- Critical Care Medicine
Clinical Assistant Professor, Anesthesiology, Perioperative and Pain Medicine
Fellowship: Massachusetts General Hospital Critical Care Anesthesia Fellowship (2020) MA
Residency: Stanford University Anesthesiology Residency (2019) CA
Medical Education: Stanford University School of Medicine (2015) CA
- Nutrition in critically ill patients with COVID-19: Challenges and special considerations. Clinical nutrition (Edinburgh, Scotland) 2020; 39 (7): 2327–28
What's in a Word? Qualitative and Quantitative Analysis of Leadership Language in Anesthesiology Resident Feedback.
Journal of graduate medical education
2019; 11 (1): 44–52
Individuals who have agentic traits (eg, assertive, confident, competent) that are more commonly associated with men are often selected for leadership roles. For women, this poses a potential barrier to entry into the higher ranks of academic medicine.We analyzed anesthesiology resident feedback for differences in the use of agentic descriptors using qualitative and quantitative methods based on resident gender and year of training.This study uses textual analysis of 435 assessments of residents over a 1-year period within a single residency program. We performed a qualitative content analysis on the words used in resident feedback and performed negative binomial regression analyses to determine significant differences in the way residents were described based on gender and year of training.Female residents were less likely than male residents to be described as agentic after controlling for excerpt length, year of training, and evaluator variability (β = -0.347; 95% confidence interval [CI] -0.666, -0.028; P = .033). Senior residents were more likely to be described as agentic (β = 0.702; 95% CI 0.402-1.002; P < .001) compared to junior residents. The increased number of agentic codes among senior residents was driven by increased agentic description of female residents' ratings in the senior cohort (β = 0.704; 95% CI 0.084-1.324; P = .026).Female residents were described as agentic less often than male residents in early years of training, but the gap was not present among senior residents.
View details for DOI 10.4300/JGME-D-18-00377.1
View details for PubMedID 30805097
View details for PubMedCentralID PMC6375319
- Surviving and THRIVE-ing the difficult airway: gaining calm, control, and time during an emergent tracheostomy. Journal of Head & Neck Anesthesia 2017; 2 (2): 23-27
Induced-anxiety differentially disrupts working memory in generalized anxiety disorder.
2016; 16: 62
Anxiety is characterized by a bias towards threatening information, anxious apprehension, and disrupted concentration. Previous research in healthy subjects suggests that working memory (WM) is disrupted by induced anxiety, but that increased task-demand reduces anxiety and WM is preserved. However, it is unknown if patients with generalized anxiety disorder (GAD) can similarly normalize their performance on difficult WM tasks while reducing their anxiety. Increased threat-related bias and impoverished top-down control in trait anxiety suggests that patients may not reap the same cognitive and emotional benefits from demanding tasks that those low in anxiety. Here we examine this possibility using a WM task of varying difficulty.GAD patients (N = 30) and healthy controls (N = 30) performed an n-back task (no-load, 1-back, 2-back, and 3-back) while at risk for shock (threat) or safe from shock (safe). Anxiety was measured via startle reflex and self-report.As predicted, healthy controls' performance was impaired under threat during low-load tasks and facilitated during high-load tasks. In contrast, GAD patients' performance was impaired under threat regardless of WM load. Anxiety was reduced as cognitive load increased in both groups.The divergence of emotion regulation (reduction) and performance (persistent impairment) in the patient but not the control group, suggests that different top-down mechanisms may be operating to reduce anxiety. Continued WM disruption in patients indicates that attentional resources are allocated to emotion regulation instead of goal-directed behavior. Implications for our understanding of cognitive disruption in patients, and related therapeutic interventions are discussed.
View details for DOI 10.1186/s12888-016-0748-2
View details for PubMedID 26976146
View details for PubMedCentralID PMC4791753
The Association of Nurse-to-Patient Ratio with Mortality and Preventable Complications Following Aortic Valve Replacement.
Journal of cardiac surgery
2014; 29 (2): 141-148
To examine hospital resources associated with patient outcomes for aortic valve replacement (AVR), including inpatient adverse events and mortality.We used the Nationwide Inpatient Sample to identify AVR procedures from 1998 to 2010 and the American Hospital Association Annual Survey to augment hospital characteristics. Primary outcomes included mortality and the development of adverse events, identified using standardized patient safety indicators (PSI). Patient and hospital characteristics associated with PSI development were evaluated using univariate and multivariate analyses.An estimated 410,157 AVRs at 5009 hospitals were performed in the US between 1998 and 2010. The number of procedures grew annually by 4.72% (p = 0.0003) in high volume hospitals, 4.48% in medium volume hospitals (p < 0.0001), and 2.03% in low volume hospitals (p = 0.154). Mortality was highest in low volume hospitals, 4.70%, decreased from 4.14% to 3.73% in medium and high volume hospitals, respectively (p = 0.0002). Rates of PSIs did not vary significantly across volume terciles (p = 0.254). Multivariate logistic regression analysis showed low volume hospitals had increased risk of mortality as compared with high volume hospitals (odds ratio [OR]: 1.42; 95% confidence interval [CI]: 1.01 to 2.00), while hospital volume was not associated with adverse events. PSI development was associated with small hospitals as compared with large (OR: 1.63, 95% CI: 1.16 to 2.28) and inversely associated with higher nurse-to-patient ratio (OR: 0.94, 95% CI: 0.90 to 0.99).The volume-outcomes relationship was associated with mortality outcomes but not postoperative complications. We identified structural differences in hospital size, nurses-to-patient ratio, and nursing skill level indicative of high quality outcomes.
View details for DOI 10.1111/jocs.12284
View details for PubMedID 24417274
The complex interaction between anxiety and cognition: insight from spatial and verbal working memory.
Frontiers in human neuroscience
2013; 7: 93
Anxiety can be distracting, disruptive, and incapacitating. Despite problems with empirical replication of this phenomenon, one fruitful avenue of study has emerged from working memory (WM) experiments where a translational method of anxiety induction (risk of shock) has been shown to disrupt spatial and verbal WM performance. Performance declines when resources (e.g., spatial attention, executive function) devoted to goal-directed behaviors are consumed by anxiety. Importantly, it has been shown that anxiety-related impairments in verbal WM depend on task difficulty, suggesting that cognitive load may be an important consideration in the interaction between anxiety and cognition. Here we use both spatial and verbal WM paradigms to probe the effect of cognitive load on anxiety-induced WM impairment across task modality. Subjects performed a series of spatial and verbal n-back tasks of increasing difficulty (1, 2, and 3-back) while they were safe or at risk for shock. Startle reflex was used to probe anxiety. Results demonstrate that induced-anxiety differentially impacts verbal and spatial WM, such that low and medium-load verbal WM is more susceptible to anxiety-related disruption relative to high-load, and spatial WM is disrupted regardless of task difficulty. Anxiety impacts both verbal and spatial processes, as described by correlations between anxiety and performance impairment, albeit the effect on spatial WM is consistent across load. Demanding WM tasks may exert top-down control over higher-order cortical resources engaged by anxious apprehension, however high-load spatial WM may continue to experience additional competition from anxiety-related changes in spatial attention, resulting in impaired performance. By describing this disruption across task modalities, these findings inform current theories of emotion-cognition interactions and may facilitate development of clinical interventions that seek to target cognitive impairments associated with anxiety.
View details for DOI 10.3389/fnhum.2013.00093
View details for PubMedID 23542914
View details for PubMedCentralID PMC3610083
Distinct contributions of human hippocampal theta to spatial cognition and anxiety.
2012; 22 (9): 1848–59
Current views of the hippocampus assign this structure, and its prominent theta rhythms, a key role in both cognition and affect. We studied this duality of function in humans, where no direct evidence exists. Whole-head magnetoencephalographic (MEG) data were recorded to measure theta activity while healthy participants (N = 25) navigated two virtual Morris water mazes, one in which they risked receiving aversive shocks without warning to induce anxiety and one in which they were safe from shocks. Results showed that threat of shock elevated anxiety level and enhanced navigation performance as compared to the safe condition. MEG source analyses revealed that improved navigation performance during threat was preferentially associated with increased left septal (posterior) hippocampal theta (specifically 4-8 Hz activity), replicating previous research that emphasizes a predominant role of the septal third of the hippocampus in spatial cognition. Moreover, increased self-reported anxiety during threat was preferentially associated with increased left temporal (anterior) hippocampal theta (specifically 2-6 Hz activity), consistent with this region's involvement in mediating conditioned and innate fear. Supporting contemporary theory, these findings highlight simultaneous involvement of the human hippocampus in spatial cognition and anxiety, and clarify their distinct correlates.
View details for DOI 10.1002/hipo.22019
View details for PubMedID 22467298
View details for PubMedCentralID PMC3390451
Describing the interplay between anxiety and cognition: from impaired performance under low cognitive load to reduced anxiety under high load.
2012; 49 (6): 842–52
Anxiety impairs the ability to think and concentrate, suggesting that the interaction between emotion and cognition may elucidate the debilitating nature of pathological anxiety. Using a verbal n-back task that parametrically modulated cognitive load, we explored the effect of experimentally induced anxiety on task performance and the startle reflex. Findings suggest there is a crucial inflection point between moderate and high cognitive load, where resources shift from anxious apprehension to focus on task demands. Specifically, we demonstrate that anxiety impairs performance under low load, but is reduced when subjects engage in a difficult task that occupies executive resources. We propose a two-component model of anxiety that describes a cognitive mechanism behind performance impairment and an automatic response that supports sustained anxiety-potentiated startle. Implications for therapeutic interventions and emotional pathology are discussed.
View details for DOI 10.1111/j.1469-8986.2012.01358.x
View details for PubMedID 22332819
View details for PubMedCentralID PMC3345059