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Article ; Online: The transition from genomics to phenomics in personalized population health.

Yurkovich, James T / Evans, Simon J / Rappaport, Noa / Boore, Jeffrey L / Lovejoy, Jennifer C / Price, Nathan D / Hood, Leroy E

Nature reviews. Genetics

2023 Volume 25, Issue 4, Page(s) 286–302

Abstract: Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data- ... ...

Abstract	Modern health care faces several serious challenges, including an ageing population and its inherent burden of chronic diseases, rising costs and marginal quality metrics. By assessing and optimizing the health trajectory of each individual using a data-driven personalized approach that reflects their genetics, behaviour and environment, we can start to address these challenges. This assessment includes longitudinal phenome measures, such as the blood proteome and metabolome, gut microbiome composition and function, and lifestyle and behaviour through wearables and questionnaires. Here, we review ongoing large-scale genomics and longitudinal phenomics efforts and the powerful insights they provide into wellness. We describe our vision for the transformation of the current health care from disease-oriented to data-driven, wellness-oriented and personalized population health.
MeSH term(s)	Phenomics ; Genomics
Language	English
Publishing date	2023-12-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2035157-4
ISSN	1471-0064 ; 1471-0056
ISSN (online)	1471-0064
ISSN	1471-0056
DOI	10.1038/s41576-023-00674-x
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Resident Productivity in the Emergency Department After Implementation of an Automated Patient Assignment System; a Brief Report.

Rosenow, Christian / Aguirre, Sophia / Polveroni, Thomas / Ginsberg, Zachary / Pollock, Jordan / Traub, Stephen / Rappaport, Douglas

Archives of academic emergency medicine

2022 Volume 10, Issue 1, Page(s) e33

Abstract: Introduction: The clinical diversity of patients presenting to the emergency department (ED) allows emergency medicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign patients at their discretion. Our ... ...

Abstract	Introduction: The clinical diversity of patients presenting to the emergency department (ED) allows emergency medicine (EM) and non-EM residents to sharpen their clinical skills. In most EDs, residents self-assign patients at their discretion. Our institution transitioned from a self-assignment-system to an automated-system, after which we sought to determine the productivity of our non-EM residents compared to the previous system. Methods: In this retrospective cross-sectional study, resident productivity was measured as number of patient visits per hour and per 8.5-hour shift before and after the implementation of an automated patient assignment system in emergency department. The automated-system assigns one patient at the start of the shift, another 30 minutes later, and one patient every hour thereafter, throughout the shift. Results: 28 residents performed 406 total shifts prior to implementation and 14 residents performed 252 total shifts post-implementation. The average number of patient visits per hour significantly increased from 0.52 ± 0.18 (95% CI 0.45-0.59, IQR 0.43-0.60) to 0.82 ± 0.11 (95% CI 0.75-0.88, IQR 0.74-0.89) after implementation of our assignment system (p<0.00001; figure 1). Additionally, the average number of patient visits per 8.5-hour shift significantly increased from 4.46 ± 1.53 (CI 3.86-5.05, IQR 3.66-5.08) to 6.52 ± 0.86 (CI 6.02-7.02, IQR 5.90-7.09) after the implementation of our system (p<0.00001; figure 1). Conclusion: These findings warrant further evaluation of the impact of patient assignment systems on trainee education.
Language	English
Publishing date	2022-04-30
Publishing country	Iran
Document type	Journal Article
ISSN	2645-4904
ISSN (online)	2645-4904
DOI	10.22037/aaem.v10i1.1516
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Multiomic signatures of body mass index identify heterogeneous health phenotypes and responses to a lifestyle intervention.

Watanabe, Kengo / Wilmanski, Tomasz / Diener, Christian / Earls, John C / Zimmer, Anat / Lincoln, Briana / Hadlock, Jennifer J / Lovejoy, Jennifer C / Gibbons, Sean M / Magis, Andrew T / Hood, Leroy / Price, Nathan D / Rappaport, Noa

Nature medicine

2023 Volume 29, Issue 4, Page(s) 996–1008

Abstract: Multiomic profiling can reveal population heterogeneity for both health and disease states. Obesity drives a myriad of metabolic perturbations and is a risk factor for multiple chronic diseases. Here we report an atlas of cross-sectional and longitudinal ...

Abstract	Multiomic profiling can reveal population heterogeneity for both health and disease states. Obesity drives a myriad of metabolic perturbations and is a risk factor for multiple chronic diseases. Here we report an atlas of cross-sectional and longitudinal changes in 1,111 blood analytes associated with variation in body mass index (BMI), as well as multiomic associations with host polygenic risk scores and gut microbiome composition, from a cohort of 1,277 individuals enrolled in a wellness program (Arivale). Machine learning model predictions of BMI from blood multiomics captured heterogeneous phenotypic states of host metabolism and gut microbiome composition better than BMI, which was also validated in an external cohort (TwinsUK). Moreover, longitudinal analyses identified variable BMI trajectories for different omics measures in response to a healthy lifestyle intervention; metabolomics-inferred BMI decreased to a greater extent than actual BMI, whereas proteomics-inferred BMI exhibited greater resistance to change. Our analyses further identified blood analyte-analyte associations that were modified by metabolomics-inferred BMI and partially reversed in individuals with metabolic obesity during the intervention. Taken together, our findings provide a blood atlas of the molecular perturbations associated with changes in obesity status, serving as a resource to quantify metabolic health for predictive and preventive medicine.
MeSH term(s)	Humans ; Body Mass Index ; Cross-Sectional Studies ; Multiomics ; Obesity/metabolism ; Phenotype
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1220066-9
ISSN	1546-170X ; 1078-8956
ISSN (online)	1546-170X
ISSN	1078-8956
DOI	10.1038/s41591-023-02248-0
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Zs.A 4212: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Book: Sessions on Experimental Methods for Chemical Models

Rappaport, Karen D.

papers presented at the 211th ACS national meeting ; held in New Orleans, LA, March 24 - 28, 1996

1997

Institution	Session on Experimental Methods for Chemical Models American Chemical Society
Author's details	guest ed.: Karen D. Rappaport
Keywords	Chemistry / congresses ; Models, Chemical / congresses ; Computer-Aided Design / congresses ; Molecular Structure / congresses
Language	English
Publishing country	Netherlands
Document type	Book
Note	In: Chemometrics and intelligent laboratory systems. - ISSN 0169-7439. - 36 (1997),2, S. [195] - 243
HBZ-ID	HT007522844
Database	Catalogue ZB MED Medicine, Health

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Zs A 2595 -36-	not available for loan	Zeitschriften-Lesesaal

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Article: Pre-matriculation clinical experience positively correlates with Step 1 and Step 2 scores.

Shah, Raj / Johnstone, Cameron / Rappaport, Douglas / Bilello, Leslie A / Adamas-Rappaport, William

Advances in medical education and practice

2018 Volume 9, Page(s) 707–711

Abstract: Background: This study investigates whether students with pre-matriculation, formalized, clinical experience performed better in Step 1 and Step 2 of the United States Medical Licensing Exams (USMLE) compared to students without formal pre-matriculation ...

Abstract	Background: This study investigates whether students with pre-matriculation, formalized, clinical experience performed better in Step 1 and Step 2 of the United States Medical Licensing Exams (USMLE) compared to students without formal pre-matriculation clinical experience. Methods: This research investigation was a retrospective cohort study conducted at the University of Arizona College of Medicine in Tucson, Arizona, USA, and analyzed students in the Class of 2017 and Class of 2018. Formal clinical experience was defined as registered nurses, physician assistants, nurse practitioners, paramedics, emergency medical technicians, or licensed practical nurses for any amount of time prior to matriculation, as well as scribing for at least 6 months prior to matriculation. Students with any amount of shadowing experience were not considered to have clinical experience. The authors performed multiple regression analyses to investigate the effects of formal clinical experience on USMLE exam performance. Statistical significance was defined as Results: Our study had a total of 227 students from the two classes, with 40 (17.6%) having formal pre-matriculation clinical experience, as already defined. Nine (3.96%) students were not assessed in USMLE Step 1 calculations, and 61 (26.9%) students were not assessed in USMLE Step 2 calculations due to an absence of recorded USMLE scores. Formal pre-matriculation clinical experience was a statistically significant positive predictor of USMLE Step 1 score ( Conclusion: Formal pre-matriculation clinical experience, as defined previously, positively correlates with an increase in USMLE Step 1 and Step 2 scores.
Language	English
Publishing date	2018-09-25
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2578539-4
ISSN	1179-7258
ISSN	1179-7258
DOI	10.2147/AMEP.S173470
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Book ; Conference proceedings: Applications of experimental design in the chemical industry

Rappaport, Karen D.

selected papers presented at the ACS Symposium on Experimental Design, Washington, DC, fall 1994

1995

Institution	Symposium on Experimental Design American Chemical Society
Author's details	guest ed.: Karen D. Rappaport
Keywords	Chemical Industry / methods / congresses ; Research Design / congresses ; Models, Statistical / congresses
Language	English
Publishing country	Netherlands
Document type	Book ; Conference proceedings
Note	In: Chemometrics and intelligent laboratory systems. - ISSN 0169-7439. - 29 (1995),1, S. [109] - 146
HBZ-ID	HT006874565
Database	Catalogue ZB MED Medicine, Health

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Zs A 2595 -29-	not available for loan	Zeitschriften-Lesesaal

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Article ; Online: Evaluating urgent care center referrals to the emergency department.

Poyorena, Chris / Patel, Shyam / Keim, Audrey / Monas, Jessica / Urumov, Andrej / Lindor, Rachel / Girardo, Marlene / Rappaport, Douglas

Journal of the American College of Emergency Physicians open

2022 Volume 3, Issue 6, Page(s) e12838

Abstract: Background and objectives: Urgent care centers (UCCs) are increasingly popular with an estimated number of 9600 stand-alone centers in the United States compared to emergency departments (EDs). These facilities offer a potentially more convenient and ... ...

Abstract	Background and objectives: Urgent care centers (UCCs) are increasingly popular with an estimated number of 9600 stand-alone centers in the United States compared to emergency departments (EDs). These facilities offer a potentially more convenient and affordable option for patients seeking care for a variety of low-acuity conditions. Because of the limitations of UCCs, patients occasionally are referred to EDs for further care. Prior studies have attempted to evaluate the appropriateness of these UCC referrals. Our study is the first to consider if these referrals require ED-specific care and the diagnostic concordance of these referrals. Methods: We performed a retrospective chart review to identify patients who were referred from UCCs to our ED between October 2020 and June 2021. We used a Boolean search strategy to screen charts for the terms urgent care, emergency department, referral, or transfer. Cases were manually screened until 300 met the inclusion criteria. Cases had to feature the patient being seen by a UCC provider and directly referred to the ED on the same day. Patients who presented to the ED of their own volition were excluded. Three independent abstractors reviewed the charts. All abstractors and a senior investigator piloted the use of a data collection sheet and discussed the management of any ambiguous data. A senior physician reviewed all discrepancies among abstractors. Data collected included ED final diagnosis and whether the final diagnosis was similar to the UCC diagnosis. A referral was deemed to require ED-specific care and resources if (1) the patient was admitted, (2) imaging (other than an x-ray) was performed, (3) specialist consultation was required, or (4) care was provided in the ED that is not conventionally available at UCCs. Results: From the 300 patient charts, 55% of patients referred from UCCs to the ED did not require ED-specific care or resources and 64% had discordant diagnoses between UCC diagnosis and ED diagnosis. A total of 41% of patients underwent advanced imaging studies, 26% received specialty consultations, and 15% were admitted. Subgroup analysis for lacerations, extremity/fracture care, and abnormal electrocardiograms (ECGs) showed disproportionally high levels of discordant diagnoses and referrals that did not require ED-specific care or resources. Conclusion: Our data found that 55% of patients referred to EDs from UCCs did not require ED-specific care or resources and 64% carried a discordant diagnosis between UC and ED diagnosis. We suggest quality remedies, such as educational sessions and engagement with telemedicine sub-specialists as well as a coordinated formalized system for UCC to ED referrals.
Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12838
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Risk factors for severe COVID-19 differ by age for hospitalized adults.

Molani, Sevda / Hernandez, Patricia V / Roper, Ryan T / Duvvuri, Venkata R / Baumgartner, Andrew M / Goldman, Jason D / Ertekin-Taner, Nilüfer / Funk, Cory C / Price, Nathan D / Rappaport, Noa / Hadlock, Jennifer J

Scientific reports

2022 Volume 12, Issue 1, Page(s) 6568

Abstract: Risk stratification for hospitalized adults with COVID-19 is essential to inform decisions about individual patients and allocation of resources. So far, risk models for severe COVID outcomes have included age but have not been optimized to best serve ... ...

Abstract	Risk stratification for hospitalized adults with COVID-19 is essential to inform decisions about individual patients and allocation of resources. So far, risk models for severe COVID outcomes have included age but have not been optimized to best serve the needs of either older or younger adults. Models also need to be updated to reflect improvements in COVID-19 treatments. This retrospective study analyzed data from 6906 hospitalized adults with COVID-19 from a community health system across five states in the western United States. Risk models were developed to predict mechanical ventilation illness or death across one to 56 days of hospitalization, using clinical data available within the first hour after either admission with COVID-19 or a first positive SARS-CoV-2 test. For the seven-day interval, models for age ≥ 18 and < 50 years reached AUROC 0.81 (95% CI 0.71-0.91) and models for age ≥ 50 years reached AUROC 0.82 (95% CI 0.77-0.86). Models revealed differences in the statistical significance and relative predictive value of risk factors between older and younger patients including age, BMI, vital signs, and laboratory results. In addition, for hospitalized patients, sex and chronic comorbidities had lower predictive value than vital signs and laboratory results.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Hospitalization ; Humans ; Middle Aged ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; United States
Language	English
Publishing date	2022-04-28
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-10344-3
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Article ; Online: Heterogeneity in statin responses explained by variation in the human gut microbiome.

Wilmanski, Tomasz / Kornilov, Sergey A / Diener, Christian / Conomos, Matthew P / Lovejoy, Jennifer C / Sebastiani, Paola / Orwoll, Eric S / Hood, Leroy / Price, Nathan D / Rappaport, Noa / Magis, Andrew T / Gibbons, Sean M

Med (New York, N.Y.)

2022 Volume 3, Issue 6, Page(s) 388–405.e6

Abstract: Background: Statins remain one of the most prescribed medications worldwide. While effective in decreasing atherosclerotic cardiovascular disease risk, statin use is associated with adverse effects for a subset of patients, including disrupted metabolic ...

Abstract	Background: Statins remain one of the most prescribed medications worldwide. While effective in decreasing atherosclerotic cardiovascular disease risk, statin use is associated with adverse effects for a subset of patients, including disrupted metabolic control and increased risk of type 2 diabetes. Methods: We investigated the potential role of the gut microbiome in modifying patient responses to statin therapy across two independent cohorts (discovery n = 1,848, validation n = 991). Microbiome composition was assessed in these cohorts using stool 16S rRNA amplicon and shotgun metagenomic sequencing, respectively. Microbiome associations with markers of statin on-target and adverse effects were tested via a covariate-adjusted interaction analysis framework, utilizing blood metabolomics, clinical laboratory tests, genomics, and demographics data. Findings: The hydrolyzed substrate for 3-hydroxy-3-methylglutarate-coenzyme-A (HMG-CoA) reductase, HMG, emerged as a promising marker for statin on-target effects in cross-sectional cohorts. Plasma HMG levels reflected both statin therapy intensity and known genetic markers for variable statin responses. Through exploring gut microbiome associations between blood-derived measures of statin effectiveness and adverse metabolic effects of statins, we find that heterogeneity in statin responses was consistently associated with variation in the gut microbiome across two independent cohorts. A Bacteroides-enriched and diversity-depleted gut microbiome was associated with more intense statin responses, both in terms of on-target and adverse effects. Conclusions: With further study and refinement, gut microbiome monitoring may help inform precision statin treatment. Funding: This research was supported by the M.J. Murdock Charitable Trust, WRF, NAM Catalyst Award, and NIH grant U19AG023122 awarded by the NIA.
MeSH term(s)	Cross-Sectional Studies ; Diabetes Mellitus, Type 2/drug therapy ; Gastrointestinal Microbiome/genetics ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Microbiota ; RNA, Ribosomal, 16S/genetics
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors ; RNA, Ribosomal, 16S
Language	English
Publishing date	2022-05-11
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2666-6340
ISSN (online)	2666-6340
DOI	10.1016/j.medj.2022.04.007
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress-Part 3 of 6: Physician Illness and Impairment.

Mull, Colette C / Thompson, Amy D / Rappaport, David I / Gartner, J Carlton / Bowman, Wesley R

Pediatric emergency care

2019 Volume 35, Issue 8, Page(s) 585–588

Abstract: Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, ...

Abstract	Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.
MeSH term(s)	Adaptation, Psychological/physiology ; Alcoholism/complications ; Alcoholism/psychology ; Analgesics, Opioid/adverse effects ; Emergency Medicine/statistics & numerical data ; Humans ; Internship and Residency/statistics & numerical data ; Physician Impairment/psychology ; Physician Impairment/statistics & numerical data ; Physicians/psychology ; Presenteeism/statistics & numerical data ; Self Care/methods ; Stress, Psychological/complications ; Stress, Psychological/psychology ; Substance-Related Disorders/complications ; Substance-Related Disorders/prevention & control ; Substance-Related Disorders/psychology ; United Kingdom/epidemiology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2019-07-23
Publishing country	United States
Document type	Journal Article ; Personal Narrative
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000001896
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