Texas Medical School Research Articles

First year of fellowship: lessons learned

First year of fellowship: lessons learned

Assessment of the Methodological Quality of Systematic Reviews Published in the Urological Literature From 1998 to 2008

Well done systematic reviews provide the highest quality evidence for clinical questions of therapeutic effectiveness. We assessed the methodological quality of systematic reviews in the urological literature. We systematically investigated all systematic reviews published in 4 major urological journals from 1998 to 2008. Studies were identified using a predefined search strategy in PubMed and confirmed by a hand search of journal tables of contents. A validated 11-point instrument to assess the methodological quality of systematic reviews was applied by 2 independent reviewers after a pilot testing phase. Disagreements were discussed and resolved by consensus. The systematic literature search identified 217 individual systematic reviews, of which 57 ultimately met study eligibility criteria. Ten (17.5%), 20 (35.1%) and 27 (47.4%) systematic reviews were published in 1998 to 2001, 2002 to 2005 and 2006 to 2008, respectively. Using the measurement tool to assess systematic reviews the mean +/- SD score was 4.8 +/- 2.0 points. Fewer than half of all systematic reviews performed a systematic literature search that included at least 2 databases (49.1%) or unpublished studies (31.6%), or provided a list of included and excluded studies (45.6%). Of the systematic reviews 63.2% assessed and documented the methodological quality of included studies. Systematic reviews with The Cochrane Collaboration authorship affiliation had a higher mean score than those with no such reported affiliation (6.5 +/- 1.2 vs 4.4 +/- 1.9 points, p <0.001). Results suggest that an increasing number of systematic reviews are published in the urological literature. However, many systematic reviews fail to meet established methodological standards, raising concerns about validity. Increased efforts are indicated to promote quality standards for performing systematic reviews among the authors and readership of the urological literature.

Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. In 2009, 59 internal medicine and family medicine residents (postgraduate year 2-3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. While 53% of residents agreed/strongly agreed they had "sufficient knowledge of advance directives, given my years of training," 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that "didactic sessions on advance directives should be offered by my hospital, residency program, or medical school." A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: "Advance directives should only be discussed with patients over 60," "I have sufficient knowledge of advance directives, given my years of training," and "I believe my experience with advance directives is adequate for the situations I routinely encounter." Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

The Term Newborn Potentially Exposed to Herpes Simplex Virus

University of Texas Medical School Robert Yetman, Professor of Pediatrics, Department of Pediatrics, University of Texas Medical School, Houston, TX.

Robotic-Assisted Roux-en-Y Gastric Bypass: Minimizing Morbidity and Mortality

Despite the rapid acceptance of laparoscopic Roux-en-Y gastric bypass (RYGB) by the community and increase in the number of these procedures being done, there is still significant morbidity and mortality. At the University of Texas Medical School at Houston, we have performed 320 RYGB with robotic assistance (RARYGB). Surgical times, length of stay, morbidity, and mortality have been recorded since the beginning of our robotic experience and represent the world's largest single institution series of RARYGB. Outcome data were examined in a postoperative cohort. The average starting BMI was 49.1 kg/m(2), and it declined by 66% to 32.5 kg/m(2) by the end of 1 year. The average operative time was 192 min, and the average length of stay was 2.7 days. Within the first year, there were a total of 77 (24.1%) complications. The foremost complications noted in the literature to be 3% to 11% were all <1% in our series, and we have no mortalities. Compared to our 356 laparoscopic RYGB, there was a significantly lower gastrointestinal leak rate in the robotic arm. A cohort of 79 postoperative patients was analyzed with respect to weight loss, resolution of co-morbidity, and quality of life. While there was no variation in quality of life over time, weight loss, resolution of co-morbidities, and overall outcome score were significantly improved. We effectively perform robotic-assisted RYGB that lowers the morbidity and mortality of this procedure compared to today's standard while maintaining thriving outcomes.

The Joint Admission Medical Program: A Statewide Approach to Expanding Medical Education and Career Opportunities for Disadvantaged Students

In 2003, Texas initiated an experiment to address enrollment disparities in its medical schools. With bipartisan support from key Texas legislators, funding was allocated in 2002 to establish the Joint Admission Medical Program (JAMP). Texas' then eight medical schools created, through JAMP, a partnership with the state's 31 public and 34 private undergraduate colleges and universities. Cognizant of legal prohibitions against reliance solely on race or ethnicity in promoting diversity, JAMP is designed to enhance opportunities for economically disadvantaged students from across the state, including those from (1) rural and remote areas of the state, and (2) institutions that have historically sent few students to medical school. Now in its seventh year of operation, JAMP is overseen by a council with representatives from all nine Texas medical schools. For the six years-2003 to 2008-for which data are available, indicators of JAMP performance can be seen in (1) the numbers of applicants to JAMP (1,230 applicants in the first six years), (2) levels of JAMP participation (480 participants), and (3) matriculation of JAMP participants into medical schools (164 of 288 of those accepted into the program in the years 2003-2006).The authors provide a brief history of JAMP, describe its structure and operation, summarize objective performance data, and identify some of the challenges still faced. These include increasing the participation of students from underrepresented minority groups within the legal structure for the program, and fostering substantive participation in JAMP by all of Texas' undergraduate institutions. A focused effort is under way to strengthen the evaluative aspects of JAMP so that more comprehensive data, including subjective evaluation data from participants, can be shared with colleagues in the future.

Letter by Patel Regarding Article, “A Primer in Longitudinal Data Analysis”

HomeCirculationVol. 120, No. 4Letter by Patel Regarding Article, “A Primer in Longitudinal Data Analysis” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Patel Regarding Article, “A Primer in Longitudinal Data Analysis” Chirag B. Patel, MSE Chirag B. PatelChirag B. Patel Department of Diagnostic and Interventional Imaging, University of Texas Medical School at Houston, Houston, Tex Search for more papers by this author Originally published28 Jul 2009https://doi.org/10.1161/CIRCULATIONAHA.108.836767Circulation. 2009;120:e25To the Editor:I read with great interest the article titled “A Primer in Longitudinal Data Analysis” by Fitzmaurice and Ravichandran.1 Focusing on longitudinal data, the authors highlighted the important chasm between advancements in statistical methods and the analysis of current biomedical studies. Furthermore, the pros and cons of 2 particular approaches (analysis of response profiles and linear mixed-effects models) were well explained through case examples of previous studies. However, with the exception of a passing mention of cited sources for further reading (references 7 and 9 in the original article), the authors did not explain another important approach for analyzing longitudinal data: generalized estimating equations (GEEs).2GEEs can be used to model correlated data from repeated measures over the course of a longitudinal study. With respect to the defining features of longitudinal studies explained by Fitzmaurice and Ravichandran (eg, covariance structure and balanced versus unbalanced designs), GEEs have been shown to be more robust when missing data, imputation techniques, and other factors are considered.3 Of particular interest to longitudinal clinical studies is the use of GEEs to identify the best correlation structure and subset of covariates for a given model. Seemingly conflicting reports on the inefficiency of GEEs compared with independence estimating equations4,5 can be explained by differences in the type of data and covariate and correlation structures under study. The use of more recent models, such as the conditional second-order GEE estimator,6 has yielded improved efficiency. Furthermore, GEE models can be implemented in the software packages discussed by Fitzmaurice and Ravichandran.Clinician investigators and article reviewers would benefit greatly from knowing which model for the analysis of longitudinal data (eg, analysis of response profiles, linear mixed-effects models, GEE, independence estimating equation, or conditional second-order GEE) is most apt given a study’s design, data structure, and other relevant factors. Moreover, and in line with Fitzmaurice and Ravichandran’s intent, such an understanding will lead to an improved interpretation of longitudinal study results. This would get us “closer to reality” in terms of understanding the true impact of devices, pharmaceuticals, and other interventions for improved care of patients with cardiovascular risk factors and disease.DisclosuresNone. References 1 Fitzmaurice GM, Ravichandran C. A primer in longitudinal data analysis. Circulation. 2008; 118: 2005–2010.LinkGoogle Scholar2 Zeger SL, Liang KY, Albert PS. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988; 44: 1049–1060.CrossrefMedlineGoogle Scholar3 Twisk J, de Vente W. Attrition in longitudinal studies: how to deal with missing data. J Clin Epidemiol. 2002; 55: 329–337.CrossrefMedlineGoogle Scholar4 Sutradhar BC, Das K. On the efficiency of regression estimators in generalised linear models for longitudinal data. Biometrika. 1999; 86: 459–465.CrossrefGoogle Scholar5 Fitzmaurice GM. A caveat concerning independence estimating equations with multivariate binary data. Biometrics. 1995; 51: 309–317.CrossrefMedlineGoogle Scholar6 Vonesh EF, Wang H, Nie LDM. Conditional second-order generalized estimating equations for generalized linear and nonlinear mixed-effects models. J Amer Statistical Assoc. 2002; 97: 271–283.CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rahman S, Sullivan J, Barger L, St. Hilaire M, O’Brien C, Stone K, Phillips A, Klerman E, Qadri S, Wright K, Halbower A, Segar J, McGuire J, Vitiello M, de la Iglesia H, Poynter S, Yu P, Sanderson A, Zee P, Landrigan C, Czeisler C and Lockley S (2021) Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians, Pediatrics, 10.1542/peds.2020-009936, 147:3, Online publication date: 1-Mar-2021. July 28, 2009Vol 120, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.836767PMID: 19635976 Originally publishedJuly 28, 2009 PDF download Advertisement SubjectsEpidemiology

Response to Letters by Furlan, and Kohrmann and Schwab

Response: Drs Furlan, Kohrmann, and Schwab make compelling arguments. However, we still maintain that placebo-controlled trials of stroke therapy beyond 3 hours are ethical, and in fact necessary. First, our editorial was written before the results of ECASS 3. We now believe there is sufficient evidence from that study and the pooled analysis of all IV tPA data that further clinical trials of treatment in the 3- to 4.5-hour time window must allow IV tPA for all eligible patients. Of course, we are in the uncomfortable situation where, at least in the United States, data and evidence move faster than guidelines and regulatory approval. Individual physicians and patients may not treat with IV tPA in the absence of such gudielines/approval, but we do not believe that clinical trials should be organized that preclude offering such treatment. However, for patients who do not qualify for IV tPA, or cannot be treated within 4.5 hours of symptom onset, placebo arms can still be used. Second, Dr Furlan argues that such trials are not feasible, but the clear answer obtained from placebo-controlled trials beyond 3 hours such as ECASS 3 and PROACT (both positive), and the numerous neuroprotection trials and DIAS 2 (all neutral or negative) demonstrate that clear-cut answers can be obtained from such studies using existing clinical trial designs. …

Psychiatry in Europe, U.S. Not an Ocean Apart

Psychiatry in Europe, U.S. Not an Ocean Apart

Periodic screening with prostate-specific antigen testing reduced mortality from prostate cancer

ACP Journal Club16 June 2009Periodic screening with prostate-specific antigen testing reduced mortality from prostate cancerSteven E. Canfield, MDSteven E. Canfield, MDUniversity of Texas Medical School at Houston, Houston, Texas, USA (S.E.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-12-200906160-02005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationSchröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-8. https://pubmed.ncbi.nlm.nih.gov/19297566Clinical Impact RatingsGIM/FP/GP: Oncology: References1 Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤ 4.0 ng per milliliter. N Engl J Med. 2004;350:2239-46. [PMID: 15163773] Google Scholar2 Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71-96. [PMID: 18287387] Google Scholar3 Johansson JE, Andrén O, Andersson SO, et al. Natural history of early, localized prostate cancer. JAMA. 2004;291:2713-9. [PMID: 15187052] Google Scholar4 Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003;95:868-78. [PMID: 12813170] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas Medical School at Houston, Houston, Texas, USA (S.E.C.)This article was published at Annals.org on 2 June 2009. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnual screening for prostate cancer did not reduce mortality from prostate cancer Steven E. Canfield Metrics 16 June 2009Volume 150, Issue 12Page: JC6-5KeywordsAntigensCancer preventionCancer screeningCancer treatmentDeath ratesForecastingLikelihood ratioMortalityProstate cancerRelative risk ePublished: 16 June 2009 Issue Published: 16 June 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Annual screening for prostate cancer did not reduce mortality from prostate cancer

ACP Journal Club16 June 2009Annual screening for prostate cancer did not reduce mortality from prostate cancerSteven E. Canfield, MDSteven E. Canfield, MDUniversity of Texas Medical School at Houston, Houston, Texas, USA (S.E.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-12-200906160-02004 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationAndriole GL, Crawford ED, Grubb RL 3rd, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-9. https://pubmed.ncbi.nlm.nih.gov/19297565Clinical Impact RatingsGIM/FP/GP: Oncology: References1 Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level ≤ 4.0 ng per milliliter. N Engl J Med. 2004;350:2239-46. [PMID: 15163773] Google Scholar2 Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71-96. [PMID: 18287387] Google Scholar3 Johansson JE, Andrén O, Andersson SO, et al. Natural history of early, localized prostate cancer. JAMA. 2004;291:2713-9. [PMID: 15187052] Google Scholar4 Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003;95:868-78. [PMID: 12813170] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas Medical School at Houston, Houston, Texas, USA (S.E.C.)This article was published at Annals.org on 2 June 2009. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPeriodic screening with prostate-specific antigen testing reduced mortality from prostate cancer Steven E. Canfield Metrics 16 June 2009Volume 150, Issue 12Page: JC6-4KeywordsAntigensCancer screeningCancer treatmentDigital rectal examinationForecastingLikelihood ratioLung and intrathoracic tumorsMortalityProstate cancerRelative risk ePublished: 16 June 2009 Issue Published: 16 June 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Introduction to Cellular Therapy

Cell therapy represents a new frontier in the development of therapeutics for stroke. Aside from physical rehabilitation, few options exist to enhance recovery from stroke. Prior studies in the 1990s provided precedence for considering a cellular approach to treat neurological disorders with the pioneering work on transplantation in Parkinson disease. These trials furnished preliminary evidence for a modest benefit in young patients with a neurodegenerative disorder who underwent neural transplantation. From those initial studies, pilot work emerged on the application of cellular replacement in Huntington disease and other neurological disorders. In an entirely different area of medicine, stem cell transplantation in oncology provided support for the idea that stem cells could be administered intravenously for a range of disorders including stroke. Over the past decade, investigators accordingly began showing that intravenously injected stem cells from the bone marrow and umbilical cord could promote recovery in animal stroke models. Thus began a new area of investigation in which adult stem cells from other sources, rather than the brain, could be tested for therapeutic applications in stroke. As transplantation studies have been growing, it has also now clearly been established that the adult brain undergoes neurogenesis. Elegant work from Lindvall and Parent and others have shown that …

Pedro Ruiz, M.D., to Become Next President of WPA

Back to table of contents Previous article Next article Members in the NewsFull AccessPedro Ruiz, M.D., to Become Next President of WPAStephanie WhycheStephanie WhycheSearch for more papers by this authorPublished Online:7 Nov 2008https://doi.org/10.1176/pn.43.21.0001Former APA President Pedro Ruiz, M.D., was voted president-elect of the World Psychiatric Association (WPA) at the XIV World Congress of Psychiatry in the Czech Republic in September.Pedro Ruiz, M.D.Credit Jack Douthitt“I am very proud of being a member of APA and now president-elect of the WPA,” Ruiz said in an interview with Psychiatric News.“ I look forward to encouraging mutual cooperation between APA and the WPA,” specifically “working toward harmonizing the DSM-V and the ICD-11.”Ruiz was elected by the General Assembly attending the congress in Prague. He received more than 800 of the 1,094 votes cast (75 percent).“We are extraordinarily proud of the support Pedro received from our colleagues all over the world,” commented APA President Nada Stotland, M.D. “We look forward to the leadership he will bring to world psychiatry over the next six years.”“It's a very good thing for psychiatry, APA, and the WPA,” said Lawrence Hartmann, M.D., a past president of APA who now chairs its Council on Global Psychiatry. Hartmann said he has known Ruiz for many years and views him “as a statesman for psychiatry with a deep and wide international understanding.”The mission of the WPA, founded in 1950 and administratively headquartered in Geneva, is “to promote the advancement of psychiatry and mental health for all peoples of the world,” according to the WPA's Web site. It does this by coordinating the international psychiatric and mental health initiatives of 110 national psychiatric societies and organizations (composed of 140,000 psychiatrists) located in one of 18 zones around the world. Zone 2 contains only the United States; APA is the sole WPA organizational member, and its representative is another former APA president, Michelle Riba, M.D.Ruiz is acting chair of the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School in Houston. His three-year term as president-elect of the WPA ends in September 2011. At that time he will become president, succeeding Mario Maj, M.D., of Italy.Ruiz has been associated with the WPA for many years. From 2002 until last month, he served as the WPA's secretary for scientific meetings. From 1996 to 1999, he was a member of the WPA's Operational Committee on Education.Ruiz said advocating for “full harmonization between DSM-V and ICD-11” is among his top priorities.The reported prevalence of mental illness varies widely around the world, according to the World Health Organization. Ruiz and other experts suspect that cross-country differences in language and psychiatric nomenclature, as well as differences in cultural norms and customs, may play a role in the disparities.For this reason, said Ruiz, it's important that DSM-V and ICD-11 have similar diagnoses and diagnostic criteria to more accurately show the epidemiology of mental illness around the world, the basis upon which health care and treatments can be more precisely targeted and standards of care developed.Also on Ruiz's “to-do list” is “to elevate the ethical standards in psychiatry... [and] to advocate for “humane care for the mentally ill worldwide,.. .better access to mental health care,... parity of care,... [and] maximum collaboration of research efforts and initiatives among countries around the world.”“I am planning to work very hard to meet all the expectations of the presidents of WPA's member societies who supported and voted for me,” Ruiz said.Information on the WPA is posted at<www.worldpsychiatricassociation.org/index-1.shtml>.▪ ISSUES NewArchived

The Persistence of Disparities in Mental Health Care

Back to table of contents Next article Taking IssueFull AccessThe Persistence of Disparities in Mental Health CarePedro Ruiz M.D.,Pedro Ruiz M.D.Search for more papers by this author,Published Online:13 Jan 2015AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail A major paradox in 21st century America is the existence of very serious inequalities in health and mental health in the wealthiest society in the world. This issue of Psychiatric Services includes three articles that focus on racial-ethnic disparities in treatment. In the past 20 years many worthy initiatives have been implemented to eliminate disparities. However, the study by Alegria and colleagues shows that significant disparities persist into the 21st century. These authors analyzed pooled data for nearly 9,000 adults from three national surveys. They found significant differences in access to and quality of depression treatments among those with a past-year depressive disorder: 40% of non-Latino whites did not access any treatment, compared with 69% of Asians, 64% of Latinos, and 59% of African Americans. Receipt of adequate treatment was less likely for individuals from minority groups who obtained care. These disparities were evident even when the analyses controlled for socioeconomic variables.The second study examined disparities within a racial-ethnic group. Lesser and colleagues focused on treatment response in two groups of Hispanic patients—those for whom English was the preferred language and those who spoke Spanish by preference. They analyzed data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, in which participants with depression received citalopram for up to 14 weeks. The Spanish-speaking patients had lower rates of and slower times to remission and response, a difference that appeared to be explained by their greater social disadvantage. As the authors note, clinicians need to be aware of the role that socioeconomic factors play in disparities and ensure that treatment addresses the difficulties patients face when they struggle with poverty, poor education, and lack of insurance.Much research on disparities looks at whether individuals are able to access care, but in the third study Elwy and colleagues looked for differences between those who had already gained access—these individuals had completed an intake for outpatient treatment. The authors found no racial-ethnic differences in the number of subsequent treatment visits. They conclude that disparities may result from racial and ethnic differences in treatment-seeking rates and that more emphasis should be placed on ensuring that treatment is available and accessible and that those who need it are activated to initiate it.These three studies underline the persistence of racial and ethnic disparities in the mental health system and also suggest lines of inquiry that may help refine our understanding of them. As the national election ushers in a new administration, let us work to ensure that initiatives to eradicate disparities—and the research that informs them—continue to receive a high priority.Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston FiguresReferencesCited byDetailsCited byRacial and Ethnic Disparities in Depression Care in Community-Dwelling Elderly in the United StatesAmerican Journal of Public Health, Vol. 102, No. 2 Volume 59Issue 11 November, 2008Pages 1239-1239PSYCHIATRIC SERVICES November 2008 Volume 59 Number 11 Metrics PDF download History Published online 13 January 2015 Published in print 1 November 2008

Report on the second Intracranial Hypertension Research Foundation conference

This report highlights a conference designed for patient education on elevated cerebrospinal fluid (CSF) pressure. The conference centered on chronic intracranial hypertension (IH) including the latest research and clinical information. It was sponsored by the Intracranial Hypertension Research Foundation and held at the University of Texas Medical School, Houston, on June 21–22nd, 2008.

Adaptation and Maladaptation of the Heart in Obesity

Obesity affects the cardiovascular system at many different levels, including the heart muscle itself. Clinical and experimental studies have shown an accumulation of triglycerides and other lipid species in cardiomyocytes. Analogous to hepatic steatosis, investigators have introduced the term “cardiac steatosis”. The present review addresses the complex relationships between cardiac fuel homeostasis, insulin resistance, and proposed mechanisms of damage to cardiomyocytes in different models of obesity, insulin resistance, and lipotoxicity. Specifically, the review weighs the evidence whether there is a heart muscle disorder in human obesity. It discusses how adipokines can modulate cardiac metabolism, and it focuses on the metabolic remodeling accompanying increased fatty acid supply in the heart of rodent models of lipotoxicity, with special attention to the role played by mitochondrial uncoupling and futile cycling. We stress the notion that, in spite of the many proposed mechanisms, cardiac lipotoxicity is still a hypothesis rather than an established pathophysiologic principle. Although the concept of a “lipotoxic cardiomyopathy” seems attractive, we propose instead a series of steps on a path from adaptation to maladaptation of the heart in obesity. A case in point is insulin resistance of the heart which may be both adaptive (protecting the heart from excess fuel) or maladaptive (associated with reactive oxygen species formation and activation of signaling pathways of programmed cell death). The present literature reflects an extraordinary complexity of the heart’s metabolic, functional and structural changes in obesity.

New technology for examining the anterior segment by ultrasonic biomicroscopy

To compare the comfort levels and measurement accuracy of the open-shell technique and a bag/balloon technology (ClearScan, ESI) in anterior segment ultrasound biomicroscopy. Department of Ophthalmology and Visual Science, Robert Cizik Eye Clinic, University of Texas Medical School at Houston, Houston, Texas, USA. In this prospective investigation, 20 subjects stated their preference and rated comfort (0 best to 5 worst) for the open-shell technique versus the bag/balloon technology. Three anterior chamber depth and sulcus-to-sulcus measurements were obtained, and the mean for each structure was taken as datum for each subject. Order presentation between the 2 methods was randomized. Pairwise t tests and linear regression analysis were used to determine statistical differences. One hundred percent of the cohort preferred the bag/balloon technology to the traditional open-shell technique. The mean comfort score was 0.40 +/- 0.53 (SD) and 2.95 +/- 0.90, respectively (P<.0001). Anterior chamber depth measurements did not differ clinically (0.056 mm) nor did sulcus-to-sulcus determinations (0.039 mm). Biometry, patient comfort, and ease of use were better with the ClearScan bag/balloon technology than with the traditional open-shell technique.

The relationship between the field-shifting phenomenon and representational coherence of place cells in CA1 and CA3 in a cue-altered environment

Subfields of the hippocampus display differential dynamics in processing a spatial environment, especially when changes are introduced to the environment. Specifically, when familiar cues in the environment are spatially rearranged, place cells in the CA3 subfield tend to rotate with a particular set of cues (e.g., proximal cues), maintaining a coherent spatial representation. Place cells in CA1, in contrast, display discordant behaviors (e.g., rotating with different sets of cues or remapping) in the same condition. In addition, on average, CA3 place cells shift their firing locations (measured by the center of mass, or COM) backward over time when the animal encounters the changed environment for the first time, but not after that first experience. However, CA1 displays an opposite pattern, in which place cells exhibit the backward COM-shift only from the second day of experience, but not on the first day. Here, we examined the relationship between the environment-representing behavior (i.e., rotation vs. remapping) and the COM-shift of place fields in CA1 and CA3. Both in CA1 and CA3, the backward (as well as forward) COM-shift phenomena occurred regardless of the rotating versus remapping of the place cell. The differential, daily time course of the onset/offset of backward COM-shift in the cue-altered environment in CA1 and CA3 (on day 1 in CA1 and from day 2 onward in CA3) stems from different population dynamics between the subfields. The results suggest that heterogeneous, complex plasticity mechanisms underlie the environment-representating behavior (i.e., rotate/remap) and the COM-shifting behavior of the place cell.

Baylor College of Medicine??s Support of Tulane University School of Medicine Following Hurricane Katrina

The authors describe how Baylor College of Medicine (BCM), with three other Texas medical schools, "adopted" virtually all the 620 medical students and 526 house officers of Tulane University School of Medicine and continued their education for eight months after most of New Orleans, including Tulane, was flooded on August 29, 2005, after Hurricane Katrina. Soon after, BCM's president asked all senior staff to take whatever actions were necessary to sustain Tulane, and on September 7, leaders from BCM and three other Texas medical schools met to plan the relocation of Tulane's students and programs. The authors explain how problems were overcome (e.g., locating the scattered Tulane students and staff, finding them lodging, obtaining their records, and providing financial aid and counseling), and how high-quality educational experiences were maintained for both Tulane's and BCM's students and residents while assisting Tulane's faculty in numerous ways, helping Tulane plan the enrollment of its following year's students, and undergoing Liaison Committee for Medical Education and Accreditation Council on Graduate Medical Education site visits to BCM. After the BCM-Tulane experience, BCM developed a disaster-management plan (available online) that could help other schools as they plan for disasters. The authors also offer lessons learned in the areas of communication, cooperation, curriculum, collaboration, contact with accrediting bodies, and compassion. They close by stating that when BCM faculty are asked "how could you take Tulane's medical school in?" their response is, "how could we not?" They continue: "In medical education, a frequent discussion is how to teach humanism and professionalism; we teach it best by modeling it."

Role of a Database-Driven Web Site in the Immediate Disaster Response and Recovery of an Academic Health Center: The Katrina Experience

In the wake of Hurricane Katrina's landfall on August 29, 2005, and the subsequent levee failures, operations of Tulane University School of Medicine became unsustainable. As New Orleans collapsed, faculty, students, residents, and staff were scattered nationwide. In response, four Texas medical schools created an alliance to assist Tulane in temporarily relocating operations to south Texas. Resuming operations in a three- to four-week time span required developing and implementing a coordinated communication plan in the face of widespread communication infrastructure disruptions. A keystone of the strategy involved rapidly creating a "recovery Web site" to provide essential information on immediate recovery plans, mechanisms for reestablishing communications with displaced persons, housing relocation options (over 200 students, faculty, and staff were relocated using Web site resources), classes and residency training, and other issues (e.g., financial services, counseling support) vitally important to affected individuals. The database-driven Web site was launched in four days on September 11, 2005, by modifying an existing system and completing new programming. Additional functions were added during the next week, and the site operated continuously until March 2006, providing about 890,000 pages of information in over 100,000 visitor sessions. The site proved essential in disseminating announcements, reestablishing communications among the Tulane family, and supporting relocation and recovery. This experience shows the importance of information technology in collaborative efforts of academic health centers in early disaster response and recovery, reinforcing recommendations published recently by the Association of Academic Health Centers and the National Academy of Sciences.