Research Spotlight

Wesson, D. and H. Kitzman (2018). “In Reply to Palmer et al.” Acad Med 93(9): 1264.

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We thank Palmer and colleagues for their comments regarding our article. They describe important and more traditional components of community-engaged work that we greatly support. Our work, however, transcends the traditional community-engaged strategies employed in community–academic partnerships that focus primarily on engagement with individuals in communities. This more traditional approach includes collaborative learning, health screening, lay health promoters, and education for both entities as described by Palmer and colleagues. Often, these strategies are voluntary in nature and not integrated into the daily operations of the health care system. Our approach aims to achieve this integration first by being grounded in engagement with community-based entities (in our case, churches, Dallas Park and Recreation) and second, by becoming institutionalized as a standard practice within the health care system. Specifically, our approach employs the concept of equal partnerships described in community based participatory research methods as essential to building trust and identifying trusted agents. We propose that involving the leadership of community entities, not just individuals independent of these important community institutions, as equal partners in the development of innovations improves efficacy and dissemination. Our Invited Commentary describes numerous ways to operationalize and institutionalize community entities within the health care system that we feel should be taught in medical education programs to promote use in the health care system. We commend Palmer and colleagues for their important community engaged work while emphasizing that our approaches extend beyond traditional methods of community engagement in academic medicine. (Text of reply to Palmer et al. concerning authors’ article, Wesson DE, Kitzman HE. How academic health systems can achieve population health in vulnerable populations through value-based care: The critical importance of establishing trusted agency. Acad Med. 2018; 93: 839–842.)

Wayson, M. B., R. W. Leggett, D. W. Jokisch, C. Lee, B. C. Schwarz, W. J. Godwin and W. E. Bolch (2018). “Suggested reference values for regional blood volumes in children and adolescents.” Phys Med Biol 63(15): 155022.

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Estimates of regional blood volumes (BVs) in humans are needed in dosimetric models of radionuclides and radiopharmaceuticals that decay in the circulation to a significant extent. These values are also needed to refine models of tissue elemental composition in computational human phantoms of both patients and exposed members of the general public. The International Commission on Radiological Protection (ICRP) in its Publication 89 provides reference values for total blood content in the full series of their reference individuals, to include the male and female newborn, 1 year-old, 5 year-old, 10 year-old, 15 year-old, and adult. Furthermore, Publication 89 provides reference values for the percentage distribution of total blood volume in 27 different blood-filled organs and tissues of the reference adult male and adult female. However, no similar distribution values are provided for non-adults. The goal of the present study is to present a volumetric scaling methodology to derive these values for the same organs and tissues at ages younger than the reference adult. Literature data on organ-specific vascular growth in the brain, kidneys, and skeletal tissues are also considered.

Wasek, B., E. Arning and T. Bottiglieri (2018). “The use of microwave irradiation for quantitative analysis of neurotransmitters in the mouse brain.” J Neurosci Methods 307: 188-193.

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BACKGROUND: Assessing neurotransmitter metabolism in the brain is essential in studying the effects of drugs, dietary modification and characterizing transgenic mouse models of human neurodegenerative diseases. Regional brain concentrations of parent neurotransmitters and related metabolites are informative and provide a snap shot of the steady-state levels. The choice in method of sacrificing mice may differ from one laboratory to another, and the technique in removal of brain may have limitations depending on speed in which tissue can be dissected and frozen to prevent post-mortem changes. NEW METHODS: In order to better assess neurotransmitter metabolism in an effective and standardized manner we evaluated microwave irradiation as a method of sacrificing mice. Mice were sacrificed by CO2 asphyxiation followed by cervical dislocation or microwave irradiation at 4 Kw for 1.1s. Brain tissue was harvested into five regions and stored at -80 degrees C until analysis by either LC-MS/MS for acetylcholine, choline and GABA, or HPLC-EC for dopamine, serotonin and norepinephrine and related metabolites. RESULTS: The results of our study showed considerable differences in the levels of neurotransmitters between the two methods of sacrifice. Overall, the concentrations of neurotransmitters were higher in mice sacrificed by microwave irradiation, except for GABA, which was lower. COMPARISON WITH EXISTING METHOD(S): Previous microwave irradiation studies employed presently outdated equipment and neurotransmitter analysis methods, and were not as comprehensive. CONCLUSIONS: The combination of microwave irradiation with LC-MS/MS and HPLC-EC detection allows accurate and sensitive measurement of several neurotransmitter systems in discrete mouse brain regions.

Wang, W. and W. Macaulay (2018). “Opioids vs Nonopioids for Chronic Back, Hip, or Knee Pain.” JAMA 320(5): 506-507.

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Dr. Krebs and colleagues compared opioid with nonopioid medications in improving pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain. We have several concerns about the study design and generalizability of the results. First, potentially eligible patients were identified by searching the electronic health record for back, hip, or knee pain diagnoses at a primary care visit. It is not clear that the patients with knee or hip pain were truly painful due to osteoarthritis. Osteoarthritic radiographic changes are common, but these radiographic manifestations of osteoarthritis often are not the cause of the pain described by the patient. Many other conditions can cause knee and hip pain. It would be helpful if more detailed description of inclusion criteria was given. Second, other treatment modalities may confound the results. Patients were allowed to participate in nonpharmacological pain therapies. Injections and surgery are effective methods of treating hip and knee osteoarthritis. The 2 groups could be different from each other with regard to utilization of other treatment modalities. Could the authors provide more detailed information regarding other treatment modalities used in each group? Third, patient outcomes were improved in both groups. The result may suggest that the patients did not get sufficient nonopioid treatments before being enrolled in this study. Fourth, treatment of chronic back pain is more complicated and controversial than treatment of hip and knee osteoarthritis. Many conditions can cause chronic low back pain, such as failed back surgical syndrome. Such patients may have a history of multiple back surgeries and have failed multiple nonopioid options and interventional procedures. Closely monitored low-dose narcotics may be an option to improve their quality of life. Therefore, to generalize the results of this study to all patients with chronic low back pain may not be appropriate. A balanced approach to opioid prescribing is preferred so that access to opioids for patients who may benefit from them is not limited. (Text of commentary on Krebs et al., Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA. 2018;319(9):872-882.)

Valenzuela, N. M., M. Askar, S. Heidt, P. Jindra, A. Madbouly, D. Pinelli, A. Jackson and L. G. Hidalgo (2018). “Minimal data reporting standards for serological testing for histocompatibility.” Hum Immunol Aug 17. [Epub ahead of print].

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Histocompatibility testing, and HLA antibody screening in particular, varies in practice among laboratories. Currently, standards are lacking regarding the reporting of testing methods in publications. It is essential that scientific methods are rigorously and transparently described upon publication, so that results can be accurately interpreted and independently corroborated. Additionally, this would allow work groups to compile diverse data to achieve clinically significant conclusions from meta-analyses. These efforts are hindered when there is a paucity of method descriptions and where variability in serum treatment, protocol modifications, and assay thresholds affecting assay interpretation are known to exist. Thus, the ASHI Science and Technology Initiatives Committee (ASHI STIC) undertook the task of formulating recommendations for reporting HLA antibody testing by solid phase assays, and the associated HLA typing required for interpretation, in scientific publications. Herein we put forth standards for minimum information about HLA antibody testing methods reported in histocompatibility publications.