ObjectiveTo describe levels of physical activity (PA) in older adults with rheumatic and musculos... more ObjectiveTo describe levels of physical activity (PA) in older adults with rheumatic and musculoskeletal diseases (RMDs) and study the association between PA level and patient-reported outcomes.MethodsUsing data from FORWARD, a cross-sectional analysis was performed among adults aged 65 years and older with RMDs to assess the levels of PA. PA was categorized as high (vigorously active for at least 30 minutes, 3 times per week), moderate (moderately active for at least 3 times per week) or low (seldom active). We assessed the self-reported levels of PA among patients with different types of RMDs and assessed the association between levels of PA and PROs, including the 29-item Patient Reported Outcomes Measurement Information System (PROMIS-29) assessment.ResultsAmong the 3343 eligible participants, rheumatoid arthritis (68%) was the most common RMD. High PA was reported by 457 (13.6%) participants, and 1820 (54.4%) reported moderate activity. Overall, participants reported a median o...
Introduction: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by varian... more Introduction: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by variants in the PAH gene which encodes for phenylalanine hydroxylase (PAH). PAH deficiency leads to phenylalanine (Phe) accumulation, which untreated can cause intellectual disability, microcephaly, delayed speech, seizures, psychiatric symptoms, and behavioral abnormalities. Early detection of elevated Phe through newborn screening allows for rapid initiation of a Phe-restricted diet to prevent severe neurological outcomes;however, suboptimal Phe control throughout the lifespan is associated with increased rates of psychiatric illness and deficits in executive function even in early treated patients. Lifelong management of PKU is challenging, and it is well documented that many adult patients become lost to follow-up, despite the American College of Medical Genetics recommendation for lifelong management. Here we describe and evaluate efforts to improve follow-up care for patients with PKU of all ages at one center through formalization of clinic guidelines and creation of an overdue outreach program. Methods: The PKU clinic team is a multidisciplinary team consisting of an APN Director, physician, dieticians, diet tech, genetic counselor, registered nurse, and social worker. Regular meetings were scheduled with all clinic staff members to review PKU treatment guidelines, recommended lab monitoring, and visit frequency. After establishing formal guidelines, algorithms were created to determine thresholds for initiating patient outreach based on both age and type of PKU treatment. EMR-based data collection is used to track adherence to both clinic visits and consistent submission of Phe levels. Data was collected and analyzed for Lurie Children’s PKU program, which consists of roughly 250 patients. Baseline levels for adherence to clinic visits and filter card submission were collected at time of implementation. Data was then collected and analyzed initially after 18 months, and has been further analyzed for a second 18 months (which correlates with the start of the COVID-19 pandemic). Results: Overall baseline adherence across the PKU patient population for annual clinic visits was 72% (144/200). Clinic visit adherence increased to 88% at 18 months, and then was essentially unchanged at 86% through COVID-19 pandemic. In the pediatric patient population, annual clinic follow-up adherence was 92% (79/86) at baseline, which increased to 98% with implementation and maintained 98% during the pandemic. In the adult patient population, 54% (57/106) were adherent at baseline with clinic follow-up. With implementation compliance increased to 80% initially and was then reported to be 74% during the pandemic. Baseline for all PKU patients showed 81% (161/200) filter card submission within the last 12 months. Submission increased to 91% after 18 months of overdue outreach, and as of October 2021, 85% of all patients had submitted a filter card within the last calendar year. Adult patients specifically showed an increase, with 53% at baseline to 69% after implementation. Hyperphenylalaninemia (hyperphe) patients over the age of 2 showed an 18% (5/28) submission at baseline. With the overdue outreach program, this increased to 31% of patients initially and has further increased to 39%. Clinic visits for patients greater than 7 years old rose from 13% (3/24) initially to 57% and has further increased to 67%. Conclusion: Implementation of a coordinated overdue outreach program is successful in re-engaging patients with the PKU clinic and improving adherence to treatment recommendations. We have seen increased patient adherence across all domains, and have maintained this improved adherence despite the global COVID-19 pandemic. We believe that integrating overdue outreach guidelines into clinical practice is a replicable model for PKU clinics.
Trusting simulation output is crucial for Sandia's mission objectives. We rely on these simulatio... more Trusting simulation output is crucial for Sandia's mission objectives. We rely on these simulations to perform our high-consequence mission tasks given national treaty obligations. Other science and modeling applications, while they may have high-consequence results, still require the strongest levels of trust to enable using the result as the foundation for both practical applications and future research. To this end, the computing community has developed workflow and provenance systems to aid in both automating simulation and modeling execution as well as determining exactly how was some output was created so that conclusions can be drawn from the data. Current approaches for workflows and provenance systems are all at the user level and have little to no system level support making them fragile, difficult to use, and incomplete solutions. The introduction of container technology is a first step towards encapsulating and tracking artifacts used in creating data and resulting insights, but their current implementation is focused solely on making it easy to deploy an application in an isolated "sandbox" and maintaining a strictly read-only mode to avoid any potential changes to the application. All storage activities are still using the system-level shared storage. This project explores extending the container concept to include storage as a new container type we call data pallets. Data Pallets are potentially writeable, auto generated by the system based on IO activities, and usable as a way to link the contained data back to the application and input deck used to create it.
(AUDIO) Rheumatoid arthritis patients with low or normal body mass index have a greater risk of p... more (AUDIO) Rheumatoid arthritis patients with low or normal body mass index have a greater risk of progression on X-ray or MRI, according to a large study.
high in males with severe mutations and we have demonstrated its lifetime exposure is strongly co... more high in males with severe mutations and we have demonstrated its lifetime exposure is strongly correlated with disease severity and organ manifestations, suggesting a role for lysoGb3 in pathophysiology and as a biomarker. Since lysoGb3 is purported to result from the activity of acid ceramidase (AC), we aim to elucidate AC potential role as a modifier of FD severity. To that end we measured enzyme activities of AC and alfa-galactosidase A (alfa-gal A) in twenty FD males and twenty-eight FD females vs healthy controls (HC) and standardised these to beta-galactosidase. Plasma lysoGB3 and urinary GB3 levels were also measured and age-adjusting severity scores (AASS) were calculated. Relative alfa-gal A activity was significantly lower in FD males than in all other cohorts (p b .001), however, no significant differences were found between HCs and FD females. Relative AC activity was higher in HC than in FD males (p b .01) and females (p b .05), but no significant differences were found between FD males and females. Pearson's correlation coefficient showed no significant correlation between AC activity and AASS or in lysoGb3 in eight FD males and seventeen females. Further analysis revealed a degree of correlation in males between alfa-gal A activity and lysoGb3 (r 2 = 0.5) regardless of AC activity. This initial analysis does not support a role for AC in heterogeneity of FD however more work is required to fully understand the relative contributions of each enzyme in lysoGb3 accumulation.
Background: Cytomegalovirus (CMV) infection is an opportunistic and often problematic infection i... more Background: Cytomegalovirus (CMV) infection is an opportunistic and often problematic infection in patients with connective tissue diseases (CTD patients) who undergoes immunosuppressive therapy. However, in immunosuppressed CTD patients, CMV infection tends to be overdiagnosed, because it manifests with various symptoms and shows organ involvement. Little is known about when to suspect CMV infection and when to conduct CMV pp65 antigenemia assay in immunosuppressed CTD patients. Objectives: To investigate the characteristics of patients who underwent CMV antigenemia assay and identify contributing factors of CMV infection in immunosuppressed CTD patients in a single center of Japan. Methods: Medical records of hospitalized CTD patients who underwent CMV antigenemia assays between April 2015 and July 2018 were retrospectively reviewed. Patients were divided into groups with/without CMV antigenemia. Clinical features, basal immunosuppressive therapies, and laboratory data were analyzed. Results: Overall, 108 patients were enrolled into the study; of these, the positive (group A) and negative (group B) CMV antigenemia groups had 49 and 59 patients, respectively. The underlying CTDs included systemic lupus erythematosus (n=27), anti-neutrophil cytoplasmic antibody-associated vasculitis (n=26), rheumatoid arthritis (n=22), polymyositis/dermatomyositis (n=13), and others (n=20). Glucocorticoid was used in 101 (93.5%) patients, and mean prednisolone dose was 27.1±18.3 mg/day. Pulse glucocorticoid therapy and intravenous cyclophosphamide (IVCY) therapy was administered in 14 (13.0%) and 22 (20.4%) patients, respectively. Group A patients had a significantly higher rate of Charlson Comorbidity Index (CCI) 3 (69.4% vs. 30.5%, p<0.001). Mean prednisolone dose was significantly higher in Group A (32.9±15.5 mg/day vs. 22.3±19.0 mg/ day, p=0.001). Pulse glucocorticoid therapy (26.5% vs. 1.7%, p<0.001) and IVCY (36.7% vs. 6.8%, p<0.001) were administered significantly more often to Group A patients. Myelosuppression was seen significantly more often in Group A (61.2% vs 39.0%, p=0.035). Laboratory data, including serum lymphocyte counts (1016±1136/ml vs. 1218±718/ml), hemoglobin level (10.5±2.6 g/dL vs. 11.5±2.1 g/dL), and platelet counts (14.5±9.7 ×10 6 /ml vs. 24.1±12.9 ×10 6 /ml) were significantly lower in Group A (p<0.05). Multivariate logistic regression analysis revealed CCI3 (odds ratio (OR) =3.21, 95% CI 1.13-9.16) and IVCY therapy (OR=8.89, 95% CI 1.99-39.7) as independent risk factors of CMV antigenemia. The result suggested that pulse glucocorticoid therapy could relate to CMV antigenemia (OR = 9.07, 95% CI 0.96-85.7). Based on the prediction criteria for CMV antigenemia defined as the existence of one or more contributing factors including CCI3, pulse glucocorticoid therapy, IVCY, and myelosuppression; sensitivity and specificity were 89.8% (95% CI 81.3-98.3) and 44.1% (95% CI 31.4-56.8), respectively. With contributing factors limited to CCI3 and IVCY, sensitivity and specificity became 75.5% (95% CI 63.5-87.5) and 64.4% (95% CI 52.2-76.6), respectively. Conclusion: Having multiple comorbidities and being on intensive immunosuppressive therapy, such as pulse glucocorticoid therapy and IVCY, were related to CMV antigenemia in CTD patients. The prediction criteria, including CCI3, pulse glucocorticoid therapy, IVCY, and myelosuppression are helpful to clinically rule out CMV infection.
ObjectiveTo determine the risk of fracture and osteoporosis among patients with psoriatic arthrit... more ObjectiveTo determine the risk of fracture and osteoporosis among patients with psoriatic arthritis (PsA) and psoriasis, compared with the general population and patients with rheumatoid arthritis (RA).MethodsA population-based cohort study was performed in The Health Improvement Network in the UK using data from 1994 to 2014. Patients aged 18–89 years with PsA or psoriasis and up to five unexposed controls matched by practice and start date within that practice were included. Patients with RA and matched controls were included for comparison. Severe psoriasis was defined by a code for psoriasis and either phototherapy or a systemic medication for psoriasis. Incidence and adjusted HRs (aHR) for fracture (all, hip, vertebral) were calculated.ResultsPatients with PsA (n=9788), psoriasis (n=158 323) and controls (n=821 834) were identified. Patients with PsA had an elevated risk of all fracture aHR 1.26 (1.06 to 1.27). Patients with mild psoriasis had elevated risk of all fractures, ve...
Objective. The objective of this study was to examine cause-specific mortality in patients with P... more Objective. The objective of this study was to examine cause-specific mortality in patients with PsA compared with the general population and compared with patients with RA. Methods. A cohort study was performed using The Health Improvement Network among patients aged 1889 years with data from 1994 to 2010. PsA and RA were defined by medical codes, and up to 10 unexposed controls were matched on practice and start date within the practice. Cause of death was classified using categories from UK death statistics. Each death was manually reviewed to ensure appropriate classification. Age-and sex-adjusted hazard ratios (HRs) and multivariable adjusted HRs were calculated using competing risks survival regression. Results. Among patients with PsA (8706), RA (41 752) and unexposed controls (81 573), 470, 7004 and 5269 deaths were observed, respectively. The most common causes of death among all patients were cardiovascular disease, followed by malignancy, respiratory deaths and infection. Cause of death was unknown in 25%.
Perspectives on psychological science : a journal of the Association for Psychological Science, 2015
Across a wide range of tasks, research has shown that people make poor probabilistic predictions ... more Across a wide range of tasks, research has shown that people make poor probabilistic predictions of future events. Recently, the U.S. Intelligence Community sponsored a series of forecasting tournaments designed to explore the best strategies for generating accurate subjective probability estimates of geopolitical events. In this article, we describe the winning strategy: culling off top performers each year and assigning them into elite teams of superforecasters. Defying expectations of regression toward the mean 2 years in a row, superforecasters maintained high accuracy across hundreds of questions and a wide array of topics. We find support for four mutually reinforcing explanations of superforecaster performance: (a) cognitive abilities and styles, (b) task-specific skills, (c) motivation and commitment, and (d) enriched environments. These findings suggest that superforecasters are partly discovered and partly created-and that the high-performance incentives of tournaments hig...
The objective of this study was to determine health-related quality of life (HRQoL) in patients w... more The objective of this study was to determine health-related quality of life (HRQoL) in patients with ANCA-associated vasculitis (AAV) as measured by the "routine assessment of patient index data 3" (RAPID3) and whether RAPID3 is correlated with disease activity as determined by the Birmingham Vasculitis Activity Score (BVAS). Data from patients at an academic institution vasculitis clinic seen between Jan 2010 and Jan 2012 were collected using chart review. BVAS and RAPID3 scores were calculated at each patient visit. RAPID3 was compared between patients in remission (BVAS = 0) and patients with active disease (BVAS > =1) at all visits for four consecutive visits, when data available, at least 3 months apart during the period mentioned. Robust generalized estimating equations (GEE) in linear regression models evaluated associations between the RAPID3 and BVAS over all available observations, adjusting for intra-subject correlations. Thirty-four patients were included in...
HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) an... more HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibia peripheral quantitative computed tomography (pQCT) to evaluate skeletal parameters in women, by HIV/HCV status. We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined by pQCT. Race-specific Z-scores for age were generated using 263 female reference participants without HIV or liver disease. Coinfected participants had lower mean trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) Z-scores than reference participants (all p<0.001). The smaller cortical dimensions were due to greater mean endosteal circumference (+0.67; p<0.001...
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgica... more Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18....
An honors thesis that examines the era of Vietnam War protests at two campuses, that of the Colle... more An honors thesis that examines the era of Vietnam War protests at two campuses, that of the College at Brockport, and the University at Buffalo.
ObjectiveTo describe levels of physical activity (PA) in older adults with rheumatic and musculos... more ObjectiveTo describe levels of physical activity (PA) in older adults with rheumatic and musculoskeletal diseases (RMDs) and study the association between PA level and patient-reported outcomes.MethodsUsing data from FORWARD, a cross-sectional analysis was performed among adults aged 65 years and older with RMDs to assess the levels of PA. PA was categorized as high (vigorously active for at least 30 minutes, 3 times per week), moderate (moderately active for at least 3 times per week) or low (seldom active). We assessed the self-reported levels of PA among patients with different types of RMDs and assessed the association between levels of PA and PROs, including the 29-item Patient Reported Outcomes Measurement Information System (PROMIS-29) assessment.ResultsAmong the 3343 eligible participants, rheumatoid arthritis (68%) was the most common RMD. High PA was reported by 457 (13.6%) participants, and 1820 (54.4%) reported moderate activity. Overall, participants reported a median o...
Introduction: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by varian... more Introduction: Phenylketonuria (PKU) is an inherited autosomal recessive disorder caused by variants in the PAH gene which encodes for phenylalanine hydroxylase (PAH). PAH deficiency leads to phenylalanine (Phe) accumulation, which untreated can cause intellectual disability, microcephaly, delayed speech, seizures, psychiatric symptoms, and behavioral abnormalities. Early detection of elevated Phe through newborn screening allows for rapid initiation of a Phe-restricted diet to prevent severe neurological outcomes;however, suboptimal Phe control throughout the lifespan is associated with increased rates of psychiatric illness and deficits in executive function even in early treated patients. Lifelong management of PKU is challenging, and it is well documented that many adult patients become lost to follow-up, despite the American College of Medical Genetics recommendation for lifelong management. Here we describe and evaluate efforts to improve follow-up care for patients with PKU of all ages at one center through formalization of clinic guidelines and creation of an overdue outreach program. Methods: The PKU clinic team is a multidisciplinary team consisting of an APN Director, physician, dieticians, diet tech, genetic counselor, registered nurse, and social worker. Regular meetings were scheduled with all clinic staff members to review PKU treatment guidelines, recommended lab monitoring, and visit frequency. After establishing formal guidelines, algorithms were created to determine thresholds for initiating patient outreach based on both age and type of PKU treatment. EMR-based data collection is used to track adherence to both clinic visits and consistent submission of Phe levels. Data was collected and analyzed for Lurie Children’s PKU program, which consists of roughly 250 patients. Baseline levels for adherence to clinic visits and filter card submission were collected at time of implementation. Data was then collected and analyzed initially after 18 months, and has been further analyzed for a second 18 months (which correlates with the start of the COVID-19 pandemic). Results: Overall baseline adherence across the PKU patient population for annual clinic visits was 72% (144/200). Clinic visit adherence increased to 88% at 18 months, and then was essentially unchanged at 86% through COVID-19 pandemic. In the pediatric patient population, annual clinic follow-up adherence was 92% (79/86) at baseline, which increased to 98% with implementation and maintained 98% during the pandemic. In the adult patient population, 54% (57/106) were adherent at baseline with clinic follow-up. With implementation compliance increased to 80% initially and was then reported to be 74% during the pandemic. Baseline for all PKU patients showed 81% (161/200) filter card submission within the last 12 months. Submission increased to 91% after 18 months of overdue outreach, and as of October 2021, 85% of all patients had submitted a filter card within the last calendar year. Adult patients specifically showed an increase, with 53% at baseline to 69% after implementation. Hyperphenylalaninemia (hyperphe) patients over the age of 2 showed an 18% (5/28) submission at baseline. With the overdue outreach program, this increased to 31% of patients initially and has further increased to 39%. Clinic visits for patients greater than 7 years old rose from 13% (3/24) initially to 57% and has further increased to 67%. Conclusion: Implementation of a coordinated overdue outreach program is successful in re-engaging patients with the PKU clinic and improving adherence to treatment recommendations. We have seen increased patient adherence across all domains, and have maintained this improved adherence despite the global COVID-19 pandemic. We believe that integrating overdue outreach guidelines into clinical practice is a replicable model for PKU clinics.
Trusting simulation output is crucial for Sandia's mission objectives. We rely on these simulatio... more Trusting simulation output is crucial for Sandia's mission objectives. We rely on these simulations to perform our high-consequence mission tasks given national treaty obligations. Other science and modeling applications, while they may have high-consequence results, still require the strongest levels of trust to enable using the result as the foundation for both practical applications and future research. To this end, the computing community has developed workflow and provenance systems to aid in both automating simulation and modeling execution as well as determining exactly how was some output was created so that conclusions can be drawn from the data. Current approaches for workflows and provenance systems are all at the user level and have little to no system level support making them fragile, difficult to use, and incomplete solutions. The introduction of container technology is a first step towards encapsulating and tracking artifacts used in creating data and resulting insights, but their current implementation is focused solely on making it easy to deploy an application in an isolated "sandbox" and maintaining a strictly read-only mode to avoid any potential changes to the application. All storage activities are still using the system-level shared storage. This project explores extending the container concept to include storage as a new container type we call data pallets. Data Pallets are potentially writeable, auto generated by the system based on IO activities, and usable as a way to link the contained data back to the application and input deck used to create it.
(AUDIO) Rheumatoid arthritis patients with low or normal body mass index have a greater risk of p... more (AUDIO) Rheumatoid arthritis patients with low or normal body mass index have a greater risk of progression on X-ray or MRI, according to a large study.
high in males with severe mutations and we have demonstrated its lifetime exposure is strongly co... more high in males with severe mutations and we have demonstrated its lifetime exposure is strongly correlated with disease severity and organ manifestations, suggesting a role for lysoGb3 in pathophysiology and as a biomarker. Since lysoGb3 is purported to result from the activity of acid ceramidase (AC), we aim to elucidate AC potential role as a modifier of FD severity. To that end we measured enzyme activities of AC and alfa-galactosidase A (alfa-gal A) in twenty FD males and twenty-eight FD females vs healthy controls (HC) and standardised these to beta-galactosidase. Plasma lysoGB3 and urinary GB3 levels were also measured and age-adjusting severity scores (AASS) were calculated. Relative alfa-gal A activity was significantly lower in FD males than in all other cohorts (p b .001), however, no significant differences were found between HCs and FD females. Relative AC activity was higher in HC than in FD males (p b .01) and females (p b .05), but no significant differences were found between FD males and females. Pearson's correlation coefficient showed no significant correlation between AC activity and AASS or in lysoGb3 in eight FD males and seventeen females. Further analysis revealed a degree of correlation in males between alfa-gal A activity and lysoGb3 (r 2 = 0.5) regardless of AC activity. This initial analysis does not support a role for AC in heterogeneity of FD however more work is required to fully understand the relative contributions of each enzyme in lysoGb3 accumulation.
Background: Cytomegalovirus (CMV) infection is an opportunistic and often problematic infection i... more Background: Cytomegalovirus (CMV) infection is an opportunistic and often problematic infection in patients with connective tissue diseases (CTD patients) who undergoes immunosuppressive therapy. However, in immunosuppressed CTD patients, CMV infection tends to be overdiagnosed, because it manifests with various symptoms and shows organ involvement. Little is known about when to suspect CMV infection and when to conduct CMV pp65 antigenemia assay in immunosuppressed CTD patients. Objectives: To investigate the characteristics of patients who underwent CMV antigenemia assay and identify contributing factors of CMV infection in immunosuppressed CTD patients in a single center of Japan. Methods: Medical records of hospitalized CTD patients who underwent CMV antigenemia assays between April 2015 and July 2018 were retrospectively reviewed. Patients were divided into groups with/without CMV antigenemia. Clinical features, basal immunosuppressive therapies, and laboratory data were analyzed. Results: Overall, 108 patients were enrolled into the study; of these, the positive (group A) and negative (group B) CMV antigenemia groups had 49 and 59 patients, respectively. The underlying CTDs included systemic lupus erythematosus (n=27), anti-neutrophil cytoplasmic antibody-associated vasculitis (n=26), rheumatoid arthritis (n=22), polymyositis/dermatomyositis (n=13), and others (n=20). Glucocorticoid was used in 101 (93.5%) patients, and mean prednisolone dose was 27.1±18.3 mg/day. Pulse glucocorticoid therapy and intravenous cyclophosphamide (IVCY) therapy was administered in 14 (13.0%) and 22 (20.4%) patients, respectively. Group A patients had a significantly higher rate of Charlson Comorbidity Index (CCI) 3 (69.4% vs. 30.5%, p<0.001). Mean prednisolone dose was significantly higher in Group A (32.9±15.5 mg/day vs. 22.3±19.0 mg/ day, p=0.001). Pulse glucocorticoid therapy (26.5% vs. 1.7%, p<0.001) and IVCY (36.7% vs. 6.8%, p<0.001) were administered significantly more often to Group A patients. Myelosuppression was seen significantly more often in Group A (61.2% vs 39.0%, p=0.035). Laboratory data, including serum lymphocyte counts (1016±1136/ml vs. 1218±718/ml), hemoglobin level (10.5±2.6 g/dL vs. 11.5±2.1 g/dL), and platelet counts (14.5±9.7 ×10 6 /ml vs. 24.1±12.9 ×10 6 /ml) were significantly lower in Group A (p<0.05). Multivariate logistic regression analysis revealed CCI3 (odds ratio (OR) =3.21, 95% CI 1.13-9.16) and IVCY therapy (OR=8.89, 95% CI 1.99-39.7) as independent risk factors of CMV antigenemia. The result suggested that pulse glucocorticoid therapy could relate to CMV antigenemia (OR = 9.07, 95% CI 0.96-85.7). Based on the prediction criteria for CMV antigenemia defined as the existence of one or more contributing factors including CCI3, pulse glucocorticoid therapy, IVCY, and myelosuppression; sensitivity and specificity were 89.8% (95% CI 81.3-98.3) and 44.1% (95% CI 31.4-56.8), respectively. With contributing factors limited to CCI3 and IVCY, sensitivity and specificity became 75.5% (95% CI 63.5-87.5) and 64.4% (95% CI 52.2-76.6), respectively. Conclusion: Having multiple comorbidities and being on intensive immunosuppressive therapy, such as pulse glucocorticoid therapy and IVCY, were related to CMV antigenemia in CTD patients. The prediction criteria, including CCI3, pulse glucocorticoid therapy, IVCY, and myelosuppression are helpful to clinically rule out CMV infection.
ObjectiveTo determine the risk of fracture and osteoporosis among patients with psoriatic arthrit... more ObjectiveTo determine the risk of fracture and osteoporosis among patients with psoriatic arthritis (PsA) and psoriasis, compared with the general population and patients with rheumatoid arthritis (RA).MethodsA population-based cohort study was performed in The Health Improvement Network in the UK using data from 1994 to 2014. Patients aged 18–89 years with PsA or psoriasis and up to five unexposed controls matched by practice and start date within that practice were included. Patients with RA and matched controls were included for comparison. Severe psoriasis was defined by a code for psoriasis and either phototherapy or a systemic medication for psoriasis. Incidence and adjusted HRs (aHR) for fracture (all, hip, vertebral) were calculated.ResultsPatients with PsA (n=9788), psoriasis (n=158 323) and controls (n=821 834) were identified. Patients with PsA had an elevated risk of all fracture aHR 1.26 (1.06 to 1.27). Patients with mild psoriasis had elevated risk of all fractures, ve...
Objective. The objective of this study was to examine cause-specific mortality in patients with P... more Objective. The objective of this study was to examine cause-specific mortality in patients with PsA compared with the general population and compared with patients with RA. Methods. A cohort study was performed using The Health Improvement Network among patients aged 1889 years with data from 1994 to 2010. PsA and RA were defined by medical codes, and up to 10 unexposed controls were matched on practice and start date within the practice. Cause of death was classified using categories from UK death statistics. Each death was manually reviewed to ensure appropriate classification. Age-and sex-adjusted hazard ratios (HRs) and multivariable adjusted HRs were calculated using competing risks survival regression. Results. Among patients with PsA (8706), RA (41 752) and unexposed controls (81 573), 470, 7004 and 5269 deaths were observed, respectively. The most common causes of death among all patients were cardiovascular disease, followed by malignancy, respiratory deaths and infection. Cause of death was unknown in 25%.
Perspectives on psychological science : a journal of the Association for Psychological Science, 2015
Across a wide range of tasks, research has shown that people make poor probabilistic predictions ... more Across a wide range of tasks, research has shown that people make poor probabilistic predictions of future events. Recently, the U.S. Intelligence Community sponsored a series of forecasting tournaments designed to explore the best strategies for generating accurate subjective probability estimates of geopolitical events. In this article, we describe the winning strategy: culling off top performers each year and assigning them into elite teams of superforecasters. Defying expectations of regression toward the mean 2 years in a row, superforecasters maintained high accuracy across hundreds of questions and a wide array of topics. We find support for four mutually reinforcing explanations of superforecaster performance: (a) cognitive abilities and styles, (b) task-specific skills, (c) motivation and commitment, and (d) enriched environments. These findings suggest that superforecasters are partly discovered and partly created-and that the high-performance incentives of tournaments hig...
The objective of this study was to determine health-related quality of life (HRQoL) in patients w... more The objective of this study was to determine health-related quality of life (HRQoL) in patients with ANCA-associated vasculitis (AAV) as measured by the "routine assessment of patient index data 3" (RAPID3) and whether RAPID3 is correlated with disease activity as determined by the Birmingham Vasculitis Activity Score (BVAS). Data from patients at an academic institution vasculitis clinic seen between Jan 2010 and Jan 2012 were collected using chart review. BVAS and RAPID3 scores were calculated at each patient visit. RAPID3 was compared between patients in remission (BVAS = 0) and patients with active disease (BVAS > =1) at all visits for four consecutive visits, when data available, at least 3 months apart during the period mentioned. Robust generalized estimating equations (GEE) in linear regression models evaluated associations between the RAPID3 and BVAS over all available observations, adjusting for intra-subject correlations. Thirty-four patients were included in...
HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) an... more HIV/hepatitis C virus (HCV) coinfection is associated with reduced bone mineral density (BMD) and increased fracture rates, particularly in women. The structural underpinnings for skeletal fragility in coinfected women have not been characterized. We used tibia peripheral quantitative computed tomography (pQCT) to evaluate skeletal parameters in women, by HIV/HCV status. We conducted a cross-sectional study among 50 HIV/HCV-coinfected, 51 HCV-monoinfected, and 50 HIV-monoinfected women. Tibial volumetric BMD and cortical dimensions were determined by pQCT. Race-specific Z-scores for age were generated using 263 female reference participants without HIV or liver disease. Coinfected participants had lower mean trabecular volumetric BMD (-0.85), cortical volumetric BMD (-0.67), cortical area (-0.61), and cortical thickness (-0.77) Z-scores than reference participants (all p<0.001). The smaller cortical dimensions were due to greater mean endosteal circumference (+0.67; p<0.001...
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgica... more Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for surgical high-risk patients with severe aortic stenosis. The aim of this study was to determine the impact of atrial fibrillation (AF) on procedural outcomes. Data from 137 patients who underwent TAVR using Edwards SAPIEN valve were reviewed. The predictors of new-onset atrial fibrillation (NOAF) after the procedure were analyzed. In addition, the post-TAVR clinical outcomes and adverse events were compared according to the presence and absence of preprocedural and postprocedural AF. Previous AF was present in 49% of the patients who underwent TAVR. After the procedure, NOAF was detected in 21% of patients, and the cumulative incidence of post-TAVR AF was 60%. After TAVR, 50% of all the episodes of NOAF occurred in the initial 24 hours after the procedure. Transapical approach was observed to an important predictor of NOAF (adjusted odds ratio [OR] 5.05, 95% confidence interval [CI] 1.40 to 18....
An honors thesis that examines the era of Vietnam War protests at two campuses, that of the Colle... more An honors thesis that examines the era of Vietnam War protests at two campuses, that of the College at Brockport, and the University at Buffalo.
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Papers by Joshua Baker