Research Recap: Weeks of November 8 – November 19
A biweekly overview of recent studies published by Institute investigators and their collaborators spans a wide variety of topics, including:
Mepolizumab for severe asthma; the global pediatric obesity epidemic; hospital respiratory protection policies in the COVID era; how provider biases may influence PrEP implementation; whether cesarean delivery affects pubertal development; examining the effectiveness of an employee COVID attestation system; and ventilator-associated events.
For all faculty publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory.
Monitoring use and adherence to a treatment for severe asthma
Approximately 5-10% of the over 25 million asthma cases in the United States are classified as severe. In 2015, the FDA approved Mepolizumab (known as Nucala) as add-on maintenance treatment of severe asthma for patients over 12 years of age with an eosinophilic phenotype. A new study led by Ann Wu with Pamela McMahon used FDA Sentinel System claims data and analytical tools to evaluate baseline characteristics and treatment patterns among adult initiators of mepolizumab in a real-life population. Results, published in BMJ Open Respiratory Research, show that adults with asthma treated with mepolizumab had varying levels of healthcare utilization. The team also observed that patients without severe asthma used mepolizumab.
The global obesity pandemic requires a multifaceted approach
Though the global childhood obesity epidemic was showing signs of plateauing before the COVID-19 pandemic, the onset of pandemic-related shutdowns and guidelines may have reversed these gains. In a new JAMA Pediatrics editorial, Izzuddin Aris and Jason Block discuss studies appearing in the issue that address research gaps in the fight against obesity and/or have shown promise in reducing overweight in children. They note that future child obesity prevention interventions should build on the DECIDE-Children study, an intensive school-based intervention targeting children and their families, and that overall, an “all hands on deck” approach is needed to effectively decrease childhood obesity levels and prevent its onset from the start.
Are current hospital respiratory protection policies outdated?
From the front lines of the COVID-19 pandemic, Meghan Baker, Chanu Rhee, and Michael Klompas and collaborators have gleaned one of the few silver linings: an increased understanding of respiratory viral transmission. They further discuss the droplet versus aerosol debate with a new narrative review published in Annals of Internal Medicine, suggesting that current models of hospital-based respiratory virus transmission are outdated, rendering current infection control policies and protocols ineffective. The team suggests that transmission risk exists along a continuum; this new understanding of disease transmission and infection control allows for hospitals to implement a graded, risk-based approach to respiratory protection.
Taking a closer look at how provider biases may influence PrEP implementation
Pre-exposure prophylaxis (PrEP) is recommended for prevention of HIV among groups at risk for HIV due to sexual activity, injection drug use, or both. Disparities in implementation across these risk groups has come to light, however. Studies suggest provider biases might contribute to these differences in prescribing by affecting clinical judgments. As gatekeepers to access, provider biases must be researched and addressed. A team including Douglas Krakower examined these potential biases in a new study published in AIDS and Behavior. Through an online survey regarding a fictitious medical record, they surveyed providers on measures of clinical judgment and prejudice related to race, risk behaviors, and drug use. Results demonstrated the possibility for provider biases to influence their clinical judgment in the context of PrEP delivery, though some providers may be less aware of their biases or the need to address those biases.
Institute Investigator(s): Douglas Krakower
Cesarean delivery: does it affect pubertal development?
Many studies look at potential long-term effects of offspring born by cesarean delivery, but few have looked at whether it has effects on pubertal development. A new Project Viva study led by Izzuddin Aris with Marie-France Hivert, Emily Oken, and Joanne Sordillo used electronic medical records to determine mode of delivery and examined four pubertal development markers: age at peak height velocity; age at menarche; parent-reported pubertal development score; and child-reported pictograph Tanner pubic hair staging. The team observed sex-specific associations of mode of delivery with offspring pubertal development. Results, published in Human Reproduction, lend support for cesarean delivery as a potential indicator of identifying children who are likely to experience earlier pubertal development.
Examining the effectiveness of daily employee attestations during the COVID-19 era
For those who have worked in-person throughout the pandemic, or are returning to the workplace, employee screening systems are a new routine occurrence. Their effectiveness in helping curb COVID-19 transmission, however, has yet to be well-characterized – the screening is recommended, but without clear evidence substantiating it. A team including Michael Klompas investigated the effectiveness of a daily attestation system used by employees of a multi-institutional academic medical center. Results, published in Infection Control and Hospital Epidemiology, showed that the system identified a handful of employees with COVID-19. Regardless of the low number, similar systems may help keep unwell employees off site and therefore prevent transmissions.
Institute Investigator(s): Michael Klompas
A narrative review of ventilator associated events in adults
Although ventilators can save the lives of those experiencing acute respiratory failure, there is a risk of complications that can prolong dependence on mechanical ventilation, and even accelerate death. A team led by former fellow Jeremy Weinberger with Noelle Cocoros and Michael Klompas conducted a review focused on the epidemiology, outcomes, risk factors, and prevention strategies for ventilator-associated events (VAEs) in adult patients. In the review, published in Infectious Disease Clinics of North America, they discuss how defining VAEs transformed national surveillance efforts for complications in adults on ventilators, also noting that hospitals now use objective data to measure events.