MedicalResearch.com Top Medical Research Interviews September 25 2015

MedicalResearch.com
Exclusive Interviews with Medical Research and
Health Care Researchers from Major and Specialty Medical
Research Journals and Meetings
Editor: Marie Benz, MD
info@medicalresearch.com
September 25 2015
For Informational Purposes Only: Not for Specific Medical Advice.
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Believing In Yourself Important For Weight Loss MaintenanceMedicalResearch.com Interview with:Linda J Ewing PhD
RN Department of Psychiatry andLora E Burke PhD, MPH, RN, FAAN Department
of Health and Community SystemsUniversity of Pittsburgh School of Nursing Pittsburgh, Pennsylvania
• Medical Research: What is the background for this study? What are the main
findings?
• Response: This study was the product both of work done in Dr. Burke’s lab as well
as cumulative findings of other investigators demonstrating that improved self-
efficacy is related to positive changes in health behaviors (e.g., physical activity,
increased Intake of healthier foods, such as fruits and vegetables). Given that, we
designed a behavioral weight loss study that included an intentional focus on
enhancing participant self-efficacy for healthy behaviors related to weight loss
maintenance. No previous study had self-efficacy enhancement as a focus of
intervention with the long-term goal of increasing weight loss maintenance. Thus
our study focused on mastery performance of weight loss related behaviors.
Findings supported our hypothesis; participants in both arms of the study
(standard behavioral weight loss (SBT) and SBT with self-efficacy enhancement
(SBT+SE) achieved clinically significant weight loss. Participants in the SBT+SE
group had greater weight loss maintenance while those in the SBT group had
clinically significant weight regain.

• Medical Research: What should clinicians and patients
take away from your report?
• Response: Study findings provided support for the
important role of self-efficacy in achieving and maintaining
behavior change goals. Clinicians are advised to monitor
their patient’s attainment of any specific goal and to
increase goals only after a prior goal is successfully attained
(and, for at least some amount of time, maintained).
Individuals experience self-efficacy as they experience
mastery (and not perceived failure). Those pursuing
behavior change lose motivation when they experience
difficulty meeting prescribed goals, and frequently become
discouraged, self-deprecating, and subsequently tell
themselves that ‘I can’t do this’, and give up.

• For individuals engaged in behavior change, the
message is similar: it is important to attain goals
that you set. If it is difficult to do so, it is better
to modify the goal (e.g., walk for 10 minutes
instead of 20 minutes if 20 minutes is not yet
attainable) and keep working on the modified
goal until you achieve it; then you can feel
motivated about increasing the goal and then
attaining a new goal. Our study definitely points
to the benefits of enhancing an individual’s self-
efficacy or, mastery of a behavior, in maintaining
health behavior change.

• Medical Research: What recommendations do you have for future
research as a result of this study?
• Response: This is the first study that specifically targeted enhancing self-
efficacy to increase weight loss maintenance. Results were encouraging in
that the group that received the added focus on SE did experience greater
weight loss maintenance. As always, a refinement and replication would
be advisable; also, adding specific self-efficacy enhancement strategies to
behavioral weight loss studies should be considered.
• Citation:
• Obesity (Silver Spring). 2015 Sep 18. doi: 10.1002/oby.21238. [Epub ahead
of print]
• The SELF trial: A self-efficacy-based behavioral intervention trial for
weight loss maintenance.
• Burke LE1,2,3, Ewing LJ4, Ye L1,5, Styn M1,2, Zheng Y1, Music E1, Loar I1,
Mancino J1, Imes CC1, Hu L1, Goode R6, Sereika SM1,

Breast Cancer Pattern Likely To Change as Population AgesMedicalResearch.com
Interview with:Philip S. Rosenberg, PhDBiostatistics Branch, Senior Investigator Division
of Cancer Epidemiology and GeneticsNational Cancer Institute, 9609 Medical Center Drive Bethesda, MD 20892
• Medical Research: What is the background for this study? What are the main
findings?
• Dr. Rosenberg: It has been previously reported that breast cancer burden (number
of new cases diagnosed in a year) is expected to rise in the future, mostly due to
the aging of the female population in the US.
• Also, it has been established that the age-adjusted breast cancer incidence rates
(cases per 100,000 women per year) are increasing for invasive ER-positive cancers
overall and decreasing for ER-negative cancers overall. When taken together,
these two trends tend balance each other out, resulting in a somewhat flat breast
cancer incidence rate overall.
• Though the overall trends for invasive breast cancer have been previously
reported, this study uses a more refined forecasting method by including recent
birth cohort patterns to forecast breast cancer to 2030 by age group, estrogen
receptor-status, and invasive vs. in situ tumors.
• New in this report are the findings for in situ tumors and the more granular break
down by age, ER status, and invasive vs. in situ tumors both for rate and burden
(number of cases).

• Medical Research: What should clinicians and
patients take away from your report?
• Dr. Rosenberg: The main take-home message of our
study is that in the future, the pattern of breast cancer
incidence will be different from today. There will be
fewer ER-negative tumors (in situ and invasive), but
more ER-positive tumors, especially in the older
population of women. In addition, since the overall
rates for ER-positive in situ cancers are going up, our
analysis suggests that future studies are needed to
better understand how best to treat women with in
situ disease.

• Medical Research: What recommendations do you have
for future research as a result of this study?
• Dr. Rosenberg: Additional studies are needed to better
understand how in situ tumors behave, and how best to
treat them. In addition, we plan to project rates for women
by race/ethnicity.
• Citation:
• Philip S. Rosenberg, Kimberly A. Barker, and William F.
Anderson
• Estrogen Receptor Status and the Future Burden of Invasive
and In Situ Breast Cancers in the United StatesJNCI J Natl
Cancer
Inst (2015) 107 (9): djv159 doi:10.1093/jnci/djv159 First
published online June 10, 2015

Hypertensive Black Patients Have Worse Outcomes From ACE Inhibitor TherapyMedicalResearch.com Interview with:
Gbenga Ogedegbe, MD, MS, MPH FACP Professor of Population Health and MedicineDirector, Division of Health and
BehaviorDirector, Center for Healthful Behavior ChangeVice Dean, NYU College of Global Public Health NYU Langone
School of Medicine Department of Population HealthNew York, NY 10016
• Medical Research: What is the background for this study?
• Dr. Ogedebge: Evidence from clinical trials have previously indicated that
a common blood pressure medication, angiotensin-converting-enzyme
(ACE) inhibitors, (when prescribed as first line treatment) may not provide
the same benefits in blacks compared to whites. However blacks are
grossly underrepresented in these studies, despite the fact they have
disproportionately higher rates of hypertension-related morbidity and
mortality than whites. Thus, we chose to study this particular question
because it allows us to evaluate this evidence in a large population of
hypertensive black patients who receive care in a real-world practice
setting. This study evaluates racial differences in cardiovascular outcomes
and mortality between hypertensive black and white patients whose
treatment was initiated with angiotensin-converting-enzyme (ACE)
inhibitors, outside of a clinical trial. ACE inhibitors are one of several
classes of drugs commonly prescribed to individuals with hypertension to
prevent deaths, heart attack, kidney failure, heart failure and stroke.

• Medical Research: What are the main findings?
• Dr. Ogedebge: This is the largest practice-based study of
comparative effectiveness of initiation of treatment with
ACE Inhibitors compared to other antihypertensive medications in
blacks and whites with hypertension.
• The main findings from this study are that hypertensive black
patients have poorer cardiovascular outcomes when treatment is
initiated with ACE-Inhibitors compared to initiation of treatment
with other blood pressure medications. Specifically, hypertensive
blacks whose treatment was initiated with ACE inhibitors had
higher rates of cardiovascular events, and were at higher risk of the
composite outcome of all-cause mortality, nonfatal heart attack, or
nonfatal stroke than whites.

• Dr. Ogedebge: The main take away message is
that ACE inhibitors should not be prescribed
as first-line treatment in black patients with
uncontrolled high blood pressure.

• Medical Research: What recommendations do you
have for future research as a result of this study?
• Dr. Ogedebge: Additional research is needed to
elucidate the mechanisms for the racial disparaties in
outcomes between blacks and whites.
• Citation:
• Ogedegbe G, Shah NR, Phillips C, et al. Comparative
Effectiveness of Angiotensin-Converting Enzyme
Inhibitor-Based Treatment on Cardiovascular
Outcomes in Hypertensive Blacks Versus Whites. J Am
Coll Cardiol. 2015;66(11):1224-1233.
doi:10.1016/j.jacc.2015.07.021.

Epstein Barr Virus and Cancers Suppress Immune System To Promote Their Own SurvivalMedicalResearch.com
Interview with:Dr. Cristiano Ferlini, MDDirector of Biomedical ResearchRudy and Sally Ruggles
Chief of cancer researchWestern Connecticut Health Network Research Institute
• Dr. Ferlini: Our aim is to understand why some cancer
patients respond well to conventional treatment while
others suffer progressive disease. Nextgen sequencing
technologies provide data that shed light on the
mechanisms underlying differences in clinical outcome.
However, analyses utilizing these data have been focused
on human genes. This is to be expected given that the
subjects under investigation are indeed humans. We
adopted a novel approach in this and a prior study which
involved in-depth, comprehensive mapping of microRNA
sequences in human cancers to viral genes to assess their
presence and significance.

• Dr. Ferlini: We discovered a surprising number of viral microRNA
sequences in a wide variety of cancer tissues. We also documented
an interplay between these viral microRNAs and genes related to
anticancer immunity. Both viruses and cancers share a common
goal of suppressing the immune system to promote their own
survival. Synergistic immunosuppression seems particularly
relevant for the Epstein Barr virus, an unfortunate fact given its
ubiquity in human populations. After the acute phase of EBV
infection, the virus persists indefinitely in a dormant state inside B
lymphocytes. When cancers grow, they create a protected
microenvironment in which anticancer immunity is suppressed.
We have obtained evidence suggesting that when EBV infected B
cells circulate within these domains, the virus becomes reactivated
and produces microRNAs which further amplify
immunosuppressive genes.

• Dr. Ferlini: EBV has been implicated for decades as an
oncogenic virus in malignancies, particularly lymphomas
and nasopharyngeal carcinomas. Our study characterizes
the role of the EBV reactivation as a determinant of cancer
aggressiveness across a broad spectrum of cancer types.
This information can potentially be harnessed to identify
subpopulations of patients at particular risk for treatment
failure. For early stage patients, this may be of particular
importance. It may point the way toward novel therapeutic
options that specifically reverse immunosuppression as a
supplement to standard treatment protocols.

• Dr. Ferlini: Our analyses were performed on nucleic acid sequences
present in cancer tissues. Ideally, blood would be the preferred sample
due to its accessibility at all stages of illness. Future efforts should assess
viral, particularly EBV, reactivation in blood from cancer patients. We are
optimistic that circulating viral microRNAs in blood will fulfill their promise
as biomarkers of cancer-related immunosuppression.
• Citation:
• PLoS One. 2015 Sep 16;10(9):e0136058. doi:
10.1371/journal.pone.0136058. eCollection 2015.
• Epstein-Barr Virus MicroRNA Expression Increases Aggressiveness of Solid
Malignancies.
• Pandya D1, Mariani M1, He S1, Andreoli M1, Spennato M1, Dowell-
Martino C1, Fiedler P1, Ferlini C1.

Pregnancy Complications Increase Risk of Heart Disease In WomenMedicalResearch.com
Interview with:Barbara A. Cohn, PhD
Director of the Child Health and Development Studies at the Public Health Institute.Berkeley, California
• Dr. Cohn: I guessed that pregnancy complications would be an early
warning sign of cardiovascular problems because of the
extraordinary demands that pregnancy places on a woman’s
cardiovascular system.
• Medical Research: What data were used for this study?
• Dr. Cohn: The Child Health and Development Studies is a large
pregnancy cohort that enrolled more than 20,000 pregnancies in
the 1960’s. Women and their families have been followed now for
more than 50 years. Information on pregnancy complications was
captured from medical records as they occurred, long before
cardiovascular disease developed. These data are the basis for the
current study.

• Medical Research: Why hasn’t this study already been
done?
• Dr. Cohn: Long-term, large studies of pregnancy are rare. I
first tried to do this study forty years ago when I was in
graduate school. At that time, Dr. Bea van den Berg, the
late, second director of the Child Health and Development
Studies advised that the study mothers were still too young
to observe their cardiovascular disease experience.
• Now 40 years later, my colleague Piera Cirillo and I have
been able to test the idea that combinations of pregnancy
complications are linked to cardiovascular disease death
for women.

• Dr. Cohn: Medical Research: What are the main findings?
• We discovered that some combinations of pregnancy complications
were associated with as much as a 7-fold increase in risk of
cardiovascular disease death overall.
• Other complications were associated with a 4- to 5-fold higher risk
of dying of cardiovascular disease early, before the age of 60. For
example, gestational hypertension in combination with preterm
delivery predicted a 5-fold increase in risk of early death from
cardiovascular disease; and pre-eclampsia accompanied by delivery
of a small-for-gestational-age infant predicted a 4-fold increase in
risk of early death from cardiovascular disease.
• We also found 2 new risk factors for cardiovascular disease death:
the presence of sugar in the urine during pregnancy and a particular
pattern of decline in hemoglobin during pregnancy.

• Medical Research: If a woman has had one or more of these
pregnancy complications, what should she do?
• Dr. Cohn:
• I would suggest that she discuss this with her doctor, because her
doctor may decide she is a candidate for discussing cardiovascular
disease prevention at an earlier age than they might otherwise.
• There is no cost or procedure associated with this. Even if a woman
doesn’t remember her own pregnancy history, this information is
easy to access in her medical record.
• The first doctor many young women talk to is an obstetrician, and
their obstetrician could either refer the woman to a physician who
addresses cardiovascular health, or work with them as a primary
provider to talk about other risk factors in the woman’s control that
could help extend her life.

• MedicalResearch: Based on your findings, what should
primary care physicians (including OBGYNs) do with
patients who have had these pregnancy complications?
• Dr. Cohn:
• Every primary care provider who cares for a woman should
ask whether their patient has had these pregnancy
complications – or check their medical record if the patient
doesn’t remember.
• If she has, they should begin surveillance early and
recommend preventive measures the patient can take to
address risk factors they can control to help prevent early
death.
• This is a low cost intervention that is easy to implement.

• Dr. Cohn: We think that it would important to find biomarkers in
early pregnancy, for example in blood, that correlate both with high
risk pregnancy complications and cardiovascular disease risk. These
studies could identify pathways to risk and lead to opportunities to
protect mothers and also their infants.
• Citation:
• Piera M. Cirillo and Barbara A. Cohn. Pregnancy Complications and
Cardiovascular Disease Death: Fifty-Year Follow-Up of the Child
Health and Development Studies Pregnancy Cohort. Circulation,
September 2015
• DOI: 10.1161/CIRCULATIONAHA.113.003901

Household Chaos Is A Causal Factor in Adolescent Risky BehaviorMedicalResearch.com Interview with:Avik Chatterjee
, MD, MPHPhysician, Boston Health Care for the Homeless Program Instructor
, Harvard Medical SchoolAssociate Epidemiologist, Division of Global Health Equity, Brigham and Women’s
Hospital Boston, MA
• Medical Research: What is the background for this study? What are the
main findings?
• Dr. Chatterjee: Substance use, sexual activity and violent behaviors are
common during adolescence. Understanding risk factors for these
behaviors will improve our ability to prevent them and their sequelae. The
Chaos, Hubbub and Order Scale (CHAOS) is a measure of household
physical and social disorder, and higher CHAOS score, as reported by
parents, has been shown to be correlated with less self-regulatory
behavior in children. Thus, CHAOS could be a risk factor for the above
behaviors in adolescents. We used data from the RISE study, in which 929
adolescents completed face-to-face and computer-assisted (for sensitive
questions) interviews about their health behaviors to analyze the
relationship between CHAOS score and risky health behaviors. We found
that students with highest CHAOS score, compared to those with zero
CHAOS score, had elevated odds for tobacco use (3x), alcohol use (2.5x),
any substance use at school (6x) and fighting in the past 12 months (2x).

Hospital Boston, MA
• Dr. Chatterjee: Household social and physical
disorder is associated with increased odds of
risky health behaviors, and while the direction
of the relationship is not yet clear, we believe
that household chaos precedes and is a causal
factor in the initiation of risky health
behaviors.

Hospital Boston, MA
• Dr. Chatterjee: A longitudinal study exploring the direction of the
relationship between CHAOS and risky health behaviors in
adolescents would be helpful. Additionally, exploring how
interventions might decrease household social and physical
disorder might be helpful in preventing risky health behaviors in
adolescents, and the consequences of those behaviors.
• Citation:
• Chaos, Hubbub, and Order Scale and Health Risk Behaviors in
Adolescents in Los Angeles
• Chatterjee, Avik et al. The Journal of Pediatrics Published
Online:September 19, 2015
• DOI: http://dx.doi.org/10.1016/j.jpeds.2015.08.043

How Do We Align DNR Orders With Patient Preferences and Prognosis?MedicalResearch.com
Interview with:Dr. Timothy J. Fendler MD MSDepartment of Cardiology,Saint Luke’s Mid America Heart
Institute Kansas City, Missouri
main findings?
• Dr. Fendler: In-hospital cardiac arrest occurs commonly in the United
States and is associated with low rates of meaningful survival. This poor
prognosis should prompt patient-clinician discussions about goals of care
and preferences for future resuscitative efforts. Little is known about how
prognosis is aligned with code status decisions among survivors of in-
hospital cardiac arrest (in other words, as prognosis worsens, are patients
more likely to adopt Do-Not-Resuscitate orders, a sign of less aggressive
treatment preferences, should recurrent cardiac arrest occur).
• We found that, among patients who survive an in-hospital cardiac arrest,
there is generally good alignment between prognosis and code status
decisions. That is, as prognosis worsens among survivors of in-hospital
cardiac arrest, the rate of DNR status adoption increases, on average.

• However, among patients with very low levels of neurologic functioning
and very poor prognosis, nearly two-thirds did not adopt DNR status,
despite the fact that only about 4% of these patients with poor prognosis
experienced actual favorable neurological survival. These results imply
that there could be better alignment between prognosis and goals of care
decisions that places the patient’s wishes, safety, and quality of life at the
forefront of decision-making and decreases the likelihood of undue
suffering when the outcome may not be improved by it.
• Second, survival rates were much lower in patients with DNR orders,
compared to those who did not adopt DNR status, after survival from in-
hospital cardiac arrest. This was observed regardless of prognosis,
implying that patients who adopt DNR status, and thus only request they
be treated differently in the setting of recurrent cardiac arrest, may be
receiving less aggressive treatment than they prefer, in areas of their care
outside of resuscitation from cardiac arrest.

• Medical Research: What should clinicians and patients take away from
your report?
• Dr. Fendler: Our results imply that, while our work to standardize
resuscitation efforts for patients during in-hospital cardiac arrest has been
exhaustive, little attention has been paid to how we assign prognosis,
share that prognosis with patients, and help those patients to make
treatment decisions reflective of their goals and preferences, after
survival form cardiac arrest. Patients who survive in-hospital cardiac arrest
might not understand that likelihood of “good” survival may be influenced
by a number of factors about their pre-arrest state, comorbidities, and
aspects of the arrest event itself, and may not have a good sense of what
their prognosis is, which could help them make the best decisions for
themselves. DNR decisions should be personal to each patient; there is
not a right or wrong choice for any one situation. However, our findings
imply that perhaps some patients would benefit from better
understanding of these complex issues before deciding about
aggressiveness of future care.

• Our findings should spur on further studies about what
patients want after surviving cardiac arrest and how
clinicians can best estimate prognosis, share it with
patients and/or their families, and support informed
decision-making in the post-arrest period about goals
of care based on individual patient preferences and
goals. clinicians should strive to increase prognostic
skills in complex clinical scenarios such as resuscitation
from in-hospital cardiac arrests so they can best
educate patients, ensure informed decisions, and
advocate for patients’ beliefs and goals.

• Dr. Fendler: The CASPRI score should be validated in other groups
of patients who have survived cardiac arrest, as it may prove to be
a useful tool in helping clinicians estimate prognosis and support
patients’ decisions about their future care. Furthermore, our
working research group is currently studying hospital rates of DNR
status adoption and survival among patients resuscitated from
cardiac arrest. The implications for a hospital-level analysis like this
may be more for policy and procedural changes in how hospitals
address and carry out patients’ code status preferences, and to
ensure all patients are treated according to their preferences,
regardless of where they seek care.

• The use of this large, national registry of in-hospital cardiac arrest
to carry out our study means that we could not get really granular
details about each case, such as whether code status discussions
occurred between clinicians and patients or their families, what the
content if such discussions was, if they did occur, and what
ultimately led patients or their families to adopt DNR status or not.
Such information is key to better understanding the reasons behind
some of the more provocative trends we discovered in our
research. Future work in this area would benefit from more
qualitative research methods, such as interviews of key
stakeholders, direct observation of discussions/meetings about
goals of care for patients who have survived cardiac arrest, and
acquisition of data points that are not normally collected in
traditional healthcare registries (for example, questions that can
only be answered by talking directly with patients and/or
clinicians).

• Finally, I think our study is timely and important because it fits in (indirectly) with
the larger narrative that is currently unfolding in our healthcare system, regarding
how we approach critical and/or terminal illness and end-of-life decision making
(though all of our patients were not end-of-life) in our current healthcare system.
While we have focused heavily in the past on the quality of how we live with
chronic diseases and illness, less emphasis has been placed on understanding and
improving the process of how we die. Both are important. Studies like ours, which
we think can help us think about how to study the ways clinicians, patients and
families make difficult decisions in response to traumatic events such as in-
hospital cardiac arrest and declines in their health, can prompt future research
that might further the national conversation about supporting patient-centered
healthcare and informed decision making, and improving the experience of
patients at all phases of health, illness, and disease progression.
• Citation:
• Alignment of Do-Not-Resuscitate Status With Patients’ Likelihood of Favorable
Neurological Survival After In-Hospital Cardiac Arrest

New Drug Combination Studied To Treat Agitation in Alzheimer’s DiseaseMedicalResearch.com
Interview with:Jeffrey L. Cummings, M.D., Sc.D.Director, Lou Ruvo Center for Brain HealthCamille and Larry Ruvo
Chair for Brain HealthCleveland Clinic Las Vegas, NV 89106
main findings?
• Dr. Cummings: Agitation is a common problem in Alzheimer’s disease
(AD); approximately 70% of patients with AD will experience periods of
agitation. This difficult behavior challenges patients and caregivers,
adversely affects quality of life, and may precipitate institutionalization.
There are not drugs approved for treatment of agitation in Alzheimer’s
disease.
• The study reported in JAMA showed that a drug based on a combination
of dextromethorphan and quinidine (DM/Q) produced statistically
significant and clinically meaningful reduction in agitation in Alzheimer’s
disease patients. The study met its primary outcome (decline in the
Neuropsychiatric Inventory agitation scale in drug compared to placebo)
and many of its secondary outcomes (e.g, decreases in caregiver stress).
The agent was safe and well tolerated.

• Dr. Cummings: Agitation is treatable and new
drugs will be developed to address this
challenge. DM/Q is being advanced to a
Phase 3 study in anticipation of submission to
the FDA and eventual market approval.

• Dr. Cummings: DM/Q should be studied further to
determine the consistency and magnitude of the effect
as well as to verify its safety.
• Citation:
• Ballard C, Sharp S, Corbett A. Dextromethorphan and
Quinidine for Treating Agitation in Patients With
Alzheimer Disease Dementia. JAMA.
2015;314(12):1233-1235.
doi:10.1001/jama.2015.10215.

ICU Treatment For Pneumonia May Decrease Readmissions and CostsMedicalResearch.com
Interview with:Thomas Valley, MDFellow, Division of Pulmonary and Critical CareUniversity of Michigan Ann
Arbor, MI
• Medical Research: What is the background for this study? What
are the main findings?
• Dr. Valley: There has been dramatic growth in intensive care unit
(ICU) use over the past 30 years. As the reasons for this growth are
not entirely clear, some have suggested that the ICU is a meaningful
source of low-value care. The value of the ICU, however, depends
on the net benefit that ICUs provide patients. Prior observational
studies assessing the effectiveness of the ICU were limited because
patients admitted to the ICU are inherently sicker and more likely
to die than patients admitted to the general ward. Given the
substantial number of patients with pneumonia who are admitted
to an ICU, it is vital to understand whether admission to the ICU is
beneficial.

Arbor, MI
• In our study of 1.1 million Medicare beneficiaries with pneumonia
between 2010 and 2012, we used an instrumental variable, a
statistical technique to pseudo-randomize patients based on their
proximity to a hospital that uses the ICU frequently for pneumonia,
in order to determine whether ICU admission saved lives and at
what financial cost. An estimated 13 percent of patients were
admitted to the ICU solely because they lived closest to a hospital
that used the ICU frequently for pneumonia. Among these patients,
ICU admission was associated with a nearly six percent reduction in
30-day mortality compared to general ward admission. In addition,
there were no significant differences in hospital costs or Medicare
reimbursement between patients admitted to the ICU and to the
general ward.

Arbor, MI
• Medical Research: What should clinicians and patients take away from your
report?
• Dr. Valley: If these findings are replicated, the results may suggest that in patients
who might be seen as on the borderline of needing intensive care because they
might receive ICU care in one hospital but not another, ICU admission may
improve survival without substantially increasing costs. It is rare to find a medical
treatment that may save lives without considerably increasing costs, and these
results suggest that the ICU may be such a treatment for these patients. For
clinicians, the potential benefits of ICU admission for borderline patients with
pneumonia should be considered. It is important to note, however, that the
study’s results should not be generalized to patients who have a clear need for the
ICU (i.e. those receiving mechanical ventilation) or to patients who clearly do not
need the ICU (i.e. low-risk admissions). For patients and their families, it is
reasonable to initiate a discussion with the medical team about the possibility of
escalating to ICU-level care. For health policy makers, these results encourage a
more nuanced discussion regarding more efficient use of existing ICU beds in
addition to ongoing conversations about whether we need more or less ICU beds.

Arbor, MI
• Dr. Valley: While our study goes against the existing literature suggesting
that the ICU is being overused, it underscores the importance of research
to better identify the vulnerable population of patients who most benefit
from ICU admission. If the results of this study are confirmed, a
randomized trial of enhanced ICU or ICU-like access for patients with
pneumonia would be useful to further test these results. In addition, it
needs to be determined whether ICU admission is beneficial for other
conditions beyond pneumonia.
• Citation:
• Thomas S. Valley, Michael W. Sjoding, Andrew M. Ryan, Theodore J.
Iwashyna, Colin R. Cooke. Association of Intensive Care Unit Admission
With Mortality Among Older Patients With Pneumonia.
• JAMA, 2015; 314 (12): 1272 DOI: 10.1001/jama.2015.11068

Selective Targeting Can Improve Deep Brain Stimulation For Parkinson’sMedicalResearch.com Interview with: Dr. Ilse
S. PienaarHonorary Lecturer in Neuroscience at Imperial College London(&Snr. Lecturer in Cellular Pathology,
Northumbria University)Centre for Neuroinflammation Neurodegeneration Division
of Brain Sciences Faculty of MedicineImperial College London
• Dr. Pienaar: A highly heterogeneous brainstem structure, the
pedunculopontine nucleus (PPN) has been deemed a promising
target for the delivery of deep-brain stimulation (DBS), to alleviate
aspects of Parkinson’s disease (PD), especially gait and postural
instability. However, optimal therapeutic targeting of the PPN has
been hampered due to DBS being unable to discriminate between
cell types being targeted. We optomised a novel technique,
Designer Receptors Exclusively Activated by Designer Drugs
(DREADD) in a rat model of PD, by which to target only the PPN
cholinergic neurons. A series of behavioral tests revealed that
selective stimulation of the PPN cholinergics completely reverses
gait problems and postural instability in the PD rats.

S. PienaarHonorary Lecturer in Neuroscience at Imperial College London(Snr. Lecturer in Cellular Pathology,
• Dr. Pienaar: Selective targeting of neuronal
types within deep-brain stimulation targets in
patients diagnosed with neurodegenerative
disease may become a possibility within the
next 5-10 years. This study illustrates the
potential of this approach for alleviating
specific symptoms of the disease.

S. PienaarHonorary Lecturer in Neuroscience at Imperial College London(Snr. Lecturer in Cellular Pathology,
• Dr. Pienaar: Other neurodegenerative diseases such as Alzheimer’s has
shown potential to benefit from deep-brain stimulation intervention also.
DREADD technology can be used to dissect out the relative contribution
made by select subpopulations of neurons in vulnerable brain structures
towards not only the disease phenotype, but to reverse disease
symptoms, following a targeted therapeutic approach.
• Citation:
• Pharmacogenetic stimulation of cholinergic pedunculopontine neurons
reverses motor deficits in a rat model of Parkinson’s disease
• Ilse S. Pienaar12*, Sarah E. Gartside3, Puneet Sharma1, Vincenzo De
Paola4, Sabine Gretenkord3, Dominic Withers4, Joanna L.
Elson56 and David T. Dexter1
• Molecular Neurodegeneration 2015, 10:47 doi:10.1186/s13024-015-
0044-5

What Measures Can Reduce Suicides At Public Hotspots?MedicalResearch.com Interview with:Professor Jane Pirkis
PhD Centre for Mental HealthMelbourne School of Population and Global HealthUniversity of Melbourne, Australia
What are the main findings?
• Professor Pirkis: Public sites that gain a reputation as
places where people might go to seek to end their lives are
a particular problem in suicide prevention. Any suicide is
tragic, but suicides at these sites have an extra level of
complexity because they can lead to copycat acts and can
have a major impact on people who work at or live near
these sites, or visit them for other reasons. Our meta-
analysis, which pooled data from 18 individual studies from
around the world, found that three interventions work
really well in reducing suicides at these sites.

• Restricting access to means (e.g., installing barriers)
can reduce suicides at these sites by 90% or more, and
• encouraging help-seeking (e.g., installing phones that
link directly to crisis services) and
• increasing the likelihood of someone intervening (e.g.,
installing CCTV cameras, training staff who work at
these sites) can each reduce them by around 50%, or
more in some cases. The interventions seem to work
well together and complement each other too.

• Medical Research:What should communities take away from your
report?
• Professor Pirkis: I think that communities that are concerned
about particular sites should certainly consider putting in place one
or more of the above interventions. Restricting access to means is
the most effective, but this may not always be possible. There is
sometimes opposition to installing barriers, for example, partly
because it is thought that they will mar the beauty of given sites,
and partly because they are expensive. The studies we looked at
provided numerous examples where barriers had been carefully
constructed to make sure that they were sympathetic to their
surroundings, and although their initial cost was not insignificant,
the ongoing cost of maintaining them was negligible. In instances
where barriers are just not an option, though, encouraging help-
seeking and increasing the likelihood of third party intervention
should definitely be considered.

• Medical Research: What recommendations do you have for future research as a result of this
study?
• Professor Pirkis: Further work to tease out the independent effects of each of these interventions
would be helpful, particularly encouraging help-seeking and increasing the likelihood of
intervention by a third party. We identified two other interventions that we could not include in
our meta-analysis because they were the subject of only one study each.
• The first of these was encouraging responsible media reporting of suicide at these sites, in order to
reduce the likelihood of copycat acts.
• The second was installing special blue lights at certain dimly-lit and risky sites; these lights are
thought to have a calming effect. The individual studies of these two interventions suggest that
they both show promise, but it would be good to investigate this further.
• Citation:
• Interventions to reduce suicides at suicide hotspots: a systematic review and meta-analysis
• Pirkis, Jane et al.
• The Lancet Psychiatry Published Online: 22 September 2015
• DOI: http://dx.doi.org/10.1016/S2215-0366(15)00266-7

Second Hand Smoke Doubles Hospitalizations For Kids With AsthmaMedicalResearch.com Interview with:Avni
Y Joshi, MD, MSc Assistant
Professor of Pediatrics and MedicinePediatric and Adult Allergy / ImmunologyCellular and Molecular Immunology
Laboratory Mayo Clinic
• Dr. Joshi: We sought to quantify the risk of asthma
outcomes in children with asthma who are exposed to
second hand tobacco smoke (SHS).
• This was a pooled analysis of 25 studies that were included
for looking at asthma outcomes in children.
• Children with asthma who were exposed to second hand
tobacco smoke (SHS) were nearly twice as likely to be
hospitalized as compared to children with asthma who
were not exposed to second hand tobacco smoke
exposure.

• Dr. Joshi: This pooled analysis has quantified
the risk of asthma outcomes in children who
are exposed to second hand tobacco smoke.
• We knew that it was bad, this study has given
a numeric quantitation to that risk.

• Dr. Joshi: Future research should look at active tobacco
control measures to assess for improvement in asthma
outcomes in this patient population.
• Citation:
• Effects of secondhand smoke exposure on asthma
morbidity and health care utilization in children: a
systematic review and meta-analysis
• Wang, Zhen et al.
• Annals of Allergy, Asthma Immunology
• September 24, 2015

ACO Model Reduced Some Low Value Medical Services in First YearMedicalResearch.com
Interview with: Aaron L. Schwartz, PhDDepartment of Health Care Policy Harvard
Medical SchoolBoston, Massachusetts
• Medical Research: What is the background for this
study? What are the main findings?
• Dr. Schwartz: It is widely believed that much health
care spending is devoted to services that provide little
or no health benefit to patients. In previous work, we
demonstrated that low-value services were commonly
delivered to the Medicare population. In this study, we
examined whether a new form of paying physicians
and hospitals was effective in discouraging the use of
low-value services.

• The payment reform we studied was the Medicare Pioneer
Accountable Care Organization (ACO) Program, a feature of the
Affordable Care Act. This program financially rewards health care
provider groups who keep spending under a specified budget and
achieve high performance on measures of quality of care. This
voluntary program employs a similar ACO payment model that
some private insurers have adopted. The hope is that such models
can encourage providers to be more efficient by allowing them to
share in the savings generated by lower health care spending. In
previous work, we demonstrated that the Pioneer ACO Program
was associated with lower overall health care spending and steady
or improved performance on health care quality measures.
However, it was unclear whether providers were focusing on low-
value services in their attempts to reduce spending.

• We examined 2009-2012 Medicare claims data and
measured the use of, and spending on, 31 services
often provided to patients that are known to provide
minimal clinical benefit. We found that patients cared
for in the ACO model experienced a greater reduction
in the use of low-value services when compared to
patients who were not served by ACOs. We attributed
a 4.5 percent reduction in low-value service spending
to the ACO program. Interestingly, this was a greater
reduction than the 1.2 percent reduction in overall
spending attributed to the program, which suggests
that providers were targeting low-value services in
their efforts to reduce spending.

• Dr. Schwartz: Physicians are best equipped to
know what services are necessary and which are
wasteful. Our study shows that, when providers
are given broad incentives to lower spending,
they will tend to focus on reducing the use of
low-value services. This means that ACO-like
payment reforms may be more effective than
other reforms that try to influence physician
decisions with respect to specific treatments.

• Dr. Schwartz: We only examined one year of the Pioneer
ACO program. Additional studies will be needed to assess
the long-term effects of policies like this. We believe that
understanding how different health care policies affect the
use of low-value care is a fertile area for research.
• Citation: 
• Schwartz AL, Chernew ME, Landon BE, McWilliams J.
Changes in Low-Value Services in Year 1 of the Medicare
Pioneer Accountable Care Organization Program.JAMA
Intern Med. Published online September 21, 2015.
doi:10.1001/jamainternmed.2015.4525.

Death Rate MedicalResearch.com Interview with: Gayatri Mirani MD and Tulane University School of Medicine New
Orleans, LouisianaPaige L. Williams, PhD Department
of BiostatisticsHarvard T. H. Chan School of Public HealthBoston, MA 02115
• Medical Research: What is the background for this study
• Response: Combination antiretroviral therapy (cART) has
resulted in a dramatic decrease in HIV-related
opportunistic infections and deaths in US youth, but both
continue to occur. IMPAACT P1074, a long-term US-based
prospective multicenter cohort study funded through NIH
was conducted from April 2008 to June 2014. We reviewed
complications and mortality rates in HIV-infected US youth
enrolled in this study. Comparisons were made with a
previous observational cohort study, P219C. While P219C
was conducted from 2000 to 2007, we restricted our
analysis to 2004-2007 in order to evaluate changes over
the past decade.

• A total of 1201 HIV-infected youth were enrolled
in the IMPAACT P1074 study, with most (1040, or
90%) infected with HIV at birth. The overall study
population was 52% female, 58% black non-
Hispanic and 28% Hispanic. Their mean age at the
first chart abstraction was 17.4 (±5.4 Std. Dev.)
years. The majority were on cART, had a stable
CD4 count (baseline mean 500 cells/mm3) and
a suppressed viral load over a median follow-up
of 3.7 years. The P219C group was younger, with
a mean age of 11.9 (±5.0 Std. Dev.) years at the
start of the 2004-2007 follow-up period.

• Response: The most commonly reported comorbidities for the P1074 group were psychiatric and
neurodevelopmental disorders, asthma, pneumonia, and genital tract infections. The incidence of
pneumonia decreased compared to P219C group. However, the incidence of substance or alcohol
abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D
deficiency or metabolic bone disorders, anxiety disorders and fractures increased 5-fold or greater
compared to the earlier cohort. Pregnancies occurred in 19% of females older than 12.5 years, and
25% of those had at least one subsequent pregnancy while on the study. Some of the increases in
incidence rates are expected since P1074 participants were generally older than P219C
participants. However, the majority of these increases persisted after adjustment for age. There
were 28 deaths in P1074 (mortality rate of 0.66/100 person-years), which was similar to the
mortality rate of 0.63/100 person-years observed from 2004-2006 in P219C study. Most deaths
(86%) were directly linked to infection or other HIV-associated medical conditions. Subjects who
died did not differ from survivors by socio-demographic background, but were older and had lower
CD4 counts and higher viral loads at death. The mortality rate was 30 times the standardized
general US population.

• Medical Research: What should clinicians and patients take away from your
report?
• Response: While many infectious conditions may have become less common with
cART, other non-infectious conditions including metabolic disorders and
neurodevelopmental conditions have emerged. We found higher rates of
dyslipidemia, asthma, eczema, hypertension, diabetes mellitus, thyroid hormone
abnormalities, vitamin D deficiency or metabolic bone disorders and fractures in
P1074 than in P219C. Multi-factorial causes are at the root of these metabolic
problems. Neurodevelopmental problems, described below, have also increased.
They not only directly contribute to morbidity but also have secondary
consequences such as medication non-adherence, risk-taking behavior, and
increased HIV transmission,. Even after age-adjustment, substance or alcohol
abuse, anxiety disorders, trauma/stress related disorders, disruptive/impulse
control disorders, and learning and communication disorders showed higher
incidence rates in P1074 than in P219C. Monitoring strategies for perinatally-
infected youth may need to be modified to capture these types of diagnoses and
provide a more comprehensive approach to retaining these individuals in care.

• Another contributing factor to increasing HIV transmission in this
population is their higher rates of genital HPV infection and
anogenital herpes, as well as substantial rates of syphilis,
chlamydia, gonorrhea, trichomoniasis, and yeast infections. While
these higher rates largely reflect an older age distribution in the
P1074 population, they raise concerns for development of cervical
dysplasia in women, penile squamous cell carcinoma in men, and
anal squamous cell carcinoma in women and in men who have sex
with men. Strategies to improve diagnosis, early and appropriate
treatment, and prevention are key components of HIV care in this
youth. While some of these conditions may not carry the same
morbidity as opportunistic infections, the mortality rate remains
substantially elevated as compared to similarly-aged youth without
HIV.

• Response: Prospective longitudinal studies involving HIV-infected youth
are important to understand the evolving long-term effects of HIV
infection and cART. Monitoring of chronic inflammatory conditions,
prevention of genital tract infections, addressing neurobehavioral
problems, and achieving healthy pregnancies with prevention of mother-
to-child transmission are key focus areas for HIV-infected youth.
• Citation: 
• Clin Infect Dis. 2015 Aug 12. pii: civ687. [Epub ahead of print]
• Changing Trends in Complications and Mortality Rates Among US Youth
and Young Adults With HIV Infection in the Era of Combination
Antiretroviral Therapy.
• Mirani G, Williams PL, Chernoff M, Abzug MJ, Levin MJ, Seage GR
3rd, Oleske JM, Purswani MU, Hazra R, Traite S, Zimmer B, Van Dyke
RB; IMPAACT P1074 Study Team.

Electronic Medical Records Make It Harder to Understand the Patient’s StoryMedicalResearch.com
Interview with: Lara Varpio, PhD Associate Professor, Department of Medicine
Acting Associate Director, Graduate Programs in Health Professions Education
Uniformed Services University of the Health Sciences Bethesda MD andDr. Judy Rashotte PhD Director
Nursing Research and Knowledge Translation Consultant Ottawa Canada
• Medical Research: What is the background for this
study?
• Drs. Varpio and Rashotte: Electronic health records
(EHRs) are being adopted in healthcare centers around
the world. The patient record is intricately implicated
in care processes, clinical reasoning activities, and in
collaborative work. As part of a larger study aimed at
understanding how EHRs impact health professionals’
interprofessional collaborative practice (ICP), we
explored how changing from a paper chart to an EHR
can impact clinical reasoning.

• Drs. Varpio and Rashotte: Our research demonstrated how different parts of the patient record
(i.e. communication genres / artefacts) are part of the contextual factors that influence clinical
reasoning and ICP. A key finding of our study is that building the patient’s story is an essential part
of clinical reasoning activities. Making and understanding data interconnections is facilitated when
clinicians are actively engaged in assembling isolated data bits into contextually-derived,
comprehensive, and comprehensible ensembles. Building the patient’s story is facilitated through
the use of a chronologically-organized textual narrative (i.e. free-text notations) structure and
structures that promote visual bundles of clinical data. The use of an EHR can problematize
clinicians’ ability to build the patient’s story and to disseminate it with other members of the care
team when data interconnections are fragmented. Fragmentation happens when narrative spaces
are dispersed and/or character-limited, and when data displays are not chronologically organized
in visual assemblies. The constraint of chronologically and contextually isolated data inhibits
clinicians’ ability to read the why and how interpretations of clinical activities from other team
members. When an EHR splinters narrative reports, there is a loss of shared interprofessional
understanding of the patient’s story, and time efficient care delivery can be compromised.

• Drs. Varpio and Rashotte: Clinicians need the opportunity
to build the patient’s story. EHR vendors can support
building the patient’s story by designing interfaces that
present data as chronological interconnections and
preserving clinician narratives as wholes (not dispersed
sentences). Healthcare administrators can support the
need for unrestricted use of free-text notations in an EHR
system despite their goal for elimination of redundancy in
charting. Healthcare educators can explicitly focus on
connectivity education, such as bundle-making and
narrative-building skills.

• Drs. Varpio and Rashotte: Give clinicians the ability to format data
input and display options. Visual and narrative “wholes” are more
informative than disconnected data “bits”. Further research is
needed to help answer the question: How do we go about
supporting the process of creating connectivity for the
enhancement of clinical reasoning and ICP through the use of EHR
systems?
• Citation:
• The EHR and Building the Patient’s Story: A Qualitative Investigation
of How EHR Use Obstructs a Vital Clinical Activity
• Varpio, Lara et al. International Journal of Medical Informatics
• Online: September 14, 2015
• DOI: http://dx.doi.org/10.1016/j.ijmedinf.2015.09.004

Which Patients on Warfarin Need Repeat CT Scan after Head Injury?MedicalResearch.com Interview with: Dr Lim Beng
Leong MBBS, MRCS (AE), FAMSJurong Health ServicesEmergency Department, Singapore
main findings?
• Dr. Leong: It is common in the emergency department to see patients
with warfarin who suffer a minor head injury (HI) with GCS 13. It is
standard practice according to international guidelines to perform a plain
CT scan of the head. What is contentious in the literature is the
subsequent management of those patients with a normal initial CT scan.
Practice is heterogeneous and includes a mandatory second CT scan at 24
hours mark or observation and repeat CT scan at the discretion of the
attending doctor.
• We have found in our study that the “observe and repeat CT scan for
symptomatic cases” approach only was safe as abnormal second CT scans
were rare (1 in 295 cases). We traced the patients’ course 2 weeks post
discharge and none of the patients were re-admitted for reasons of
delayed intra-cranial hemorrhage (ICH).

• However, the cohort of patients consist
largely of geriatric patients with falls. More
than 50% of these patients were hospitalized
for more than 3 days; the longest of 2-3
weeks. They were likely to have various
reasons that required longer hospitalizations
apart from observation for delayed ICH, such
as assessing for risk, etc.

• Dr. Leong: The main message to take home is
that observation and repeat CT scan was safe in
patients with minor head injury and warfarin.
However, the duration and mode of observation
(i.e a structured program inpatient or outpatient)
for this largely geriatric patients with fall as
presenting complaint remain to be determined.

• Dr. Leong: Future research should look at reasons why these
geriatric patients need prolonged hospitalization and only through
understanding these reasons, each clinical service can devise a
thorough yet targeted screening and assessment program which
can be inpatient or outpatient to manage them who present with HI
from a seemingly trivial fall.
• Citation: 
• Outcomes of warfarinized patients with minor head injury and
normal initial CT scan
• Leong, Lim Beng et al.
• The American Journal of Emergency Medicine
• DOI: http://dx.doi.org/10.1016/j.ajem.2015.09.009

Telemedicine Post-Op Visits Preferred By Patients in Pilot StudyMedicalResearch.com Interview with: Michael A. Vella
, M.D.Veterans Affairs Medical CenterVanderbilt University, Nashville
• Dr. Vella: We are fortunate to take care of Veterans from all over
Middle TN at the Tennnessee Valley Healthcare System Nashville
Campus. A significant number of Veterans travel long distances and
invest time and money in order to visit with us. We noticed that
many patients undergoing “low complexity” operations like
removal of gallbladders and repair of groin hernia spend a
significant amount of time, energy, and, in some cases, money to
travel to our facility for post operative visits relative to the amount
of time they spend in their evaluations. We wanted to look at the
quality of and Veteran preference for telehealth visits (phone and
video) with the idea that, if feasible, we could implement a
telehealth program at our facility.

• In our small pilot study, 23 Veterans underwent sequential phone, video,
and in-person visits. The Veterans were evaluated on four domains at
each visit type: general recovery, follow-up needs, wound care needs, and
complications. We then determined the agreement among the three visit
types. There was 100% agreement across the three visit types in the
domains of general recovery and follow-up needs. Percent agreement for
wound needs and complications was 96%, reflecting a possible infection
on a phone encounter that was not present on clinic or video assessment.
One Veteran in the sample had a wound infection that was detected by
both phone and video and confirmed during the in-person visit.
Importantly, there were no instances in which we failed to detect a
wound issue or postoperative complication by phone or video. We also
found an association between preference for telehealth visits and
distance traveled, although the majority of Veterans in our study
preferred telehealth visitation over traditional face-to-face encounters.

• We found that over the phone and video visits
were not only high quality, but were preferred
by our Veterans, especially those living far
from our facility. We have implemented a
telehealth program for general surgery post
operative follow up at our institution and
currently evaluate 3-5 patients a week using
telehealth modalities with plans to continue
to expand.

• Dr. Vella: With the traditional in-person visit as the
reference, the negative predictive values of phone and
video visits in our study were 95% (95%, CI 78%-99%) and
100% (95%, CI 85%-100%), respectively. This suggests that
these telehealth modalities can identify patients requiring
additional follow-up in addition to being preferred by
patients. The ability to follow-up with patients on the
phone or by video may decrease time and expenses
associated with Veteran travel and may also free up
additional clinic space, improving access to care to
Veterans as a whole.

• Dr. Vella: This is a small pilot study of Veterans from
Middle TN. As we (and other programs) implement
telehealth programs for post-operative follow up and
surgical care in general, it will be extremely important to
monitor patient outcomes and asses patient preferences
moving forward.
• Citation: 
• Christianne L. Roumie, MD, MPH et al. Postoperative
Telehealth VisitsAssessment of Quality and Preferences of
Veterans. JAMA Surgery, September 2015
DOI: 10.1001/jamasurg.2015.2660

Herpes Zoster/Shingles Vaccine Not Found Cost Effective In Patients Under 60MedicalResearch.com Interview with: 
Phuc Le, Ph.D., M.P.H.Center for Value-Based Care Research, Medicine InstituteCleveland, OH
• Dr. Phuc Le: The live attenuated herpes zoster vaccine is
approved by the FDA for persons aged 50 years and above.
However, the Advisory Committee on Immunization
Practices recommends it for only persons aged 60 years
and older. Therefore, we aimed to analyze the vaccine’s
cost-effectiveness among persons aged 50-59 years to see
if ACIP’s recommendation is reasonable. We found that the
vaccine is not cost-effective among people at aged 50
years, having an incremental costs of $323,000 per QALY
gained, which is 3 times more than a commonly accepted
threshold ($100,000/QALY).

Herpes Zoster/Shingles Vaccine Not Found Cost Effective In Patients Under 60MedicalResearch.com Interview with:
• Dr. Phuc Le: The vaccine may be effective to
prevent herpes zoster among persons aged 50
years, but the benefit the vaccine brings is
small relative to the money spent.

Herpes Zoster/Shingles Vaccine Not Found Cost Effective In Patients Under 60MedicalResearch.com Interview with:
• Dr. Phuc Le: The study will need to be revisited once
we have data on long-term vaccine efficacy in people
aged 50-59 years. However, we are unsure when this
information would be available.
• Citation:
• Ann Intern Med. 2015 Sep 8. doi: 10.7326/M15-0093.
[Epub ahead of print]
• Cost-Effectiveness of Herpes Zoster Vaccine for
Persons Aged 50 Years.
• Le P, Rothberg MB.

Where Does Optimism Reside in the Brain?MedicalResearch.com Interview with:Dr. Sanda Dolcos PhD
Post-doc FellowUniversity of Illinois
• Dr. Dolcos : With its high prevalence rate, anxiety is a pressing
• concern in our society. Identifying psychological and neural markers
• indexing resilience against anxiety will help the development of
• prevention and intervention programs. It has been recognized that
• trait optimism fosters resilience against anxiety, and the
• orbitofrontal cortex (OFC) is sensitive to anxiety symptoms, but the
• relationship among the factors at these different levels
• –personality, brain, and symptoms– has not been clear.

• 1) trait optimism was associated with lower level of
• anxiety
• 2) trait optimism is positively associated with the left
OFC
• volume
• 3) the left OFC volume was negatively linked to
anxiety, a
• relation partially accounted for by their mutual
association with
• trait optimism.

• Dr. Dolcos : This study identified orbitofrontal cortex
volume and trait optimism as resilience factors associated
with lower level of anxiety symptoms. In light of
• current evidence showing that both factors are malleable
to training
• effects, it is promising that interventions targeting OFC
function or
• those aiming to increase optimism can improve anxiety
symptoms. From
• these, practices cultivating optimism are accessible to both
• clinicians and patients.

• Dr. Dolcos : This study opens possible avenues for the development
of training/intervention programs, which can target the brain
and/or
• personality traits, such as optimism and positive affect. Studies
• using such interventions will also help establish causal effects in
• the relations among brain, personality, and symptom level factors.
• Citation:
• Sanda Dolcos et al. Optimism and the Brain: Trait Optimism
Mediates the Protective Role of the Orbitofrontal Cortex Gray
Matter Volume against Anxiety. Social, Cognitive and Affective
Neuroscience, September 2015 DOI: 1093/scan/nsv106

Brain-Computer Interface Allows Man With Paraplegia To WalkMedicalResearch.com Interview with: An Do, MD
Assistant ProfessorDepartment of NeurologyUniversity of California, Irvine
• Dr. An Do: In this study, we demonstrated that it is possible for a
person with paraplegia due to spinal cord injury to regain brain-
controlled walking through the use of a brain-computer interface.
This system records EEG signals as a person is thinking about
walking. While the person is thinking about walking, EEG signals
change in a manner which can be detected by a computer
algorithm. Upon detecting that a person is thinking about walking
from the EEG signals, the computer sends a command signal to an
electrical stimulation system to stimulate the nerves in the legs to
continuously generate alternating right and left stepping
movements. This stepping stimulation stops when he stops thinking
about walking.

• Dr. An Do: At this point, the study represents a
proof-of-concept. It does give hope that perhaps
in the future, a refined version of such a system
may eventually become a means to help restore
brain-controlled walking to those with paraplegia
due to spinal cord injury.

• Dr. An Do: Future research will need to determine such a
system can be used by a larger population of people with
spinal cord injury.
• Citation:
• Christine E. King, Po T. Wang, Colin M. McCrimmon, Cathy
CY Chou, An H. Do, Zoran Nenadic. The feasibility of a
brain-computer interface functional electrical stimulation
system for the restoration of overground walking after
paraplegia. Journal of NeuroEngineering and Rehabilitation,
2015; 12 (1) DOI: 10.1186/s12984-015-0068-7

Firefighters May Face Increased Risk of CancerMedicalResearch.com Interview with: Robert D. Daniels Ph.D
Division of Surveillance, Hazard Evaluations, and Field StudiesNational Institute for Occupational Safety and HealthCincinnati, O
• Dr. Daniels: In 2010, National Institute for Occupational Safety and Health
(NIOSH) researchers, with funding assistance from the U.S. Fire
Administration, launched a multi-year study to examine whether fire
fighters have a higher risk of cancer and other causes of death due to job
exposures. Our study was designed to address limitations of previous fire
fighter cancer research.
•  We included a significantly larger population. With more than
30,000 career fire fighters who served in Chicago, Philadelphia, and San
Francisco Fire Departments between 1950 and 2010, it is the largest study
of United States fire fighters ever undertaken. In addition, both non-white
and female fire fighters are represented.
•  We looked not only at deaths from cancer, but also at the diagnosis
of certain kinds of cancer, such as testicular and prostate cancer, which
have higher survival rates. We also examined other causes of death to
better understand the risk for various cancers and illnesses among fire
fighters compared to the general public.

• We also examined the relation between cancer and
several proxies of exposure, such as the number of fire
runs, time spent at fires, and duration of employment
of each firefighter (Dahm et al. 2015).
• The study was conducted in two parts. The first part
was aimed to answer the question: “Is cancer
associated with firefighting?” by comparing firefighter
cancer risk to that of the general population. The
second part focused on the question: “Are higher-
exposed firefighters more at risk?” Findings from both
parts have been published in the journal, Occupational
and Environmental Medicine (Daniels et al. 2014,
2015).

• Dr. Daniels: In the first phase, we found that a combined
population of fire fighters from San Francisco, Chicago, and
Philadelphia showed higher-than-expected rates of certain
types of cancer than the general U.S. population. The
findings suggested that firefighters may be at higher risk of
digestive, oral, respiratory, and urinary system cancers
than the general population. When we compared
firefighters based on their exposure potential, we found
that the risk of lung cancer and leukemia increased with
exposures. Finding a correlation between estimates of
exposure and some cancer types adds to the evidence of a
cause and effect relationship between firefighting and
cancer.

• Dr. Daniels: Some studies, including the current study,
suggest that firefighters may be at increased risk of
developing certain cancers as a result of their
occupational exposures. Clinicians should be aware of
and consider these risks when treating patients who
are also firefighters. In addition to recommended
cancer screening tests for the general population,
clinicians should consider initiating earlier screening or
screening at an increased frequency in firefighter
patients. This is a common practice among populations
believed to be at increased risk of cancer.

• Medical Research: What can be done to reduce
a firefighter’s cancer risk?
• Dr. Daniels: Raised awareness and exposure
prevention efforts are cost-effective means to
reduce occupational cancer risk. Efforts to
educate firefighters about safe work practices
including proper training, proper use of
protective clothing, and proper use of approved
respiratory protection during all phases of
firefighting should be increased.

• Dr. Daniels: Future studies that continue to explore these findings
in this and other cohorts will improve our understanding of cancer
risks in the fire service.
• Citation:
• Occup Environ Med. 2015 Oct;72(10):699-706. doi:
10.1136/oemed-2014-102671. Epub 2015 Feb 11.
• Exposure-response relationships for select cancer and non-
cancer health outcomes in a cohort of US firefighters from San
Francisco, Chicago and Philadelphia (1950-2009).
• Daniels RD1, Bertke S1, Dahm MM1, Yiin JH1, Kubale TL1, Hales
TR1, Baris D2, Zahm SH2, Beaumont JJ3, Waters KM1, Pinkerton
LE1.

MedicalResearch.com Top Medical Research Interviews September 25 2015

MedicalResearch.com Top Medical Research Interviews September 25 2015

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MedicalResearch.com Top Medical Research Interviews September 25 2015