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March 30, 2017

Research Notes

Inclusive campuses may lower sexual assault risk

Students who perceive that their college campus is more inclusive and welcoming of sexual- and gender-minority people have lower odds of being victims of sexual assault, according to a study led by the Graduate School of Public Health that was published in Journal of Interpersonal Violence.

In a complementary study, the researchers found that some minority groups are at considerably higher risk for sexual assault in college than peers in majority groups. Published in Prevention Science, it is among the first analyses to explore how populations with intersecting minority identities have varying risks of sexual assault victimization.

Said Robert Coulter, a doctoral candidate in Pitt’s Department of Behavioral and Community Health Sciences and lead author of both studies: “Despite the formation of the White House task force to protect students from sexual assault in 2014, few interventions have been shown to be effective in preventing such assault. Even fewer interventions are tailored for racial and ethnic minorities, and not one intervention has been evaluated with sexual- and gender-minority people. Our studies highlight the need for college prevention and treatment programs to focus efforts on sexual, gender, racial and ethnic minority groups.”

Coulter and his team analyzed surveys completed by 71,421 undergraduate students from 120 U.S. post-secondary institutions in 2011-13, and found:

• Non-transgender women had nearly 150 percent greater odds of being sexually assaulted in the previous year than non-transgender men.

• But transgender people were at even greater risk: They had nearly 300 percent higher odds of being sexually assaulted than non-transgender men.

• Among non-transgender men, gay and bisexual men had higher odds of sexual assault than heterosexual men, and black men had higher odds than white men.

• Among non-transgender women, bisexual women had higher odds of sexual assault than heterosexual women. Compared with white women, black women had higher odds of sexual assault, while Latino and Asian women had lower odds.

• Among transgender people, black transgender people had higher odds of sexual assault than white transgender people.

“What is particularly unique about this analysis, aside from being one of the largest studies to examine sexual assault on college campuses, is that it provided insights into how sexual assault varies among populations with multiple and intersecting marginalized identities, such as being both transgender and black,” said Coulter.

In their other study, Coulter and his team examined surveys completed by nearly 2,000 sexual- and gender-minority undergraduates from colleges in all 50 U.S. states.

Students who perceived that their campus was more inclusive of sexual- and gender-minority people had 27 percent lower odds of having been sexually assaulted than their peers who felt their campus was less inclusive.

The researchers hypothesize that sexual- and gender-minority inclusive campus climates may embolden bystanders to stop, or attempt to stop, sexual assault of sexual- and gender-minority people. Such campuses also may dissuade perpetrators from targeting sexual- and gender-minority people. Additionally, inclusive campuses may empower people to reduce their likelihood of becoming sexual assault victims by, for example, being cautious when drinking alcohol.

Examples of potential ways to make colleges more inclusive include programs that train faculty, staff and students to be allies for sexual- and gender-minority people; establishing resource centers and student groups for these minorities; and creating/enforcing anti-discrimination policies that protect these groups.

“If sexual assault prevention efforts solely focus on heterosexual violence, they may invalidate sexual- and gender-minority people’s assault experiences and be ineffective for them,” said Coulter. “To overcome this, existing programs could be augmented to explicitly address homophobia, biphobia, transphobia and racism. And new interventions could be created specifically for sexual, gender, racial and ethnic minorities.”

The Journal of Interpersonal Violence study included a co-author from Rankin & Associates Consulting. Additional Pitt authors on the Prevention Science study were Christina Mair and Derrick Matthews. Colleagues from Children’s Hospital, the Department of Veterans Affairs and Michigan State University also contributed.

This research was supported by the National Institutes of Health (NIH), the Department of Veterans Affairs and Campus Pride.

Tissue regeneration therapies center established

The School of Dental Medicine has received an $11.7 million grant from the National Institute of Dental and Craniofacial Research (NIDCR) to establish a resource center dedicated to advancing therapies for regenerating damaged dental, oral and craniofacial tissues.

Pitt established the center in partnership with the University of Michigan and Harvard University as part of the NIDCR’s Dental, Oral and Craniofacial Tissue Regeneration Consortium. The goal of the consortium is to guide new therapies from the research stages through preclinical studies and into human clinical trials. The center is named the Michigan-Pittsburgh-Wyss Resource Center: Supporting Regenerative Medicine in Dental, Oral and Craniofacial Technologies.

Said principal investigator Charles Sfeir, who is associate dean for research and director of the school’s Center for Craniofacial Regeneration: “There is tremendous value in craniofacial regenerative medicine research, and our goal is to create therapies and technologies that help patients. This newly established consortium is dedicated to making the most promising research in this field a clinical reality.”

Pitt, Michigan and Harvard researchers joined forces during an initial year-long organizational phase funded by an NIDCR planning grant. The current award provides funding for a second three-year phase, which will consist of researchers evaluating projects based on their clinical and commercial viability. The resource center then will match selected projects with the clinical, scientific, industrial and regulatory expertise necessary to more efficiently translate the research into clinical trials and eventually clinical practice.

Sfeir and William Wagner, director of Pitt’s McGowan Institute for Regenerative Medicine, are the principal investigators at the resource center in Pittsburgh.

Engineering research seed grants awarded

The Mascaro Center for Sustainable Innovation has selected recipients of its 2017-18 research seed grants from the Swanson School of Engineering:

• “Protein Lithography: A Sustainable Technology for sub-5-nm Nanomanufacturing”; primary investigator is Mostafa Bedewy, industrial engineering.

• “High Efficiency Refrigeration and Cooling Through Additive Manufactured Magnetocaloric Devices”; primary investigator is Markus Chmielus, mechanical engineering and materials science.

• “Toward Machine Learning Blueprints for Greener Chelants”; primary investigator is John Keith, chemical and petroleum engineering.

• “H2P: HydoPonics to Pyrolysis: An Enclosed System for the Phytoremediation and Destruction of Perfectly Persistent Emerging Contaminants in Our Water”; primary investigators are Carla Ng, civil and environmental engineering, and David Sanchez, civil and environmental engineering.

Physician judgments sound for sepsis

Doctors across 138 hospitals in seven countries shared treatment protocols and harmonized data collection from three clinical trials, resulting in a comprehensive analysis on care for sepsis, the leading killer of hospital patients worldwide. The international evaluation was overseen by physicians at Pitt’s School of Medicine, who expect the work to serve as a model for future research on this scale.

When combined, the trials confirm that, even in acutely sick patients, the previously accepted, standardized approach to diagnosing and treating sepsis did not change survival chances. The findings were announced at the International Symposium on Intensive Care and Emergency Medicine in Brussels, and published in The New England Journal of Medicine.

Said Derek Angus, Distinguished Professor and Mitchell P. Fink Chair, Department of Critical Care Medicine, and principal investigator of the U.S. trial, the first of the three to be funded: “These results are reassuring because we’ve already been changing sepsis care based on individual findings from the three trials.”

Sepsis arises when the body’s response to an infection injures its own tissues and organs, sometimes progressing to septic shock. According to NIH, it may occur in more than a million U.S. patients every year, and — despite best practice — an estimated 28-50 percent of these people do not survive.

In 2008, the U.S.-based “Protocolized Care for Early Septic Shock” (ProCESS) trial, the U.K.-based “Protocolised Management in Sepsis” trial and the “Australasian Resuscitation in Sepsis Evaluation” trial, based in Australia and New Zealand, were launched with federal funding from each country. They were designed to build on a 2001 study of 263 patients at a single Detroit hospital suggesting that early, goal-directed therapy (EGDT) reduced mortality from sepsis by 16 percent.

Before enrolling a single patient, the scientists leading each trial worked together to ensure that their trials tested treatments and collected information in a way that would make the findings compatible. In doing so, the scientists effectively tripled their data, allowing more detailed analyses compared to any single trial.

The combined meta-analysis of the three trials included 3,723 sepsis patients, approximately half treated with “usual care,” in which the bedside physician directs the course of treatment based on what he or she determines is best for the patient, and the other half treated with EGDT, which requires the clinician to follow a protocol that includes placing a catheter called a central line in the jugular vein to monitor blood pressure and oxygen levels, as well as delivery of drugs, fluids and blood transfusions.

The meta-analysis determined that EGDT did not improve patient outcome and increased hospitalization costs when compared with usual care, supporting previously announced findings from the ProCESS trial. In other words, good early bedside sepsis care with therapies matched to severity is key, not the use of a singular protocol.

Said Donald M. Yealy, faculty member and chair of the Department of Emergency Medicine and lead author of the previous ProCESS trial publication: “Randomized clinical trials are the gold standard of medicine, but are very difficult and expensive to perform, and are best when merged with data from other trials to get the best picture possible. However, merging such data is a challenge because often the information is not collected consistently across trials. We planned ahead, two years before these three big sepsis trials started, and created an approach allowing each trial to not only stand on its own, but also be able to contribute to a whole that is greater than the sum of its parts.”

Other Pitt authors were Amber E. Barnato, Elizabeth Gimbel, David T. Huang, John A. Kellum and Edvin Music.

This research was funded by the National Institute of General Medical Sciences, the Australian National Health and Medical Research Council, the Intensive Care Foundation, the Alfred Foundation and the U.K. health technology assessment programme of the National Institute for Health Research.

Pre-pregnancy nutrition guidelines not met

Vegetables and FruitBlack, Hispanic and less-educated women consume a less nutritious diet than their well-educated, white counterparts in the weeks leading up to their first pregnancy, according to a large-scale analysis of preconception adherence to national dietary guidelines.

The study, published in Journal of the Academy of Nutrition and Dietetics and led by Pitt’s public health school, also found that, while inequalities exist, none of the women in any racial and socioeconomic group evaluated achieved recommendations set forth by the dietary guidelines for Americans.

Healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, pre-eclampsia and maternal obesity.

Said lead author Lisa Bodnar, faculty member and vice chair of research in the Department of Epidemiology: “Unlike many other pregnancy and birth risk factors, diet is something we can improve. While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient.”

Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in “The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to- Be,” which followed women who enrolled in the study at one of eight U.S. medical centers. The women reported on their dietary habits during the three months around conception.

The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).

Nearly a quarter of the white women surveyed had scores that fell into the highest scoring fifth of those surveyed, compared with 14 percent of the Hispanic women and 4.6 percent of the black women. Almost half — 44 percent — of black mothers had a score in the lowest-scoring fifth.

The scores increased with greater education levels for all three racial/ethnic groups, but the increase was greatest among white women. At all levels of education — high school or less through graduate degree — black mothers had the lowest average scores.

When scores were broken down into the 12 aspects of diet, fewer than 10 percent of the women met the dietary guidelines for the whole grains, fatty acids, sodium or empty calories categories.

Approximately 34 percent of the calories — or energy — the women consumed were from empty calories. Top sources of energy were sugar-sweetened beverages, pasta dishes and grain desserts. Soda was the primary contributor to energy intake among black, Hispanic and less-educated women. Women with a college or graduate degree consumed more energy from beer, wine and spirits than any other source.

Juices and sugar-sweetened beverages combined for a much larger proportion of vitamin C intake than solid fruits or vegetables for black, Hispanic and less-educated women. The opposite was true for white women or more-educated women.

For all groups, green salad was the only vegetable in the top 10 sources of iron. Green salad and processed cereals were the top two sources of folate for all groups except black women, whose second highest folate source was 100 percent orange or grapefruit juice. Folate and iron are important nutrients for developing fetuses and healthy pregnancies.

“Our findings mirror national nutrition and dietary trends,” said Bodnar, also a faculty member in obstetrics, gynecology and reproductive sciences at the School of Medicine. “The diet quality gap among non-pregnant people is thought to be a consequence of many factors, including access to and price of healthy foods, knowledge of a healthy diet and pressing needs that may take priority over a healthy diet. Future research needs to determine if improving pre-pregnancy diet leads to better pregnancy and birth outcomes. If so, then we need to explore and test ways to improve the diets for everyone, particularly women likely to become pregnant.”

Hyagriv N. Simhan of Pitt was an additional author on this research. Also contributing were colleagues from RTI International, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Case Western Reserve University, Northwestern University, Indiana University, the University of California-Irvine, Christiana Care Health System, the University of Pennsylvania; the University of Utah; the University of Texas, Columbia University and Ohio State University.

Funding was provided by Pitt, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, RTI International, Case Western Reserve, Columbia, Indiana University, Northwestern, the University of California-Irvine, Penn and the University of Utah.

Grant to fight county infant mortality rates

The Richard King Mellon Foundation has given $5 million to Magee-Womens Research Institute and Foundation (MWRIF) for the study of Allegheny County’s infant mortality.

Between 2008 and 2012, 434 infants died in Allegheny County within their first year of life, ranking the county slightly worse than the national average, which is well below global averages for wealthy countries. Additionally, racial disparity in the infant mortality rate is 27 percent greater in Allegheny County than nationally.

Twenty percent of the grant will be dedicated to general research on pregnancy and fetal development, which affects infant mortality, and the remaining $4 million will be used to expand the Magee obstetrical maternal infant database, which has been collecting patient information from births at Magee since 1995. A biobank also will be created to document tissues and other pregnancy-related specimens.

Researchers from Magee-Womens Research Institute (MWRI) will use the expanded database and biobank to track risk factors for infant mortality, ultimately working to develop a predictive model for infant mortality prevention and clinical interventions.

Said Yoel Sadovsky, MWRI director, faculty member in obstetrics, gynecology and reproductive sciences in the School of Medicine and lead investigator on the infant mortality project: “Realizing that the most common conditions associated with infant mortality occur before birth, it is clear that a healthy pregnancy is key to prevention of an infant’s death or disease by a child’s first year of life.”

Pitt and RAND Corporation also received Richard King Mellon Foundation grants of $725,000 and $640,000 respectively. These funds will be used to create algorithms that predict or score infant mortality risk. After identifying those at risk, the new tool will enable physicians to connect patients with appropriate and effective interventions tailored to them.

Healthy lifestyle institute formed

Running feet of young woman closeup on shoeThe University has established an umbrella organization coordinating internal efforts to improve the health and wellness of society at large.

Said John M. Jakicic, founding director of the new Healthy Lifestyle Institute and chair of the School of Education’s Department of Health and Physical Activity: “The institute harnesses the collective efforts of top researchers, clinicians and thought leaders throughout the Pitt community. Bringing these thoughtful minds together under the same umbrella to collaborate and share ideas will potentially make a substantial impact on the well-being of our society.”

Housed within the school, the institute aims to integrate health-related research endeavors from Pitt centers, departments, laboratories and related divisions. University officials envision the institute becoming a leader in the development of behavioral modification interventions, a resource for understanding how lifestyle factors impact health and a model for how universities can communicate internally.

The institute will develop new approaches for modifying lifestyle behaviors that detract from overall health. It will examine how biological factors, such as genetics, influence lifestyle behaviors as well as how these factors impact chronic diseases and negative health outcomes. The institute also will innovate institutional outreach approaches and training measures for health care professionals.

Key to the success of the institute’s mission will be the implementation of new initiatives to enhance research capacity. These initiatives — centers and programs to be installed within various schools — will bring new technologies into Pitt laboratories, improve understanding of biological influences on human behavior and foster collaborative efforts between Pitt and the broader community. Additionally, the institute will forge collaborative pursuits with nonprofit organizations and public schools throughout southwestern Pennsylvania.

An advisory board appointed by the dean of the School of Education will guide the institute’s direction, while an executive committee composed of Pitt administrators will provide governance.

Access to infertility services lacking

New research from the School of Medicine shows that nearly 40 percent of reproductive-aged women in the United States — approximately 25 million — have limited or no nearby access to assisted reproductive technology (ART) clinics, which provide services that are vital to many women aiming to become pregnant. Results of the study were published in Fertility & Sterility.

While basic infertility evaluations and ovulation induction treatments can be performed by a woman’s obstetrician/gynecologist, advanced procedures such as in vitro fertilization are provided only by more specialized providers in ART clinics. Study authors John Harris and Marie Menke, faculty members in obstetrics, gynecology and reproductive sciences and Magee-Womens Hospital, together with co-authors from the University of Michigan, used federal data on infertility clinics and where women live to evaluate and assess women’s access to infertility care in the U.S.

Using data from the Centers for Disease Control and Prevention to locate 510 ART clinics in the United States and population data from the 2010 U.S. census, the research team determined that 18.2 million women 20-49 years old — about 29 percent of that population — live in metropolitan areas with no ART clinics. Another 6.8 million women — or nearly 11 percent of those 20-49 years old — live in areas with only a single ART clinic, and are without choice of a provider. The remaining 60 percent of the population, or 38.1 million women, live in census regions with multiple ART clinics, allowing them to seek ART services from a provider of their choice.

“Infertility is by itself a difficult issue for couples to face emotionally and financially,” said Harris. “Based on geography, many couples who are trying to start families may have only one clinic nearby where they seek these services, and many women with infertility do not have any nearby access to these services at all, adding additional anxiety during an already stressful time of life.”

The findings raise additional questions about access to ART services that warrant further consideration and research. It is not known how far patients would be willing to travel for these services, or if the U.S. census metropolitan areas used in the study accurately reflect where patients would consider seeking treatment. It also is not known how much time and money patients are willing to invest into reproductive services, and how these barriers interact with other demographic disparities, including race, socioeconomic status and age.

Investigative support for this study was provided by the National Institute of Child Health and Human Development, the Robert Wood Johnson Foundation and the Department of Veterans Affairs.

ACA component working without added cost

A key component of the Affordable Care Act saved Medicare $345 per person in medical costs in its first year without driving up prescription drug coverage costs, according to an analysis led by Pitt’s public health school.

Published in Medical Care, the study looks at how the Accountable Care Organization (ACO) model affected Medicare Part D prescription drug spending and use in 2012, the first year the ACO model was implemented in Medicare.

In an ACO, a group of providers is collectively accountable for overall costs and the quality of care for a defined group of patients. Providers’ payments are aligned with their performance in improving quality and reducing costs, giving them incentives to provide integrated and coordinated care and effective low-cost treatments to improve patient outcome.

Said lead author Yuting Zhang of health policy and management: “We found that Medicare beneficiaries with Part D prescription coverage with six or more chronic conditions who were aligned to an ACO had the highest savings on medical costs — $966 per patient in 2012, compared to their peers not assigned to an ACO. This is encouraging because it demonstrates that ACO providers may be prioritizing their focus on beneficiaries with multiple chronic conditions.”

Zhang and collaborators in the Centers for Medicare and Medicaid Services compared outcomes for 316,366 Medicare Part D beneficiaries aligned with an ACO in 2012 to a random sample of 559,241 similar Medicare beneficiaries not in an ACO during the same time period.

For each group, the research team looked at per person total annual Part D spending, total 30-day prescription drug counts, percent of brand name drugs and total annual Part A and Part B spending, including all non-drug claims.

Being in an ACO didn’t significantly affect patients’ Part D spending, total prescriptions filled or the percent of claims for brand name drugs. While it is possible that the effect of ACOs on Part D spending and use is highly limited to specific classes of drugs, teasing this apart was beyond the scope of the analysis.

“In the future, we’ll need to evaluate the effect of medication prescribing and adherence on clinical outcomes for patients in ACOs compared to their peers who are not in ACOs,” said Zhang. “For example, we could link changes in medication adherence for cardiovascular drugs with heart attacks to see if there is a clear difference in prescribing practices and patient outcomes.”

This research was funded by Commonwealth Fund.


—Compiled by Marty Levine

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