Inova Fairfax Medical Campus DEPARTMENT OF MEDICINE and Research... · 2017-10-18 · DEPARTMENT OF MEDICINE QUALITY PROGRAM PG 16 ... building on our relationship with nursing units

Inova Fairfax Medical Campus

DEPARTMENT OF MEDICINE

A N N UA L R E PORT2016

Acknowledgements:

We would like to thank the following Beatty Liver & Obesity Research Program team membersfor their valuable contributions and excellent work in developing this annual report:

Puneetinder Kaur MannTrevor GogollCarey EscheikLeyla de AvilaMina Younossi

Vision2020

Individualized Wellness

PopulationHealth

PersonalizedMedicine

CULTURE

INOVABRAND IT

MESSAGE FROM THE DEPARTMENTAL LEADERSHIP PG 2

DEPARTMENT OF MEDICINE VISION AND GOALS PG 4

DIVISION OF HOSPITAL MEDICINE PG 5

DIVISION OF MEDICAL CRITICAL CARE SERVICES PG 8

DEPARTMENT OF MEDICINE CLINICAL PROGRAMS PG 10

DEPARTMENT OF MEDICINE QUALITY PROGRAM PG 16

DEPARTMENT OF MEDICINE CLINICAL SECTIONS PG 17

DEPARTMENT OF MEDICINE EDUCATION PROGRAMS PG 18

DEPARTMENT OF MEDICINE PHYSICIAN COMMUNICATION PROGRAM PG 22

DEPARTMENT OF MEDICINE GROUP PHOTO PG 27

DEPARTMENT OF MEDICINE RESEARCH PROGRAMS PG 28

DEPARTMENT OF MEDICINE & BEATTY LIVER & OBESITY RESEARCH PROGRAMS PG 29

BEATTY LIVER & OBESITY RESEARCH PROGRAM – SCIENTIST SUMMARIES PG 32

BEATTY LIVER & OBESITY RESEARCH PROGRAM – TEAMS PG 39

BEATTY LIVER & OBESITY RESEARCH PROGRAM GROUP PHOTO PG 45

DEPARTMENTAL ACADEMIC PRODUCTIVITY PG 46

TABLE OF CONTENTS

MESSAGE FROM THE DEPARTMENTAL LEADERSHIP

We are proud to report that the Department of Medicine (DOM) has continued its

productive journey to provide excellent high quality clinical care in an academic

environment. In this context, DOM’s di�erent programs and divisions have shown

tremendous growth and productivity. Furthermore, DOM takes pride in championing and

promoting a culture of justice and trust with highly engaged and productive teams.

2016 was a productive year for the quality and general medicine programs in the

Department of Medicine. Despite a large volume of patients, the Inova Fairfax Hospital

medicine hospitalist team, under the leadership of Dr. Ashiq Mannan, continued to

provide the highest level of care to hospitalized patients as manifested by one of the

lowest mortality rates in the country. The hospitalist team also developed an internal

governance structure called the “hospitalist executive committee” to further

improve engagement of the hospitalist team. Finally, the CNS hospitalist

team, directed by Dr. Brigid Gray, once separate from the DOM, merged with

the adult medicine hospitalist team. We believe we will be able to capitalize

on the power in numbers while still supporting a group of hospitalists with

expertise in neurologic diseases and relationships with neurologists and

neurosurgeons.

In 2016, the team worked hard to bridge the gap between hospitalist operations and nursing unit quality measures

by assigning hospitalists to lead key nursing units in partnership with the clinical directors. This partnership between

physicians, nurses, and other ancillary services has already paid dividends in unit-based quality measures and has

given our hospitalists experience in leadership.

Our quality program, led by Dr. Rishi Garg, has pioneered integrating “just culture”

principles into the peer review process. By doing so, we hope to encourage more near

miss reporting and to thoroughly investigate systems, problems, and processes rather

than individuals.

In the upcoming year, we anticipate further solidifying the merger with the CNS hospitalist

team, enhancing the cardiac hospitalist program, development of a medicine consult

service, building on our relationship with nursing units by implementing dyad medical

director models, and permeating the DOM with just culture principles. Finally, in order to

achieve sustained success, we will be working on a model of daily work that promotes

hospitalist retention and alleviates burnout.

In addition to our hospitalists, our medical specialties have seen much

growth and progress in 2016. While each of our medical directors will

provide details about their own areas, we would like to briefly summarize

some of the accomplishments in these areas. Dr. Denise Mohess has

taken over the geriatrics program and the inpatient program continues to

provide a robust inpatient service. Dr. Mohess has also been developing

the outpatient portion of geriatrics care to our community. Palliative

care, under the leadership of Dr. Jessica Heintz, continues to grow

and has successfully added inpatient hospice beds to their services. In addition, they have taken the

lead on bringing Schwartz Rounds to our campus, which has been well received by our health care

professionals. For rheumatology, Dr. Lynn Gerber has been involved in growing the program.

CHAIR, DEPARTMENTOF MEDICINE

Zobair, Younossi, MD, MPHChair, Department of MedicineVice President for Research,Inova Health System

ACADEMIC AFFAIRS ANDMEDICAL SUB-SPECIALTIES

Madeline Erario, MDVice Chair, Academic A�airsand Medical Sub-SpecialtiesDirector, Graduate Medical Education, Inova Health System

Department of Medicine 2016 Annual Report 2

Department of Medicine 2016 Annual Report

Additionally, Dr. Ramona Raya continues to manage all of our inpatient rheumatology

consults here at Inova Fairfax Medical Campus (IFMC). The outpatient side has added a

second rheumatologist who plans to provide one day of inpatient service here at IFMC.

Endocrinology continues to thrive under the leadership of Dr. Stephen Clement and we

hope to commence the anticipated clinical research program. The Coronary Care Unit

(CCU) restructuring overseen by the director, Dr. Behnam Tehrani, has been a great

success as our patients receive continuous cardiology coverage and our house sta�

benefit from their teaching and expertise. Finally, our medical critical care services

(MCCS), under the direction of Dr. Albert Holt, continues to care for patients in four adult

units across our campus and their ongoing participation in patient safety and quality

initiatives has been superb. With the leadership of our medical directors and our section

chiefs, we will continue to develop our programs and service lines in order to

provide the best care to our patients.

Finally, on our academic side, we are extremely proud of our young, highly

successful internal medicine residency program which is directed by Dr. Alita

Mishra. We now have our full complement of PGY 1, 2, and 3 residents, totaling

27 in all. In 2016, we watched our first PGY 3 class successfully match in

fellowship programs while others are considering job opportunities. Currently, we are anxiously awaiting the

match results to welcome in our next class of interns. We continue to educate numerous residents and students

from our a�liates, and we are thankful for our talented teaching faculty both from Inova Medical Group and our

private practice colleagues.

The Department of Medicine continues to provide superb clinical service, both for general medicine and specialty

medicine. Our teaching programs are exemplary and our research programs continue to be one of the strongest on

the campus. We look forward to continued growth and success as we all work to improve the lives of our patients

and educate the next generation of physicians.

MESSAGE FROM THE DEPARTMENTAL LEADERSHIP

QUALITY ANDGENERAL MEDICINE

Chapy Venkatesan, MDVice Chair, Quality andGeneral Medicine

A RDepartment of Medicine 2016 Annual Report 3

DEPARTMENT OF MEDICINE VISION AND GOALS

VISION

The Department of Medicine at Inova Fairfax Medical

Campus (IFMC) will be recognized as a leader in

delivering compassionate and personalized patient care

by ensuring innovative and superior medical services for

its patients and community. We will continue to train

future physicians and create an environment that will

attract and retain highly talented physicians and sta�. We

will integrate cutting-edge research into our clinical

practice and educational activities.

GOALS

1) Clinical and Quality – Become a national leader in delivering high quality, evidence-based personalized care

that provides the highest value to our patients.

2) Education – Develop a top-tier Internal Medicine Residency Program and fellowship programs to ensure the

development and retention of highly qualified physicians.

3) Safety – Improve the culture of safety in the department and Inova by implementing principles of a just culture.

4) Research – Develop a patient-focused research portfolio including clinical, translational, and health services

research.

5) Reputation, Growth, and Development – Expand the depth and reputation of the Department of Medicine

programs and services to better integrate and support Inova’s vision, and to be recognized for clinical excellence

by patients, physicians, sta�, and the community.

6) Physician Relations – Develop the best physician team which will provide collaborative opportunities with hospi-

tal and community-based physicians allowing us to develop and achieve quality and growth objectives despite

location of employment.

7) Fundraising and Philanthropy – Collaborate and enhance philanthropic e�orts for the Department of Medicine

in order to fund research, education, and clinical programs.



MEDICAL HOSPITALISTSAshiq Mannan, MDMedical Director of the Medical Hospitalist Program

During 2016, the Department of Medicine Hospitalist Program continued to experience tremendous growth with an increase in patient volume by ~20%. We worked hard to become more e�cient and streamlined to continue to make significant progress in optimizing the quality of our patient care while at the same time being more productive. This past year we have focused e�orts on standardizing our workflow processes, especially surrounding rounding and discharges. Specifically, we have taken our two main daily existing rounding processes – bedside rounds and multi-disciplinary rounds, and have tried to make them as useful and consistent as possible.

Our daily bedside trio rounds include the patient / family, nursing, and physician all together at the bedside. This is a great opportunity on daily basis to ensure there are no gaps in communication and to review plan of care and any safety items. We review why the patient is in the hospital, why they need to stay in the hospital and care plan, when to anticipate discharge and what exactly the expected discharge needs are. At this time we also review important safety issues such as DVT prophylaxis, lines, foley catheters, and fall risk. If there are issues with patient comprehension for whatever reason and the family is not available at the bedside, we will call the designated family contact to review.

Our daily multi-disciplinary rounds occur in central locations on our main nursing units and along with physician and nursing teams, including case management. Often various other care team members including physical therapy (PT) / occupational therapy (OT), pharmacy, etc., are also present. During these rounds, we review the plan of care, discharge timing, and the needs for each patient. This process is begun as soon as possible upon admission and the entire care team prepares together to create the best possible discharge plan. This is another opportunity to raise and address any potential safety or patient care issues.

By having a standardized systematic approach each day to our patient care and improving the quality of existing workflow processes and communication among the entire care team, we are trying to e�ciently improve our throughout, patient care quality and safety, decrease readmissions, and improve overall patient experience. We have also spent considerable time and e�ort in creating ideal state models of further growth including the optimal use of mid-levels, nurse navigators, and pharmacy techs as part of our care team to help us prepare and meet the challenges of the future successfully.

Additionally, we have continued to try to optimize our communication among each other in the hospital including our specialists and outside referring physicians by making use of TigerText, a HIPPA compliant 2‐way cell phone messaging system. Please contact our o�ce at 703‐776‐3582 if would like help to obtain TigerText access and be able to communicate with our hospitalist team directly.

I am fortunate to be able to work with Drs. Sam Elgawly and Paul Weisbruch (Associate Medical Directors), Dr. Anne Summers (Medical Director of the Cardiac Hospitalist Program), and Dr. Brigid Gray (Medical Director of the CNS Hospitalist Program) who are all very devoted to making our group as successful as possible and helping us meet the needs of our community and hospital.

DIVISION OF HOSPITAL MEDICINE



CARDIAC HOSPITALISTSAnne Summers, MDAssociate Chief Medical O�cer, Inova Fairfax Medical CampusMedical Director of the Cardiac Hospitalist Program

The Cardiac Hospitalist Program continues to serve patients in the Inova Heart and

Vascular Institute (IHVI) since November 2014. This service is sta�ed by a small core

group of hospitalists comprised of one teaching and three rounding teams that provide

consistency and improved communication with cardiologists, pulmonologists, advanced

heart failure physicians, advanced lung disease physicians, vascular surgeons, and

cardiac surgeons in the joint care of these complex patients. Patient throughput has been

a major focus of 2016 with enhanced MDR’s (multi-disciplinary rounds) supported by psychological safety of honest,

open, and compassionate discussion of barriers regarding transitions of care from the acute care setting to the next

level of care. Engaging all team

members, including residents,

hospitalists, bedside nurses,

nursing leadership, clinical case

managers, discharge planners,

and navigators has been

paramount to the improvement of

Hospital Consumer Assessment

of Healthcare Providers and

Systems (HCAHPS) scores, safety

surrogates, and hospital-acquired

conditions.

The team is led by cardiologist

and Associate Chief Medical

O�cer, Dr. Anne Summers, who

is a liaison with the cardiology

section and many of the

specialists within IHVI. Collegial,

patient-first, and teamwork are

paramount to the mission of

delivering guideline driven and advanced therapies to this critically ill patient population. The Cardiac Bundle

Program continues to help drive better processes and protocols in the heart failure and myocardial infarction cohorts.

The patient advancement program (PAP) is an ongoing initiative to help with the transition from CCU to PCCU with

248 patient touches in 2016, allowing patients to meet providers that will help with education of disease state,

medication, and alerts that patients can monitor at home.



CNS HOSPITALISTSBrigid Gray, MDMedical Director of the CNS Hospitalist Program

The CNS (central nervous system) Hospitalist or Neuro Hospitalist Program at Inova

Fairfax Medical Campus (IFMC) was created in 2010. The team provides specialized

care for neurology and neurosurgery patients 24 hours a day, 7 days a week. The CNS

team triages and accepts neuroscience transfer patients from outside hospitals

providing care that patients are not able to obtain at outside facilities. In combination

with radiation oncology, neurosurgery and other neurologic specialists, the team brings

together many best practices on both the neuroscience and stroke units.

The CNS hospitalists conduct daily discharge rounds with the nursing and case

management leadership to ensure that transition of care is satisfactorily accomplished.

Dr. Brigid Gray is the Medical Director of the CNS Hospitalist Program. She had previously served as Director of

Primary Care Services at the Northern Virginia Mental Health Institute. Under her experienced leadership the CNS

team hopes to continue to improve and provide excellent care for all neuroscience patients.



DIVISION OF MEDICAL CRITICAL CARE SERVICES

MEDICAL CRITICAL CARE SERVICES Albert Holt, MDSystem Medical Director for Adult Critical CareMedical Director for Medical Critical Care Services at Inova Fairfax Medical Campus

Medical Critical Care Services (MCCS) is a collaborative team of intensivist physicians and

mid-level providers that provide support to the critical care services throughout the

hospital, and specifically in the Neurosciences ICU (NSICU), the Medical-Surgical ICU

(MSICU), the Cardiovascular ICU (CVICU), and the Coronary Care Unit (CCU) at Inova

Fairfax Medical Campus (IFMC). This includes being the priority responders to all MSETs

and Rapid Response Team (RRT) calls in the hospital. All of our e�orts have been

successful because our team of physicians and mid-level providers work together to ensure that we provide the best

and safest care to critically ill patients at IFMC.

In 2016, in response to the growth in patient volume and complexity that we have seen in the four ICUs that we

support at IFMC, we added six new intensivists and two new nurse practitioners to our team.

Our team has supported both hospital and system-wide initiatives. We had several members of our team contributing

to the most productive system-wide sprint of 2016. The team developed a process for early identification and prompt

management of patients with severe sepsis and septic shock. These e�orts were coordinated with a team of Epic

programmers and clinical e�ectiveness analysts in order to develop tools for use by clinicians throughout Inova.

This multi-disciplinary endeavor involved physicians, nurses, pharmacists, respiratory therapists, programmers,

and analysts.

The MSICU, led by Dr. Svetolik Djurkovic, continued to improve the approach to care for patients requiring

mechanical ventilation. This included consistent support of evidence-based measures of spontaneous awakening

and spontaneous breathing trials, which resulted in continued low ventilator days and the liberation of patients from

mechanical ventilation when they had recovered from their respiratory illnesses. We also saw a dramatic reduction

in the use of inhaled nitric oxide, as evidence grew in support of alternative means of oxygenation and ventilation for

critically ill patients when standard ventilator strategies fail. Drs. Megan Terek and Mehul Desai presented the work

that was done in conjunction with Dr. Christopher King on these ECMO patients at the Society of Critical Care’s

annual meeting in January 2017.

To that end, our team in the CVICU expanded the ECMO program to record levels of patients and survival rates on

both V-V ECMO and V-A ECMO that mirrored and surpassed national standards, which is exceptional for a nascent

program. In 2017, we anticipate further growth and use of ECMO though the system as our e�orts are support by the

Inova eICU. Dr. Rachel Hinerman provided the leadership for our ECMO initiative to identify and establish timely

access and management for ECMO patients.

Our team in the Inova Heart and Vascular Institute (IHVI) has supported the successful deployment of an aggressive

cardiogenic shock program that utilizes the latest technology with Impella, VADs and other devices and techniques

to provide patients with the best opportunity for myocardial salvage and improved quality of life. In 2017, we expect

to report on the outcomes that are being achieved with these e�orts.


Our team in the NSICU has grown dramatically with seven neuro-intensivists in support of a daily patient census that

averages over twenty patients. They have provided care for a record number of intracranial and subarachnoid

hemorrhages, complicated stroke patients (that frequently require neuro-interventional thrombectomy and

neurosurgical hemicraniectomy), as well as hundreds of post-operative craniotomy patients.

Dr. Osman Malik has developed an improved process for peer review through collaboration and education. He has

also participated as the Medical Director for MCCS Quality, which has involved numerous initiatives to ensure

appropriate clinical care, and particularly, for the transfer of critically ill patients to IFMC.

Dr. Terek has taken on the responsibility of leading our teaching e�orts among mid-level providers and house sta�

and has led the e�orts to update and improve the MSET and RRT teams at IFMC.

In 2017, our team will continue to strive to expand our skills in the use of ultrasound and echocardiography in

the assessment of critically ill patients, develop greater skills in airway and pharmacological management of

patients requiring mechanical ventilator support and sedation, as well as test new technologies in measuring

brain oxygenation, perfusion and other important physiologic parameters to ensure the best outcomes for our

critically ill patients.

DIVISION OF MEDICAL CRITICAL CARE SERVICES


DEPARTMENT OF MEDICINE CLINICAL PROGRAMS

THE DEPARTMENT OF MEDICINE AND TRANSITIONS OF CAREJohn Paul Verderese, MDMedical Director of Transitions of Care

E�orts to improve care transitions continue to draw a great deal of focus nationwide as

the reimbursement model for healthcare shifts from a fee-for-service to fee-for-value

system. The Department of Medicine (DOM) continues to lead this realm of quality

improvement at Inova Fairfax Medical Campus (IFMC) and throughout the entire Inova

Health System.

Inova Transitional Services Transitional Care Management Program (TCM) and Inova

Transitional Services Clinics (ITSC) in partnership with Inova VNA Home Health, all under the medical direction of Dr.

Verderese, have evolved to form the “collective” hub for post-acute transitional care support for patients serviced by

the health system that are the highest risk for re-hospitalization and often the highest utilizers. Particular attention has

been given to Medicare patients with heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and

myocardial infarction, as well as patients that fall into Medicare’s Bundled Payment for Care Improvement Initiative.

Inpatient physicians, nurses, case managers, and diagnosis-specific navigators can e�ectively hand o� inpatient

cases to this complimentary multi-disciplinary ambulatory team that continues to serve any needs patients may have.

All three programs share a common mission to serve the uninsured and pride themselves on the continued service

provided for patients in need in Northern Virginia.

ITSC now has four clinics geographically situated to

serve all Inova hospitals with sites in Fairfax,

Herndon, Leesburg, and now Alexandria. Clinics are

sta�ed with physicians, nurse practitioners, nurses,

pharmacists, podiatrists, and psychiatrists – all

specialized in caring for the most complex patients

on a medical and psychosocial level. In addition to

recently hospitalized patients without access to

primary care, the ITSC also services Inova ERs so

that patients can be given expedited follow-up as

an alternative to a hospital admission. ITSC also has

an anti-coagulation clinic and performs

pre-operative evaluations. ITSC is a favorite site

among residents and students and anticipates the

additional support by IFMC Chief Medical Residents

in the 2017 academic year.

ITSC has certainly proven its e�ectiveness, as the observed over expected (O/E) readmission rates for TCM and ITSC

in 2016 were 0.63 (9.9%) and 0.53 (6.4%), respectively. The volume of patients enrolled continue to rise yearly, as the

TCM program enrolled approximately 4,100 patients and ITSC performed almost 9,000 patient encounters last year.

Goals for 2017 include promoting these wrap-around services to patients in addition to the standard care they

receive from existing primary care physicians and specialists. The ultimate goal is to improve their overall quality of

care and experience at Inova.


DEPARTMENT OF MEDICINE INPATIENT DIABETES AND ENDOCRINOLOGY CONSULTATIVE SERVICESStephen Clement, MDMedical Director of Endocrinology Services

We experienced steady growth in demand for our endocrinology inpatient diabetes

and consultative services. Average monthly patient encounters grew significantly: 168,

182, and 366 per month for the years 2014, 2015 and 2016, respectively (P < 0.0001 for

trend). This growth allowed the endocrinology consult service to hire an additional

endocrinologist, an internist, a physician assistant, and a part-time community

endocrinologist. As the needs of the consult service grew, the role of the

endocrinologist-led team expanded to include perioperative diabetes management and comprehensive

discharge planning for patients with diabetes. The spectrum of problems addressed were diabetes (77%), adrenal

(4%), pituitary (6%), hyponatremia (4%), thyroid (6%), and other

metabolic problems (3%). The subgroup of patients with a diagnosis

of diabetes that were seen by the consult service had a reduced

30-day readmission rate (9.46% vs. expected rate of 13.9%) during a

4 month observation period.

The result of our work has made us a regional referral center for

complex endocrine problems. It is now routine that patients are

transferred to Inova Fairfax Medical Campus (IFMC) from

neighboring hospitals because of our expertise in endocrinology.

Inova Endocrinology NetworkSince 2014 Inova has grown the manpower for endocrinologist care

from two FTEs to nine. We all work together to provide continuity

between the outpatient and inpatient environment.

ResearchWe are finalizing negotiations with a major corporate provider of

insulin to conduct a “real-world” demonstration project using digital

devices and communication to advance adherence in patients with

diabetes. The study will use a cloud-connected glucose meter that

sends data in real time to a community nurse coordinator. The nurse

coordinator will act as the patient’s diabetes coach to encourage

adherence. The anticipated start of this project is May 2017.




PALLIATIVE MEDICINE AND COMPREHENSIVE CAREJessica Heintz, MDMedical Director of Palliative Care

Ongoing goals:

1) Expansion of clinical services to meet the needs

2) Mentorship for hospitalists and critical care partners

3) Strategic collaboration with selected units

4) Submission for grant funding to expand key initiatives

5) Submit work for publication

2016 was a year of continued growth for our team, and we continue to recruit high performing, experienced clinicians

to meet this need. We continue to partner with various service lines, and in 2016, began bi-weekly co-rounding with

Medical Critical Care Teams in the medical and surgical intensive care unit (MSICU). This led to an earlier

identification of patients in need of palliative care and helped with the coordination of family meetings. The result is

a 68% increase in referrals for ICU patients.

As our hospital-based volume grew, we also

recognized the increasing need for

outpatient palliative care. To this end we

successfully made the case for and began

recruiting for a Medical Director of Palliative

Medicine for the Inova Schar Cancer Institute

(ISCI). Dr. Jean Paul Pinzone will be joining

ISCI from the National Institutes of Health

(NIH) Pain and Palliative Care Service.

Additionally, Dr. Denise Mohess was named

System Medical Director for Advanced Illness

and Geriatric Programs and began strategic

planning for non-oncology outpatient

palliative care.

Dr. Heintz led a regional collaboration of hospice agencies and Fairfax County Fire and Rescue (FCFR) to analyze and

create solutions for the emergency care needs of hospice patients. The group explored reasons why hospice

patients call 911 and looked at gaps in care contributing to unwanted ER visits and hospitalizations. New strategies

for helping patients remain at home include: the creation of standardized “Crisis Care Plans” and a regional

educational e�ort for FCFR sta� on hospice and end of life education. The group is seeking grant funding for this

innovative partnership.

Mary Wheeler, NP (nurse practitioner) published Primary Palliative Care for Every Nurse Practitioner in the Journal

for Nurse Practitioners; Nov-Dec Vol. 12,Issue 10, PP: 647-653. We encourage all to read and share with your

advanced practice nurses (APNs) and physician assistants (PAs).


l collaboration of hospice agencies and Fairfax County Fire and Rescion of hospice agencies an

e emergency care needs of hospice patients. The group explorency

oked at gaps in care contributing to unwanted ER visits and hospitagap

emain at home include: the creation of standardized “Crisis Careat

CFR sta� on hospice and end of life education. The group is seekista

se practitioner) publishedpra Primary Palliative Care for Every Nurse Pr

; Nov-Dec Vol. 12,Issue 10, PP: 647-653. We encourage all to reav-D

ses (APNs) and physician assistants (PAs).Ns

Lastly, palliative care is a comprehensive, coordinated approach to serious illness which aims to improve quality

of life by:

• Providing expertise to optimize physical, psychosocial, and spiritual su�ering.

• Exploring all treatment options, including impact on disease trajectory, quality of life, and life expectancy.

• Assisting in understanding and documenting goals of care, including advance care planning and

facilitating a comprehensive plan to these ends across the care continuum.

• Providing expertise in communication that incorporates the unique needs, including native language,

cultural norms, health literacy, and other needs, such as of the individual patient and family to discuss

di�cult information, including prognosis.




GERIATRICS INTEGRATIVE CARE SERVICEDenise Mohess, MDSystem Medical Director for Advanced Illness and Geriatric Programs

2016 was a very dynamic year for the geriatric service line. Denise Mohess, MD became the Section Chief of Geriatrics and the System Medical Director for Advanced Illness and Geriatric Programs in December 2016. In addition, in collaboration with the population health program, we launched outpatient geriatric services.

The Inpatient Geriatrics Consult Service The consult service added new members to the team in 2016. Sangeetha Shan-Bala, MD joined the Department of Medicine (DOM) as the new Medical Director for Inpatient Geriatrics Consult Service, Keiko Kuykendall and Suvi Hyytiainen as nurse practitioners, and Anna Lea as the program manager.

This team provided care to over 1,350 patients in 2016. There has been continued increase in the number of new consults with the highest number of 359 seen in the last quarter of the year. The inpatient geriatrics consult service continues to be a standard rotation site for pharmacy students, internal medicine residents, and psychiatry residents. It continues to be a popular elective rotation for medicine students and nurse practitioner students. In addition, there has been an increased di�usion of geriatric consults to the inpatient psychiatry unit. We are currently engaged in initiatives on collaborating with hospitalists, nurses, and the Hospital Elder Life Program (HELP) to decrease falls and delirium.

The Geriatrics Grand Rounds This is a continuing medical education (CME) multi-disciplinary rounds that is held the 4th Wednesday of the month from January through October. Attendees include healthcare professionals from many disciplines that provide care to elderly patients, such as physicians, nurses, rehabilitations services, psychiatry from Inova, population health, and the community. This CME provides interesting topics which focus on caring for elderly patients with one CME credit being available after attending.

The Geriatric Assessment Clinic The clinic is a multi-disciplinary consultative clinic designed to provide a resource for both patients and primary care providers to help evaluate medical conditions in the elderly. Eligibility includes a person’s age (i.e., 65 years and over). Common reasons for evaluation include: concerns about memory, function, mood, medication management, fall risk, and advanced care planning. A follow-up visit to the Geriatric Assessment Clinic can also be arranged to assess for improvement after the implementation of recommendations.

The Advanced Illness Clinic The clinic will serve as a medical home to our most medically complex patients who require more time and services than the typical primary care o�ces can o�er. These patients tend to have multiple comorbidities, multiple medications, high risk of emergency visits, and avoidable hospitalizations. Through relationship-centered care we will have the opportunity to develop a plan of care consistent with their goals and values for quality of life. Outpatient palliative care consult services will be available for patients with advanced stages of disease in need of symptom management and advanced care planning.

The Inova House Calls Program The program is an interdisciplinary team of providers (physicians, nurse practitioners, and social workers) poised to provide comprehensive biopsychosocial primary care services for homebound patients with advanced and complex illness.

The Geriatric Psychiatry Clinic The clinic assists in the management of age-related cognitive impairment, dementia, dementia-related neurobehavioral comorbidities, mood disorders, anxiety disorders, neuropsychiatric disorders, substance abuse in the elderly, and medication induced neuropsychiatric disorders.


Clinic a medical home to our most medically complex patients who requirehome to our most medicallyry care o�ces can o�er. These patients tend to have multiple �ces can o�er. These pof emergency visits, and avoidable hospitalizations. Through relatioency to develop a plan of care consistent with their goals and values for eloservices will be available for patients with advanced stages of diseas wnced care planning.ca

ProgramProgrdisciplinary team of providers (physicians, nurse practitioners, andrdiscsive biopsychosocial primary care services for homebound patiee b

ry Clinicthe management of age-related cognitive impairment, demna

RHEUMATOLOGY CONSULT SERVICELynn Gerber, MDSection Chief of RheumatologyDirector of Research, Department of Medicine

The rheumatology section of the Department of Medicine consists of the administrative

section chief and two clinical rheumatologists who serve in the inpatient and outpatient

settings. The inpatient service manages: consultative services and patients with

complicated rheumatic conditions, including systemic vasculitis, lupus, and

inflammatory arthritis. The inpatient rheumatologist provides consultative support to all

Inova physicians for challenging diagnostic problems pertaining to rheumatic disease

and connective tissue disorders. The outpatient rheumatologist providing consultation and management delivers

comprehensive care for rheumatological and non-inflammatory conditions, with special interest in osteoarthritis

and osteoporosis.

There were several noteworthy 2016 accomplishments achieved by the rheumatology section. Inova Fairfax

Medical Campus (IFMC) became an approved site for a drug trial in scleroderma and recruitment began in 2016.

This e�ort is collaboration between the advanced lung disease and rheumatology service lines and the

rheumatologists are sub-principal investigators on this study evaluating the e�cacy of oral nintedanib treatment

in scleroderma patients with interstitial lung disease.

Inova rheumatology section members have

attended national meetings, presented

talks at resident educational sessions,

including medical and obstetrical /

gynecological residents. Throughout the

year, the rheumatologists work closely with

the medical students and residents as they

rotate through the clinic and hospital

teaching them concepts in rheumatology.

The rheumatology section has also hosted

journal clubs for community rheumatolo-

gists. The club meets quarterly and serves

as a rheumatology section meeting and

opportunity to discuss upcoming clinical

trials and patient management.



DEPARTMENT OF MEDICINE QUALITY PROGRAM

DEPARTMENT OF MEDICINE QUALITYRishi Garg, MDMedical Director of Quality, Compliance, and Documentation

In 2016, the Department of Medicine’s (DOM) Quality and Safety Team continued to make

great strides towards our goal of providing our patients with the highest quality care, and

for our practitioners, a just place to work. In 2016, we reviewed 530 cases referred to us

via Safety Always, Patient Relations, or other departments, and 91 of these cases were

referred for practitioner peer review as appropriate.

We have revamped our processes in Internal Medicine Peer Review to align ourselves

more with the “Just Culture” principles. Specifically, we have: 1) blinded the committee from the outcome to limit any

potential for outcome bias; 2) separated the event investigation from the adjudication of a case; and 3) interviewed

the practitioner involved prior to the scoring in order to provide the committee with his / her perspective at the time

of discussion. All of these steps have provided for a more transparent and just approach to Peer Review and we

anticipate implementation of these principles in the remaining DOM Peer Review Committees. In addition to these

improvements, several other departments in our hospital and other Inova operating units have sought our advice for

their respective Peer Review Committees.

We also worked with the Inova Fairfax Medical Campus’ (IFMC) Medical Records Department in identifying and

verifying their reports to ensure all practitioners were given adequate notification regarding medical records and

delinquencies and were not just inappropriately placed on suspension.

On the documentation side, the DOM

hospitalists and intensivists continued

their working collaboration with the

Clinical Documentation Improvement

Team to attain a 95% query response rate.

The DOM continues to be up-to-date

with the Joint Commission's mandate

for Ongoing Professional Practice

Evaluation (OPPE). We have continued

to enlist the assistance of our

sub-specialty section chiefs to identify

and report out on various quality metrics

specific to each section.

Lastly, we participated in the “United for Patient Safety” week and submitted a poster presentation on our Just

Culture Peer Review initiative. We also helped arrange a three-day Just Culture certification course for all of the

Inova operating units that took place in January 2017.


pp

ssion's mandatema

ssional Practice actic

e have continued tinue

stance of our of

chiefs to identify o

us quality metrics alit

n.

in the “United for Patient Safety” week and submitted a poster pin th

nitiative. We also helped arrange a three-day Just Culture certificative

that took place in January 2017.ok

Pictured in the front row, from left to right, are: Eric Libre, MD (Pulmonology), Madeline Erario, MD (Vice Chair, Academic A�airs and Medical Subspecialties),

Zobair Younossi, MD (Chair, Department of Medicine and VP for Research, IHS),Chapy Venkatesan, MD (Vice Chair, Quality and General Medicine),

and Lynn Gerber, MD (Rheumatology)

Pictured in the back row, from left to right, are: Richard Rosenthal, MD (Allergy and Immunology), Svetolik Djurkovic, MD (Critical Care),John Paul Verderese, MD (General Internal Medicine), Ranjit Cheriyan, MD (Nephrology),

Nahrain Alzubaidi, MD (Endocrinology), Dipti Patel-Donnelly, MD (Hematology / Oncology),Albert Kim, MD (Cardiovascular Disease), and Stacy Oshry, MD (General Internal Medicine)

DEPARTMENT OF MEDICINE CLINICAL SECTIONS


DEPARTMENT OF MEDICINE EDUCATION PROGRAMS

DEPARTMENT OF MEDICINE EDUCATION PROGRAMSAlita Mishra, MDDirector of EducationProgram Director for the Internal Residency Program

Department of Medicine (DOM) Education Programs

The Educational Programs in the DOM are thriving under Dr. Younossi’s leadership. 2016

was the first year where we had the full complement of our Internal Medicine residents.

We have a class of nine for each of the three years of Internal Medicine residency training.

Despite the youth of our residency program, we have been able to recruit top tier medical

students to come to train with us at Inova Fairfax Medical Campus (IFMC). The

enthusiasm, support, and dedication to teaching and mentorship of our faculty members in general medicine,

hospital medicine, pulmonary medicine, infectious diseases, gastroenterology, cardiology, nephrology,

rheumatology, endocrinology, hematology, oncology, and critical care have been outstanding. Our core curriculum

foundation is based on inpatient training on our inpatient wards, critical care units, and continuity clinics at Inova

Medical Group primary care clinics. We are able to augment and individualize electives to include all Internal

Medicine sub-specialties and also have a focus on quality improvement, procedural training, residents as teachers,

ambulatory medicine, and scholarly activities. We also tailor exposure to women’s health, o�ce-based orthopedics

and dermatology clinics, neurology, and geriatrics. Our residents are a crucial part of the rapid response team at

IFMC. In addition, the residents also rotate through the Transitional Care Clinic and help in our e�orts to keep

vulnerable patients out of the hospital. Our residents have felt welcome and enjoyed the opportunity of being able

to work directly with the faculty experts during their required and elective rotations. All of our residents have faculty

mentors in their areas of interest and in addition, some of our residents are also pursuing research. In partnership

with the National Institutes of Health (NIH), we have successfully had three of our residents’ complete rotations in

oncology and rheumatology at the NIH and plan to send additional residents in the upcoming year.

This year was also our first year for fellowship match for our soon to be graduates. We are delighted to report that

both of our residents got their top choice in their chosen specialty. Dr. Nina Badoe is headed to University of

Louisville School of Medicine for a cardiology fellowship. Dr. Eleni Footman is headed to Cornell University Program

for Geriatrics. Additionally, our chief resident Dr. Shelley Kon is headed to University of Colorado for an infectious

diseases fellowship.

Complementing a robust clinical training, we also provide ample opportunities for scholarly and quality improvement

activities. Please see the list of scholarly work done by our residents in 2016 at the end of this report, which is quite

impressive for our small program. In addition, our internal medicine residents present and lead all of our monthly

interdisciplinary Medicine-Pathology-Radiology conferences and monthly Morbidity and Mortality/Patient Safety

conference. They also run weekly resident reports and get many opportunities to teach their peers and medical

students. With regards to quality improvement, currently, they are working on four key quality improvement

initiatives: 1) hand hygiene, 2) minimizing interruptions and improving communications across health care teams, 3)

high quality discharge appointments, and 4) know your doctor projects.


st clinical training, we also provide ample opportunities for scholarly aaining, we also provide am

e list of scholarly work done by our residents in 2016 at the end of tho

ll program. In addition, our internal medicine residents present andm.

ine-Pathology-Radiology conferences and monthly Morbidity and ho

run weekly resident reports and get many opportunities to teach we

s to quality improvement, currently, they are working on four keto q

ene, 2) minimizing interruptions and improving communications acroene, 2

appointments, and 4) know your doctor projects.oin

Some of our residents and faculty are also very involved in the American College of Physicians (ACP). The Virginia

chapter of ACP recently had their annual meeting. Our department was represented very well at the meeting. Dr.

Homan Wai received the ACP Virginia Young Internist Award. Dr. Ivan Garcia received the Attending of the Year

Award – he was voted by our residents for being an outstanding teacher, clinician, and mentor. Residents

recognized him as someone who sets

the bar high for them. In addition,

congrats to our residents, Drs. Larry

Istrail and Anly Tsang for being the

select few residents across the state,

chosen for oral podium presentations

out of hundreds of resident abstracts.

They both did a phenomenal job and

represented Inova well. In addition, Dr.

Istrail received a third place award in

the research category. Our first year

resident, Dr. Logan Rhea, is one of the

two resident representatives for the

state of Virginia and he moderated

resident day activities with Dr. Eileen

West representing us on the program

committee and Dr. J.P. Verderese was

one of the town hall meeting panelists.

In the midst of a productive academic year, we also received notification from ACGME (Accreditation Council for

Graduate Medical Education) that our very own, Dr. Madeline Erario, will be the recipient of the prestigious Parker J.

Palmer Courage to Lead Award in 2017. This national award honors designated institutional o�cials who have

demonstrated excellence in overseeing residency programs at their sponsoring institutions. Dr. Erario, both as the

Vice Chair of Medicine and the Director of Graduate Medical Education has been monumental in establishing and

expanding residency programs at Inova. We want to extend our hearty congratulations to Dr. Erario for this award.

Continuing Medical Education (CME)

The DOM continues to be a leader in high quality Medical Grand Rounds series. In 2016, we had an impressive

number of our Inova-based physicians as well as national and internationally known experts give important updates

on their areas of expertise. Starting in January 2016, we added monthly Inova Heart and Vascular Institute (IHVI)

Cardiology Grand Rounds and visiting professor series which have brought an impressive caliber of nationally

well-known cardiologists to our institution.

Our annual DOM Research Day was held in May 2016 which included a key note and a number of oral and poster

presentations from DOM scientists and physicians. Our residents Dr. Badoe and Dr. Locklear presented their

research on this day. We also had another successful CME event on Advances in Pulmonary and Critical Care

Medicine in March. This full day symposium included many nationally well-known speakers and cutting edge

advances in pulmonary and critical care medicine. We hope to continue inviting many more speakers in 2017 that can

provide their expertise and education to DOM.




UNDERGRADUATE MEDICAL EDUCATIONHoman Wai, MDMedicine Clerkship Director for Virginia Commonwealth University (VCU)

The Department of Medicine continues to host third and fourth year medical students

from VCU, Georgetown University, and George Washington University for their clerkship

experiences. The clerkship continues to be led by Dr. Homan Wai (Clerkship Director), Dr.

Meena Raj (Associate Clerkship Director and Director of the Acting Internship) and Kristin

Kazem (Academic Administrator). We are proud of the quality medical education our

faculty and clerkship provides for our students.

We are happy to report that following the 2016 site visit, the VCU School of Medicine has obtained full accreditation

for the next eight years. There were no major areas of concern and we have taken their suggestions to make

continual refinement to our educational structure.

In the upcoming academic year, as we focus on growing and strengthening our undergraduate and graduate medical

education programs, we have decided to phase out George Washington and Georgetown students from our

required core clerkships. This will allow us to focus on our VCU Inova campus students and successfully implement

key curricular changes. The changes will be three-fold:

1) We will be adopting a new trainee evaluation system along the lines of a “trust” model, referred to as Entrustable

Professional Activities (EPA). Simply put, at what level do we trust our trainees to perform certain aspects of

patient care? This is in concert with the national project that was started in 2014.

2) We will be using a new exam for knowledge assessment called the “Key Features Exam” by MedU rather than

the traditional “Shelf Exam” developed by NBME. The new exam focuses on more clinically relevant diagnostics

and management and is more in-line with our mission to create good clinicians.

3) We will be making the orientation into a more comprehensive workshop experience where students can refine

their knowledge and skills before the start of the clerkship.




INOVA FAIRFAX MEDICAL CAMPUS INTERNAL RESIDENCY PROGRAM

16 Annual Report

RESIDENT CLASS OF 2017



DEPARTMENT OF MEDICINE PHYSICIAN COMMUNICATION PROGRAM

HEALTH INFORMATION TECHNOLOGYMaruf Haider, MDMedical Director of Clinical Integration

This has been the first full year that our Medicine Informatics Team has been meeting and

sharing technical expertise with each other to support data driven projects. Its members

have been highly productive in producing approximately over 1,000 data and quality

reports for the Department of Medicine (DOM). The team has met its directive to facilitate

DOM collaboration with technology and administrative departments and to streamline

data collecting and reporting. The team hosted several guests during the year to help its

members develop technical expertise such as the Epic Reporting Team. The team also

continues to be available for in-house IT training and consultation, such as with Microsoft Excel / Word programs for

DOM medical directors and sta�, as well as the DOM administrative sta�.

2016 marked the second year for the Med Hospitalist dashboard being integrated into the Oracle database program

which allowed for continued streamlining and data mining capabilities. During the year, all of the Med Hospitalist sta�

was trained on navigating the dashboard, and the dashboard performance metrics were shared at the monthly Med

Hospitalist sta� meetings. Also, using the Oracle database program, an Allied Health Provider Ongoing Professional

Practice Evaluation (OPPE) database was developed and is set for pilot testing in early 2017. This database will be

critical for Joint Commission compliance moving forward and will allow for better data mining and trend reporting.

We are continually looking to improve our own processes to be able to better serve our medical sta� that strives to

decrease adverse events, improve patient-centered outcomes, engage physicians / other providers, and optimize

utilization of resources.


JUST CULTURE INITIATIVEJoseph Hallal, MD

The Department of Medicine (DOM) continued its physician-led, grassroots “Just

Culture” (now known as “Culture of Accountability”) initiative in 2016 led by DOM

quality physician leaders: Chapy Venkatesan, MD (Vice Chair of Quality and General

Medicine) and Rishi Garg, MD (Chair of Internal Medicine Peer Review). The DOM

Culture of Accountability Team (DOMCA Team) accomplished a number of noted

achievements and milestones in 2016, as well as, worked with quality leaders from the

System and Inova Fairfax Medical Campus (IFMC) to help develop a foundation for

future collaboration and knowledge sharing.

In 2016, David Marx, CEO of Outcome Engenuity, which is a preeminent leader in risk management and safety,

visited the IFMC campus to speak to IFMC executives and DOM physician leaders about Just Culture concepts

and algorithms. These could then be used to foster a fair culture and improve overall quality, cost, and employee

satisfaction. In 2016, Dr. Garg began implementing the Culture of Accountability techniques and algorithms

developed by Outcome Engenuity in the IFMC DOM Internal Medicine Peer Review Committee. In addition, Dr.

Garg began using the Workplace Accountability algorithms during coaching sessions in an e�ort to remove

severity bias. As momentum began to grow around the use of Culture of Accountability concepts and algorithms

in the Internal Medicine Peer Review, Osman Malik, MD (Chair of the Medical Critical Care Services (MCCS) at

IFMC), adopted these same techniques and began implementing them into the MCCS Peer Review Committee.

Thus far, both committees’ use of these Culture of Accountability principles has been well received. Additionally,

the DOMCA Team in 2016 was very active in working with the IFMC Grants Management O�ce (GMO) to search

and apply to potential grants to help provide additional resources to aid this ground breaking physician-lead

initiative. Lastly in 2016, the DOMCA Team was proud to have submitted its “Culture of Accountability Peer

Review Initiative” poster to IFMC’s United in Patient Safety Poster Contest, and our poster was well received by

leaders, sta�, and visitors during the poster presentation.

Moving forward in 2017, the DOMCA Team will continue to pursue the DOM becoming a Center of Excellence for

a Culture of Accountability and a model for other hospital systems. The DOM is hoping to implement Workplace

Accountability into all Peer Review Committees in 2017, as well as, send its physician leaders to Outcome

Engenuity certification-training courses. These leaders can then become certified in the Culture of Accountability

and can further develop this initiative in their respective departments and sections. The DOMCA Team will

continue to pursue external grant opportunities to provide additional funding for educational activities and

provide resources so that DOM can be at the forefront of research in regards to Safety and a Culture of

Accountability. This will then lead to robust data for analytics and scholarly publication.




Barry Strauch, MDChair Emeritus and Consultant to the Department of Medicine

Dr. Barry Strauch, in his role as Chair Emeritus of the Department of Medicine (DOM),

continues to use his years of experience and expertise in quality and safety initiatives. He

also utilizes his experience over the past five years as an appointee to the Armstrong

Institute for Safety and Quality at Johns Hopkins and experience with the safety and

quality committee of the Board of Trustees of Johns Hopkins Medicine to continue

monitoring several sections of DOM at Inova Fairfax Medical Campus (IFMC). Dr. Strauch

continues to attend the DOM monthly meeting on the morbidity and mortality conference

as well as the ethics committee of the hospital, which is a committee that is undergoing a

major transformation and assuming a major role in the functioning of the hospital.

DEPARTMENT OF MEDICINE PHYSICIAN LIAISON PROGRAMRichard Binder, MD

The Physician Liaison Program continued in 2016 to interface with the wide variety of

physicians that make up the Department of Medicine (DOM) which include both

community and employed physicians. The program is designed to be a resource and

support to physicians so that they have an avenue for feedback and enhanced

communication. 2015 marked the first full year that the Inova Simulation Center has been

open and continues to be a successful facility used by both community and employed

physicians to refresh and enhance their medical skills, as well as build competence in new

skills. Also, the free standing Internal Medicine Program had its first three classes of

residents and the

presence of these talented residents has

enhanced the quality of care of both inpatients

and outpatients. They continue to be

mentored by voluntary sta�, particularly in the

subspecialty areas, as well as by our hospitalist

teams. In addition, the hope is to develop

specialty fellowships in the near future.

An additional focus has been teaching

medical students and residents the art of

taking a medical history and performing

physical examinations focusing on four

principles. These principles include: 1) asking

the right question to get the right answer; 2)

if you don’t look you won’t see; 3) if you don’t

touch you won’t feel; and 4) if you don’t listen

you won’t hear. The patient is the reason and

focus of all we do.


PATIENT EXPERIENCEDenise Mohess, MDSystem Medical Director for Advanced Illness and Geriatric ProgramsLeader of Patient Experience Initiative for the Department of Medicine

Patient experience in 2016 was all about connecting the behaviors of the care delivery

model to quality and safety, improving e�ciency, and provider and patient experience.

Purposeful rounding, bedside reporting (ISHAPED), the white board, and leader

rounding all have led to standardized processes, and the patient experience team

worked with sta� to ensure that these translated into episodes of care that were

meaningful for the patient, family, and care team.

Every behavior of the care delivery model went up percentage points this year. Although, we only met our

goal in 4 of the 9 HCAHPS composites, every composite saw a rise in ranking, except “responsiveness and

pain management.”

Trio rounding, also known as doctor / nurse /

patient rounding, has been improving all year.

In 2015, of all the patients that returned a

survey, 46% said they had the physician come

in daily with a nurse. In 2016, 63% of all the

patients that returned a survey said they had

the physician come in daily with a nurse. This is

significant growth for a campus the size of

Inova Fairfax Medical Campus (IFMC)! The goal

for 2017 is to reach 80%.

The patient experience team collaborated with

the Department of Medicine (DOM) to

participate in Educational Grand Rounds as well

as Medicine Grand Rounds to have the voice of

patients and providers heard. Residents and

faculty discussed their experiences as patients and / or family members. Meanwhile, patients from our Patient and

Family Advisory Council spoke to providers about their experiences. These sessions allowed patients and

providers to share perspectives and reflections to reinforce partnership and relationship-centered care.

To support the culture of appreciation for sta�, the patient experience team shared stories that exemplify the

Inova Promise: "We Seek Every Opportunity to Meet the Unique Needs of Each Person We Are Privileged to Serve

– Every Time, Every Touch." The Inova Promise stories are the real stories of the amazing actions of our sta�

across campus that is shared weekly with the Administrative Council. Inova sta� is encouraged to go to the

administration board room to share their story with the leaders who then are able to give their appreciation and

regards to the sta� and the teams. The stories come from emails, letters, and phone calls from patients, families,

and even other sta� members.

We look forward to continued collaboration in 2017.




GLOBAL HEALTH RESEARCH AND EDUCATION INITIATIVEIan Shenk, MD

We continue to be actively involved in global health research projects with undergraduate

and graduate students from various a�liated universities to help highlight the major

global health issues present in the world today. We are particularly conscious of the ever

increasing number of global health problems and aware that all health is global health.

We are also especially aware of the socio-political factors that currently compromise our

ability to study and respond to these many issues.

We maintain our desire to educate our community and reinforce our community's

devotion to our global neighbors. These e�orts are reflected in our encouragement and support of global health

educational activities both on our own campus as well as neighboring venues. Many members of our faculty are

connected with international and global health organizations.

The majority of our current research activities are focused on the epidemic of global obesity and its liver-related

sequelae- non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as well as other

co-morbidities present with metabolic syndrome. To date, we have presented our findings at such prestigious

organizations such as Digestive Disease Week (DDW).

A brief list of our ongoing research projects include:

• Global obesity and NAFLD rates from 2010 to 2016;

• Obesity and the correlation with female fertility in developed nations; and

• Global neonatal mortality rates and correlates for the last ten years.


Global Prevalence of Obesity, T2D and Predicted NAFLD; Birerdinc et al. 2015

DEPARTMENT OF MEDICINE GROUP PHOTO


DEPARTMENT OF MEDICINE RESEARCH PROGRAMS


The number of active protocols and research funds make the Department of Medicine Research Programs the most active and well-funded department.

DEPARTMENT OF MEDICINE & BEATTY LIVER & OBESITY RESEARCH PROGRAMS


The Department of Medicine (DOM) continues to boast a varied and innovative research program. The connection

between the bedside and the bench allows our investigators to bring together cutting-edge personalized

research protocols to our patients, institution, and community, as well as o�er research and education

opportunities for our students, residents, and fellows.

The DOM Research Program includes the Beatty Liver & Obesity Research Program (BLORP), Outcomes Research

Program, Liver Pathology Research Program, Diabetes Research Program, and the Infectious Disease Research Program.

BLORP has been involved in obesity and non-alcoholic fatty liver

disease (NAFLD) research. Over the past two decades, there has

been an increase in our understanding of obesity-related NAFLD

and non-alcoholic steatohepatitis (NASH). NASH is the subtype of

NAFLD which can progress to cirrhosis and liver-related mortality. In

the United States, at least one-third of Americans are estimated to

have NAFLD and approximately 6 million have progressed to

NASH.1-3 Consequently, NASH has become the second most

common reason for liver transplants in the United States.4, 5 By 2020,

NASH is expected to become the leading cause for liver transplants

in the United States.6

Our investigators continue to shed new light on NAFLD and NASH by sharing their findings on the world stage.

They have presented at numerous international conferences and written articles which have been published in

reputable peer-reviewed journals. Such exposure adds to the body of research and positions Inova as a major

player in this critical area of investigation.

The BLORP team continues to pioneer clinical and translational research in several chronic liver diseases and

obesity. The following are the core program areas within BLORP and a more detailed description of their aims and

accomplishments will be described later in this report:

• Clinical Trials Research Team – Where numerous phase II and phase III trials in hepatitis C virus (HCV) and

NASH are conducted.

• Liver Pathology Research – Investigators conduct research in the pathogenesis of chronic liver diseases by

providing an accurate assessment of patient clinical samples from participants in translational research.

• Basic Science Laboratory – Techniques such as gene expression technologies, proteomic assays, cell culture,

and immunology assays are used to investigate numerous components of obesity-related liver disease. The

investigators generate original discoveries and pursue clinical trials for new pharmaceutical interventions and

aid in the development of novel biomarkers for the diagnosis and treatment of NAFLD.

• Outcomes Research Program – Detailed quality of life data is accrued and correlated to liver histopathology

and outcome measures to aid in assessing quality of life and functional measures.

• Clinical Genomics Team – In charge of managing a large specimen bio-repository specifically designed to

house -80°C freezers in a temperature controlled environment with backup electricity and a sophisticated

electronic freezer temperature monitoring system.

• Mental / Emotional Health Program – A new program initiative, which was developed to understand the

mechanisms by which mental, emotional, and cognitive dysfunction occur in patients with chronic liver

diseases (CLD), to define the phenotypes of mental, emotion, and cognitive dysfunction in patients with CLD in

order to develop proper diagnostic and psychosocial approaches, and to identify and test interventions likely

to prevent morbidity and restore function.


The sta� includes PhD-trained scientists, data analysts, clinical trial research coordinators, and other research

support sta�. A large number of graduate and undergraduate students are trained at this center. In 2016, the group

has presented more than 95 abstracts and published more than 57 manuscripts in internationally peer-reviewed

journals.

Additionally, the Beatty Liver & Obesity Research Program support sta� members include: Manirath Srishord (Senior

Director); Trevor Gogoll (Director); Deena Hallaji (Executive Assistant); Gerry Rice (Program Manager); Aimal Arsalla

(Program Manager); Puneetinder Kaur Mann (Project Manager & Research Coordinator); Brian Lam, PA-C (Physician

Assistant); Kathy Terra (Nurse); and Pegah Golabi, MD (Research Fellow)

References

1) Younossi ZM et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of

prevalence, incidence, and outcomes. Hepatology. 2016 Jul; 64(1):73-84.

2) Dharel N, Fuchs M (2014) Nonalcoholic Fatty Liver Disease – A Major Public Health Challenge for the 21st

Century. JSM Gastroenterol Hepatol 2(2): 1018.

3) Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of nonalcoholic

steatosis syndromes. Semin Liver Dis. 2001; 21(1) 17-26.

4) Wong et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting

liver transplantation in the United States. Gastroenterology. 2015 Mar; 148(3):547-55.

5) Younossi ZM et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and

Europe. Hepatology. 2016 Nov; 64(5):1577-1586.

6) Wree et al. From NAFLD to NASH to cirrhosis-new insights into disease mechanisms. Nat Rev Gastroenterol

Hepatol. 2013 Nov; 10(11):627-36.


DEPARTMENT OF MEDICINE & BEATTY LIVER & OBESITY RESEARCH PROGRAMSLynn Gerber, MDDirector of Research, Department of Medicine Section Chief of Rheumatology

Dr. Gerber serves as the Director of Research for the Department of Medicine (DOM)

and as the Section Chief of Rheumatology and is internationally known in the field of

rheumatology and rehabilitation medicine. Dr. Gerber brings her vast experience as

former Chief of the Rehabilitation Medicine Department in the Clinical Center of

National Institutes of Health and as University Professor at George Mason University.

She is the former Director of George Mason University’s Center for the Study of Chronic Illness and Disability and

Co-Director of the Laboratory for the Study and Simulation of Human Movement. In addition to her tremendous

clinical and academic accomplishments, Dr. Gerber has been selected as a member of the prestigious National

Academy of Medicine (formerly, Institute of Medicine (IOM)). Election to the IOM, which is considered one of the

highest honors in the fields of health and medicine, places Dr. Gerber among an elite few physicians named each

year, and is a resounding acknowledgement of Dr. Gerber’s outstanding accomplishments as a clinician and

researcher.

In her capacity as Director of Research, Dr. Gerber directs all aspects of research for DOM, including outcomes

research, student and resident research projects, and integration of di�erent research teams within DOM.




BEATTY LIVER & OBESITY RESEARCH PROGRAM – SCIENTIST SUMMARIES

Elzafir Elsheikh Abdelrahman, PhD

Association between non-alcoholic fatty liver disease (NAFLD) and coronary artery disease

Currently, there is accumulating evidence showing an association between NAFLD and the presence of coronary

artery disease (CAD). Epidemiological data has shown that NAFLD is associated with advanced atherosclerosis

and a higher risk of cardiovascular disease (CVD). In addition to increased prevalence of cardiovascular risk

factors and surrogate markers of atherosclerosis and cardiac events in NAFLD, several recent longitudinal studies

have actually shown that CVD is the most important cause of mortality in patients with NAFLD. A prospective

study is necessary to more carefully determine how NAFLD is associated with CVD.

For a better understanding of the association between NAFLD and CAD, the following studies were performed:

Serum Biomarkers of Cardiovascular Disease in Patients with NAFLD

Recently, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), osteopontin (OPN), Midkine, Kidney

Injury Molecule-1 (KIM-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) have been shown to be associated

with CVD. In collaboration with Dr. Henry Tran (Inova Heart & Vascular Institute), we aim to see if these biomarkers

are associated with the aggressive form of NAFLD such as non-alcoholic steatohepatitis (NASH) or significant

hepatic fibrosis. We found that increased serum levels of OPN seem to be associated with a presence of NASH

and advanced hepatic fibrosis in patients with NAFLD. Further studies are needed to validate these findings and

to determine if serum OPN can also predict the presence of development of CVD in subjects with NAFLD.

Pathological Production of Nitric Oxide Synthase in Patients with NAFLD and CAD

Nitric oxide (NO) has been found to be involved in numerous aspects of vascular health and regulation. NO also

plays an important role in vascular health by reducing platelet adherence and cell growth within the vessel wall.

Little is known about the role of nitric oxide and nitric oxide synthase (NOS) in patients with coronary artery

disease (CAD) and NAFLD. The main goal of this project is to determine whether or not NO serum levels are

elevated in CAD / NAFLD patients versus just NAFLD patients. This information is important because it has not

been researched extensively and could potentially lead to a new area of focus with regards to NO in CAD /

NAFLD cohorts. This information can then be utilized to develop targeted drug therapy that could prevent CAD

development in NAFLD patients.



Aybike Birerdinc, PhD

Dr. Birerdinc focuses on research aimed at understanding the contribution of visceral adipose tissue (VAT) to the

overall signaling deregulation in Metabolic Syndrome in general and non-alcoholic fatty liver disease (NAFLD) in

particular. Her background in both biochemistry and molecular biology has allowed the analysis of these signaling

cascades, tracing them from the genetic to the protein levels. Some of the most prominent research projects are

presented below.

Morphometric Analysis Allows for Greater Specificity in Biomarker Selection in NAFLD and NASH

NAFLD is currently one of the most common causes of chronic liver disease worldwide. In addition, discovering

adequate non-invasive biomarkers have been hampered by the observer variability of histologic features of

non-alcoholic steatohepatitis (NASH) by liver histology assessments. Semi-quantitative morphometric analysis of

liver histology in NAFLD may be superior for factors associated with progression in NAFLD. To test this hypothesis

we aimed to correlate the % fat and % collagen in a cohort of NAFLD subjects using quantitative morphometric

techniques and to correlate these with levels of key inflammatory signaling molecules. To date, our data indicate that

the morphometric assessment of % collagen and % fat are superior to semi-quantitative histologic assessment for

detecting a metabolic signaling profile. Both of these categories correlated with distinct cytokines indicative of

biologically active pathways thought to be involved in the pathogenesis and progression of NAFLD and NASH. We

are expanding our cohort size and validating the cytokine profiles associated with % collagen and % fat.

TGFb, a Master Regulator of the TH1/TH2 Pathways, May Also Be Involved in the Depression Disorders Seen in

Patients with NAFLD

The aim of this study was to assess the association of

VAT-related TGF-b gene expression, tissue protein and

serum protein with levels of serotonin in a cohort of obese

NAFLD subjects. Using serum and VAT tissue from

biopsy-proven NAFLD patients and the Bio-Plex platform

from Bio-Rad Laboratories in the United States, TGFb1, 2

and 3 were quantified on a genetic level, in tissue protein,

and in circulation from serum. In addition, the serum levels

of serotonin were measured with ALPCO human serotonin

ELISA kit. Spearmans correlations were done on all

variables; a statistically significant cuto� of p≤0.05 was

used. To date, our data suggest that the TGF-b signaling is

not only involved in the metabolic crosstalk between the

liver and VAT, but does indeed contribute to the

inflammatory cascade leading to reduced levels of

serotonin in NAFLD patients with depression.

The Fibrosis Component of NASH with Fibrosis May Have Upstream Pro-Fibrosis Signaling Originating in VAT

Although VAT is known to be an endocrine organ that contributes to the pathogenesis of NAFLD, its exact

contribution is yet to be elucidated. There has been some promising research to indicate that the pro-fibrotic

signaling cascades seen in NAFLD may be aided by feedback or de novo signaling from VAT. The aim of this

research project was to determine pro-fibrotic signaling molecules in VAT, both on the genetic and protein level and

to assess these in tandem with circulating protein levels as well as liver histology in a cohort of obese NAFLD

subjects. To date, our research indicates that certain pro-fibrotic signaling pathways are indeed initiated in the VAT

and the signal is amplified and transmitted outward. This project highlights the role of VAT not only in metabolic

syndrome, but also the fibrotic component of NAFLD.



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Michael Estep, PhD

2016 has been another exciting year of studying the basic science behind clinically relevant questions in the

Beatty Liver & Obesity Research laboratory. Our research group continues to explore underlying biochemistry

impacting the quality of life in patients with chronic liver disease. Additionally, we have been examining with

greater resolution, not only those genetic changes that contribute to chronic liver disease, but genetic

distinctions that may protect against the development of chronic disease in the presence of strong pathogenic

stimuli. Finally, we continue to refine our technique for identifying and quantifying particular liver lesions, aiding

in the grading and staging of fatty liver disease and perhaps eventually leading to targets for pharmaceutical

intervention. Specific examples of 2016 studies include the following:

Single Nucleotide Polymorphism (SNPs) Related to Stellate Cell Activation: Associations with Lower Risk of

Pericellular Fibrosis in Diabetics with Non-alcoholic Fatty Liver Disease (NAFLD)

Hepatic fibrosis is a serious development of NAFLD, leading to cirrhosis and hepatocellular carcinoma in a

significant portion of the patient population. However, many NAFLD patients, even some with a BMI >35, do not

develop significant fibrosis. Pericellular fibrogenesis is a complex coordinated process requiring paracrine

signaling of several cell types in the liver ultimately leading to the trans-di�erentiation of the hepatic stellate cell

into its “activated” myofibroblast-like form. Allelic variation of genes at the signaling interface may impart

resistance to fibrogenesis. The aim was to investigate the association between the minor allele frequencies of

non-synonymous SNPs in genes associated with stellate cell activation in NAFLD. The methodology was using

DNA from 100 diabetic subjects with biopsy proven NAFLD patients were extracted by standard methods. All liver

biopsies were read by a single hepatopathologist. Whole blood was used for patients to be genotyped for

rs35597368 (located in PDGFRA), rs2297518 (located in NOS2), and rs58542926 (located in FAS/TNFSFR6) by

TaqMan genotyping assays. The results were that combined minor allele load for PDGFRA, NOS2, and FAS

significantly and negatively correlated with the degree of pericellular fibrosis (rho = -0.388, P<0.0001). Although,

none of the minor alleles for these genes individually are associated with the phenotype, pairwise comparison of

patients with and without pericellular fibrosis showed significant distinctions in both the presence (P=0.01), and

quantity (P=0.01) of the combined minor alleles. Further, chi-square test supported the association between

possession of at least one of the minor alleles and pericellular fibrosis (chi-square statistic =8.63, P=0.003). The

odds ratio of having pericellular fibrosis in at least one of the minor alleles is 0.2641 (P=0.004). The conclusions

were that these data suggest that subtle disruption of pathways involved in stellate cell activation can retard or

inhibit pericellular fibrogenesis in diabetic patients with NAFLD. Our data imply that a panel of well-chosen

polymorphisms could potentially be used to screen for NALFD patients who are at high risk of fibrosis.

Kynurenine and Kynurenic Acid Metabolism Modulates According with Circulating Inflammatory Signals and

Correlates with Improvement in the Fatigue Component of the FACIT Questionnaire in Chronic CH-C Patients

Undergoing Treatment

Both kynurenine (KYN), a tryptophan metabolite associated with cognitive impairment and depression, and

inflammation have been reported as modulators of fatigue in chronic hepatitis-C patients (CH-C) by our group and

others. Kynurenic Acid (KYNA), a downstream metabolite of KYN with contrasting neuroactive activity, whose

production is, in part, suppressed by inflammation, may be an important component of fatigue in CH-C patients.

The aim was to assess the relationship of circulating KYNA to fatigue, inflammation, and KYN in chronic HCV

patients during, pre- and post-treatment. The methods were consenting CH-C patients were treated for 12 weeks

with oral sofosbuvir (SOF) regimens (either ledipasvir/SOF (LDV/SOF) or simeprevir (SIM/SOF)) underwent serial

serum collection (Initial Visit, Treatment Week 4, End of Treatment, Post Treatment Week 4, and Post treatment

Week 12; N=45). Additionally, at each time point, patients completed the fatigue component of the FACIT

questionnaire. Circulating KYN, KYNA, CCL2, and TNF were measured by ELISA and compared to the fatigue

component of the FACIT questionnaire. The results indicated that unlike KYN which, as previously



reported by our group, did not reveal a direct relationship with FACIT score at any time point, circulating KYNA was

modestly correlated with better FACIT score at treatment week 4 and end of treatment (rho=0.43, P<0.05 and

rho=0.40, P<0.05, respectively). An increase in circulating KYNA between baseline and post treatment week 4

correlates with FACIT score improvement over the same time (rho 0.40, P<0.05). Interestingly, a strong negative

correlation is seen between KYN and KYNA at post treatment week 12 (rho= -0.73, P<0.001), but no relationship is

revealed at any other time point. Circulating KYNA is significantly negatively correlated with circulating CCL2

pretreatment (rho= -0.40, P<0.05), at treatment week 4 (rho= -0.04, P<0.05), and especially at post treatment week

12 (rho= -0.57, P<0.05). However, only at post treatment week 12 is the ratio of KYNA to KYN associated with

circulating CCL2 (rho= -0.54, P<0.05). Additionally, no association was seen when KYNA was compared to circulating

TNF. The conclusion was that our cumulative findings suggest that both KYN and KYNA may have a complex

antagonistic relationship to fatigue in CH-C patients. Further, suppression of KYNA production by inflammation may

be an important factor.

Assessment of Hepatocellular Ballooning Degeneration using Computer Assisted Morphometry (CAM)

The prevalence of NAFLD and non-alcoholic steatohepatitis (NASH) is increasing locally, nationally, and

internationally. It has been predicted that NAFLD associated cirrhosis will outpace HCV as the leading cause of

liver-related death in the United States in the near future. The current methods for the assessment of NAFLD and

diagnosis of NASH have inadequate resolution to reveal important histopathological subtleties that may distinguish

progressive from non-progressive subtypes of NAFLD. Because the output of CAM is accurate enough to o�er a

percentage rather than a crude numbering system, CAM can potentially relieve this issue by allowing for the

development of a gradient for the severity of any specific histologic criterion. The use of CAM has been successfully

used by our research group to assess both hepatic steatosis and hepatic fibrosis. Hepatic expression of Sonic

Hedgehog (SHH) is associated with NAFLD. The aim of this study is to examine a potential relationship between the

degree of hepatic SHH expression, as measured by CAM and NAFLD. The methodology used included liver biopsy

and clinical data were available for patients with biopsy-proven NAFLD (N=33). Biopsies were read by a single

hepatopathologist. Immunohistochemical assay for SHH was carried out using standard procedure and 1:4000

dilution of anti-SHH antibody (Abcam, ab53281). A digitized image of the entire stained section was then acquired

using the Aperio Scanscope XT scanner at 40X magnification. Two independent researchers chose a total area of

0.27mm^2 divided into 12 equal squares distributed throughout the biopsy to which a positive pixel count algorithm

was applied to quantify the degree of SHH expression. Circulating M65 was measured in patient serum by ELISA.

The presence and degree of SHH reactivity were statistically analyzed against clinical, demographic, and laboratory

data. The results were that biopsy-proven NAFLD patients were included (N=33, ALT=64.17±48.3, AST=50.51±44.6,

Glucose=115±44.4, HDL=42±10.5, LDL=98±33.4, Total Cholesterol=172.6±33.2, Triglycerides=143.6±56.3). Of these, 31

had a diagnosis of NASH. SHH expression ranged from 0-8.4% of area scanned with an average of 2%±2.4. Degree

of SHH expression was highly correlated between observers (rho=0.94, P<.001). SHH expression positively

correlated with circulating M65 (rho=0.54, P<0.001). Additionally, SHH expression correlated with histologic

assessments Mallory-Denk bodies (rho=0.48, P=0.002), cirrhosis (rho=0.36, P<0.05), lymphocytic infiltration

(rho=0.36, P<0.05), portal fibrosis (rho=0.35, P<0.05), and focal necrosis (rho=0.345, p=0.05). The conclusions were

that these data support the association between hepatic SHH expression and NASH. A larger cohort will be

necessary to gauge the utility of CAM measured SHH as a tool for assessing NAFLD.



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Azza Karrar, PhD

Projects on immune dysregulation of non-alcoholic fatty liver disease (NAFLD) is an area of research started in

2012 and is led by Azza Karrar, PhD. Dr. Karrar has several years of experience working on immunopathology of

liver disease. The significance of these projects is that they may reveal new pathogenic pathways that may

influence individualized patient response, which will ultimately improve personalized medicine. These projects

have been able to develop robust knowledge, education, and training for research students that will also help

benefit the community. Some of the main projects we focused on in 2016 are as follows:

Proteomics of steatohepatitis (NASH) related-fibrosis

Liver biopsy is currently the only reliable tool for the staging of non-alcoholic steatohepatitis (NASH)-related

fibrosis. Therefore, non-invasive serum biomarkers for accurate assessment of liver disease and fibrosis are

urgently needed. Currently, no approved treatments exist for NASH, and patients with advanced fibrosis would

potentially benefit from new therapeutic options to halt and / or reverse the progression of their disease. We used

quantitative proteomic analysis of liver signaling targets and serum proteome to identify biomarker candidates in

NAFLD patients with fibrosis. Simultaneous proteomic profiling of NAFLD patients of the proteome and

phosphoproteome reveals that α2M in circulation and ASK-1 S38, METY1234/1235, p38 MAPK T180/Y182, IL-10

and LIMK1 T508/LIMK2 T505 in the liver are associated with collagen deposition (fibrosis) in patients with NASH.

This systemic proteomic analysis reveals important information regarding the pathogenesis of NAFLD and NASH

and demonstrates key changes in serum protein expression levels between advanced stage and early stage

fibrosis. Future validation of these potential biomarkers is needed such that these proteins may be used

non-invasively to facilitate diagnosis and treatment of patients with NAFLD.

Lower Levels of Hepatokines Angiopoietin-Like 4 and RBP-4 are Independently Associated with NASH

Experimental and human studies point to the role of hepatokines in the pathogenesis of NAFLD. The liver may

a�ect the metabolism of lipids and glucose metabolism by altering hepatokine production, which may play a role

in the pathogenesis of NAFLD. The aim of this study is to assess the association of hepatokines with NAFLD. Our

results indicate that lower serum levels of hepatokines are associated with NASH. In addition, hepatokine

deficiency is associated with lipid accumulation. This may indicate that hepatokines play a major role in lipid

metabolism. In addition, an inflamed liver also releases an altered pattern of hepatokines that directly a�ects

metabolism in NAFLD.

Associations of Obesity-related NAFLD and Autoimmune Diseases: A Secondary Data Analysis of the National

Health and Nutrition Examination Survey (NHANES) 1999-2014.

Obesity, NAFLD, and autoimmune diseases (AID) are associated with inflammatory states and disability. The aim

of this study is to assess the association of AID and obesity-related NAFLD at the population level. The

prevalence rates of AID subjects with psoriasis, psoriatic arthritis, or rheumatoid arthritis conditions and the

laboratory measures of autoimmunity were compared between patients with and without NAFLD in eight cycles

(1999-2014) of National Health and Nutrition Examination Survey (NHANES) data. The prevalence of autoimmune

diseases was significantly higher in NAFLD subjects when compared to the non-NAFLD group. The association of

having rheumatoid or psoriatic arthritis with the presence of NAFLD remained significant. Participants with NAFLD

had significantly higher levels of globulins, lymphocytes, monocytes, neutrophils, eosinophils, basophils, the

acute phase protein CRP, and the thyroid antibodies in comparison to patients without NAFLD. This study

demonstrates there is a low but significant excessive prevalence of autoimmune diseases in patients with NAFLD.



Rohini Mehta, PhD

Epigenetic variation in mitochondria in non-alcoholic fatty liver disease (NAFLD)

Mitochondrial response to energy requirements is dynamic involving altered mitochondrial DNA mass and gene

expression. Methylation of DNA refers to addition of methyl group to cytosine, often in the context of CpG

dinucleotides. DNA methylation often contributes to transcriptional silencing. Because changes in mtDNA a�ect the

integrity, assembly, and operation of the mitochondrial respiratory chain, it is conceivable that methylation of

mitochondrial DNA can dynamically regulate mitochondrial function and thereby inflammatory potential of T cells.

Apart from the 37 genes, mtDNA contains a non-coding D-loop. This region is the major control site for mtDNA as it

contains origin of replication and origin of transcription. Methylation in this region has been shown to alter mtDNA

mass. Changes in mtDNA methylation play a critical role in metabolic disorders. The purpose of the proposed study

is multi-fold; first, to assess the mitochondrial methylation pattern, and second, to assess correlation between

methylation levels and the prevalence of liver histopathological changes in NAFLD.

Detecting chromosomal number abnormalities in patients with fibrotic non-alcoholic steatohepatitis (NASH) by

in-situ hybridization (ISH)

Polyploidy (containing more than two paired sets of chromosomes) in the liver is extensively described in many

vertebrate species, including humans, rats, and mice. Since most hepatocytes become polyploid in the postnatal

period when growth and regeneration are ongoing, the overall result is that most hepatocytes are aneuploidy

(presence of an abnormal number of chromosomes in a cell). Aneuploidy in the liver is pervasive, a�ecting 60% of

hepatocytes in mice and 30%-90% of hepatocytes in humans. Does liver utilize polyploidy mechanisms to adapt to

chronic injury? Could polyploidy a�ord resistance to cellular and tissue damage and thus be protective against

fibrosis? Gene expression is dosage sensitive, and chromosomes harboring susceptibility or resistance alleles for a

particular injury could be selected for or against. Specific gains and losses of chromosomes harboring

injury-resistance alleles in normal, non-transformed hepatocytes may render them di�erentially resistant to chronic

insults such as viral hepatitis as well as alcohol- and fat-induced hepatitis. Polyploid hepatocytes specifically

tetraploid and octaploid mouse hepatocytes have been shown to be highly regenerative. New evidence suggests

that random hepatic aneuploidy can promote adaptation to liver injury. For instance, in response to chronic liver

damage, subsets of aneuploid hepatocytes that are di�erentially resistant to the injury remain healthy, regenerate

the liver and restore function. The hypothesis is, hepatotoxic insults (high lipid, high glucose, inflammation, etc.)

selects for hepatocytes with aneuploidy, rendering them resistant to injury. Thus, aneuploidy may be a pro-adaptive

and protective mechanism.

Cellular response of hepatocytes to di�erent lipid species

Mitochondria have been thought to play a role as they are the main site of fatty acid breakdown. Increased lipid

accumulation leads to improper function of the mitochondria and can lead to the generation of reactive oxygen

species and other harmful compounds that can damage cells and lead to cell death (reviewed by Rolo et al., 2011).

Understanding how various lipid species contribute to altered mitochondrial functioning in hepatocytes would lead

to a better understanding for the pathogenesis of NAFLD. In this study variation in cellular and mitochondrial

response of hepatocytes to lipids will be assessed by in vitro studies.



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Mitochondrial genotype as a predisposing factor for progressive NAFLD

mtDNA represents one of the most informative systems for inter- and intra-specific study of human genetic diversity.

The existence of hypervariable sites (sites that evolve at a rate much faster than average) in the non-coding human

mtDNA control region has been well documented via various analyses of human mtDNA variation. Both germline and

somatic mtDNA mutations occur preferentially at hypervariable sites, which support the view that hypervariable sites

are indeed mutational hotspots. Given the role of mitochondria in metabolic pathways, we are investigating the

variation in mitochondrial sequence as a predisposing factor in metabolic diseases, especially NAFLD.

Mechanism of fatty acid metabolism in obesity and associated NAFLD

An important component of energy homeostasis is regulation of fatty acid metabolism. In the presence of massive

influx of lipids, adipocytes and hepatocytes are expected to upregulate LD biogenesis, as a mechanism of defense

against the toxicity of FA. However, in order to prevent uncontrolled expansion of LDs, lipolysis activation also occurs

concurrently under these conditions and contributes to maintain LD size. The catabolic process of lipolysis is

dynamic and was until recently thought to be mediated by cytoplasmic lipases only. The clearance of lipid droplets

(LDs) mediated by lipid specific autophagy (lipophagy) has been shown only recently. Given the increased circulation

of free fatty acids in obesity, it is highly plausible that this leads to upregulation of fatty acid uptake and inhibition of

lipophagy. This altered fatty acid flux contributes to the expansion of adipocytes. Once the capacity of adipocytes to

store fat is exceeded, there is spillover of fat into ectopic sites such as liver culminating in steatosis and

steatohepatitis. This study aims to explore fatty acid metabolism in vitro using primary cell culture.

Figure 1: Pathways in Non-alcoholic fatty liver disease (NAFLD). There are several pathways with extensive crosstalk amongst them that are

known to be involved in NAFLD.


BEATTY LIVER & OBESITY RESEARCH PROGRAM – TEAMS

CLINICAL GENOMICS TEAM

The collection of biological specimens and clinical data remains the most important part of the ongoing lab projects in clinical and translation research. In 2016, the team enrolled over 227 subjects across three active protocols and collected close to 6,000 biological samples. Specimens include serum, plasma, and whole blood, as well as adipose and liver tissue. The translational research protocol allows for the collection of biological samples and clinical data from a wide population of subjects with chronic diseases, along with healthy controls who are not diagnosed with a chronic disease. Subjects consist of obese patients undergoing bariatric surgery, individuals diagnosed with chronic kidney disease, or individuals diagnosed with a chronic liver disease such as hepatitis C virus (HCV), hepatitis B virus (HBV), or non-alcoholic fatty liver disease (NAFLD). A separate protocol in place assesses the molecular relationship between NAFLD and coronary artery disease. Subjects are enrolled prior to undergoing a cardiac catheterization and subsequently have biological samples collected during the procedure. Lastly, there is a protocol in place that examines response to treatment of hepatitis C as well as quality of life. Subjects have research visits throughout their treatment and follow-up. We have currently enrolled 3,000 subjects across all of our protocols. This has resulted in over 58,000 samples collected which are stored in ten freezers located in our biorepository.

Members of the team include: Zahra Younoszai (Program Manager); Thomas Je�ers (Research Project Associate); Sean Felix (Research Project Associate); and Leo McLaughlin (Research Project Associate)

CLINICAL TRIALS RESEARCH TEAM

The clinical trials team is led by our

investigators, James Cooper, MD and

Nila Rafiq, MD. The team has

successfully conducted numerous

phase II and phase III clinical trials over

the past year in both hepatitis C and

non-alcoholic steatohepatitis (NASH).

The clinical trial team is shifting their

primary focus to NASH and is increasing

their research in this area. Current

physician recommendations for NASH

patients include lifestyle changes, such

as diet and exercise to reduce body

weight to prevent progression of NASH. Our studies are currently using medications

that may improve fibrosis measures and potentially result in a resolution of NASH.

Currently, there are no approved therapies for treating NASH so there is a great

need for more research in this area.

Members of the team include: James Cooper, MD (Principal Investigator); Nila Rafiq,

MD (Investigator); Fatema Nader (Regulatory and Clinical Trial Consultant); Rebecca

Cable (Clinical Research Associate Lead); Mariam Afendy (Clinical Research

Associate); Huong Pham (Clinical Research Associate); and Issah Younossi

(Research Project Associate)

James N. Cooper, MD

Nila Rafiq, MD

Department of Medicine 2016 Annual Report 40 Department of Medicine 2016 Annual Report


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DATABASE AND DATA ANALYSIS TEAM

The database and data analysis team includes two database administrators, two statisticians, and a research

investigator who work to support the Beatty Liver & Obesity Research Program (BLORP) data initiatives, as well as,

the Department of Medicine (DOM) research endeavors.

The database administrators have developed many new processes and databases providing new opportunities

for improved data control and availability. In addition to the integrated clinical and genomics specimen data

system that supports all liver and obesity research, the senior database administrator integrated new DNA

laboratory testing results to enhance research data availability and compatibility. Finally, there is continuous

collaboration with DOM on creating the DOM dashboard / database applications that the administrators, clinicians,

and sta� utilize for quality or research. Lastly, the database and data analysis team is further developing the

post-database applications and data processes for all databases including the publications database that supports

the tracking of all presentations and publications.

The database and data analysis team also includes the biostatistics specialists that are responsible for validating,

processing, analyzing, and reporting against a wide range of biomedical datasets for both BLORP and the DOM. They

also interface with the scientists to

develop data analysis protocols,

methodology, and apply data

management and quality surveillance.

They are responsible for the development

of statistical analysis methods,

bioinformatics algorithms, data mining

techniques, data design implementation,

annotation of programming code for data

analysis, and provide interpretation and

presentation of the results of analysis of

biomedical data as needed. Furthermore,

they each specialize in epidemiological

research using national health surveys or

health care data such as the National

Health and Nutrition Examination Survey

(NHANES), Nationwide Inpatient Sample

(NIS), and Medicare databases, as well as

the national cancer database,

Surveillance, Epidemiology, and End Results (SEER). Their e�orts have resulted in co-authorship in over 30

published manuscripts in 2016 and over 50 presented abstracts. In collaboration with the statisticians, our

research investigator works with the physicians in designing research studies, analyzing the clinical data,

describing the results, and writing the manuscripts. The team also supports large pharmaceutical Patient Reported

Outcomes (PROs) investigations that have earned national and international recognition for these endeavors.

Members of the team include: Andrei Racila (Informatics Manager); Munkhzul Otgonsuren (Research Statistician);

Yun Fang (Database Administrator); Maria Stepanova, PhD (Consultant); Linda Henry, PhD (Consultant); Sharon

Hunt (Consultant); and Wisna'odom Keo (Consultant)



LIVER PATHOLOGY RESEARCHZachary Goodman, MDDirector of Liver Pathology Research

The Liver Pathology Research team conducts investigations into the pathogenesis of

chronic liver diseases. The team supports the activities of the Beatty Liver & Obesity

Research Program and other programs by providing an accurate assessment of

patient material from participants in translational research and clinical trials. It

collaborates with other academic institutions and industry as the central pathology

site in multicenter clinical trials. Techniques employed include qualitative and

quantitative histopathologic assessment of liver and adipose tissue,

immunohistochemistry for identification of tissue components, and computer-assisted morphometry for

quantification of targeted tissue components.

Members of the team include: Zachary Goodman, MD

(Pathologist); Hala Abdul-Al, MD (Pathologist); Fanny

Monge (Program Manager); Lakshmi Alaparthi (Image

Analysis Scientist); Gary Bratthauer (Research Consultant);

Irfan Ali (Research Project Associate); Daisong (Albert) Tan

(Research Project Associate); and Dinan Abdelatif

(Research Project Associate)

Current projects include:

1) Evaluation of hedgehog signaling as a marker of

hepatocellular injury in nonalcoholic fatty liver disease

2) Identification of hepatic and adipose tissue

inflammatory cells in nonalcoholic fatty liver disease

3) Multicenter trial of selonsertib as a potential therapy in nonalcoholic fatty liver disease

4) Multicenter trial of emricasan as a potential antifibrotic agent in post-transplant patients with sustained virological responseafter recurrence of hepatitis C

5) Multicenter trial of emricasan as a potential therapy in nonalcoholic fatty liver disease

6) Multicenter trial of cenicriviroc as treatment for nonalcoholic steatohepatitis

7) Multicenter trial of seblipase alfa as treatment for congenital lysosomal acid lipase deficiency

8) Multicenter trial of obeticholic acid as a potential therapy in nonalcoholic fatty liver disease

9) Multicenter trial of GR-MD-02 as a potential antifibrotic agent in nonalcoholic fatty liver disease

Department of Medicine 2016 Annual Report 42 De


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OUTCOMES RESEARCH PROGRAM

The goals and objectives of the Outcomes Research Program of the Center for Integrated Research are to

investigate contributors to functional outcomes important to patients with liver disease and obesity. These measures

are utilized to determine an individual’s performance, perception, and overall quality of life as they pertain to general

human physical, social, and psychological activities.

Members of the Outcomes Research Program are performing clinical research in two major areas. The first area is to

explore fatigue from the perspective of how the patient is doing, including their activities and their perception of how

it impacts their lives. We also measure biological markers to learn about whether there are metabolic or inflammatory

problems associated with this. We have identified two types of fatigue. One is associated with physical activity

(peripheral fatigue) and the other relates to motivation

and the ability to concentrate (central fatigue). For

patients with hepatitis C, there is evidence of both.

Both improve with eradication of the virus, but there are

some whose fatigue persists and we continue to study

this. In patients with obesity and fatty liver, physical

fatigue is more prevalent and seems to be related to

their ability to metabolize glucose and convert it to

energy. Focus groups have been conducted to

interview patients to obtain input about how they

experience fatigue and which questions are best to

ascertain their di�culties. The analysis of these

interviews will inform us about devising a

questionnaire.

The second area of investigation is trying to

understand which approaches are successful in

helping people achieve lifestyle changes. Behavioral

change is one of the most significant challenges for the

healthcare community. We have devised a

personalized method that incorporates a unique

educational and problem solving approach to

nutritional management. We are incorporating an

activity-based approach to exercise that teaches

patients to target heart rate in the moderate range to

try to assure ongoing participation in a long-term

commitment to exercise.

In addition to the two major areas of clinical research,

the team was awarded with a five year sub-award (2016

– 2021) from the American Institutes for Research (AIR), which is a part of the Department of Health and Human

Services grant to study aspects of knowledge translation (KT). The research focus is to determine the contributions

to promote and facilitate the translational research to clinical practice.

Members of the team include: Lynn Gerber, MD (Director of Research); Ali Weinstein, PhD (Research Medical

Psychologist); Carey Escheik (Program Manager); Jillian Price (Program Manager); Patrick Austin (Clinical Research

Associate); Sophie Afdhal (Research Consultant); and Haley Bush (Research Consultant)



MENTAL / EMOTIONAL HEALTH PROGRAM

The mission of the Mental / Emotional Health Program (MEHP) at the Beatty Liver & Obesity Research Program is to

improve the quality of life, reduce morbidity, and increase function in patients with chronic hepatitis C and

non-alcoholic fatty liver disease (NAFLD). This is accomplished by substantially reducing the prevalence and impact

of mental, emotional, and cognitive dysfunction (MECD) in people with these chronic liver diseases (CLD).

Members of MEHP are performing research in two major areas. The first area is to examine patient-reported

outcomes (PROs) and neurocognitive performance in patients with hepatitis C virus (HCV). Historically, HCV-related

neurocognitive dysfunction was believed to be present only in patients with hepatic encephalopathy. However,

despite the introduction of well-tolerated medication [direct acting antiviral agents (DAA)], the problem persists even

in those patients that achieve sustained virologic response (SVR). We utilize neurocognitive performance, clinical,

and PROs data from an anti-HCV clinical trial to measure quality of life in patients’ pre-and post-virus clearance. We

also measure serum biological markers to determine if there are any metabolic or inflammatory associations with

neurocognitive performance and PROs. The analysis of these variables will help us define the phenotypes of MECD

in HCV patients in order to develop proper diagnostic approaches in the future.

The second area of investigation is to explore

MECD in patients with NAFLD. In the United

States and globally, NAFLD is the most

common cause of chronic liver disease. NAFLD

is frequently co-morbid with type 2 diabetes

mellitus (T2DM) and shares similar risk factors

(i.e., abdominal obesity, dyslipidemia, raised

blood pressure, and insulin resistance). The

association between T2DM and an increased

risk of impairment in cognitive performance

beyond the scope of normal aging is well

established in the literature, specifically in the

domains of attention, psychomotor speed,

executive functions, and learning and memory.

Our aim is to investigate the cognitive

performance of those with NAFLD, those with

T2DM, those with NAFLD and T2DM, and those without either diagnoses. The levels of cognitive performance will

be compared between these groups as well as serum biological parameters and PROs. This investigation will provide

a better understanding of the mechanisms by which MECD may occur in patients with CLD. MEHP has active clinical

protocols in which these areas are currently being studied.

Members of the team include: Ali Weinstein, PhD (Program Lead); Leyla de Avila (Program Manager & Research

Project Associate); and Pegah Golabi, MD (Research Fellow)



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ULTRASOUND AND ELASTOGRAPHY RESEARCH

The Department of Medicine (DOM) team is supported

by providing ultrasound and transient elastographs.

FibroScan is a useful test in almost any patient in whom

a clinician wishes to stage liver fibrosis.

Two non-invasive radiologic techniques to assess

hepatic fibrosis have been studied. Both rely on

assessment of the e�ect of liver sti�ness (fibrosis) on

the velocity of transmission of a shear wave through

the liver.

Ultrasound Elastography, commercially known as

FibroScan®, uses a modified ultrasound probe to

measure the velocity of a shear wave created by a

vibratory source. Estimates of sti�ness of the liver by

ultrasound correlate with fibrosis stage. Ultrasound

Elastography can be performed in approximately 95%

of patients, although older patients and patients who

are obese can be more di�cult to study. FibroScan

exams were performed with almost 100% accuracy.

Number of exams performed in 2016:

• 253 FibroScans

• 234 Ultrasounds

Members of the team include: Hussain Allawi (Clinical

Research Associate) and Brian Lam, PA-C (Physician

Assistant)


BEATTY LIVER & OBESITY RESEARCH PROGRAM GROUP PHOTO


DEPARTMENTAL ACADEMIC PRODUCTIVITY

One of the most important outcomes of an academically active department is the number of high-caliber publications

and presentations that are generated by the members of the department. Authorship, especially first or senior

authorship of articles published in peer-reviewed, high-impact journals, provide validity of the academic standing of

the department and its members. Additionally, research presentations to national and international scientific

meetings will bring immense recognition to the department, the faculty, and the institution. Finally, delivering faculty

lectures during these international meetings is a great honor that recognizes our faculty as the top leaders in their

fields. This productivity is not only invaluable to the department, but also brings great value to Inova Health System.

Members of the Department of Medicine enjoyed tremendous success and academic productivity by publishing

articles in high-impact journals and presenting their research to a number of international meetings. Furthermore, a

number of our faculty had opportunities to discuss their research findings in the media. Also, a number of members

of our department were listed as top doctors in their fields by the U.S. News and World Report. Finally, our faculty

served on the editorial board of several important journals. In fact, Dr. Younossi is now a co-editor of Liver

International which is the o�cial journal of the International Association for the Study of the Liver (IASL).


DEPARTMENT OF MEDICINE ACADEMIC PRODUCTIVITY

PUBLISHED MANUSCRIPTS

1) Pegah Golabi, Munkhzul Otgonsuren, Winnie Suen, Aaron B. Koenig, Bashir Noor, Zobair M Younossi. Predictors

of Inpatient Mortality and Resource Utilization for the Elderly Patients with Chronic Hepatitis C (CH-C) in the

United States, Medicine. 2016 Jan;95(3):e2482. doi: 10.1097/MD.0000000000002482.

2) Ali Weinstein, Carey Escheik, Bibiana Oe, Jillian Kallman Price, Lynn Gerber, Zobair M Younossi. Perception of

E�ort During Activity in Patients With Chronic Hepatitis C and Nonalcoholic Fatty Liver Disease, Physical

Medicine and Rehabilitation Clinics of North America. 2016 Jan;8(1):28-34. doi: 10.1016/j.pmrj.2015.06.001. Epub

2015 Jun 11.

3) Zobair M Younossi, Maria Stepanova, James M. Estep, Francesco Negro, Paul Clark, Sharon Hunt, Qinghua

Song, Matthew Paulson, Luisa Stamm, Diana Brainard, Mani Subramanian, John McHutchison, Keyur Patel.

Dysregulation of Distal Cholesterol Biosynthesis in Association with Relapse and Advanced Disease in CHC

Genotype 2 and 3 Treated with Sofosbuvir and Ribavirin, Journal of Hepatology. 2016 Jan;64(1):29-36. doi:

10.1016/j.jhep.2015.08.027. Epub 2015 Sep 1.

4) Pegah Golabi, Mehmet Sayiner, Yousef Fazel, Aaron B. Koenig, Linda Henry, Zobair M Younossi. Current

complications and challenges in nonalcoholic steatohepatitis screening and diagnosis, Expert Review of

Gastroenterology Hepatology. 2016 Jan;10(1):63-71. doi: 10.1586/17474124.2016.1099433. Epub 2015 Oct 15.

5) Zobair M Younossi, Maria Stepanova, Stanislas Pol, Jean-Pierre Bronowicki, Maria Patrizia Carrieri, Marc

Bourliere. The Impact of Ledipasvir/Sofosbuvir on Patient-Reported Outcomes in Cirrhotic Patients with Chronic

Hepatitis C: The SIRIUS Study., Liver International. 2016 Jan;36(1):42-8. doi: 10.1111/liv.12886. Epub 2015 Jun 24.

6) Issah Younossi, Ali Weinstein, Maria Stepanova, Sharon Hunt, Zobair M Younossi. Mental and Emotional

Impairment in Patients With Hepatitis C is Related to Lower Work Productivity, Psychosomatics. 2016

Jan-Feb;57(1):82-8. doi: 10.1016/j.psym.2015.10.005. Epub 2015 Oct 23.

7) Ali Weinstein, Carey Escheik, Bibiana Oe, Jillian Kallman Price, Lynn Gerber, Zobair M Younossi. Perception of

E�ort During Activity in Patients with Chronic Hepatitis C and Nonalcoholic Fatty Liver Disease, PM&R. 2016

Jan;8(1):28-34. doi: 10.1016/j.pmrj.2015.06.001. Epub 2015 Jun 11.

8) Lynn Gerber, James M. Estep, Maria Stepanova, Carey Escheik, Ali Weinstein, Zobair M Younossi. E�ects of Viral

Eradication with Ledipasvir and Sofosbuvir, With or Without Ribavirin, on Measures of Fatigue in Patients with

Chronic HCV Infection, Clinical Gastroenterology And Hepatology. 2016 Jan;14(1):156-164.e3. doi:

10.1016/j.cgh.2015.07.035. Epub 2015 Aug 1.

9) Ryan Perumpail, Thomas A Hahambis, Avin Aggarwal, Zobair M Younossi, Aijaz Ahmed. Treatment strategies for

chronic hepatitis C prior to and following liver transplantation, World Journal of Hepatology. 2016 Jan

8;8(1):69-73. doi: 10.4254/wjh.v8.i1.69.

10) Yousef Fazel, Aaron B. Koenig, Mehmet Sayiner, Zachary Goodman, Zobair M Younossi. Epidemiology and

natural history of non-alcoholic fatty liver disease, Metabolism: Clinical & Experimental. Metabolism. 2016

Aug;65(8):1017-25. doi: 10.1016/j.metabol.2016.01.012. Epub 2016 Jan 29.

11) Zobair M Younossi, Maria Stepanova, Fatema Nader, Linda Henry. Patient-Reported Outcomes of Elderly Adults

with Chronic Hepatitis C Treated with Interferon- and Ribavirin-Free Regimens, Journal of the American

Geriatrics Society. 2016 Feb;64(2):386-93. doi: 10.1111/jgs.13928. Epub 2016 Jan 30.

s M. Estep, Maria Stepanova, Carey Escheik, Ali Weinstein, Zobair M YCarey Escheik, Ali Weinstein, Z

edipasvir and Sofosbuvir, With or Without Ribavirin, on Measures ofor Without Ribavirin, on Me

fection, Clinical Gastroenterology And Hepatology. 2016 Jaology And Hepatology.

07.035. Epub 2015 Aug 1.

homas A Hahambis, Avin Aggarwal, Zobair M Younossi, Aijaz Ahmed.z A

C prior to and following liver transplantation, World Journal of urn

0.4254/wjh.v8.i1.69.

on B. Koenig, Mehmet Sayiner, Zachary Goodman, Zobair M YounYoun

non-alcoholic fatty liver disease, Metabolism: Clinical & Experimepe

doi: 10.1016/j.metabol.2016.01.012. Epub 2016 Jan 29.

, Maria Stepanova, Fatema Nader, Linda Henry. Patient-Reported Ouepo

atitis C Treated with Interferon- and Ribavirin-Free Regimens, JoReg



12) Pegah Golabi, Munkhzul Otgonsuren, Rebecca Cable, Sean C. Felix, Aaron B. Koenig, Mehmet Sayiner, Zobair

M Younossi. Non-alcoholic Fatty Liver Disease (NAFLD) Is Associated with Impairment of Health Related Quality

of Life (HRQOL), Health and Quality of Life Outcomes. 2016 Feb 9;14(1):18. doi: 10.1186/s12955-016-0420-z.

13) Zobair M Younossi, Aaron B. Koenig, Dinan Abdelatif, Yousef Fazel, Linda Henry, Mark Wymer. Global

epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and

outcomes, Hepatology. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431. Epub 2016 Feb 22.

14) Zobair M Younossi, Linda Henry, Haesuk Park, Ayoade Adeyemi, Maria Stepanova. The Extra-Hepatic

Manifestations of Hepatitis C - A Meta-Analysis of Prevalence Rates, E�ects on Patient-Reported Outcomes and

Economic Burden, Gastroenterology. 2016 Feb 25. pii: S0016-5085(16)00230-4. doi:

10.1053/j.gastro.2016.02.039. [Epub ahead of print].

15) Ryan Perumpail, Robert John Wong, Andy Liu, Jayasekera Channa R. , Douglas T. Dieterich, Zobair M Younossi,

Aijaz Ahmed. Trends in Liver Transplantation in Hepatitis C Virus-Infected Persons, United States, Emerging

Infectious Diseases. 2016 Mar; 22(3): 565–567. doi: 10.3201/eid2203.151650.

16) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Ira M. Jacobson, Kosh Agarwal, Christophe

Hezode, Fatema Nader, Linda Henry, Sharon Hunt. Sofosbuvir/Velpatasvir Improves Patient-Reported

Outcomes in HCV Patients: Results from ASTRAL-1 Placebo-Controlled Trial, Journal of Hepatology. J Hepatol.

2016 Jul;65(1):33-9. doi: 10.1016/j.jhep.2016.02.042. Epub 2016 Mar 5.

17) Zobair M Younossi, Maria Stepanova, Linda Henry, Fatema Nader, Sharon Hunt. An In-Depth Analysis of

Patient-Reported Outcomes in Patients With Chronic Hepatitis C Treated With Di�erent Anti-Viral Regimens,

American Journal of Gastroenterology. 2016 Mar 29. doi: 10.1038/ajg.2016.99. [Epub ahead of print].

18) Mehmet Sayiner, Mark Wymer, Pegah Golabi, Joel Ford, Indie Srishord, Zobair M Younossi. Presence of

Hepatitis C (HCV) Infection in Baby Boomers with Medicare is independently associated with mortality and

resource utilisation , Alimentary Pharmacology & Therapeutics. 15 MAR 2016 DOI: 10.1111/apt.13592.

19) Zobair M Younossi, Maria Stepanova, Henry Lik-Yuen Chan, Mei Hsuan Lee, Ming-Lung Yu, Yock Young Dan,

Moon Seok Choi, Linda Henry. Patient-Reported Outcomes in Asian Patients with Chronic Hepatitis C Treated

with Ledipasvir and Sofosbuvir, Medicine. 2016 Mar;95(9):e2702. doi: 10.1097/MD.0000000000002702.

20) Zobair M Younossi, Linda Henry. Contribution of Alcoholic and Nonalcoholic Fatty Liver Disease to the Burden

of Liver-Related Morbidity and Mortality, Gastroenterology. 2016 Jun;150(8):1778-85. doi:

10.1053/j.gastro.2016.03.005. Epub 2016 Mar 12.

21) Kelly Grotzinger, Zobair M Younossi, EG Giannini, P.J. Chen, R Rendas-Baum, D Theodore. Health-related quality

of life in thrombocytopenic patients with chronic hepatitis C with or without cirrhosis in the ENABLE-1 and

ENABLE-2 studies, Health and Quality of Life Outcomes. 2016 Mar 22;14(1):49. doi: 10.1186/s12955-016-0447-1.

22) Zobair M Younossi, Douglas T. Dieterich, Bruce R. Bacon, Michael P. Curry, Steven L. Flamm, Kris V. Kowdley,

Yoori Lee, Naoky Tsai, Nezam H. Afdhal. Access to Therapy in the Era of All Direct Acting Antiviral Regimens:

Real World Experience From the TRIO Network, Gastroenterology. APRIL 2016 Vol 5 Issue 4 Supplement 4 _

S1-S1271.

A R



23) Zobair M Younossi, Louis L. LaLuna, John J. Santoro, Flavia Mendes, Victor Araya, Natarajan Ravendhran, Lisa

Pedicone, Idania Lio, Fatema Nader, Sharon Hunt, Andrei Racila, Maria Stepanova. Implementation of Baby

Boomer Hepatitis C Screening and Linking to Care in Gastroenterology Practices: A Multi-Center Pilot Study,

BMC Gastroenterology. BMC Gastroenterol. 2016 Apr 4;16(1):45. doi: 10.1186/s12876-016-0438-z.

24) George Cholankeril, Ryan Perumpail, Menghan Hu, Gail Skowron, Zobair M Younossi, Aijaz Ahmed. Chronic

Hepatitis B is Associated with Higher Inpatient Resource Utilization and Mortality versus Chronic Hepatitis C,

Digestive Diseases And Sciences. Dig Dis Sci. 2016 Sep;61(9):2505-15. doi: 10.1007/s10620-016-4160-z. Epub

2016 Apr 15..

25) Mehmet Sayiner, Maria Stepanova, Huong T. Pham, Bashir Noor, Mercedes Walters, Zobair M Younossi. Assess-

ment of Health Utilities and Patients’ Quality of Life in Patients with Non-Alcoholic Fatty Liver Disease, BMJ Open

Gastroenterology. BMJ Open Gastroenterol. 2016 Aug 16;3(1):e000106. doi: 10.1136/bmjgast-2016-000106. eCol-

lection 2016..

26) Pegah Golabi, Cameron T. Locklear, Patrick Austin, Sophie K. Afdhal, Melinda Byrns, Lynn Gerber, Zobair M

Younossi. E�ectiveness of exercise in hepatic fat mobilization in nonalcoholic fatty liver disease: Systematic

review, World Journal of Gastroenterology. 2016 July 21; 22(27): 6318-6327. DOI: 10.3748/wjg.v22.i27.6318 .

27) Zobair M Younossi, Maria Stepanova, Linda Henry. Performance and Validation of Chronic Liver Disease Ques-

tionnaire-Hepatitis C Version (CLDQ-HCV) in Clinical Trials of Patients with Chronic Hepatitis C, Value in Health.

Value Health. 2016 Jul-Aug;19(5):544-51. doi: 10.1016/j.jval.2016.02.005. Epub 2016 Apr 26.

28) Zobair M Younossi, Haesuk Park, Stuart C. Gordon, John R. Ferguson, Aijaz Ahmed, Douglas T. Dieterich,

Sammy Saab. Real-World Outcomes of Ledipasvir/Sofosbuvir in Treatment-Naïve Patients With Hepatitis C,

American Journal of Managed Care. Am J Manag Care. 2016 May;22(6 Spec No.):SP205-11.

29) Aaron B. Koenig, Maria Stepanova, Sean C. Felix, Shirley Kalwaney, Stephen C. Clement, Zobair M Younossi.

Vaccination against hepatitis A and B in patients with chronic liver disease and type 2 diabetes: has anything

changed?, Liver International. Liver Int. 2016 Aug;36(8):1096-100. doi: 10.1111/liv.13164. Epub 2016 Jun 2.

30) Zobair M Younossi, Maria Stepanova, Linda Henry, Fatema Nader, Youssef Younossi, Sharon Hunt. ADHER-

ENCE TO TREATMENT OF CHRONIC HEPATITIS C: FROM INTERFERON CONTAINING REGIMENS TO INTER-

FERON AND RIBAVIRIN FREE REGIMENS, Medicine. 2016 Jul;95(28):e4151. doi:

10.1097/MD.0000000000004151. PubMed PMID: 27428205; PubMed Central PMCID.

31) Aaron B. Koenig, Maria Stepanova, Sammy Saab, Aijaz Ahmed, Robert John Wong, Zobair M Younossi.

Long-term outcomes of lung transplant recipients with hepatitis C infection: a retrospective study of the U.S.

transplant registry. Alimentary Pharmacology & Therapeutics. Aliment Pharmacol Ther. 2016 Aug;44(3):271-8.

doi: 10.1111/apt.13693. Epub 2016 Jun 9.

32) Zobair M Younossi, Maria Stepanova, Mark S. Sulkowski, Susanna Naggie, Linda Henry, Sharon Hunt. Sofosbuvir

and Ledipasvir Improve Patient-Reported Outcomes in Patients Co-infected with Hepatitis C and Human Immu-

nodeficiency Virus, Journal of Viral Hepatitis. 2016 Jun 13. doi: 10.1111/jvh.12554.

33) Kellie Young, M Aquilar, R. Gish, Zobair M Younossi, Sammy Saab, Taft Bhuket, Benny Liu, Aijaz Ahmed, Robert

John Wong. Lower rates of receiving model for end-stage liver disease exception and longer time to transplant

among nonalcoholic steatohepatitis hepatocellular carcinoma., Liver Transplantation. Liver Transpl. 2016

Oct;22(10):1356-66. doi: 10.1002/lt.24507.

RIBAVIRIN FREE REGIMENS, Medicine. 2016 JEGIMENS, Medicine. 2

000000004151. PubMed PMID: 27428205; PubMed Central PMCID.: 27428205; PubMed Centra

Maria Stepanova, Sammy Saab, Aijaz Ahmed, Robert John Wonab, Aijaz Ahmed, Robert

es of lung transplant recipients with hepatitis C infection: a retrospon:

Alimentary Pharmacology & Therapeutics. Aliment Pharmacol Thema

93. Epub 2016 Jun 9.

, Maria Stepanova, Mark S. Sulkowski, Susanna Naggie, Linda Henry, enry

prove Patient-Reported Outcomes in Patients Co-infected with HepatHepat

, Journal of Viral Hepatitis. 2016 Jun 13. doi: 10.1111/jvh.12554.

quilar, R. Gish, Zobair M Younossi, Sammy Saab, Taft Bhuket, Benny t, B

rates of receiving model for end-stage liver disease exception and pti

olic steatohepatitis hepatocellular carcinoma., Liver Transplantatioran



34) Mehmet Sayiner, Munkhzul Otgonsuren, Rebecca Cable, Issah Younossi, Mariam Afendy, Pegah Golabi, Linda Henry, Zobair M Younossi. Variables associated with inpatient and outpatient resource utilization among medicare beneficiaries with NAFLD with or without cirrhosis, Journal of Clinical Gastroenterology. June 21, 2016, doi: 10.1097/MCG.0000000000000567.

35) Zobair M Younossi, Maria Stepanova, Mark S. Sulkowski, Graham R. Foster, Nancy Reau, Alessandra Mangia, Keyur Patel, Norbert Brau, Stuart Roberts, Nezam H. Afdhal, Fatema Nader, Linda Henry. RIBAVIRIN-FREE REGIMEN WITH SOFOSBUVIR AND VELPATASVIR IS ASSOCIATED WITH HIGH EFFICACY AND IMPROVEMENT OF PATIENT-REPORTED OUTCOMES IN PATIENTS WITH GENOTYPES 2 AND 3 CHRONIC HEPATITIS C: RESULTS FROM ASTRAL-2 AND 3 CLINICAL TRIALS, Clinical Infectious Diseases. Clin Infect Dis. 2016 Oct 15;63(8):1042-8. doi: 10.1093/cid/ciw496. Epub 2016 Jul 20.

36) Maria Stepanova, Leyla de Avila, Mariam Afendy, Issah Younossi, Huong T. Pham, Rebecca Cable, Zobair M Younossi. Direct and Indirect Economic Burden of Chronic Liver Disease in the United States, Clinical Gastroenterology And Hepatology. Clin Gastroenterol Hepatol. 2016 Jul 25. pii: S1542-3565(16)30441-4. doi: 10.1016/j.cgh.2016.07.020. [Epub ahead of print].

37) Rohini Mehta, Munkhzul Otgonsuren, Zahra Younoszai, Hussain Allawi, Bryan Raybuck, Zobair M Younossi. Circulating miRNA in patients with non-alcoholic fatty liver disease and coronary artery disease, BMJ Open Gastroenterology. BMJ Open Gastroenterol. 2016 Jul 26;3(1):e000096. doi: 10.1136/bmjgast-2016-000096. eCollection 2016.

38) Elzafir Elsheikh Abdelrahman, Thomas Je�ers, Zahra Younoszai, Sharon Hunt, Brian P. Lam, Munkhzul Otgonsuren, Maria C. Albano, Ingrid Schneider, Brian Marsiglia, Bryan Raybuck, Zobair M Younossi. Non-Hematopoietic Circulating Progenitor Cells and Presence of Coronary Artery Disease in Patients with Non-Alcoholic Fatty Liver Disease, Journal of Cytology & Histology. Elsheikh et al., J Cytol Histol 2016, 7:3 DOI: 10.4172/2157-7099.1000423.

39) Aaron B. Koenig, Maria Stepanova, Sean C. Felix, Shirley Kalwaney, Stephen C. Clement. Hepatitis A and B Vaccinations Rates in Patients with Chronic Liver Disease (CLD) and Type 2 Diabetes (DM), Liver International. 2016 Aug;36(8):1096-100. doi: 10.1111/liv.1316.

40) Zobair M Younossi, Maria Stepanova, Masao Omata, Masashi Mizokami, Mercedes Walters, Sharon Hunt. Quality of Life of Japanese Patients with Chronic Hepatitis C Treated with Ledipasvir and Sofosbuvir, Medicine. Medicine (Baltimore). 2016 Aug;95(33):e4243. doi: 10.1097/MD.0000000000004243.

41) Zobair M Younossi, Maria Stepanova, Michael R. Charlton, Michael P. Curry, Robert S. Brown, Sharon Hunt. Patient-Reported Outcomes in Decompensated Cirrhotics with Hepatitis C Treated with Sofosbuvir and Velpatasvir with or without Ribavirin: Results from a Phase 3 Randomised Controlled Trial, The Lancet Gastroenterology and Hepatology. Lancet Gastroenterol Hepatol. 2016 Oct;1(2):122-132. doi: 10.1016/S2468-1253(16)30009-7. Epub 2016 Aug 3..

42) Mehmet Sayiner, Maria Stepanova, Huong T. Pham, Bashir Noor, Mercedes Walters, Zobair M Younossi. Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease, BMJ Open Gastroenterology. BMJ Open Gastroenterol. 2016 Aug 16;3(1):e000106. doi: 10.1136/bmjgast-2016-000106. eCollection 2016..

43) Elliot B. Tapper, Bruce R. Bacon, Michael P. Curry, Douglas T. Dieterich, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi, Nezam H. Afdhal. Evaluation of proton pump inhibitor use on treatment outcomes with ledipasvir and sofosbuvir in a real-world cohort study., Hepatology. Hepatology. 2016 Aug 17. doi: 10.1002/hep.28782. [Epub ahead of print].

A R



44) Zobair M Younossi, Maria Stepanova, Linda Henry, Issah Younossi, Ali Weinstein, Fatema Nader, Sharon Hunt.

Association of work productivity with clinical and patient-reported factors in patients infected with hepatitis C

virus, Journal of Viral Hepatitis. 2016 Aug;23(8):623-30. doi: 10.1111/jvh.12528. Epub 2016 Mar 14.

45) C Ferri, M Ramos-Casals, Al Zignego, L. Arcaini, D. Roccatello, A Antonelli, D Saadoun, AC Desbois, M Sebas-

tiani, M. Casato, C. Lamprecht, Alessandra Mangia, A.G. Tzioufas, Zobair M Younossi, Patrice Cacoub, ISG-EHCV

co-authors . International diagnostic guidelines for patients with HCV-related extrahepatic manifestations. A

multi-disciplinary expert statement, Autoimmunity Reviews. 2016 Sep 16. pii: S1568-9972(16)30201-4. doi:

10.1016/j.autrev.2016.09.006. [Epub ahead of print.

46) George Cholankeril, Eric R. Yoo, Ryan Perumpail, Menghan Hu, Gail Skowron, Zobair M Younossi, Aijaz Ahmed.

Disparities in Liver Transplantation Resulting From Variations in Regional Donor Supply and Multiple Listing

Practices, Clinical Gastroenterology And Hepatology. Clin Gastroenterol Hepatol. 2016 Sep 5. pii:

S1542-3565(16)30617-6. doi: 10.1016/j.cgh.2016.08.036.

47) Rohini Mehta, Kianoush Jeiran, Aaron B. Koenig, Munkhzul Otgonsuren, Zachary Goodman, Ancha Baranova,

Zobair M Younossi. The Role of Mitochondrial Genomics in Patients with Non-Alcoholic Steatohepatitis (NASH) ,

Biomed Central Medical Genetics. BMC Med Genet. 2016 Sep 5;17(1):63. doi: 10.1186/s12881-016-0324-0.

48) Ryan Perumpail, Eric R. Yoo, George Cholankeril, Luke Hogan, Melodie Deis, Waldo Concepciom, Clark

Bonham, Zobair M Younossi, Robert John Wong, Aijaz Ahmed. Underutilization of Living Donor Liver Transplan-

tation in the United States: Bias against MELD 20 and Higher, Journal of Clinical and Translational Hepatology.

J Clin Transl Hepatol. 2016 Sep 28;4(3):169-174. Epub 2016 Sep 25..

49) Zobair M Younossi, Deidre Blissett, Rob Blissett, Linda Henry, Maria Stepanova, Youssef Younossi, Andrei

Racila, Sharon Hunt, Rachel Beckerman. The Economic and Clinical Burden of Nonalcoholic Fatty Liver Disease

(NAFLD) in the United States and Europe, Hepatology. Hepatology. 2016 Nov;64(5):1577-1586. doi:

10.1002/hep.28785. Epub 2016 Sep 26.

50) Zobair M Younossi, Haesuk Park, Douglas T. Dieterich, Sammy Saab, Aijaz Ahmed, Stuart C. Gordon. Assess-

ment of Cost of Innovation versus the Value of Health Gains Associated with Treatment of Chronic Hepatitis C

in the United States: The Quality-Adjusted Cost of Care, Medicine. 2016 Oct;95(41):e5048.

51) Maria Stepanova, Zobair M Younossi. Letter: e�ects of hepatitis C infection on the post-lung transplant mortality

- authors' reply., Alimentary Pharmacology & Therapeutics. Aliment Pharmacol Ther. 2016 Oct;44(7):768-9. doi:

10.1111/apt.13759.

52) Zobair M Younossi, Aybike Birerdinc, Linda Henry. Hepatitis C Infection: A Multi-Faceted Systemic Disease with

Clinical, Patient Reported and Economic Consequences, Journal of Hepatology. 2016 Oct;65(1 Suppl):S109-19.

doi: 10.1016/j.jhep.2016.07.005.

53) Linda Henry, Zobair M Younossi. Patient-reported and economic outcomes related to sofosbuvir and ledipasvir

treatment for chronic hepatitis C. Expert Review of Pharmacoeconomics and Outcomes Research. Expert Rev

Pharmacoecon Outcomes Res. 2016 Dec;16(6):659-665. Epub 2016 Oct 12.

54) Zobair M Younossi, Haesuk Park, Douglas T. Dieterich, Sammy Saab, Aijaz Ahmed, Stuart C. Gordon. The value

of cure associated with treating treatment-naïve chronic hepatitis C genotype 1: Are the new all-oral regimens

good value to society. Liver International. DOI: 10.1111/liv.13298.

Zobair M Younossi. Letter: e�ects of hepatitis C infection on the post-cts of hepatitis C infection on

imentary Pharmacology & Therapeutics. Aliment Pharmacol Ther. 2apeutics. Aliment Pharma

, Aybike Birerdinc, Linda Henry. Hepatitis C Infection: A Multi-Faceteult

eported and Economic Consequences, Journal of Hepatology. 2016 gy

2016.07.005.

ir M Younossi. Patient-reported and economic outcomes related to sd to s

nic hepatitis C. Expert Review of Pharmacoeconomics and Outcometcom

tcomes Res. 2016 Dec;16(6):659-665. Epub 2016 Oct 12.

, Haesuk Park, Douglas T. Dieterich, Sammy Saab, Aijaz Ahmed, Stuhm

with treating treatment-naïve chronic hepatitis C genotype 1: Are thyp



55) Pegah Golabi, Elzafir Elsheikh Abdelrahman, Azza Karrar, James M. Estep, Issah Younossi, Maria Stepanova, Lynn Gerber, Zobair M Younossi. The Levels of Monoamine Neurotransmitters and Measures of Mental and Emotional Health in HCV Patients Treated with Ledipasvir (LDV) and Sofosbuvir (SOF) with or without Ribavirin (RBV) , Medicine.

56) Zobair M Younossi. Sofosbuvir (SOF) and Ledipasvir (LDV) Improves Patient-Reported Outcomes (PROs) in Patients Co-infected with Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) (manuscript), Journal of Viral Hepatitis. Volume 23, Issue 11, November 2016, Pages 857–865.

57) Maria Stepanova, Mehmet Sayiner, Leyla de Avila, Zahra Younoszai, Andrei Racila, Zobair M Younossi. Long-term outcomes of liver transplantation in patients with hepatitis C infection are not a�ected by HCV positivity of a donor., BMC Gastroenterology. BMC Gastroenterol. 2016 Nov 15;16(1):137.

58) Maria Stepanova, Cameron T. Locklear, Nila Rafiq, Alita Mishra, Chapy Venkatesan, Zobair M Younossi. Long-term outcomes of heart transplant recipients with hepatitis C positivity: the data from the U.S. transplant registry., Clinical Transplantation. Clin Transplant. 2016 Dec;30(12):1570-1577. doi: 10.1111/ctr.12859. Epub 2016 Nov 8.

59) Zobair M Younossi, Maria Stepanova, Linda Henry, Andrei Racila, Brian P. Lam, Huong T. Pham, Sharon Hunt. A Disease-Specific Quality of Life Instrument for Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis: CLDQ-NAFLD, Liver International. Liver Int. 2017 Feb 17. doi: 10.1111/liv.13391. [Epub ahead of print].

60) Zobair M Younossi, Maria Stepanova, Rafael Esteban, Ira M. Jacobson, Stefan Zeuzem, Mark S. Sulkowski, Linda Henry, Fatema Nader, Rebecca Cable, Mariam Afendy, Sharon Hunt. Superiority of Interferon-Free Regimens for Chronic Hepatitis C: The E�ect on Health-Related Quality of Life and Work Productivity, Medicine. Medicine (Baltimore). 2017 Feb;96(7):e5914. doi: 10.1097/MD.0000000000005914.

61) Ali Weinstein, G Diao, Heibatollah Baghi, Carey Escheik, Lynn Gerber, Zobair M Younossi. Demonstration of Two Types of Fatigue in Subjects with Chronic Liver Disease using Factor Analysis, Quality of Life Research. Qual Life Res. 2017 Feb 21. doi: 10.1007/s11136-017-1516-6. [Epub ahead of print].

62) Zobair M Younossi, Stuart C. Gordon, Aijaz Ahmed, Douglas T. Dieterich, Sammy Saab, Rachel Beckerman. Treating Medicaid Patients with Hepatitis C: Clinical and Economic Impact, American Journal of Managed Care. Am J Manag Care. 2017 Feb;23(2):107-112.

63) Maria Patrizia Carrieri, Camelia Protopopescu, Zobair M Younossi, Antoine Vilotitch, Helene Fontaine, Ventzislava Petrov-Sanchez, Fabienne Marcellin, Fabrice Carrat, Christophe Hezode, Marc Bourliere. Health-Related Quality of Life in Chronic HCV-Infected Patients Switching to Pegylated-Interferon-Free Regimens (ANRS CO20 CUPIC Cohort Study and SIRIUS Trial), The Patient - Patient-Centered Outcomes Research. Patient. 2017 Mar 28. doi: 10.1007/s40271-017-0232-1. [Epub ahead of print].

64) Pegah Golabi, Munkhzul Otgonsuren, Mehmet Sayiner, Aimal Arsalla, Trevor Gogoll, Zobair M Younossi. The Prevalence of Parkinson Disease among Patients with Hepatitis C Infection, Annals of Hepatology.

65) Zobair M Younossi, Maria Stepanova, Mark S. Sulkowski, David Wyles, Shyam Kottilil, Sharon Hunt. Patient-Reported Outcomes in Patients Co-infected with HCV and HIV Treated with Sofosbuvir and Velpatasvir: The ASTRAL-5 Study , Liver International. Liver Int. 2017 May 4. doi: 10.1111/liv.13462. [Epub ahead of print].

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66) Haley Bush, Pegah Golabi, Zobair M Younossi. Pediatric Non-Alcoholic Fatty Liver Disease, Children.

67) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Mark S. Sulkowski, Graham R. Foster,

Alessandra Mangia, Michael R. Charlton, Jacqueline G O'Leary, Michael P. Curry, Fatema Nader, Linda Henry.

The E�ect of Sofosbuvir/Velpatasvir on Patient-Reported Outcomes: From Non-Cirrhotics to Decompensated

Cirrhotics with Hepatitis C, Clinical Gastroenterology And Hepatology.

68) Zobair M Younossi. Rising Rate of Liver Transplantation in the Baby Boomer Generation with Nonalcoholic

Steatohepatitis in United States, Journal of Clinical and Translational Hepatology.

69) Ali Weinstein, Patrice Winter, Ancha Baranova, Aybike Birerdinc, Katherine Doyle, Lynn Gerber. Poster 16 E�ect

of Cancer-Related Fatigue on Cytokine Reactivity to Challenge Tasks in Breast Cancer Survivors., Physical

Medicine and Rehabilitation Clinics of North America. PM R. 2016 Sep;8(9S):S166. doi:

10.1016/j.pmrj.2016.07.059. Epub 2016 Sep 24.

70) Maria Stepanova, Stephen C. Clement, Robert John Wong, Sammy Saab, Aijaz Ahmed, Zobair M Younossi.

Diabetic Patients with Chronic Liver Disease are at Increased Risk for Overall Mortality: A Population Study from

the United States, Clinical Diabetes. Clin Diabetes. 2017 Apr;35(2):79-83. doi: 10.2337/cd16-0018.

71) Pegah Golabi, Sofie Fazel, Munkhzul Otgonsuren, Mehmet Sayiner, Cameron T. Locklear, Zobair M Younossi.

Mortality Assessment of Patients with Hepatocellular Carcinoma According to Underlying Disease and

Treatment Modalities, Medicine. Medicine (Baltimore). 2017 Mar;96(9):e5904. doi:

10.1097/MD.0000000000005904.

72) Patel K, Tillmann HL, Matta B, Sheridan MJ, Gardner SD, Shackel NA, McHutchison JG, Goodman ZD:

Longitudinal assessment of hepatitis C fibrosis progression by collagen and smooth muscle actin morphometry

in comparison to serum markers. Aliment Pharmacol Ther. 2016; 43:356-363.

73) Friedman S, Sanyal A, Goodman Z, Lefebvre E, Gottwald M, Fischer L, Ratziu V: E�cacy and safety study of

cenicriviroc for the treatment of non-alcoholic steatohepatitis in adult subjects with liver fibrosis: CENTAUR

Phase 2b study design. Contemp Clin Trials. 2016; 47:356-365.

74) Barr RG, Ferraioli G, Palmeri ML, Goodman ZD, Garcia-Tsao G, Rubin J, Garra B, Myers RP, Wilson SR, Rubens D,

Levine D: Elastography Assessment of Liver Fibrosis: Society of Radiologists in Ultrasound Consensus

Conference Statement. Ultrasound Q. 2016; 32:94-107.

75) Meissner EG, McLaughlin M, Matthews L, Gharib AM, Wood BJ, Levy E, Sinkus R, Virtaneva K, Sturdevant D,

Martens C, Porcella SF, Goodman ZD, Kanwar B, Myers RP, Subramanian M, Hadigan C, Masur H, Kleiner DE,

Heller T, Kottilil S, Kovacs JA, Morse CG: Simtuzumab treatment of advanced liver fibrosis in HIV and

HCV-infected adults: results of a 6-month open-label safety trial. Liver Int 2016; 36:1783-1792.

76) Goodman ZD: Phenotypes and Pathology of Drug-Induced Liver Disease. Clin Liver Dis. 2017; 21:89-101.

77) Haber B, Alonso E, Pedreira A, Rodriguez-Baez N, Ciocca M, Lacaille F, Lang T, Gonzalez T, Goodman Z, Yang

Z, Jackson B, Noviello S, Albrecht JK: Long-term Follow-up of Children Treated With Peginterferon and Ribavirin

for Hepatitis C Virus Infection. J Pediatr Gastroenterol Nutr. 2016 Apr 21. [Epub ahead of print]



78) Karsdal MA, Henriksen K, Nielsen MJ, Byrjalsen I, Leeming DJ, Gardner S, Goodman Z, Patel K, Krag A,

Christiansen C, Schuppan D: Fibrogenesis assessed by serological type III collagen formation identifies patients

with progressive liver fibrosis and responders to anti-fibrotic therapy. Am J Physiol Gastrointest Liver Physiol

2016; 311:G1009-G1017.

79) Abdel-Hameed EA, Rouster SD, Zhang X, Chen J, Medvedovic M, Goodman ZD, Sherman KE: Characterization

of HCV NS3 Protease Variants in HCV/HIV Coinfected Patients by Ultra-deep Sequence Analysis: Relationship

to Hepatic Fibrosis. J Acquir Immune Defic Syndr. 2016 Nov 25. [Epub ahead of print].

80) Chapy Venkatesan, Alita Mishra, Amanda Morgan, Maria Stepanova, Linda Henry, Zobair M Younossi. Outcomes

Trends for Acute Myocardial Infarction, Congestive Heart Failure, and Pneumonia, 2005-2009, American

Journal of Managed Care. 2016 Jan 1;22(1):e9-17.

81) Sarah Elfeky, Pegah Golabi, Munkhzul Otgonsuren, Svetolik Djurkovic, Mary E. Schmidt, Zobair M Younossi. The

Epidemiological Characteristics, Temporal Trends, Predictors of Death and Discharge Disposition in Patients

with a Diagnosis of Sepsis: A Cross-Sectional Retrospective Cohort Study, Journal of Critical Care. J Crit Care.

2017 Jun;39:48-55. doi: 10.1016/j.jcrc.2017.01.006. Epub 2017 Jan 20.

ACCEPTED ABSTRACTS AND PRESENTATIONS

1) Kellie Young, Benny Liu, Taft Bhuket, Zobair M Younossi, Sammy Saab, Aijaz Ahmed, Robert John Wong.

Despite Plateauing of Chronic Hepatitis B Virus (HBV) Patients Listed for Liver Transplantation, the Proportion of

Patients With HBV-Related Hepatocellular Carcinoma Continues to Rise, American Association for the Study of

Liver Diseases. Boston, November 14, 2016.

2) Stevan Gonzalez, Sammy Saab, Ryan Perumpail, George Cholankeril, Aijaz Ahmed, Zobair M Younossi. Cost

E�ectiveness Analysis of Pre vs. Post LT Treatment with All Oral Direct Acting Antivirals in Hepatitis C Patients

with Hepatocellular Carcinoma in the US, American Association for the Study of Liver Diseases. Boston,

November 13, 2016.

3) Maria Stepanova, Mehmet Sayiner, Leyla de Avila, Zahra Younoszai, Andrei Racila, Zobair M Younossi.

LONG-TERM OUTCOMES IN LIVER TRANSPLANT RECIPIENTS TRANSPLANTED FROM HCV-POSITIVE

DONORS, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

4) Zobair M Younossi, Munkhzul Otgonsuren, Wisna'odom Keo, Trevor Gogoll, Aimal Arsalla, Nina Badoe, Joel

Ford, Puneetinder Mann, James Cooper, Andrei Racila. Is the Risk of Mortality increased in Lean Patients in

Non-alcoholic Fatty Liver Disease (NAFLD)?, American Association for the Study of Liver Diseases. Boston,

November 14, 2016.

5) Zobair M Younossi, Issah Younossi, Huong T. Pham, Maria Stepanova, Brian P. Lam, Sharon Hunt. Development

and Validation of a Disease-Specific Health-Related Quality (HRQL) Instrument for Patients with Non-alcoholic

Fatty Liver Disease (NAFLD) and Non-alcoholic Steatohepatitis (NASH): The CLDQ-NAFLD, American

Association for the Study of Liver Diseases. Boston, November 14, 2016.

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6) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Mark S. Sulkowski, Graham R. Foster, Alessandra Mangia, Michael R. Charlton, Jacqueline G O'Leary, Michael P. Curry, Fatema Nader, Linda Henry, Sharon Hunt. Sofosbuvir/Velpatasvir (SOF/VEL)-Based Regimens are Associated with Excellent E�cacy and a Significant Improvement of Patients-Reported Outcomes (PROs) across Patient Populations: From Non-Cirrhotics to Compensated Cirrhotics to Decompensated Cirrhotics, American Association for the Study of Liver Diseases. Boston, November 13, 2016.

7) Zobair M Younossi, Maria Stepanova, Masashi Mizokami, Masao Omata, Sharon Hunt. Higher Quality of Life Gains in Japanese Hepatitis C Patients treated with Ledipasvir/Sofosbuvir , Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

8) Zobair M Younossi, Maria Stepanova, Linda Henry, Fatema Nader, Sharon Hunt. Predictors of Adherence to Treatment of Chronic Hepatitis C (CHC), Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

9) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Ira M. Jacobson, Kosh Agarwal, Christophe Hezode, Sharon Hunt. The Use of Sofosbuvir and Velpatasvir is Associated with High E�cacy and Improvement in Patient-Reported Outcomes in Patients with Genotype 1, 2, 4, 5 and 6 Chronic Hepatitis C: Results from the ASTRAL-1 Clinical Trials - (DDW), Digestive Disease Week. San Diego, May 21, 2016.

10) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Mark S. Sulkowski, Graham R. Foster, Alessandra Mangia, Michael R. Charlton, Jacqueline G O'Leary, Michael P. Curry, Fatema Nader, Sharon Hunt. Patient-Reported Outcomes in Chronic Hepatitis C Patients with Cirrhosis Treated with Ribavirin-Containing Regimens: Sofosbuvir/Velpatasvir and Ribavirin or Sofosbuvir and Ribavirin, Digestive Disease Week. San Diego, CA, May 21, 2016.

11) Zobair M Younossi, Henry Lik-Yuen Chan, Yock Young Dan, Mei Hsuan Lee, Young-Suk Lim, Ming-Lung Yu, Marta Silva, Jorge Felix. High therapeutic e�ciency of LDV/SOF in Asian patients with CHC Genotype 1 infection, Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

12) Zobair M Younossi, Henry Lik-Yuen Chan, Yock Young Dan, Mei Hsuan Lee, Young-Suk Lim, Eliza Kruger, Seng Tan. Impact of Ledipasvir/Sofosbuvir on the Work Productivity of Chronic Hepatitis C patients in Asia, Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

13) Zobair M Younossi, Maria Stepanova, Linda Henry, Fatema Nader, Sharon Hunt. HCV Patients Treated with IFN-Free Regimens Experience Improvement of Patient-Reported Outcomes, Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

14) Zobair M Younossi, Douglas T. Dieterich, Bruce R. Bacon, Michael P. Curry, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Nezam H. Afdhal. Access to Therapy in Era of All DAA Regimens: Real-World Experience from the Trio Network, Digestive Disease Week. San Diego, CA, May 21, 2016.

15) Michael P. Curry, Bruce R. Bacon, Douglas T. Dieterich, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi, Nezam H. Afdhal. Ledipasvir/Sofosbuvir+/-Ribavirin in HCV Post-Transplant Patients: Real-world Heterogeneous Population from the TRIO Network, International Liver Transplantation Society. Seoul, May 4, 2016.

16) Douglas T. Dieterich, Bruce R. Bacon, Michael P. Curry, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi, Nezam H. Afdhal. Ledipasvir/Sofosbuvir+/-Ribavirin in Patients Co-infected with HCV and HIV: Real-world Heterogeneous Population from the TRIO Network, Digestive Disease Week. San Diego, CA, May 21, 2016.



17) Aybike Birerdinc, Lei Wang, Leyla de Avila, Pegah Golabi, Mehmet Sayiner, Manirath Srishord, Ian Shenk, Zobair M Younossi. Global Burden of Metabolic Conditions Associated with Non-alcoholic Fatty Liver Disease (NAFLD), Digestive Disease Week. San Diego, CA, May 21, 2016.

18) Leyla de Avila, Maria Stepanova, Mariam Afendy, Issah Younossi, Huong T. Pham, Rebecca Cable, Amanda Morgan, Lynn Gerber, Zobair M Younossi. Chronic Liver Disease (CLD) is Associated with Significant Health Care Expenditure in the United States (U.S.), Digestive Disease Week. San Diego, CA, May 21, 2016.

19) Azza Karrar, Dinan Abdelatif, Irfan Ali, Tasneem Shaikh, Sofie Fazel, Tibyan Mohamed, Sami J. Morse, Fanny Monge, Munkhzul Otgonsuren, Zacharia Nayer, Lakshmi Alaparthi, Zachary Goodman, Zobair M Younossi. Collagen Deposition in White Adipose Tissue (WAT) Correlates with Hepatic Fibrosis in Non-alcoholic Fatty Liver Disease (NAFLD) as Quantified by Computer-Assisted Morphometry (CAM), Digestive Disease Week. San Diego, CA, May 21, 2016.

20) Elzafir Elsheikh Abdelrahman, Munkhzul Otgonsuren, Elena Younossi, Bryan Raybuck, Zobair M Younossi. HIGH CONCENTRATIONS OF SIMVASTATIN ARE ASSOCIATED WITH LOW LEVELS OF ENDOCAN AND INCREASED CORONARY ARTERY ENDOTHELIAL CELL DEATH IN VITRO, International Academy of Cardiology.

21) Zobair M Younossi, Maria Stepanova, Mark S. Sulkowski, Graham R. Foster, Nancy Reau, Alessandra Mangia, Keyur Patel, Norbert Brau, Stuart Roberts, Nezam H. Afdhal, Fatema Nader, Sharon Hunt. Ribavirin-Free Regimen with Velpatasvir and Sofosbuvir is Associated with High E�ciency and Improvement of Patient-Reported Outcomes in Patients with Genotypes 2 and 3 Chronic Hepatitis C: Results From ASTRAL-2 and 3 Clinical Trials, Digestive Disease Week. San Diego, CA, May 21, 2016.

22) Aijaz Ahmed, Sammy Saab, Stuart C. Gordon, Douglas T. Dieterich, Robert John Wong, Kimberly Brown, Marcelo Kugelmas, Zobair M Younossi. A Decision Analytic Markov Model to Evaluate the Health Outcomes of Sofosbuvir/Velpatasvir for Patients with Chronic Hepatitis C Virus Genotypes 1 to 6 and Decompensated Cirrhosis in the US, American Association for the Study of Liver Diseases. Boston, November 12, 2016.

23) Sammy Saab, Stevan Gonzalez, Ryan Perumpail, George Cholankeril, Aijaz Ahmed, Zobair M Younossi. Cost E�ectiveness Analysis of Pre vs. Post LT Treatment with All Oral Direct Acting Antivirals in Hepatitis C Patients with Decompensated Cirrhosis in the US, American Association for the Study of Liver Diseases. Boston, November 11, 2016.

24) Zobair M Younossi, Maria Stepanova, Kwang-Hyub Han, Wan-Long Chuang, Henry Lik-Yuen Chan, Young-Suk Lim, Rong-Nan Chien, Sang Hoon Ahn, Sook-Hyang Jeong, Ting-Tsung Chang, Seung-Woon Paik, Cheng-Yuan Peng, Chi-Jen Chu, Youn-Jae Lee, Ching-Lung Lai, Jia-Horng Kao, Sharon Hunt. Comparison of Health-Related Quality of Life (HRQL) in Asian Patients with Chronic Hepatitis C Treated with Interferon (IFN)-free Ribavirin (RBV)-Containing Regimens vs Interferon-free and Ribavirin-free Regimens, American Association for the Study of Liver Diseases. Boston, November 12, 2016.

25) Stuart C. Gordon, Aijaz Ahmed, Marcelo Kugelmas, Douglas T. Dieterich, Robert John Wong, Kimberly Brown, Sammy Saab, Zobair M Younossi. A Decision Analytic Markov Model to Evaluate the Health Outcomes of Sofosbuvir/Velpatasvir for Patients with Chronic Hepatitis C Virus Genotype 2 and 3 Infection in the US, American Association for the Study of Liver Diseases. Boston, November 12, 2016.

26) George Cholankeril, Ryan Perumpail, Menghan Hu, Jayasekera Channa R. , EW Holt, Stevan Gonzalez, Stephen A. Harrison, Zobair M Younossi, Robert John Wong, Aijaz Ahmed. Geographic Variation in Nonalcoholic Steatohepatitis-Related Liver Transplantation, American Association for the Study of Liver Diseases. Boston, MA. November 11, 2016.

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27) Lisa M. Nyberg, Xia Li, Su-Jau Yang, Kevin M. Chiang, T. Craig Cheetham, Susan Caparosa, Zobair M Younossi, Anders H. Nyberg. Identification of Patient Groups Previously Not Candidates for Interferon Therapy for Chronic Hepatitis C and Implications for Planning and Budgeting for Treatment with Current Regimens, American Association for the Study of Liver Diseases. Boston, November 12, 2016.

28) Patrice Cacoub, M Vauthier, AC Desbois, M. Doz, A. Lafuma, Zobair M Younossi. Direct Medical Costs Associated with the Extrahepatic Manifestations of Hepatitis C Infection in France, American Association for the Study of Liver Diseases. Boston, November 11, 2016.

29) Hesam Tavakoli, Ann Robinson, Benny Liu, Taft Bhuket, Zobair M Younossi, Sammy Saab, Aijaz Ahmed, Robert John Wong. Patients with Nonalcoholic Steatohepatitis Cirrhosis Are Significantly Less Likely To Receive Appropriate Screening for Hepatocellular Carcinoma Compared to Patients with Chronic Hepatitis C Virus Cirrhosis, American Association for the Study of Liver Diseases. Boston, November 13, 2016.

30) Peter Masschelin, Kathleen Gwilliam, Rohini Mehta, Zobair M Younossi. In Hepatocytes, DNA Methylation and Hydroxymethylation Are Altered in Response to Oleic Acid Exposure: A Potential Mechanism for Non-alcoholic Fatty Liver Disease (NAFLD), American Association for the Study of Liver Diseases. Boston, November 11, 2016.

31) Azza Karrar, Dinan Abdelatif, Tibyan Mohamed, Mohamad Houry, Fanny Monge, Lakshmi Alaparthi, Munkhzul Otgonsuren, Zahra Younoszai, Sharon Hunt, Zachary Goodman, Zobair M Younossi. Intrahepatic B cells (IHB) as an Independent Predictor of Hepatic Fibrosis in Non-alcoholic Fatty Liver Disease (NAFLD) as Quantified by Computer-Assisted Morphometry (CAM), American Association for the Study of Liver Diseases. Boston, November 11, 2016.

32) Elzafir Elsheikh Abdelrahman, Azza Karrar, Sean C. Felix, Hussain Allawi, Mehmet Sayiner, Thomas Je�ers, Zahra Younoszai, Munkhzul Otgonsuren, Andrei Racila, Brian P. Lam, Jason Po�, Bryan Raybuck, Lynn Gerber, Zobair M Younossi. Serum Nitrotyrosine is Independently Associated with the Presence of Coronary Artery Disease in Patients with Nonalcoholic Fatty Liver Disease (NAFLD), American Association for the Study of Liver Diseases. Boston, November 12, 2016.

33) Rohini Mehta, Zahra Younoszai, Thomas Je�ers, Munkhzul Otgonsuren, Zachary Goodman, Zobair M Younossi. Association of Circulating Receptors for Advanced Glycation Endproducts (RAGE) and RAGE Gene Polymorphism G82S (rs207600) polymorphism in Non-alcoholic Fatty Liver Disease (NAFLD), American Association for the Study of Liver Diseases. Boston, November 11, 2016.

34) James M. Estep, Rohini Mehta, Gary Bratthauer, Lakshmi Alaparthi, Fanny Monge, Irfan Ali, Dinan Abdelatif, Zahra Younoszai, Thomas Je�ers, Sean C. Felix, Zachary Goodman, Zobair M Younossi. Hepatic Sonic Hedgehog (SHH) Expression Measured by Computer Assisted Morphometry Correlates Histologic Features of Non-Alcoholic Steatohepatitis (NASH) and Circulating Markers of Apoptosis and Cell Injury, American Association for the Study of Liver Diseases.

35) Zobair M Younossi, Linda Henry, Maria Stepanova, Youssef Younossi, Sharon Hunt, Rachel Beckerman. Non-alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes (DM): A Costly Combination, Digestive Disease Week. San Diego, CA, May 21, 2016.

36) Zobair M Younossi, Munkhzul Otgonsuren, Linda Henry, Fatema Nader, Andrei Racila, Sharon Hunt. The Extra Hepatic Manifestation of Hepatitis C Virus in the Asian Countries- A Systematic Review of the Epidemiologic Burden, Asian Pacific Digestive Week. Kobe, November 02, 2016.



37) Zobair M Younossi, Maria Stepanova, Kwang-Hyub Han, Young-Suk Lim, Youn-Jae Lee, Wan-Long Chuang,

Jia-Horng Kao, Rong-Nan Chien, Ting-Tsung Chang, Cheng-Yuan Peng. Asian Patients with Hepatitis C (HCV)

Genotype 1 Treated with Ledipasvir and Sofosbuvir (LDV/SOF) Experience Very High E�cacy and Improvement

of Health-related Quality of Life (HRQL), Asian Pacific Digestive Week. Kobe, November 02, 2016.

38) Zobair M Younossi, Maria Stepanova, Kwang-Hyub Han, Sook-Hyang Jeong, Seung-Woon Paik, Ting-Tsung

Chang, Chi-Jen Chu, Henry Lik-Yuen Chan, Ching-Lung Lai, Sharon Hunt. A Mild and Reversible Health Related

Quality of Life (HRQL) Impairments is observed in Asian Patients with Hepatitis C Virus (HCV) Infection Who Are

Treated with Ribavirin-Containing Regimens, Asian Pacific Digestive Week. Kobe, November 02, 2016.

39) Pegah Golabi, Elzafir Elsheikh Abdelrahman, Azza Karrar, James M. Estep, Issah Younossi, Maria Stepanova,

Lynn Gerber, Zobair M Younossi. THE LEVELS OF MONOAMINE NEUROTRANSMITTERS IN HCV PATIENTS

TREATED WITH LEDIPASVIR (LDV)/SOFOSBUVIR (SOF), European Association for the Study of the Liver.

Barcelona, Spain, April 2016.

40) Maria Stepanova, Leyla de Avila, Thomas Je�ers, Robert John Wong, Aijaz Ahmed, Zobair M Younossi.

LONG-TERM OUTCOMES OF HEART TRANSPLANT RECIPIENTS WITH HEPATITIS C INFECTION, European

Association for the Study of the Liver. Barcelona, Spain, April 2016.

41) Zobair M Younossi, Maria Stepanova, Sharon Hunt. Development of A Validated Disease-Specific

Health-Related Quality (HRQL) Instrument for Patients with Non-alcoholic Fatty Liver Disease (NAFLD) and

Non-alcoholic Steatohepatitis (NASH): CLDQ-NAFLD (ADA), American Diabetes Association. New Orleans, La,

June 10, 2016.

42) Maria Stepanova, Leyla de Avila, Mariam Afendy, Issah Younossi, Huong T. Pham, Rebecca Cable, Lynn Gerber,

Zobair M Younossi. Extensive Economic and Quality of Life Burden of Viral Hepatitis (VH): The Data from the U.S.

Medical Expenditure Panel Survey (MEPS), American Association for the Study of Liver Diseases. Boston,

November 11, 2016.

43) Zobair M Younossi, Deidre Blissett, Rob Blissett, Maria Stepanova, Linda Henry, Youssef Younossi, Rachel

Beckerman, Sharon Hunt. The Economic and Clinical Burden of Non-alcoholic Fatty Liver Disease (NAFLD) in the

United States and Europe: A Steady-State Prevalence Model (abstract), American Association for the Study of

Liver Diseases. Boston, November 14, 2016.

44) Zobair M Younossi, Maria Stepanova, Fatema Nader, Sharon Hunt, Christophe Bureau, Neil Inhaber, Rajiv

Jalan. Patients with Refractory Ascites Treated with alfapump® System (AP) have Better Health-related

Quality of Life (HRQL) as Compared to those Treated with Large Volume Paracentesis (LVP): Results of a

Multicenter Randomized Controlled Study, American Association for the Study of Liver Diseases. Boston,

November 11, 2016.

45) Mehmet Sayiner, Munkhzul Otgonsuren, Rebecca Cable, Issah Younossi, Mariam Afendy, Zobair M

Younossi. Contributors of Inpatient and Outpatient Resource Utilization for Medicare Beneficiaries with

Non-Alcoholic Fatty Liver Disease and the Relation with Cirrhosis Status in 2010, Digestive Disease

Week. San Diego, CA, May 21, 2016.

46) Pegah Golabi, Cameron T. Locklear, Patrick Austin, Sophie K. Afdhal, Lynn Gerber, Zobair M Younossi. Evidence

for E�ectiveness of Exercise in Fat Mobilization from the Liver in People with Non-Alcoholic Fatty Liver:

Systematic Review of Literature, Digestive Disease Week. San Diego, CA, May 21, 2016.

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47) Sarah Elfeky, Pegah Golabi, Munkhzul Otgonsuren, Svetolik Djurkovic, Zobair M Younossi. Factors Associated with Discharge to Short Term Care, Long Term Care and Death among Patients with a Hospital Diagnosis of Sepsis, Chest.

48) Mehmet Sayiner, Maria Stepanova, Huong T. Pham, Bashir Noor, Mercedes Walters, Zobair M Younossi. Health-Related Quality of Life and Health Utilities in Patients with Non-alcoholic Fatty Liver Disease, Digestive Disease Week. San Diego, CA, May 21, 2016.

49) Pegah Golabi, Mehmet Sayiner, James M. Estep, Spencer Frost, Brian P. Lam, Sean C. Felix, A. Rose Srishord, Lynn Gerber, Zobair M Younossi. Association of Fatigue with Serum Tumor Necrosis Factor-a (TNF-a) and Chemokine (C-C motif) Ligand 2 (CCL2) in Patients with Chronic Hepatitis C Virus (HCV) Infection, Digestive Disease Week. San Diego, CA, May 21, 2016.

50) Sofie Fazel, Pegah Golabi, Munkhzul Otgonsuren, Cameron T. Locklear, Nina Badoe, Chapy Venkatesan, Alita Mishra, Zobair M Younossi. Mortality Assessment of Patients with Hepatocellular Carcinoma According to Types of Underlying Liver Disease and Treatment Modalities, Digestive Disease Week. San Diego, CA, May 21, 2016.

51) Leo Mclaughlin, Sean C. Felix, Zahra Younoszai, Thomas Je�ers, Ossman Cossio, Ameeta Kumar, Hussain Allawi, Maria Stepanova, Jason Po�, Bryan Raybuck, Sharon Hunt, Zobair M Younossi. Association of Non-alcoholic Fatty Liver Disease and Coronary Artery Disease in Patients Undergoing Coronary Angiography, Digestive Disease Week. San Diego, CA, May 21, 2016.

52) Zobair M Younossi, Maria Stepanova, Masao Omata, Masashi Mizokami, Sharon Hunt. Quality of Life of Japanese Patients with Chronic Hepatitis C Treated with Ledipasvir and Sofosbuvir (poster), Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

53) Zobair M Younossi, Maria Stepanova, Masao Omata, Masashi Mizokami, Mercedes Walters, Fatema Nader, Sharon Hunt. Improvement of Health-related Quality of Life(HRQL) Scores in Japanese Cirrhotic Patients with Chronic Hepatitis C(CH-C) who are Treated with Sofosbuvir(SOF)-Containing Regimens, Asian Pacific Digestive Week. Kobe, November 2, 2016.

54) Steven L. Flamm, Bruce R. Bacon, Michael P. Curry, Douglas T. Dieterich, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi, Nezam H. Afdhal. LEDIPASVIR/SOFOSBUVIR+/-RIBAVIRIN IN HCV POST-TRANSPLANT PATIENTS: REAL-WORLD HETEROGENEOUS POPULATION FROM THE TRIO NETWORK, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

55) Douglas T. Dieterich, Bruce R. Bacon, Michael P. Curry, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi. LEDIPASVIR/SOFOSBUVIR+/-RIBAVIRIN IN PATIENTS CO-INFECTED WITH HCV AND HIV: REAL-WORLD HETEROGENEOUS POPULATION FROM THE TRIO NETWORK, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

56) Zobair M Younossi, Stuart C. Gordon, Aijaz Ahmed, Douglas T. Dieterich, Sammy Saab, Rachel Beckerman. Reduction in Clinical and Economic Burden by Treating All Medicaid Patients with Chronic Hepatitis C (CHC): A Decision-Analytic Model (DDW), Digestive Disease Week. San Diego, CA, May 21, 2016.

57) Zobair M Younossi, Haesuk Park, Douglas T. Dieterich, Sammy Saab, Aijaz Ahmed, Stuart C. Gordon. The Value of Cure for Chronic Hepatitis C (CH-C) to the Society, Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.



58) Zobair M Younossi, Maria Stepanova, Henry Lik-Yuen Chan, Mei Hsuan Lee, Ming-Lung Yu, Yock Young Dan,

Moon Seok Choi, Linda Henry. Work Productivity Impairment in Asian Patients with Hepatitis C Treated with

Di�erent Regimens, Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

59) Zobair M Younossi, Maria Stepanova, William Balistreri, Kathleen B. Schwarz, Karen Murray, Philip Rosenthal,

Sanjay Bansal, Sharon Hunt. High E�cacy and Significant Improvement of Quality of Life (QoL) in Adolescent

Patients with Hepatitis C Genotype 1 (GT1) Treated with Sofosbuvir (SOF) and Ledipasvir (LDV), American


60) Zobair M Younossi, Stuart C. Gordon, Douglas T. Dieterich, Robert John Wong, Kimberly Brown, Marcelo

Kugelmas, Sammy Saab, Aijaz Ahmed. A Decision Analytic Markov Model to Evaluate the Health Outcomes of

Sofosbuvir/Velpatasvir for Patients with Chronic Hepatitis C Virus Genotype 1 Infection in the US, American


61) Zobair M Younossi, Maria Stepanova, Mark S. Sulkowski, David Wyles, Shyam Kottilil, Sharon Hunt. The

Sofosbuvir (SOF) and Velpatasvir (VEL) Regimen is Associated with High E�cacy and Improvement of

Patient-Reported Outcomes (PROs) in Patients Co-infected with Hepatitis C Virus (HCV) and Human

Immunodeficiency Virus (HIV): The Data from ASTRAL-5, American Association for the Study of Liver Diseases.

Boston, November 13, 2016.

62) Anders H. Nyberg, Ekaterina Sadikova, Jiaxiao M. Shi, T. Craig Cheetham, Kevin M. Chiang, Zobair M Younossi,

Lisa M. Nyberg. Increased Cancer Rates in CHC Patients: An analysis of the Cancer Registry in a large U.S. HMO,

Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

63) Lisa M. Nyberg, Xia Li, Su-Jau Yang, Kevin M. Chiang, T. Craig Cheetham, Susan Caparosa, Jose Pio, Zobair M

Younossi, Anders H. Nyberg. Association of SVR and All-cause Mortality Post INF-based Therapy for CHC in a

US Community Setting , Asian Pacific Association for the Study of Liver. Tokyo, Japan, February 20, 2016.

64) Nezam H. Afdhal, Bruce R. Bacon, Michael P. Curry, Douglas T. Dieterich, Steven L. Flamm, Lauren Guest, Kris V.

Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi. Failure with All-oral DAA Regimens: Real-World Experience

from the TRIO Network, Digestive Disease Week. San Diego, CA, May 21, 2016.

65) Zobair M Younossi, Deidre Blissett, Rob Blissett, Linda Henry, Youssef Younossi, Rachel Beckerman, Sharon

Hunt. In The Era of Highly E�ective Direct Acting Anti-Viral Agents, Screening The Entire United States

Population for Hepatitis C is Cost E�ective, American Association for the Study of Liver Diseases. Boston,

November 12, 2016.

66) Janki Patel, Parambir Dulai, Siddharth Singh, Zobair M Younossi, Giada Sebastiani, Mattias Ekstedt, Hannes

Hagstrom, Patrik Nasr, Per Stal, Stergios Kechagias, Rolf Hultcranz, Rohit Loomba. Increased Risk of Mortality by

Fibrosis Stage in Non-Alcoholic Fatty Liver Disease: Systematic Review and Meta-Analysis, American

Association for the Study of Liver Diseases. Boston, MA. November 11, 2016.

67) Kevin M. Korenblat, Bruce R. Bacon, Michael P. Curry, Douglas T. Dieterich, Steven L. Flamm, Lauren Guest, Kris

V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi, Nezam H. Afdhal. E�ect of Ethnicity on HCV Patient

Outcomes and Access to Therapy in Era of All DAA Regimens: Real-World Experience From the Trio Network,

American Association for the Study of Liver Diseases. Boston, November 14, 2016.

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68) Jennifer Wang, John Ha, Michele Tana, Taft Bhuket, Benny Liu, Zobair M Younossi, Robert John Wong. Insured Patients with Hepatocellular Carcinoma (HCC) in the United States are more likely to have HCC within Milan Criteria, are more likely to receive treatment, and have higher survival compared to uninsured and Medicaid patients, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

69) Anders H. Nyberg, Ekaterina Sadikova, Jiaxiao M. Shi, T. Craig Cheetham, Kevin M. Chiang, Zobair M Younossi, Lisa M. Nyberg. STATIN USE IS ASSOCIATED WITH A LOWER RATE OF LIVER CANCER IN PATIENTS WITH CHRONIC HEPATITIS C, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

70) Lisa M. Nyberg, Xia Li, Su-Jau Yang, T. Craig Cheetham, Kevin M. Chiang, Jose Pio, Susan Caparosa, Zobair M Younossi, Anders H. Nyberg. SUSTAINED VIROLOGICAL RESPONSE AFTER INTERFERON-BASED THERAPY FOR CHRONIC HEPATITIS C AND ITS ASSOCIATION WITH REDUCED ALL-CAUSE MORTALITY AND LIVER-RELATED MORTALITY, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

71) Zobair M Younossi, Maria Stepanova, Michael R. Charlton, Jacqueline G O'Leary, Michael P. Curry, Robert S. Brown, Sharon Hunt. EFFICACY AND PATIENT-REPORTED OUTCOMES IN DECOMPENSATED CIRRHOTIC WITH CHRONIC HEPATITIS C TREATED WITH SOFOSBUVIR AND VELPATASVIR WITH OR WITHOUT RIBAVIRIN: RESULTS FROM ASTRAL-4 CLINICAL TRIAL (abstract), European Association for the Study of the Liver. Barcelona, Spain, April 2016.

72) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Stefan Zeuzem, Mark S. Sulkowski, Graham R. Foster, Alessandra Mangia, Michael R. Charlton, Jacqueline G O'Leary, Michael P. Curry, Sharon Hunt. IMPRESSIVE GAINS IN PATIENT-REPORTED OUTCOMES ARE OBSERVED IN CHRONIC HEPATITIS C PATIENTS WITH OR WITHOUT CIRRHOSIS WHO ARE TREATED WITH SOFOSBUVIR AND VELPATASVIR: RESULTS FROM ASTRAL-1, -2, -3 AND -4, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

73) Zobair M Younossi, Linda Henry, Maria Stepanova, Youssef Younossi, Andrei Racila, Sharon Hunt, Rachel Beckerman. THE ECONOMIC AND CLINICAL BURDEN OF NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) IN THE UNITED STATES, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

74) Lauren Guest, Michael P. Curry, Bruce R. Bacon, Douglas T. Dieterich, Steven L. Flamm, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi. EFFECTIVENESS OF 8 OR 12 WEEK LDV/SOF IN TREATMENT-NAÏVE PATIENTS WITH NON-CIRRHOTIC, GENOTYPE 1 HEPATITIS C: REAL-WORLD EXPERIENCE FROM THE TRIO NETWORK, International Society of Pharmacoeconomics and Outcomes Research. Washington, DC, May 21, 2016.

75) Lauren Guest, Michael P. Curry, Bruce R. Bacon, Douglas T. Dieterich, Steven L. Flamm, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi. EFFECTIVENESS OF 12 OR 24 WEEK LDV/SOF AND 12 WEEK LDV/SOF+RBV IN TREATMENT-EXPERIENCED PATIENTS WITH CIRRHOTIC, GENOTYPE 1 HEPATITIS C: REAL-WORLD EXPERIENCE FROM THE TRIO NETWORK, International Society of Pharmacoeconomics and Outcomes Research. Washington, DC, May 21, 2016.

76) Zobair M Younossi, Maria Stepanova, Masao Omata, Masashi Mizokami, Fatema Nader, Sharon Hunt. FATIGUE IN JAPANESE PATIENTS WITH CHRONIC HEPATITIS C TREATED WITH LEDIPASVIR AND SOFOSBUVIR WITH OR WITHOUT RIBAVIRIN , International Society of Pharmacoeconomics and Outcomes Research. Washington, DC, May 21, 2016.

77) Zobair M Younossi, Maria Stepanova, Masao Omata, Masashi Mizokami, Fatema Nader, Sharon Hunt. HEALTH UTILITY ASSESSMENT IN JAPANESE PATIENTS WITH CHRONIC HEPATITIS TREATED WITH INTERFERON-FREE REGIMENS , International Society of Pharmacoeconomics and Outcomes Research. Washington, DC, May 21, 2016.



78) Nezam H. Afdhal, Bruce R. Bacon, Michael P. Curry, Douglas T. Dieterich, Steven L. Flamm, Lauren Guest, Kris V. Kowdley, Yoori Lee, Naoky Tsai, Zobair M Younossi. NO EFFECT OF PROTON PUMP INHIBITOR (PPI) USE ON SVR WITH LEDIPASVIR/SOFOSBUVIR (LDV/SOF): REAL WORLD DATA FROM 2034 GENOTYPE 1 PATIENTS IN THE TRIO NETWORK, European Association for the Study of the Liver. Barcelona, Spain, April 13, 2016.

79) Lisa M. Nyberg, Xia Li, Su-Jau Yang, Kevin M. Chiang, T. Craig Cheetham, Susan Caparosa, Jose Pio, Zobair M Younossi. The Association of Sustained Virological Response and Mortality After Interferon-based Therapy for Chronic Hepatitis C (HCV) in a Large U.S. Community-based Health Care Delivery System, European Association for the Study of the Liver. Barcelona, Spain, April 13, 2016.

80) Jillian Kallman Price, Patrick Austin, Carey Escheik, Lynn Gerber, Zobair M Younossi. Resting VO2 Significantly Lower in Non-alcoholic Fatty Liver Disease Than General Population Estimate, American College of Sports Medicine. Boston, MA. May 31, 2016.

81) Sophie K. Afdhal, Ali Weinstein, Christina Spataro, Carey Escheik, Patrick Austin, Lynn Gerber, Zobair M Younossi. Fatigue & Hepatitis C: A Focus Group Study, American Association for the Study of Liver Diseases. Boston, November 14, 2016.

82) Spencer Frost, James M. Estep, Kellie Perry, Sean C. Felix, Leo Mclaughlin, Brian P. Lam, Maria Stepanova, Pegah Golabi, Lynn Gerber, Zobair M Younossi. Interferon lambda 4 (IFN-¿4) genotype is associated with fatigue in patients with chronic hepatitis C (CH-C) receiving direct-acting antiviral (DAA) treatment, Digestive Disease Week. San Diego, CA, May 21, 2016.

83) Zobair M Younossi, Azza Karrar, Mariaelena Pierobon, Maria Stepanova, Kianoush Jeiran, Kimberly Reeder, Thomas Je�ers, Zahra Younoszai, Zachary Goodman, Emanuel F. Petricoin. PHOSPHOPROTEOMIC ANALYSIS OF INTRACELLULAR SIGNALING IN THE HUMAN HEPATIC TISSUE OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND FIBROSIS, European Association for the Study of the Liver. Barcelona, Spain, April 2016.

84) James M. Estep, Rohini Mehta, Gary Bratthauer, Zacharia Nayer, Lakshmi Alaparthi, Fanny Monge, Irfan Ali, Dinan Abdelatif, Zahra Younoszai, Zachary Goodman, Zobair M Younossi. COMPUTER ASSISTED MORPHOMETRIC ANALYSIS OF HEPATIC SONIC HEDGEHOG EXPRESSION (SHH) CORRELATES WITH CIRCULATING MARKERS OF CELL DEATH AND KEY HISTOLOGIC FEATURES OF NONALCOHOLIC STEATOHEPATITIS (NASH), European Association for the Study of the Liver. Barcelona, Spain, April 2016.

85) Michael-Angelo Orciga, Zahra Younoszai, Kuan Yao, Maria Keaton, Ancha Baranova, Aybike Birerdinc, Zobair M Younossi. The Role of Insulin-like Growth Factor 1 (IGF1) in Polycystic Ovarian Syndrome in Patients with Non-alcoholic Fatty Liver Disease (NAFLD), Digestive Disease Week. San Diego, CA, May 21, 2016.

86) Azza Karrar, Alex Sa�ran, Pegah Golabi, Tibyan Mohamed, An Nguyen, Leo Mclaughlin, Zahra Younoszai, Sharon Hunt, Munkhzul Otgonsuren, Dinan Abdelatif, Zachary Goodman, Zobair M Younossi. Liver-Type Fatty Acid Binding Protein (L- FABP) is Strongly Associated with Non-Alcoholic Steatohepatitis (NASH), Digestive Disease Week. San Diego, CA, May 21, 2016.

87) Azza Karrar, Alex Sa�ran, Mehmet Sayiner, Tasneem Shaikh, Thomas Je�ers, Sean C. Felix, Tibyan Mohamed, Munkhzul Otgonsuren, Sharon Hunt, Dinan Abdelatif, Zachary Goodman, Zobair M Younossi. The Mucosal Addressin Cell Adhesion Molecule-1 (sMADCAM-1) and MAp44 Activation Are Associated with Di�erent Clinical and Pathologic Features of Non Alcoholic Steatohepatitis (NASH), Digestive Disease Week. San Diego, CA, May 21, 2016.

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88) Aaron B. Koenig, Maria Stepanova, Sammy Saab, Aijaz Ahmed, Robert John Wong, Trevor Gogoll, Zobair M Younossi. Long-Term Outcomes of Lung Transplantation in Patients with Hepatitis C Infection: The Data from the U.S. Transplant Registry, Digestive Disease Week. San Diego, CA, May 21, 2016.

89) Elzafir Elsheikh Abdelrahman, Sean C. Felix, Leo Mclaughlin, Hussain Allawi, Thomas Je�ers, Susan Chen, Zahra Younoszai, Munkhzul Otgonsuren, Brian P. Lam, Jason Po�, Bryan Raybuck, Zobair M Younossi. Low Levels of Circulating Angiopoietin-like 4 Protein are Associated with the Presence of Coronary Artery Disease in Patients with Nonalcoholic Fatty Liver Disease, Digestive Disease Week. San Diego, CA, May 21, 2016.

90) Aybike Birerdinc, Max Marzouk, Anthony Loria, Lei Wang, Leyla de Avila, Ancha Baranova, Zobair M Younossi. A Meta-Analysis of the Global Prevalence of Hepatitis B in light of increasing HBV vaccination: Is there Any Change?, Digestive Disease Week. San Diego, CA, May 21, 2016.

91) James M. Estep, Rohini Mehta, Spencer Frost, Mehmet Sayiner, Thomas Je�ers, Zahra Younoszai, Isabella Lao, Zachary Goodman, Zobair M Younossi. Minor Alleles for PNPLA3 and TM6SF2 Inadequate for Diagnosis of Non-Alcoholic Steatohepatitis in a Morbidly Obese Population, Digestive Disease Week. San Diego, CA, May 21, 2016.

92) Zobair M Younossi, Azza Karrar, Mariaelena Pierobon, Maria Stepanova, Kianoush Jeiran, Alex Hodge, Fanny Monge, Lakshmi Alaparthi, Dinan Abdelatif, Aybike Birerdinc, Vikas Chandhoke, Zachary Goodman, Emanuel F. Petricoin. Protein Pathway Activation Mapping of Non-alcoholic Steatohepatitis (NASH): The Role Phosphorylation of Proteins Involved in Apoptosis and Collagen Deposition, American Association for the Study of Liver Diseases. Boston, November 12, 2016.

93) Azza Karrar, Sara Kim, Dinan Abdelatif, Tibyan Mohamed, Mohamad Houry, Fanny Monge, Lakshmi Alaparthi, Andrei Racila, Munkhzul Otgonsuren, Zachary Goodman, Zobair M Younossi. Liver Type Arginase (Arginase-1) is Independently Associated with Focal Necrosis in Patients with Non Alcoholic Steatohepatitis (NASH), American Association for the Study of Liver Diseases. Boston, November 11, 2016.

94) Edgar Rodriguez, Katherine Doyle, Kameron Tavakolian, Rohini Mehta, Leo Druker, Aybike Birerdinc, Zachary Goodman, Zobair M Younossi. Protein Levels in The Visceral Adipose Tissue (VAT) of Morbidly Obese Subjects with Non-alcoholic Fatty Liver Disease (NALFD) Suggests Pro-inflammatory and Pro-fibrotic Signaling. American College Gastroenterology. Las Vegas, October 14, 2016.

95) Rohini Mehta, Aybike Birerdinc, Katherine Doyle, Maria Keaton, Indie Srishord, Leo Mclaughlin, Thomas Je�ers, Sean C. Felix, Zachary Goodman, Zobair M Younossi. Receptors for Advanced Glycation Endproducts and Markers of Systemic Inflammation In Non-Alcoholic Fatty Liver Disease (NAFLD), Digestive Disease Week. San Diego, CA, May 21, 2016.

96) Nadia Busekrus, Lynn Gerber, Patrick Austin, Sophie K. Afdhal, Suzannah Gerber, Sina Gallo, Zobair M Younossi. Scoping Review and Development of a Food Behaviors Questionnaire for a Non-Alcoholic Fatty Liver Disease Population, American College Gastroenterology.

97) Patrick Austin, Ali Weinstein, Lynn Gerber, Carey Escheik, Sophie K. Afdhal, Jillian Kallman Price, Matthew Eiman, Zobair M Younossi. Association of Fitbit Activity Monitor and Human Activity Profile with Clinical Markers of Health and Fitness, American College Gastroenterology.

98) James M. Estep, Rohini Mehta, Azza Karrar, Aybike Birerdinc, Elzafir Elsheikh Abdelrahman, Zachary Goodman, Mariaelena Pierobon, Kianoush Jeiran, Alex Hodge, Emanuel F. Petricoin, Zobair M Younossi. Patients with Non-alcoholic Fatty Liver Disease and Advanced Fibrosis with the “G” allele of rs738409 (PNPLA3): Phophoproteomics Evidence for Diminished Cell Survival Signaling Pathway, American Association for the Study of Liver Diseases.



99) Zobair M Younossi, Maria Stepanova, Chapy Venkatesan, Alita Mishra, Madeline Erario, Yun Fang, Manirath

Srishord, Aimal Arsalla, Yousef Fazel, Linda Henry. Low Employment Rates in Subject Infected With Hepatitis C:

Data from the U.S. Population, Digestive Disease Week.

100) Pegah Golabi, Sofie Fazel, Munkhzul Otgonsuren, Brian P. Lam, Mehmet Sayiner, Ali Weinstein, Jillian Kallman

Price, Zobair M Younossi. Chronic Liver Disease is Associated with Low Rates of Live Birth in the United States,

American Association for the Study of Liver Diseases.

101) Brian P. Lam, Hussain Allawi, Sean C. Felix, Sharon Hunt, Thomas Je�ers, Jason Po�, Bryan Raybuck, Mehmet

Sayiner, Maria Stepanova, Drew Venuto, Zahra Younoszai, Zobair M Younossi. Fatty Liver by Ultrasound

Independently Predicts Presence of Coronary Artery Disease, American Association for the Study of Liver

Diseases.

102) Mehmet Sayiner, Munkhzul Otgonsuren, Aimal Arsalla, Andrei Racila, Yun Fang, Zobair M Younossi. The

Association of Activity and Diet with Mortality of Patients with Non-alcoholic Fatty Liver Disease (NAFLD),


103) Pegah Golabi, Mehmet Sayiner, Munkhzul Otgonsuren, Alita Mishra, Chapy Venkatesan, Madeline Erario, Zobair

M Younossi. Factors Associated with Mortality and Resource Utilization in Patients with Viral Hepatitis Related

Hepatocellular Carcinoma (HCC), Digestive Disease Week.

104) Leyla de Avila, Munkhzul Otgonsuren, Cameron T. Locklear, Aijaz Ahmed, Robert John Wong, Zobair M

Younossi. The Economic Impact Liver Transplantation (LT) to the Medicare Program in the United States,


105) Zobair M Younossi, Maria Stepanova, Jordan J Feld, Ira M. Jacobson, Kosh Agarwal, Christophe Hezode, Sharon

Hunt. THE USE OF SOFOSBUVIR AND VELPATASVIR IS ASSOCIATED WITH HIGH EFFICACY AND

IMPROVEMENT IN PATIENT-REPORTED OUTCOMES IN PATIENTS WITH GENOTYPE 1, 2, 4, 5 AND 6 CHRONIC

HEPATITIS C: RESULTS FROM THE ASTRAL-1 CLINICAL TRIAL, European Association for the Study of the Liver.

106) George Cholankeril, Ryan Perumpail, Menghan Hu, Jayasekera Channa R. , Stephen A. Harrison, Zobair M

Younossi, Renumathy Dhanasekaran, Aijaz Ahmed. Racial/Ethnic Di�erences in Utilization of Curative Treatment

for Localized Early-Stage Hepatocellular Carcinoma in Urban United States, American Association for the Study

of Liver Diseases.

107) Ali Weinstein, Christina Spataro, Sophie K. Afdhal, Carey Escheik, Patrick Austin, Lynn Gerber, Zobair M

Younossi. Chronic Hepatitis C Fatigue: A Qualitative Focus Group Study, Digestive Disease Week.

108) Aybike Birerdinc, Azza Karrar, Elzafir Elsheikh Abdelrahman, Rohini Mehta, James M. Estep, Mariaelena

Pierobon, Maria Stepanova, Leo Druker, Kianoush Jeiran, Alex Hodge, Fanny Monge, Lakshmi Alaparthi, Dinan

Abdelatif, Zachary Goodman, Emanuel F. Petricoin, Zobair M Younossi. The Molecular Crosstalk Between the

Liver and the Visceral Adipose at Various Stages of Non-Alcoholic Fatty Liver Disease (NAFLD), American

Association for the Study of Liver Diseases.

109) Sasha Stoddard, Murad Alfaqih, Leo Druker, Fanny Monge, Thomas Je�ers, Sean C. Felix, Lakshmi Alaparthi,

Aybike Birerdinc, Zachary Goodman, Zobair M Younossi. Association of Serum Cytokines and Percent Collagen

in the Liver Biopsies of Patients with Non-Alcoholic Fatty Liver Disease (NAFLD), American Association for the

Study of Liver Diseases.

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110) Zobair M Younossi, Stuart C. Gordon, Aijaz Ahmed, Douglas T. Dieterich, Sammy Saab, Rachel Beckerman.

Reduction in Clinical and Economic Burden by Treating All Medicaid Patients with Chronic Hepatitis C (CHC): A

Decision-Analytic Model (AMCP), Academy of Managed Care Pharmacy.

111) Lisa M. Nyberg, Kevin M. Chiang, Santiago Lindsay, T. Craig Cheetham, Ekaterina Sadikova, Jiaxiao M. Shi,

Zobair M Younossi, Anders H. Nyberg. Cost per Sustained Virological Response 4 (SVR 4) in Genotype 1 Patients

Treated with Sofosbuvir and Ledipasvir With and Without Ribavirin. A Detailed Cost-Mapping Study, Digestive

Disease Week.

112) Lisa M. Nyberg, Kevin M. Chiang, Santiago Lindsay, T. Craig Cheetham, Ekaterina Sadikova, Jiaxiao M. Shi,

Zobair M Younossi, Anders H. Nyberg. COST PER SUSTAINED VIROLOGICAL RESPONSE 4 (SVR 4) IN

GENOTYPE 1 PATIENTS TREATED WITH SOFOSBUVIR AND LEDIPASVIR WITH AND WITHOUT RIBAVIRIN. A

DETAILED COST-MAPPING STUDY, European Association for the Study of the Liver.

113) Shea PR, Eksteen B, Hirshfield GM, Shi�man ML, Janssen HLA, Montano-Loza AJ, Goodman Z, Kleinstein SE,

Myers RP, Subramanian GM, McHutchinson JG, Bowlus CL, Manns M, Chapman R, Levy C, Muir AJ, Goldstein

DB: Genome-wide association study (GWAS) of liver fibrosis phenotypes in patients with primary sclerosing

cholangitis (PSC) reveals common genetic variation influencing serum levels of lysyl oxidase-like-2 (LOXL2)

Serum lysyl oxidase-like-2 (SLOXL2) levels correlate with disease severity in patients with primary sclerosing

cholangitis. J Hepatol 2016; 64:S180-181.

114) Sanyal A , Goodman Z, Harrison S, Rockey DC, Diehl AM, Caldwell S, Shi�man ML, Thuluvath8 P, Myers RP ,

Subramanian GM , McHutchison JG , Abdelmalek MF, Ratziu V, Afdhal N, Bosch J: Correlation between the

hepatic venous pressure gradient and αlpha-smooth muscle actin (SMA) expression in patients with

compensated cirrhosis due to nonalcoholic steatohepatitis. J Hepatol 2016; 64:S251.

115) Muir AJ, Goodman Z, Bowlus CL, Caldwell S, Invernizzi P, Luketic V, Minuk G, Hirschfield GM, Myers RP, Ding D,

Aguilar R, Subramanian GM, McHutchison JG, Eksteen B, Levy C: Serum lysyl oxidase-like-2 (SLOXL2) levels

correlate with disease severity in patients with primary sclerosing cholangitis. J Hepatol 2016; 64:S428.

116) Bowlus CL, Montano-Loza AJ, Invernizzi P, Chazouillères O, Hirschfield G, Metselaar HJ, Goodman Z, Myers RP,

Aguilar R, Subramanian GM, McHutchison JG, Chapman R, Muir AJ, Eksteen B, Levy C:Liver sti�ness

measurement by transient elastography for the prediction of fibrosis in patients with primary sclerosing

cholangitis in a randomized trial of simtuzumab. J Hepatol 2016; 64:S434.

117) Goodman Z, Patel K, Guha I, Hameed B, Kowdley K, Alaparthi L, Monge F, Myers RP, Aguilar R, Subramanian GM,

McHutchison JG, Bowlus CL, Levy C, Manns M, Chapman R, Muir AJ: Correlations between hepatic

morphometric collagen content, histologic fibrosis stage, and serum markers in patients with primary sclerosing

cholangitis (PSC). J Hepatol 2016; 64:S652-653.

118) Sanyal AJ, Ratziu V, Goodman Z, Lefebvre E, Vest J, Gottwald MD, Fischer L, Friedman SL: APRI and FIB-4 Index

scores can enrich for subjects with fibrotic non-alcoholic steatohepatitis (NASH) in clinical trials - The CENTAUR

trial data. Gastroenterology 2016; 150:S:1037-1038.



119) Henson JB, Levy C, Goodman Z, Ding D, Aguilar R, Myers RP, Muir A: Sex-Specific Di�erences in Patients With

Primary Sclerosing Cholangitis. Gastroenterology 2016; 150: S1070.

120) French D, Huntzicker EG, Goodman ZD, Shea PR, Ding D, Aguilar Schall RE, Smith V, Subramanian M, Levy C,

Bowlus CL, Eksteen B, Chapman RW, Muir AJ, Goldstein DB, Myers RP: Hepatic expression of lysyl

oxidase-like-2 (LOXL2) in primary sclerosing cholangitis (PSC). Hepatology 2016; 64:194A.

121) Karsdal MA, Henriksen K, Nielsen MJ, Byrjalsen I, Leeming DJ, Gardner SD, Goodman ZD, Patel K, Krag A,

Christiansen C, Schuppan D: Pro-C3, a novel serum marker of pure fibrogenesis, identifies patients with

progressive liver fibrosis and responders to anti-fibrotic therapy. Hepatology 2016; 64:209-210A.

122) Goodman ZD, Burton B, Alaparthi L, Monge F, Friedman M, Soni P: Change in liver fibrosis in children and adults

with lysosomal acid lipase deficiency after 52 weeks of Sebelipase alfa (ARISE Trial). Hepatology 2016;

64:279-280A.

123) French D, Turner S, Nichols A, Goodman ZD, Delaney WE, Subramian M, Gaggar A, Fletcher SP, Feierbach B:

Characterization of intrahepatic viral antigens and immune markers in chronic hepatitis B patients by multiplex

immunofluorescence. Hepatology 2016; 64:297-298A.

124) Sarkar N, Gururajan A, Li B, Jiang Z, Xu R, Djedjos CS, Patterson S, Myers RP, Goodman ZD, Charlton MR, Afdhal

NH, Loomba R: Circulating microRNAs as markers for liver histological lesions in patients with nonalcoholic

steatohepatitis. Hepatology 2016; 64:535-536A.

125) Povero D, Johnson C, Yamashita H, Myers RP, Djedjos CS, Subramian M, Goodman ZD, Harrison SA, Sanya AJ,

Bosch J, Feldstein AE: Circulating, hepatocyte-derived extracellular vesicles correlate with fibrosis stage and

portal pressure in patients with nonalcoholic steatohepatitis. Hepatology 2016; 64:566A.

126) Vuppalanchi R, Abdelmalek MF, Lawitz E, Traber PG, Allgood AE, Harrison SA, Goodman ZD, Chalasani NP,

Garcia-Tsao G: Vibration-controlled transient elastography (VCTE) is useful in identifying clinically significant

portal hypertension in patients with NASH cirrhosis. Hepatology 2016; 64:844-8455A.

127) Pegah Golabi, Munkhzul Otgonsuren, Aimal Arsalla, Madeline Erario, Manirath Srishord, Zobair M Younossi.

Long Term Mortality of Patients with Non-alcoholic Fatty Liver Disease (NAFLD), American Association for the

Study of Liver Diseases. Boston, November 12, 2016.

128) Zobair M Younossi, Munkhzul Otgonsuren, Leyla de Avila, Cameron T. Locklear, Amanda Morgan, Issah

Younossi, Chapy Venkatesan, Alita Mishra, Andrei Racila, Linda Henry. Health Care Utilization and Mortality

Associated with Primary Biliary Cholangitis (PBC), American Association for the Study of Liver Diseases. Boston,

November 11, 2016.

129) Zobair M Younossi, Maria Stepanova, Leyla de Avila, Chapy Venkatesan, Alita Mishra, Aijaz Ahmed, Robert John

Wong, Andrei Racila. Liver Transplantation (LT) for Primary Biliary Cholangitis (PBC) Over the Last Two Decades

in the United States: The Scientific Registry of Transplant Recipients (SRTR) Data, American Association for the

Study of Liver Diseases.

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130) Dr. Nina Badoe, PGY 3 – Invasive Hemodynamic Testing in Ambulatory Left Ventricular Assist Device (LVAD) Patients.

Poster presentation at the International Society for Heart and Lung Transplant National Meeting, April 2016

131) Dr. Nina Badoe, PGY 3 - Invasive Hemodynamic Ramp Test: A Comparison of Ventricular Unloading between Current

Generation Continuous-Flow LVADs. K. Abdullah, N. Badoe, S. Phillips, J. Nabut, R. Singh, S.S. Desai, P. Shah. Oral

presentation at The International Society For Heart & Lung Transplant (ISHLT) National Meeting April 2016

132) Dr. Nina Badoe, PGY 3 - Exercise Stress ECG Testing to Diagnose Coronary Artery Disease in Women. M. Lui, S.

Gupta; N. Badoe, L. Evans, S. Tewolde, H. Tran. Abstract submission to the 2016 American Heart Association

(AHA) 2016 Scientific Session. Circulation. 2016; 134:A20663

133) Dr. Sarah Elfeky, PGY 3 and Dr. Amanda Morgan, PGY 3 – Standardizing the Discharge Process with the

Resident-Led Discharge Appointment. Poster presentation at the Alliance of Academic Internal Medicine (AAIM)

annual meeting. April 2016

134) Dr. Sarah Elfeky, PGY 3 – Factors Associated with Discharge to Acute Short Term Care, Skilled Outpatient

Facility and Death in patients with a Diagnosis of Sepsis. Poster presentation at the annual American College of

Chest Physicians (CHEST) meeting, October 2016

135) Dr. Eleni Footman, PGY 3 – Transitioning Residents from Interns to Leaders: One Residency Program’s

Approach to Boosting Resident Confidence In Leadership. Podium presentation to American College of

Physicians Virginia Chapter Annual Residents’ competition, March 2016. Second place winner.

136) Dr. Eleni Footman, PGY 3 – publication. E. Service-Learning in Communities of Elders (SLICE): Development and

Evaluation of an Introductory Geriatrics Course for Medical Students. Laks J, Wilson LA, Khandelwal C, Footman

E, Jamison M, Roberts Teaching and Learning in Medicine. April-June 2016. PMID 27064723

137) Dr. Eleni Footman, PGY 3 – A Brief Descriptive Analysis of Recreational Therapy used in the Inpatient Setting.

Poster presentation at the 2016 Annual Scientific Meeting of the American Geriatrics Society.

138) Dr. Natsu Fukui, PGY 2 – A Rare Case of Isolated Pauci-immune Pulmonary Capillaritis: Managing Recurrent

Alveolar Hemorrhage and Concomitant Pulmonary Embolism. Poster presentation at the Annual Thoracic

Society Research Competition April 2016

139) Dr. Natsu Fukui, PGY 2 – A Rare Case of Isolated Pauci-immune Pulmonary Capillaritis: Managing Recurrent

Alveolar Hemorrhage and Concomitant Pulmonary Embolism. Poster presentation at the American College of

Chest Physicians (CHEST) annual meeting, October 2016

140) Dr. Joel Ford, PGY 3 and Dr. Danubia Hester, PGY 2 – publication. The Incidental Use of High-Dose Vitamin D3

in Pancreatic Cancer. Cannon, TL., Ford, J, Hester, D, and Trump, DL. Case Reports in Pancreatic Cancer. May

2016, 2 (1): 32‐35. doi:10.1089/crpc.2016.0003

141) Dr. Joel Ford, PGY 3 – publication. Health and Big Data: An Ethical Framework for Health Information Collection

by Corporate Wellness Programs. Ajunwa l, Crawford K, Ford, JS, J Law Med Ethics. 2016 Sep; 44(3); 474‐80, doi:

10.1177/1073110516667943



142) Dr. Mehmet Sayiner, PGY 1 – Publication. Epidemiology of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis in the United States and the Rest of the World. Sayiner M, Koenig A, Henry L, Younossi ZM. Clin Liver Dis. 2016 May;20(2):205-14. doi: 10.1016/j.cld.2015.10.001. Review. PMID:27063264

143) Dr. Anly Tsang, PGY 2 – Suspected Fatal Bacterial Pericarditis After Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. Podium presentation to American College of Physicians Virginia Chapter Annual Residents’ competition, March 2016.

DR. ZOBAIR YOUNOSSI NATIONAL AND INTERNATIONAL MEETINGS AND LECTURES

1) Management of NAFLD/NASH Diagnostic Modalities and Future Treatment Options. Vienna, Austria.

October 2016.

2) 2017 AASLD Emerging Trends Conference: Emerging Trends in Non-alcoholic Fatty Liver Disease Two Day

Signe Topic Conference), Washington DC, Course Director, Session Chair and Speaker. April 2016

3) How SVR impacts hepatic and extrahepatic disease outcomes. EASL and ASSLD Joint Meeting. Paris, France,

September 2016.

4) Value-Based Medicine in Hepatology Course (Chair and Speaker), AASLD, Boston MA, November 2016

5) Patient Center Research in Hepatology (Course Director and Speaker) AASLD, Boston 2016

6) Quality of Life and HCV. Paris, France. January 2016.

7) DAAs in HCV Patients with Decompensated Cirrhosis: Who, When, Why and What? Riyadh, Saudi Arabia.

January 2016.

8) INF-free DAA Treatment for HCV Genotypes 1 & 4: Should this be the Only Choice? Riyadh, Saudi Arabia.

January 2016.

9) Di�cult to treat hepatitis C patients. Philadelphia, PA. April 2016

10) Long-term outcomes in liver transplant recipients transplanted from HCV-positive donors. Barcelona, Spain.

April 2016.

11) HCV Advanced. Mclean, VA. December 2016.

12) Sofosbuvir/Valpatasvir- Will it make a di�erence, ISGCON meeting New Delhi, India. December 2016.

13) Viral Hepatitis and Complication of Cirrhosis: Therapy Decision Making. Dallas, TX. April 2016

14) Management of NAFLD/NASH diagnostic modalities and future treatment options. Dallas, TX. April 2016

15) Overview of HEOR and PRO data regarding HCV. Barcelona, Spain. April 2016

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16) Value of Health Economics in the U.S. Newark, NJ. April 2016

17) Hepatitis B vaccination in diabetic and liver disease patients. Barcelona, Spain. April 2016.

18) George Washington University Grand Rounds: Quality of Life in Liver Disease. Washington, D.C. May 2016

19) Current and Future Treatment Options for PBC, NASH, and Hepatic Encephalopathy. Fairfax, VA. May 2016

20) The face of the PBC patient. Are you missing the diagnosis? San Diego, CA. May 2016

21) Management of NAFLD/NASH: Diagnostic Modalities and Future Treatment Options. Cleveland, OH. June 2016.

22) Current and Future Treatment Options for PBC, NASH and Hepatic Encephalopathy. McLean, VA. August 2016.

23) Fatty Liver When To Biopsy and How to Manage. Mercy Medical Center. Baltimore, MD. September 2016.

24) NASH Global Clinical Advisory Board. Chicago, IL. September 2016.

25) Value-Based Medicine in Hepatology (Chair and Course Director). Boston, MA. November 2016.

DR. ZACHARY GOODMAN NATIONAL AND INTERNATIONAL MEETINGS AND LECTURES

1) “Acute Liver Injury”, presented at annual meeting of International Liver Study Group, Adelaide, Australia.

April 28, 2016.

2) “Liver biopsy and computer-assisted histomorphometry”, presented at AGA Emmet B. Kee�e Symposium:

Assessing Hepatic Fibrosis – Truth, Lies and Wishes, Digestive Disease Week, San Diego, CA. May 22, 2016.

DR. LYNN GERBER NATIONAL AND INTERNATIONAL MEETINGS AND LECTURES

1) Value-Based Medicine in Hepatology Course (Speaker for Examples from Rheumatology), AASLD, Boston MA,

November 2016.

2) Foundations of Clinical Research (Inova Residents – March 2016; August 17, 2016; and December 4, 2016).

3) Model Systems Directors Meeting (Speaker, Arlington, VA – June 2016; December 2016; and March 2016).

4) American Academy of PMR. October 19 – 23, 2016. 2 talks on “Cancer-Related Fatigue” and E�ects of Aging on

Organ Systems in Athletes”.

5) “The Role of the ICF in Health Systems Research”. George Mason University, October 2016.

6) American Congress of Rehabilitation Medicine, Chicago, IL. (October 2016) Speaker, Cancer Rehabilitation

Round Table.

NOTES

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