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1. 2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium.

Author

Orechwa, Allison, Abhat, Anshu, Amezcua, Lilyana, Boden-Albala, Bernadette, Buchanan, Thomas, Chen, Steve, Daskivich, Lauren, Feldman, Brett, Gould, Michael, Lee, Wei-An, Lynch, Christopher, Meltzer, Carolyn, Mittman, Brian, Pereyda, Margarita, Raff, Evan, Robinson, Jehni, Saluja, Sonali, Turner, Barbara, Taira, Breena, Trotzky-Sirr, Rebecca, Williams, Linda, Wu, Shinyi, Yee, Hal, and Towfighi, Amytis

Subjects
disruptive innovation, evidence‐based interventions, health equity, healthcare delivery science, multi‐stakeholder engagement
Abstract

INTRODUCTION: This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium. METHODS: The symposium brought together esteemed experts from various disciplines to explore models for translating evidence-based interventions into practice. RESULTS: The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi-stakeholder engagement, and the significance of family and community involvement in healthcare interventions. CONCLUSIONS: The article concluded with a call to action for advancing healthcare delivery science to achieve health equity.

Published
2024

2. Persistent Inequities in Intravenous Thrombolysis for Acute Ischemic Stroke in the United States: Results From the Nationwide Inpatient Sample.

Author

Sun, Philip, Zheng, Ling, Lin, Michelle, Cen, Steven, Hammond, Gmerice, Joynt Maddox, Karen, Kim-Tenser, May, Sanossian, Nerses, Mack, William, and Towfighi, Amytis

Subjects
epidemiology, ethnicity, inequities, sex differences, thrombolysis, Humans, Female, United States, Male, Ischemic Stroke, Aged, Middle Aged, Thrombolytic Therapy, Healthcare Disparities, Adult, Aged, 80 and over, Young Adult, Adolescent, Fibrinolytic Agents, Inpatients, Time Factors, Administration, Intravenous, Insurance Coverage
Abstract

BACKGROUND: Despite its approval for acute ischemic stroke >25 years ago, intravenous thrombolysis (IVT) remains underused, with inequities by age, sex, race, ethnicity, and geography. Little is known about IVT rates by insurance status. METHODS AND RESULTS: We assessed temporal trends from 2002 to 2015 in IVT for acute ischemic stroke in the Nationwide Inpatient Sample using adjusted, survey-weighted logistic regression. We calculated odds ratios for IVT for each category in 2002 to 2008 (period 1) and 2009 to 2015 (period 2). IVT use for acute ischemic stroke increased from 1.0% in 2002 to 6.8% in 2015 (adjusted annual relative ratio, 1.15). Individuals aged ≥85 years had the most pronounced increase during 2002 to 2015 (adjusted annual relative ratio, 1.18) but were less likely to receive IVT compared with 18- to 44-year-olds in period 1 (adjusted odds ratio [aOR], 0.23) and period 2 (aOR, 0.36). Women were less likely than men to receive IVT, but the disparity narrowed over time (period 1: aOR, 0.81; period 2: aOR, 0.94). Inequities in IVT resolved for Hispanic individuals in period 2 (aOR, 0.96) but not for Black individuals (period 2: aOR, 0.81). The disparity in IVT for Medicare patients, compared with privately insured patients, lessened over time (period 1: aOR, 0.59; period 2: aOR, 0.75). Patients treated in rural hospitals remained less likely to receive IVT than in urban hospitals; a more dramatic increase in urbanity widened the inequity (period 2, urban nonteaching versus rural: aOR, 2.58, period 2, urban teaching versus rural: aOR, 3.90). CONCLUSIONS: IVT for acute ischemic stroke increased among adults. Despite some encouraging trends, the remaining disparities highlight the need for intensified efforts at addressing inequities.

Published
2024

3. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment.

Author

Poblete, Roy, Zhong, Charlotte, Patel, Anish, Kuo, Grace, Sun, Philip, Xiao, Jiayu, Fan, Zhaoyang, Sanossian, Nerses, Towfighi, Amytis, and Lyden, Patrick

Subjects
cerebral venous thrombosis, cervical artery dissection, stroke, traumatic brain injury, vasospasm
Abstract

Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.

Published
2024

6. Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help

Author

Holly D. Shan, Samuel S. Huffman, John D. Bovill, Zoë K. Haffner, Parhom Towfighi, Carol D. Benedict, and Karen K. Evans

Subjects
hidradenitis suppurativa, anxiety, depression, psychiatric comorbidities, financial stress, Surgery, RD1-811
Abstract

Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS.

Published
2024
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7. Doxorubicin Removal from Water using Acid-treated Activated Carbon, Multi-walled Carbon Nanotubes, and Montmorillonite

Author

N. Rezaei, J. Rahbar Shahrouzi, A. Ebadi, F. Towfighi, and F. Moradi

Subjects
activated carbon, adsorption, carbon nanotube, doxorubicin, montmorillonite, Chemical engineering, TP155-156
Abstract

Medical wastewater is a significant contributor to environmental pollution, posing severe risks to both human health and the environment. To resolve this challenge, the removal of anti-cancer drugs from medical wastewater has been considered. This study investigated the removal of doxorubicin, an effective anti-cancer drug, from an aqueous solution using three types of adsorbents: activated carbon, multi-walled carbon nanotube, and montmorillonite. Our findings revealed that carbon nanotubes exhibited superior performance in doxorubicin removal from water compared to the other two adsorbents. Specifically, the maximum adsorption capacity of doxorubicin with an initial concentration of 50 mg L–1 on the carbon nanotube reached 500 mg g–1. In addition, surface modification of the adsorbents with acid resulted in a 15 % and 41 % increase in adsorption capacity, and an 85 % and 67 % reduction in equilibrium time for carbon nanotube and montmorillonite, respectively. The increasing pH proved to enhance the adsorption efficiency of carbon nanotubes and activated carbon, with the best performance achieved at solution pH of 10 and 8 for MWCNTs and AC, respectively.

Published
2024
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8. A bifunctional catalyst for direct CO2 conversion to clean fuels: Mechanistic insights and a comprehensive kinetic model

Author

Masoud Safari Yazd and Jafar Towfighi Darian

Subjects
Modified Fischer-Tropsch synthesis, CO2 hydrogenation, Bifunctional catalyst, Molecular dynamic evaluated mechanism, Minimum energy pathway, Kinetic model, Fuel, TP315-360, Renewable energy sources, TJ807-830
Abstract

The escalating global concern over CO2 emissions has spurred extensive research aimed at developing innovative solutions for capturing, storing, and utilizing CO2, crucial for establishing a closed carbon loop. Thermo-catalytic CO2 hydrogenation stands out as a promising approach, though challenged by CO2's high stability, hindering the production of heavy liquid hydrocarbons. This study explores the design and performance of a bifunctional cobalt-based catalyst, promoted by Ru and supported by multiple shells of carbon, mesoporous silica, and ceria for CO2 hydrogenation in the Modified Fischer-Tropsch Synthesis (MFTS) route. Through meticulous characterization and evaluation, the catalyst demonstrates suitable textural properties, reducibility, and dispersion of active sites, promoting CO2 conversion and selectivity towards heavier hydrocarbons, highlighting the significance of catalyst design and operating conditions. The catalyst exhibits notable stability across catalyst deactivation, attributed to its thermal conductivity provided by SiC matrices. SiC-supported catalysts play a pivotal role in enhancing the efficiency, selectivity, and stability of CO2 hydrogenation catalysts. Moreover, in this study, through meticulous evaluation of elementary reactions based on molecular dynamic (MD) computations, a detailed mechanism for MFTS is presented. Key to this mechanism is the H-assisted CO2 dissociation pathway, supported by computational analysis. The pathway involves sequential reactions starting from CO2 adsorption on catalyst sites, followed by successive transformations leading to the formation of hydrocarbon building blocks. Ultimately, a developed MFTS kinetic model based on the MD-evaluated mechanism, which accurately predicts product selectivity across various operational conditions, indicating its robustness and reliability, is presented.

Published
2024
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9. Adsorption study of CO2/CH4 and CO2/N2 binary mixtures on titanosilicates ETS-10 and SrETS-10; industrial application aspects

Author

Amirhossein Khademi, Ensieh Ganji Babakhani, Jafar Towfighi Darian, Hamid Reza Mahdipoor, and Mahnaz Pourkhalil

Subjects
Adsorption, Carbon dioxide, ETS-10, Ion-exchange, IAST, Adsorption kinetics, Industrial electrochemistry, TP250-261
Abstract

Despite the outstanding features of the titanosilicate ETS-10 and some studies done on CO2 adsorption so far, there is a lack of coherent information to evaluate its potential industrial application in CO2 separation from natural gas and flue gas. In this work, ETS-10 and SrETS-10 were synthesized and characterized by PXRD, SEM, DTA, EDX, and BET. Pure gas adsorption isotherms of CO2, CH4, and N2 at 298 K were obtained by the constant-volume method. The obtained adsorption data were fitted with Langmuir and UNILAN isotherm models. The CO2/CH4 selectivity (yCO2 = 0.05) predicted by Ideal Adsorption Solution Theory (IAST) was 67.54 and 35.65 for ETS-10 and SrETS-10, respectively, while the CO2/N2 selectivity (yCO2 = 0.04) was 94.64 and 99.94. The Pseudo-Nth-Order (PNO) and micropore diffusion model were used to evaluate the CO2 adsorption kinetics and diffusivity of the adsorbents. The results showed that both ETS-10 and SrETS-10 exhibited fast kinetics for CO2 adsorption, but SrETS-10 had a slightly smaller diffusion coefficient (DC/rC2 = 0.01494 and 0.01458 s−1 for ETS-10 and SrETS-10, respectively) resulting in a slower adsorption rate than ETS-10. The regenerability of ETS-10 and SrETS-10 was studied and it was found that for ETS-10 about 79.07% and 96.32% of the capacity can be regenerated by applying vacuum and heating, respectively and also 79.67% of the SrETS-10 capacity can also be regenerated by applying vacuum. From the results of this work with an approach of industrial application, it was concluded that ETS-10 and SrETS-10 can be used in a combined PSA and TSA process for CO2 separation.

Published
2024
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10. 2023 Inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium

Author

Allison Z. Orechwa, Anshu Abhat, Lilyana Amezcua, Bernadette Boden‐Albala, Thomas A. Buchanan, Steve Chen, Lauren P. Daskivich, Brett Feldman, Michael K. Gould, Wei‐an Lee, Christopher Lynch, Carolyn C. Meltzer, Brian S. Mittman, Margarita Pereyda, Evan Raff, Jehni Robinson, Sonali Saluja, Barbara J. Turner, Breena R. Taira, Rebecca Trotzky‐Sirr, Linda Williams, Shinyi Wu, Hal Yee Jr., and Amytis Towfighi

Subjects
disruptive innovation, evidence‐based interventions, health equity, healthcare delivery science, multi‐stakeholder engagement, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Abstract Introduction This article provides an overview of presentations and discussions from the inaugural Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium. Methods The symposium brought together esteemed experts from various disciplines to explore models for translating evidence‐based interventions into practice. Results The symposium highlighted the importance of disruptive innovation in healthcare, the need for multi‐stakeholder engagement, and the significance of family and community involvement in healthcare interventions. Conclusions The article concluded with a call to action for advancing healthcare delivery science to achieve health equity.

Published
2024
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11. Post-Traumatic Cerebral Infarction: A Narrative Review of Pathophysiology, Diagnosis, and Treatment

Author

Roy A. Poblete, Charlotte Zhong, Anish Patel, Grace Kuo, Philip Y. Sun, Jiayu Xiao, Zhaoyang Fan, Nerses Sanossian, Amytis Towfighi, and Patrick D. Lyden

Subjects
traumatic brain injury, stroke, cervical artery dissection, cerebral venous thrombosis, vasospasm, Medicine, Internal medicine, RC31-1245, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

Traumatic brain injury (TBI) is a common diagnosis requiring acute hospitalization. Long-term, TBI is a significant source of health and socioeconomic impact in the United States and globally. The goal of clinicians who manage TBI is to prevent secondary brain injury. In this population, post-traumatic cerebral infarction (PTCI) acutely after TBI is an important but under-recognized complication that is associated with negative functional outcomes. In this comprehensive review, we describe the incidence and pathophysiology of PTCI. We then discuss the diagnostic and treatment approaches for the most common etiologies of isolated PTCI, including brain herniation syndromes, cervical artery dissection, venous thrombosis, and post-traumatic vasospasm. In addition to these mechanisms, hypercoagulability and microcirculatory failure can also exacerbate ischemia. We aim to highlight the importance of this condition and future clinical research needs with the goal of improving patient outcomes after TBI.

Published
2024
Full Text
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21. Early trajectories of virological and immunological biomarkers and clinical outcomes in patients admitted to hospital for COVID-19: an international, prospective cohort study

Author

Sahner, David, Tierney, John, Vogel, Susan E., Herpin, Betsey R., Smolskis, Mary C., McKay, Laura A., Cahill, Kelly, Crew, Page, Sardana, Ratna, Raim, Sharon Segal, Hensely, Lisa, Lorenzo, Johsua, Mock, Rebecca, Zuckerman, Judith, Atri, Negin, Miller, Mark, Vallee, David, Chung, Lucy, Kang, Nayon, Barrett, Kevin, Adam, Stacey J., Read, Sarah, Draghia-Akli, Ruxandra, Currier, Judy, Hughes, Eric, Harrigan, Rachel H., Amos, Laura, Carlsen, Amy, Carter, Anita, Collins, Gary, Davis, Bionca, Denning, Eileen, DuChene, Alain, Eckroth, Kate, Engen, Nicole, Frase, Alex, Gandits, Greg, Grund, Birgit, Harrison, Merrie, Hurlbut, Nancy, Kaiser, Payton, Koopmeiners, Joseph, Larson, Gregg, Meger, Sue, Mistry, Shweta Sharma, Murray, Thomas, Nelson, Ray, Quan, Kien, Quan, Siu Fun, Reilly, Cavan, Siegel, Lianne, Thompson, Greg, Vock, David, Walski, Jamie, Gelijns, Annetine C., Moskowitz, Alan J., Bagiella, Emilia, Moquete, Ellen, O'Sullivan, Karen, Marks, Mary E., Accardi, Evan, Kinzel, Emily, Burris, Sarah, Bedoya, Gabriela, Gupta, Lola, Overbey, Jessica R., Santos, Milerva, Gillinov, Marc A., Miller, Marissa A., Taddei-Peters, Wendy C., Fenton, Kathleen, Sandkovsky, Uriel, Gottlieb, Robert L., Mack, Michael, Berhe, Mezgebe, Haley, Clinton, Dishner, Emma, Bettacchi, Christopher, Golden, Kevin, Duhaime, Erin, Ryan, Madison, Tallmadge, Catherine, Estrada, Lorie, Jones, Felecia, Villa, Samatha, Wang, Samatha, Robert, Raven, Coleman, Tanquinisha, Clariday, Laura, Baker, Rebecca, Hurutado-Rodriguez, Mariana, Iram, Nazia, Fresnedo, Michelle, Davis, Allyson, Leonard, Kiara, Ramierez, Noelia, Thammavong, Jon, Duque, Krizia, Turner, Emma, Fisher, Tammy, Robinson, Dianna, Ransom, Desirae, Maldonado, Nicholas, Lusk, Erica, Killian, Aaron, Palacious, Adriana, Solis, Edilia, Jerrow, Janet, Watts, Matthew, Whitacre, Heather, Cothran, Elizabeth, Smith, Peter K., Barkauskas, Christina E., Vekstein, Andrew M., Ko, Emily R., Dreyer, Grace R., Stafford, Neil, Brooks, Megan, Der, Tatyana, Witte, Marie, Gamarallage, Ruwan, Franzone, John, Ivey, Noel, Lumsden, Rebecca H., Mosaly, Nilima, Mourad, Ahmaad, Holland, Thomas L., Motta, Mary, Lane, Kathleen, McGowan, Lauren M., Stout, Jennifer, Aloor, Heather, Bragg, Kennesha M., Toledo, Barvina, McLendon-Arvik, Beth, Bussadori, Barbara, Hollister, Beth A., Griffin, Michelle, Giangiacomo, Dana M., Rodriguez, Vicente, Bokhart, Gordon, Eichman, Sharon M., Parrino, Patrick E., Spindel, Stephen, Bansal, Aditya, Baumgarten, Katherine, Hand, Johnathan, Vonderhaar, Derek, Nossaman, Bobby, Sylvia Laudun, Ames, DeAnna, Broussard, Shane, Hernandez, Nilmo, Isaac, Geralyn, Dinh, Huan, Zheng, Yiling, Tran, Sonny, McDaniel, Hunter, Crovetto, Nicolle, Perin, Emerson, Costello, Briana, Manian, Prasad, Sohail, M. Rizwan, Postalian, Alexander, Hinsu, Punit, Watson, Carolyn, Chen, James, Fink, Melyssa, Sturgis, Lydia, Walker, Kim, Mahon, Kim, Parenti, Jennifer, Kappenman, Casey, Knight, Aryn, Sturek, Jeffrey M., Barros, Andrew, Enfield, Kyle B., Kadl, Alexandra, Green, China J., Simon, Rachel M., Fox, Ashley, Thornton, Kara, Adams, Amy, Badhwar, Vinay, Sharma, Sunil, Peppers, Briana, McCarthy, Paul, Krupica, Troy, Sarwari, Arif, Reece, Rebecca, Fornaresico, Lisa, Glaze, Chad, Evans, Raquel, Di, Fang, Carlson, Shawn, Aucremanne, Tanja, Tennant, Connie, Sutton, Lisa Giblin, Buterbaugh, Sabrina, Williams, Roger, Bunner, Robin, Traverse, Jay H., Rhame, Frank, Huelster, Joshua, Kethireddy, Rajesh, Davies, Irena, Salamanca, Julianne, Majeski, Christine, Skelton, Paige, Zarambo, Maria, Sarafolean, Andrea, Bowdish, Michael E., Borok, Zea, Wald-Dickler, Noah, Hutcheon, Douglass, Towfighi, Amytis, Lee, Mary, Lewis, Meghan R., Spellberg, Brad, Sher, Linda, Sharma, Aniket, Olds, Anna P., Justino, Chris, Loxano, Edward, Romero, Chris, Leong, Janet, Rodina, Valentina, Quesada, Christine, Hamilton, Luke, Escobar, Jose, Leshnower, Brad, Bender, William, Sharifpour, Milad, Miller, Jeffrey, Farrington, Woodrow, Baio, Kim T., McBride, Mary, Fielding, Michele, Mathewson, Sonya, Porte, Kristina, Maton, Missy, Ponder, Chari, Haley, Elisabeth, Spainhour, Christine, Rogers, Susan, Tyler, Derrick, Madathil, Ronson J., Rabin, Joseph, Levine, Andrea, Saharia, Kapil, Tabatabai, Ali, Lau, Christine, Gammie, James S., Peguero, Maya-Loren, McKernan, Kimberly, Audette, Mathew, Fleischmann, Emily, Akbari, Kreshta, Lee, Myounghee, Chi, Andrew, Salehi, Hanna, Pariser, Alan, Nyguyen, Phuong Tran, Moore, Jessica, Gee, Adrienne, Vincent, Shelika, Zuckerman, Richard A., Iribarne, Alexander, Metzler, Sara, Shipman, Samantha, Johnson, Haley, Newton, Crystallee, Parr, Doug, Miller, Leslie, Schelle, Beth, McLean, Sherry, Rothbaum, Howard R., Alvarez, Michael S., Kalan, Shivam P., Germann, Heather H., Hendershot, Jennifer, Moroney, Karen, Herring, Karen, Cook, Sharri, Paul, Pam, Walker-Ignasiak, Rebecca, North, Crystal, Oldmixon, Cathryn, Ringwood, Nancy, Muzikansky, Ariela, Morse, Richard, Fitzgerald, Laura, Morin, Haley D., Brower, Roy G., Reineck, Lora A., Bienstock, Karen, Steingrub, Jay H., Hou, Peter K., Steingrub, Jay S., Tidswell, Mark A., Kozikowski, Lori-Ann, Kardos, Cynthia, DeSouza, Leslie, Romain, Sarah, Thornton-Thompson, Sherell, Talmor, Daniel, Shapiro, Nathan, Andromidas, Konstantinos, Banner-Goodspeed, Valerie, Bolstad, Michael, Boyle, Katherine L., Cabrera, Payton, deVilla, Arnaldo, Ellis, Joshua C., Grafals, Ana, Hayes, Sharon, Higgins, Conor, Kurt, Lisa, Kurtzman, Nicholas, Redman, Kimberly, Rosseto, Elinita, Scaffidi, Douglas, Filbin, Michael R., Hibbert, Kathryn A., Parry, Blair, Margolin, Justin, Hillis, Brooklynn, Hamer, Rhonda, Brait, Kelsey, Beakes, Caroline, McKaig, Brenna, Kugener, Eleonore, Jones, Alan E., Galbraith, James, Nandi, Utsav, Peacock, Rebekah, Hendey, Gregory, Kangelaris, Kirsten, Ashktorab, Kimia, Gropper, Rachel, Agrawal, Anika, Yee, Kimberley J., Jauregui, Alejandra E., Zhuo, Hanjing, Almasri, Eyad, Fayed, Mohamed, Hubel, Kinsley A., Hughes, Alyssa R., Garcia, Rebekah L., Lim, George W., Chang, Steven Y., Lin, Michael Y., Vargas, Julia, Sihota, Hena, Beutler, Rebecca, Agarwal, Trisha, Wilson, Jennifer G., Vojnik, Rosemary, Perez, Cynthia, McDowell, Jordan H., Roque, Jonasel, Wang, Henry, Huebinger, Ryan M., Patel, Bela, Vidales, Elizabeth, Albertson, Timothy, Hardy, Erin, Harper, Richart, Moss, Marc A., Baduashvili, Amiran, Chauhan, Lakshmi, Douin, David J., Martinez, Flora, Finck, Lani L., Bastman, Jill, Howell, Michelle, Higgins, Carrie, McKeehan, Jeffrey, Finigan, Jay, Stubenrauch, Peter, Janssen, William J., Griesmer, Christine, VerBurg, Olivia, Hyzy, Robert C., Park, Pauline K., Nelson, Kristine, McSparron, Jake I., Co, Ivan N., Wang, Bonnie R., Jimenez, Jose, Olbrich, Norman, McDonough, Kelli, Jia, Shijing, Hanna, Sinan, Gong, Michelle N., Richardson, Lynne D., Nair, Rahul, Lopez, Brenda, Amosu, Omowunmi, Offor, Obiageli, Tzehaie, Hiwet, Nkemdirim, William, Boujid, Sabah, Mosier, Jarrod M., Hypes, Cameron, Campbell, Elizabeth Salvagio, Bixby, Billie, Gilson, Boris, Lopez, Anitza, Bime, Christian, Parthasarathy, Sairam, Cano, Ariana M., Hite, R. Duncan, Terndrup, Thomas E., Wiedemann, Herbert P., Hudock, Kristin, Tanzeem, Hammad, More, Harshada, Martinkovic, Jamie, Sellers, Susan, Houston, Judy, Burns, Mary, Kiran, Simra, Roads, Tammy, Kennedy, Sarah, Duggal, Abhijit, Thiruchelvam, Nirosshan, Ashok, Kiran, King, Alexander H., Mehkri, Omar, Dugar, Siddharth, Sahoo, Debasis, Yealy, Donald M., Angus, Derek C., Weissman, Alexandra J., Vita, Tina M., Berryman, Emily, Hough, Catherine L., Khan, Akram, Krol, Olivia F., Mills, Emmanuel, Kinjal, Mistry, Briceno, Genesis, Reddy, Raju, Hubel, Kinsley, Jouzestani, Milad K., McDougal, Madeline, Deshmukh, Rupali, Johnston, Nicholas J., Robinson, Bryce H., Gundel, Staphanie J., Katsandres, Sarah C., Chen, Peter, Torbati, Sam S., Parimon, Tanyalak, Caudill, Antonina, Mattison, Brittany, Jackman, Susan E., Chen, Po-En, Bayoumi, Emad, Ojukwu, Cristabelle, Fine, Devin, Weissberg, Gwendolyn, Isip, Katherine, Choi-Kuaea, Yunhee, Mehdikhani, Shaunt, Dar, Tahir B., Fleury Augustin, Nsole Biteghe, Tran, Dana, Dukov, Jennifer Emilow, Matusov, Yuri, Choe, June, Hindoyan, Niree A., Wynter, Timothy, Pascual, Ethan, Clapham, Gregg J., Herrera, Lisa, Caudill, Antonia, O’Mahony, D. Shane, Nyatsatsang, Sonam T., Wilson, David M., Wallick, Julie A., Duven, Alexandria M., Fletcher, Dakota D., Miller, Chadwick, Files, D. Clark, Gibbs, Kevin W., Flores, Lori S., LaRose, Mary E., Landreth, Leigha D., Palacios, D. Rafael, Parks, Lisa, Hicks, Madeline, Goodwin, Andrew J., Kilb, Edward F., Lematty, Caitlan T., Patti, Kerilyn, Grady, Abigail, Rasberry, April, Morris, Peter E., Sturgill, Jamie L., Cassity, Evan P., Dhar, Sanjay, Montgomery-Yates, Ashley A., Pasha, Sarah N., Mayer, Kirby P., Pharm.D., Brittany Bissel, Trott, Terren, Rehman, Shahnaz, de Wit, Marjolein, Mason, Jessica, Bledsoe, Joseph, Knowlton, Kirk U., Brown, Samuel, Lanspa, Michael, Leither, Lindsey, Pelton, Ithan, Armbruster, Brent P., Montgomery, Quinn, Kumar, Naresh, Fergus, Melissa, Imel, Karah, Palmer, Ghazal, Webb, Brandon, Klippel, Carolyn, Jensen, Hannah, Duckworth, Sarah, Gray, Andrew, Burke, Tyler, Knox, Dan, Lumpkin, Jenna, Aston, Valerie T., Applegate, Darrin, Serezlic, Erna, Brown, Katie, Merril, Mardee, Harris, Estelle S., Middleton, Elizabeth A., Barrios, Macy A.G., Greer, Jorden, Schmidt, Amber D., Webb, Melissa K., Paine, Roert, Callahan, Sean J., Waddoups, Lindsey J., Yamane, Misty B., Self, Wesley H., Rice, Todd W., Casey, Jonathan D., Johnson, Jakea, Gray, Christopher, Hays, Margaret, Roth, Megan, Menon, Vidya, Kasubhai, Moiz, Pillai, Anjana, Daniel, Jean, Sittler, Daniel, Kanna, Balavenkatesh, Jilani, Nargis, Amaro, Francisco, Santana, Jessica, Lyakovestsky, Aleksandr, Madhoun, Issa, Desroches, Louis Marie, Amadon, Nicole, Bahr, Alaa, Ezzat, Imaan, Guerrero, Maryanne, Padilla, Joane, Fullmer, Jessie, Singh, Inderpreet, Ali Shah, Syed Hamad, Narang, Rajeev, Mock, Polly, Shadle, Melissa, Hernandez, Brenda, Welch, Kevin, Payne, Andrea, Ertl, Gabriela, Canario, Daniel, Barrientos, Isabel, Goss, Danielle, DeVries, Mattie, Folowosele, Ibidolapo, Garner, Dorothy, Gomez, Mariana, Price, Justin, Bansal, Ekta, Wong, Jim, Faulhaber, Jason, Fazili, Tasaduq, Yeary, Brian, Ndolo, Ruth, Bryant, Christina, Smigeil, Bridgette, Robinson, Philip, Najjar, Rana, Jones, Patrice, Nguyen, Julie, Chin, Christina, Taha, Hassan, Najm, Salah, Smith, Christopher, Moore, Jason, Nassar, Talal, Gallinger, Nick, Christian, Amy, Mauer, D’Amber, Phipps, Ashley, Waters, Michael, Zepeda, Karla, Coslet, Jordan, Landazuri, Rosalynn, Pineda, Jacob, Uribe, Nicole, Garcia, Jose Ruiz, Barbabosa, Cecilia, Sandler, Kaitlyn, Overcash, J. Scott, Marquez, Adrienna, Chu, Hanh, Lee, Kia, Quillin, Kimberly, Garcia, Andrea, Lew, Pauline, Rogers, Ralph, Shehadeh, Fadi, Mylona, Evangelia K., Kaczynski, Matthew, Tran, Quynh-Lam, Benitez, Gregorio, Mishra, Biswajit, Felix, Lewis Oscar, Vafea, Maria Tsikala, Atalla, Eleftheria, Davies, Robin, Hedili, Salma, Monkeberg, Maria Andrea, Tabler, Sandra, Harrington, Britt, Meegada, Sreenath, Koripalli, Venkata Sandeep, Muddana, Prithvi, Jain, Lakshay, Undavalli, Chaitanya, Kavya, Parasa, Ibiwoye, Mofoluwaso, Akilo, Hameed, Lovette, Bryce D., Wylie, Jamie-Crystal, Smith, Diana M., Poon, Kenneth, Eckardt, Paula, Heysu, Rubio-Gomez, Sundararaman, Nithya, Alaby, Doris, Sareli, Candice, Sánchez, Adriana, Popielski, Laura, Kambo, Amy, Viens, Kimberley, Turner, Melissa, Vjecha, Michael J., Weintrob, Amy, Brar, Indira, Markowitz, Norman, Pastor, Erika, Corpuz, Roweena, Alangaden, George, McKinnon, John, Ramesh, Mayur, Herc, Erica, Yared, Nicholas, Lanfranco, Odaliz Abreu, Rivers, Emanuel, Swiderek, Jennifer, Gupta, Ariella Hodari, Pabla, Pardeep, Eliya, Sonia, Jazrawi, Jehan, Delor, Jeremy, Desai, Mona, Cook, Aaron, Jaehne, Anja Kathrina, Gill, Jasreen Kaur, Renaud, Sheri, Sarveswaran, Siva, Gardner, Edward, Scott, James, Bianchini, Monica, Melvin, Casey, Kim, Gina, Wyles, David, Kamis, Kevin, Miller, Rachel, Douglas, Ivor, Haukoos, Jason, Hicks, Carrie, Lazarte, Susana, Marines-Price, Rubria, Osuji, Alice, Agbor Agbor, Barbine Tchamba, Petersen, Tianna, Kamel, Dena, Hansen, Laura, Garcia, Angie, Cha, Christine, Mozaffari, Azadeh, Hernandez, Rosa, Cutrell, James, Kim, Mina, DellaValle, Natalie, Gonzales, Sonia, Somboonwit, Charurut, Oxner, Asa, Guerra, Lucy, Hayes, Michael, Nguyen, Thi, Tran, Thanh, Pinto, Avenette, Hatlen, Timothy, Anderson, Betty, Zepeda-Gutierrez, Ana, Martin, Dannae, Temblador, Cindi, Cuenca, Avon, Tanoviceanu, Roxanne, Prieto, Martha, Guerrero, Mario, Daar, Eric, Correa, Ramiro, Hartnell, Gabe, Wortmann, Glenn, Doshi, Saumil, Moriarty, Theresa, Gonzales, Melissa, Garman, Kristin, Baker, Jason V., Frosch, Anne, Goldsmith, Rachael, Driver, Brian, Frank, Christine, Leviton, Tzivia, Prekker, Matthew, Jibrell, Hodan, Lo, Melanie, Klaphake, Jonathan, Mackedanz, Shari, Ngo, Linh, Garcia-Myers, Kelly, Kunisaki, Ken M., Wendt, Chris, Melzer, Anne, Wetherbee, Erin, Drekonja, Dimitri, Pragman, Alexa, Hamel, Aimee, Thielen, Abbie, Hassler, Miranda, Walquist, Mary, Augenbraun, Michael, George, Jensen, Demeo, Lynette, Mishko, Motria, Thomas, Lorraine, Tatem, Luis, Dehovitz, Jack, Abassi, Mahsa, Leuck, Anne-Marie, Rao, Via, Pullen, Matthew, Luke, Darlette, LaBar, Derek, Christiansen, Theresa, Howard, Diondra, Biswas, Kousick, Harrington, Cristin, Garcia, Amanda, Bremer, Tammy, Burke, Tara, Koker, Brittany, Davis-Karim, Anne, Pittman, David, Vasudeva, Shikha S., Johnstone, Jaylynn R., Agnetti, Kate, Davis, Ruby, Trautner, Barbara, Hines-Munson, Casey, Van, John, Dillon, Laura, Wang, Yiqun, Nagy-Agren, Stephanie, Vasudeva, Shikha, Ochalek, Tracy, Caldwell, Erin, Humerickhouse, Edward, Boone, David, McGraw, William, Looney, David J., Mehta, Sanjay R., Johns, Scott Thompson, St. John, Melissa, Raceles, Jacqueline, Sear, Emily, Funk, Stephen, Cesarini, Rosa, Fang, Michelle, Nicalo, Keith, Drake, Wonder, Jones, Beatrice, Holtman, Teresa, Nguyen, Hien H., Maniar, Archana, Johnson, Eric A., Nguyen, Lam, Tran, Michelle T., Barrett, Thomas W., Johnston, Tera, Huggins, John T., Beiko, Tatsiana Y., Hughes, Heather Y., McManigle, William C., Tanner, Nichole T., Washburn, Ronald G., Ardelt, Magdalena, Tuohy, Patricia A., Mixson, Jennifer L., Hinton, Charles G., Thornley, Nicola, Allen, Heather, Elam, Shannon, Boatman, Barry, Baber, Brittany J., Ryant, Rudell, Roller, Brentin, Nguyen, Chinh, Mikail, Amani Morgan, Research, Marivic Hansen, Lichtenberger, Paola, Baracco, Gio, Ramos, Carol, Bjork, Lauren, Sueiro, Melyssa, Tien, Phyllis, Freasier, Heather, Buck, Theresa, Nekach, Hafida, Holodniy, Mark, Chary, Aarthi, Lu, Kan, Peters, Theresa, Lopez, Jessica, Tan, Susanna Yu, Lee, Robert H., Asghar, Aliya, Karyn Isip, Tasadduq Karim, Le, Katherine, Nguyen, Thao, Wong, Shinn, Raben, Dorthe, Murray, Daniel D., Jensen, Tomas O., Peters, Lars, Aagaard, Bitten, Nielsen, Charlotte B., Krapp, Katharina, Nykjær, Bente Rosdahl, Olsson, Christina, Kanne, Katja Lisa, Grevsen, Anne Louise, Joensen, Zillah Maria, Bruun, Tina, Bojesen, Ane, Woldbye, Frederik, Normand, Nick E., Esman, Frederik V.L., Benfield, Thomas, Clausen, Clara Lundetoft, Hovmand, Nichlas, Israelsen, Simone Bastrup, Iversen, Katrine, Leding, Caecilie, Pedersen, Karen Brorup, Thorlacius-Ussing, Louise, Tinggaard, Michaela, Tingsgard, Sandra, Krohn-Dehli, Louise, Pedersen, Dorthe, Villadsen, Signe, Staehr Jensen, Jens-Ulrik, Overgaard, Rikke, Rastoder, Ema, Heerfordt, Christian, Hedsund, Caroline, Ronn, Christian Phillip, Kamstrup, Peter Thobias, Hogsberg, Dorthe Sandbaek, Bergsoe, Christina, Søborg, Christian, Hissabu, Nuria M.S., Arp, Bodil C., Ostergaard, Lars, Staerke, Nina Breinholt, Yehdego, Yordanos, Sondergaard, Ane, Johansen, Isik S., Pedersen, Andreas Arnholdt, Knudtzen, Fredrikke C., Larsen, Lykke, Hertz, Mathias A., Fabricius, Thilde, Holden, Inge K., Lindvig, Susan O., Helleberg, Marie, Gerstoft, Jan, Kirk, Ole, Jensen, Tomas Ostergaard, Madsen, Birgitte Lindegaard, Pedersen, Thomas Ingemann, Harboe, Zitta Barrella, Roge, Birgit Thorup, Hansen, Thomas Michael, Glesner, Matilde Kanstrup, Lofberg, Sandra Valborg, Nielsen, Ariella Denize, Leicht von Huth, Sebastian, Nielsen, Henrik, Thisted, Rikke Krog, Petersen, Kristine Toft, Juhl, Maria Ruwald, Podlekareva, Daria, Johnsen, Stine, Andreassen, Helle Frost, Pedersen, Lars, Clara Ellinor Lindnér, Cecilia Ebba, Wiese, Lothar, Knudsen, Lene Surland, Skrøder Nytofte, Nikolaj Julian, Havmøller, Signe Ravn, Expósito, Maria, Badillo, José, Martínez, Ana, Abad, Elena, Chamorro, Ana, Figuerola, Ariadna, Mateu, Lourdes, España, Sergio, Lucero, Maria Constanza, Santos, José Ramón, Lladós, Gemma, Lopez, Cristina, Carabias, Lydia, Molina-Morant, Daniel, Loste, Cora, Bracke, Carmen, Siles, Adrian, Fernández-Cruz, Eduardo, Di Natale, Marisa, Padure, Sergiu, Gomez, Jimena, Ausin, Cristina, Cervilla, Eva, Balastegui, Héctor, Sainz, Carmen Rodríguez, Lopez, Paco, Carbone, Javier, Escobar, Mariam, Balerdi, Leire, Legarda, Almudena, Roldan, Montserrat, Letona, Laura, Muñoz, José, Camprubí, Daniel, Arribas, Jose R., Sánchez, Rocio Montejano, Díaz-Pollán, Beatriz, Stewart, Stefan Mark, Garcia, Irene, Borobia, Alberto, Mora-Rillo, Marta, Estrada, Vicente, Cabello, Noemi, Nuñez-Orantos, M.J., Sagastagoitia, I., Homen, J.R., Orviz, E., Montalvá, Adrián Sánchez, Espinosa-Pereiro, Juan, Bosch-Nicolau, Pau, Salvador, Fernando, Burgos, Joaquin, Morales-Rull, Jose Luis, Moreno Pena, Anna Maria, Acosta, Cristina, Solé-Felip, Cristina, Horcajada, Juan P., Sendra, Elena, Castañeda, Silvia, López-Montesinos, Inmaculada, Gómez-Junyent, Joan, Gonzáles, Carlota Gudiol, Cuervo, Guilermo, Pujol, Miquel, Carratalà, Jordi, Videla, Sebastià, Günthard, Huldrych, Braun, Dominique L., West, Emily, M’Rabeth-Bensalah, Khadija, Eichinger, Mareile L., Grüttner-Durmaz, Manuela, Grube, Christina, Zink, Veronika, pharmacist, Goes pharmacist, Josefine, Fätkenheuer, Gerd, Malin, Jakob J., Tsertsvadze, Tengiz, Abutidze, Akaki, Chkhartishvili, Nikoloz, Metchurtchlishvili, Revaz, Endeladze, Marina, Paciorek, Marcin, Bursa, Dominik, Krogulec, Dominika, Pulik, Piotr, Ignatowska, Anna, Horban, Andrzej, Bakowska, Elzbieta, Kowaska, Justyna, Bednarska, Agnieszka, Jurek, Natalia, Skrzat-Klapaczynska, Agata, Bienkowski, Carlo, Hackiewicz, Malgorzata, Makowiecki, Michal, Platowski, Antoni, Fishchuk, Roman, Kobrynska, Olena, Levandovska, Khrystyna, Kirieieva, Ivanna, Kuziuk, Mykhailo, Naucler, Pontus, Perlhamre, Emma, Mazouch, Lotta, Kelleher, Anthony, Polizzotto, Mark, Carey, Catherine, Chang, Christina C., Hough, Sally, Virachit, Sophie, Davidson, Sarah, Bice, Daniel J., Ognenovska, Katherine, Cabrera, Gesalit, Flynn, Ruth, Young, Barnaby E., Chia, Po Ying, Lee, Tau Hong, Lin, Ray J., Lye, David C., Ong, Sean W.X., Puah, Ser Hon, Yeo, Tsin Wen, Diong, Shiau Hui, Ongko, Juwinda, Yeo, He Ping, Eriobu, Nnakelu, Kwaghe, Vivian, Zaiyad, Habib, Idoko, Godwin, Uche, Blessing, Selvamuthu, Poongulali, Kumarasamy, Nagalingeswaran, Beulah, Faith Ester, Govindarajan, Narayan, Mariyappan, Kowsalya, Losso, Marcelo H., Abela, Cecilia, Moretto, Renzo, Belloc, Carlos G., Ludueña, Jael, Amar, Josefina, Toibaro, Javier, Macias, Laura Moreno, Fernandez, Lucia, Frare, Pablo S., Chaio, Sebastian R., Pachioli, Valeria, Timpano, Stella M., Sanchez, Marisa del Lujan, de Paz Sierra, Mariana, Stanek, Vanina, Belloso, Waldo, Cilenti, Flavia L., Valentini, Ricardo N., Stryjewski, Martin E., Locatelli, Nicolas, Soler Riera, Maria C., Salgado, Clara, Baeck, Ines M., Di Castelnuovo, Valentina, Zarza, Stella M., Hudson, Fleur, Parmar, Mahesh K.B., Goodman, Anna L., Dphil, Badrock, Jonathan, Gregory, Adam, Goodall, Katharine, Harris, Nicola, Wyncoll, James, Bhagani, S., Rodger, A., Luntiel, A., Patterson, C., Morales, J., Witele, E., Preston, A.-M., Nandani, A., Price, D.A., Hanrath, Aiden, Nell, Jeremy, Patel, Bijal, Hays, Carole, Jones, Geraldine, Davidson, Jade, Bawa, T., Mathews, M., Mazzella, A., Bisnauthsing, K., Aguilar-Jimenez, L., Borchini, F., Hammett, S., Touloumi, Giota, Pantazis, Nikos, Gioukari, Vicky, Souliou, Tania, Antoniadou, A., Protopapas, K., Kavatha, D., Grigoropoulou, S., Oikonomopoulo, C., Moschopoulos, C., Koulouris, N.G., Tzimopoulos, K., Koromilias, A., Argyraki, K., Lourida, P., Bakakos, P., Kalomenidis, I., Vlachakos, V., Barmparessou, Z., Balis, E., Zakynthinos, S., Sigala, I., Gianniou, N., Dima, E., Magkouta, S., Synolaki, E., Konstanta, S., Vlachou, M., Stathopoulou, P., Panagopoulos, P., Petrakis, V., Papazoglou, D., Tompaidou, E., Isaakidou, E., Poulakou, G., Rapti, V., Leontis, K., Nitsotolis, T., Athanasiou, K., Syrigos, K., Kyriakoulis, K., Trontzas, I., Arfara-Melanini, M., Kolonis, V., Kityo, Cissy, Mugerwa, Henry, Kiweewa, Francis, Kimuli, Ivan, Lukaakome, Joseph, Nsereko, Christoher, Lubega, Gloria, Kibirige, Moses, Nakahima, William, Wangi, Deus, Aguti, Evelyne, Generous, Lilian, Massa, Rosemary, Nalaki, Margaret, Magala, Felix, Nabaggala, Phiona Kaweesi, Kidega, Robert, Faith, Oryem Daizy, Florence, Apio, Emmanuel, Ocung, Beacham, Mugoonyi Paul, Geoffrey, Amone, Nakiboneka, Dridah, Apiyo, Paska, Kirenga, Bruce, Atukunda, Angella, Muttamba, Winters, Remmy, Kyeyume, Segawa, Ivan, Pheona, Nsubuga, Kigere, David, Mbabazi, Queen Lailah, Boersalino, Ledra, Nyakoolo, Grace, Fred, Aniongo, Alupo, Alice, Ebong, Doryn, Monday, Edson, Nalubwama, Ritah Norah, Kainja, Milton, Ambrose, Munu, Kwehayo, Vanon, Nalubega, Mary Grace, Ongoli, Augustine, Obbo, Stephen, Sebudde, Nicholus, Alaba, Jeniffer, Magombe, Geoffrey, Tino, Harriet, Obonya, Emmanuel, Lutaakome, Joseph, Kitonsa, Jonathan, Onyango, Martin, Naboth, Tukamwesiga, Naluyinda, Hadijah, Nanyunja, Regina, Irene, Muttiibwa, Jane, Biira, Wimfred, Kyobejja, Leonard, Ssemazzi, Deus, Tkiinomuhisha, Babra, Namasaba, Taire, Paul, Nabankema, Evelyn, Ogavu, Joseph, Mugerwa, Oscar, Okoth, Ivan, Mwebaze, Raymond, Mugabi, Timothy, Makhoba, Anthony, Arikiriza, Phiona, Theresa, Nabuuma, Nakayima, Hope, Frank, Kisuule, Ramgi, Patrícia, Pereira, Kássia, Osinusi, Anu, Cao, Huyen, Klekotka, Paul, Price, Karen, Nirula, Ajay, Osei, Suzette, Tipple, Craig, Wills, Angela, Peppercorn, Amanda, Watson, Helen, Gupta, Rajesh, Alexander, Elizabeth, Mogalian, Erik, Lin, Leo, Ding, Xiao, Margolis, David, Yan, Li, Girardet, Jean-Luc, Ma, Ji, Hong, Zhi, Zhu, Quing, Seegobin, Seth, Gibbs, Michael, Latchman, Mickel, Hasior, Katarzyna, Bouquet, Jerome, Wei, Jianxin, Streicher, Katie, Schmelzer, Albert, Brooks, Dennis, Butcher, Jonny, Tonev, Dimitar, Arbetter, Douglas, Damstetter, Philippe, Legenne, Philippe, Stumpp, Michael, Goncalves, Susana, Ramanathan, Krishnan, Chandra, Richa, Baseler, Beth, Teitelbaum, Marc, Schechner, Adam, Holley, H. Preston, Jankelevich, Shirley, Becker, Nancy, Dolney, Suzanne, Hissey, Debbie, Simpson, Shelly, Kim, Mi Ha, Beeler, Joy, Harmon, Liam, Asomah, Mabel, Jato, Yvonne, Stottlemyer, April, Tang, Olivia, Vanderpuye, Sharon, Yeon, Lindsey, Buehn, Molly, Eccard-Koons, Vanessa, Frary, Sadie, MacDonald, Leah, Cash, Jennifer, Hoopengardner, Lisa, Linton, Jessica, Schaffhauser, Marylu, Nelson, Michaela, Spinelli-Nadzam, Mary, Proffitt, Calvin, Lee, Christopher, Engel, Theresa, Fontaine, Laura, Osborne, C.K., Hohn, Matt, Galcik, Michael, Thompson, DeeDee, Kopka, Stacey, Shelley, Denise M., Mendez, Gregg, Brown, Shawn, Albert, Sara, Balde, Abby, Baracz, Michelle, Bielica, Mona, Billouin-Frazier, Shere, Choudary, Jay, Dixon, Mary, Eyler, Carolyn, Frye, Leanne, Gertz, Jensen, Giebeig, Lisa, Gulati, Neelam, Hankinson, Liz, Hogarty, Debi, Huber, Lynda, Krauss, Gary, Lake, Eileen, Manandhar, Meryan, Rudzinski, Erin, Sandrus, Jen, Suders, Connie, Natarajan, Ven, Rupert, Adam W., Baseler, Michael, Lynam, Danielle, Imamichi, Tom, Laverdure, Sylvain, McCormack, Ashley, Paudel, Sharada, Cook, Kyndal, Haupt, Kendra, Khan, Ayub, Hazen, Allison, Badralmaa, Yunden, Smith, Kenneth, Patel, Bhakti, Kubernac, Amanda, Kubernac, Robert, Hoover, Marie L., Solomon, Courtney, Rashid, Marium, Murphy, Joseph, Brown, Craig, DuChateau, Nadine, Ellis, Sadie, Flosi, Adam, Fox, Lisa, Johnson, Les, Nelson, Rich, Stojanovic, Jelena, Treagus, Amy, Wenner, Christine, Williams, Richard, Jensen, Tomas O, Murray, Thomas A, Grandits, Greg A, Jain, Mamta K, Shaw-Saliba, Kathryn, Matthay, Michael A, Baker, Jason V, Dewar, Robin L, Goodman, Anna L, Hatlen, Timothy J, Highbarger, Helene C, Lallemand, Perrine, Leshnower, Bradley G, Looney, David, Moschopoulos, Charalampos D, Murray, Daniel D, Mylonakis, Eleftherios, Rehman, M Tauseef, Rupert, Adam, Stevens, Randy, Turville, Stuart, Wick, Katherine, Lundgren, Jens, and Ko, Emily R

Published
2024
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22. Persistent Inequities in Intravenous Thrombolysis for Acute Ischemic Stroke in the United States: Results From the Nationwide Inpatient Sample

Author

Philip Sun, Ling Zheng, Michelle Lin, Steven Cen, Gmerice Hammond, Karen E. Joynt Maddox, May Kim‐Tenser, Nerses Sanossian, William Mack, and Amytis Towfighi

Subjects
epidemiology, ethnicity, inequities, sex differences, thrombolysis, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Despite its approval for acute ischemic stroke >25 years ago, intravenous thrombolysis (IVT) remains underused, with inequities by age, sex, race, ethnicity, and geography. Little is known about IVT rates by insurance status. Methods and Results We assessed temporal trends from 2002 to 2015 in IVT for acute ischemic stroke in the Nationwide Inpatient Sample using adjusted, survey‐weighted logistic regression. We calculated odds ratios for IVT for each category in 2002 to 2008 (period 1) and 2009 to 2015 (period 2). IVT use for acute ischemic stroke increased from 1.0% in 2002 to 6.8% in 2015 (adjusted annual relative ratio, 1.15). Individuals aged ≥85 years had the most pronounced increase during 2002 to 2015 (adjusted annual relative ratio, 1.18) but were less likely to receive IVT compared with 18‐ to 44‐year‐olds in period 1 (adjusted odds ratio [aOR], 0.23) and period 2 (aOR, 0.36). Women were less likely than men to receive IVT, but the disparity narrowed over time (period 1: aOR, 0.81; period 2: aOR, 0.94). Inequities in IVT resolved for Hispanic individuals in period 2 (aOR, 0.96) but not for Black individuals (period 2: aOR, 0.81). The disparity in IVT for Medicare patients, compared with privately insured patients, lessened over time (period 1: aOR, 0.59; period 2: aOR, 0.75). Patients treated in rural hospitals remained less likely to receive IVT than in urban hospitals; a more dramatic increase in urbanity widened the inequity (period 2, urban nonteaching versus rural: aOR, 2.58, period 2, urban teaching versus rural: aOR, 3.90). Conclusions IVT for acute ischemic stroke increased among adults. Despite some encouraging trends, the remaining disparities highlight the need for intensified efforts at addressing inequities.

Published
2024
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23. Improvement of catalyst activity in cracking of n-hexane via metal (Fe/Ga) impregnation over ZSM-12 catalyst

Author

Samira Soltani, Akbar Zamaniyan, Jafar Towfighi Darian, and Saeed Soltanali

Subjects
Light olefins, ZSM-12, Metal impregnation, Cracking, MTW, Chemistry, QD1-999
Abstract

In this research, zeolite ZSM-12 with Si/Al ratio = 80 was synthesized by hydrothermal method. The synthesized zeolite ZSM-12 was modified using Fe and Ga metals and a combination of these two metals, 1 % iron metals (Z80-Fe) and 1 % gallium metals(Z80-Ga), and a 2 % combination of these two metals (Z80-Fe-Ga). The physicochemical properties of synthesized zeolites were evaluated and compared by XRD, EDX-dot-mapping, NH3-TPD, BET, FT-IR, and TGA analyses. The catalytic assessment of synthesized zeolites in the HTO (n-hexane to olefins) process in a fixed bed reactor under atmospheric pressure and Weight hourly space velocity (WHSV) equal to 4 h−1 at 550 °C was evaluated. Various parameters such as selectivity towards light olefins, propylene to ethylene (P/E ratio), production of light alkanes, and aromatic compounds (BTX) were investigated. The results show that using metals led to the improvement and adjustment of the acid sites of zeolite, and the highest amount of light olefin and the lowest amount of coke were obtained. The result of the n-hexane to olefin process showed that the yield of light olefins was significantly improved in all modified catalysts compared to parent zeolite MTW. Compared to other modified zeolites, Z80-Fe-Ga zeolite has the highest yield of light olefins, equal to 59 %. This zeolite performs better due to the presence of gallium and iron metals and shows the highest propylene selectivity (P/E = 2.4). In addition, according to the results of the TGA analysis, the content of coke on the Z80-Fe-Ga catalyst after the catalytic reaction is much less than that of other catalysts after the catalytic reactor test.

Published
2024
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25. Moving Towards Equity With Digital Health Innovations for Stroke Care

Author

Verma, Aradhana, Towfighi, Amytis, Brown, Arleen, Abhat, Anshu, and Casillas, Alejandra

Subjects
Health Services and Systems, Public Health, Health Sciences, Prevention, Brain Disorders, Clinical Research, Health Services, Stroke, 8.1 Organisation and delivery of services, Health and social care services research, Good Health and Well Being, COVID-19, Health Equity, Humans, Inventions, Pandemics, SARS-CoV-2, Telemedicine, digital divide, health, health services, ischemic stroke, telerehabilitation, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Digital health has long been championed as a means to expanding access to health care. Now that the COVID-19 pandemic accelerated many health systems' integration of digital tools for care, digital health may provide a path towards more accessible stroke prevention and treatment, particularly for historically disadvantaged patient populations. Stroke management is composed of multiple time points where digital health innovations have the potential to augment health access and treatment: from primary prevention, to the time-sensitive detection of ischemic stroke, administration of thrombolytic agents and consideration for endovascular interventions, to appropriate post-acute care, rehabilitation, and lifelong secondary stroke prevention-stroke care relies on a multidisciplinary and standardized approach. However, as we discuss pointedly in this Focused Update, underrepresented individuals face multilevel digital health disparities that potentially diminish the benefits of these digital advances. As such, these multilevel needs must be discussed and accounted for as health systems seek to integrate innovative and equitable digital health solutions towards stroke care.

Published
2022

26. Optimization of La-Ce/HZSM-5 catalyst for thermal catalytic cracking of naphtha to light olefins to save energy and reduce CO2 emission

Author

Shadi Moammer and Jafar Towfighi

Subjects
catalytic cracking, light olefins, optimization, analysis of variance, Environmental technology. Sanitary engineering, TD1-1066
Abstract

Thermal cracking of hydrocarbons at 850-900 degree centigrade is the governing technology worldwide for light olefins production. But the most disadvantages of this route is large energy consumption and air pollution because of flue gas emission containing CO2 and NOx. To overcome these drawbacks catalytic cracking is an important and new field for research. So, in this work the effects of temperature and loadings of cerium and lanthanum over HZSM-5 catalyst for thermal catalytic cracking of naphtha were investigated using response surface methodology. In these experiments, the temperature, Ce, and La loadings were varied from 600 to 700 °C, 4 to 12wt.%, and 0.8 to 3wt%, respectively. The Box-Behnken design was utilized and a set of experiments were designed to obtain the optimum catalyst for maximizing the yield of ethylene and propylene. The analysis of variance (ANOVA) was carried out to identify the statistical significance of independent factors and their interactions. The results showed that temperature and Ce loading had the highest effects on the yields of ethylene and propylene, respectively. Based on the multi-objective optimization, the maximum yields of ethylene and propylene (17 and 33wt%, respectively) were obtained at cerium loading of 12 wt.%, lanthanum loading of 1.2 wt.%, and temperature of 700 °C

Published
2023
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29. Mass cytometry reveals single-cell kinetics of cytotoxic lymphocyte evolution in CMV-infected renal transplant patients

Author

Ishiyama, Kenichi, Arakawa-Hoyt, Janice, Aguilar, Oscar A, Damm, Izabella, Towfighi, Parhom, Sigdel, Tara, Tamaki, Stanley, Babdor, Joel, Spitzer, Matthew H, Reed, Elaine F, Sarwal, Minnie M, Lanier, Lewis L, Ahn, Richard, Brook, Jenny, Bunnapradist, Suphamai, Datta, Nakul, Deng, Mario, Diamond, Don, Doung, Tin, Gadzhyan, Janette, Elashoff, David, Gjertson, David, Groysberg, Victoria, Hoffman, Alexander, Lum, Erik, Pickering, Harry, Qian, Zach, Ramirez, Michelle, Rossetti, Maura, Rychov, Dimitri, Schaenman, Joanna, Schroeder, Andrew, Sen, Subha, Sim, Danielle, Sirota, Marina, Vicenti, Flavio, and Yang, Otto

Subjects
Kidney Disease, Infectious Diseases, Transplantation, Organ Transplantation, Inflammatory and immune system, Adult, CD8-Positive T-Lymphocytes, Cell Separation, Cytomegalovirus, Cytomegalovirus Infections, Female, Flow Cytometry, Graft Rejection, Humans, Kidney Transplantation, Killer Cells, Natural, Kinetics, Lymphocyte Activation, Male, Middle Aged, NK Cell Lectin-Like Receptor Subfamily C, Single-Cell Analysis, Viremia, NK cell, renal transplantation, cytomegalovirus, mass cytometry, cytotoxic lymphocyte, CMV Systems Immunobiology Group
Abstract

Cytomegalovirus (CMV) infection is associated with graft rejection in renal transplantation. Memory-like natural killer (NK) cells expressing NKG2C and lacking FcεRIγ are established during CMV infection. Additionally, CD8+ T cells expressing NKG2C have been observed in some CMV-seropositive patients. However, in vivo kinetics detailing the development and differentiation of these lymphocyte subsets during CMV infection remain limited. Here, we interrogated the in vivo kinetics of lymphocytes in CMV-infected renal transplant patients using longitudinal samples compared with those of nonviremic (NV) patients. Recipient CMV-seropositive (R+) patients had preexisting memory-like NK cells (NKG2C+CD57+FcεRIγ-) at baseline, which decreased in the periphery immediately after transplantation in both viremic and NV patients. We identified a subset of prememory-like NK cells (NKG2C+CD57+FcεRIγlow-dim) that increased during viremia in R+ viremic patients. These cells showed a higher cytotoxic profile than preexisting memory-like NK cells with transient up-regulation of FcεRIγ and Ki67 expression at the acute phase, with the subsequent accumulation of new memory-like NK cells at later phases of viremia. Furthermore, cytotoxic NKG2C+CD8+ T cells and γδ T cells significantly increased in viremic patients but not in NV patients. These three different cytotoxic cells combinatorially responded to viremia, showing a relatively early response in R+ viremic patients compared with recipient CMV-seronegative viremic patients. All viremic patients, except one, overcame viremia and did not experience graft rejection. These data provide insights into the in vivo dynamics and interplay of cytotoxic lymphocytes responding to CMV viremia, which are potentially linked with control of CMV viremia to prevent graft rejection.

Published
2022

30. Perturbations of the T-cell immune repertoire in kidney transplant rejection

Author

Sigdel, Tara K, Fields, Paul A, Liberto, Juliane, Damm, Izabella, Kerwin, Maggie, Hood, Jill, Towfighi, Parhom, Sirota, Marina, Robins, Harlan S, and Sarwal, Minnie M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Immunology, Digestive Diseases, Kidney Disease, Rare Diseases, Transplantation, Clinical Research, Organ Transplantation, Renal and urogenital, Inflammatory and immune system, Humans, T-Lymphocytes, Kidney Transplantation, Cross-Sectional Studies, Postoperative Complications, Biopsy, Antibodies, kidney transplantation, TCR sequencing, acute rejection, immune repertoire, T cell-mediated rejection, antibody-mediated rejection, Medical Microbiology, Biochemistry and cell biology, Genetics
Abstract

In this cross-sectional and longitudinal analysis of mapping the T-cell repertoire in kidney transplant recipients, we have investigated and validated T-cell clonality, immune repertoire chronology at rejection, and contemporaneous allograft biopsy quantitative tissue injury, to better understand the pathobiology of acute T-cell fraction, T-cell repertoire and antibody-mediated kidney transplant rejection. To follow the dynamic evolution of T-cell repertoire changes before and after engraftment and during biopsy-confirmed acute rejection, we sequenced 323 peripheral blood samples from 200 unique kidney transplant recipients, with (n=100) and without (n=100) biopsy-confirmed acute rejection. We report that patients who develop acute allograft rejection, have lower (p=0.01) T-cell fraction even before transplantation, followed by its rise after transplantation and at the time of acute rejection accompanied by high TCR repertoire turnover (p=0.004). Acute rejection episodes occurring after the first 6 months post-transplantation, and those with a component of antibody-mediated rejection, had the highest turnover; p=0.0016) of their T-cell repertoire. In conclusion, we validated that detecting repertoire changes in kidney transplantation correlates with post-transplant rejection episodes suggesting that T-cell receptor sequencing may provide recipient pre-transplant and post-transplant predictors of rejection risk.

Published
2022

33. 137 Systematic Development of a Multidisciplinary Online Training Program in Healthcare Delivery Science

Author

Allison Orechwa and Amytis Towfighi

Subjects
Medicine
Abstract

OBJECTIVES/GOALS: We created an online, competency-based training program for Healthcare Delivery Science (HDS) that incorporates a wide range of disciplines and best educational practices. METHODS/STUDY POPULATION: In collaboration with a curriculum design expert and thirteen content experts from multiple schools and departments, we reviewed and adapted a published set of competencies for learning health system researchers. We followed educational best practices to collaboratively create learning objectives, aligned content with the objectives, and created quiz questions that addressed the objectives. After recording the coursework and building the program in a learning management system, we tested, evaluated, and revised the courses. RESULTS/ANTICIPATED RESULTS: The systematic approach resulted in a novel set of eight online courses: Introduction to Healthcare Delivery Science, Research Methods, Dissemination & Implementation Science, Behavioral Economics, Leadership & Management, Quality Improvement, Systems Engineering, and Multi-Stakeholder Engagement. The courses are applicable to learners from diverse fields, including medicine, public health, pharmacy, engineering, health system administration, and translational science. Students can earn digital badges for individual courses and a certificate of completion for the entire set of courses. DISCUSSION/SIGNIFICANCE: Compared to previously available offerings, the new training program offers a more comprehensive view of this important field. Next, we plan to develop additional courses and create a Masters program that includes synchronous learning and a complementary experiential component for hands-on application of HDS principles.

Published
2024
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34. A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction

Author

Parhom Towfighi, Alison Hill, Jason R. Crossley, Amanda Walsh, James A. Leonard, Jonathan P. Giurintano, Matthew L. Pierce, and Michael J. Reilly

Subjects
free flap reconstruction, head and neck, multimodal analgesia, opioids, postoperative pain, Otorhinolaryngology, RF1-547, Surgery, RD1-811
Abstract

Abstract Objectives Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery. Methods A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed. Data captured included demographics, postoperative inpatient pain, pain at postoperative visits, morphine equivalent doses (MEDs) administration, medication history, and comorbidities. Data were analyzed using regression models, χ2 tests, and student's t‐tests. Results Seventy‐three percent of patients were discharged with opioid medication, with over half (53.4%) continuing to take opioids at their second postoperative visit, and over one‐third (34.2%) continuing to take them around 4‐month postoperatively. One out of every five (20.3%) opioid‐naïve patients chronically took opioids postoperatively. There was a poor association between inpatient postoperative pain scores and daily MEDs administered (R2 = 0.13, 0.17, and 0.22 in postoperative Days 3, 5, and 7, respectively). Neither preoperative radiotherapy nor postoperative complications were associated with an increase in opioid usage. Conclusions For patients undergoing head and neck free flap operations, opioid medications are commonly used for postoperative analgesia. This practice may increase the chance an opioid‐naïve patient uses opioids chronically. We found a poor association between MEDs administered and patient‐reported pain scores, which suggests that standardized protocols aimed at optimizing analgesia while reducing opioid administration may be warranted. Level of Evidence: 3 (Retrospective cohort study).

Published
2023
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35. Synthesis, characterization, and CO2 adsorption properties of pure ETS-10

Author

Amirhossein Khademi, Ensieh Ganji Babakhani, Jafar Towfighi Darian, and Hamid Reza Mahdipoor

Subjects
OFAT approach, Titanosilicate, ETS-10, CO2 capture, Chemistry, QD1-999
Abstract

Synthesis of titanosilicate ETS-10 with high purity and crystallinity is a big challenge due to its limited crystallization region. ETS-10 was synthesized and characterized by SEM, EDX, BET, and TGA/DTA methods. The effect of synthesis parameters including pH of the gel, crystallization temperature and time, and the potassium source, were studied using the one-at-a-time (OFAT) approach. The results showed that the ETS-10 with the highest purity was achieved considering the gel pH of 11.3, and the crystallization time and temperature of 72 h and 230 °C. It was also revealed that there was considerable interaction between the potassium source with other synthesis parameters. Afterward, CO2 adsorption of the pure synthesized sample was obtained at 298 K using a volumetric setup. The Dual-site Langmuir, Toth, and UNILAN isotherms were applied to model the obtained equilibrium adsorption data. The CO2 adsorption capacity of the synthesized pure ETS-10 was obtained equal to 3.37 mmol/g. Finally, the adsorption kinetics data were modeled using the PNO model with n = 3.5. The results showed that about 90% of the equilibrium absorption was achieved in only 25 s, which indicates the remarkable capability of using pure ETS-10 for CO2 capture by the PSA method.

Published
2023
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37. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission

Author

Feigin, Valery L, Abd-Allah, Foad, Akinyemi, Rufus O, Bhattacharjee, Natalia V, Brainin, Michael, Cao, Jackie, Caso, Valeria, Dalton, Bronte, Davis, Alan, Dempsey, Robert, Duprey, Joseph, Feng, Wuwei, Ford, Gary A, Gall, Seana, Gandhi, Dorcas, Good, David C, Hachinski, Vladimir, Hacke, Werner, Hankey, Graeme J, Ishida, Marie, Johnson, Walter, Kim, Julie, Lavados, Pablo, Lindsay, Patrice, Mahal, Ajay, Martins, Sheila, Murray, Christopher, Nguyen, Thuy Phuong, Norrving, Bo, Olaiya, Muideen T, Olalusi, Oladotun V, Pandian, Jeyaraj, Phan, Hoang, Platz, Thomas, Ranta, Anna, Rehman, Sabah, Roth, Greg, Sebastian, Ivy Anne, Smith, Amanda E, Suwanwela, Nijasri C, Sylaja, P N, Thapa, Rajshree, Thrift, Amanda G, Uvere, Ezinne, Vollset, Stein Emil, Yavagal, Dileep, Yaria, Joseph, Owolabi, Mayowa O, Abera, Semaw Ferede, Akinyemi, Rufus, Dempsey, Robert J, Ibrahim, Norlinah Mohamed, Liu, Liping, Ovbiagele, Bruce, Piradov, Michael, Suwanwela, Nijasri, Abanto, Carlos, Addissie, Adamu, Adeleye, Amos O, Adilbekov, Yerzhan, Adilbekova, Bibigul, Adoukonou, Thierry A, Aguiar de Sousa, Diana, Akhmetzhanova, Zauresh, Akpalu, Albert, El Alaoui-Faris, Mustapha, Ameriso, Sebastian F, Andonova, Silva, Arsovska, Anita, Awoniyi, Folorunso E, Bakhiet, Moiz, Barboza, Miguel A, Basri, Hamidon, Bath, Philip M, Bereczki, Daniel, Beretta, Simone, Berkowitz, Aaron L, Bernhardt, Julie, Berzina, Guna, Bhavsar, Bhavan, Bisharyan, Mher S, Bohara, Manoj, Bovet, Pascal, Budincevic, Hrvoje, Cadilhac, Dominique A, Čerimagić, Denis, Charway-Felli, Augustina, Chen, Christopher, Chin, Jerome H, Christensen, Hanne, Chwojnicki, Kamil, Conforto, Adriana B, Correia, Manuel, Mora Cuervo, Daissy L, Członkowska, Anna, D'Amelio, Marco, Danielyan, Kristine E, Davis, Stephen, Demarin, Vida, Demchuk, Andrew M, Dichgans, Martin, Dokova, Klara, Donnan, Geoffrey, Duran, Juan Carlos, Ekeng, Gloria, Elkind, Mitchell S, Endres, Matthias, Fischer, Urs, Flomin, Yuriy, Gankpe, Fortuné, Gavidia, Martin, Gaye Saavedra, Andrés, Gebreyohanns, Mehari, George, Mary, Gierlotka, Marek, Giroud, Maurice, Gnedovskaya, Elena V, Gonçalves, Ivete Pillo, Gongora-Rivera, Fernando, Gunaratne, Padma S, Hamadeh, Randah R, Hamzat, Tal-hatu K, Heldner, Mirjam R, Ibrahim, Etedal, Ihle-Hansen, Hanne, Jee, Sungju, Jiann-Shing, Jeng, Johnston, S Clay, Jovanovic, Dejana, Jurjāns, Kristaps, Kalani, Rizwan, Kalkonde, Yogeshwar, Kamenova, Saltanat, Karaszewski, Bartosz, Kelly, Peter, Kiechl, Stefan, Kondybayeva, Aida, Kõrv, Janika, Kozera, Grzegorz, Kravchenko, Michael, Krespi, Yakup, Krishnamurthi, Rita, Kruja, Jera, Kutluk, Kursad, Langhorne, Peter, Law, Zhe K, Lebedynets, Dmytro, Lee, Tsong-Hai, Leung, Thomas W, Liebeskind, David S, López-Jaramillo, Patricio, Lotufo, Paulo A, Machline-Carrion, M Julia, Maia, Luis F, Malojcic, Branko, Markus, Hugh S, Marquez-Romero, Juan M, Medina, Marco T, Medukhanova, Sabina, Mehndiratta, Man Mohan, Miglāne, Evija, Mihejeva, Illa, Mikulik, Robert, Mirrakhimov, Erkin, Mohl, Stephanie, Munakomi, Sunil, Murphy, Sean, Musa, Kamarul I, Nasreldein, Ahmed, Nogueira, Raul G, Nolte, Christian H, Noubiap, Jean Jacques, Novarro-Escudero, Nelson, Ocampo, Cassandra, O'Donnell, Martin, Ogun, Yomi, Ogunniyi, Adesola, Oraby, Mohammed I, Ōrken, Dilek N, Ōzdemir, Atilla O, Ozturk, Serefnur, Paccot, Mélanie, Pereira, Telmo, Peeters, André, Potpara, Tatjana, Proios, Hariklia, Rathore, Farooq A, Sacco, Ralph L, Sahathevan, Ramesh, Sandset, Else S, Renato Santos, Irving, Saposnik, Gustavo, Sarfo, Fred S, Sargento-Freitas, João, Sharma, Mukul, Shaw, Louise, Sheth, Kevin N, Shin, Yong-Il, Shobhana, A, Silva, S Nishan, Tedim Cruz, Vitor, Thakur, Kiran, Thapa, Lekh Jung, Toni, Danilo, Topcuoglu, Mehmetakif A, Torales, Julio, Towfighi, Amytis, Truelsen, Thomas, Tsiskaridze, Alexander, Tulloch-Reid, Marshall, Useche, Juan N, Vanacker, Peter, Vassilopoulou, Sophia, Vukorepa, Gorana, Vuletic, Vladimira, Wahab, Kolawole W, Wang, Wenzhi, Wijeratne, Tissa, Wojtyniak, Bogdan, Wolfe, Charles, Yacouba, Mapoure N, Yang, Jie, Yifru, Yared M, Yock-Corrales, Adriana, Yonemoto, Naohiro, Yperzeele, Laetitia, and Zagożdżon, Pawel

Published
2023
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41. Symbolic regression by uniform random global search

Author

Towfighi, Sohrab

Subjects
Computer Science - Neural and Evolutionary Computing
Abstract

Symbolic regression (SR) is a data analysis problem where we search for the mathematical expression that best fits a numerical dataset. It is a global optimization problem. The most popular approach to SR is by genetic programming (SRGP). It is a common paradigm to compare an algorithm's performance to that of random search, but the data comparing SRGP to random search is lacking. We describe a novel algorithm for SR, namely SR by uniform random global search (SRURGS), also known as pure random search. We conduct experiments comparing SRURGS with SRGP using 100 randomly generated equations. Our results suggest that a SRGP is faster than SRURGS in producing equations with good R^2 for simple problems. However, our experiments suggest that SRURGS is more robust than SRGP, able to produce good output in more challenging problems. As SRURGS is arguably the simplest global search algorithm, we believe it should serve as a control algorithm against which other symbolic regression algorithms are compared. SRURGS has only one tuning parameter, and is conceptually very simple, making it a useful tool in solving SR problems. The method produces random equations, which is useful for the generation of symbolic regression benchmark problems. We have released well documented and open-source python code, currently under formal peer-review, so that interested researchers can deploy the tool in practice.

Published
2019

42. Factors Associated With Participation in the Chronic Disease Self-Management Program

Author

Lin, Amy M, Vickrey, Barbara G, Barry, Frances, Lee, Martin L, Ayala-Rivera, Monica, Cheng, Eric, Montoya, Ana V, Mojarro-Huang, Elizabeth, Gomez, Patricia, Castro, Marissa, Corrales, Marilyn, Sivers-Teixeira, Theresa, Tran, Jamie L, Johnson, Renee, Ediss, Chris, Shaby, Betty, Willis, Phyllis, Sanossian, Nerses, Mehta, Bijal, Dutta, Tara, Razmara, Ali, Bryg, Robert, Song, Shlee, and Towfighi, Amytis

Subjects
Health Services and Systems, Public Health, Health Sciences, Brain Disorders, Behavioral and Social Science, Prevention, Stroke, Aging, Clinical Research, Clinical Trials and Supportive Activities, Rehabilitation, Good Health and Well Being, Aged, Chronic Disease, Female, Humans, Ischemic Attack, Transient, Male, Middle Aged, Quality of Life, Secondary Prevention, Self Efficacy, Self-Management, quality of life, secondary prevention, self-efficacy, self-management, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurosciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and purposeSelf-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance.MethodsFrom 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods.ResultsNearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01-1.12]), severe (IRR, 2.34 [95% CI, 1.65-3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07-2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08-1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95-0.99]).ConclusionsLess than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01763203.

Published
2020

43. Erratum: Bridging the gap between research, policy, and practice: Lessons learned from academic-public partnerships in the CTSA network - CORRIGENDUM.

Author

Towfighi, Amytis, Orechwa, Allison Zumberge, Aragón, Tomás J, Atkins, Marc, Brown, Arleen F, Brown, Jen, Carrasquillo, Olveen, Carson, Savanna, Fleisher, Paula, Gustafson, Erika, Herman, Deborah K, Inkelas, Moira, Liu, Wylie, Meeker, Daniella, Mehta, Tara, Miller, Doriane C, Paul-Brutus, Rachelle, Potter, Michael B, Rittner, Sarah S, Rodriguez, Brendaly, Rusch, Dana, Skinner, Anne, and Yee, Hal F

Abstract

[This corrects the article DOI: 10.1017/cts.2020.23.].

Published
2020

44. Bridging the gap between research, policy, and practice: Lessons learned from academic–public partnerships in the CTSA network

Author

Towfighi, Amytis, Orechwa, Allison Zumberge, Aragón, Tomás J, Atkins, Marc, Brown, Arleen F, Brown, Jen, Carrasquillo, Olveen, Carson, Savanna, Fleisher, Paula, Gustafson, Erika, Herman, Deborah K, Inkelas, Moira, Liu, Wylie, Meeker, Daniella, Mehta, Tara, Miller, Doriane C, Paul-Brutus, Rachelle, Potter, Michael B, Ritner, Sarah S, Rodriguez, Brendaly, Rusch, Dana, Skinner, Anne, and Yee, Hal F

Subjects
Health Services and Systems, Public Health, Health Sciences, Human Society, Policy and Administration, Clinical Research, Health Services, 8.1 Organisation and delivery of services, Health and social care services research, Generic health relevance, Translational research, policy-relevant research, implementation science, community engagement, public health
Abstract

A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Health's (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic-public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic-public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.

Published
2020

45. Derivation and Application of a Tool to Estimate Benefits From Multiple Therapies That Reduce Recurrent Stroke Risk

Author

Richards, Adam, Jackson, Nicholas J, Cheng, Eric M, Bryg, Robert J, Brown, Arleen, Towfighi, Amytis, Sanossian, Nerses, Barry, Frances, Li, Ning, and Vickrey, Barbara G

Subjects
Epidemiology, Health Services and Systems, Health Sciences, Prevention, Stroke, Brain Disorders, Clinical Trials and Supportive Activities, Clinical Research, Neurosciences, Cardiovascular, Aged, Anticholesteremic Agents, Anticoagulants, Antihypertensive Agents, Aspirin, Diet Therapy, Exercise, Female, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, Platelet Aggregation Inhibitors, Prognosis, Recurrence, Risk Reduction Behavior, Secondary Prevention, Smoking Cessation, Warfarin, cardiovascular diseases, health services research, humans, outcome assessment health care, stroke, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Neurology & Neurosurgery, Clinical sciences, Allied health and rehabilitation science
Abstract

Background and Purpose- Lowering blood pressure and cholesterol, antiplatelet/antithrombotic use, and smoking cessation reduce risk of recurrent stroke. However, gaps in risk factor control among stroke survivors warrant development and evaluation of alternative care delivery models that aim to simultaneously improve multiple risk factors. Randomized trials of care delivery models are rarely of sufficient duration or size to be powered for low-frequency outcomes such as observed recurrent stroke. This creates a need for tools to estimate how changes across multiple stroke risk factors reduce risk of recurrent stroke. Methods- We reviewed existing evidence of the efficacy of interventions addressing blood pressure reduction, cholesterol lowering, antiplatelet/antithrombotic use, and smoking cessation and extracted relative risks for each intervention. From this, we developed a tool to estimate reductions in recurrent stroke risk, using bootstrapping and simulation methods. We also calculated a modified Global Outcome Score representing the proportion of potential benefit (relative risk reduction) achieved if all 4 individual risk factors were optimally controlled. We applied the tool to estimate stroke risk reduction among 275 participants with complete 12-month follow-up data from a recently published randomized trial of a healthcare delivery model that targeted multiple stroke risk factors. Results- The recurrent stroke risk tool was feasible to apply, yielding an estimated reduction in the relative risk of ischemic stroke of 0.36 in both the experimental and usual care trial arms. Global Outcome Score results suggest that participants in both arms likely averted, on average, 45% of recurrent stroke events that could possibly have been prevented through maximal implementation of interventions for all 4 individual risk factors. Conclusions- A stroke risk reduction tool facilitates estimation of the combined impact on vascular risk of improvements in multiple stroke risk factors and provides a summary outcome for studies testing alternative care models to prevent recurrent stroke. Registration- URL: https://www.clinicaltrials.gov; Unique identifier: NCT00861081.

Published
2020

46. Prophylactic Lymphovenous Bypass at the Time of Axillary Lymph Node Dissection Decreases Rates of Lymphedema

Author

Romina Deldar, MD, Daisy Spoer, MS, Nisha Gupta, MS, Parhom Towfighi, BS, Marc Boisvert, MD, Patricia Wehner, MD, Ian T. Greenwalt, MD, Eric M. Wisotzky, MD, Katherine Power, MD, Kenneth L. Fan, MD, and Laura K. Tom, MD

Subjects
Surgery, RD1-811
Abstract

Background:. Breast cancer-related lymphedema impacts 30% to 47% of women who undergo axillary lymph node dissection (ALND). Studies evaluating the effectiveness of prophylactic lymphovenous bypass (LVB) at the time of ALND have had small patient populations and/or short follow-up. The aim of this study is to quantitatively and qualitatively evaluate prophylactic LVB in patients with breast cancer. Methods:. A retrospective review of patients who underwent ALND from 2018 to 2022 was performed. Patients were divided into cohorts based on whether they underwent prophylactic LVB at the time of ALND. Primary outcomes included 30-day complications and lymphedema. Lymphedema was quantitatively evaluated by bioimpedance analysis, with L-dex scores >7.1 indicating lymphedema. Results:. One-hundred five patients were identified. Sixty-four patients (61.0%) underwent ALND and 41 patients (39.0%) underwent ALND+LVB. Postoperative complications were similar between the cohorts. At a median follow-up of 13.3 months, lymphedema occurred significantly higher in the ALND only group compared with ALND+LVB group (50.0% vs 12.2%; P < 0.001). ALND without LVB was an independent risk factor for lymphedema development (odds ratio, 4.82; P = 0.003). Conclusions:. Prophylactic LVB decreases lymphedema and is not associated with increased postoperative complications. A multidisciplinary team approach is imperative to decrease lymphedema development in this patient population.

Published
2023
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48. Cahn-Hilliard diffuse interface simulations of bubble-wall collisions

Author

Towfighi, Sohrab and Mehrabian, Hadi

Subjects
Physics - Fluid Dynamics
Abstract

The collision of a rising bubble with a superhydrophilic horizontal surface is studied numerically using the Cahn-Hilliard diffuse-interface method. For the studied systems, the Bond number, $Bo=\rho R^2 g/\sigma$, varies between 0.25 to 1.5, and the Galileo number, $Ga=\rho (R^3 g)^{1/2}/\mu$, changes between 8.5 to 50. We assume that the viscosity and density of the bubble are negligible compared to the surrounding medium. We show that our computations reproduce experimentally observed dynamics for the collision of a bubble with a solid surface. Furthermore, for the studied range of parameters, the bubble-wall collision is mainly in the inertial regime. Our simulations show that even in the absence of substantial viscous dissipation, the ratio of rebound-to-collision velocity, the so-called coefficient of restitution, is much smaller than one for the studied systems. More importantly, the coefficient of restitution best scales with the Froude number, $Fr=U_{t}/\sqrt{g R}$, the ratio of inertial to gravitational forces.

Published
2018

50. Optimizing Detection of Kidney Transplant Injury by Assessment of Donor-Derived Cell-Free DNA via Massively Multiplex PCR

Author

Sigdel, Tara K, Archila, Felipe Acosta, Constantin, Tudor, Prins, Sarah A, Liberto, Juliane, Damm, Izabella, Towfighi, Parhom, Navarro, Samantha, Kirkizlar, Eser, Demko, Zachary P, Ryan, Allison, Sigurjonsson, Styrmir, Sarwal, Reuben D, Hseish, Szu-Chuan, Chan-On, Chitranon, Zimmermann, Bernhard, Billings, Paul R, Moshkevich, Solomon, and Sarwal, Minnie M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Kidney Disease, Organ Transplantation, Transplantation, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, Renal and urogenital, cfDNA, kidney transplantation, rejection, Biomedical and clinical sciences
Abstract

Standard noninvasive methods for detecting renal allograft rejection and injury have poor sensitivity and specificity. Plasma donor-derived cell-free DNA (dd-cfDNA) has been reported to accurately detect allograft rejection and injury in transplant recipients and shown to discriminate rejection from stable organ function in kidney transplant recipients. This study used a novel single nucleotide polymorphism (SNP)-based massively multiplexed PCR (mmPCR) methodology to measure dd-cfDNA in various types of renal transplant recipients for the detection of allograft rejection/injury without prior knowledge of donor genotypes. A total of 300 plasma samples (217 biopsy-matched: 38 with active rejection (AR), 72 borderline rejection (BL), 82 with stable allografts (STA), and 25 with other injury (OI)) were collected from 193 unique renal transplant patients; dd- cfDNA was processed by mmPCR targeting 13,392 SNPs. Median dd-cfDNA was significantly higher in samples with biopsy-proven AR (2.3%) versus BL (0.6%), OI (0.7%), and STA (0.4%) (p < 0.0001 all comparisons). The SNP-based dd-cfDNA assay discriminated active from non-rejection status with an area under the curve (AUC) of 0.87, 88.7% sensitivity (95% CI, 77.7⁻99.8%) and 72.6% specificity (95% CI, 65.4⁻79.8%) at a prespecified cutoff (>1% dd-cfDNA). Of 13 patients with AR findings at a routine protocol biopsy six-months post transplantation, 12 (92%) were detected positive by dd-cfDNA. This SNP-based dd-cfDNA assay detected allograft rejection with superior performance compared with the current standard of care. These data support the feasibility of using this assay to detect disease prior to renal failure and optimize patient management in the case of allograft injury.

Published
2019

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