Montefiore Hospital Research Articles

Transportation Cost Is a Significant Barrier to Quality Care for Hematologic Malignancy Patients in a Minority-Rich, Socioeconomically Disadvantaged Population

Background Transportation to and from clinics is a barrier to care for cancer patients. Depending on treatment regimen, patients' clinic visits could be frequent, and this could lead to cumulative financial toxicity. We aim to study transportation costs as a barrier to care in hematologic malignancy patients with new cancer diagnosis and in patients referred for cellular therapy at a tertiary care academic Medical Center located in Bronx, NY. A deeper understanding of the role of financial toxicity in relation to transportation will help to understand the effect this may have on health outcomes and ways to overcome this barrier to medical care that predominantly affects minorities from low socioeconomic backgrounds. Methods This is an ongoing prospective survey-based study carried out at Montefiore Medical center, Bronx NY. Adult patients with either a newly diagnosed (ND) hematologic malignancy (HM) or those undergoing cellular therapy (CT), such as autologous, allogeneic stem cell transplant or CAR-T therapy are identified at Montefiore Oncology clinics. Patients who agree to participate are given a research team generated 5-question survey to gauge their concerns surrounding transportation for oncology visits. Responses are grouped according to cohort (ND vs CT). Sociodemographic information was collected, and race and ethnicity were self-identified. For patients with long-term follow-up, we also capture no-show rates. The study is approved by the local IRB. Results There were 72 patients across groups at the time of analysis. Forty-one patients completed surveys for the ND group and 31 for the CT group. Twelve (29%) and three (7%) patients identified their race as Black and White respectively in ND group with 8 (26%) and 4 (13%) as Black and White in the CT group, respectively. In ND, 22 (54%) patients identified their ethnicity as Hispanic/Latino with 17 (55%) in CT. The median distances between Montefiore Hospital and the patient's homes according to zip code were 3.59 miles (mi) with range 0-81.42 mi for ND and 3.47 mi with range 0-50.35 mi in the CT group. Nearly 50% of patients in ND and CT groups reported concerns about access and cost of transportation to the oncology clinic. Insurance paid for transportation for only 12.5 and 17.9% of patients in ND and CT groups, respectively. Across groups, over half of patients (52.5%) used a personal vehicle to get to appointments in the ND group with 46.5% in the CT group. Many of patients in the ND (18%) and CT (17%) group reported missing their appointments due to transportation issues. Ten percent of patients in ND and 13% in CT groups reported missing appointments due to caregiver issues. Fifty-nine percent of patients in ND and 47% in CT groups reported feeling comfortable with phone/video visits. Of patients with long term follow up and >10% no-show rates, 60% in ND and 50% in CT groups use a personal vehicle. Conclusion We report preliminary results from an ongoing prospective study evaluating transportation barriers to care for hematologic malignancy patients in an underserved population in Bronx. Even in a well-connected city such as New York City, half of patients with new hematologic cancer and those referred for cell therapy are worried about access and cost of transportation to and from medical appointments. Although the distance between clinic and home is less than 5 miles for over half of patients, patients are still missing appointments due to transportation and caregiver issues. Patients who travel using personal vehicles may also have difficulty driving due to chemotherapy or being accompanied for visits due to caregiver issues. As many novel cellular therapies recently approved are only available at tertiary centers, transportation is expected to be a bigger factor affecting social determinants of health. One potential solution is to incorporate more tele-visits as nearly half our patients are amenable to them. More information including follow-up surveys and the number of missed appointments is being collected to identify specific groups of patients who will benefit from interventions.

Editorial introductions.

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeDr Jimmy Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianShahzad I. Mian, M.D., is a professor of ophthalmology and visual sciences in the University of Michigan Medical School. He also serves the Department as Vice Chair for Clinical Sciences and Learning. Dr. Mian earned his medical degree in 1996 from the Emory University School of Medicine. He then completed a residency at the Wills Eye Hospital of Thomas Jefferson University in Philadelphia. From 2000-02, he was a fellow in cornea and refractive surgery at Harvard Medical School, Massachusetts Eye and Ear Infirmary. He joined the U-M faculty in 2002 and was promoted to associate professor with tenure in 2010. He became professor of ophthalmology and visual sciences in 2016. His research focuses on eye banking, keratoplasty techniques, and ocular graft versus host disease. He served as director of the residency training program between 2004 and 2019 and previously served as fellowship director in the department. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. Dr. Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Center, and the Senior Achievement Award from the American Academy of Ophthalmology. He received the Straatsma Award for resident education from the Association of University Professors in Ophthalmology in 2017 and the Payton Award for Eye banking from the Eye Bank Association of America in 2019. He serves as the Senior Medical Director for Eversight Eye banks as well as on the Board of Directors. He also serves on the Board of Directors for the Cornea Society and the Eye Bank Association of America. He also serves on the Residency Review Committee for Ophthalmology.

A History of Headache Medicine Training in the United States (P4-3.007)

<h3>Objective:</h3> To review the history of training in Headache Medicine in the 20th and 21st Century in America and provide insights into key dates and events that shape current practice. <h3>Background:</h3> Headache is a burgeoning field within Neurology with 49 fellowships now UCNS accredited. These accredited centers represent signficant growth over short period. Unofficial apprenticeships date to the 1940s with Montefiore Hospital. The last 14 years accreditation has been under UCNS with subsequent exponential growth of programs. 700+ candidates hold certificates with invagination of training programs into academic centers around the country making higher level care available to more. <h3>Design/Methods:</h3> The timeline of UCNS was reviewed and information gathered about which programs became certified with the data graphed out and compared to yearly certification numbers of specialists. Individuals at centers including the Diamond Institute, the Graham Institute, the Jefferson H Center and Montefiore Center were interviewed and primary sources were contacted to discuss the history. Finally, a literature search was performed to look into what headache centers existed prior to inception of the UCNS and to understand what model of education was performed and how successful those centers were at developing new headache specialists in practice. <h3>Results:</h3> The last 15 years led to more formalized structure for accreditation of programs and certification of specialists under the UCNS. Historically training centers were limited, idiosynchratic and followed an apprenticeship model. The current growth in training programs has led to 49 current acc credited programs and dozens of yearly graduates. Several named centers have trained a large volume of providers and have fostered practitioners who have created other centers. <h3>Conclusions:</h3> Schools of thought in Headache Medicine have grown around several centers with roots in an apprenticeship form of education. Over 15 years fellowship training has become more formalized, clearer in objectives and in expectations for trainees with dramatic growth. <b>Disclosure:</b> Dr. Rosen has received personal compensation for serving as an employee of Northwell Health. An immediate family member of Dr. Rosen has received personal compensation for serving as an employee of New York University. Dr. Rosen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/ Abbvie. Dr. Rosen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen/ Novartis. Dr. Rosen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Rosen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Rosen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Rosen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Rosen has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Allergan/ Abbvie. Dr. Rosen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Rosen has received personal compensation in the range of $500-$4,999 for serving as a Speaker with American Headache Society.

Outreach and equity in patient centered outcomes research: Lessons from the adaptable study at Montefiore hospital

Background and Aims: ADAPTABLE is the first PCOR trial in US, comparing the effectiveness of two aspirin doses for secondary prevention of atherosclerotic disease. Novel features include patients’ representation as research partners, leveraging of electronic health records, participation via internet and low cost. Direct patient engagement can improve research impact and provide access to minority populations, often less represented in clinical research. We aim to analyze patient's data from Montefiore Hospital in Bronx, NY, serving a community of socioeconomically disadvantaged minorities.

An Eye Toward the Future: Montefiore Hospital Provides Expanded Newborn Screening Options.

An Eye Toward the Future: Montefiore Hospital Provides Expanded Newborn Screening Options.

A Feeling for the Human Subject: Margaret Lasker and the Genetic Puzzle of Pentosuria.

In 1933 Margaret Lasker, a biochemist who worked at the labs of Montefiore Hospital in New York, developed an accurate method for the differentiation between pentosuria and diabetes. Research into pentosuria, and mostly its genetic aspects, became Lasker's lifelong passion. Since research was not part of her job description, she conducted the chief part of her study in her home kitchen. Lasker's extensive and personal correspondence with her patients and their families may be the secret key for her success in maintaining a prolonged research career against all odds. Laker's last article was published in 1955 in Human Biology, presenting data on 72 cases of pentosuria, which occurs almost exclusively in Ashkenazi Jews. More than half a century later, and long after Lasker was gone, her well kept data and family records allowed the discovery of two mutations in the DCXR gene, by Mary-Claire King and her team.

Outcome of Hospitalized Parkinson's Disease Patients with and without COVID-19.

ABSTRACTBackgroundThe Parkinson's disease (PD) patient population, with an already reduced life expectancy, is rendered particularly vulnerable by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2).ObjectivesWe determined the risk factors that increase the risk of death in patients with Parkinson's disease who are infected by SARS‐CoV‐2.MethodsPatients with a diagnosis of PD admitted to Montefiore Hospital (Bronx, New York) and tested for SARS‐CoV‐2 were identified. Retrospective review of electronic medical records confirmed the diagnosis; patients were classified by severity of PD. PD severity, demographic, socioeconomic factors, and co‐morbidities were correlated with mortality rates in patients with SARS‐CoV‐2.ResultsWe identified 162 patients meeting criteria; chart review confirmed a diagnosis of PD in 70 patients. Of the 70 patients, 53 were positive for SARS‐CoV‐2 and 17 were negative. PD patients with SARS‐CoV‐2 infection had a higher mortality rate (35.8%) compared to PD patients without the infection (5.9%, P = 0.028). PD patients older than 70 years of age, those with advanced Parkinson's disease, those with reductions in their medications, and non‐Hispanics (largely comprised of Black/African‐ Americans) had a statistically significant higher mortality rate, if infected.ConclusionsPD did not increase mortality rates from SARS‐CoV‐2 infection when age was controlled. However, certain unalterable factors (advanced disease and age greater than 70 years) and alterable ones (reductions in PD medications) placed PD patients at increased risk for mortality. Also several socioeconomic factors contributed to mortality, for example, non‐Hispanic patients with SARS‐CoV‐2 infection fared worse, likely driven by poorer outcomes in the Black/African‐American cohort.

Prof. James Tait Goodrich 1946 - 2020+

James Tait Goodrich was born on April 16, 1946 in Portland, Oregon, United States, the son of Richard Goodrich and Gail (Josselyn) Goodrich. Dr. Goodrich served as a Marine officer during the Vietnam War, during which time he decided his next step would be to pursue a medical career. Not only was he an elite surgeon, but over the years he was also a generous mentor and teacher who shared his craft with many young surgeons who wanted to follow in his footsteps. During the Tet Offensive, he spotted a Vietnamese surgeon in a medical tent opening up a soldier’s head. “Cool,” he thought. “I want to do that” (1). Upon return to the USA, Jim married Judy Loudin on December 27, 1970, the love of his life who gave him the confidence and support to pursue his dreams. Dr. Goodrich completed his undergraduate work at the University of California, Irvine and his graduate studies at the School of Arts and Sciences of Columbia University (1972), receiving his Masters and Doctor of Philosophy degrees in 1978 and 1980, respectively. He received his Medical Degree from Columbia University College of Physicians and Surgeons. After an internship at Columbia- Presbyterian Medical Center (1980-1981), he completed his residency training at the Presbyterian Hospital in New York City and the New York Neurological Institute (1981-1986). He also holds the rank of Professor Contralto of Neurological Surgery at the University of Palermo in Palermo, Italy. He was Director of the Division of Pediatric Neurosurgery at the Children’s Hospital of Montefiore Health System and he served as a Professor of Clinical Neurological Surgery, Pediatrics, Plastic and Reconstructive Surgery at the Albert Einstein College of Medicine since 1998 (2). Dr. James T. Goodrich dedicated his life to saving children with complex neurological conditions. He had a particular interest in the treatment of craniofacial abnormalities. He was a pioneer in this field and developed a multi-stage approach for separating craniopagus twins who have their brain and skull conjoined. In 2016, he famously led a team of 40 doctors in a 27-hour procedure to separate the McDonald twins. Throughout his distinguished career, he became known as the world’s leading expert on this lifesaving procedure. He has been consulted on hundreds of cases, and he routinely traveled the world sharing his vast knowledge and expertise with colleagues (3,4). In Brazil, Dr. Goodrich played a very important role in leading the processes to successfully separate craniopagus sets in Ribeirao Preto (2017-2018), and in Brasilia (2019). A classical multistage surgery was performed to separate the Ribeirao Preto conjoined twins, and Dr. Goodrich participated on all the neurosurgical procedures as a great mentor. In the final operation, on October 28, 2019, some members of Montefiore Hospital medical staff (Dr. Oren Tepper, plastic surgeon, Dr. Carlene Broderick, pediatric anesthesiologist and Kamilah A. Dowling, nurse) also worked alongside Jim and the Brazilian team. An extraordinary and humble man, his words after the first surgical step, during an interview for a TV channel, were that in “this particular surgery we were able to do more than we expected because the anatomy was very good and the team had exceptional skills that made the difference”. Dr. Goodrich was a chief supporter of the Latin American Pediatric Neurosurgery Course (LACPN), having participated in all editions since 2004. In these events, he did not hesitate to share his knowledge during the hands-on sessions and, likewise, his wonderful conferences. Prof. Goodrich was officially honored by the Brazilian Society for Pediatric Neurosurgery during the “XII Brazilian Congress of Pediatric Neurosurgery”, in Florianopolis, Brazil. Dr. Goodrich was a gentle and truly caring man. He did not crave the limelight and was beloved by his colleagues and staff. He has authored numerous book chapters and articles on Pediatric Neurosurgery and is known worldwide as a prominent lecturer in this field. Outside his work, he was also known for his passion for historical artifacts, travelling, wine, and surfing. Dr. Goodrich was an incredible human being. In March 30th, 2020, he passed away after complications due to Covid-19 (5). In that day the world has become a little less bright without Jim. Our sympathy and prayers go to his wife Judy, his three sisters, and all those who were close to him

The association of neighborhood racial mix and ED visit count in a cohort of patients on hemodialysis

BackgroundNeighborhood racial mix is associated with dialysis facility performance metrics and mortality outcomes in patients on hemodialysis. We explored the association of neighborhood racial mix with emergency department (ED) visits in patients receiving hemodialysis.MethodsUsing Looking Glass (Montefiore’s clinical database) we identified a cohort of patients on hemodialysis with an index ED visit at any of 4 Montefiore Hospital locations, between January 2013 and December 2017 and followed it for number of ED visits through December of 2017 or dropout due to death. The racial mix data for the Bronx block group of each subject’s residence was derived from the Census Bureau. We then used negative binomial regression to test the association of quintile of percent of Black residents per residential block group with ED visits in unadjusted and adjusted models. To adjust further for quality offered by local dialysis facilities, with the facility zip code as the locus, we used data from the “Dialysis Compare” website.ResultsThree thousand nine-hundred and eighteen subjects were identified and the median number of ED visits was 3 (interquartile range (IQR) 1–7) during the study period. Subjects living in the highest quintile of percent Black residents were older, more commonly female and had lower poverty rates and higher rates of high school diplomas. Unadjusted models showed a significant association between the highest quintiles of Black neighborhood residence and count of ED visits. Fully adjusted, stratified models revealed that among males, and Hispanic and White subjects, living in neighborhoods with the highest quintiles of Black residents was associated with significantly more ED visits (p-trend =0.001, 0.02, 0.01 respectively). No association was found between dialysis facility locations’ quintile of Black residents and quality metrics.ConclusionsLiving in a neighborhood with a higher percentage of Black residents is associated with a higher number of ED visits in males and non-Black patients on hemodialysis.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeDr Jimmy K. Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Mian is a Professor in ophthalmology and visual sciences at University of Michigan/Kellogg Eye Center and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. His practice is focused in cornea and refractive surgery and research interests include corneal transplantation techniques, ocular graft versus host disease, and eye banking. He is the Vice Chair for Clinical Sciences and Learning and has been director of the residency training program since 2004. In 2003 and 2012, he received the Bergstrom Faculty Teaching Award presented by ophthalmology residents. He received the Straatsma award for resident education in 2017. He serves on the Residency Review Committee for Ophthalmology, Accreditation Board for the Eye Bank Association of America, as the senior medical director of Eversight Michigan Eye bank, and is the past-president of the Program Director's Council of the Association of University Professor in Ophthalmology.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeJimmy K. Lee, MD, is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the cornea, refractive surgery, and external diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the Medical Director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the AUPO. Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Validation of Systemic Lupus Erythematosus Diagnosis as the Primary Cause of Renal Failure in the US Renal Data System.

Using American College of Rheumatology (ACR) and Systemic Lupus International Collaborating Clinics (SLICC) criteria for systemic lupus erythematosus (SLE) classification as gold standards, we determined sensitivity, specificity, positive and negative predictive values (PPV and NPV) of having SLE denoted as the primary cause of end-stage renal disease (ESRD) in the US Renal Data System (USRDS). ESRD patients were identified by International Classification of Diseases, Ninth Revision codes in electronic medical records of 1 large tertiary care center, Montefiore Hospital, from 2006 to 2012. Clinical data were extracted and reviewed to establish SLE diagnosis. Data were linked by social security number, name, and date of birth to the USRDS, where primary causes of ESRD were ascertained. Of 7,396 ESRD patients at Montefiore, 97 met ACR/SLICC SLE criteria, and 86 had SLE by record only. Among the 97 SLE patients, the attributed causes of ESRD in the USRDS were 77 SLE and 12 with other causes (unspecified glomerulonephritis, hypertension, scleroderma), and 8 missing. Sensitivity, specificity, PPV, and NPV for SLE in the USRDS were 79%, 99.9%, 93%, and 99.7%, respectively. Of the 60 patients with biopsy-proven lupus nephritis, 44 (73%) had SLE as primary ESRD cause in the USRDS. Attribution of the primary ESRD causes among SLE patients with ACR/SLICC criteria differed by race, ethnicity, and transplant status. The diagnosis of SLE as the primary cause of ESRD in the USRDS has good sensitivity, and excellent specificity, PPV, and NPV. Nationwide access to medical records and biopsy reports may significantly improve sensitivity of SLE diagnosis.

Predictors of Non-Attendance to the Postpartum Follow-up Visit.

Objectives This study aimed to measure the incidence and identify predictors of postpartum visit non-attendance, using medical records of women who received prenatal care and went on to deliver live births at Montefiore Hospital in 2013. Methods Pearson's Chi square tests were used to assess the association between maternal demographics, insurance status, and delivery information with non-attendance of a postpartum visit. Logistic regression and modified Poisson regression models were then used to identify statistically significant predictors of postpartum visit non-attendance. Results We found that one-third of all women who attended a prenatal visit at Montefiore Hospital did not return for a postpartum visit. Variables significantly associated with non-attendance include having Medicaid or no insurance (RR 1.4, 95 % CI 1.2-1.6), being Hispanic or Latino (RR 1.2, 95 % CI 1.1-1.3), having a vaginal delivery (RR 1.2, 95 % CI 1.1-1.4), and age <20years (RR 0.77, 95 % CI 0.64-0.92). Conclusions for Practice We conclude that the risk of postpartum visit non-attendance disproportionately impacts socially and economically vulnerable patients who are: younger, part of a minority ethnic background, and depend on state funded health insurance. Our results highlight the disparity in access to postpartum care and the importance of identifying barriers to attendance as well as developing creative strategies of providing postpartum care outside of the traditional postpartum visit framework.

The Impact of Family Engagement on Anxiety Levels in a Cardiothoracic Intensive Care Unit.

The Impact of Family Engagement on Anxiety Levels in a Cardiothoracic Intensive Care Unit.

Phase I / II trial of dose adjusted EPOCH chemotherapy with bortezomib combined with integrase inhibitor therapy for HTLV-1 associated T-cell leukemia lymphoma

Adult T-cell leukemia lymphoma (ATLL) acute and lymphoma subtypes have a poor prognosis, with median survival of about one year. The malignant cells are characterized by high levels of nuclear factor kappa B (NFkappaB). In order to improve therapy, we assessed the safety, tolerance, and efficacy of a combination of dose-adjusted EPOCH chemotherapy (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), combined with proteasome inhibitor, bortezomib, to prevent degradation of the inhibitor of NFkappaB (IkappaB). In addition, integrase inhibitor, raltegravir, was added to the regimen to block virus replication occurring during treatment. This multicenter study enrolled 18 of 20 planned subjects over 2.5 yrs in the U.S., although 15 of the subjects were born in the Caribbean. Six subjects had acute ATLL, and the remainder lymphoma subtype, all but one with stage 4 disease. Therapy was well tolerated; subjects received 1-6 cycles of therapy (mean 4.5 cycles). Two subjects achieved complete remission lasting for >12 mos, 10 subjects had a partial remission, and 3 subjects had stable disease as their best response. Baseline calcium level, absolute lymphocyte count, and proviral DNA load were not predictive of response. Correlations with proviral expression, integration site, and integrase gene analyses will be presented. Supported by NIH grants CA94056, CA1730, CA63413, Lymphoma Leukemia Society grant 6067-10, and Lymphoma Research Foundation grant 307181203. Authors’ details Division of Oncology, Washington University, St Louis, MO, USA. University of Miami, Miami, FL, USA. Lymphoma & Hematology Division, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Divisions of Hematology-Oncology, Montefiore Hospital, New York, NY, USA. Columbia University, New York, NY, USA. Division of Hematologic Malignancies, Johns Hopkins University, Baltimore, MD, USA. NINDS, NIH, Bethesda, MD, USA.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Joan Shinkus Clark, DNP, RN, NEA-BC, CENP, FACHE, FAAN

Dr. Joan Shinkus Clark is the senior vice president and system chief nursing officer for Texas Health Resources (THR) headquartered in Arlington, Texas. Dr. Clark joined the THR leadership team in 2008, assuming overall responsibility for the nursing enterprise across the THR system. THR has 25 acute care and short-stay hospitals that are owned, operated, joint-ventured, or affiliated with the system, representing more than 3,800 licensed beds. THR has more than 21,100 employees at fully owned and operated facilities plus 1,400 employees of consolidated joint ventures and more than 5,500 physicians with active staff privileges. In her system role, Dr. Clark has responsibility for advancing strategic nursing initiatives and represents nursing at the senior executive level. Dr. Clark has also been a member of AONE for 25 years and has served AONE and chapter affiliates in Texas, Florida, and Georgia on numerous committees and in multiple elected positions, including 2 terms: 1 as Region 4 and as Region 7 AONE board director.

A Retrospective Analysis on the Use of Age-Adjusted D-Dimer Cutoff Values in Ruling out Pulmonary Embolism at Montefiore Hospital

A Retrospective Analysis on the Use of Age-Adjusted D-Dimer Cutoff Values in Ruling out Pulmonary Embolism at Montefiore Hospital

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology Program Directors Council (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Kevin Delgado Barron, MD (1929–2013)

Dr. Kevin Delgado Barron died on October 28, 2013, at his home in Loudonville, New York, in the company of his family. He was 84. Dr. Barron was born in St. John's, Newfoundland, British Dominion, Canada, in 1929, third son of John A. Barron and Mercedes Delgado. He attended medical school at Dalhousie Medical School in Halifax, Nova Scotia, Canada. After concluding his internal medicine clerkship at Victoria General Hospital in Halifax and Queen Mary VA Hospital, Montreal, Canada, and a brief stint in 1952 as ship's doctor on coastal steamer the SS Kyle , he completed his neurology residency at Montefiore Hospital, New York, followed by a fellowship in neuropathology. Subsequent academic appointments included instructor at the Neurological Institute at Columbia University Medical Center, New York; associate in neurology, psychiatry, and pathology at Northwestern University Medical School, Chicago; and section chief of neurology service and director of the electron microscope laboratory and the neuropathology research service at the VA Hospital, Hines, Illinois.