ASCO, Author Interviews, Cancer Research, Genetic Research, JAMA, Race/Ethnic Diversity, Stanford / 06.06.2023

MedicalResearch.com Interview with: Allison W. Kurian, M.D., M.Sc. Professor of Medicine and of Epidemiology and Population Health Associate Chief, Division of Oncology Co-Leader, Population Sciences Program, Stanford Cancer Institute Director, Women’s Clinical Cancer Genetics Program Stanford University School of Medicine Stanford, CA 94305-5405 MedicalResearch.com: What is the background for this study? What types of cancers were in the study? Response: Genetic testing for cancer risk is increasingly important after a cancer diagnosis, to inform use of targeted therapies, secondary cancer prevention approaches and cascade genetic testing of family members. However, very little is known about how genetic testing is used after a cancer diagnosis at the population level. We leveraged a very large population-based data resource, the Surveillance, Epidemiology and End Results (SEER) cancer registries of the states of California and Georgia, and linked data from these registries to clinical genetic testing results provided by the four major laboratories that provide such testing. We used this linked registry-genetic testing dataset to study adults (age >=20 years) diagnosed with all types of cancer in the states of Georgia and California from 2013-2019. (more…)
Alzheimer's - Dementia, Author Interviews, Biomarkers, JAMA, MRI / 22.05.2023

MedicalResearch.com Interview with: Ruben Smith MD, PhD Associate professor at Clinical Memory Research Division of Neurology Lund University   MedicalResearch.com: What is the background for this study? Response: Since a few years it has become possible to visualize tau pathology in Alzheimer’s Disease (AD) using positron emission tomography (PET). The tau-PET radiotracer Flortaucipir (Tauvid) was recently approved by the US Food and Drug Administration as an AD diagnostic tool. Since PET imaging is costly and exposes the patient to radioactivity we wanted to study the added clinical value of tau-PET in the diagnostic work-up of patients with cognitive symptoms, before widespread implementation in clinical practice. (more…)
Alzheimer's - Dementia, Author Interviews, Cost of Health Care, JAMA, UCLA / 20.05.2023

MedicalResearch.com Interview with: Julia Cave Arbanas Project Manager and     John N. Mafi, MD, MPH Associate Professor of Medicine General Internal Medicine & Health Services Research David Geffen School of Medicine at UCLAJohn N. Mafi, MD, MPH Associate Professor of Medicine General Internal Medicine & Health Services Research David Geffen School of Medicine at UCLA   MedicalResearch.com: What is the background for this study? What is lecanemab used for and how well does it work? Response: Lecanemab is a treatment for mild cognitive impairment and mild dementia that was approved in January 2023 as part of the Food and Drug Administration’s (FDA) accelerated approval program. The results from a recent phase 3 clinical trial show a modest clinical benefit: the rate of cognitive decline by 27% in an 18-month study involving participants experiencing the early stage of Alzheimer’s, with an 0.45-point absolute difference in cognitive testing scores. However, due to the risk of brain swelling and bleeding (also known as amyloid-related imaging abnormalities), treatment with lecanemab involves frequent MRIs and neurology or geriatrics appointments to monitor for these abnormalities, which can be life threatening. So far, three patient deaths have potentially been tied to lecanemab. It is likely that the FDA will grant is lecanemab traditional approval later this year, prompting Medicare to reconsider its current coverage restrictions and potentially enabling widespread use. (more…)
Author Interviews, Dermatology, JAMA / 15.05.2023

MedicalResearch.com Interview with: Matthew Zirwas, MD Founder, Bexley Dermatology Research Clinic Bexley, OH 43209 MedicalResearch.com: What is the background for this study? How does Roflumilast differ from other treatments for seb derm? Response: Seborrheic dermatitis affects up to 5% of the population globally and can have major impacts on quality of life. Treatment regimens are often complicated given the association of seborrheic dermatitis to hair bearing areas of the body, requiring multiple treatments for different parts of the body. Our phase 2 study aimed to understand the efficacy and safety of once-daily roflumilast foam 0.3% in adults with seborrheic dermatitis on their scalp, face and trunk. Roflumilast foam is a selective and highly potent phosphodiesterase (PDE) 4 inhibition that is being studied for a range of inflammatory skin conditions. (more…)
Author Interviews, Infections, JAMA, NYU, USPSTF / 09.05.2023

MedicalResearch.com Interview with: Gbenga Ogedegbe, MD, MPH Dr. Adolph & Margaret Berger Professor of Population Health Director, Division of Health & Behavior Director Center for Healthful Behavior Change Department of Population Health NYU Langone Health NYU School of Medicine Member of the U.S. Preventive Services Task Force MedicalResearch.com: What is the background for this study? Response: Tuberculosis (TB) is a bacterial infection that is spread through the air from one person to another and usually affects the lungs. It’s a significant public health concern in the U.S. People can be infected with TB bacteria but not have any symptoms or be contagious, which is known as a latent TB infection or LTBI. If LTBI is left untreated, it can progress to active TB, which can cause serious health problems and become contagious. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Mediterranean Diet, Mental Health Research / 08.05.2023

MedicalResearch.com Interview with: Yuan Changzheng ScD, MSc, B.M. Research Professor Doctoral supervisor, School of Medicine Zhejiang University School of Public Health Adjunct assistant professor Harvard T.H. Chan School of Public Health   MedicalResearch.com: What is the background for this study? Response: The prevention of all-cause dementia is important as it poses substantial burdens on healthcare systems and threatens the well-being of older adults, and lack of effective treatments makes its prevention crucial. The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet is a hybrid of the Mediterranean diet and the DASH diet, and it emphasizes natural plant-based foods, limited intake of certain animal foods and foods high in saturated fat and encourages consumption of berries and green leafy vegetables rich in vitamins and antioxidants. The MIND diet has previously been associated with lower risk of Alzheimer's disease and slower cognitive decline but few studies have examined its association with all-cause dementia or AD with inconclusive results. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, MRSA, Radiation Therapy / 06.05.2023

MedicalResearch.com Interview with: Beth McLellan, M.D. Chief, Division of Dermatology Montefiore Medical Center Albert Einstein College of Medicine MedicalResearch.com: What is the background for this study? How is the decolonization initiated and maintained? Response: We were interested in exploring whether bacteria on the skin plays a role in radiation dermatitis like it does in other skin diseases that cause a breakdown in the skin barrier. We used a bacterial decolonization regimen that includes chlorhexidine 2% cleanser for the body and mupirocin 2% ointment to the inside of the nose for 5 consecutive days before starting radiation therapy and repeated for an additional 5 days every other week for the duration of radiation. (more…)
Author Interviews, Health Care Systems, JAMA, Technology, UCSD / 01.05.2023

MedicalResearch.com Interview with: Zechariah Zhu, B.S. Affiliate Scientist with the Qualcomm Institute at UC San Diego and study co-author First author: John W. Ayers, PhD, MA MedicalResearch.com: What is the background for this study? Response: In today’s day and age (especially after the COVID-19 pandemic), an increasing number of people are turning to virtual options for healthcare. Most notably, there was a 1.6-fold increase in electronic patient messages, which significantly increased the burden on physicians, with a record-high proportion of physicians (62%) reporting burnout symptoms. On the other hand, we also see the rise of AI technologies like ChatGPT—an AI chatbot assistant that has taken the world by storm recently with its ability to provide lengthy response essays to many questions it is asked. Our objective for this study, then, was to evaluate the ability of ChatGPT to provide quality and empathetic responses to patient questions. (more…)
Author Interviews, Breast Cancer, JAMA, Race/Ethnic Diversity / 25.04.2023

MedicalResearch.com Interview with: Mahdi Fallah, MD, PhD Study and Group Leader Risk Adapted Prevention (RAD) Group Division of Preventive Oncology National Center for Tumor Diseases (NCT) German Cancer Research Center (DKFZ) Heidelberg, Germany   MedicalResearch.com: What is the background for this study? Response: Breast cancer is a significant public health problem, being the most commonly diagnosed cancer and the second leading cause of cancer death in women in the US. Breast cancer screening from age 50 has been associated with a reduction in mortality and is recommended by the US Preventive Services Task Force. However, there is a significant disparity in mortality rates between Black and White individuals, with Black women having a higher death rate, especially before age 50. The current one-size-fits-all policy for breast cancer screening may not be equitable or optimal, and risk-adapted starting ages of screening based on known risk factors, such as race and ethnicity, may be recommended to optimize the benefit of screening. Our study aimed to provide evidence for a risk-adapted starting age of screening by race and ethnicity. (more…)
Author Interviews, Cancer Research, JAMA, NCI, Ovarian Cancer / 21.04.2023

MedicalResearch.com Interview with: Lauren Hurwitz, PhD Postdoctoral Fellow Division of Cancer Epidemiology & Genetics National Cancer Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior studies have demonstrated that frequent (i.e., daily or near daily) use of aspirin is associated with a lower risk of developing ovarian cancer. We sought to determine if this risk reduction is also observed for individuals with greater genetic susceptibility to ovarian cancer, who may benefit more from preventive interventions. Our study found that individuals who took aspirin frequently had a lower risk of ovarian cancer, regardless of whether they had higher or lower genetic susceptibility to ovarian cancer. (more…)
ADHD, Author Interviews, JAMA, Pediatrics, University of Michigan / 18.04.2023

MedicalResearch.com Interview with: Sean Esteban McCabe, PhD Director, Center for the Study of Drugs, Alcohol, Smoking and Health Department of Health Behavior and Biological Sciences University of Michigan School of Nursing Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Prescription stimulant therapy for ADHD helps millions of people, including in my own family, and students, friends and colleagues. It's critical to balance the need for access to these medications while reducing the risk for misuse. This is more important than ever now because there have been recent increases in the prescribing of stimulant therapy for ADHD. There is a need to understand the prevalence of stimulant therapy for ADHD and prescription stimulant misuse in U.S. middle and high schools. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Gender Differences, JAMA, Menopause / 03.04.2023

MedicalResearch.com Interview with: Rachel Buckley, PhD ​Assistant Professor Department of Neurology Massachusetts General Hospital/Harvard Medical School MedicalResearch.com: What is the background for this study? Response: While a fair amount of studies have focused on the effects of menopause and hormone therapy on risk of dementia, far fewer studies have tested their association with the biology of Alzheimer’s disease, namely amyloid and tau. This is critical to know given that it still remains unclear what might be the driving mechanism of the menopause transition on risk for dementia. This is what our study set out to investigate. This study is one of the first to report a link between women’s age at menopause and tau in the brain, which we measured with positron emission tomography neuroimaging. We found that in multiple areas of the brain that tend to be most likely to show higher tau in women than men, women with earlier age at menopause and elevated levels of amyloid showed higher levels of tau than those who reported an average age at menopause (~50 years in the United States). Women who reported premature menopause (<40 years at menopause onset) exhibited a much higher risk of tau in the brain. This supports the notion that longer exposure to estrogen throughout life might be protective against Alzheimer’s disease. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, JAMA / 29.03.2023

MedicalResearch.com Interview with: Kelly Potter, PhD, RN, CNE T32 Postdoctoral Scholar CRISMA Center, Department of Critical Care Medicine University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: While it is well-recognized that survivors of critical illness often experience persistent problems with mental, cognitive, and physical health, very little is known about how these problems (collectively known as post-intensive care syndrome (PICS)) affect resumption of meaningful activities, such as driving. (more…)
Author Interviews, Cancer Research, Genetic Research, JAMA, Personalized Medicine, Vanderbilt / 18.03.2023

MedicalResearch.com Interview with: Jonathan Mosley, MD, PhD Associate Professor Division of Clinical Pharmacology Departments of Internal Medicine and Biomedical Informatics Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Prostate cancer is an important source of morbidity and mortality among men. Earlier detection of disease is essential to reduce these adverse outcomes. Prostate cancer is heritable, and many single nucleotide polymorphisms (SNPs) associated with disease risk have been identified. Thus, there is considerable interest in using tools such as polygenic risk scores, which measure the burden of genetic risk variants an individual carries, to identify men at elevated risk of disease. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, Race/Ethnic Diversity / 09.03.2023

MedicalResearch.com Interview with:
Hyuna Sung, PHDHyuna Sung, PHD Senior Principal Scientist, Cancer Surveillance Research American Cancer Society Kennesaw, GA 30144
  MedicalResearch.com: What is the background for this study? Response: Triple-negative breast cancer (TNBC) accounts for 10% to 20% of all breast cancer diagnoses in the US. This subtype of breast cancer tends to spread faster and has fewer treatment options. In the US, Black women are about two-fold more likely than White women to develop TNBC. (more…)
Author Interviews, Heart Disease, JAMA, Statins / 09.03.2023

MedicalResearch.com Interview with: Myeong-Ki Hong, MD PhD Professor of Cardiology Yonsei University College of Medicine Severance Cardiovascular Hospital Seoul, Korea MedicalResearch.com: What is the background for this study? Response: The background of this study was to compare the long-term clinical outcomes between the two distinct strategies regarding statin intensity in patients with coronary artery disease (CAD). One is to titrate statin intensity to meet a target low-density lipoprotein cholesterol (LDL-C) level (treat-to-target strategy), the other is to maintain high-intensity statin without a target goal (high-intensity statin strategy). (more…)
Author Interviews, Infections, JAMA, OBGYNE, Pediatrics / 08.03.2023

MedicalResearch.com Interview with: Anna Roca PhD MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine Fajara, The Gambia MedicalResearch.com: What is the background for this study? Response: Context specific interventions are needed to decrease the high burden of severe neonatal morbidity and mortality in sub-Saharan Africa. Severe bacterial infections are a main cause of neonatal mortality in the continent. Oral intra-partum azithromycin is a cheap intervention easily scalable. Before embarking on this trial, we conducted a proof-of-concept trial that showed the intervention reduced maternal and neonatal bacterial carriage of the most prevalent bacteria causing neonatal sepsis in the continent. (more…)
Author Interviews, Gender Differences, JAMA, Surgical Research / 03.03.2023

MedicalResearch.com Interview with: Mario FL Gaudino, MD, PhD, MSCE, FEBCTS, FACC, FAHA Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery (II) Assistant Dean for Clinical Trials Professor of Clinical Epidemiology and Health Services Research at Weill Cornell Graduate School Director of the Joint Clinical Trials Office (JCTO) Director of Translational and Clinical Research, Department of Cardiothoracic Surgery Chair Coronary Artery Task Force, European Association for Cardio-Thoracic Surgery Weill Cornell Medicine | NewYork – Presbyterian Hospital Department of Cardiothoracic Surgery MedicalResearch.com: What is the background for this study? Response: It is well-documented that women undergoing CABG have higher mortality and morbidity when compared with men. They are referred to surgery later than men, with more cardiovascular risk factors than men, and present more frequently with heart failure or in non-elective settings. However, overall CABG outcomes have improved over time, and so we sought to evaluate national trends in outcomes specifically in women. (more…)
Author Interviews, Herpes Viruses, JAMA, STD, USPSTF / 23.02.2023

MedicalResearch.com Interview with: James Stevermer, M.D., M.S.P.H. Vice chair for clinical affairs Professor of family and community medicine University of Missouri Medical director of MU Health Care Family Medicine–Callaway Physicians, Dr. Stevermer joined the U.S. Preventive Service Task Force in January 2021.     MedicalResearch.com: What is the background for this study? Response: Genital herpes is a common sexually transmitted infection (STI) that unfortunately has no cure and cannot accurately be detected in people who do not have signs of the condition. The current screening tests have limitations and there is a high chance that test results will say a person has the condition when they do not. In addition, the available treatments are focused on managing symptoms and preventing the condition from reoccurring. As a result, the Task Force concluded that the harms of screening outweigh the benefits. (more…)
Author Interviews, Gender Differences, JAMA / 21.02.2023

MedicalResearch.com Interview with: Michael Liu, MPhil Rhodes Scholar,MPhil in Evidence-Based Social Intervention and Policy Evaluation. Harvard Medical School Boston, Massachusetts   MedicalResearch.com: What is the background for this study? Response: Over the past few decades, research has shown that lesbian, gay, and bisexual (LGB) individuals have worse health outcomes and face unique challenges related to their experiences and costs of care. These disparities are driven by “minority stress” associated with belonging to a marginalized group. Such stressors erode health through a range of structural and interpersonal forces, including employment discrimination, family rejection, and internalized stigma One early analysis established national baseline estimates for LGB health outcomes using 2013-2014 National Health Interview Survey (NHIS) data. Since then, there have been substantial shifts in social policy and public opinion that may have differentially affected sexual minority subgroups. The US Supreme Court decision in Obergefell v. Hodges guaranteed the constitutional right to same-sex marriage across all states. Over the last decade, states have expanded rights and protections for LGB populations related to employment and housing discrimination, sexual orientation conversion efforts, HIV criminalization, and religious exemptions. Public support for LGB-related issues has also been increasing with more representation in media, uptake of LGB-affirming policies, and advocacy efforts. No studies have assessed national trends in health status or healthcare access among specific sexual minority subgroups amid the rapidly shifting sociocultural and policy landscape. Thus, we sought out to evaluate if and how health status and healthcare access have changed between 2013 and 2018 in the US among LGB adults, and whether differences relative to their heterosexual counterparts have changed over time. (more…)
Author Interviews, Coffee, Genetic Research, JAMA, Kidney Disease / 15.02.2023

MedicalResearch.com Interview with: Dr. Sara Mahdavi, PhD Clinical Scientist and Clinical Instructor Research Appointment in the Faculty of Medicine University of Toronto Toronto, ON MedicalResearch.com: What is the background for this study? Response: This was a long-term study spanning 16 years and began with a population of young adults who were medically assessed on a regular basis. It was remarkable to see just how striking the effects of coffee were in the group that had the susceptible genetic variant, what we termed “slow caffeine metabolizers” yet no effect whatsoever in those who did not were termed “fast metabolizers”. (more…)
Author Interviews, Health Care Systems, JAMA / 13.02.2023

MedicalResearch.com Interview with: David A. Hyman, JD, MD The Scott K. Ginsburg Professor of Health Law & Policy Georgetown University Law Center Washington, DC MedicalResearch.com: What is the background for this study? Response: Many doctors believe medical malpractice claiming is effectively random — meaning good doctors are equally likely as bad doctors to end up being the target of a malpractice claim.  Past research has studied whether physicians with 2 paid claims are likely to have another claim than doctors with 1 paid claim. We study whether physicians with 1 paid claim are more likely to have another paid claim, compared to physicians with zero paid claims.  We also compare the pattern of observed claims with what we would expect to find if claiming were truly random (by running a simulation). (more…)
Author Interviews, Autism, JAMA, Pediatrics, UCSD / 08.02.2023

MedicalResearch.com Interview with: Karen Pierce, Ph.D. Professor, Department of Neurosciences, UCSD Co-Director, Autism Center of Excellence, UCSD MedicalResearch.com: What is the background for this study? Response: The mean age of ASD diagnosis and eventual treatment remains at ~52 months in the United States1 - years beyond the disorder’s prenatal origins2, and beyond the age when it can be reliably diagnosed in many cases3. Currently the only way to determine if a child has autism spectrum disorder (ASD) is to receive a developmental evaluation from an experienced clinician (usually a licensed clinical psychologist). There are often long waiting lists, and only a small number of clinicians have the experience required to make early-age (i.e., between 12-36 months) diagnoses of ASD. Thus, there are many places in the country as well as world wide wherein children wait months or years to receive a formal diagnosis due to a lack of available expertise. Moreover, diagnostic evaluations are expensive and usually cost the parent and/or insurance approximately ~$2,000 or more per evaluation.  Finally, clinical evaluations usually take between 2-3 hours to complete and result in fatigue for both the parent and toddler. Eye-tracking, which generates biologically-relevant, objective, and quantifiable metrics of both visual and auditory preference profiles in babies and toddlers in just minutes, is a technology that can dramatically change how ASD is diagnosed. (more…)
Author Interviews, Genetic Research, JAMA, Karolinski Institute, Weight Research / 31.01.2023

MedicalResearch.com Interview with: Lisa Dinkler, Ph.D. | Postdoctoral researcher Center for Eating Disorders Innovation (CEDI) Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Stockholm MedicalResearch.com: What is the background for this study? Response: Avoidant restrictive food intake disorder (ARFID) is a relatively recently defined eating disorder. Affected people severely restrict their food intake in terms of total amount or variety. This leads to serious physical, psychological, and social consequences such as weight loss, nutritional deficiencies, and social isolation. Compared to people with other eating disorders – such as anorexia nervosa, bulimia nervosa, and binge-eating disorder – food restriction in people with ARFID is not driven by body dissatisfaction or the desire to lose weight. Despite how serious ARFID is, we still know very little about what causes it – making it difficult to develop effective treatments. We do know that genetic factors contribute significantly to the development of other eating disorders (so-called heritability), but we did not yet know to which degree genetic factors play a role in the development of ARFID. We therefore conducted the first twin study of ARFID, using a sample of ~34,000 Swedish twins including ~700 children with ARFID. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmaceutical Companies, Yale / 22.01.2023

MedicalResearch.com Interview with: Neeraj Patel Medical Student (MS-2), Yale School of Medicine New Haven, CT MedicalResearch.com: What is the background for this study? Response: Direct-to-consumer pharmaceutical advertising has been increasing in popularity for the past two decades or so, particularly via television. But it’s highly controversial. Only two high-income countries (the U.S. and New Zealand) widely permit this type of advertising for prescription drugs. Critics have pointed to a growing body of literature that suggests that direct-to-consumer advertising for prescription drugs can be misleading, lead to inappropriate prescribing, and inflate healthcare costs. Proponents have argued that it improves public health by promoting clinically beneficial prescribing. (more…)
Author Interviews, Health Care Systems, JAMA, Sleep Disorders, Yale / 18.01.2023

MedicalResearch.com Interview with: César Caraballo-Cordovez, MD Postdoctoral Associate Yale/YNHH Center for Outcomes Research and Evaluation (CORE) New Haven, CT 06511 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our group has been interested in how patients’ experience during hospitalization impacts their recovery and their health for a while. In 2013, Dr. Harlan Krumholz (senior author of the current study) identified that patients who were recently hospitalized experienced a period of generalized risk for myriad adverse health events, a condition that he named ‘post-hospital syndrome’. One of the possible explanations for this observation is that the stress from being hospitalized negatively impacts patients’ health during their stay in the hospital and after being discharged. The stress in a hospital may come from different sources–including sleep deprivation. Sleep is fundamental for recovery, and there are many challenges for patients to have adequate sleep while being hospitalized. Among the many sources of sleep interruption are early morning blood draws. Blood draws are often performed in the early morning in order to have recent lab tests results available during morning medical rounds. However, this common practice may disrupt patients’ recovery by interrupting their sleep. We were interested in determining to what extent blood draws contribute to early morning sleep disruptions and whether there has been recent progress in reducing them. We used data from Yale New Haven Hospital from 2016 to 2019 and found that nearly 4 in 10 of total daily blood draws were collected between 4:00am and 7:00am–a proportion that was persistently high over the 3 years we studied. Importantly, we found that this occurred across patients with different sociodemographic characteristics, including older individuals who are at highest risk of adverse health events from sleep deprivation. (more…)
Author Interviews, JAMA, Surgical Research / 13.01.2023

MedicalResearch.com Interview with: Casey Hribar Fourth-year medical student University of North Carolina MedicalResearch.com: What is the background for this study? Response: Several great pieces of literature already exist about patient perception of doctors wearing white coats, formal attire, business attire, and the like. But recently, scrubs are garnering favor, especially as a result of the COVID-19 pandemic. While there has been some interest in what is worn over scrubs (jackets, vests, name tags, etc.), to our knowledge, there has not been any investigation into scrub color. Scrubs are a highly variable article of clothing, from fit, to pockets, pattern, and color, and it makes sense that these variations could have their own associated perceptions. Our study served as a way to open up the conversation around scrubs and the potential impact of their color on patients. (more…)