Publications by authors named "Michael Ulrich"

29 Publications

  • Page 1 of 1

Does teaching Optimism lower Burnout in residency training- a pilot study.

J Community Hosp Intern Med Perspect 2021 Jun 21;11(4):429-432. Epub 2021 Jun 21.

Director Medical Research.

: Residents frequently experience burnout. Multiple interventions to decrease the risk of burnout have had inconsistent results. In non-medical settings, improving optimism promotes a positive outlook and enhances well-being. Thus, psychological interventions that improve optimism could have potential to decrease the risk for burnout. : Using Lazarus' Ways of Coping as an organizational framework, this intervention sought to evaluate the impact of an optimism curriculum on residents' burnout. : Thirty-six Internal Medicine residents participated in an optimism improvement program from November 2019 to April 2020. We determined pre- and post-curriculum measures of optimism, happiness, and burnout with validated surveys. The Optimism Curriculum was comprised of three one-hour long sessions, which included lectures, group and self-reflective exercises. A post - curriculum evaluation rating the effectiveness of the program was administered separately. : Thirty-four out of thirty-six residents completed the post curricular surveys. Individuals with low optimism scores had a higher score for burnout compared to those with higher optimism scores. The post-intervention survey showed numerical improvement in optimism, happiness and burnout, although these changes were not statistically significant. The post-intervention survey showed a decrease in the measure of burnout; however, this was not significant (p = 0.24) with an effect size of 0.34 (Cohen's d). : Teaching optimism to residents with the objective of decreasing the risk of burnout is feasible and easily integrated into residency education sessions. The encouraging results of this pilot study lay the foundation for additional studies and suggest a practical role for implementing optimism curricula in residency training programs.
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http://dx.doi.org/10.1080/20009666.2021.1910408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221164PMC
June 2021

All Signs Point to Cancer: A Case of Cryptic Miliary Tuberculosis in the Setting of Concomitant Cancer.

Case Rep Infect Dis 2021 4;2021:4623086. Epub 2021 Jun 4.

Loma Linda University Medical Center, Department of Medicine, 1234 Anderson Street Rm. 1503 Loma Linda, Loma Linda 92354, CA, USA.

Dissemination of tuberculosis (TB) is known as miliary tuberculosis. When miliary tuberculosis lacks classic radiographic and clinical features, it can be labeled cryptic miliary tuberculosis and may mimic metastatic cancer. This unusual presentation of an already atypical form of TB often delays diagnosis. We present a case of a 58-year-old female who presented with presumed metastatic carcinoma, who was ultimately diagnosed with both primary breast cancer and disseminated TB. This case emphasizes the need for a high index of suspicion for miliary tuberculosis in patients with presumed or proven malignancy.
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http://dx.doi.org/10.1155/2021/4623086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195647PMC
June 2021

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel against Echinococcus multilocularis infections in cats.

Parasite 2021 2;28:29. Epub 2021 Apr 2.

Boehringer-Ingelheim Animal Health, 29 Avenue Tony Garnier, 69007 Lyon, France.

NexGard Combo, a novel topical endectoparasiticide formulation for cats combining esafoxolaner, eprinomectin and praziquantel, for the treatment of internal and external parasite infestations, including arthropods, nematodes and cestodes, was tested for efficacy against induced infections of Echinococcus multilocularis in cats, in two experimental studies. The two studies were performed in the United States with the same E. multilocularis isolate sourced locally. In each study, 20 cats were inoculated intra-gastrically with ~30,000 E. multilocularis protoscoleces three weeks before treatment, then ten cats were randomly allocated to a placebo control group or to the novel formulation treated group. Inoculated cats were treated topically once at the minimum recommended dose of the novel formulation, or with an identical volume of placebo. One week after treatment, cats were humanely euthanized for parasite recovery and count. The efficacy calculation was based on comparison of number of scoleces found in the control group and the novel formulation group. In the two control groups, E. multilocularis scoleces were found in five (range: 30-1025) and eight (range 2-345) cats, the geometric means inclusive of the ten cats per group were 8.9 and 28.8, respectively. In the two novel formulation-treated groups, none of the cats harbored any E. multilocularis scoleces, demonstrating 100% efficacy.
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http://dx.doi.org/10.1051/parasite/2021025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019559PMC
April 2021

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel against ear mite (Otodectes cynotis) infestations in cats.

Parasite 2021 2;28:26. Epub 2021 Apr 2.

Boehringer-Ingelheim Vetmedica GmbH, Kathrinenhof Research Center, Walchenseestr. 8-12, 83101 Rohrdorf, Germany.

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel, nematodicidal and cestodicidal compounds, in NexGard Combo, a novel topical endectoparasiticide formulation for cats. The efficacy of this formulation was assessed against Otodectes cynotis in two laboratory studies conducted in South Africa and in the USA with local isolates, and in one field trial conducted in Europe. In each study, cats were randomly allocated to a placebo-treated control group and a novel formulation-treated group. In the laboratory studies, cats were treated at the minimum recommended dose; in the field trial, cats were treated at label dose. All included cats were diagnosed positive for O. cynotis prior to treatment by otoscopy. The main variable of efficacy was a comparison of the number of live O. cynotis collected in both ear canals of all cats in the treated and control groups, one month after treatment. Efficacy of the novel topical formulation exceeded 97% in the three studies. These studies demonstrated the high effectiveness of NexGard Combo in cats for the treatment of O. cynotis infestations. No health abnormalities were attributed to the treatment in any of the studies.
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http://dx.doi.org/10.1051/parasite/2021022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019571PMC
April 2021

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel against ear mite (Otodectes cynotis) infestations in cats.

Parasite 2021 2;28:26. Epub 2021 Apr 2.

Boehringer-Ingelheim Vetmedica GmbH, Kathrinenhof Research Center, Walchenseestr. 8-12, 83101 Rohrdorf, Germany.

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel, nematodicidal and cestodicidal compounds, in NexGard Combo, a novel topical endectoparasiticide formulation for cats. The efficacy of this formulation was assessed against Otodectes cynotis in two laboratory studies conducted in South Africa and in the USA with local isolates, and in one field trial conducted in Europe. In each study, cats were randomly allocated to a placebo-treated control group and a novel formulation-treated group. In the laboratory studies, cats were treated at the minimum recommended dose; in the field trial, cats were treated at label dose. All included cats were diagnosed positive for O. cynotis prior to treatment by otoscopy. The main variable of efficacy was a comparison of the number of live O. cynotis collected in both ear canals of all cats in the treated and control groups, one month after treatment. Efficacy of the novel topical formulation exceeded 97% in the three studies. These studies demonstrated the high effectiveness of NexGard Combo in cats for the treatment of O. cynotis infestations. No health abnormalities were attributed to the treatment in any of the studies.
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http://dx.doi.org/10.1051/parasite/2021022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019571PMC
April 2021

Investigating the Effect of Perioperative Chlorzoxazone on Acute Postoperative Pain After Total Hip and Knee Replacement Surgery.

Clin J Pain 2020 05;36(5):352-358

Department of Clinical Medicine, Aalborg University.

Background And Aims: Severe preoperative and acute postoperative pain have been associated with the development of chronic postoperative pain. Chlorzoxazone (a muscle relaxant) has been suggested to enhance acute postoperative pain recovery, but the lack of larger randomized controlled trials has, however, questioned the continued use. Despite this, chlorzoxazone is still used for acute postoperative pain management following total knee replacement (TKR) or total hip replacement (THR). The current randomized, double-blinded, placebo-controlled, parallel-group, clinical trial aimed to assess the effect of chlorzoxazone for postoperative pain management following TKR or THR.

Methods: A total of 393 patients scheduled for TKR or THR were included in the trial. Patients were assigned to 250 mg chlorzoxazone 3 times daily for the first 7 days postoperatively or to placebo. The primary outcome was pain after 5 m walk assessed 24 hours postoperatively. Secondary outcomes included changes in preoperative pain at rest, worst pain in the last 24 hours, and Oxford Knee or Hip Score compared with 12 months' follow-up. In addition, adverse events were assessed in the perioperative period.

Results: No significant differences were found for any of the outcome parameters after TKR or THR. As regards TKR or THR, no effects were demonstrated for pain after 5 m walk 24 hours after surgery (P>0.313), or for any of the secondary outcomes (P>0.288) or adverse events (P>0.112) in the group receiving chlorzoxazone compared with placebo.

Conclusion: The current study demonstrated no analgesic effects of postoperative chlorzoxazone administration compared with placebo on acute or chronic postoperative pain 12 months following TKR and THR.
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http://dx.doi.org/10.1097/AJP.0000000000000805DOI Listing
May 2020

Revisionist History? Responding to Gun Violence Under Historical Limitations.

Authors:
Michael R Ulrich

Am J Law Med 2019 May;45(2-3):188-201

Juris Doctor from the University of Maryland Francis King Carey School of Law, Masters of Public Health from Harvard T. H. Chan School of Public Health.

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http://dx.doi.org/10.1177/0098858819860608DOI Listing
May 2019

Laboratory and field studies to investigate the efficacy of a novel, orally administered combination product containing moxidectin, sarolaner and pyrantel for the prevention of heartworm disease (Dirofilaria immitis) in dogs.

Parasit Vectors 2019 Sep 11;12(1):445. Epub 2019 Sep 11.

Veterinary Medicine Research and Development, Zoetis, Inc., 333 Portage St, Kalamazoo, MI, 49007, USA.

Background: Dirofilaria immitis is a filarial parasite of dogs that can cause serious or fatal cardiopulmonary disease. Three studies were conducted to evaluate the efficacy and safety of monthly treatment with moxidectin in a chewable tablet product in combination with sarolaner and pyrantel to prevent heartworm disease in dogs after experimental challenge and in a clinical field study in the USA.

Methods: In two laboratory studies, dogs (8 per group) that had been inoculated 30 days prior with 50 third-stage D. immitis larvae were randomized to treatment on Day 0 with placebo or combination product, at the minimum dose of 24 µg/kg moxidectin, 2 mg/kg sarolaner and 5 mg/kg pyrantel (as pamoate salt). Study 2 also included groups treated with tablets containing moxidectin-alone (24 µg/kg) or sarolaner-alone (2 mg/kg). Efficacy was evaluated ~ 5 months after inoculation by adult heartworm counts at necropsy. In the field study, 410 dogs ≥ 8 weeks-old from 23 USA veterinary clinics were treated for 11 months with either combination product at 24-48 µg/kg moxidectin, 2-4 mg/kg sarolaner and 5-10 mg/kg pyrantel (n = 272) or Heartgard® Plus (ivermectin/pyrantel) at the label recommended dose rate (n = 138). Efficacy was evaluated on Day 330 using antigen and microfilaria testing to assess adult heartworm infection.

Results: In the laboratory studies, there were no heartworms recovered from any dog treated with the combination product or moxidectin alone and all dogs treated with placebo or sarolaner-alone were infected with 20-44 adult heartworms. In the field study, all dogs treated with the combination product tested negative for heartworm infection on Day 330, whereas two dogs treated with Heartgard® Plus tested positive. The Heartgard® Plus-treated dogs that tested heartworm positive were from the lower Mississippi River Valley region, where heartworm resistance has been confirmed to occur. The combination product was well tolerated in all studies.

Conclusions: In laboratory studies, no heartworms were recovered from dogs treated with a single dose of the novel combination product containing moxidectin, sarolaner and pyrantel. Additionally, in the field study no dog tested positive for adult heartworm infection when dosed with the combination product monthly for 11 months, while two dogs treated with Heartgard® Plus tested positive.
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http://dx.doi.org/10.1186/s13071-019-3702-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737634PMC
September 2019

A Public Health Approach to Gun Violence, Legally Speaking.

Authors:
Michael R Ulrich

J Law Med Ethics 2019 06;47(2_suppl):112-115

Michael R. Ulrich, J.D., M.P.H., is an Assistant Professor of Health Law, Ethics, & Human Rights at the Boston University School of Public Health. His scholarship focuses on the intersection between public health, constitutional law, bioethics, and social justice, with an emphasis on the role of law in the health outcomes of vulnerable and underserved populations.

The call for a public health approach to gun violence has largely ignored what role the nascent Second Amendment jurisprudence will play in hindering change. Given the state interest for infringing on Second Amendment rights is nearly always public safety, public health law doctrine provides an apt framework for analysis.
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http://dx.doi.org/10.1177/1073110519857332DOI Listing
June 2019

Pregnant Women and Equitable Access to Emergency Medical Care.

Authors:
Michael R Ulrich

Am J Bioeth 2018 07;18(7):57-59

a Boston University.

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http://dx.doi.org/10.1080/15265161.2018.1478034DOI Listing
July 2018

Quarantine and the Federal Role in Epidemics.

SMU Law Rev 2018;71(2):391-444

Boston University School of Law.

Every recent presidential administration has faced an infectious disease threat, and this trend is certain to continue. The states have primary responsibility for protecting the public's health under their police powers, but modern travel makes diseases almost impossible to contain intrastate. How should the federal government respond in the future? The Ebola scare in the U.S. repeated a typical response--demands for quarantine. In January 2017, the Department of Health and Human Services and the Centers for Disease Control and Prevention issued final regulations on its authority to issue Federal Quarantine Orders. These regulations rely heavily on confining persons who may or may not be ill, raising serious questions about federal commitment to due process protections as well as the scope of statutory authority to impose quarantine. As the Supreme Court has stated in United States v. Salerno, "liberty is the norm, and detention prior to trial or without trial is the carefully limited exception." Unconstrained use of quarantines undermines both the rule of law and public confidence in government decisions in times of crisis. This article analyzes the regulations and argues for a rights-based approach to infectious disease control that also protects public health. By respecting constitutional rights, the federal government can encourage public trust and cooperation and minimize harm, both essential requirements for controlling an epidemic.
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September 2018

Recurrent CSF Rhinorrhea Misdiagnosed as Chronic Allergic Rhinitis with Subsequent Development of Bacterial Meningitis.

Case Rep Med 2017 26;2017:9012579. Epub 2017 Jul 26.

Infectious Diseases Section, Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, CA, USA.

Introduction: Cerebrospinal fluid (CSF) rhinorrhea results from an abnormal communication of the dura mater to the nasal mucosa. The majority of cases of CSF rhinorrhea are the result of trauma or surgery involving the skull base. Spontaneous CSF rhinorrhea is a rare clinical entity with increased risk of ascending infection. Delay in diagnosis places the patient at risk of developing meningitis.

Case Presentation: A 36-year-old African American female with significant medical history of obesity and hypertension presented to the emergency department with headache, altered level of consciousness, fever, and neck stiffness. Previously, the patient was diagnosed with chronic allergic sinusitis by multiple providers. Physical exam findings and laboratory tests were consistent with bacterial meningitis. The patient was admitted and started on appropriate antibiotic therapy. The patient continued to complain of persistent unilateral clear nasal drainage. The initial report from the computerized tomography scan of the sinuses indicated findings consistent with chronic sinusitis. Magnetic resonance imaging of the orbits revealed findings consistent with CSF rhinorrhea. Otolaryngology was consulted for surgical intervention.

Conclusion: Suspected CSF rhinorrhea should prompt immediate biochemical and radiologic evaluation and surgical consultation. CSF rhinorrhea places patients at risk of developing bacterial meningitis.
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http://dx.doi.org/10.1155/2017/9012579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5551538PMC
July 2017

Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care.

AMA J Ethics 2017 May 1;19(5):475-485. Epub 2017 May 1.

Chief of the behavioral sciences service in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center and a professor of psychology in the Department of Healthcare Policy and Research at Weill Cornell Medical College, both in New York City.

Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns. We also contend that health care professionals have an ethical responsibility to try to mitigate stigmatizing messages of public health campaigns with empathic patient-clinician communication during clinical encounters.
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http://dx.doi.org/10.1001/journalofethics.2017.19.5.msoc1-1705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679230PMC
May 2017

Guardianship and Clinical Research Participation: The Case of Wards with Disorders of Consciousness.

Kennedy Inst Ethics J 2017;27(1):43-70

We review relevant federal law about research on human subjects and state laws on guardian authority to determine whether guardians can consent on behalf of their wards to participation in research. The Common Rule is silent on the issue as are most state guardianship laws. Our analysis shows significant variation in guardians' decision-making authority in the states that do regulate wards' participation in research.We consider how the appointment of guardians for patients with disorders of consciousness (DOC) impacts such patients' access to research. We assert that it is important that such persons be permitted to participate in research, so that their conditions and potential medical interventions can be studied, and that those with similar conditions can benefit from the knowledge gained from these studies. We argue that state guardianship laws should be adapted to specifically give guardians the authority to consent to research on behalf of wards who may be able to regain decisional capacity.
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http://dx.doi.org/10.1353/ken.2017.0003DOI Listing
August 2017

Efficacy of oral afoxolaner plus milbemycin oxime chewables against induced gastrointestinal nematode infections in dogs.

Vet Parasitol 2016 Jul 3;225:117-22. Epub 2016 Jun 3.

Merial, Inc., 3239 Satellite Blvd., Duluth, GA 30096, USA. Electronic address:

The efficacy of oral afoxolaner plus milbemycin oxime combination chewables against induced gastrointestinal nematode infections in dogs was evaluated in six separate studies. Two studies were performed to evaluate the efficacy of the product against Toxocara canis, two studies evaluated the efficacy against Toxascaris leonina, one study evaluated the efficacy against Ancylostoma braziliense, and one study evaluated the efficacy against Ancylostoma caninum. In the A. caninum study, the efficacy of milbemycin oxime alone and afoxolaner alone was also evaluated. Dogs in all studies were inoculated with infective eggs or larvae and confirmed to have patent infections based on a fecal examination prior to allocation to study group and treatment. Each study utilized a randomized block design with blocks based on pre-treatment body weight. All dogs were assigned to blocks based on body weight, and then each dog within a block was randomly assigned to treatment group. There were two groups of 10 dogs each in the T. canis, T. leonina, and A. braziliense studies: 1) an untreated (control) group and 2) a group treated with afoxolaner plus milbemycin oxime chewables (NexGard Spectra(®), Merial). This group was treated at a dose as close as possible to the minimum effective dose of afoxolaner and milbemycin oxime (2.5mg+0.5mg per kg body weight, respectively) once on Day 0 using whole chews. There were four groups of 10 dogs each in the A. caninum study: 1) untreated (control), 2) NexGard Spectra(®) as described above, 3) milbemycin oxime alone (dose of at least 0.5mg per kg of body weight) and 4) afoxalaner alone (dose of at least 2.5mg per kg body weight). For parasite recovery and counts, dogs were euthanized humanely and necropsied seven days after treatment. The efficacy of the afoxolaner plus milbemycin oxime combination was ≥98% against T. canis, ≥95.8% against T. leonina, and 90.2% against A. braziliense. Efficacy of the combination against A. caninum was 99.7%, while the efficacy of milbemycin oxime alone was 99.6% and the efficacy of afoxolaner alone was 2.1%. Dogs treated with afoxolaner plus milbemycin oxime chewables had significantly (p≤0.0002) fewer nematodes than the untreated controls in all studies. There were no adverse events or other health problems that were related to treatment with Nexgard Spectra(®) in these studies. The results of these controlled studies demonstrate the high efficacy of the afoxolaner plus milbemycin oxime chewables against a broad range of canine intestinal nematode infections.
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http://dx.doi.org/10.1016/j.vetpar.2016.06.003DOI Listing
July 2016

Whither the "Improvement Standard"? Coverage for Severe Brain Injury after Jimmo v. Sebelius.

J Law Med Ethics 2016 03;44(1):182-93

Joseph J. Fins, M.D., M.A.C.P., is The E. William Davis, Jr. M.D. Professor of Medical Ethics and Chief of the Division of Medical Ethics at Weill Cornell Medical College where he is a Tenured Professor of Medicine, Professor of Medical Ethics in Neurology, Professor of Health Care Policy and Research, and Professor of Medicine in Psychiatry. He Co-Directs, the Consortium for the Advanced Study of Brain Injury (CASBI) at Weill Cornell and Rockefeller University, is a Senior Research Scholar in Law at the Yale Law School, an elected Member of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Academy of Arts and Sciences and an Academico de Honor (Honored Academic) of the Real Academia Nacional de Medicina de Espana (the Royal Academy of Medicine of Spain). He received his B.A. with Honors from Wesleyan University (Middletown, CT) and M.D. from Cornell University (New York, NY). Megan S. Wright, Ph.D., is a J.D. candidate (2016) at Yale Law School (New Haven, CT). She earned a Ph.D. in Sociology from the University of Arizona (Tucson, Arizona). Claudia Kraft is a third-year law student at Yale Law School (New Haven, CT). She received a B.A. in Human Biology from the University of Virginia (Charlottesville, VA). Alix Rogers, M.Phil., is concurrently pursuing a J.D. at Yale Law School (New Haven, CT), and a Ph.D. in the History and Philosophy of Science at the University of Cambridge (Cambridge, United Kingdom). She holds a M.Phil from the University of Cambridge (Cambridge, United Kingdom), and a B.A. from the University of Pennsylvania (Philadelphia, PA). Marina Romani is a J.D Candidate (2016) at Yale Law School (New Haven, CT). She received a B.S. in Biology from Dartmouth College (Hanover, NH). Samantha Godwin, J.D., is a Ph.D candidate and Gates Cambridge Scholar at Cambridge University and an LL.M student at Yale Law School. She received her B.A. and MA from University College London department of philosophy and her J.D. from

As improvements in neuroscience have enabled a better understanding of disorders of consciousness as well as methods to treat them, a hurdle that has become all too prevalent is the denial of coverage for treatment and rehabilitation services. In 2011, a settlement emerged from a Vermont District Court case, Jimmo v. Sebelius, which was brought to stop the use of an "improvement standard" that required tangible progress over an identifiable period of time for Medicare coverage of services. While the use of this standard can have deleterious effects on those with many chronic conditions, it is especially burdensome for those in the minimally conscious state (MCS), where improvements are unpredictable and often not manifested through repeatable overt behaviors. Though the focus of this paper is on the challenges of brain injury and the minimally conscious state, which an estimated 100,000 to 200,000 individuals suffer from in the United States, the post-Jimmo arguments presented can and should have a broad impact as envisioned by the plaintiffs who brought the case on behalf of multiple advocacy groups representing patients with a range of chronic care conditions.
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http://dx.doi.org/10.1177/1073110516644209DOI Listing
March 2016

Law and Politics, an Emerging Epidemic: A Call for Evidence-Based Public Health Law.

Authors:
Michael R Ulrich

Am J Law Med 2016 05;42(2-3):256-283

Research Scholar, Senior Fellow in Health Law, & Lecturer in Law, Yale Law School. J.D. 2011, University of Maryland Francis King Carey School of Law; M.P.H. 2013, Harvard T.H. Chan School of Public Health.

As Jacobson v. Massachusetts recognized in 1905, the basis of public health law, and its ability to limit constitutional rights, is the use of scientific data and empirical evidence. Far too often, this important fact is lost. Fear, misinformation, and politics frequently take center stage and drive the implementation of public health law. In the recent Ebola scare, political leaders passed unnecessary and unconstitutional quarantine measures that defied scientific understanding of the disease and caused many to have their rights needlessly constrained. Looking at HIV criminalization and exemptions to childhood vaccine requirements, it becomes clear that the blame cannot be placed on the hysteria that accompanies emergencies. Indeed, these examples merely illustrate an unfortunate array of examples where empirical evidence is ignored in the hopes of quelling paranoia. These policy approaches are not only constitutionally questionable, they generate their own risk to public health. The ability of the law to jeopardize public health approaches to infectious disease control can, and should, be limited through a renewed emphasis on science as the foundation of public health, coordination through all levels and branches of government, and through a serious commitment by the judiciary to provide oversight. Infectious disease creates public anxiety, but this cannot justify unwarranted dogmatic approaches as a response. If we as a society hope to ensure efficient, constitutional control over the spread of disease, it is imperative that science take its rightful place at the forefront of governmental decision-making and judicial review. Otherwise, the law becomes its own public health threat.
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http://dx.doi.org/10.1177/0098858816658270DOI Listing
May 2016

Health affairs blog post: challenges for people with disabilities within the health care safety net.

Authors:
Michael R Ulrich

Yale J Health Policy Law Ethics 2015 ;15(1):247-50

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May 2015

[Metal-on-metal hip arthroplasty].

Ugeskr Laeger 2014 ;176(34)

Ortopædkirurgisk Afdeling, Aalborg Universitetshospital, Hobrovej 18-22, 9100 Aalborg.

In Denmark 4,456 metal-on-metal (MoM) hip prostheses have been implanted. Evidence demonstrates that some patients develope adverse biological reactions causing failures of MoM hip arthroplasty. Some reactions might be systemic. Failure rates are associated with the type and the design of the MoM hip implant. A Danish surveillance programme has been initiated addressing these problems.
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July 2016

Guidance from vaccination jurisprudence.

Authors:
Michael R Ulrich

Am J Bioeth 2013 ;13(9):40-2

Harvard School of Public Health, Boston, MA 02115, USA.

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http://dx.doi.org/10.1080/15265161.2013.813608DOI Listing
November 2013

The gait pattern is not impaired in subjects with external snapping hip: a comparative cross-sectional study.

BMC Musculoskelet Disord 2013 Jul 19;14:212. Epub 2013 Jul 19.

Background: Symptomatic external snapping hip is a painful condition, where pain in the trochantor region and limitations of daily activity dominate clinical findings. The aetiology of symptomatic external snapping hip is elusive, but previous studies have suggested that weakness of the hip abductors and an altered walking pattern may play a role in the development of symptomatic external snapping hip. The aim of this study was to compare the walking pattern and muscular activity of the hip muscles between subjects with symptomatic external snapping hip and healthy subjects.

Methods: Thirteen subjects with diagnosed symptomatic external snapping hip (age: 25.5 years) were matched with 13 healthy subjects (age: 25.6 years). Joint kinematics and kinetics of the lower extremity were quantified by the peak hip adduction angle; the average knee rotation range of motion (ROM) and the peak valgus knee angle after data recording using a Vicon 612 motion capture system. Muscle activity was recorded bilaterally using surface electromyography (sEMG) on five muscles: gluteus maximus, gluteus medius, tensor fascia latae, rectus femoris and biceps femoris. A paired t-test was used to evaluate differences between the two groups.

Results: No significant differences were found between the groups concerning the peak hip adduction angle, the average knee rotation ROM, and the static valgus knee angle. No significant between-group differences were found concerning all other kinematics, kinetics or muscle activity. In subjects with symptomatic external snapping hip activity of the gluteus medius muscle during the acceptance phase of walking was 0.58 ± 0.19 whereas the activity was 0.68±0.07 in the asymptomatic group (p=0.115).

Conclusions: No significant differences in the walking pattern were found between subjects with symptomatic external snapping hip and healthy subjects. This suggest that subjects with symptomatic external snapping hip does not have an impaired gait pattern.
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http://dx.doi.org/10.1186/1471-2474-14-212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724713PMC
July 2013

The duty to rescue in genomic research.

Authors:
Michael Ulrich

Am J Bioeth 2013 ;13(2):50-1

Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.

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http://dx.doi.org/10.1080/15265161.2012.754067DOI Listing
May 2013

Obtaining an isolate of Ancylostoma braziliense from cats without the need for necropsy.

J Parasitol 2012 Oct 6;98(5):1037-8. Epub 2012 Mar 6.

Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853-6401, USA.

Because the eggs of Ancylostoma species of dogs and cats are difficult to readily distinguish morphologically, isolation of a certain species often requires the humane death of the source animal or holding an animal after treatment to obtain worms for specific identification or to harvest ex utero eggs. The objective of this study was to obtain an isolate of Ancylostoma braziliense from 1-time, field-collected samples of feline feces without the need for the killing of any animals. During a collection trip to Florida, fecal samples (n  =  40) were collected and identified as containing A. braziliense eggs (n  =  26) using centrifugal sugar flotation. Eggs from hookworm-positive slides were washed into tubes, DNA was extracted, and 10 samples were identified as containing A. braziliense using restriction fragment length polymorphism (RFLP) with Hinf1. Six of these samples also contained DNA of Ancylostoma tubaeforme and, thus, only 4 samples were from cats infected only with A. braziliense. Larvae cultured from two of the latter samples were used to subcutaneously inoculate a purpose-bred puppy with the intention to inhibit the growth of any potentially contaminating A. tubaeforme larvae in the culture. The infection was patent at 14 days after inoculation, and the eggs were identified as A. braziliense by RFLP and DNA sequencing. Larvae were cultured from the feces of this dog and used to infect a laboratory-reared, specific-pathogen-free cat; the eggs and larvae produced by the cat were also identified molecularly as those of A. braziliense. The larvae from this cat were used to infect other cats to maintain the isolate for further research. Both the puppy and the first cat used in this study were treated to clear their infections and have since been adopted by new owners.
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http://dx.doi.org/10.1645/GE-2981.1DOI Listing
October 2012

Treatment of naturally occurring, asymptomatic Giardia sp. in dogs with Drontal Plus flavour tablets.

Parasitol Res 2009 Aug;105 Suppl 1:S125-34

Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, USA.

The administration of three consecutive daily doses of the recommended 1x dose of Drontal Plus flavour tablets (Bayer) was examined for its effect on Giardia sp. cyst-shedding in 7 treated and 7 untreated random-source dogs. Dogs were treated on study days 0, 1 and 2. Cysts were quantified using direct immunofluorescent labelling on days -7, -5, -3 and -2, and daily from day 1 through 11. Three treated dogs never shed cysts again during the study, one shed again only on day 4, and the remaining three dogs started to shed again on days 8, 9 and 11. The mean numbers of cysts per gramme in the faeces of the treated dogs were significantly reduced (t-tests using log(10)(counts)) on days 1 and 2 (geometric means: controls = 447,000; treated = 1,050; p = 0.004) and days 3 to 8 (geometric means: controls = 23,400; treated 5.0; p < 0.001). Four controls that had been consistently positive, changed to negative status on day 11, and thus, on the final day of the trial, there were only three positive control and three positive treated dogs. Three consecutive days of treatment with Drontal Plus flavour tablets halted Giardia sp. cyst shedding by dogs. But starting six days post third treatment, some of the dogs started shedding cysts again. Since the prepatent period of Giardia sp. can be as short as 4 days, shedding of Giardia sp. cysts 6 days after treatment could be caused by a reinfection.
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http://dx.doi.org/10.1007/s00436-009-1503-0DOI Listing
August 2009

Live lecture versus video-recorded lecture: are students voting with their feet?

Acad Med 2008 Dec;83(12):1174-8

Harvard School of Dental Medicine, Boston, Massachusetts 02115, USA.

Purpose: In light of educators' concerns that lecture attendance in medical school has declined, the authors sought to assess students' perceptions, evaluations, and motivations concerning live lectures compared with accelerated, video-recorded lectures viewed online.

Method: The authors performed a cross-sectional survey study of all first- and second-year students at Harvard Medical School. Respondents answered questions regarding their lecture attendance; use of class and personal time; use of accelerated, video-recorded lectures; and reasons for viewing video-recorded and live lectures. Other questions asked students to compare how well live and video-recorded lectures satisfied learning goals.

Results: Of the 353 students who received questionnaires, 204 (58%) returned responses. Collectively, students indicated watching 57.2% of lectures live, 29.4% recorded, and 3.8% using both methods. All students have watched recorded lectures, and most (88.5%) have used video-accelerating technologies. When using accelerated, video-recorded lecture as opposed to attending lecture, students felt they were more likely to increase their speed of knowledge acquisition (79.3% of students), look up additional information (67.7%), stay focused (64.8%), and learn more (63.7%).

Conclusions: Live attendance remains the predominant method for viewing lectures. However, students find accelerated, video-recorded lectures equally or more valuable. Although educators may be uncomfortable with the fundamental change in the learning process represented by video-recorded lecture use, students' responses indicate that their decisions to attend lectures or view recorded lectures are motivated primarily by a desire to satisfy their professional goals. A challenge remains for educators to incorporate technologies students find useful while creating an interactive learning culture.
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http://dx.doi.org/10.1097/ACM.0b013e31818c6902DOI Listing
December 2008

Six-month prophylactic efficacy of moxidectin sustained release (SR) injectable for dogs against experimental heartworm infection in growing puppies.

Vet Parasitol 2005 Oct;133(2-3):233-41

Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

The purpose of this study was to assess the efficacy of moxidectin sustained release injectable for dogs (moxidectin SR, Fort Dodge Animal Health) in protecting growing puppies from experimental infection with the heartworm, Dirofilaria immitis, six months after treatment. The study involved 27 puppies, approximately 12 weeks of age at the beginning of the study, with nine puppies in each of three size classes. The small breed class included eight Pekingese and one purpose-bred small breed mongrel; the medium breed class included nine purpose-bred mongrels, and the large breed class included nine puppies with an anticipated adult weight >or=30-35 kg. Both genders were included with no attempt made to have equal numbers of male and female puppies. Puppies were blocked by weight within each size class and randomly assigned to three treatment groups of nine dogs. On Day 0, pups in two groups were injected subcutaneously with moxidectin SR, dosed to deliver 0.17 mg moxidectin/kg b.w. The third group was injected with sterile saline. Personnel making observations were blinded to the treatment status of the animals. Following treatment, puppies were observed for signs of adverse local and systemic reactions. Puppy weights and serum moxidectin levels were also monitored. On Day 180, puppies in all treatment groups were inoculated subcutaneously with 50 third-stage larvae of D. immitis. On Days 348 and 349, puppies were euthanatized and necropsied. Hearts and lungs were examined for adult heartworms. All animals in the saline control group were infected with an arithmetic mean of 39.22 adult heartworms each. Seventeen of 18 dogs in the moxidectin SR-treated groups were uninfected. One treated puppy was infected with a single adult heartworm. This infected individual was from the large breed size class and had the second highest percent increase in body weight. Based on arithmetic means, the heartworm recovery from all treated puppies represents a 99.86% reduction relative to the saline control. There were no adverse local or systemic reactions to treatment in any animal.
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http://dx.doi.org/10.1016/j.vetpar.2005.06.019DOI Listing
October 2005

Treatment of Baylisascaris procyonis infections in dogs with milbemycin oxime.

Vet Parasitol 2005 May;129(3-4):285-90

Cheri-Hill Kennel R&D, 17190 Polk Road, Stanwood, MI 49346, USA.

An examination was made as to the ability of Sentinel Flavor Tabs (milbemycin oxime/lufenuron) to treat Baylisascaris procyonis infections in dogs. The study was designed as a critical trial and included five naturally infected dogs and two dogs that were experimentally infected. Another dog from a prior clinical trial that was treated with Sentinel Flavor Tabs as part of the original FDA submission package for intestinal nematode infections was also included with the treated dogs. Of the five naturally infected dogs treated as part of the critical trial, three were cleared of their infections. These five dogs passed a total of 52 worms after treatment; one dog retained 23 worms and the other retained 1 worm at necropsy 7 days after treatment. Two of five experimentally infected Beagle dogs that had been given mice that had been fed 200 infectious eggs, developed patent infections with the parasite. These dogs were treated, and one of the dogs passed one worm and the other passed two worms after treatment with no worms being detected at necropsy 7 days after treatment. The one dog that was treated with milbemycin oxime as part of the FDA submission was clear of worms at necropsy. Overall, the mean efficacy of Sentinel Flavor Tabs was found to be 91.0%. Of the eight dogs that were treated, six were totally cleared of their infections, a cure rate of 75%. The two dogs that did not clear their infections had very large numbers of adult B. procyonis within their intestinal tracts at the time of treatment, one dog had 40 worms (23 remaining) and the other had 26 worms (1 remaining). It is suggested that the treatment of dogs with monthly Sentinel Flavor Tabs could markedly reduce the chance of infected dogs contaminating the environment. Also, additional monthly treatments are highly likely to clear dogs of any worms not killed with the initial treatment.
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http://dx.doi.org/10.1016/j.vetpar.2004.02.030DOI Listing
May 2005

Composition and surface charge of DNA-loaded microparticles determine maturation and cytokine secretion in human dendritic cells.

Pharm Res 2004 Jul;21(7):1240-7

Department of Applied Biosciences, Swiss Federal Institute of Technology Zurich (ETH), Zurich, Switzerland.

Purpose: Biodegradable microparticles prepared from poly(lactide) (PLA) and poly(lactide-co-glycolide) (PLGA) have been shown to be promising carrier systems for vaccine delivery. Here, we have investigated the capacity of different PLA and PLGA microparticle formulations to induce stimulation of human blood monocyte-derived dendritic cells (DCs).

Methods: Stimulation of human derived dendritic cells by plain microparticles were compared with microparticles loaded with plasmid DNA or double-stranded salmon DNA either by encapsulation or adsorption to the surface of cationic microparticles. Stimulation of DCs was monitored by the up-regulation of surface maturation markers CD83 and CD86 and the secretion of IL-12 and TNF-alpha.

Results: Slowly degrading PLA microparticles did not induce any detectable stimulation or activation of DCs. In contrast, fast degrading PLGA microparticles were able to influence DC maturation and cytokine secretion dependent on their surface charge. Anionic PLGA microparticles induced an up-regulation of CD83 and high TNF-alpha secretion, which was further enhanced up to the level of the potent stimulator lipopolysaccharide (LPS) when plasmid DNA was encapsulated. Moreover, the secretion of significant amounts of IL-12 was observed. Cationic PLGA microparticles induced an up-regulation of CD86 and moderate TNF-alpha secretion, but no IL-12 secretion, with no additional effects in the presence of plasmid DNA.

Conclusions: The data suggest that the composition and charge of biodegradable DNA-loaded microparticles profoundly influences maturation and cytokine secretion in DCs. Thus, the individual formulation of microparticles used as a vaccine carrier system might considerably influence the profile of the immune response.
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http://dx.doi.org/10.1023/b:pham.0000033012.16152.5dDOI Listing
July 2004

Persistent efficacy of moxidectin canine sustained-release injectable against experimental infections of Ancylostoma caninum and Uncinaria stenocephala in dogs.

Vet Ther 2003 ;4(3):228-33

CHK-R&D, 17190 Polk Rd, Stanwood, MI 49346, USA.

The efficacy of moxidectin canine sustained-release injectable administered at fixed intervals before administration of an oral hookworm challenge was evaluated in 40 laboratory dogs. Groups of eight dogs were treated with the moxidectin sustained-release formulation by SC injection approximately 3, 4, 5, or 6 months before being given oral inoculations with 300 Ancylostoma caninum larvae on Day 0 and 400 Uncinaria stenocephala larvae one day later. Dogs were euthanized 21 days after parasite inoculations. Fecal samples and the intestinal contents collected at necropsy from each dog were examined for hookworms. Fecal egg count reductions based on geometric means relative to controls were 99.2% (3 months) to 81.2% (6 months). The reduction in A. caninum worm recoveries at 3, 4, 5, and 6 months based on geometric means were 94.7%, 90.3%, 82.0%, and 60.2%, respectively. The mean reductions in U. stenocephala worm counts at these intervals were 94.6%, 85.3%, 71.6%, and 48.2%,respectively.
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May 2004
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