School of Medicine

To characterize the utilization of ultrasound in the urgent and emergency department setting at CRH before and after an educational ultrasound curriculum is implemented. Rates of utilization, body part examined, gender of patient, age of patient and chief complaint will be captured before and after the educational intervention.

Among diabetic individuals with clinically suspected PAD, both those with low and high ABI scores are at higher risk of CVD death. In contrast, a linear relationship was observed between TBI scores and CVD death irrespective of diabetes status. These findings suggest that stiffened ankle arteries may limit the predictive value of ABI scores in individuals with diabetes; a limitation that may be overcome by measurement of the TBI.

Background: Coronary artery calcium (CAC) predicts incident cardiovascular disease (CVD) beyond traditional risk factors. While higher CAC volume is associated with higher CVD risk, higher CAC density is associated with lower CVD risk. Whether risk factors for CAC volume and CAC density are similar or distinct is unknown. We sought to evaluate the independent associations of CVD risk factors with CAC volume an CAC density. Methods: Baseline measurements from 6,814 participants free of clinical CVD were collected for the Multi-Ethnic Study of Atherosclerosis between 2000 and 2002. Participants with no CAC )n=3,416) and missing data were excluded, for a final analytic sample of 3.375 participants. Multivariable linear regression models were used to evaluate independent predictors of CAC density and CAC volume. Conclusions: Whereas most CVD risk factors were associated with higher CAC volume, the same risk factors were assocated with lower CAC density. For example, diabetes was associated with higher natural logarithm (ln) transformed CAC volume (standardized [beta]=0.44 ln-units, p<0.01) but lower CAC density ([beta]=-0.07 Hounsfield unit (Hu) category unit, p<0.01). Relative to Non-Hispanic White, Chinese, African-American, and Hispanic race/ethnicities were associated with lower ln CAC volume ([beta]=-0.62, -0.52, and -0.40 ln-units, respectively, p<0.01 for each), and higher CAC density ([beta]=0.41, 0.18, and 0.21 Hu category units, respectively, p<0.01 for each). CAC density and CAC volume were also differentially associated with race/ethnicity.

Today's science increasingly requires effective ways to find and access existing datasets that are distributed across a range of repositories. For researchers in the life sciences, discoverability of datasets may soon become as essential as identifying the latest publications via PubMed. Through an international collaborative effort funded by the National Institutes of Health (NIH)'s Big Data to Knowledge (BD2K) initiative, we have designed and implemented the DAta Tag Suite (DATS) model to support the DataMed data discovery index. DataMed's goal is to be for data what PubMed has been for the scientific literature. Akin to the Journal Article Tag Suite (JATS) used in PubMed, the DATS model enables submission of metadata on datasets to DataMed. DATS has a core set of elements, which are generic and applicable to any type of dataset, and an extended set that can accommodate more specialized data types. DATS is a platform-independent model also available as an annotated serialization in schema.org, which in turn is widely used by major search engines like Google, Microsoft, Yahoo and Yandex.

Abstract Background Rectal gonorrhea (NG) and chlamydia (Connecticut) infections are common among men who have sex with men (MSM). Rectal douching/enema (RDE) is a common practice among MSM that can affect the rectal microbiome. It is unclear if this practice is associated with acquiring rectal infections (RI) with either NG or CT. Methods From 2013–2015, 398 adult HIV-negative MSM and transwomen were enrolled in a randomized controlled study on text messaging for adherence to pre-exposure prophylaxis (PrEP). Participants were surveyed on sexual behavior, frequency of RDE, drug use, and nutritional habits in conjunction with routine sexually transmitted infection testing. Pearson’s χ 2 and two sample t-tests were used to measure significance of RDE and other risk factors with RI. Multivariable logistic regression model was used to control for confounding and assess the association of RDE with RIs. Confounders (i.e., age, number anal receptive sex, number sex partners) were selected a priori for inclusion in the final model based on a causal model and statistical significance. Results Of 397 participants, 262 (67%) performed RDE and 132 (33%) had at least one NG or CT rectal infection over 48 weeks. Number of condomless anal receptive sex acts (mean = 19, P < 0.001), condom use for anal receptive sex (P = 0.017), number of male sex partners in past 3 months (mean = 14, P = 0.001), and the use of poppers (P < 0.001) were associated with RI. There was no significant association between nutritional habits, probiotic foods or supplements and RI, with the exception of energy bars (P = 0.029). Controlling for confounders, RI was associated with RDE less than weekly with OR = 1.02 (95% CI 0.52–1.99) while RDE weekly or more had OR = 2.08 (95% CI 1.03–4.17). Stratified by number of partners, MSMs with more than the median (>6) number of partners had OR = 4.96 (95% CI 1.29–19.03) if performing RDE less than weekly, and OR = 6.03 (95% CI 1.55–23.49) if weekly or more. Conclusion Rectal hygiene with douching/enemas is a common practice among MSMs on PrEP, which increases the odds of acquiring rectal NG and/or CT. This finding is suggestive for the use of rectal hygiene products/practices as potential targets for sexually transmitted infection prevention. Disclosures All authors: No reported disclosures.

Multiphasic computed tomography (CT) and magnetic resonance imaging (MRI) are both used for noninvasive diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis. To determine if there is a relative diagnostic benefit of one over the other, we synthesized evidence regarding the relative performance of CT, extracellular contrast-enhanced MRI, and gadoxetate-enhanced MRI for diagnosis of HCC in patients with cirrhosis. We also assessed whether liver biopsy versus follow-up with the same versus alternative imaging is best for CT-indeterminate or MRI-indeterminate liver nodules in patients with cirrhosis. We searched multiple databases from inception to April 27, 2016, for studies comparing CT with extracellular contrast-enhanced MRI or gadoxetate-enhanced MRI in adults with cirrhosis and suspected HCC. Two reviewers independently selected studies and extracted data. Of 33 included studies, 19 were comprehensive, while 14 reported sensitivity only. For all tumor sizes, the 19 comprehensive comparisons showed significantly higher sensitivity (0.82 versus 0.66) and lower negative likelihood ratio (0.20 versus 0.37) for MRI over CT. The specificities of MRI versus CT (0.91 versus 0.92) and the positive likelihood ratios (8.8 versus 8.1) were not different. All three modalities performed better for HCCs ≥2 cm. Performance was poor for HCCs <1 cm. No studies examined whether adults with cirrhosis and an indeterminate nodule are best evaluated using biopsy, repeated imaging, or alternative imaging. Concerns about publication bias, inconsistent study results, increased risk of bias, and clinical factors precluded support for exclusive use of either gadoxetate-enhanced or extracellular contrast-enhanced MRI over CT.

Conclusion