Northwestern University

About: Northwestern University is a education organization based out in Evanston, Illinois, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 75430 authors who have published 188857 publications receiving 9463252 citations. The organization is also known as: Northwestern & NU.

Development and Evaluation of the Universal ACS NSQIP Surgical Risk Calculator: A Decision Aid and Informed Consent Tool for Patients and Surgeons

Abstract: Background Accurately estimating surgical risks is critical for shared decision making and informed consent. The Centers for Medicare and Medicaid Services may soon put forth a measure requiring surgeons to provide patients with patient-specific, empirically derived estimates of postoperative complications. Our objectives were to develop a universal surgical risk estimation tool, to compare performance of the universal vs previous procedure-specific surgical risk calculators, and to allow surgeons to empirically adjust the estimates of risk. Study Design Using standardized clinical data from 393 ACS NSQIP hospitals, a web-based tool was developed to allow surgeons to easily enter 21 preoperative factors (demographics, comorbidities, procedure). Regression models were developed to predict 8 outcomes based on the preoperative risk factors. The universal model was compared with procedure-specific models. To incorporate surgeon input, a subjective surgeon adjustment score, allowing risk estimates to vary within the estimate's confidence interval, was introduced and tested with 80 surgeons using 10 case scenarios. Results Based on 1,414,006 patients encompassing 1,557 unique CPT codes, a universal surgical risk calculator model was developed that had excellent performance for mortality (c-statistic = 0.944; Brier score = 0.011 [where scores approaching 0 are better]), morbidity (c-statistic = 0.816, Brier score = 0.069), and 6 additional complications (c-statistics > 0.8). Predictions were similarly robust for the universal calculator vs procedure-specific calculators (eg, colorectal). Surgeons demonstrated considerable agreement on the case scenario scoring (80% to 100% agreement), suggesting reliable score assignment between surgeons. Conclusions The ACS NSQIP surgical risk calculator is a decision-support tool based on reliable multi-institutional clinical data, which can be used to estimate the risks of most operations. The ACS NSQIP surgical risk calculator will allow clinicians and patients to make decisions using empirically derived, patient-specific postoperative risks.

Facile Conjugation of Biomolecules onto Surfaces via Mussel Adhesive Protein Inspired Coatings

Abstract: Immobilization of biomolecules onto surfaces is important in many of the biological and physical sciences, including cell and molecular biology, analytical chemistry, and in applied and interdisciplinary fields such as medical diagnostics, tissue engineering, and bioprocess engineering.[1-4] Strategies for biomolecule immobilization onto surfaces generally exploit either noncovalent or covalent reactions. Noncovalent methods allow reversible immobilization of biomolecules under specific conditions, and include physical adsorption and affinity immobilization. Some widely adapted examples are (strep)avidin-biotin, nitriloacetic acid (NTA)-histidine, and DNA-DNA interactions.[5-8] In contrast, covalent immobilization of molecules onto surfaces typically relies on conjugation reactions between ‘active’ functional groups, such as N-hydroxysuccinimide (NHS)[9] or maleimide,[10] and companion target moieties, such as amines and sulfhydryls. For reactions involving biomolecules performed in aqueous solvents, susceptibility of NHS, maleimide, and other activating groups to hydrolysis during storage and reaction can lead to low efficiency of surface bioconjugation.[11,12] In this study, we report a facile two-step aqueous approach to immobilization of biomolecules onto surfaces. The approach involves simple dip-coating of a biomimetic polymer thin film onto a substrate, followed by conjugation of biomolecules to the biomimetic polymer film. The method exploits the latent reactivity of the biomimetic polymer thin film towards nucleophiles, is unaffected by water, and allows for discrimination between nucleophiles on the basis of pKa.

Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis

Abstract: BackgroundDupilumab, a human monoclonal antibody against interleukin-4 receptor alpha, inhibits signaling of interleukin-4 and interleukin-13, type 2 cytokines that may be important drivers of atopic or allergic diseases such as atopic dermatitis. MethodsIn two randomized, placebo-controlled, phase 3 trials of identical design (SOLO 1 and SOLO 2), we enrolled adults with moderate-to-severe atopic dermatitis whose disease was inadequately controlled by topical treatment. Patients were randomly assigned in a 1:1:1 ratio to receive, for 16 weeks, subcutaneous dupilumab (300 mg) or placebo weekly or the same dose of dupilumab every other week alternating with placebo. The primary outcome was the proportion of patients who had both a score of 0 or 1 (clear or almost clear) on the Investigator’s Global Assessment and a reduction of 2 points or more in that score from baseline at week 16. ResultsWe enrolled 671 patients in SOLO 1 and 708 in SOLO 2. In SOLO 1, the primary outcome occurred in 85 patients (38%) who...