Bryant Lin

All Publications

• Foundation metrics for evaluating effectiveness of healthcare conversations powered by generative AI. NPJ digital medicine Abbasian, M., Khatibi, E., Azimi, I., Oniani, D., Shakeri Hossein Abad, Z., Thieme, A., Sriram, R., Yang, Z., Wang, Y., Lin, B., Gevaert, O., Li, L. J., Jain, R., Rahmani, A. M. 2024; 7 (1): 82

  Abstract

  Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, dynamic scheduling of follow-ups, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients' well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present a comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process.

  View details for DOI 10.1038/s41746-024-01074-z

  View details for PubMedID 38553625

  View details for PubMedCentralID PMC10980701

• Who Are We Missing? Reporting of Transgender and Gender-Expansive Populations in Clinical Trials. Journal of the American Heart Association Rice, E. N., Lan, R. H., Nunes, J. C., Shah, R., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Echols, M., Awad, C., Idris, M. Y., Cruz, E. R., Poullos, P. D., Lewis, E. F., Brown-Johnson, C., Igwe, J., Shen, S., Palaniappan, L., Stefanick, M. L., Ritter, V., Pemu, P., Rodriguez, F., Deb, B., Pundi, K., Wang, P. J. 2023: e030209

  View details for DOI 10.1161/JAHA.123.030209

  View details for PubMedID 37947088

• Disabilities Reporting in Cardiac Clinical Trials: How Are We Doing? Journal of the American Heart Association Lan, R. H., Rice, E. N., Nunes, J. C., Shah, R., Igwe, J. K., Clark, K., Periyakoil, V. S., Chen, J. H., Lin, B., Awad, C., Idris, M., Cruz, E. R., Lewis, E. F., Johnson, C. B., Wang, P. J. 2023: e029726

  View details for DOI 10.1161/JAHA.123.029726

  View details for PubMedID 37949834

• Voices of Musicians: Virtual Live Bedside Music Concerts in Inpatient Care. Healthcare (Basel, Switzerland) Ambler, M., Janss, A., Stafford, R. S., Lin, B., Florom-Smith, A., Kang, A. W. 2023; 11 (22)

  Abstract

  The COVID-19 pandemic presented unprecedented challenges to patients, family members, and healthcare staff that resulted in increased stress and isolation and decreased quality of life. We evaluate the impact of a novel virtual concert program, the Vital Sounds Initiative (VSI) of Project: Music Heals Us (PMHU), which began at the beginning of the pandemic to combat patient isolation and provide employment to professional musicians. Using a qualitative analysis of VSI data, we examined post-concert written responses by musicians. These responses were coded by independent coders via inductive coding and thematic analysis. Between 7 April 2020 and 20 July 2022, 192 musicians played 2203 h of music for 11,222 audience members in 39 care facilities nationwide. A total of 114 musicians submitted a total of 658 responses. Three main themes (with corresponding subthemes) arose: (1) Patient Experience; (2) Musician Experience; (3) Caregiver (family or staff) Experience. The responses offered valuable insight into the overwhelmingly positive aspects of the virtual concerts. Overall, we found that VSI favorably impacts individuals at every level, including the patients, musician, and caregivers. These findings provide preliminary evidence for the benefits of virtual music concerts. Upscaling similar virtual music interventions/programs should be considered.

  View details for DOI 10.3390/healthcare11222929

  View details for PubMedID 37998421

  View details for PubMedCentralID PMC10671553

• Acoustic resonance therapy is safe and effective for the treatment of nasal congestion in rhinitis: A randomized sham-controlled trial. International forum of allergy & rhinology Luong, A. U., Yong, M., Hwang, P. H., Lin, B. Y., Gopi, P., Mohan, V., Ma, Y., Johnson, J., Yen, D. M., DeMera, R. S., Bleier, B. S. 2023

  Abstract

  Acoustic resonance therapy (ART) is a novel vibrational treatment that delivers patient-specific resonant frequency acoustic energy to the sinonasal cavities. In a pilot study, ART was effective for the acute treatment of nasal congestion. We conducted a sham-controlled randomized trial to validate the efficacy of ART when administered daily for 2 weeks.A total of 52 adult patients were enrolled in a multi-center, randomized, double-blinded, sham-controlled, interventional study evaluating ART administered by a vibrational headband. Patients received either active treatment or a non-therapeutic sham treatment twice daily over 2 weeks. Clinical endpoints were the average change in nasal congestion sub-score of the Total Nasal Symptom Score (TNSS) and the average change in composite TNSS.ART resulted in a significantly greater mean change in the nasal congestion sub-score compared to sham (-0.87 [95% confidence interval [CI] -1.11, -0.62] vs. -0.44 [95% CI -0.64, -0.23], p = 0.008). ART also resulted in a significantly greater reduction in the composite TNSS versus sham, (-2.85 [95% CI -3.85, -1.85], vs. -1.32 [95% CI -2.27, -0.36], p = 0.027). The response rate, determined by a nasal congestion sub-score minimal clinically important difference of 0.23, was 80.8% for ART and 46.2% for sham, with an adjusted risk ratio of 1.95 (95% CI 1.26, 3.02, p = 0.003) in favor of ART. Safety endpoints showed no adverse events.ART is a safe and effective non-pharmacologic alternative for the treatment of nasal congestion.

  View details for DOI 10.1002/alr.23284

  View details for PubMedID 37812532

• Testing the Appropriateness of Diabetes Prevention and Care Information Given by the Online Conversational AI ChatGPT. Clinical diabetes : a publication of the American Diabetes Association Hong, J., Kikuta, N. T., Simos, A., Tsai, S., Lin, B., Rodriguez, F., Palaniappan, L. 2023; 41 (4): 549-552

  View details for DOI 10.2337/cd23-0026

  View details for PubMedID 37849522

  View details for PubMedCentralID PMC10577494

• THE EFFECT OF ACOUSTIC RESONANCE THERAPY ON CPAP ADHERENCE Munafo, D., Gopi, P., Mohan, V., Hwang, P., Lin, B., Hekier, E., Lane, B., Guerrero, C., Dauphin, B., Kushida, C. OXFORD UNIV PRESS INC. 2023: A216

  View details for Web of Science ID 001008232900485

• Design and development of a digital shared decision-making tool for stroke prevention in atrial fibrillation. JAMIA open Nunes, J. C., Baykaner, T., Pundi, K., DeSutter, K., True Hills, M., Mahaffey, K. W., Sears, S. F., Morin, D. P., Lin, B., Wang, P. J., Stafford, R. S. 2023; 6 (1): ooad003

  Abstract

  Shared decision-making (SDM) is an approach in which patients and clinicians act as partners in making medical decisions. Patients receive the information needed to decide and are encouraged to balance risks, benefits, and preferences. Informative materials are vital to SDM. Atrial fibrillation (AF) is the most common cardiac arrhythmia and responsible for 10% of ischemic strokes, however 1/3 of patients are not on appropriate anticoagulation. Decision sharing may facilitate treatment acceptance, improving outcomes.To develop a framework of the components needed to create novel SDM tools and to provide practical examples through a case-study of stroke prevention in AF.We analyze the design values of a web-based SDM tool created to better inform AF patients about anticoagulation. The tool was developed in partnership with patient advocates, multi-disciplinary investigators, and private design firms. It was refined through iterative, recursive testing in patients with AF. Its effectiveness is being evaluated in a multisite clinical trial led by Stanford University and sponsored by the American Heart Association.The main components considered when creating the Stanford AFib tool included: design and software; content identification; information delivery; inclusive communication, user engagement; patient feedback; clinician experience; and anticipation of implementation and dissemination. We also highlight the ethical principles underlying SDM; matters of diversity and inclusion, linguistic variety, accessibility, and health literacy. The Stanford AFib Guide patient tool is available at: https://afibguide.com and the clinician tool at https://afibguide.com/clinician.Attention to a range of vital development and design factors can facilitate tool adoption and information acquisition by diverse cultural, educational, and socioeconomic subpopulations. With thoughtful design, digital tools may decrease decision regret and improve treatment outcomes across many decision-making situations in healthcare.

  View details for DOI 10.1093/jamiaopen/ooad003

  View details for PubMedID 36751465

  View details for PubMedCentralID PMC9893868

• Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared DecisionMaking Pathway Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J. P., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Shah, R., Newswanger, P., DeSutter, K., Nunes, J., Albert, M. A., Schulman, K., Heidenreich, P. A., Bunch, T. J., Sanders, L., Turakhia, M., Stafford, R. S. LIPPINCOTT WILLIAMS & WILKINS. 2022: E582-E583

  View details for Web of Science ID 000928164500042

• A Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway. Journal of the American Heart Association Wang, P. J., Lu, Y., Mahaffey, K. W., Lin, A., Morin, D. P., Sears, S. F., Chung, M. K., Russo, A. M., Lin, B., Piccini, J., Hills, M. T., Berube, C., Pundi, K., Baykaner, T., Garay, G., Lhamo, K., Rice, E., Pourshams, I. A., Shah, R., Newswanger, P., DeSutter, K., Nunes, J. C., Albert, M. A., Schulman, K. A., Heidenreich, P. A., Bunch, T. J., Sanders, L. M., Turakhia, M., Verghese, A., Stafford, R. S. 2022: e8009

  Abstract

  Background Oral anticoagulation (OAC) reduces stroke and disability in atrial fibrillation (AF) but is underutilized. We evaluated the effects of a novel patient-clinician shared decision-making (SDM) tool in reducing OAC patient's decisional conflict as compared to usual care. Methods and Results We designed and evaluated a new digital decision aid in a multicenter, randomized, comparative effectiveness trial, ENHANCE-AF (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention). The digital AF SDM Toolkit was developed using patient-centered design with clear health communication principles (e.g. meaningful images, limited text). Available in English and Spanish, the toolkit included the following: 1) a brief animated video; 2) interactive questions with answers; 3) a quiz to check on understanding; 4) a worksheet to be used by the patient during the encounter; and 5) an online guide for clinicians. The study population included English or Spanish speakers with non-valvular AF and a CHA2DS2-VASc stroke score ≥1 for men or ≥2 for women. Participants were randomized in a 1:1 ratio to either Usual Care (UC) or the SDM Toolkit. The primary endpoint was the validated 16-item Decisional Conflict Scale (DCS) at 1 month. Secondary outcomes included DCS at 6 months and the 10-item Decision Regret Scale (DRS) at 1 and 6 months as well as a weighted average of Mann-Whitney U-statistics for both DCS and DRS. A total of 1001 participants were enrolled and followed at 5 different sites in the United States between 12/18/19 and 8/17/22. The mean patient age was 69 ±10years (40% females, 16.9% Black, 4.5% Hispanic, 3.6% Asian), and 50% of participants had CHA2DS2-VASc scores ≥3 (M) or ≥4 (F). The primary endpoint at 1 month showed a clinically meaningful reduction in decisional conflict: a 7-point difference in median scores between the two arms (16.4 v 9.4; Mann-Whitney U-statistics=0.550; p-value=0.007). For the secondary endpoint of 1-month DRS, the difference in median scores between arms was 5 points in the direction of less decisional regret (p-value of 0.078). The treatment effects lessened over time: at 6 months the difference in medians was 4.7 points for DCS (p-value=0.060) and 0 points for DRS (p-value=0.35). Conclusions Implementation of a novel, Shared Decision-Making Toolkit (afibguide.com; afibguide.com/clinician) achieved significantly lower decisional conflict compared to usual care in patients with AF.

  View details for DOI 10.1161/JAHA.122.028562

  View details for PubMedID 36342828

• Diagnostic journeys: characterization of patients and diagnostic outcomes from an academic second opinion clinic. Diagnosis (Berlin, Germany) Chao, S., Lotfi, J., Lin, B., Shaw, J., Jhandi, S., Mahoney, M., Singh, B., Nguyen, L., Halawi, H., Geng, L. N. 2022

  Abstract

  Diagnostic programs and second opinion clinics have grown and evolved in the recent years to help patients with rare, puzzling, and complex conditions who often suffer prolonged diagnostic journeys, but there is a paucity of literature on the clinical characteristics of these patients and the efficacy of these diagnostic programs. This study aims to characterize the diagnostic journey, case features, and diagnostic outcomes of patients referred to a team-based second opinion clinic at Stanford.Retrospective chart review was performed for 237 patients evaluated for diagnostic second opinion in the Stanford Consultative Medicine Clinic over a 5 year period. Descriptive case features and diagnostic outcomes were assessed, and correlation between the two was analyzed.Sixty-three percent of our patients were women. 49% of patients had a potential precipitating event within about a month prior to the start of their illness, such as medication change, infection, or medical procedure. A single clear diagnosis was determined in 33% of cases, whereas the remaining cases were assessed to have multifactorial contributors/diagnoses (20%) or remained unclear despite extensive evaluation (47%). Shorter duration of illness, fewer prior specialties seen, and single chief symptom were associated with higher likelihood of achieving a single clear diagnosis.A single-site academic consultative service can offer additional diagnostic insights for about half of all patients evaluated for puzzling conditions. Better understanding of the clinical patterns and patient experiences gained from this study helps inform strategies to shorten their diagnostic odysseys.

  View details for DOI 10.1515/dx-2022-0029

  View details for PubMedID 35596123

• The ENHANCE-AF Clinical Trial to Evaluate an Atrial Fibrillation Shared Decision-Making Pathway: Rationale and Study Design. American heart journal Baykaner, T., Pundi, K., Lin, B., Lu, Y., DeSutter, K., Lhamo, K., Garay, G., Nunes, J. C., Morin, D. P., Sears, S. F., Chung, M. K., Paasche-Orlow, M. K., Sanders, L. M., Bunch, T. J., Hills, M. T., Mahaffey, K. W., Stafford, R. S., Wang, P. J. 2022

  Abstract

  Shared decision making (SDM) may result in treatment plans that best reflect the goals and wishes of patients, increasing patient satisfaction with the decision-making process.  There is a knowledge gap to support the use of decision aids in SDM for anticoagulation therapy in patients with atrial fibrillation (AF). We describe the development and testing of a new decision aid, including a multicenter, randomized, controlled, 2-arm, open-label ENHANCE-AF clinical trial (Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AF Stroke Prevention) to evaluate its effectiveness in 1,200 participants.Participants will be randomized to either usual care or to a shared decision-making pathway incorporating a digital tool designed to simplify the complex concepts surrounding AF in conjunction with a clinician tool and a non-clinician navigator to guide the participants through each step of the tool. The participant-determined primary outcome for this study is the Decisional Conflict Scale, measured at 1 month after the index visit during which a decision was made regarding anticoagulation use. Secondary outcomes at both 1 and 6 months will include other decision making related scales as well as participant and clinician satisfaction, oral anticoagulation adherence, and a composite rate of major bleeding, death, stroke, or transient ischemic attack. The study will be conducted at four sites selected for their ability to enroll participants of varying racial and ethnic backgrounds, health literacy, and language skills. Participants will be followed in the study for 6 months.The results of the ENHANCE-AF trial will determine whether a decision aid facilitates high quality shared decision making in anticoagulation discussions for stroke reduction in AF. An improved shared decision-making experience may allow patients to make decisions better aligned with their personal values and preferences, while improving overall AF care.

  View details for DOI 10.1016/j.ahj.2022.01.013

  View details for PubMedID 35092723

• Training Internal Medicine Residents in Difficult Diagnosis: A Novel Diagnostic Second Opinion Clinic Experience. Journal of medical education and curricular development Testa, S., Joshi, M., Lotfi, J., Lin, B., Artandi, M., Chiang, K. F., Chang, K., Singh, B., Geng, L. N. 2022; 9: 23821205221091036

  Abstract

  Background: In primary care clinics, time constraints and lack of exposure to highly complex cases may limit the breadth and depth of learning for internal medicine residents. To address these issues, we piloted a novel experience for residents to evaluate patients with puzzling symptoms referred by another clinician.Objective: To increase internal medicine residents' exposure to patients with perplexing presentations and foster a team-based approach to solving diagnostically challenging cases.Methods: During the academic year 2020-2021, residents participating in their 2-week primary care "block" rotation were given protected time to evaluate 1-2 patients from the Stanford Consultative Medicine clinic, an internist-led diagnostic second opinion service, and present their patients at the case conference. We assessed the educational value of the program with resident surveys including 5-point Lickert scale and open-ended questions.Results: 21 residents participated in the pilot with a survey response rate of 66.6% (14/21). Both the educational value and overall quality of the experience were rated as 4.8 out of 5 (SD 0.4, range 4-5; 1:"very poor"; 5:"excellent"). Residents learned about new diagnostic tools as well as how to approach complex presentations and diagnostic dilemmas. Residents valued the increased time devoted to patient care, the team-based approach to tackling difficult cases, and the intellectual challenge of these cases. Barriers to implementation include patient case volume, time, and faculty engagement.Conclusions: Evaluation of diagnostically challenging cases in a structured format is a highly valuable experience that offers a framework to enhance outpatient training in internal medicine.

  View details for DOI 10.1177/23821205221091036

  View details for PubMedID 35372696

• Shifting our stance for current COVID-19 outbreaks: A global response to an international pandemic. Journal of global health Obra, J. K., Lin, B., Palaniappan, L., Kim, G. S. 2021; 11: 03123

  View details for DOI 10.7189/jogh.11.03123

  View details for PubMedID 34956633

  View details for PubMedCentralID PMC8684779

• Achieving Equity in Asian American Healthcare: Critical Issues and Solutions. Journal of Asian health Obra, J. K., Lin, B., Đoàn, L. N., Palaniappan, L., Srinivasan, M. 2021; 1 (1)

  Abstract

  Equity is a fundamental goal of the US health care system. Asians comprise 6% of the US population, and 60% of the world's population. Less than 1% of National Institutes of Health funding is directed toward Asian health. Asian health outcomes are often worse than non-Hispanic Whites (NHWS) in America. Increasing federal and foundation resources and funding toward Asian health research could illuminate these risks and develop precision interventions to reduce known health disparities. When disaggregated by race/ethnicity, Asian health risks are even more apparent. Here, we discuss critical health outcome differences between the six major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) comprising 80% of the US Asian population, highlighting demographic, pharmacologic, disease prevalence, and mortality outcomes. We then outline seven critical issues contributing to Asian American health disparities, including aggregated Asian health data, undersampling, invalid extrapolations, underrepresentation in clinical trials, lack of funding and awareness of disparities, and the model minority myth. Building on the successes of national public health initiatives, we propose nine leverage points to improve Asian American health including the following: obtaining disaggregated Asian health data, improved Asian health research (oversampling Asians, improving clinical trial participation, and increasing research funding), stakeholder collaboration (national and with Asian nations), community engagement, providing culturally precise health care, and expansion of the Asian American research ecosystem. Achieving health equity takes deliberate practice and does not occur by accident. By addressing critical issues that perpetuate Asian health disparities, we grow closer to understanding how to effectively improve Asian health and build a nationally unified mindset toward action that emphasizes equitable care for all.

  View details for DOI 10.59448/jah.v1i1.3

  View details for PubMedID 37872960

  View details for PubMedCentralID PMC10593109

• MACHINE LEARNING CLUSTERING FOR BLOOD PRESSURE VARIABILITY: VALIDATION FROM THE SPRINT TO THE HONG KONG COMMUNITY COHORT Tsoi, K., Chan, N., Yiu, K., Poon, S., Ho, K., Lin, B. LIPPINCOTT WILLIAMS & WILKINS. 2021: E69

  View details for Web of Science ID 000672599900181

• Precision Public Health Matters: An International Assessment of Communication, Preparedness, and Coordination for Successful COVID-19 Responses. American journal of public health Sales, C., Kim, Y., Kim, G., Lin, B., Palaniappan, L. 2021; 111 (3): 392–94

  View details for DOI 10.2105/AJPH.2020.306129

  View details for PubMedID 33566659

• Disaggregated Mortality from Gastrointestinal Cancers in Asian Americans: Analysis of United States Death Records. International journal of cancer Huang, R. J., Sharp, N., Talamoa, R., Kapphahn, K., Sathye, V., Lin, B., Srinivasan, M., Palaniappan, L. P. 2021

  Abstract

  Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003-2017, we report age-standardized mortality rates, standardized mortality ratios, and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver, and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/ijc.33490

  View details for PubMedID 33527405

• Blood Thinners for Atrial Fibrillation Stroke Prevention. Circulation. Arrhythmia and electrophysiology Pundi, K., Baykaner, T., True Hills, M., Lin, B., Morin, D. P., Sears, S. F., Wang, P. J., Stafford, R. S. 2021: CIRCEP120009389

  View details for DOI 10.1161/CIRCEP.120.009389

  View details for PubMedID 34111936

• Resonant vibration of the sinonasal cavities for the treatment of nasal congestion. International forum of allergy & rhinology Khanwalkar, A., Johnson, J., Zhu, W., Johnson, E., Lin, B., Hwang, P. H. 2021

  View details for DOI 10.1002/alr.22877

  View details for PubMedID 34355851

• Shifting our stance for current COVID-19 outbreaks: A global response to an international pandemic JOURNAL OF GLOBAL HEALTH Obra, J., Lin, B., Palaniappan, L., Kim, G. S. 2021; 11

  View details for DOI 10.7189/jogh.11.03123

  View details for Web of Science ID 000731629200001

• A Speech Test to Assess Mask Efficacy 43rd Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) Parameswaran, K., Lin, B. 2021
• Achieving Equity in Asian American Healthcare: Critical Issues and Solutions Journal of Asian Health Obra, J., Lin, B., Doan, L., Palaniappan, L., Srinivasan, M. 2021; 1 (1)
• Increased Self-Reported Racial/Ethnic Discrimination and Concern for Physical Assault Due to the COVID-19 Pandemic in Chinese, Vietnamese, Korean, Japanese, and Filipino Americans Journal of Asian Health Ha, S. K., Nguyen, A. T., Sales, C., Chang, R. S., Ta, H., Srinivasan, M., Chung, S., Palaniappan, L., Lin, B. 2021; 1 (1)
• A Summary of the 2020 Gastric Cancer Summit at Stanford University. Gastroenterology Huang, R. J., Koh, H., Hwang, J. H., Summit Leaders, Abnet, C. C., Alarid-Escudero, F., Amieva, M. R., Bruce, M. G., Camargo, M. C., Chan, A. T., Choi, I. J., Corvalan, A., Davis, J. L., Deapen, D., Epplein, M., Greenwald, D. A., Hamashima, C., Hur, C., Inadomi, J. M., Ji, H. P., Jung, H., Lee, E., Lin, B., Palaniappan, L. P., Parsonnet, J., Peek, R. M., Piazuelo, M. B., Rabkin, C. S., Shah, S. C., Smith, A., So, S., Stoffel, E. M., Umar, A., Wilson, K. T., Woo, Y., Yeoh, K. G. 2020

  View details for DOI 10.1053/j.gastro.2020.05.100

  View details for PubMedID 32707045

• Machine Learning Clustering for Blood Pressure Variability Applied to Systolic Blood Pressure Intervention Trial (SPRINT) and the Hong Kong Community Cohort. Hypertension (Dallas, Tex. : 1979) Tsoi, K. K., Chan, N. B., Yiu, K. K., Poon, S. K., Lin, B., Ho, K. 2020: HYPERTENSIONAHA11914213

  Abstract

  Visit-to-visit blood pressure variability (BPV) has been shown to be a predictor of cardiovascular disease. We aimed to classify the BPV levels using different machine learning algorithms. Visit-to-visit blood pressure readings were extracted from the SPRINT study in the United States and eHealth cohort in Hong Kong (HK cohort). Patients were clustered into low, medium, and high BPV levels with the traditional quantile clustering and 5 machine learning algorithms including K-means. Clustering methods were assessed by Stability Index. Similarities were assessed by Davies-Bouldin Index and Silhouette Index. Cox proportional hazard regression models were fitted to compare the risk of myocardial infarction, stroke, and heart failure. A total of 8133 participants had average blood pressure measurement 14.7 times in 3.28 years in SPRINT and 1094 participants who had average blood pressure measurement 165.4 times in 1.37 years in HK cohort. Quantile clustering assigned one-third participants as high BPV level, but machine learning methods only assigned 10% to 27%. Quantile clustering is the most stable method (stability index: 0.982 in the SPRINT and 0.948 in the HK cohort) with some levels of clustering similarities (Davies-Bouldin Index: 0.752 and 0.764, respectively). K-means clustering is the most stable across the machine learning algorithms (stability index: 0.975 and 0.911, respectively) with the lowest clustering similarities (Davies-Bouldin Index: 0.653 and 0.680, respectively). One out of 7 in the population was classified with high BPV level, who showed to have higher risk of stroke and heart failure. Machine learning methods can improve BPV classification for better prediction of cardiovascular diseases.

  View details for DOI 10.1161/HYPERTENSIONAHA.119.14213

  View details for PubMedID 32594794

• Pharmacogenomics in Asian subpopulations and impacts on commonly prescribed medications. Clinical and translational science Lo, C. n., Nguyen, S. n., Yang, C. n., Witt, L. n., Wen, A. n., Liao, T. V., Nguyen, J. n., Lin, B. n., Altman, R. B., Palaniappan, L. n. 2020

  Abstract

  Asians as a group comprise of over 60% the world's population. There is an incredible amount of diversity in Asian and admixed populations that has not been studied in a pharmacogenetic context. The known pharmacogenetic differences in Asians subgroups generally represent previously known variants that are present at much lower or higher frequencies in Asians compared to other populations. This review aims to summarize the main drugs and known genes that appear to have differences in their pharmacogenetic properties in certain Asian populations. Evidence based guidelines and summary statistics from the Food and Drug Administration (FDA) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) were analyzed for ethnic differences in outcomes. Implicated drugs included commonly prescribed drugs such as warfarin, clopidogrel, carbamazepine, and allopurinol. The majority of these associations are due to Asians more commonly being CYP2C19 poor metabolizers and carriers of the HLA-B*15:02 allele. The relative risk increase seen ranged between genes and drugs but could be over 100x more likely in Asians such as the 172x increase in risk of SJS and TEN with carbamazepine use amongst HLA-B*15:02 carriers. The effects ranged from relatively benign reactions such as reduced drug efficacy to severe cutaneous skin reactions. These reactions are severe and prevalent enough to warrant pharmacogenetic testing and appropriate changes in dosing and medication choice for at risk populations. Further studies should be done on Asian cohorts to more fully understand pharmacogenetic variants in these populations to understand how such differences may influence drug response.

  View details for DOI 10.1111/cts.12771

  View details for PubMedID 32100936

• Cryosurgical posterior nasal tissue ablation for the treatment of rhinitis Hwang, P. H., Lin, B., Weiss, R., Atkins, J., Johnson, J. WILEY. 2017: 952–56

  Abstract

  Endoscopic posterior nasal nerve (PNN) resection has been described as an efficacious surgical treatment of allergic and nonallergic rhinitis, but the requirement for surgery under general anesthesia has limited its acceptance. We report the first series of patients treated for chronic rhinitis using a novel device designed for office-based cryosurgical ablation of the PNN.Twenty-seven patients with chronic rhinorrhea and/or nasal congestion for >3 months were recruited (allergic or nonallergic rhinitis), with minimum rhinorrhea and/or congestion subscores of 2 as part of the Total Nasal Symptom Score [TNSS]). Under local anesthesia, the cryotherapy device was applied endoscopically to the posterior middle meatus and was used to freeze the PNN region bilaterally. Patients were followed up after 7, 30, 90, 180, and 365 days to assess TNSS.The procedure was successfully completed in 100% of patients, with no complications; 74% reported no or mild discomfort by the first postprocedure day. TNSS was reduced significantly at 30 days (mean ± standard deviation: 6.2 ± 0.5 at baseline, 2.6 ± 0.3 at 30 days, n = 27, p < 0.001), with continued reduction at 90 (2.7 ± 0.4, n = 24, p < 0.001), 180 (2.3 ± 0.5, n = 21, p < 0.001), and 365 days (1.9 ± 0.3, n = 15, p < 0.001). Both rhinorrhea and congestion subscores decreased significantly at 30, 90, 180, and 365 days compared to baseline (p < 0.001). Allergic and nonallergic subcohorts both appeared to benefit from treatment.Office-based cryotherapy of the PNN region is safe and well tolerated. Symptom scores were significantly decreased by 7 days postprocedure and remained lower at 30, 90, 180, and 365 days.

  View details for PubMedID 28799727

• Visualizing ablation gaps in vitro using a deflectable fiber optic endocardial visualization catheter JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY Irani, A. R., Lin, B., Eversull, C., Hsia, H. H., Zei, P. C., Wang, P. J., Al-Ahmad, A. 2009; 25 (2): 107-110

  Abstract

  The efficacy of pulmonary vein isolation for the treatment of atrial fibrillation may be limited by the ability to make continuous and transmural lesions utilizing an ablation catheter. Gaps often persist between ablation lesions leading to failed electrical isolation and thus failed ablation. Recently, a deflectable fiberoptic endocardial visualization catheter has been introduced for use in imaging the coronary sinus using light in the visible spectrum. We utilize this catheter to visualize the endocardial surface and examine radiofrequency ablation lesions in porcine endocardium to determine the presence of gaps between radiofrequency lesions.Videos were taken of the lesions and shown to two readers who were asked to identify the gaps ranging from less than 0.1 mm-9.8 mm.Ninety-four lesion gaps were reviewed. The readers demonstrated a combined accuracy of 98.4% at identifying gaps.Gaps between ablation lesions can be accurately identified down to less than 1 mm distances in vitro using a direct visualization catheter. Further studies are warranted to confirm these finding in vivo.

  View details for DOI 10.1007/s10840-008-9338-7

  View details for Web of Science ID 000267683500004

  View details for PubMedID 19148727

• Direct Visualization of Cardiac Radiofrequency Ablation Lesions JOURNAL OF CARDIOVASCULAR TRANSLATIONAL RESEARCH Eversull, C. S., Lin, B., Irani, A. R., Quigley, M. L., Mourlas, N. J., Hsia, H. H., Zei, P. C., Al-Ahmad, A., Wang, P. J. 2009; 2 (2): 198-201

  Abstract

  Effective ablation of atrial fibrillation and other cardiac arrhythmias requires precise catheter navigation and controlled delivery of energy to cardiac tissue. In this study, we summarize our initial experience using a fiber optic direct visualization catheter to evaluate and guide placement of endocardial radiofrequency (RF) ablation lesions. RF lesions were created in cadaveric porcine hearts and examined in a blood-filled field using a direct visualization catheter. Direct visualization of RF lesions was repeated in vivo using an ovine model. Lesions and interlesion gaps were clearly identifiable using the direct visualization catheter. It was possible to place lesions in proximity to anatomical landmarks and in relation to one another. Catheter-generated images correlated well with lesion appearance on gross examination. Direct catheter-based visualization is a feasible technique for guiding RF lesion placement, estimating lesion size, and identifying interlesion gaps. Future work is needed to correlate surface appearance with transmurality and electrical isolation.

  View details for DOI 10.1007/s12265-009-9094-9

  View details for Web of Science ID 000284690100010

  View details for PubMedID 20559988

• A New Approach for ICD Rhythm Classification based on Support Vector Machines Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society Kamousi, B., Tewfik, A., Lin, B., Al-Ahmad, A., Hsia, H., Zei, P., Wang, P. IEEE. 2009: 2478–2481

  Abstract

  Inappropriate shocks due to misclassification of supraventricular and ventricular arrhythmias remain a major problem in the care of patients with Implantable Cardioverter Defibrillators (ICDs). The purpose of this study was to investigate the ability of a new covariance-based support vector machine classifier, to distinguish ventricular tachycardia from other rhythms such as supraventricular tachycardia. The proposed algorithm is applicable on both single and dual chamber ICDs and has a low computational demand. The results demonstrate that suggested algorithm has considerable promise and merits further investigation.

  View details for Web of Science ID 000280543601357

  View details for PubMedID 19964965

• Dynamic Time Warping: A novel algorithm for rhythm discrimination in ICDs Kamousi, B., Lin, B., Lee, G., Ai-Ahmad, A., Hsia, H. H., Zei, P. C., Wang, P. J. ELSEVIER SCIENCE INC. 2008: A14

  View details for Web of Science ID 000253997100059

• Visualizing ablation gaps in vitro using a deflectable fiber optic endocardial visualization catheter Irani, A. R., Lin, B., Eversull, C., Wang, P. J., Al-Ahmad, A. ELSEVIER SCIENCE INC. 2008: A8

  View details for Web of Science ID 000253997100035

• A Covariance-Based Algorithm: A Novel Technique for Rhythm Discrimination in ICDs 30th Annual International Conference of the IEEE-Engineering-in-Medicine-and-Biology-Society Kamousi, B., Lin, B., Al-Ahmad, A., Hsia, H., Zei, P., Natale, A., Moss, A., Daubert, J., Zareba, W., Wang, P. IEEE. 2008: 5478–5481

  Abstract

  Inappropriate shocks due to misclassification of supraventricular and ventricular arrhythmias remain a major problem in the care of patients with Implantable Cardioverter defibrillators (ICDs). In this study we have investigated the ability of a new covariance-based algorithm, to distinguish Ventricular Tachycardia from other rhythms such as Supraventricular Tachycardia. The proposed algorithm has a low computational demand and with a small adjustment is applicable on both single-chamber and dual-chamber ICDs. The results are promising and suggest that the new covariance-based algorithm may be an effective method for ICD rhythm classification and may decrease inappropriate shocks.

  View details for Web of Science ID 000262404503170

  View details for PubMedID 19163957

• Feasibility Testing of Novel Ablation Catheter-based Temperature Measurement Device Cardiostim 2008 Bryant Lin MD, Ronald Lo MD, Z Cheng MD, Manuela Kuehnel, Peter van der Sluis, Henry H. Hsia MD, Paul C. Zei MD PhD Paul J Wang MD, Amin Al-Ahmad MD 2008
• Novel Method to Assess Gap Distance Between Ablation Lesions Featured Poster Heart Rhythm Society Lin BY, Eversull C, Chen H, Hsia H, Al-Ahmad A 2006
• Extraction of buried P waves from printed electrocardiograms ANNALS OF NONINVASIVE ELECTROCARDIOLOGY Lin, B., Wang, P. J., Mahapatra, S., Homoud, M., Link, M., Estes, N. A., Al-Ahmad, A. 2005; 10 (2): 142-145

  Abstract

  Morphologic identification of ectopic P-waves from surface ECGs can be challenging, particularly when the P-wave is buried in the QRST wave complex. Because ECGs are often available on paper and not digitally, we developed a method of subtracting the T-wave from the buried P-wave complex on paper ECGs.To validate our system, an atrial extrastimulus was introduced during and following the T-wave. The ECGs were scanned and then transformed from an image format to a digital format. A computer algorithm digitally subtracted a QRST with no buried P-wave from one with a buried P-wave, thus resulting in an extracted P-wave. The extracted P-waves were compared to the nonburied P-wave by determining correlation coefficients and by visual grading by two independent reviewers.Visual grading comparing the buried P-wave with the exposed paced P-wave was 94%. The median correlation coefficient was 85%.An ectopic atrial P-wave obscured by a coincident QRST wave complex can be accurately derived from printed ECG using this PC-based system. Addition of this technique to the existing methods may aid in the localization and ablation of ectopic atrial foci.

  View details for Web of Science ID 000228826100004

  View details for PubMedID 15842425

• Contractile actin expression in torn human menisci WOUND REPAIR AND REGENERATION Lin, B. Y., Richmond, J. C., Spector, M. 2002; 10 (4): 259-266

  Abstract

  The human meniscus is subject to injury that necessitates repair or removal. Many aspects of the cellular response to injury have not been well characterized. The purpose of this study was to describe the cellular distributions within the torn human meniscus. In addition to evaluating the cell density in selected regions, we investigated the cellular expression of a contractile actin isoform that has recently been found in the intact human meniscus. Included as a contemporaneous comparative group were torn human meniscal allografts. We hypothesized that a hypercellular surface zone would be found in the torn menisci, with a higher percentage of cells in this peripheral region expressing alpha-smooth muscle actin compared with other locations in the interior of the remnant. The rationale for this hypothesis was based on prior immunohistochemical investigations of the distribution of alpha-smooth muscle actin-containing cells in the torn human anterior cruciate ligament. Eighteen torn meniscal specimens were obtained from 17 patients, 0.5 to 84 months after injury, and four torn allograft meniscal samples were retrieved from three patients, 11 to 49 months after implantation. Microtomed sections of paraffin-embedded tissue were stained with hematoxylin and eosin and a monoclonal antibody to alpha-smooth muscle actin. The cell density and percentage of cells containing alpha-smooth muscle actin were determined in the following zones: synovial, vascular, hypercellular with loose collagen, hypocellular with dense collagen, and organized collagen. A cellular layer that resembled synovium was present on the surface of all but two of the specimens. Vascular regions were often continuous with the synovium abutting the more interior loose collagen zones. The total cell density was greatest in each of the zones closest to the periphery (synovium, vascular, and loose collagen; p < 0.001), when compared to the interior of the tissue. The synovium-like layer was found to have the highest percentage of alpha-smooth muscle actin-expressing cells and the highest alpha-smooth muscle actin-containing cell density (p < 0.05). Similar results were found for the torn allograft menisci. These findings confirm the working hypothesis and suggest that the torn human meniscus is capable of mounting a reparative response, including the proliferation of cells capable of contributing to wound closure. This underscores the importance of providing a bridging scaffold into which such cells can migrate.

  View details for Web of Science ID 000177543900010

  View details for PubMedID 12191009

• Changes in Physical and Biochemical Properties of Cartilage in the Guinea Pig Spontaneous OA Model are Consistent with Hypertrophic Remodeling Transactions of the Orthopaedic Research Society Lin BY, Sebern EL, Frank EH, Dube N, Grodzinsky AJ 1998; 23: 130
• Design and Testing of a Wearable Device to Detect Leg Position in Patients with Edema IEEE Eng Med Biol Soc Sharma, K., Sathye, V., Gole, S., Lin, B. 2018
• Association Between Financial Literacy and Diabetes and Hypertension Control among US Adults SGIM Annual Yank, V., Lin, B., Loftus, P., Agarwal, S., Rehkopf, D. 2018: S124

  View details for DOI 10.1007/s11606-018-4413-y