N., Close, J., Wilson, T., George, P., Wood, H., Wong, B., Tezcan, A., and Tezcan, H.
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- 2019
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10. Bills and Notes: Personal Liability of Agent Who Signs Note Which Principal Has No Legal Power to Execute
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Peterman, N. S.
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- 1949
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11. Quasi-Contracts: Taxation: Rescission of Gift for Failure to Achieve Donor's Purpose of Minimizing Federal Income Taxes
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Peterman, N. S.
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- 1949
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12. Insurance: Effect of Incontestable Clause in Suit for Reformation of Policy
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Peterman, N. S.
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- 1949
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13. Socioeconomic Disadvantage Predicts Decreased Likelihood of Maintaining a Functional Knee Arthroplasty Following Treatment for Prosthetic Joint Infection.
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Pagani NR, Grant A, Bamford M, Peterman N, Smith EL, and Gordon MR
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- Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Socioeconomic Factors, Knee Joint surgery, Aged, 80 and over, United States, Socioeconomic Disparities in Health, Arthroplasty, Replacement, Knee, Prosthesis-Related Infections surgery, Reoperation statistics & numerical data, Knee Prosthesis adverse effects
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Background: Prosthetic joint infection (PJI) carries major morbidity and mortality as well as a complicated and lengthy treatment course. In patients who have high degrees of socioeconomic disadvantage, this may be a particularly devastating complication. Our study sought to evaluate the impact of socioeconomic deprivation on outcomes following treatment for PJI of the knee., Methods: We conducted a retrospective review of revision total knee arthroplasty (TKA) procedures performed for the treatment of initial PJI between 2008 and 2020 at a single tertiary care center in the United States. The Area Deprivation Index (ADI) was used to quantify socioeconomic deprivation. The primary outcome measure was presence of a functional knee joint at the time of most recent follow-up defined as TKA components or an articulating spacer. A total of 96 patients were included for analysis. The median follow-up duration was 26.5 months., Results: There was no significant difference in the rate of treatment failure (P = .63). However, the proportion of patients who had a functional knee arthroplasty (in contrast to having undergone arthrodesis, amputation, or retention of a static spacer) declined significantly with increasing ADI index (81.8% for the least disadvantaged group, 58.7% for the middle group, 42.9% for the most disadvantaged group, P = .021)., Conclusions: Patients who have a higher socioeconomic disadvantage as measured by ADI are less likely to maintain a functional knee arthroplasty following treatment for TKA PJI. These findings support continued efforts to improve access to care and optimize treatment plans for patients who have socioeconomic disadvantage., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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14. Geospatial Evaluation of Disparities in Access to Cervical Spine Fusion in Metropolitan Areas Across the United States.
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Peterman N, Shivdasani K, Naik A, Dharnipragada R, Harrop J, Vaccaro AR, and Arnold PM
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- Humans, United States, Female, Male, Socioeconomic Factors, Medicare, Aged, Urban Population statistics & numerical data, Spinal Fusion, Cervical Vertebrae surgery, Health Services Accessibility statistics & numerical data, Healthcare Disparities
- Abstract
Study Design: Retrospective study with epidemiologic analysis of public Medicare data., Objective: The purpose of this study is to use geospatial analysis to identify disparities in access to cervical spine fusions in metropolitan Medicare populations., Summary of Background Data: Cervical spine fusion is among the most common elective procedures performed by spine surgeons and is the most common surgical intervention for degenerative cervical spine disease. Although some studies have examined demographic and socioeconomic trends in cervical spine fusion, few have attempted to identify where disparities exist and quantify them at a community level., Methods: Center for Medicare and Medicaid Services physician billing and Medicare demographic data sets from 2013 to 2020 were filtered to contain only cervical spine fusion procedures and then combined with US Census socioeconomic data. The Moran Index geospatial clustering algorithm was used to identify statistically significant hotspot and coldspots of cervical spine fusions per 100,000 Medicare members at a county level. Univariate and multivariate analysis was subsequently conducted to identify demographic and socioeconomic factors that are associated with access to care., Results: A total of 285,405 cervical spine fusions were analyzed. Hotspots of cervical spine fusion were located in the South, while coldspots were throughout the Northern Midwest, the Northeast, South Florida, and West Coast. The percent of Medicare patients that were Black was the largest negative predictor of cervical spine fusions per 100,000 Medicare members ( β =-0.13, 95% CI: -0.16, -0.10)., Conclusions: Barriers to access can have significant impacts on health outcomes, and these impacts can be disproportionately felt by marginalized groups. Accounting for socioeconomic disadvantage and geography, this analysis found the Black race to be a significant negative predictor of access to cervical spine fusions. Future studies are needed to further explore potential socioeconomic barriers that exist in access to specialized surgical care., Level of Evidence: Level III-retrospective., Competing Interests: Dr G.D.S has received funds to travel from AOSpine and Medtronic. Dr A.R.V. has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr A.R.V. has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr A.R.V. has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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15. National Trends in Orthopaedic Pain Management from 2016 to 2020.
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Peterman N, Shivdasani K, Pagani N, Mann R, Naik A, Pekas D, and Sun D
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- Humans, United States, Anticonvulsants therapeutic use, Drug Prescriptions statistics & numerical data, Orthopedic Surgeons trends, Orthopedic Surgeons statistics & numerical data, Male, Orthopedic Procedures trends, Orthopedic Procedures statistics & numerical data, Female, Pain Management trends, Pain Management statistics & numerical data, Practice Patterns, Physicians' trends, Practice Patterns, Physicians' statistics & numerical data, Medicare statistics & numerical data, Analgesics, Opioid therapeutic use, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Pain, Postoperative drug therapy
- Abstract
Introduction: Effective pain management is vital in orthopaedic care, impacting postoperative recovery and patient well-being. This study aimed to discern national and regional pain prescription trends among orthopaedic surgeons through Medicare claims data, using geospatial analysis to ascertain opioid and nonopioid usage patterns across the United States., Methods: Physician-level Medicare prescription databases from 2016 to 2020 were filtered to orthopaedic surgeons, and medications were categorized into opioids, muscle relaxants, anticonvulsants, and NSAIDs. Patient demographics were extracted from a Medicare provider demographic data set, while county-level socioeconomic metrics were obtained primarily from the American Community Survey. Geospatial analysis was conducted using Geoda software, using Moran I statistic for cluster analysis of pain medication metrics. Statistical trends were analyzed using linear regression, Mann-Whitney U test, and multivariate logistic regression, focusing on prescribing rates and hotspot/coldspot identification., Results: Analysis encompassed 16,505 orthopaedic surgeons, documenting more than 396 million days of pain medication prescriptions: 57.42% NSAIDs, 28.57% opioids, 9.84% anticonvulsants, and 4.17% muscle relaxants. Annually, opioid prescriptions declined by 4.43% ( P < 0.01), while NSAIDs rose by 3.29% ( P < 0.01). Opioid prescriptions dropped by 210.73 days yearly per surgeon ( P < 0.005), whereas NSAIDs increased by 148.86 days ( P < 0.005). Opioid prescriptions were most prevalent in the West Coast and Northern Midwest regions, and NSAID prescriptions were most prevalent in the Northeast and South regions. Regression pinpointed spine as the highest and hand as the lowest predictor for pain prescriptions., Discussion: On average, orthopaedic surgeons markedly decreased both the percentage of patients receiving opioids and the duration of prescription. Simultaneously, the fraction of patients receiving NSAIDs dramatically increased, without change in the average duration of prescription. Opioid hotspots were located in the West Coast, Utah, Colorado, Arizona, Idaho, the Northern Midwest, Vermont, New Hampshire, and Maine. Future directions could include similar examinations using non-Medicare databases., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)
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- 2024
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16. Geospatial evaluation of access to otolaryngology care in the United States.
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Pozin M, Nyaeme M, Peterman N, and Jagasia A
- Abstract
Objectives: This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions., Methods: Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables., Results: Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20)., Conclusion: These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions., Level of Evidence: Level 3., Competing Interests: The authors declare no conflicts of interest to disclose., (© 2024 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)
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- 2024
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17. Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations.
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Peterman N, Shivdasani K, Naik A, Yeo E, Simon J, Garst J, Moawad C, Stauffer C, Kaptur B, and Arnold PM
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- Aged, Humans, United States, Retrospective Studies, Incidence, Lumbar Vertebrae surgery, Medicare, Spinal Fusion methods
- Abstract
Study Design: Retrospective study with epidemiologic analysis of public Medicare data., Objective: This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations., Summary of Background Data: With an aging population and new technologies, lumbar fusion is an increasingly common procedure. There is controversy, however, regarding which indications and techniques achieve optimal outcomes, leading to significant intersurgeon variation and potential national disparities in care., Materials and Methods: Medicare billing datasets were supplemented with Census Bureau socioeconomic data from 2013 to 2020. These databases listed lumbar fusions billed to Medicare by location, specialty, and technique. Hotspots and coldspots of lumbar fusion incidence and technique choice were identified with county-level analysis and compared with Mann-Whitney U . A linear regression of fusion incidence and a logistic regression of lumbar fusion hotspots/coldspots were also calculated., Results: Between 2013 and 2020, 624,850 lumbar fusions were billed to Medicare. Lumbar fusion hotspots performed fusions at nearly five times the incidence of coldspots (101.6-21.1 fusions per 100,000 Medicare members) and were located in the Midwest, Colorado, and Virginia while coldspots were in California, Florida, Wisconsin, and the Northeast. Posterior and posterolateral fusion were the most favored techniques, with hotspots in the Northeast. Combined posterior and posterolateral fusion and posterior interbody fusion was the second most favored technique, predominantly in Illinois, Missouri, Arkansas, and Colorado., Conclusions: The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the nonstandardization of lumbar fusion indication has led to both overtreatment and undertreatment across the nation., Level of Evidence: Level 3-retrospective., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2024
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18. MMS hotspots: a cross-sectional comparison of U.S. counties with and without Mohs micrographic surgery.
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Sharma AN, Peterman N, Juhasz M, and Shive M
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- Aged, Humans, United States epidemiology, Mohs Surgery methods, Cross-Sectional Studies, Medicare, Retrospective Studies, Skin Neoplasms diagnosis, Skin Neoplasms epidemiology, Skin Neoplasms surgery, Surgeons
- Abstract
Healthcare access greatly impacts skin cancer diagnosis and mortality rates. Recognition of current disparities in Mohs micrographic surgery (MMS) access can assist future policy and clinical decisions to correct them. For the years 2014-2018, the CPT codes for MMS (17,311 and 17,313) were counted on a per county level across the United States per the Medicare Centers for Medicare & Medicaid Services (CMS) Medicare Prescriber Database. Any county with 0 MMS CPT codes recorded were classified as "without MMS cases." MMS "hotspots" were identified as counties that possessed a high average number of MMS cases compared to the national average, while also being surrounded by counties that possessed a low average number of MMS cases compared to the national average. Three thousand eighty-four counties in the United States were analyzed; 785 (25%) counties were designated as "with MMS cases" and 2301 (75%) "without MMS cases." There were no significant differences in age, ethnicity distribution, or cost per enrollee between the two designations. 74% of counties with MMS cases were considered urban, while only 25% of those without cases were urban (p < 0.01). The median household income was markedly higher in counties with MMS cases ($71,428 vs. $58,913, p < 0.01). With respect to education, more individuals in counties with MMS cases possessed their General Education Development (GED) (89% vs. 86%, p < 0.01) or a college degree (30% vs. 19%, p < 0.01). Forty-nine counties were considered MMS "hotspots." The density of MMS procedures varies greatly based on geography, maintaining the urban-rural disparity matched by the distribution of MMS surgeons. Additionally, there remains a wide income and educational gap between counties with and without MMS. Identifying MMS hotspots may facilitate further investigation into potential surgical access disparities., (© 2023. The Author(s).)
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- 2023
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19. Changes in Management at the Postoperative Visit After In-Office Wide Awake Local Anesthetic No Tourniquet Carpal Tunnel Release.
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Beck JH, Sandefur EP, Vest MO, Yu-Shan AA, Peterman N, and Apel PJ
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Purpose: Patients are commonly seen for two postoperative visits following carpal tunnel release (CTR), the first visit being at 1-2 weeks and the second at approximately 6 weeks. Our study aimed to determine if these visits led to changes in postoperative medical management., Methods: A retrospective review was conducted of 748 procedures performed in an in-office procedure room under wide awake local anesthetic no tourniquet between August 2020 and December 2022. Charts were reviewed for changes in management related to the patient's CTR. Management changes involving a separate diagnosis or solely an additional follow-up visit were classified as unrelated to postoperative CTR care., Results: A total of 730 patients returned for follow-up. There were 100 patients (13.7 %) who had a CTR-related change in management at the first postoperative visit. Most management changes at this timepoint were due to superficial surgical site infection. There were 29 patients (4.0 %) who had a CTR-related change in management at their second postoperative visit, most commonly a referral to therapy for stiffness or hypersensitivity., Conclusions: While postoperative visits for CTR may have intangible benefits, changes in CTR-related care occur only in 17.7% of patients., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
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- 2023
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20. Trends in medical device company payments in neurosurgery: a nationwide, multidatabase, geospatial analysis.
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Naik A, Peterman N, Berke C, Furey CG, DiDomenico J, Abbatematteo J, Detchou D, Catapano JS, Snyder LA, Lawton MT, Stroink A, and Arnold PM
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- Aged, Humans, United States, Medicare, Pandemics, Neurosurgeons, Databases, Factual, Neurosurgery, Physicians
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Objective: Industry partnerships help advance the field of neurosurgery. Given the nature of the field and its close relationship with innovation, neurosurgeons frequently partner with the medical device industry to advance technology and improve outcomes. However, this can create important ethical concerns for patients. In this paper, the authors sought to comprehensively study how physician payments from medical device companies have changed and what geographic parameters influence the trends observed over the years., Methods: The authors queried and merged several large databases, including Medicare and Medicaid provider usage data and databases from the Open Payments Program, National Plan and Provider Enumeration System, and US Census Bureau. Geospatial analysis was performed using Moran's I and II clustering. Univariate and multivariable analyses were performed using the Mann-Whitney U-test and geospatially weighted multivariable regression for hot spot and cold spot membership., Results: Data for 952 counties across the continental United States were analyzed. Ninety-seven counties constituted geographic hot spots. These hot spots were primarily concentrated in Florida, the New York-Pennsylvania region, central Colorado, and southwestern United States. Independent predictors of hot spot membership included greater unemployment rates, the percentage of White patients, the presence of mobile homes, and the percentage of county Hispanic and Black populations. Company-based differences were examined. The vast majority of Medtronic's payments were in the form of royalties and licensing (86.6%). Royalties and licensing accounted for the majority of payments for DePuy (69.4%), Globus Medical (62%), and NuVasive (77.1%). In contrast, other companies, such as Boston Scientific, opted to pay physicians in the form of ownership and investment interests (42.1%). The impact of the COVID-19 pandemic was also assessed. During the onset of the pandemic in 2020, physician payments fell or remained the same across all regions with the exception of the South Atlantic region. However, it was observed that nearly all regions rebounded, with stark elevations in physician payments immediately in 2021., Conclusions: This analysis demonstrates that there are national hot spots and cold spots of physician payments, and offers some social, economic, and company-dependent predictors that may influence the magnitude of payments. Further analysis is needed to better understand this clinical-commercial partnership in healthcare, specifically within neurosurgical practice.
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- 2023
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21. Factors influencing geographic gender disparity in neurosurgery: a nationwide geospatial clustering analysis.
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Naik A, Peterman N, Furey C, Paisan G, Catapano J, Bhardwaj D, Iyer A, Bederson M, Pappu S, Snyder L, Stroink A, Lawton MT, and Arnold PM
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- Humans, Female, Neurosurgeons, Neurosurgical Procedures, Cluster Analysis, Prevalence, Neurosurgery
- Abstract
Objective: Women neurosurgeons (WNs) continue to remain a minority in the specialty despite significant initiatives to increase their representation. One domain less explored is the regional distribution of WNs, facilitated by the hiring practices of neurosurgical departments across the US. In this analysis, the authors coupled the stated practice location of WNs with regional geospatial data to identify hot spots and cold spots of prevalence and examined regional predictors of increases and decreases in WNs over time., Methods: The authors examined the National Provider Identifier (NPI) numbers of all neurosurgeons obtained via the National Plan and Provider Enumeration System (NPPES), identifying the percentage of WNs in each county for which data were appended with data from the US Census Bureau. Change in WN rates was identified by calculating a regression slope for all years included (2015-2022). Hot spots and cold spots of WNs were identified through Moran's clustering analysis. Population and surgeon features were compared for hot spots and cold spots., Results: WNs constituted 10.73% of all currently active neurosurgical NPIs, which has increased from 2015 (8.81%). Three hot spots were found-including the Middle Atlantic and Pacific divisions-that contrasted with scattered cold spots throughout the East Central regions that included Memphis as a major city. Although relatively rapidly growing, hot spots had significant gender inequality, with a median WN percentage of 11.38% and a median of 0.61 WNs added to each respective county per year., Conclusions: The authors analyzed the prevalence of WNs by using aggregated data from the NPPES and US Census Bureau. The authors also show regional hot spots of WNs and that the establishment of WNs in a region is a predictor of additional WNs entering the region. These data suggest that female neurosurgical mentorship and representation may be a major driver of acceptance and further gender diversity in a given region.
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- 2023
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22. Geospatial Distribution of Ambulatory Surgery Center Utilization for Otorhinolaryngologic Surgeries Among Medicare Patients From 2015 to 2019.
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Nyaeme M, Yerrabelli RS, Peterman N, Kaptur B, Yeo E, and Carpenter KR
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Objective: To investigate the geographic clustering of ambulatory surgical center (ASC) utilization in otolaryngology to determine hot spot areas of high utilization and cold spot areas of low utilization and socioeconomic factors that correlate with these hot spots and cold spots., Study Design: To develop a national epidemiologic study of ASC utilization in otolaryngology in the United States., Setting: United States of America., Methods: Multiple county-level national databases were reviewed including Center for Medicare Services (CMS) physician billing data, CMS Medicare demographic data, and US Census socioeconomic data. The analysis was conducted using the average of all Medicare billing information from 2015 to 2019. Whether a procedure was performed in an ASC was extracted from CMS data using the CMS definition of an ASC. The percentage ASC billing was calculated as the fraction of CMS payments that were performed in ASCs for the top ENT procedures. A Python-based script for database building and GeoDa, Moran's I clustering coefficient, and a 1-way analysis of variance was utilized to chart and analyze demographic, geographic, and socioeconomic trends., Results: Hot spots of utilization, with an average ASC billing of 80.13%, were seen in Southern California, Florida, Mid-Atlantic, and clusters throughout the Deep South. Cold spot clusters, with an average ASC billing of 2.21%, were located in large swaths of New England, Ohio, and the Deep South with clusters bisecting the Midwest. Cold spots had a higher percentage of poverty and percent eligible for Medicaid., Conclusion: ASC utilization is best used to improve cost-effectiveness and accessibility of care but what is seen is that ASC use is currently highest in cities in coastal areas which already have high levels of care access and are making the most proportional money compared to their rural counterparts., Competing Interests: The authors deny any financial or ethical conflicts of interest. Specifically, no authors have financial ties or ownership of surgical centers., (© 2023 The Authors. OTO Open published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)
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- 2023
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23. Geospatial evaluation of disparities in neurosurgical access in the United States.
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Peterman N, Smith EJ, Liang E, Yeo E, Kaptur B, Naik A, Arnold PM, and Hassaneen W
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- Aged, Humans, Neurosurgeons, Socioeconomic Factors, Texas, United States epidemiology, Medicare, Neurosurgery
- Abstract
When neurosurgical care is needed, the distance to a facility staffed with a neurosurgeon is critical. This work utilizes geospatial analysis to analyze access to neurosurgery in the Medicare population and relevant socioeconomic factors. Medicare billing and demographic data from 2015 to 2019 were combined with national National Provider Identifier (NPI) registry data to identify the average travel distance to reach a neurosurgeon as well as the number of neurosurgeons in each county. This was merged with U.S. Census data to capture 23 socioeconomic attributes. Moran's I statistic was calculated across counties. Socioeconomic variables were compared using ANOVA. Hotspots with the highest neurosurgeon access were predominantly located in the Mid-Atlantic region, central Texas, and southern Montana. Coldspots were found in the Great Plains, Midwest, and Southern Texas. There were statistically significant differences (p < 0.05) between high- and low-access counties, including: stroke prevalence, poverty, median household income, and total population density. There were no statistically significant differences in most races or ethnicities. Overall, there exist statistically significant clusters of decreased neurosurgery access within the United States, with varying sociodemographic characteristics between access hotspots and coldspots., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)
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- 2022
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24. Nutraceuticals and dietary supplements: Disparities in usage and potential for harm.
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Kaptur B, Peterman N, and Lee J
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- Humans, Middle Aged, Surveys and Questionnaires, United States, Dietary Supplements adverse effects
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Background: The use of nutraceuticals and dietary supplements has a complex history. Aim: This work seeks to discuss the current state of nutraceuticals and dietary supplements, with a particular focus on the ambiguity of these terms, their current usage, potential harms, roles within the healthcare system, and associated disparities. Methods: This work reviews recent literature spanning the history of nutraceuticals and expands upon recommendations made by previous authors. Results: While a substantial portion of the United States population consumes these substances, their safety profiles are rarely well characterized. Taking a broad definition of these terms paints a picture of harmless use by a population that is middle-aged, educated, and white. However, focusing on specific substances reveals concerning disparities in race, ethnicity, income, physical health, and health literacy. This is of particular concern when looking at the side effects of these supplements both in isolation and due to drug-supplement interactions. Conclusions: In this work, the authors build upon the recommendations of others to propose ways in which physicians and healthcare systems can work to reduce the disproportionate harms of these substances on historically marginalized groups.
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- 2022
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25. Changes in Circulating Tumor DNA Reflect Clinical Benefit Across Multiple Studies of Patients With Non-Small-Cell Lung Cancer Treated With Immune Checkpoint Inhibitors.
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Vega DM, Nishimura KK, Zariffa N, Thompson JC, Hoering A, Cilento V, Rosenthal A, Anagnostou V, Baden J, Beaver JA, Chaudhuri AA, Chudova D, Fine AD, Fiore J, Hodge R, Hodgson D, Hunkapiller N, Klass DM, Kobie J, Peña C, Pennello G, Peterman N, Philip R, Quinn KJ, Raben D, Rosner GL, Sausen M, Tezcan A, Xia Q, Yi J, Young AG, Stewart MD, Carpenter EL, Aggarwal C, and Allen J
- Subjects
- Biomarkers, Tumor genetics, Clinical Trials as Topic, Humans, Immune Checkpoint Inhibitors pharmacology, Prognosis, Antineoplastic Agents, Immunological therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Circulating Tumor DNA genetics, Lung Neoplasms drug therapy
- Abstract
Purpose: As immune checkpoint inhibitors (ICI) become increasingly used in frontline settings, identifying early indicators of response is needed. Recent studies suggest a role for circulating tumor DNA (ctDNA) in monitoring response to ICI, but uncertainty exists in the generalizability of these studies. Here, the role of ctDNA for monitoring response to ICI is assessed through a standardized approach by assessing clinical trial data from five independent studies., Patients and Methods: Patient-level clinical and ctDNA data were pooled and harmonized from 200 patients across five independent clinical trials investigating the treatment of patients with non-small-cell lung cancer with programmed cell death-1 (PD-1)/programmed death ligand-1 (PD-L1)-directed monotherapy or in combination with chemotherapy. CtDNA levels were measured using different ctDNA assays across the studies. Maximum variant allele frequencies were calculated using all somatic tumor-derived variants in each unique patient sample to correlate ctDNA changes with overall survival (OS) and progression-free survival (PFS)., Results: We observed strong associations between reductions in ctDNA levels from on-treatment liquid biopsies with improved OS (OS; hazard ratio, 2.28; 95% CI, 1.62 to 3.20; P < .001) and PFS (PFS; hazard ratio 1.76; 95% CI, 1.31 to 2.36; P < .001). Changes in the maximum variant allele frequencies ctDNA values showed strong association across different outcomes., Conclusion: In this pooled analysis of five independent clinical trials, consistent and robust associations between reductions in ctDNA and outcomes were found across multiple end points assessed in patients with non-small-cell lung cancer treated with an ICI. Additional tumor types, stages, and drug classes should be included in future analyses to further validate this. CtDNA may serve as an important tool in clinical development and an early indicator of treatment benefit.
- Published
- 2022
- Full Text
- View/download PDF
26. Geospatial distribution of relative cesarean section rates within the USA.
- Author
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Yerrabelli RS, Peterman N, Kaptur B, Yeo E, and Carpenter K
- Subjects
- Female, Humans, Pregnancy, Rural Population, Socioeconomic Factors, Spatial Analysis, Cesarean Section, Obstetrics
- Abstract
Objective: To evaluate the existence of statistically significant clusters of Cesarean section rates at the county level and assess the relationship of such clusters with previously implicated socioeconomic factors., Results: County-level obstetrics data was extracted from March of Dimes, originally sourced from National Center for Health Statistics. County-level demographic data were extracted from the US Census Bureau. Access to obstetricians was extracted from National Provider Identifier records. Rural counties were identified using Rural Urban Commuting Area codes developed by the department of agriculture. The dataset was geospatially analyzed using Moran's I statistic, a metric of local spatial autocorrelation, to identify clusters of increased or decreased Cesarean section rates. The American South, especially the Deep South, is a major cluster of increased Cesarean section rates. As a general but not absolute pattern, the American West and Midwest had lower Cesarean section rates than the Northeast. Focal areas of increased Cesarean section rates included the Kansas-Nebraska border, Michigan's upper peninsula, and the New York City metropolitan area. The gross geospatial differences were not explained by rurality, obstetric access, or ethnic and racial factors alone., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
27. Prematurity and low birth weight: geospatial analysis and recent trends.
- Author
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Peterman N, Kaptur B, Lewis M, Ades L, and Carpenter K
- Abstract
Prematurity and low birth weight are of concern in neonatal health. In this work, geospatial analysis was performed to identify the existence of statistically significant clusters of prematurity and low birth weight using Moran's I. Data was obtained from March of Dimes and the National Center for Health Statistics for the years 2015 to 2019. Analysis demonstrated the presence of hotspot (High-High) and coldspot (Low-Low) geographic clusters of these variables in regions across the United States. Additionally, factorial ANOVA was performed, and revealed the significance of demographic variables of interest. Given the strong relationship between these two variables, regions that are hotspots for one variable, but not the other, are of particular interest for further study., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
28. Presentation and Management of a Giant Coronary Artery Aneurysm with a Fistula to the Right Ventricle.
- Author
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Peterman N, Kaptur B, and Adoni N
- Abstract
A 27-year-old female presented to our emergency department in ventricular tachycardia. During her workup, she was found to have an extremely rare giant aneurysmal left anterior descending artery (LAD) ending in a coronary fistula to the right ventricle (RV). After stabilization, a variety of treatment options were considered, as there is no standard first-line treatment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Nicholas Peterman et al.)
- Published
- 2022
- Full Text
- View/download PDF
29. Early Assessment of Molecular Progression and Response by Whole-genome Circulating Tumor DNA in Advanced Solid Tumors.
- Author
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Davis AA, Iams WT, Chan D, Oh MS, Lentz RW, Peterman N, Robertson A, Shah A, Srivas R, Wilson TJ, Lambert NJ, George PS, Wong B, Wood HW, Close JC, Tezcan A, Nesmith K, Tezcan H, and Chae YK
- Subjects
- Adult, Aged, Aged, 80 and over, Circulating Tumor DNA analysis, Female, Follow-Up Studies, Gene Expression Regulation, Neoplastic, Humans, Male, Middle Aged, Neoplasms drug therapy, Neoplasms genetics, Prognosis, Retrospective Studies, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Biomarkers, Tumor genetics, Circulating Tumor DNA genetics, Genome, Human, Mutation, Neoplasms pathology
- Abstract
Treatment response assessment for patients with advanced solid tumors is complex and existing methods require greater precision. Current guidelines rely on imaging, which has known limitations, including the time required to show a deterministic change in target lesions. Serial changes in whole-genome (WG) circulating tumor DNA (ctDNA) were used to assess response or resistance to treatment early in the treatment course. Ninety-six patients with advanced cancer were prospectively enrolled (91 analyzed and 5 excluded), and blood was collected before and after initiation of a new, systemic treatment. Plasma cell-free DNA libraries were prepared for either WG or WG bisulfite sequencing. Longitudinal changes in the fraction of ctDNA were quantified to retrospectively identify molecular progression (MP) or major molecular response (MMR). Study endpoints were concordance with first follow-up imaging (FFUI) and stratification of progression-free survival (PFS) and overall survival (OS). Patients with MP ( n = 13) had significantly shorter PFS (median 62 days vs. 310 days) and OS (255 days vs. not reached). Sensitivity for MP to identify clinical progression was 54% and specificity was 100%. MP calls were from samples taken a median of 28 days into treatment and 39 days before FFUI. Patients with MMR ( n = 27) had significantly longer PFS and OS compared with those with neither call ( n = 51). These results demonstrated that ctDNA changes early after treatment initiation inform response to treatment and correlate with long-term clinical outcomes. Once validated, molecular response assessment can enable early treatment change minimizing side effects and costs associated with additional cycles of ineffective treatment., (©2020 American Association for Cancer Research.)
- Published
- 2020
- Full Text
- View/download PDF
30. A Co-registration Pipeline for Multimodal MALDI and Confocal Imaging Analysis of Stem Cell Colonies.
- Author
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Nikitina A, Huang D, Li L, Peterman N, Cleavenger SE, Fernández FM, and Kemp ML
- Subjects
- Algorithms, Cluster Analysis, Fluorescent Antibody Technique, Humans, Microscopy, Confocal, Software, Image Processing, Computer-Assisted methods, Induced Pluripotent Stem Cells, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization methods
- Abstract
Multimodal mass spectrometry imaging (MSI) data presents unique big data challenges in handling and analysis. Here, we present a pipeline for co-registering matrix-assisted laser desorption/ionization MSI and confocal immunofluorescence imaging data for extracting single-cell metabolite signatures. We further describe methods and introduce software for the simultaneous analysis of these concatenated data sets, which are designed to establish a connection between cell traits of interest (shape metrics, position within sample) and the cells' own metabolic signatures.
- Published
- 2020
- Full Text
- View/download PDF
31. Dynamics of translation can determine the spatial organization of membrane-bound proteins and their mRNA.
- Author
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Korkmazhan E, Teimouri H, Peterman N, and Levine E
- Subjects
- Bacterial Proteins genetics, Cell Membrane metabolism, Membrane Proteins genetics, Models, Biological, Protein Biosynthesis, Protein Transport, RNA, Messenger genetics, Bacterial Proteins metabolism, Membrane Proteins metabolism, RNA, Messenger metabolism
- Abstract
Unlike most macromolecules that are homogeneously distributed in the bacterial cell, mRNAs that encode inner-membrane proteins can be concentrated near the inner membrane. Cotranslational insertion of the nascent peptide into the membrane brings the translating ribosome and the mRNA close to the membrane. This suggests that kinetic properties of translation can determine the spatial organization of these mRNAs and proteins, which can be modulated through posttranscriptional regulation. Here we use a simple stochastic model of translation to characterize the effect of mRNA properties on the dynamics and statistics of its spatial distribution. We show that a combination of the rate of translation initiation, the availability of secretory apparatuses, and the composition of the coding region determines the abundance of mRNAs near the membrane, as well as their residence time. We propose that the spatiotemporal dynamics of mRNAs can give rise to protein clusters on the membrane and determine their size distribution., Competing Interests: The authors declare no conflict of interest., (Copyright © 2017 the Author(s). Published by PNAS.)
- Published
- 2017
- Full Text
- View/download PDF
32. Sort-seq under the hood: implications of design choices on large-scale characterization of sequence-function relations.
- Author
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Peterman N and Levine E
- Subjects
- Computer Simulation, Flow Cytometry, Gene Library, Likelihood Functions, Mutation, High-Throughput Nucleotide Sequencing methods, Models, Genetic, Sequence Analysis, RNA methods
- Abstract
Background: Sort-seq is an effective approach for simultaneous activity measurements in a large-scale library, combining flow cytometry, deep sequencing, and statistical inference. Such assays enable the characterization of functional landscapes at unprecedented scale for a wide-reaching array of biological molecules and functionalities in vivo. Applications of sort-seq range from footprinting to establishing quantitative models of biological systems and rational design of synthetic genetic elements. Nearly as diverse are implementations of this technique, reflecting key design choices with extensive impact on the scope and accuracy the results. Yet how to make these choices remains unclear. Here we investigate the effects of alternative sort-seq designs and inference methods on the information output using mathematical formulation and simulations., Results: We identify key intrinsic properties of any system of interest with practical implications for sort-seq assays, depending on the experimental goals. The fluorescence range and cell-to-cell variability specify the number of sorted populations needed for quantitative measurements that are precise and unbiased. These factors also indicate cases where an enrichment-based approach that uses a single sorted population can offer satisfactory results. These predications of our model are corroborated using re-analysis of published data. We explore implications of these results for quantitative modeling and library design., Conclusions: Sort-seq assays can be streamlined by reducing the number of sorted populations, saving considerable resources. Simple preliminary experiments can guide optimal experiment design, minimizing cost while maintaining the maximal information output and avoiding latent biases. These insights can facilitate future applications of this highly adaptable technique.
- Published
- 2016
- Full Text
- View/download PDF
33. Quantitative effect of target translation on small RNA efficacy reveals a novel mode of interaction.
- Author
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Lavi-Itzkovitz A, Peterman N, Jost D, and Levine E
- Subjects
- Binding Sites, Models, Genetic, Ribosomes metabolism, 5' Untranslated Regions, Gene Silencing, Protein Biosynthesis, RNA, Small Untranslated metabolism
- Abstract
Small regulatory RNAs (sRNAs) in bacteria regulate many important cellular activities under normal conditions and in response to stress. Many sRNAs bind to the mRNA targets at or near the 5' untranslated region (UTR) resulting in translation inhibition and accelerated degradation. Often the sRNA-binding site is adjacent to or overlapping with the ribosomal binding site (RBS), suggesting a possible interplay between sRNA and ribosome binding. Here we combine quantitative experiments with mathematical modeling to reveal novel features of the interaction between small RNAs and the translation machinery at the 5'UTR of a target mRNA. By measuring the response of a library of reporter targets with varied RBSs, we find that increasing translation rate can lead to increased repression. Quantitative analysis of these data suggests a recruitment model, where bound ribosomes facilitate binding of the sRNA. We experimentally verified predictions of this model for the cell-to-cell variability of target expression. Our findings offer a framework for understanding sRNA silencing in the context of bacterial physiology., (© The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.)
- Published
- 2014
- Full Text
- View/download PDF
34. Large-scale mapping of sequence-function relations in small regulatory RNAs reveals plasticity and modularity.
- Author
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Peterman N, Lavi-Itzkovitz A, and Levine E
- Subjects
- Flow Cytometry, Models, Biological, Mutation, Nucleic Acid Conformation, RNA, Small Untranslated metabolism, Sequence Analysis, RNA, RNA, Small Untranslated chemistry
- Abstract
Two decades into the genomics era the question of mapping sequence to function has evolved from identifying functional elements to characterizing their quantitative properties including, in particular, their specificity and efficiency. Here, we use a large-scale approach to establish a quantitative map between the sequence of a bacterial regulatory RNA and its efficiency in modulating the expression of its targets. Our approach generalizes the sort-seq method, introduced recently to analyze promoter sequences, in order to accurately quantify the efficiency of a large library of sequence variants. We focus on two small RNAs (sRNAs) in E. coli, DsrA and RyhB, and their regulation of both repressed and activated targets. In addition to precisely identifying functional elements in the sRNAs, our data establish quantitative relationships between structural and energetic features of the sRNAs and their regulatory activity, and characterize a large set of direct and indirect interactions between nucleotides. A core of these interactions supports a model where specificity can be enhanced by a rigid molecular structure. Both sRNAs exhibit a modular design with limited cross-interactions, dividing the requirements for structural stability and target binding among modules., (© The Author(s) 2014. Published by Oxford University Press on behalf of Nucleic Acids Research.)
- Published
- 2014
- Full Text
- View/download PDF
35. Fabrication and characterization of nanopores with insulated transverse nanoelectrodes for DNA sensing in salt solution.
- Author
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Healy K, Ray V, Willis LJ, Peterman N, Bartel J, and Drndić M
- Subjects
- Computer Simulation, DNA chemistry, Electrochemical Techniques methods, Electrodes, Equipment Design, Finite Element Analysis, Potassium Chloride chemistry, Sequence Analysis, DNA methods, Silicon Compounds chemistry, DNA analysis, Electrochemical Techniques instrumentation, Nanopores, Sequence Analysis, DNA instrumentation
- Abstract
We report on the fabrication, simulation, and characterization of insulated nanoelectrodes aligned with nanopores in low-capacitance silicon nitride membrane chips. We are exploring these devices for the transverse sensing of DNA molecules as they are electrophoretically driven through the nanopore in a linear fashion. While we are currently working with relatively large nanopores (6-12 nm in diameter) to demonstrate the transverse detection of DNA, our ultimate goal is to reduce the size sufficiently to resolve individual nucleotide bases, thus sequencing DNA as it passes through the pore. We present simulations and experiments that study the impact of insulating these electrodes, which is important to localize the sensing region. We test whether the presence of nanoelectrodes or insulation affects the stability of the ionic current flowing through the nanopore, or the characteristics of DNA translocation. Finally, we summarize the common device failures and challenges encountered during fabrication and experiments, explore the causes of these failures, and make suggestions on how to overcome them in the future., (© 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)
- Published
- 2012
- Full Text
- View/download PDF
36. Discrimination of methylcytosine from hydroxymethylcytosine in DNA molecules.
- Author
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Wanunu M, Cohen-Karni D, Johnson RR, Fields L, Benner J, Peterman N, Zheng Y, Klein ML, and Drndic M
- Subjects
- Animals, Cytosine chemistry, Molecular Dynamics Simulation, Nucleic Acid Conformation, Polymerase Chain Reaction, 5-Methylcytosine chemistry, Cytosine analogs & derivatives, DNA chemistry
- Abstract
Modified DNA bases are widespread in biology. 5-Methylcytosine (mC) is a predominant epigenetic marker in higher eukaryotes involved in gene regulation, development, aging, cancer, and disease. Recently, 5-hydroxymethylcytosine (hmC) was identified in mammalian brain tissue and stem cells. However, most of the currently available assays cannot distinguish mC from hmC in DNA fragments. We investigate here the physical properties of DNA with modified cytosines, in efforts to develop a physical tool that distinguishes mC from hmC in DNA fragments. Molecular dynamics simulations reveal that polar cytosine modifications affect internal base pair dynamics, while experimental evidence suggest a correlation between the modified cytosine's polarity, DNA flexibility, and duplex stability. On the basis of these physical differences, solid-state nanopores can rapidly discriminate among DNA fragments with mC or hmC modification by sampling a few hundred molecules in the solution. Further, the relative proportion of hmC in the sample can be determined from the electronic signature of the intact DNA fragment.
- Published
- 2011
- Full Text
- View/download PDF
37. DNA translocation through graphene nanopores.
- Author
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Merchant CA, Healy K, Wanunu M, Ray V, Peterman N, Bartel J, Fischbein MD, Venta K, Luo Z, Johnson AT, and Drndić M
- Subjects
- Biological Transport, DNA chemistry, Membranes, Artificial, Nanostructures
- Abstract
We report on DNA translocations through nanopores created in graphene membranes. Devices consist of 1-5 nm thick graphene membranes with electron-beam sculpted nanopores from 5 to 10 nm in diameter. Due to the thin nature of the graphene membranes, we observe larger blocked currents than for traditional solid-state nanopores. However, ionic current noise levels are several orders of magnitude larger than those for silicon nitride nanopores. These fluctuations are reduced with the atomic-layer deposition of 5 nm of titanium dioxide over the device. Unlike traditional solid-state nanopore materials that are insulating, graphene is an excellent electrical conductor. Use of graphene as a membrane material opens the door to a new class of nanopore devices in which electronic sensing and control are performed directly at the pore.
- Published
- 2010
- Full Text
- View/download PDF
38. Bankruptcy bill would protect patients.
- Author
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Shapiro KJ and Peterman NA
- Subjects
- Health Facilities legislation & jurisprudence, Information Storage and Retrieval, Medical Record Linkage, Patient Advocacy legislation & jurisprudence, United States, Bankruptcy legislation & jurisprudence, Confidentiality legislation & jurisprudence, Patient Transfer legislation & jurisprudence
- Published
- 1998
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