tbuckley/cabot-search huggingface dataset:
Combined Inhibition of p38MAPK and PIKfyve Synergistically Disrupts Autophagy to Selectively Target Cancer Cells
Authors: Constandina E. O'Connell, Alex Vassilev
Journal: Cancer Research (2021)

In nutrient-poor conditions, autophagy buffers metabolic stress and counteracts the effects of chemotherapy and radiation on cancer cells, which depend on autophagy for survival. However, clinical trials targeting autophagy have failed to produce successful anticancer treatments using currently available inhibitors. Recent studies have shown that PIKfyve kinase inhibitors disrupt lysosome function in autophagy and can selectively kill certain cancer cells. Analysis of biochemical changes caused by PIKfyve inhibition revealed that resistant cells contain significantly higher levels of cellular p38MAPK protein and phosphorylation. Expression of the lysosomal protein, lysosomal-associated membrane protein 2, carrying phosphomimetic mutations of the p38MAPK phosphorylation sites prevented all effects caused by PIKfyve inhibition-induced lysosome dysfunction. Thus, the activation of p38MAPK in response to PIKfyve inhibition revealed a novel compensatory role in maintaining lysosome function in autophagy. The functional cooperation between the cellular PIKfyve and p38MAPK pathways in regulating lysosome homeostasis was especially important in cancer cells. Combined inhibition of PIKfyve and p38MAPK activities synergistically blocked autophagy-mediated protein degradation, prevented cathepsin maturation, and markedly reduced the viability of multiple cancer cell types without affecting the viability of normal cells. Furthermore, combined PIKfyve and p38MAPK inhibitors synergistically reduced tumor growth in mice bearing xenografts of human colorectal adenocarcinoma, suggesting a novel way to target cancer cells by prolonged inhibition of autophagy using lower drug concentrations. SIGNIFICANCE: This study demonstrates that PIKfyve and p38MAPK cooperate to regulate lysosome homeostasis and their combined inhibition synergistically blocks autophagy to reduce cancer cell viability in vitro and in vivo.
Longer follow-up data of circulating miR371a-3p expression across the spectrum of germ cell tumors (GCT).
Authors: Lucia Nappi, Marisa Thi, Neetu Saxena, Maryam Soleimani, Bernhard J. Eigl, Kim N. Chi, Martin Gleave, Alan I. So, Peter C. Black, Siamak Daneshmand, Hamed Ahmadi, Robert James Hamilton, Craig R. Nichols, Christian K. Kollmannsberger
Journal: Journal of Clinical Oncology (2021)

379 Background: miR371a-3p (miR371) is overexpressed in seminoma (S) and nonseminoma (NS) active germ cell malignancy (aGCM) and easily detectable in blood. We previously described 1 a remarkably high accuracy of miR371 in detecting aGCM in early and advanced stages germ cell tumor (GCT) patients (pts). We here present the updated miR371 expression data with a longer follow-up, particularly relevant to assess miR371 clinical utility to predict GCT relapse in clinical stage I (CSI) and stage IIA pts. Methods:119 samples from 99 pts enrolled in the GU biobank program at the British Columbia Cancer – Vancouver were analyzed. The pts were divided according to their risk of aGCM in low (CSIA NS and CSI S), moderate (CSIB NS, stage IIA markers negative/low elevated S and NS), and high risk (definitively metastatic aGCM) groups. Blood of the low and moderate risk pts was collected post orchiectomy and at the time of the clinical relapse; prior to/post-chemotherapy in the high risk group. Plasma miR371 expression was evaluated by RT-PCR and quantified by ΔΔCT method. Sensitivity, specificity, negative and positive predictive values (NPV, PPV) and AUC of the ROC curve were analyzed. Results: Five (2 moderate - 3 low risks) pts were lost at follow-up and 1 high risk pt had deceased. Overall, 113 samples (50, 36, 27 in the low, moderate, and high risk groups, respectively) were analyzed. The median follow-up from study entry was 30 (6-51), 28 (20-52), and 29 (7-53) months for the low, moderate and high risk, respectively. Seven more relapses occurred: 4 in the low risk (3 S and 1 NS) and 3 in the moderate risk groups (2 NS and 1 S). miR371 was found falsely negative post-orchiectomy in 4 pts and truly negative in 3 relapsed pts (2 pure teratoma and 1 unconfirmed relapse). Serial analysis of the false negative relapsed pts showed that miR371 became detectable at the time of clinical relapse. The operating characteristics of miR371 are summarized in the table below. Conclusions: Our follow-up has exceeded the expected time of relapse even in the low risk pts. The high accuracy of miR371 in detecting aGCM was confirmed with a longer follow up. However, the few false negatives in relapsed pts and the serial analysis suggest a lack of sensitivity in the detection of microscopic disease post-orchiectomy with the current methodology while miR371 high sensitivity was confirmed in presence of radiologic measurable disease (≥ 1 cm). The definitive operating characteristics of miR371 post-orchiectomy and during the follow-up of stages I/ IIA pts will be prospectively validated by the S1823 study that is actively recruiting pts. [Table: see text]
Surgeon who lied about his experience to get consultant post is struck off
Authors: Clare Dyer
Journal: BMJ (2021)

A surgeon who served three years in prison for lying about his experience to obtain a consultant’s post has been struck off the UK medical register.

Sudip Sarker was sentenced in February 2018 at Worcester Crown Court to six years’ imprisonment for dishonestly making a false representation for gain, but he was released on licence after serving three years.1

Sarker, who qualified at Glasgow University in 1991, began higher surgical training in 1999, but his progress was assessed as unsatisfactory in many areas, and he was required to repeat the final year.

He then worked for two years at London’s Royal Free Hospital, …
Estimated Prevalence of US Physicians With Disabilities
Authors: Zakia Nouri, Michael J. Dill, Sarah S. Conrad, Christopher J. Moreland, Lisa M. Meeks
Journal: JAMA Network Open (2021)

This survey study uses data from the Association of American Medical Colleges National Sample Survey of Physicians to assess the prevalence and characteristics of US physicians with disabilities among a survey of 6000 practicing physicians.
SARS-CoV-2 transmission risk from asymptomatic carriers: Results from a mass screening programme in Luxembourg
Authors: Paul Wilmes, Jacques Zimmer, Jasmin Schulz, Frank Glod, Lisa Veiber, Laurent Mombaerts, Bruno Rodrigues, Atte Aalto, Jessica Pastore, Chantal J. Snoeck, Markus Ollert, Guy Fagherazzi, Joël Mossong, Jorge Goncalves, Alexander Skupin, Ulf Nehrbass
Journal: The Lancet Regional Health - Europe (2021)
Factors associated with palliative care utilization in advanced and metastatic renal cell carcinoma.
Authors: Hiren V. Patel, Joshua Sterling, Arnav Srivastava, Sinae Kim, Biren Saraiya, Tina M. Mayer, Isaac Yi Kim, Saum Ghodoussipour, Thomas L. Jang, Eric A. Singer
Journal: Journal of Clinical Oncology (2021)

146 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with Stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC among the overall cohort and treatment-based cohorts. Results: Among 20,122 and 42,014 patients with Stage III and IV RCC, 329 and 9,317 patients received PC, respectively. From 2004 to 2014, PC utilization was stable at ̃1% for Stage III RCC and minimally increased from 17% to 20% for Stage IV RCC. Multivariable analysis demonstrated that increased comorbidities, insurance status, higher education status, facility location, care at a comprehensive cancer program or integrated network, sarcomatoid histology, and prior treatments significantly increased likelihood of palliative care utilization. We uncover socioeconomic and clinical factors that are associated with receipt of palliative care use in a treatment-specific manner. Conclusions: While PC utilization has minimally increased for Stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC use, especially in a treatment-specific manner, among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.
Suggestions for the prevention of Clostridioides difficile spread within outpatient hemodialysis facilities
Authors: Erika M.C. D’Agata, Ibironke W. Apata, Stephanie Booth, John M. Boyce, Karen Deaver, Nicole Gualandi, Alicia Neu, Duc Nguyen, Sharon Novosad, Paul M. Palevsky, Darlene Rodgers
Journal: Kidney International (2021)
Bike handlebar grip in the rectum: minimally invasive endoscopic management
Authors: Danilo Paduano, Francesco Auriemma, Mario Bianchetti, Alessandro Repici, Benedetto Mangiavillano
Journal: Endoscopy (2021)

A 54-year-old man presented to the emergency department of our hospital complaining of severe pelvic pain from a large cylindrical-shaped object he had inserted into his rectum approximately 5 hours prior to presentation. The patient reported that multiple attempts to remove it at home had failed.
Reliability, validity, and clinically important differences (CIDs) on the NCCN/FACT Bladder Symptom Index (NFBISI-18) among individuals with locally advanced or metastatic urothelial cancer (UC).
Authors: John Peipert, Jane Chang, Si Li, Alessandra Di Pietro, Paul Cislo, Joseph C Cappelleri, David Cella
Journal: Journal of Clinical Oncology (2021)

408 Background: The NFBlSI-18 is a measure of advanced bladder cancer–specific symptoms composed of a total scale and 3 subscales representing physical disease–related symptoms (DRS-P), emotional disease–related symptoms (DRS-E), treatment side effects (TSE), and function/well-being (F/WB). There is evidence for the reliability and content validity of this instrument, but a full psychometric evaluation of the full 18-item format has not been done. In addition, CIDs have not been estimated. Methods: With the exception of test-retest (TRT) analyses, baseline data (n=651) from the JAVELIN Bladder 100 trial (NCT02603432), which compared maintenance treatment with avelumab + best supportive care (BSC) vs BSC alone in patients with unresectable, locally advanced or metastatic UC that did not progress with first-line platinum-containing chemotherapy, were used for this study. Since we focused on baseline, we did not analyze the TSE. We estimated internal consistency reliability (Cronbach coefficient α), tested convergent validity by estimating Spearman ρ correlations with the EQ-5D-5L utility index (UI) and visual analog score (VAS) scales, and estimated known group validity using age (&lt;65, ≥65 years), ECOG performance status rating (PSR), and number of comorbidities/symptoms (1-9, ≥10) as anchors. We estimated TRT reliability using data from treatment cycles 2-3 with intraclass correlation coefficients (ICCs). To estimate and compare CIDs, we calculated differences in means between categories of the known group anchors for which Cohen’s d was &gt;0.2 (ie, at least a small effect). To provide context for the CIDs, we calculated distributional properties of the scales (1/2 standard deviation [SD], 1 standard error of measurement [SEM]). Results: The table shows the reliability, convergent validity, and CID estimates. Reliability estimates often exceeded thresholds for reliability generally considered acceptable. Cohen’s d for NFBlSI-18 scale score differences between known groups ranged between 0.05 and 0.25 (age), 0.35 and 0.6 (ECOG PSR 0 vs 1), and 0.1 and 0.41 (number of comorbidities/symptoms). Conclusions: This analysis demonstrated that the NFBlSI-18 is a reliable and valid instrument to measure symptoms in patients with advanced UC. The CID estimates can help clinicians and researchers to understand what difference in patient symptoms are clinically meaningful, as measured by NFBlSI-18, to inform clinical practice. [Table: see text]
Healthcare Utilization and End-of-Life Outcomes in Patients Receiving CAR T-Cell Therapy
Authors: P. Connor Johnson, Caron Jacobson, Alisha Yi, Anna Saucier, Tejaswini M. Dhawale, Ashley Nelson, Mitchell W. Lavoie, Mathew J. Reynolds, Carlisle E.W. Topping, Matthew J. Frigault, Areej El-Jawahri
Journal: Journal of the National Comprehensive Cancer Network (2021)

Background: CAR T-cell therapy has revolutionized the treatment of patients with hematologic malignancies, but it can result in prolonged hospitalizations and serious toxicities. However, data on the impact of CAR T-cell therapy on healthcare utilization and end-of-life (EoL) outcomes are lacking. Methods: We conducted a retrospective analysis of 236 patients who received CAR T-cell therapy at 2 tertiary care centers from February 2016 through December 2019. We abstracted healthcare utilization and EoL outcomes from the electronic health record, including hospitalizations, receipt of ICU care, hospitalization and receipt of systemic therapy in the last 30 days of life, palliative care, and hospice referrals. Results: Most patients (81.4%; n=192) received axicabtagene ciloleucel. Overall, 28.1% of patients experienced a hospital readmission and 15.5% required admission to the ICU within 3 months of CAR T-cell therapy. Among the deceased cohort, 58.3% (49/84) were hospitalized and 32.5% (26/80) received systemic therapy in the last 30 days of life. Rates of palliative care and hospice referrals were 47.6% and 30.9%, respectively. In multivariable logistic regression, receipt of bridging therapy (odds ratio [OR], 3.15; P =.041), index CAR-T hospitalization length of stay &gt;14 days (OR, 4.76; P =.009), hospital admission within 3 months of CAR T-cell infusion (OR, 4.29; P =.013), and indolent lymphoma transformed to diffuse large B-cell lymphoma (OR, 9.83; P =.012) were associated with likelihood of hospitalization in the last 30 days of life. Conclusions: A substantial minority of patients receiving CAR T-cell therapy experienced hospital readmission or ICU utilization in the first 3 months after CAR T-cell therapy, and most deceased recipients of CAR T-cell therapy received intensive EoL care. These findings underscore the need for interventions to optimize healthcare delivery and EoL care for this population.
Splanchnic Nerve Block Mediated Changes in Stressed Blood Volume in Heart Failure
Authors: Marat Fudim, Manesh R Patel, Richard Boortz-Marx, Barry A Borlaug, Adam D DeVore, Arun Ganesh, Cynthia L Green, Renato D Lopes, Robert J Mentz, Chetan B Patel, Joseph G Rogers, G Michael Felker, Adrian F Hernandez, Kenji Sunagawa, Daniel Burkhoff
Journal: JACC Heart Failure (2021)
Anti-interleukin-21 antibody and liraglutide for the preservation of β-cell function in adults with recent-onset type 1 diabetes: a randomised, double-blind, placebo-controlled, phase 2 trial
Authors: Matthias von Herrath, Stephen C Bain, Bruce Bode, Jesper Ole Clausen, Ken Coppieters, Leylya Gaysina, Janusz Gumprecht, Troels Krarup Hansen, Chantal Mathieu, Cristobal Morales, Ofri Mosenzon, Stine Segel, George Tsoukas, Thomas R Pieber, Bernhard Ludvik, Rudolf Prager, Bernhard Paulweber, Christoph F Ebenbichler, B Keymeulen, C De Block, Loren Grossman, Robyn Houlden, Patrice Perron, Thomas Ransom, Peter Senior, S. John Weisnagel, Vincent Woo, Richard Dumas, David Thompson, Tina Vilsbøll, Jeppe Gram, Claus Bogh Juhl, Janne Hukkanen, Jorma Lahtela, Leo Niskanen, Donal O'Shea, Timothy O'Brien, Seamus Sreenan, Julio Wainstein, Moshe Phillip, Hilla Knobler, Francesco Dotta, Pier Marco Piatti, Trevisan Roberto, Agostino Gnasso, Hanne Gulseth, John Cooper, Ewa Pankowska, Monika Lukaszewicz, Bogumił Wolnik, Isabel Manita, Olinda Marques, Cristina Roque, Rosa Maria Príncipe, Celestino Neves, Susana Heitor, L Ruyatkina, Irina Dvoryashina, Gulnar Vagapova, Lidiya Belousova, Marina Sergeeva-Kondrachenko, Andrey Peskov, Elena Frolova, Albina Golovach, Marina Kunitsyna, Natalia Krasnopeeva (Kabachkova), Irina Ipatko, Carmen De la Cuesta, Francisco José Tinahones, Mercedes Rigla, Juan Francisco Merino, Luis Alberto Gómez, Mercè Fernández, Rafael Simó, Mikael Rydén, Johan Jendle, Karin Filipsson, Björn Eliasson, Borys Mankovsky, Iurii Lymar, Liubov Sokolova, Galyna Myshanych, Tetiana Zlova, Maryna Vlasenko, Petro Kuskalo -, Hamish Courtney, Colin Dayan, Patrick English, Simon Heller, Andrew B Johnson, Sunil Nair, R. D Leslie, P Narendran, Nick Oliver, Shenaz Ramtoola, Jim Shaw, Adie Viljoen -, Amer Al-Karadsheh, Jean Marie Dostou, Sumana Gangi, Peter Gottlieb, Terri Jerkins, Michael Magnotti, Jennifer Marks, Samer Nakhle, Gholamreza Bonabi, Lyle Myers, Richard Pratley, William Hagopian, Jeremy Pettus, Bernt Johan von Scholten, Johnna D Wesley, Frederik F Kreiner
Journal: The Lancet Diabetes & Endocrinology (2021)
Clinically advanced penile (pSCC) and male urethral (uSCC) squamous cell carcinoma: A comparative genomic profiling (CGP) study.
Authors: Philippe E. Spiess, Douglas A Mata, Gennady Bratslavsky, Joseph M Jacob, Andrea Necchi, Ole Gjoerup, Natalie Danziger, Douglas I. Lin, Brennan James Decker, Ethan Sokol, Richard Huang, Jeffrey S. Ross
Journal: Journal of Clinical Oncology (2021)

2 Background: Although SCC of the penile skin (pSCC) and the male urethral surface epithelium (uSCC) arise in nearby locations and can feature similar histology, their clinical manifestations, disease course, and surgical and medical treatment options are distinct. We performed CGP on pSCC and uSCC to examine genomic profiles differences. Methods: Tissues obtained from men with clinically advanced pSCC (n = 230) and uSCC (n = 17) underwent hybrid capture-based CGP to evaluate all classes of genomic alterations (GAs). Tumor mutational burden (TMB) was determined on up to 1.1 Mb of sequenced DNA and microsatellite instability (MSI) was determined on up to 114 loci. PD-L1 expression was determined by IHC (Dako 22C3). Results: The median ages were similar in both groups. pSCC exhibited a slightly higher frequency of HPV-16/18 infection (29% vs. 12%, P = .16), although the TP53 mutation frequencies were nearly identical (55% vs. 59%, NS). CDKN2A inactivation (P = .08), CCND1 amplification trending higher and TERT promoter mutations (P = .01) were more frequent in pSCC, potentially indicating prior HPV infection. GAs in NOTCH1 were exclusively identified in pSCC. Potentially actionable GAs identified in both groups included PIK3CA activating mutations (TKIs) as well as pathogenic alterations in FBXW7 and PTEN (MTOR inhibitors). Rare BRCA1 and BRCA2 inactivation (PARP inhibitors) was seen in pSCC only. High-positive PD-L1 staining was elevated in pSCC (34 vs. 14%, P = .06). Although average TMB was similar in both groups, pSCC exhibited an elevated frequency of cases with CD274 ( PD-L1) amplification as well as TMB &gt;10 mut/Mb which are on label for immune checkpoint inhibitor (ICPI) treatment. Conclusions: CGP of pSCC and uSCC identifies opportunities for both targeted and ICPI therapies. Compared to uSCC, pSCC had genomic features more similar to head and neck SCC including slightly increased cell-cycle perturbation, HPV infection, and NOTCH pathway signaling alterations. Further use of CGP in the treatment planning for pSCC and uSCC may be warranted. [Table: see text]
Abstract 15539: Clinical Predictors of Ventricular Tachycardia Induced Cardiomyopathy
Authors: Zahra Azizi, Pouria Alipour, Hadi Tohidi, Yaariv Khaykin, Andrea Chiocchini, Maria Terricabras, Atul Verma
Journal: Circulation (2019)

Introduction: Frequent Idiopathic Ventricular tachyarrhythmias (IVT) can lead to reversible ventricular dysfunction known as Tachycardia Induced Cardiomyopathy (TIC). Predicting factors that are as...
Health- and Vision-Related Quality of Life in a Randomized Controlled Trial Comparing Methotrexate and Mycophenolate Mofetil for Uveitis
Authors: Nicole K. Kelly, Aheli Chattopadhyay, S.R. Rathinam, John A. Gonzales, Radhika Thundikandy, Anuradha Kanakath, S. Bala Murugan, R. Vedhanayaki, Dean Cugley, Lyndell L. Lim, Eric B. Suhler, Hassan A. Al-Dhibi, Caleb D. Ebert, Elyse J. Berlinberg, Travis C. Porco, Nisha R. Acharya, S.R. Rathinam, Radhika Thundikandy, R. Vedhanayaki, A.L. Sivarama Subramanian, G. Jeyakohila, Gracy Evangelin, A.M. Azhagupandi, C.V. Praba, S. Bharati, S. Gomathi, N.J. Nirmaladevi, Mohammed Siddiq, B. Vijayakumar, S.R. Devi, Anuradha Kanakath, V.R. Saravanan, Upendra Babu, R. Srija, S. Dhanalakshmi, R.R. Sakthimari, P.S. Keerthana, A.M. Mallika, C. Vasanthi, P.B. Mariselvi, P. Pandeeswari, S.M. Sudarvanitha, R. Prema, S. Bala Murugan, Prabu Baskaran, S. Madanagopalan, Chokkahalli K. Nagesha, R. Thilagavathi, Chitra Krishnakumari, Irudhaya Raj P, S. Saravanan, Grace Mary, S. Nagarasi, Kiruba Gnansi, Lourdes Arellanes-Garcia, Luz Elena Concha del Rio, Rashel Cheja Kalb, Nancy Fernández, Yoko Burgoa, Hilda Hernández, Roberto Fabela Cuello, Lorenzo Agustín Martínez Garcia, Ricardo Montoya Rodríguez, Maria del Carmen Preciado, Andrea Arreola, Hassan A. Al-Dhibi, Donald Stone, Mohammed Al-Shamrani, Sara Al-Nuwaysir, Abdulrahman Al-Hommadi, Abdullah Al-Omran, Saleh Al-Nasser, Gahram Al-Zahrani, Eman Mashan, Mizher Al-Ghamdi, Ayshah Al-Tuwejri, Debra A. Goldstein, Anna Liza Castro-Malek, Gemma Dela Rosa, Marriner Skelly, Eric Suhler, James Rosenbaum, Phoebe Lin, Sherveen Salek, Kristin Biggee, Amde Shifera, Laura Kopplin, George Mount, Tracy Giles, Susan Nolte, Ann Lundquist, Teresa Liesegang, Albert Romo, Chris Howell, Scott Pickell, Peter Steinkemp, Dawn Ryan, Jordan Barth, Jocelyn Hui, Chiedozie Ukachukwu, Lyndell Lim, Richard Stawell, Robyn Troutbeck, Cecilia Ling, Xavier Fagan, Julian Bosco, Timothy Godfrey, Tanya Pejnovic, Carly D’Sylva, Sutha Sanmugasundram, Tina-Marie van Tonder, Maria Kolic, Nisha Acharya, John Gonzales, Thuy Doan, Sarah Lopez, Maya Rao, Erica Browne, Betty Hom, Mary Lew, Salena Lee, Nisha Acharya, Travis Porco, Thomas Lietman, Jeremy Keenan, Eric Kim, Hieu Nguyen, Caleb Ebert, Maya Rao, Elyse Berlinberg, Erica Browne, Andrew Hirst, Rachel Weinrib, Maureen G. Maguire, William E. Barlow, Steven Yeh, Albert T. Vitale, Jaqueline J. Glover, Narsing A. Rao, Debra A. Goldstein, Donald F. Everett
Journal: Ophthalmology (2021)
Housing Is an Essential Part of Health Care—“Treat ‘Em and House ‘Em”
Authors: Joshua A. Barocas, Esther K. Choo
Journal: JAMA Network Open (2021)

Jonathan D. Fuchs, MD, MPH; Henry Clay Carter, BA; Jennifer Evans, MPH; Dave Graham-Squire, PhD; Elizabeth Imbert, MD, MPH; Jessica Bloome, MD, MPH; Charles Fann, BA; Tobi Skotnes, MPH; Jonathan Sears, MPH; Rebecca Pfeifer-Rosenblum, RN; Alice Moughamian, MSN, RN, CNS; Joanna Eveland, MD; Amber Reed, BA; Deborah Borne, MD, LCSW; Michele Lee, BA; Molly Rosenthal, MD; Vivek Jain, MD, MAS; Naveena Bobba, MD; Margot Kushel, MD; Hemal K. Kanzaria, MD, MSc