Tennessee Health Science Center Research Articles

The Unforeseen Costs of Medical Education.

Financial burdens of medical education are a major barrier for many students. The goal of this study is to identify and quantify unforeseen costs associated with being a medical student. Medical students at the University of Tennessee Health Science Center were surveyed on unforeseen financial costs. Qualitative data were collected. Students spent significant extra funds in professional development, social spending, living, and technology. Schools and students should consider all aspects of life to have a fruitful education and appropriately provide loan funding and financial education for both enough and thoughtful use of financial resources during medical education.

Carotid Artery Calcification Detected on Panoramic Radiography Is Significantly Related to Cerebrovascular Accident, Coronary Artery Disease, and Poor Oral Health: A Retrospective Cross-Sectional Study.

Panoramic radiography imaging modality is widely used by dentists for diagnosing dental and jaw conditions. It can also detect carotid artery calcification (CAC), indicative of calcified atherosclerotic plaques in the carotid arteries. This cross-sectional retrospective study at the University of Tennessee Health Science Center investigated the link between CAC identified on panoramic radiograph (PR) and cerebrovascular accident (CVA), coronary artery disease (CAD), and poor oral health. Data from 314 CAC patients collected from 2014 to 2023 included age at diagnosis, gender, and clinical histories of hypertension, hyperlipidemia, diabetes mellitus, CVA, CAD, and the decay, missing, and filled permanent teeth (DMFT) index. These patients were age- and gender-matched with non-CAC patients for analysis. The findings revealed high prevalences of hypertension (86.2%), hyperlipidemia (57.6%), diabetes mellitus (30.7%), CVA (15.5%), and CAD (28.7%) amongst CAC patients and the average DMFT index was 26.6. A comparative analysis of 276 matched controls demonstrated significant differences in hypertension (85.9% vs. 57.6%), hyperlipidemia (58.3% vs. 33.7%), diabetes (32.6% vs. 22.1%), CVA history (14.9% vs. 5.1%), CAD (26.1% vs. 9.8%), and DMFT scores (26.3 vs. 23.7), all indicating strong associations between CAC and these health conditions. The adjusted analysis showed that hypertension (aOR: 3.20 [95% CI: 2.06-5.07]), hyperlipidemia (aOR: 1.70 [95% CI: 1.14-2.50]), CVA (aOR: 2.20 [95% CI: 1.13-4.30]), and CAD (aOR: 2.10 [95% CI: 1.28-3.60]) were significantly associated with CAC. Notably, only 41.7% of the patients received a medical consultation after CAC detection on PR. It is crucial for dentists to refer patients for further evaluation.

Feasibility of remote monitoring for fatal coronary heart disease using Apple Watch ECGs

BackgroundFatal Coronary Heart Disease (FCHD) is often described as sudden cardiac death (affects >4 million people/year), where coronary artery disease is the only identified condition. Electrocardiographic-Artificial Intelligence (ECG-AI) models for FCHD risk prediction using ECG data from wearable devices could enable wider screening/monitoring efforts. ObjectivesTo develop a single-lead ECG-based deep learning model for FCHD risk prediction and assess concordance between clinical and Apple Watch ECGs. MethodsA FCHD single-lead (‘Lead I’ from 12-Lead ECGs) ECG-AI model was developed using 167,662 ECGs (50,132 patients) from the University of Tennessee Health Sciences Center. 80% of the data (five-fold cross-validation) was used for training and 20% as a holdout. Cox Proportional Hazard (CPH) models incorporating ECG-AI predictions with age, sex and race were also developed. The models were tested on paired clinical single-lead and Apple Watch ECGs from 243 St. Jude Life Cohort participants. The correlation and concordance of the predictions were assessed using Pearson’s correlation(R), Spearman’s correlation(ρ) and Cohen’s Kappa. ResultsThe ECG-AI and CPH models resulted in AUCs=0.76 and 0.79, respectively, on the 20% holdout and AUC=0.85 and 0.87 on the AHWFB external validation data. There was moderate-strong positive correlation between predictions (R=0.74, ρ=0.67 and Kappa=0.58) when tested on the 243 paired ECGs. The clinical (Lead I) and Apple Watch predictions led to the same low/high risk FCHD classification for 99% of the participants. CPH prediction correlation resulted in a R=0.81, ρ=0.76 and Kappa=0.78. ConclusionRisk of FCHD can be predicted from single-lead ECGs obtained from wearable devices and are statistically concordant with Lead I of a 12-lead ECG.

Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series.

Osteoradionecrosis of the jaw is a morbid complication of radiotherapy in patients with oral and oropharyngeal cancers that may be precipitated by dental extractions. Pentoxifylline and tocopherol (PENTO) has been utilized in the management of osteoradionecrosis and as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. This observational study aims to report the outcome of the prophylactic use of PENTO in the prevention of osteoradionecrosis of the jaw after dental extractions in post-radiated oral and oropharyngeal cancer patients and to review the current literature on this topic. Four post-radiated oral and oropharyngeal oncology patients were referred to the dental oncology clinic of the University Dental Practice, University of Tennessee Health Sciences Center for dental extractions. All four patients were prescribed pentoxifylline 400 mg BID (twice a day) and tocopherol 400 IU BID (oral tablets) for 2 weeks before extraction(s) and for 6 weeks after extraction(s). All patients were followed up every week after the second week post-extraction if feasible until the extraction site(s) healed (covered by mucosa). The assessment endpoint was defined as 6 weeks post-extraction with the outcomes assessed as using four categories determined by the area of exposed bone: complete healing (complete mucosal coverage of extraction site); partial healing (reduction in size of extraction site); no change; and progression (increase in size of the extraction site). At the assessment endpoint, all patients had complete healing of all extraction sites. The ORN rate at the patient level (0/4) and individual tooth level (0/8) was 0%. All patients tolerated the PENTO medications and no adverse effects from the use of these medications were reported. This limited study in addition to the other reviewed studies estimates the rate of ORN at the patient level as 3.2% (14/436) for post-radiated head and neck oncology patients after dental extractions/invasive oral procedures. In conclusion, this PENTO regimen can reduce/prevent the incidence of ORN in post-radiated head and neck oncology patients. This safe and cost-effective protocol (PENTO regimen) should be further evaluated as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. We recommend large prospective studies to be carried out to further validate these findings.

Development and validation of an electrocardiographic artificial intelligence model for detection of peripartum cardiomyopathy

This study used electrocardiogram data in conjunction with artificial intelligence methods as a noninvasive tool for detecting peripartum cardiomyopathy. This study aimed to assess the efficacy of an artificial intelligence-based heart failure detection model for peripartum cardiomyopathy detection. We first built a deep-learning model for heart failure detection using retrospective data at the University of Tennessee Health Science Center. Cases were adult and nonpregnant female patients with a heart failure diagnosis; controls were adult nonpregnant female patients without heart failure. The model was then tested on an independent cohort of pregnant women at the University of Tennessee Health Science Center with or without peripartum cardiomyopathy. We also tested the model in an external cohort of pregnant women at Atrium Health Wake Forest Baptist. Key outcomes were assessed using the area under the receiver operating characteristic curve. We also repeated our analysis using only lead I electrocardiogram as an input to assess the feasibility of remote monitoring via wearables that can capture single-lead electrocardiogram data. The University of Tennessee Health Science Center heart failure cohort comprised 346,339 electrocardiograms from 142,601 patients. In this cohort, 60% of participants were Black and 37% were White, with an average age (standard deviation) of 53 (19) years. The heart failure detection model achieved an area under the curve of 0.92 on the holdout set. We then tested the ability of the heart failure model to detect peripartum cardiomyopathy in an independent University of Tennessee Health Science Center cohort of pregnant women and an external Atrium Health Wake Forest Baptist cohort of pregnant women. The independent University of Tennessee Health Science Center cohort included 158 electrocardiograms from 115 patients; our deep-learning model achieved an area under the curve of 0.83 (0.77-0.89) for this data set. The external Atrium Health Wake Forest Baptist cohort involved 80 electrocardiograms from 43 patients; our deep-learning model achieved an area under the curve of 0.94 (0.91-0.98) for this data set. For identifying peripartum cardiomyopathy diagnosed ≥10 days after delivery, the model achieved an area under the curve of 0.88 (0.81-0.94) for the University of Tennessee Health Science Center cohort and of 0.96 (0.93-0.99) for the Atrium Health Wake Forest Baptist cohort. When we repeated our analysis by building a heart failure detection model using only lead-I electrocardiograms, we obtained similarly high detection accuracies, with areas under the curve of 0.73 and 0.93 for the University of Tennessee Health Science Center and Atrium Health Wake Forest Baptist cohorts, respectively. Artificial intelligence can accurately detect peripartum cardiomyopathy from electrocardiograms alone. A simple electrocardiographic artificial intelligence-based peripartum screening could result in a timelier diagnosis. Given that results with 1-lead electrocardiogram data were similar to those obtained using all 12 leads, future studies will focus on remote screening for peripartum cardiomyopathy using smartwatches that can capture single-lead electrocardiogram data.

AI-based preeclampsia detection and prediction with electrocardiogram data.

More than 76,000 women die yearly from preeclampsia and hypertensive disorders of pregnancy. Early diagnosis and management of preeclampsia can improve outcomes for both mother and baby. In this study, we developed artificial intelligence models to detect and predict preeclampsia from electrocardiograms (ECGs) in point-of-care settings. Ten-second 12-lead ECG data was obtained from two large health care settings: University of Tennessee Health Science Center (UTHSC) and Atrium Health Wake Forest Baptist (AHWFB). UTHSC data was split into 80% training and 20% holdout data. The model used a modified ResNet convolutional neural network, taking one-dimensional raw ECG signals comprising 12 channels as an input, to predict risk of preeclampsia. Sub-analyses were performed to assess the predictive accuracy for preeclampsia prediction within 30, 60, or 90 days before diagnosis. The UTHSC cohort included 904 ECGs from 759 females (78.8% African American) with a mean ± sd age of 27.3 ± 5.0 years. The AHWFB cohort included 817 ECGs from 141 females (45.4 African American) with a mean ± sd age of 27.4 ± 5.9 years. The cross-validated ECG-AI model yielded an AUC (95% CI) of 0.85 (0.77-0.93) on UTHSC holdout data, and an AUC (95% CI) of 0.81 (0.77-0.84) on AHWFB data. The sub-analysis of different time windows before preeclampsia prediction resulted in AUCs (95% CI) of 0.92 (0.84-1.00), 0.89 (0.81-0.98) and 0.90 (0.81-0.98) when tested on ECGs 30 days, 60 days and 90 days, respectively, before diagnosis. When assessed on early onset preeclampsia (preeclampsia diagnosed at <34 weeks of pregnancy), the model's AUC (95% CI) was 0.98 (0.89-1.00). We conclude that preeclampsia can be identified with high accuracy via application of AI models to ECG data.

Building Statewide Quality Improvement Capacity to Improve Cardiovascular Care and Health Equity: Lessons from the Tennessee Heart Health Network

Many states with high rates of cardiovascular disease (CVD) lack statewide quality improvement (QI) infrastructure (for example, resources, leadership, community) to address relevant health needs of the population. Academic health centers are well positioned to play a central role in addressing this deficiency. This article describes early experience and lessons learned in building statewide QI infrastructure through the Tennessee Heart Health Network (Network). A statewide, multistakeholder network composed of primary care practices (PCPs), health systems, health plans, QI organizations, patients, and academic institutions was led by the University of Tennessee Health Science Center (UTHSC), an academic health center, to improve cardiovascular health by supporting dissemination and implementation of patient-centered outcomes research (PCOR) evidence-based interventions in primary care. PCPs were required to select and implement at least one of three interventions (health coaching, tailored health-related text messaging, and pharmacist-physician collaboration). Thirty statewide organizational partners joined the Network in year one, including 18 health systems representing 77 PCPs (30.0% of 257 potentially eligible PCPs identified) with approximately 300,000 patients. The organizational partners share EHRs for the ongoing tracking and reporting of key health metrics, including hypertension control and delivery of tobacco cessation counseling. Of the 77 PCPs, 62 continue participation after year two (80.5% retention). Main barriers to participation and reasons for discontinuing participation included reluctance to share data and changes in leadership at the health system level. These 62 PCPs selected the following interventions to implement: health coaching (41.9%), tailored health-related text messages (48.4%), and pharmacist-physician collaboration (40.3%). Academic health centers have broad reach and high acceptability by diverse stakeholders. Tennessee's experience illustrates how academic health centers can serve as platforms for building a statewide infrastructure for disseminating, implementing, and sustaining QI interventions at the practice level. Assessment of Network impact is ongoing.

Using Data Interviews to Map Research Data Services (RDS) Needs at a Health Science Institution

Objective: On January 21, 2023 the National Institutes of Health Data Management and Sharing Policy (NIH DMSP 2023) went into effect. Ahead of these expanded data sharing requirements, the Health Sciences Library at the University of Tennessee Health Science Center (UTHSC) set out to better understand health science research data service (RDS) needs and how the Library could develop new services in alignment with existing institutional support.Methods: Building upon a set of data interview questions created by Read et al. (2015), the author conducted a series of semi-structured interviews with 10 researchers in the fall of 2022. The interview transcripts were inductively coded and analyzed for themes relevant to RDS needs.Results: Analysis of the interviews identified several opportunities for the Library to take ownership of RDS activities in the areas of support services, training and instruction, and tools and technology. Additionally, these interviews helped to characterize existing institutional support and to develop an informal community of practice at the University of Tennessee Health Science Center (UTHSC). These RDS topics were mapped onto Harvard’s Biomedical Data Lifecyle to further clarify areas of need and opportunities for growth for the Library and institutional RDS partners.&amp;nbsp;Conclusions: The study identified critical RDS needs among UTHSC researchers and highlighted the potential role of the Library as a valuable partner in addressing these needs and fostering collaboration among campus stakeholders. Conversations informed by these findings continue with stakeholders about the best way to meet the needs of researchers on campus as well as centralize and coordinate existing endeavors.

Serum Copeptin, Perceived Stress, and Pain in Patients Living with Sickle Cell Disease

Sickle cell disease (SCD) is a hereditary blood disorder characterized by intense acute and chronic pain episodes, resulting in a complex interplay of negative physical and emotional experiences. One of the main barriers to addressing pain in this disease state is the limited information about the mechanisms affecting the variable degree and types of pain and stress that impact patients in this population. The arginine vasopressin receptor1a gene (AVPR1A) single nucleotide polymorphism (rs10877969) is associated with aspects of acute pain and stress related pain in patients living with SCD. Arginine vasopressin (AVP) is a hormone known for its role in regulating extracellular fluid, vasoconstriction, and the endocrine stress response. However, due to its short half-life, AVP is difficult to measure. Thus, copeptin, the stable biologically inactive C-terminal portion of pro-vasopressin, is often used as a surrogate marker for AVP secretion. Copeptin is a marker of hypothalamic-pituitary-adrenal axis activation, however, its levels have not been studied in patients living with SCD. Psychological stress has been associated with changes in circulating copeptin concentrations. Considering the relationship between pain, stress, and copeptin, it is important to investigate their relationship in the context of SCD. The primary objective of this study was to examine serum copeptin levels with reports of perceived stress and pain in this patient population. In this cross-sectional study, we investigated serum copeptin levels, perceived stress, and pain experiences in a cohort of 50 adults living with SCD. Th participants had a mean age of 39.8±8.5 years, ranging from 29 to 59 years. Ninety-six percent of the participants were of African ancestry and 62% were female. Participants had the following hemoglobin genotypes: 68% had SS, 24% had SC, and 8% had other Hgb genotypes. To assess pain experiences, participants responded to questionnaires, including the Average Pain Intensity (API, average of current, least, and worst pain experienced within a 24-hour period, measured on a scale from 0 to 10). The Adult Sickle Cell Quality of Life Measure (ASCQ-Me) was used to measure number of vaso-occlusive crises (VOC). Perceived stress was assessed using the Perceived Stress Scale (PSS). Serum copeptin levels were quantified using a well-established laboratory. All the participants provided blood samples and completed psychological scales. Descriptive statistics and bivariate associations were conducted using R statistical software package. The study received approval from the Institutional Review Board at the University of Tennessee Health Science Center. We observed no significant differences in mean copeptin levels by sex ( p=.33) or associations between copeptin levels and age ( p=.66), weight ( p=.81), number of hospitalizations due to pain crisis ( p=.23), and the number of pain crisis managed at home ( p=0.07). The coefficients for API .92 ( p=.05) and PSS .97 ( p=.03) exhibited statistically significant positive association with copeptin levels. Our findings provide insights into the relationship between serum copeptin levels, perceived stress, and pain intensity in patients with sickle cell disease (SCD). The positive associations observed between copeptin levels and both perceived stress and average pain intensity underscore the potential interchange of pain and psychological stress in the regulation of copeptin secretion in this patient population. Our results indicate that copeptin levels are not significantly influenced by sex, age, or weight suggesting that these demographic factors may not be major determinants of copeptin viability in patients living with SCD. While sickle cell severity indicators did not show significant associations with copeptin levels, further investigation with larger sample sizes is needed to validate these findings and explore additional factors contributing to pain and psychological stress in individuals living with SCD. Ultimately, understanding the complexities of copeptin regulation may lead to improved pain management strategies and enhanced overall well-being for patients with this challenging disorder.

Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding

BackgroundSegmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure. MethodsPatients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed. Factors examined included clinical presentation, diagnostic evaluation, operative time, and technique, 90-day morbidity and mortality, and pathologic and survival outcomes. ResultsThirty-one patients were identified with majority female and a median age of 61. Diagnostic studies included computed tomography and upper (including push) endoscopy. Reconstruction most often involved side-to-side duodenojejunostomy following distal duodenal resection. Intraoperative evaluation (IOE) of the biliary tree was utilized to assess and protect pancreaticobiliary structures in eleven patients. Median operative time was 206 min, increasing to 236 min when IOE was necessary. Procedure-related morbidity was 23% with one 90-day mortality. Median postoperative length of stay was 9 days. Pathology included benign adenoma, adenocarcinoma, GIST, neuroendocrine neoplasms, and erosive metastatic deposit. ConclusionDuodenal resections can be effectively employed to safely address diverse pathologies. These procedures are characterized by long operative times, extended hospital stays, and an incidence of postoperative complications that mimics that of pancreatic resection. This work highlights the need for modification to the CPT system to accurately define these distinct procedures for future research endeavors and development of a more accurate valuation unit.

Meet the First Authors.

Meet the First Authors.

Preselected Choices

1 University of Tennessee Health Science Center, Memphis, TN. 2 Division of Critical Care, Lebonheur Children’s Hospital, Memphis, TN. Dr. Spentzas has disclosed that he does not have any potential conflicts of interest.

A Survey of Hiring and Non-hiring Pharmacists’ Perceptions of a Primary Care Certificate Training Program

Objective. To survey pharmacists, including those who make or contribute to hiring decisions, regarding certificate training programs and specifically about a primary care certificate for pharmacists.Methods. We conducted a cross-sectional survey of pharmacist registrants of the Office of Continuing Professional Development at the University of Tennessee Health Science Center College of Pharmacy's listserve, including both hiring and non-hiring pharmacists. The 40-question survey probed perceptions of various types of postgraduate training and the design of a primary care certificate training program for pharmacists. Data were collected between November and December 2020.Results. A total of 230 pharmacists participated in this study (14% response rate), and most reported practicing in the community (n=126, 57%). Nearly half of the respondents reported making or contributing to hiring decisions of other pharmacists (n=94, 41%), and, of those, most reported that completion of a primary care certificate program by a candidate would increase their likelihood of hiring that candidate (n=50, 78%). Both groups (hiring and non-hiring pharmacists) most commonly reported that a primary care certificate training program should be 30 hours total and 12 weeks in length, ranked communication as the most important topic to be included, and indicated the didactic and simulation/experiential components should be similarly weighted.Conclusions. Pharmacists, including those who make or contribute to hiring decisions, reported valuing certificate training programs. Developing a certificate training program that is at least 30 hours in length over 12 weeks may serve as an opportunity to address gaps in primary care in the United States.

ChatGPT and the Future of Medical Writing.

HomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryPerspectivesChatGPT and the Future of Medical WritingSom Biswas Som Biswas Author AffiliationsFrom the Department of Radiology, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center College of Medicine, Memphis, TN 38103.Address correspondence to the author (email: [email protected]).Som Biswas Published Online:Feb 2 2023https://doi.org/10.1148/radiol.223312MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Three fabricated references that are not cited in the body of this article:Fabricated

Pyogenic Granuloma-Like Kaposi Sarcoma: Answer.

Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, TN. Correspondence: Olivia Lawson, BS, Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science, Center, Suite 840, 930 Madison Avenue, Memphis, TN 38163 (e-mail: [email protected]). O. Lawson: Writing (Reviewing, Editing). T. Patel: Writing (original draft), Supervision. L. Lange: Writing (original draft). The author declares no conflicts of interest. Ethics: Informed consent was obtained from the individual in the report.

Clinical Pathologic Challenge: A Solitary Red Nodule.

Kaplan-Amonette Department of Dermatology, University of Tennessee Health Science Center, Memphis, TN. Correspondence: Olivia Lawson, BS, Kaplan-Amonette Department of Dermatology, The University of Tennessee Health Science Center, Suite 840, 930 Madison Avenue, Memphis, TN 38163 (e-mail: [email protected]). O. Lawson: Writing (Reviewing, Editing). T. Patel: Writing (original draft), Supervision. L. Lange: Writing (original draft). The authors declare no conflicts of interest. Informed consent was obtained from the individual in the report.

Ethics and Moral Agency for a Postpandemic Era: Beyond the Storm.

Laura Lee (Dolly) Swisher, PT, MDiv, PhD, FAPTA, the 53rd Mary McMillan Lecturer, is professor emerita and former director of the school of physical therapy and rehabilitation sciences at the University of South Florida in the USF Health Morsani College of Medicine. Dr Swisher received a bachelor of arts degree from Wilson College and is a 1986 physical therapy graduate of the University of Tennessee Health Science Center, Memphis. She received the M.Div. from Andover Newton Theological School and a doctoral degree in public administration from Tennessee State University. Dr Swisher is a highly regarded expert on professionalism, ethics, and interprofessional education and has been a featured speaker at local, state, and national conferences. She is the coauthor of Rehabilitation Ethics for Professional Practice, Professionalism in Physical Therapy and Legal and Ethical Issues in Physical Therapy and is a lead author or coauthor of multiple peer reviewed articles and individual book chapters. She served as a member and chair of the Commission on Accreditation for Physical Therapy Education, was former chair and member of the APTA Ethics and Judicial Committee, and served as co-chair of the Task Force to Revise the Core Ethics Documents. Dr Swisher served on the Editorial Board of the Journal of Physical Therapy Education and is a member of the Editorial Board of the Journal of Humanities in Rehabilitation. She is the recipient of APTA's Lucy Blair Service Award and the Polly Cerasoli Lecture Award and is a Catherine Worthingham Fellow of the APTA.

Suture Compared With Staples for Skin Closure After Cesarean Delivery: A Systematic Review and Meta-analysis.

Department of Obstetrics & Gynecology, University of Missouri-Kansas City, Kansas City, Missouri Department of Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure The authors did not report any potential conflicts of interest.

Altha Stewart, M.D., Honored With Pardes Humanitarian Prize

Altha Stewart, M.D., Honored With Pardes Humanitarian Prize

Biography: Frederick A. Boop MD.

Dr. Boop is the president of the 48th annual meeting of the ISPN. Hehas served Semmes-Murphey Clinic as a member of the Board of Directors, Chief of the pediatric neurosurgery division, and as pediatric neurosurgery fellowship director. He has held the JT Robertson endowed chair from The University of Tennessee Health Science Center (UTHSC) Department of Neurosurgery residency training program and the St. Jude endowed chair in pediatric neurosurgery where he is currently a member of the St. Jude Global Program. He is currently Emeritus Chair at UTHSC.