Research Spotlight

Criminger, C. and C. Swank (2019). “Impact of dual-tasking on mobility tasks in Parkinson’s disease as described through 2D kinematic analysis.” Aging Clin Exp Res Jul 3. [Epub ahead of print].

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BACKGROUND: Walking for people with Parkinson’s disease (PD) degrades during motor-cognitive interplay (i.e., dual task conditions). Declining gait mechanics and turning ability result in more frequent falls and an interruption of daily activities in persons with PD. AIMS: To determine the impact of dual-tasking on key mobility elements during a walking task in people with PD with 2D motion analysis. METHODS: Participants performed Timed Up and Go (TUG) single, dual task conditions (TUGalone, TUGmotor, and TUGcognitive). 2D motion analysis application was used to quantify seven key mobility elements including: sit-to-walk (STW) (s), walking turn time (WTT) (s), number of turn steps, turn-to-sit (TTS) (s), total number of TUG steps, total TUG time and turn strategy (on-the-spot or u-shaped). RESULTS: Thirty-one participants with PD completed this study [age M= 69 +/- 8.19, UPDRSm M= 23.21 +/- 10.03, HY MED= 2 (range 1-4)]. All key elements were significantly different between TUG conditions with the exception of sit-to-walk and turn strategy. Turn strategy was consistent across TUG tasks despite added cognitive loading. Repeated-measures MANOVA differences were observed in WTT (p = 0.01), number of turn steps (p = 0.03), TTS (p < 0.001), total number of TUG steps (p = 0.01), and total TUG time (p = 0.01). No significant relationships were found between disease severity (HY/UPDRSm) and turn strategy. DISCUSSION/CONCLUSION: Key mobility elements were significantly affected across dual task walking conditions in persons with PD. The use of 2D motion analysis assisted with identification of key mobility elements impacted during the single and dual task conditions.

Creary, L. E., S. G. Guerra, W. Chong, C. J. Brown, T. R. Turner, J. Robinson, W. P. Bultitude, N. P. Mayor, S. G. E. Marsh, K. Saito, K. Lam, J. L. Duke, T. L. Mosbruger, D. Ferriola, D. Monos, A. Willis, M. Askar . . . and M. A. Fernandez-Vina (2019). “Next-generation HLA typing of 382 International Histocompatibility Working Group reference B-lymphoblastoid cell lines: Report from the 17th International HLA and Immunogenetics Workshop.” Hum Immunol 80(7): 449-460.

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Extended molecular characterization of HLA genes in the IHWG reference B-lymphoblastoid cell lines (B-LCLs) was one of the major goals for the 17th International HLA and Immunogenetics Workshop (IHIW). Although reference B-LCLs have been examined extensively in previous workshops complete high-resolution typing was not completed for all the classical class I and class II HLA genes. To address this, we conducted a single-blind study where select panels of B-LCL genomic DNA samples were distributed to multiple laboratories for HLA genotyping by next-generation sequencing methods. Identical cell panels comprised of 24 and 346 samples were distributed and typed by at least four laboratories in order to derive accurate consensus HLA genotypes. Overall concordance rates calculated at both 2- and 4-field allele-level resolutions ranged from 90.4% to 100%. Concordance for the class I genes ranged from 91.7 to 100%, whereas concordance for class II genes was variable; the lowest observed at HLA-DRB3 (84.2%). At the maximum allele-resolution 78 B-LCLs were defined as homozygous for all 11 loci. We identified 11 novel exon polymorphisms in the entire cell panel. A comparison of the B-LCLs NGS HLA genotypes with the HLA genotypes catalogued in the IPD-IMGT/HLA Database Cell Repository, revealed an overall allele match at 68.4%. Typing discrepancies between the two datasets were mostly due to the lower-resolution historical typing methods resulting in incomplete HLA genotypes for some samples listed in the IPD-IMGT/HLA Database Cell Repository. Our approach of multiple-laboratory NGS HLA typing of the B-LCLs has provided accurate genotyping data. The data generated by the tremendous collaborative efforts of the 17th IHIW participants is useful for updating the current cell and sequence databases and will be a valuable resource for future studies.

Callewaert, C., T. Nakatsuji, R. Knight, T. Kosciolek, A. Vrbanac, P. Kotol, M. Ardeleanu, T. Hultsch, E. Guttman-Yassky, R. Bissonnette, J. I. Silverberg, J. Krueger, A. Menter, N. M. H. Graham, G. Pirozzi, J. D. Hamilton and R. L. Gallo (2019). “IL-4Ralpha Blockade by Dupilumab Decreases Staphylococcus aureus Colonization and Increases Microbial Diversity in Atopic Dermatitis.” J Invest Dermatol Jun 25. [Epub ahead of print].

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Dupilumab is a fully human antibody to interleukin-4 receptor alpha that improves the signs and symptoms of moderate-to-severe atopic dermatitis. To determine the effects of dupilumab on Staphylococcus aureus colonization and microbial diversity on the skin, bacterial DNA was analyzed from swabs collected from lesional and nonlesional skin in a double-blind, placebo-controlled study of 54 patients with moderate-to-severe atopic dermatitis randomized (1:1) and treated with either dupilumab (200 mg weekly) or placebo for 16 weeks. Microbial diversity and relative abundance of Staphylococcus were assessed by DNA sequencing of 16S rRNA, and absolute S. aureus abundance was measured by quantitative PCR. Before treatment, lesional skin had lower microbial diversity and higher overall abundance of S. aureus than nonlesional skin. During dupilumab treatment, microbial diversity increased and the abundance of S. aureus decreased. Pronounced changes were seen in nonlesional and lesional skin. Decreased S. aureus abundance during dupilumab treatment correlated with clinical improvement of atopic dermatitis and biomarkers of type 2 immunity. We conclude that clinical improvement of atopic dermatitis that is mediated by interleukin-4 receptor alpha inhibition and the subsequent suppression of type 2 inflammation is correlated with increased microbial diversity and reduced abundance of S. aureus. ClinicalTrials.gov identifier: NCT01979016.

Borsh, S., S. Sikka, L. Callender, M. Bennett, M. Reynolds and S. Driver (2019). “Borsh, S., S. Sikka, L. Callender, M. Bennett, M. Reynolds and S. Driver (2019). “Implementation of a Neurogenic Bowel Program for Spinal Cord Injury in the Acute Care Setting: Perceptions of Patients and Staff.” Occup Ther Health Care 33(3): 306-322.

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A prospect cohort and case-control was employed to (1) establish a neurogenic bowel (NB) program after spinal cord injury (SCI) in the acute care setting; (2) examine clinician knowledge ability to deliver the NB program; and (3) evaluate patient knowledge, satisfaction, and quality of life. Educational in-service describing NB clinical practice guidelines (CPGs) and order set was delivered to staff followed by a pre-/post-education, 3- and 12-month survey. The patient intervention followed 24 patients with NB to evaluate the program and compared to 28 retrospective case-control patients followed by a pre-/post-intervention survey to measure knowledge of SCI, NB program and quality of life. Injury information and bowel medication use was compared between cases and controls. Clinician knowledge of NB CPGs improved. There were no significant clinical differences between patient groups. Patient knowledge and satisfaction improved post-intervention. Education to staff and patients is imperative to facilitate a NB program to meet the needs for individuals with SCI.

Blankenship, J. C., J. W. Choi, T. S. Das, P. M. McElgunn, D. Mukherjee, L. L. Paxton, R. Piana, J. R. Sauer, C. J. White and P. L. Duffy (2019). “SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: If the cath lab is your home you should understand its finances.This statement was endorsed by the Alliance of Cardiovascular Professionals (ACVP) in April 2019.” Catheter Cardiovasc Interv 94(1): 123-135.

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This article is intended for any physician, administrator, or cardiovascular catheterization laboratory (CCL) staff member who desires a fundamental understanding of finances and economics of CCLs in the United States. The authors’ goal is to illuminate general economic principles of CCL operations and provide details that can be used immediately by CCL leaders. Any article on economics in medicine should start by acknowledging the primacy of the principles of medical ethics. While physicians have been trained to act in the best interests of their patients and avoid actions that would harm patients it is vitally important that all professionals in the CCL focus on patients’ needs. Caregivers both at the bedside and in the office must consider how their actions will affect not only the patient they are treating at the time, but others as well. If the best interests of a patient were to conflict with any recommendation in this article, the former should prevail. KEY POINTS: To be successful and financially viable under current payment systems, CCL physicians, and managers must optimize the outcomes and efficiency of care by aligning CCL leadership, strategy, organization, processes, personnel, and culture. Optimizing a CCL’s operating margin (profitability) requires maximizing revenues and minimizing expenses. CCL managers often focus on expense reduction; they should also pay attention to revenue generation. Expense reduction depends on efficiency (on-time starts, short turn-over time, smooth day-to-day schedules), identifying cost-effective materials, and negotiating their price downward. Revenue optimization requires accurate documentation and coding of procedures, comorbidities, and complications. In fee-for-service and bundled payment reimbursement systems, higher volumes of procedures yield higher revenues. New procedures that improve patient care but are expensive can usually be justified by negotiating with vendors for lower prices and including the “halo effect” of collateral services that accompany the new procedure. Fiscal considerations should never eclipse quality concerns. High quality CCL care that prevents complications, increases efficiency, reduces waste, and eliminates unnecessary procedures represents a win for patients, physicians, and CCL administrators.