Andrea Jonas

All Publications

• Impact of vaping on respiratory health. BMJ (Clinical research ed.) Jonas, A. 2022; 378: e065997

  Abstract

  Widespread uptake of vaping has signaled a sea change in the future of nicotine consumption. Vaping has grown in popularity over the past decade, in part propelled by innovations in vape pen design and nicotine flavoring. Teens and young adults have seen the biggest uptake in use of vape pens, which have superseded conventional cigarettes as the preferred modality of nicotine consumption. Relatively little is known, however, about the potential effects of chronic vaping on the respiratory system. Further, the role of vaping as a tool of smoking cessation and tobacco harm reduction remains controversial. The 2019 E-cigarette or Vaping Use-Associated Lung Injury (EVALI) outbreak highlighted the potential harms of vaping, and the consequences of long term use remain unknown. Here, we review the growing body of literature investigating the impacts of vaping on respiratory health. We review the clinical manifestations of vaping related lung injury, including the EVALI outbreak, as well as the effects of chronic vaping on respiratory health and covid-19 outcomes. We conclude that vaping is not without risk, and that further investigation is required to establish clear public policy guidance and regulation.

  View details for DOI 10.1136/bmj-2021-065997

  View details for PubMedID 35851281

• Machine learning to distinguish lymphangioleiomyomatosis from other diffuse cystic lung diseases. Respiratory investigation Jonas, A., Muelly, M., Gupta, N., Reicher, J. J. 2022

  Abstract

  Patients with lymphangioleiomyomatosis (LAM) frequently experience delays in diagnosis, owing partly to the delayed characterization of imaging findings. This project aimed to develop a machine learning model to distinguish LAM from other diffuse cystic lung diseases (DCLDs). Computed tomography scans from patients with confirmed DCLDs were acquired from registry datasets and a recurrent convolutional neural network was trained for their classification. The final model provided sensitivity and specificity of 85% and 92%, respectively, for LAM, similar to the historical metrics of 88% and 97%, respectively, by experts. The proof-of-concept work holds promise as a clinically useful tool to assist in recognizing LAM.

  View details for DOI 10.1016/j.resinv.2022.01.001

  View details for PubMedID 35181263

• Use of home pulse oximetry with daily short message service messages for monitoring outpatients with COVID-19: The patient's experience DIGITAL HEALTH Vaughan, L., Eggert, L. E., Jonas, A., Sung, A., Singer, S. 2021; 7: 20552076211067651

  Abstract

  Studies have shown COVID-19 patients may have a low oxygen saturation (SpO2) independent of visible respiratory distress, a phenomenon termed "silent hypoxia." Silent hypoxia creates uncertainty in the outpatient setting for clinicians and patients alike. In this study, we examined the potential for pulse oximeters in identifying early signs of clinical deterioration. We report descriptive results on COVID-positive patients' experiences with a comprehensive home monitoring tool comprised of home SpO2 measurements with a novel symptom-tracking short message service/text messaging application. Of patients who required hospitalization, 83% sought care as a result of low pulse oximeter readings. Nearly all patients who did not require hospitalization reported that having a pulse oximeter provided them with the confidence to stay at home. Essentially all patients found a home pulse oximeter useful. Keeping COVID-19-positive patients at home reduces the potential for disease spread and prevents unnecessary costs and strain on the healthcare system.

  View details for DOI 10.1177/20552076211067651

  View details for Web of Science ID 000731017000001

  View details for PubMedID 34925873

  View details for PubMedCentralID PMC8679026

• Lipid-Laden alveolar macrophages and vaping: Lessons from EVALI. EBioMedicine Jonas, A. n. 2020; 60: 103010

  View details for DOI 10.1016/j.ebiom.2020.103010

  View details for PubMedID 32971470

• Vaping-related Acute Parenchymal Lung Injury: A Systematic Review. Chest Jonas, A. M., Raj, R. n. 2020

  Abstract

  The ongoing U.S. outbreak of vaping-related acute lung injury, recently named EVALI (E-cigarette or vaping product use associated acute lung injury), has reignited concerns about the health effects of vaping. Initial case reports of vaping-related lung injury date back to 2012, but the ongoing outbreak of EVALI began in the summer of 2019 and has been implicated in 2,807 cases and 68 deaths as of this writing. Review of the scientific literature reveals 216 patient cases spanning 41 reports of parenchymal lung injury attributed to vaping. In this review, we detail the clinical, radiographic, pathologic patterns of lung injury attributable to vaping, as well as provide an overview of the scientific literature to date on the effects of vaping on respiratory health. Tetrahydrocannabinol was the most common vaped substance and Vitamin E acetate was found in bronchoalveolar lavage specimens from many affected individuals, however no specific component or contaminant has conclusively been identified as the cause for the injury to date. Patients present with cough, dyspnea, constitutional symptoms, and gastrointestinal symptoms. Radiology and histopathology demonstrate a spectrum of nonspecific acute injury patterns. A high index of suspicion combined with a good history are the key to an accurate diagnosis. Treatment is supportive, mortality is low, and most patients recover. Corticosteroids have been used with apparent success in patients with severe disease but more rigorous studies are needed to clarify their role in treating vaping related lung injury.

  View details for DOI 10.1016/j.chest.2020.03.085

  View details for PubMedID 32442559

• Evidence-Based Practice When the Evidence Changes Daily: Lessons from Stanford in Building a Critical Care Task Force During COVID-19. Health Management, Policy and Innovation Jonas, A., Aslakson, R., Ramsey, M., Staudenmeyer, K., Sung, A., Wilson, J., Rogers, A. 2020
• Corticosteroids for COVID-19-Associated ARDS Clinical Pulmonary Medicine Marmor, M. B., Jonas, A. M. 2020; 27 (6): 165-167

  View details for DOI 10.1097/CPM.0000000000000381

• Covid-19 and Health Care's Digital Revolution. The New England journal of medicine Keesara, S. n., Jonas, A. n., Schulman, K. n. 2020

  View details for DOI 10.1056/NEJMp2005835

  View details for PubMedID 32240581

• Opportunities to Improve Utilization of Palliative Care among Adults with Cystic Fibrosis: A Systematic Review. Journal of pain and symptom management Marmor, M. n., Jonas, A. n., Mirza, A. n., Rad, E. n., Wong, H. n., Aslakson, R. A. 2019

  Abstract

  Individuals with Cystic Fibrosis (CF) frequently survive into adulthood and many have multi-faceted symptoms that impair quality of life.We conducted a systematic review to investigate opportunities to improve utilization of palliative care among adults with CF.We searched PubMed, Embase, Scopus, Web of Science and CINAHL databases from inception until September 27, 2018, and reviewed references manually. Eligible articles were published in English, involved adults age 18 years and older with CF and contained original data regarding patient outcomes related to presence of advanced care planning (ACP), symptom experience, and preferred and/or received end-of-life care.We screened 652 article abstracts and 32 full text articles; 12 studies met inclusion criteria. All studies were published between 2000 and 2018. Pertinent findings include that while 43% to 65% of adults with CF had contemplated completing ACP, the majority only completed ACP during their terminal hospital admission. Patients also reported high prevalence of untreated symptoms, with adequate symptom control reported in 45% among those with dyspnea, 22% among those with pain and 51% among those with anxiety and/or depression. Prevalence of in-hospital death ranged from 62% to 100%, with a third dying in the intensive care unit (ICU). The majority received antibiotics and preventative treatments during their terminal hospitalization. Finally, treatment from a palliative care specialist was associated with a higher prevalence of patient completion of advanced directives, decreased likelihood of in-ICU death and decreased use of mechanical ventilation at end-of-life.Adults with CF often have untreated symptoms and many opportunities exist for palliative care specialists to improve ACP completion and quality of end-of-life care.

  View details for DOI 10.1016/j.jpainsymman.2019.08.017

  View details for PubMedID 31437475

• A crowdsourcing model for creating preclinical medical education study tools. Academic medicine : journal of the Association of American Medical Colleges Bow, H. C., Dattilo, J. R., Jonas, A. M., Lehmann, C. U. 2013; 88 (6): 766-70

  Abstract

  During their preclinical course work, medical students must memorize and recall substantial amounts of information. Recent trends in medical education emphasize collaboration through team-based learning. In the technology world, the trend toward collaboration has been characterized by the crowdsourcing movement. In 2011, the authors developed an innovative approach to team-based learning that combined students' use of flashcards to master large volumes of content with a crowdsourcing model, using a simple informatics system to enable those students to share in the effort of generating concise, high-yield study materials. The authors used Google Drive and developed a simple Java software program that enabled students to simultaneously access and edit sets of questions and answers in the form of flashcards. Through this crowdsourcing model, medical students in the class of 2014 at the Johns Hopkins University School of Medicine created a database of over 16,000 questions that corresponded to the Genes to Society basic science curriculum. An analysis of exam scores revealed that students in the class of 2014 outperformed those in the class of 2013, who did not have access to the flashcard system, and a survey of students demonstrated that users were generally satisfied with the system and found it a valuable study tool. In this article, the authors describe the development and implementation of their crowdsourcing model for creating study materials, emphasize its simplicity and user-friendliness, describe its impact on students' exam performance, and discuss how students in any educational discipline could implement a similar model of collaborative learning.

  View details for DOI 10.1097/ACM.0b013e31828f86ef

  View details for PubMedID 23619061

• The T1D Exchange clinic registry. The Journal of clinical endocrinology and metabolism Beck, R. W., Tamborlane, W. V., Bergenstal, R. M., Miller, K. M., DuBose, S. N., Hall, C. A. 2012; 97 (12): 4383-9

  Abstract

  The T1D Exchange includes a clinic-based registry, a patient-centric web site called Glu, and a biobank.The aim of the study was to describe the T1D Exchange clinic registry and provide an overview of participant characteristics.Data obtained through participant completion of a questionnaire and chart extraction include diabetes history, management, and monitoring; general health; lifestyle; family history; socioeconomic factors; medications; acute and chronic diabetic complications; other medical conditions; and laboratory results.Data were collected from 67 endocrinology centers throughout the United States.We studied 25,833 adults and children with presumed autoimmune type 1 diabetes (T1D).Participants ranged in age from less than 1 to 93 yr, 50% were female, 82% were Caucasian, 50% used an insulin pump, 6% used continuous glucose monitoring, and 16% had a first-degree family member with T1D. Glycosylated hemoglobin at enrollment averaged 8.3% and was highest in 13 to 25 yr olds. The prevalence of renal disease was ≤4% until T1D was present for at least 10 yr, and retinopathy treatment was ≤2% until T1D was present for at least 20 yr. A severe hypoglycemic event (seizure or coma) in the prior 12 months was reported by 7% of participants and diabetic ketoacidosis in the prior 12 months by 8%.The T1D Exchange clinic registry provides a database of important information on individuals with T1D in the United States. The rich dataset of the registry provides an opportunity to address numerous issues of relevance to clinicians and patients, including assessments of associations between patient characteristics and diabetes management factors with outcomes.

  View details for DOI 10.1210/jc.2012-1561

  View details for PubMedID 22996145

• Wnt5a-Ror-Dishevelled signaling constitutes a core developmental pathway that controls tissue morphogenesis. Proceedings of the National Academy of Sciences of the United States of America Ho, H. H., Susman, M. W., Bikoff, J. B., Ryu, Y. K., Jonas, A. M., Hu, L., Kuruvilla, R., Greenberg, M. E. 2012; 109 (11): 4044-51

  Abstract

  Wnts make up a large family of extracellular signaling molecules that play crucial roles in development and disease. A subset of noncanonical Wnts signal independently of the transcription factor β-catenin by a mechanism that regulates key morphogenetic movements during embryogenesis. The best characterized noncanonical Wnt, Wnt5a, has been suggested to signal via a variety of different receptors, including the Ror family of receptor tyrosine kinases, the Ryk receptor tyrosine kinase, and the Frizzled seven-transmembrane receptors. Whether one or several of these receptors mediates the effects of Wnt5a in vivo is not known. Through loss-of-function experiments in mice, we provide conclusive evidence that Ror receptors mediate Wnt5a-dependent processes in vivo and identify Dishevelled phosphorylation as a physiological target of Wnt5a-Ror signaling. The absence of Ror signaling leads to defects that mirror phenotypes observed in Wnt5a null mutant mice, including decreased branching of sympathetic neuron axons and major defects in aspects of embryonic development that are dependent upon morphogenetic movements, such as severe truncation of the caudal axis, the limbs, and facial structures. These findings suggest that Wnt5a-Ror-Dishevelled signaling constitutes a core noncanonical Wnt pathway that is conserved through evolution and is crucial during embryonic development.

  View details for DOI 10.1073/pnas.1200421109

  View details for PubMedID 22343533

  View details for PubMedCentralID PMC3306699