Publications by authors named "Daniel Rubin"

A prediction model to assess the risk of hospital readmission can be valuable to identify patients who may benefit from extra care. Developing hospital-specific readmission risk prediction models using local data is not feasible for many institutions. Models developed on data from one hospital may not generalize well to another hospital.

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Background: Psychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m) and may be associated with hypertension.

Objectives: To determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS).

Setting: Academic medical center.

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The US Food and Drug Administration recognizes the unmet medical need for antibacterial drugs to treat serious bacterial diseases caused by resistant pathogens for which effective therapies are limited or lacking. The agency also recognizes that designing and conducting clinical trials to assess the safety and efficacy of drugs to treat resistant infections is challenging, especially for drugs only active against a single or a few bacterial species, and that a more flexible development program might be appropriate. In this article, we discuss several regulatory considerations for flexible development programs for antibacterial drugs intended to meet an unmet medical need.

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  • Massive transfusion of citrated blood products can cause hypocalcemia, which is linked to higher mortality rates; however, the ideal dosage of calcium to prevent this issue is still unclear.
  • This study analyzed trauma patients who underwent surgery after receiving blood transfusions, looking for effective calcium dosing to avoid severe hypocalcemia and identify possible cases of hypercalcemia.
  • Results showed that while calcium dosage did not reliably predict severe hypocalcemia, a specific ratio of calcium to blood transfusions indicated hypercalcemia; further research is needed to optimize calcium administration during trauma treatment.
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Understanding how the body is represented in motor cortex is key to understanding how the brain controls movement. The precentral gyrus (PCG) has long been thought to contain largely distinct regions for the arm, leg and face (represented by the "motor homunculus"). However, mounting evidence has begun to reveal a more intermixed, interrelated and broadly tuned motor map.

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Older adults living in retirement communities are an understudied population, and the association between their motivation and daily physical activity is unknown. We recruited participants (n = 173) living in a retirement community who completed the Behavioral Regulation in Exercise Questionnaire-2 and wore an activPAL accelerometer to evaluate this relationship. Participants had a median age of 81 years and demonstrated low levels of daily activity with an average step count of 3,637 (±1,965) steps per day and 52 (±25) min of daily stepping time.

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  • Patient-centered outcomes (PCOs) are crucial for understanding the quality of life in cancer patients, but collecting relevant data has been challenging due to the unstructured nature of clinical narratives.
  • Researchers evaluated the performance of three large language models (GPT-2, BioGPT, and PMC-LLaMA) in extracting PCO information from clinical notes at multiple institutions, finding that these models struggle without fine-tuning.
  • The study concluded that fine-tuning improves the models' accuracy significantly, especially with GPT-2 outperforming the other models, suggesting a more efficient method for extracting PCO data from clinician notes.
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Artificial intelligence (AI) shows potential to improve health care by leveraging data to build models that can inform clinical workflows. However, access to large quantities of diverse data is needed to develop robust generalizable models. Data sharing across institutions is not always feasible due to legal, security, and privacy concerns.

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Despite current therapies, heart failure and chronic kidney disease continue to be major causes of morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have recently become standard-of-care therapy for these conditions. This review summarizes important randomized controlled trials of SGLT-2 inhibitors and guidelines for using these agents in patients with heart failure and chronic kidney disease in both clinic and hospital settings.

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Background: Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status.

Local Problem: There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center.

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Background: Artificial intelligence (AI) and machine learning (ML) technology design and development continues to be rapid, despite major limitations in its current form as a practice and discipline to address all sociohumanitarian issues and complexities. From these limitations emerges an imperative to strengthen AI and ML literacy in underserved communities and build a more diverse AI and ML design and development workforce engaged in health research.

Objective: AI and ML has the potential to account for and assess a variety of factors that contribute to health and disease and to improve prevention, diagnosis, and therapy.

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Background: Frailty predicts poorer outcomes in surgical patients. Recent studies have found socioeconomic status to be an important characteristic for surgical outcomes. We evaluated the association of Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), two geospatial atlases that provide a multidimensional evaluation of neighborhood deprivation, with frailty in a surgery population.

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  • - The study utilizes deep learning and PheWAS techniques to explore the connections between abdominal CT-based skeletal muscle metrics (like SMI and SMD) and various medical conditions within a large North American group of adults. - Analyzed data from 17,646 participants revealed that CT-derived SMI was linked to 268 medical phenotypes, while SMD was associated with 340, uncovering new significant findings like higher SMI correlating with lower rates of cardiac dysrhythmias and epilepsy. - The results emphasize the potential of PheWAS to identify novel associations in medical phenotypes related to body composition, highlighting how muscle metrics can impact health outcomes significantly.
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Background: Desirability of outcome ranking (DOOR) is an innovative approach to clinical trial design and analysis that uses an ordinal ranking system to incorporate the overall risks and benefits of a therapeutic intervention into a single measurement. Here we derived and evaluated a disease-specific DOOR endpoint for registrational trials for hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP).

Methods: Through comprehensive examination of data from nearly 4000 participants enrolled in six registrational trials for HABP/VABP submitted to the Food and Drug Administration (FDA) between 2005 and 2022, we derived and applied a HABP/VABP specific endpoint.

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  • On March 22, 2023, the FDA approved rezafungin (Rezzayo) for treating candidemia and invasive candidiasis in adults lacking alternative treatments.
  • Rezafungin is an echinocandin that allows for weekly dosing, potentially reducing the need for central venous catheters by enabling outpatient treatment.
  • The approval was based on a phase 3 study showing rezafungin's effectiveness compared to other echinocandins, with identified safety concerns from animal studies being consistent with the safety profiles of existing approved drugs.
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COVID-19 vaccination is estimated to have averted more than 2.4 million deaths globally. In the United States (U.

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A major barrier to deploying healthcare AI is trustworthiness. One form of trustworthiness is a model's robustness across subgroups: while models may exhibit expert-level performance on aggregate metrics, they often rely on non-causal features, leading to errors in hidden subgroups. To take a step closer towards trustworthy seizure onset detection from EEG, we propose to leverage annotations that are produced by healthcare personnel in routine clinical workflows-which we refer to as workflow notes-that include multiple event descriptions beyond seizures.

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Older adults with burn injuries have a high risk of readmission after the initial burn admission. Frailty is associated with poor outcomes from the initial burn injury, however, it remains unknown if frailty impacts readmission in older adults after the initial index burn admission. Our study aims to examine patient, frailty, burn, surgical, and hospital factors that contribute to 90-day readmissions in older adults with an acute burn.

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Background: Comprehensive geriatric assessment (CGA) involves a formal broad approach to assess frailty and creating a plan for management. However, the impact of CGA and its components on listing for kidney transplant in older adults has not been investigated.

Methods: We performed a single-center retrospective study of patients with end-stage renal disease who underwent CGA during kidney transplant candidacy evaluation between 2017 and 2021.

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Background: For older, frail adults, exercise before surgery through prehabilitation (prehab) may hasten return recovery and reduce postoperative complications. We developed a smartwatch-based prehab program (BeFitMe) for older adults that encourages and tracks at-home exercise. The objective of this study was to assess patient perceptions about facilitators and barriers to prehab generally and to using a smartwatch prehab program among older adult thoracic surgery patients to optimize future program implementation.

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Objectives: The American Association for Thoracic Surgery recommends using frailty assessments to identify patients at higher risk of perioperative morbidity and mortality. We evaluated what patient factors are associated with frailty in a thoracic surgery patient population.

Methods: New patients aged more than 50 years who were evaluated in a thoracic surgery clinic underwent routine frailty screening with a modified Fried's Frailty Phenotype.

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How the human cortex integrates ("binds") information encoded by spatially distributed neurons remains largely unknown. One hypothesis suggests that synchronous bursts of high-frequency oscillations ("ripples") contribute to binding by facilitating integration of neuronal firing across different cortical locations. While studies have demonstrated that ripples modulate local activity in the cortex, it is not known whether their co-occurrence coordinates neural firing across larger distances.

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Objectives: To compare cardiac computed tomography (CCT) and cardiac magnetic resonance (CMR) for the quantitative assessment of the left ventricular (LV) trabeculated layer in patients with suspected noncompaction cardiomyopathy (NCCM).

Materials And Methods: Subjects with LV excessive trabeculation who underwent both CMR and CCT imaging as part of the prospective international multicenter NONCOMPACT clinical study were included. For each subject, short-axis CCT and CMR slices were matched.

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  • Current risk scores for predicting ischemic heart disease (IHD) events are limited and could be improved with imaging biomarkers from CT scans.
  • A study involving 8,139 CT examinations developed automated models that integrate body composition features from imaging with electronic medical record data, outperforming existing clinical risk scores in some cases.
  • The research introduces a new method for understanding tissue-level contributions and provides the OL3I dataset to support further studies in predicting IHD using multimodal data.
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