Roy Sabo's research while affiliated with Virginia Commonwealth University and other places
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Publications (204)
Purpose
Cancer treatment nonadherence is associated with higher rates of cancer recurrence and decreased survival. Rural cancer patients experience a 10% higher mortality rate compared with their nonrural counterparts; geographic differences in nonadherence may contribute to this increased mortality. The goal of this study was to assess for geograp...
Reduced intensity conditioning (RIC) is fraught with risk for disease relapse. This may be overcome by donor T cell alloreactivity. Reducing the duration of intense immune suppression in the early term following transplantation may create an immunologic environment favoring rapid T cell reconstitution to influence longer term transplant outcomes. T...
p> Background: To exchange the type of subjective Bayesian prior selection for assumptions more directly related to statistical decision making in clinician studies and trials, the decreasingly informative prior (DIP) is considered. We expand standard Bayesian early termination methods in one-parameter statistical models for Phase II clinical trial...
Objectives:
Compare Virginia nursing homes in the top- and bottom-quintiles of antipsychotic use for variation in community, social, and facility factors.
Methods:
2018 CMS data ascertained Virginia nursing homes in the top and bottom quintiles for antipsychotic use. The Virginia Health Department provided social determinant of health (SDOH) sta...
This retrospective cohort analysis of claims data used logistic regression to evaluate change in antipsychotic and antiepileptic mood stabilizer prescription frequencies in Virginia nursing homes among residents with and without seizure-epilepsy between the years 2011 and 2016. Over that period, prescription of antipsychotics decreased 13.1% to 5.6...
Background:
Screening for food insecurity (FI) and providing nutrition care are important management strategies for chronic diseases, but rates are low. Aspects of team-based care and providers' nutrition competence may help inform interventions to improve these services. The objectives of this study were to describe US primary care providers' FI...
Context:
There were 50,000 U.S. opioid overdose deaths in 2019. Millions suffer from opioid addiction. Identifying protective factors for low community opioid mortality may have important implications for addressing the opioid epidemic. This study was funded through the Virginia (VA) Department of Medical Assistance Services (DMAS) through a SUPPO...
Background
Filipino Americans (FAs) are the third-largest Asian American subgroup in the United States (US). Some studies showed that FAs experience more cardiometabolic diseases (CMDs) than other Asian subgroups and non-Hispanic Whites. The increased prevalence of CMD observed in FAs could be due to genetics and social/dietary lifestyles. While FA...
Introduction:
Health behaviors, mental health, and social needs impact health, but addressing these needs is difficult. Clinicians can partner with community programs to provide patients support. The relationship between program location and community need is uncertain.
Methods:
We identified and geolocated community programs in Richmond, Virgin...
Background
Metagenomic next-generation sequencing of plasma cell-free DNA (Karius®) (plasma mcf-DNA-seq) is a noninvasive approach that may have a unique role for the diagnosis of infectious complications in immunocompromised patients. The rapid turn-around time and noninvasive nature makes this a promising supplement to standard of care.
Methods...
Introduction
Cytomegalovirus (CMV) is one of the most common and clinically significant viral infections following allogeneic hematopoietic cell transplantation (HCT). Currently available options for CMV prophylaxis and treatment present challenges related to side effects and cost.
Methods
In this retrospective medical record review, the incidence...
This study proposes transformation functions and matrices between coefficients in the original and reparameterized parameter spaces for an existing linear-linear piecewise model to derive the interpretable coefficients directly related to the underlying change pattern. Additionally, the study extends the existing model to allow individual measureme...
Background: Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic.
Method...
Background and objectives:
The American Academy of Pediatrics recommends against the routine use of β-agonists, corticosteroids, antibiotics, chest radiographs, and viral testing in bronchiolitis, but use of these modalities continues. Our objective for this study was to determine the patient, provider, and health care system characteristics that...
Our primary objectives are to empirically identify distinct childhood groups based on trajectories of waist circumference (WC) and waist circumference index measurements, and then to estimate associations between these groups and adult diabetes incidence, as well as other outcomes, including blood pressure, body size, body composition, and hemoglob...
While web-based surveys are a convenient research tool, the ease of dropping out in the online setting has become a growing issue in ensuring data quality. One theory is that dropout, or attrition, occurs in phases that can be generalized to phases of high dropout and phases of stable use. In order to detect these phases, survey dropout is consider...
Empirical researchers are usually interested in investigating the impacts that baseline covariates have when uncovering sample heterogeneity and separating samples into more homogeneous groups. However, a considerable number of studies in the structural equation modeling (SEM) framework usually start with vague hypotheses in terms of heterogeneity...
Introduction:
Clinical preventive services can reduce mortality and morbidity, but Americans receive only half of the recommended care. Although wellness visits protect time for clinicians to review needs and discuss care with patients, studies have not shown that having a wellness visit improves health outcomes. This study seeks to understand the...
Objective
To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption.
Design
A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting.
Setting
A 399-bed, tertiary-care, Veterans’ Affai...
Background
Patients with type 2 diabetes require recommendations for self-management education and support.
Objective
In this study, we aim to design the Diabetes Engagement and Activation Platform (DEAP)—an automated patient education tool integrated into primary care workflow—and examine its implementation and effectiveness.
Methods
We invited...
Sequential multiple assignment randomized trial (SMART) designs tailor individual treatment by re-randomizing participants to subsequent therapies based on their response to initial treatment. Misclassification of participant responses to initial treatment can lead to inappropriate treatment assignment and thus impact the final outcome. The aim of...
Introduction
As educators seek to improve medical student well‐being, it is essential to understand the interplay between distress and important outcomes. Performance on Step 1 of the United States Medical Licensing Examination has played a significant role in selection for postgraduate residency positions in the U.S., and consequently is a source...
Response‐adaptive (RA) allocation designs can skew the allocation of incoming subjects toward the better performing treatment group based on the previously accrued responses. While unstable estimators and increased variability can adversely affect adaptation in early trial stages, Bayesian methods can be implemented with decreasingly informative pr...
Introduction:
In December 2013, cholesterol treatment guidelines changed the approach to statin therapy by recommending fixed doses of low-, medium-, or high-intensity statins based on cardiovascular risk. We sought to evaluate the guideline's adoption in a diverse group of practices.
Methods:
Using a mixed-methods approach, we analyzed electron...
Background
Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow spectrum agents within a drug class. A multidisciplinary team developed CR algorithms for Gram-negative bacteria based on the local antibiogram and infectio...
UNSTRUCTURED
Aims: To help patients with type 2 diabetes receive recommended self-management education and support (DSMES), we designed the Diabetes Engagement and Activation Platform (DEAP) – an automated patient education tool integrated into primary care workflow – and examined its implementation and effectiveness. Methods: We invited patients a...
Objective
Prenatal care (PNC) and well child visit (WCV) attendance are associated with improved health outcomes. We aimed to determine if the factors affecting maternal and child attendance are similar or different.
Methods
We conducted a retrospective case control study at Virginia Commonwealth University Health System. We used the Adequacy of P...
Objective
Excluded from reporting to CMS's Percentage of long-stay residents who got an antipsychotic medication quality-measure are antipsychotics prescribed to nursing home patients with schizophrenia, Tourette's, or Huntington's. Over the 4 years following its 2012 debut, the quality-measure calculated a 27% reduction in inappropriate antipsycho...
Introduction: Indolent B-Cell Non-Hodgkin's Lymphomas (NHL) represent a heterogeneous group of lymphoproliferative malignancies, that remain largely incurable. Marginal zone lymphomas (MZL) are the second most common subtype of indolent NHL, and lack a unique cytogenetic identifying abnormality. The B-cell receptor signaling pathway is activated in...
The standard of care for patients with newly diagnosed multiple myeloma who are transplant eligible is induction therapy followed by conditioning with high dose melphalan and autologous hematopoietic cell transplant (HCT). While the value of a single HCT (S-HCT) is established in standard-risk myeloma (SRM), there is controversy about whether tande...
Intravenous (IV) ascorbic acid (AA) improves organ function and reduces inflammation in sepsis, an inflammatory state similar to the post-hematopoietic cell transplant (HCT) milieu. This salutary effect is mediated by antioxidant activity as well transcriptional modulation by AA. HCT recipients are deficient in AA, therefore we evaluated the safety...
Scientists in biomedical and psychosocial research need to deal with skewed data all the time. In the case of comparing means from two groups, the log transformation is commonly used as a traditional technique to normalize skewed data before utilizing the two-group t-test. An alternative method that does not assume normality is the generalized line...
Background:
Previous research demonstrated that registries are effective for improving clinical guideline adherence for the care of patients with type 2 diabetes. However, registry implementation has typically relied on intensive support (such as practice facilitators) for practice change and care improvement.
Objective:
To determine whether a r...
Introduction:
Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences s...
Random allocation models used in clinical trials aid researchers in determining which of a particular treatment provides the best results by reducing bias between groups. Often however, this determination leaves researchers battling ethical issues of providing patients with unfavorable treatments. Many methods such as Play the Winner and Randomized...
Objectives
Lung cancer remains the leading cause of cancer-related deaths in the United States. In 2013, the US Preventive Services Task Force recommended annual screening for lung cancer with low-dose computed tomography in adults meeting certain criteria. This study seeks to assess lung cancer screening uptake in three health systems.
Setting
Th...
Background:
Many patients with poorly controlled multiple chronic conditions (MCC) also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management of MCC may have limited benefit if patients are struggling to address their basic life needs. Health systems and communities increasingly recognize the need to addres...
Introduction: Indolent B-cell non-Hodgkin’s lymphomas (NHL) represent a heterogeneous group of lymphoproliferative malignancies that remain largely incurable. Marginal zone lymphomas (MZL) are the second most common subtype of indolent NHL and lack a unique cytogenetic identifying abnormality. The B-cell receptor signaling pathway is activated in B...
Background:
Unhealthy alcohol use is the third leading cause of preventable death in the United States. Evidence demonstrates that screening for unhealthy alcohol use and providing persons engaged in risky drinking with brief behavioral and counseling interventions improves health outcomes, collectively termed screening and brief interventions. Me...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has a variable clinical presentation that ranges from asymptomatic, to severe disease with cytokine storm. The mortality rates also differ across the globe, ranging from 0.5-13%. This variation is likely due to both pathogen and host factors. Host factors may include genetic differences i...
Killer immunoglobulin-like receptor (KIR) and KIR-ligand (KIRL) interactions play an important role in natural killer (NK) cell mediated graft versus leukemia (GVL) effect following hematopoietic cell transplantation (HCT). However, there is considerable heterogeneity in the KIR gene and KIRL content in individuals, making it difficult to estimate...
Intravenous (IV) ascorbic acid (AA) improves organ function and reduces inflammation in sepsis, an inflammatory state similar to post-hematopoietic cell transplant (HCT) milieu. This salutary effect is mediated by antioxidant activity as well transcriptional modulation by AA. We evaluated the safety and efficacy of IV AA in ameliorating the inflamm...
Introduction
Current guidelines recommend monitoring and preemptive therapy for cytomegalovirus (CMV) reactivation in patients receiving allogeneic hematopoietic cell transplantation (HCT). Treatment options are limited by side effects such as myelosuppression and renal toxicity. Effective CMV prophylaxis may avoid these complications. At our insti...
The medical school admissions process seeks to assess a core set of cognitive and non-cognitive competencies that reflect professional readiness and institutional mission alignment. The standardized format of multiple mini-interviews (MMIs) can enhance assessments, and thus many medical schools have switched to this for candidate interviews. Howeve...
The linear spline growth model (LSGM) is a popular tool for examining nonlinear change patterns over time. It approximates complex patterns by attaching at least two linear trajectories. Besides examining within-person changes and between-person differences of trajectories simultaneously, it poses interesting statistical challenges, such as estimat...
The linear spline growth mixture model (LSGMM), which extends the linear spline growth model (LSGM) to the growth mixture model framework, is an appropriate tool for analyzing longitudinal data sets that come from a mixture of at least two latent classes and the underlying growth trajectories within each class are nonlinear. For each latent class,...
Background
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia, and remains largely incurable with current therapies. The anti-apoptotic protein Bcl-2 is overexpressed in CLL patients, where it mediates survival and resistance to chemotherapy and targeted therapies. Venetoclax is the first-in-class BH3 mimetic to specifical...
Background and objectives:
Specialized medical school educational tracks aim to increase the primary care workforce. The International/Inner-City/Rural Preceptorship (I2CRP) Program is unique in addressing multiple communities, a large cohort and applying the Self Determination Theory framework. This study examined program impact by analyzing the...
Killer immunoglobulin-like receptor (KIR) and KIR-ligand (KIRL) interactions play an important role in natural killer (NK) cell mediated graft versus leukemia effect following hematopoietic cell transplantation (HCT). However, there is considerable heterogeneity in the KIR gene and KIRL content in individuals, making it difficult to estimate the fu...
Background:
Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS.
Methods:
We conducted a cross-sectional state-level ecologic study using 36 states w...
Background
Residency programs and the Accreditation Council for Graduate Medical Education (ACGME) use survey data for the purpose of program evaluation. A priority for many programs is to improve resident wellness, often relying on self-reported surveys to drive interventions.
Objective
We tested for result differences on wellness surveys collect...
Background:
Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns.
Objective:
This study proposed the application of and assess...
Background
Though there is thorough examination of psychosocial issues in SCT, there are few longitudinal studies examining the meaning SCT patients attribute to their treatment.
Objective
The object of this study was to examine change in situational appraisal over time, and to explore potential modifiers of that change.
Methods
A prospective, lo...
Introduction: Indolent B-Cell Non-Hodgkin’s Lymphoma (i-NHL) represents a heterogeneous group of lymphoproliferative malignancies, encompassing 40% of NHL, that remains largely incurable. The B-cell receptor signaling pathway is activated in B-cell malignancy and mediates its activity mainly through the Phosphoinositide 3-kinase (PI3K) pathway. Fur...
A doubly-inflated Poisson distribution is presented to account for count inflation at some positive integer value k in addition to that seen at zero. Maximum likelihood and moment estimators are derived, and their performances are compared using asymptotic relative efficiencies. The doubly-inflated Poisson distribution is also incorporated into the...
Killer immunoglobulin-like receptor (KIR) and KIR-ligand (KIRL) interactions play an important role in natural killer (NK) cell mediated graft versus leukemia effect following hematopoietic cell transplantation (HCT). However, there is considerable heterogeneity in the KIR gene and KIRL content in individuals, making it difficult to estimate the fu...
Introduction:
We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making...
A novel antimicrobial consumption metric designed to identify the proportion of carbapenem consumption (PoCC) among broad-spectrum antipseudomonal antimicrobials has been shown to vary significantly by US Census Bureau region. This retrospective surveillance study identified significant total PoCC variability (27%; P = .001) across 8 inpatient unit...
Background:
Primary care clinicians write 45% of all opioid prescriptions in the United States, but little is known about the characteristics of patients who receive them and the clinicians who prescribe opioids in primary care settings. Our study aimed to describe the patient and clinician characteristics and clinicians' perspectives of chronic o...
Objectives:
To investigate the relationship between barometric pressure and the incidence of benign paroxysmal positional vertigo (BPPV).
Methods:
181 patients diagnosed with classic BPPV seen between 2011 and 2016 were identified. Demographic information, data of onset, and date of presentation were recorded. Historical barometric data for each...
Stem cell transplant, meaning making, coping, adjustment; situational attribution, illness representations. Longitudinal; prospective.
Loneliness is associated with poor health outcomes, and there is growing attention on loneliness as a social determinant of health. Our study sought to determine the associations between community factors and loneliness. The Three-Item Loneliness Scale and zip codes of residence were collected in primary care practices in Colorado and Virginia. Liv...
Purpose:
Loneliness has important health consequences. Little is known, however, about loneliness in primary care patient populations. This study describes the prevalence of loneliness in patients presenting for primary care and associations with self-reported demographic factors, health care utilization, and health-related quality of life.
Metho...
