Life Landmarks

The research pertaining to my thesis shares the exploration of my identity that is manifested through the process of making ceramic sculptures. These sculptures are informed from the better part of a decade I spent traveling around the world which coincided with dealing with family issues. In both, my travels and time at home I continuously relied on others and in turn became stressed about things that I had no influence over. I highlight certain aspects of these experiences through my artwork as a way for me to channel the frustrations and ambiguities from these memories that are etched in my mind. My outlet for my ongoing stresses is the mindfulness practice of throwing on the potter’s wheel. The wheel and clay allow me to clear my head, be present, and reflect. With that introspection, I create sculptures that share my personal narrative

Screening for Social Determinants of Health in Pediatric Resident Continuity Clinic

ABSTRACTBACKGROUND: The American Academy of Pediatrics and the Academic Pediatric Association have published guidelines supporting screening and referral for social determinants of health (SDH) in pediatric primary care. Despite this charge, little is known about the current prevalence of screening practices taking place in medical homes across the country. OBJECTIVE: The objective of this study is to describe current practices for systematically screening for social determinants of health in nationwide pediatric continuity clinics enrolled in the CORNET network. METHODS: We recruited 144 pediatric resident continuity clinics enrolled in the Continuity Research Network (CORNET) of the Academic Pediatric Association. Continuity clinic directors at 75 sites agreeing to participate received an electronic survey instrument requesting clinic demographics and information on screening and educational practices for fifteen social determinants of health. RESULTS: In the sixty-four clinic sites that responded to the survey, the range of SDH being screened for was 0-15 with a mean of 7. The most commonly screened SDH were maternal depression (86%), child education (84%), food insecurity (71%) and firearm exposure (65%). Most commonly, screening instruments are paper documents original to the clinic. Primary providers, nurses or medical assistants administer the majority of screens on rooming or during the encounter. Clinics not currently screening have plans to begin screening for nearly a quarter of those SDH not currently being screened within the next 3 years. Clinic directors most often cited lack of time (63%), lack of resources to address positive screen (50%) and inadequate training (46%) as barriers to SDH screening. Less than 10% of resident continuity clinic directors cited lack of indication or evidence for screening as barriers. CONCLUSIONS: Screening for SDH in pediatric resident continuity clinics has not yet been universally implemented. Screening practices are variable reflecting the complex nature of screening and the heterogeneity of the various SDH. Characteristics of commonly screened SDH include validated, concise screening tools, longstanding Bright Futures recommendations, literature suggesting benefit, and identifiable interventions. The major barriers to SDH screening are lack of time and lack of resources to address positive screens. A variety of measures including comprehensive, concise screening tools, up-to-date community resource guides, streamlined referral processes, embedded multidisciplinary teams, and strong community partnerships could mitigate these barriers.Master of Public Healt

An In Vivo Screen Identifies PYGO2 as a Driver for Metastatic Prostate Cancer

Advanced prostate cancer displays conspicuous chromosomal instability and rampant copy number aberrations, yet the identity of functional drivers resident in many amplicons remain elusive. Here, we implemented a functional genomics approach to identify new oncogenes involved in prostate cancer progression. Through integrated analyses of focal amplicons in large prostate cancer genomic and transcriptomic datasets as well as genes upregulated in metastasis, 276 putative oncogenes were enlisted into an in vivo gain-of-function tumorigenesis screen. Among the top positive hits, we conducted an in-depth functional analysis on Pygopus family PHD finger 2 (PYGO2), located in the amplicon at 1q21.3. PYGO2 overexpression enhances primary tumor growth and local invasion to draining lymph nodes. Conversely, PYGO2 depletion inhibits prostate cancer cell invasion in vitro and progression of primary tumor and metastasis in vivo In clinical samples, PYGO2 upregulation associated with higher Gleason score and metastasis to lymph nodes and bone. Silencing PYGO2 expression in patient-derived xenograft models impairs tumor progression. Finally, PYGO2 is necessary to enhance the transcriptional activation in response to ligand-induced Wnt/β-catenin signaling. Together, our results indicate that PYGO2 functions as a driver oncogene in the 1q21.3 amplicon and may serve as a potential prognostic biomarker and therapeutic target for metastatic prostate cancer.Significance: Amplification/overexpression of PYGO2 may serve as a biomarker for prostate cancer progression and metastasis. Cancer Res; 78(14); 3823-33. ©2018 AACR

Antiviral treatment for Bell's palsy (idiopathic facial paralysis)

BACKGROUND: Antiviral agents against herpes simplex virus are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but their effectiveness is uncertain. Significant morbidity can be associated with severe cases. OBJECTIVES: This review addresses the effect of antiviral therapy on Bell's palsy. SEARCH STRATEGY: We updated the search of the Cochrane Neuromuscular Disease Group Trials Register (December 2008), MEDLINE (from January 1966 to December 8 2008), EMBASE (from January 1980 to December 8 2008) and LILACS (from January 1982 to December 2008). SELECTION CRITERIA: Randomized trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. DATA COLLECTION AND ANALYSIS: Twenty-three papers were selected for consideration. MAIN RESULTS: Seven trials including 1987 participants met the inclusion criteria, adding five studies to the two in the previous review.Incomplete recovery at one year. There was no significant benefit in the rate of incomplete recovery from antivirals compared with placebo (n = 1886, RR 0.88, 95% CI 0.65 to 1.18). In meta-analyses with some unexplained heterogeneity, the outcome with antivirals was significantly worse than with corticosteroids (n = 768, RR 2.82, 95% CI 1.09 to 7.32) and the outcome with antivirals plus corticosteroids was significantly better than with placebo (n = 658, RR 0.56, 95% CI 0.41 to 0.76).Motor synkinesis or crocodile tears at one year. In single trials, there was no significant difference in long term sequelae comparing antivirals and corticosteroids with corticosteroids alone (n = 99, RR 0.39, 95% CI 0.14 to 1.07) or antivirals with corticosteroids (n = 101, RR 1.03, 95% CI 0.51 to 2.07).Adverse events.There was no significant difference in rates of adverse events between antivirals and placebo (n = 1544, RR 1.06, 95% CI 0.81 to 1.38), between antivirals and corticosteroids (n = 667, RR 0.96, 95% CI 0.65 to 1.41) or between the antiviral-corticosteroid combination and placebo (n = 658, RR 1.15, 95% CI 0.79 to 1.66). AUTHORS' CONCLUSIONS: High quality evidence showed no significant benefit from anti-herpes simplex antivirals compared with placebo in producing complete recovery from Bell's palsy. Moderate quality evidence showed that antivirals were significantly less likely than corticosteroids to produce complete recovery.</p

Comprehensive profiling of pre-infection antibodies identifies HIV targets associated with viremic control and viral load

BackgroundHigh HIV viral load (VL) is associated with increased transmission risk and faster disease progression. HIV controllers achieve viral suppression without antiretroviral (ARV) treatment. We evaluated viremic control in a community-randomized trial with &gt;48,000 participants.MethodsA massively multiplexed antibody profiling system, VirScan, was used to quantify pre- and post-infection antibody reactivity to HIV peptides in 664 samples from 429 participants (13 controllers, 135 viremic non-controllers, 64 other non-controllers, 217 uninfected persons). Controllers had VLs &lt;2,000 copies/mL with no ARV drugs detected at the first HIV-positive visit and one year later. Viremic non-controllers had VLs 2,000 copies/mL with no ARV drugs detected at the first HIV-positive visit. Other non-controllers had either ARV drugs detected at the first HIV-positive visit (n=47) or VLs &lt;2,000 copies/mL with no ARV drugs detected at only one HIV-positive visit (n=17).ResultsWe identified pre-infection HIV antibody reactivities that correlated with post-infection VL. Pre-infection reactivity to an epitope in the HR2 domain of gp41 was associated with controller status and lower VL. Pre-infection reactivity to an epitope in the C2 domain of gp120 was associated with non-controller status and higher VL. Different patterns of antibody reactivity were observed over time for these two epitopes.ConclusionThese studies suggest that pre-infection HIV antibodies are associated with controller status and modulation of HIV VL. These findings may inform research on antibody-based interventions for HIV treatment