Alejandro C. Arroliga M.D.

Shrank, W.H., Caveney, B., Miller, S., Medows, R.M., Arroliga, A., Doga, B., Ban, K., Muldoon, S., Seiden, J.M., Tong, I., Chaguturu, S. and Wohlgemuth, J.G. (2020). “A Simple Algorithm for Return to Workplace Employer Antibody Testing.” Popul Health Manag Aug 26. [Epub ahead of print.].

Full text of this article.

The role of serological antibody testing to aid in the management of the COVID-19 pandemic has garnered considerable enthusiasm in the lay media and policy spheres. There is intuitive appeal in using Immunoglobin G (IgG) testing to better understand levels of immunity in individuals and population as we develop plans for resuming economic activity. [No abstract available; excerpt from article.].

Mutnal, M. B., A. C. Arroliga, K. Walker, A. Mohammad, M. M. Brigmon, R. M. Beaver, J. K. Midturi and A. Rao (2020). “Early trends for SARS-CoV-2 infection in central and north Texas and impact on other circulating respiratory viruses.” J Med Virol May 15;10.1002/jmv.26010. [Epub ahead of print].

Full text of this article.

Rapid diagnosis and isolation are key to containing the quick spread of a pandemic agent like severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), which has spread globally since its initial outbreak in Wuhan province in China. SARS-CoV-2 is novel and the effect on typically prevalent seasonal viruses is just becoming apparent. We present our initial data on the prevalence of respiratory viruses in the month of March 2020. This is a retrospective cohort study post launching of SARS-CoV-2 testing at Baylor Scott and White Hospital (BSWH), Temple, Texas. Testing for SARS-CoV-2 was performed by real-time reverse transcription polymerase chain reaction assay and results were shared with State public health officials for immediate interventions. More than 3500 tests were performed during the first 2 weeks of testing for SARS-CoV-2 and identified 168 (4.7%) positive patients. Sixty-two (3.2%) of the 1912 ambulatory patients and 106 (6.3%) of the 1659 emergency department/inpatients tested were positive. The highest rate of infection (6.9%) was seen in patients aged 25 to 34 years, while the lowest rate of infection was seen among patients aged <25 years old (2%). County-specific patient demographic information was shared with respective public health departments for epidemiological interventions. Incidentally, this study showed that there was a significant decrease in the occurrence of seasonal respiratory virus infections, perhaps due to increased epidemiological awareness about SARS-CoV-2 among the general public, as well as the social distancing measures implemented in response to SARS-CoV-2. Data extracted for BSWH from the Centers for Disease Control and Prevention's National Respiratory and Enteric Virus Surveillance System site revealed that Influenza incidence was 8.7% in March 2020, compared with 25% in March 2019. This study was intended to provide an initial experience of dealing with a pandemic and the role of laboratories in crisis management. This study provided SARS-CoV-2 testing data from ambulatory and inpatient population. Epidemiological interventions depend on timely availability of accurate diagnostic tests and throughput capacity of such systems during large outbreaks like SARS-CoV-2.

Colbert, C. Y., J. C. French, A. C. Arroliga and S. B. Bierer (2019). “Best practice versus actual practice: an audit of survey pretesting practices reported in a sample of medical education journals.” Med Educ Online 24(1): 1673596.

Full text of this article.

Background: Despite recommendations from survey scientists, surveys appear to be utilized in medical education without the critical step of pretesting prior to survey launch. Pretesting helps ensure respondents understand questions as survey developers intended and that items and response options are relevant to respondents and adequately address constructs, topics, issues or problems. While psychometric testing is important in assessing aspects of question quality and item performance, it cannot discern how respondents, based upon their lived experiences, interpret the questions we pose.Aim: This audit study explored whether authors of medical education journal articles within audited journals reported pretesting survey instruments during survey development, as recommended by survey scientists and established guidelines/standards for survey instrument development.Methods: Five national and international medical education journals publishing survey articles from Jan. 2014 – Dec. 2015 were audited to determine whether authors reported pretesting during survey development. All abstracts within all issues of these journals were initially reviewed. Two hundred fifty-one articles met inclusion criteria using a protocol piloted and revised prior to use.Results: The number of survey articles published per journal ranged from 11 to 106. Of 251 audited articles, 181 (72.11%) described using a new instrument without pretesting, while 17 (6.77%) described using a new instrument where items were pretested. Fifty-three (21.12%) articles described using pre-existing instruments; of these, no articles (0%) reported pretesting existing survey instruments prior to use.Conclusions: Findings from this audit study indicate that reported survey pretesting appears to be lower than that reported in healthcare journals. This is concerning, as results of survey studies and evaluation projects are used to inform educational practices, guide future research, and influence policy and program development. Findings apply to both survey developers and faculty across a range of fields, including evaluation and medical education research.

Tew, B. Y., C. Legendre, M. A. Schroeder, T. Triche, G. C. Gooden, Y. Huang, L. Butry, D. J. Ma, K. Johnson, R. A. Martinez, M. Pierobon, E. F. Petricoin, J. O’Shaughnessy, C. Osborne, C. Tapia, D. N. Buckley, J. Glen, M. Bernstein, J. N. Sarkaria, S. A. Toms and B. Salhia (2019). “Patient-derived xenografts of central nervous system metastasis reveal expansion of aggressive minor clones.” Neuro Oncol Aug 21. [Epub ahead of print].

Full text of this article.

BACKGROUND: The dearth of relevant tumor models reflecting the heterogeneity of human central nervous system metastasis (CM) has hindered development of novel therapies. METHODS: We established 39 CM patient-derived xenograft (PDX) models representing the histological spectrum, and performed phenotypic and multi-omic characterization of PDXs and their original patient tumors. PDX clonal evolution was also reconstructed using allele-specific copy number and somatic variants. RESULTS: PDXs retained their metastatic potential, with flank-implanted PDXs forming spontaneous metastases in multiple organs, including brain, and CM subsequent to intra-cardiac injection. PDXs also retained the histological and molecular profiles of the original patient tumors, including retention of genomic aberrations and signaling pathways. Novel modes of clonal evolution involving rapid expansion by a minor clone were identified in two PDXs, including CM13, which was highly aggressive in vivo forming multiple spontaneous metastases, including to brain. These PDXs had little molecular resemblance to the patient donor tumor, including reversion to a copy number neutral genome, no shared non-synonymous mutations, and no correlation by gene expression. CONCLUSIONS: We generated a diverse and novel repertoire of PDXs that provides a new set of tools to enhance our knowledge of CM biology and improve preclinical testing. Furthermore, our study suggests that minor clone succession may confer tumor aggressiveness and potentiate brain metastasis.

Tlayjeh, H., Y. M. Arabi, N. D. Ferguson, Q. Zhou, F. Lamontagne, A. Arroliga, V. Danesh, G. Dominguez-Cherit, E. Jimenez, A. Mullaly, B. Staub and M. O. Meade (2019). “Body Mass Index and Mortality in Subjects With ARDS: Post-hoc Analysis of the OSCILLATE Trial.” Respir Care May 28. [Epub ahead of print].

Full text of this article.

BACKGROUND: Studies on the association of obesity with mortality in subjects with ARDS have yielded inconsistent results. METHODS: In a sub-analysis of the Oscillation for ARDS Treated Early (OSCILLATE) randomized controlled trial, 451 subjects were divided into 5 strata based on their body mass index (BMI) using the World Health Organization definitions: underweight < 18.5 kg/m(2); normal weight 18.5-24.99 kg/m(2); overweight 25-29.99 kg/m(2); obese 30-39.99 kg/m(2); severely obese > 40 kg/m(2). The primary outcome was all-cause hospital mortality across BMI strata for all subjects and for the 2 study arms (high-frequency oscillatory ventilation [HFOV] vs conventional ventilation) separately using multivariable logistic regression adjusting for potential confounding variables. RESULTS: Hospital mortality was not different across the BMI strata for all subjects (P = .86), for the HFOV arm (P = .94) or for the conventional ventilation arm (P = .59). After risk adjustment, BMI was not associated with increased risk for hospital mortality (odds ratio 1.01, 95% CI 0.97-1.04, P = .67), whereas HFOV was independently associated with increased mortality (odds ratio 1.74, 95% CI 1.11- 2.72, P = .02) with no effect modification by BMI strata (for this interaction, P = .56). Although there was no difference in the use of rescue therapies or in the number of days on sedation or analgesia, higher daily doses of fentanyl and midazolam were administered as BMI increased. CONCLUSIONS: There was no difference in adjusted hospital mortality across BMI strata in subjects with moderate to severe ARDS. Processes of care were not different across BMI strata except for higher daily doses of fentanyl as BMI increased.