Paul Mosca

Overview:

My research focuses on three areas. One is the development of more effective and entirely novel treatments for melanoma. I have a special interest in immunotherapy, novel targeted molecular therapies, and regional chemotherapy for advanced melanoma of the arm or leg. Another area of interest is palliative surgery for cancer with an emphasis on understanding the optimal role and application of this type of surgery in the care of advanced malignancy. A third area of interest is quality and patient safety with an emphasis on communication and work culture.

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1994

University of Virginia

M.D. 1995

University of Virginia

M.B.A. 2011

Desales University

Intern, Surgery

Duke University

Junior Assistant Resident, Surgery

Duke University

Senior Assistant Resident, Surgery

Duke University

Surgical Research Fellow, Surgery

Duke University

2nd Year SAR, Surgery

Duke University

Chief Resident, Surgery

Duke University

Assistant Professor, Surgery

Duke University School of Medicine

Assistant Professor, Surgery

Lehigh Valley Health Network

Grants:

Dendritic Cell Immunotherapy For Breast Cancer

Awarded By
National Institutes of Health
Role
PI-Fellow
Start Date
End Date

Publications:

Intracellular Cytokine Assays

This chapter provides an overview of intracellular cytokine assays. Intracellular cytokine assays are a relatively new method of identifying cytokine production by individual T cells and have the ability to correlate cytokine expression with cell surface phenotype without cell separation. In addition, this highly sensitive flow cytometric method allows for the rapid detection of low frequency T cells expressing cytokine in response to specific antigen stimulation. The unique capabilities of this method make it a model assay for clinical and research applications. The overall premise of intracellular cytokine assays is direct detection of intracellular cytokine expression in response to antigen stimulation. Intracellular cytokine assays can be performed using various sources of cells and antigen depending on the target(s) of interest. T cell stimulation can be performed directly on whole blood, peripheral blood mononuclear cells, in vitro manipulated lymphocytes, isolated cells, and lymph nodes; although using whole blood for these assays provides a more physiological environment and may have an effect on the T cell response to stimulation. Since these assays are most often used to detect very low frequency events, appropriate control antigens are particularly important to ensure clear antigen specific response.
Authors
Hobeika, AC; Morse, MA; Clay, TM; Osada, T; Mosca, PJ; Lyerly, HK
MLA Citation
Hobeika, A. C., et al. “Intracellular Cytokine Assays.” Measuring Immunity: Basic Science and Clinical Practice, 2004, pp. 336–40. Scopus, doi:10.1016/B978-012455900-4/50290-7.
URI
https://scholars.duke.edu/individual/pub1532297
Source
scopus
Published Date
Start Page
336
End Page
340
DOI
10.1016/B978-012455900-4/50290-7

ASO Visual Abstract: Racial Disparities in Surgery for Malignant Bowel Obstruction.

Authors
Penny, CL; Tanino, SM; Mosca, PJ
MLA Citation
Penny, Caitlin L., et al. “ASO Visual Abstract: Racial Disparities in Surgery for Malignant Bowel Obstruction.Ann Surg Oncol, vol. 29, no. 5, May 2022, pp. 3134–35. Pubmed, doi:10.1245/s10434-021-11248-8.
URI
https://scholars.duke.edu/individual/pub1505990
PMID
35000088
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
29
Published Date
Start Page
3134
End Page
3135
DOI
10.1245/s10434-021-11248-8

Racial Disparities in Surgery for Malignant Bowel Obstruction.

BACKGROUND: Operative management of patients with malignant bowel obstruction (MBO) may provide effective palliation, but is associated with substantial risks. This study aimed to analyze racial and ethnic differences in surgical outcomes for patients with MBO. METHODS: This retrospective study, using National Surgical Quality Improvement Program (NSQIP) registry data from 2010 to 2019, compared differences in outcomes by race and ethnicity for 2762 patients undergoing surgery for MBO. Multivariable logistic regression controlled for relevant covariates. RESULTS: Black patients (n = 407) had higher rates of preoperative comorbidity and were more likely than White patients (n = 2081) to have major complications (28.5% vs 21.8%; p = 0.0031), overall complications (47.4% vs 40.4%; p = 0.0087), a longer median hospital stay (12 days; interquartile range [IQR, 8-19 days] vs 10 days [IQR, 7-17 days]; p = 0.0007), and unplanned readmission (17.1% vs 12.9%; p = 0.0266). Black patients had a similar mortality rate to that of White patients and were less frequently discharged to home (67.6% vs 73.0%; p = 0.0315). Differences in morbidity between Black patients and White patients persisted after controlling for potentially confounding variables. Hispanic patients had lower mortality than White patients (6.3% vs 13.1%; p = 0.0130) and a longer hospital stay (12 days [IQR, 8-18 days] vs 10 days [IQR, 7-17 days]; p = 0.0313). Outcomes did not differ between Asian patients and White patients. CONCLUSIONS: This study demonstrated significant disparities for Black patients undergoing surgery for MBO. Understanding and addressing what drives these differences, including systemic inequalities such as access to care and racial biases, is essential to the achievement of more equitable, higher-quality patient care.
Authors
Penny, CL; Tanino, SM; Mosca, PJ
MLA Citation
Penny, Caitlin L., et al. “Racial Disparities in Surgery for Malignant Bowel Obstruction.Ann Surg Oncol, vol. 29, no. 5, May 2022, pp. 3122–33. Pubmed, doi:10.1245/s10434-021-11161-0.
URI
https://scholars.duke.edu/individual/pub1507044
PMID
35041096
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
29
Published Date
Start Page
3122
End Page
3133
DOI
10.1245/s10434-021-11161-0

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cerebrospinal (CSF) tau, p-tau-181p, or Aβ levels after non-cardiac, non-neurologic surgery in older adults. METHODS: Participants underwent cognitive testing before and 6 weeks after surgery, and lumbar punctures before, 24 h after, and 6 weeks after surgery. Cognitive scores were combined via factor analysis into an overall cognitive index. In total, 110 patients returned for 6-week postoperative testing and were included in the analysis. RESULTS: There was no significant change from before to 24 h or 6 weeks following surgery in CSF tau (median [median absolute deviation] change before to 24 h: 0.00 [4.36] pg/mL, p = 0.853; change before to 6 weeks: -1.21 [3.98] pg/mL, p = 0.827). There were also no significant changes in CSF p-tau-181p or Aβ over this period. There was no change in cognitive index (mean [95% CI] 0.040 [-0.018, 0.098], p = 0.175) from before to 6 weeks after surgery, although there were postoperative declines in verbal memory (-0.346 [-0.523, -0.170], p = 0.003) and improvements in executive function (0.394, [0.310, 0.479], p < 0.001). There were no significant correlations between preoperative to 6-week postoperative changes in cognition and CSF tau, p-tau-181p, or Aβ42 changes over this interval (p > 0.05 for each). INTERPRETATION: Neurocognitive changes after non-cardiac, non-neurologic surgery in the majority of cognitively healthy, community-dwelling older adults are unlikely to be related to postoperative changes in AD neuropathology (as assessed by CSF Aβ, tau or p-tau-181p levels or the p-tau-181p/Aβ or tau/Aβ ratios). TRIAL REGISTRATION: clinicaltrials.gov (NCT01993836).
Authors
Berger, M; Browndyke, JN; Cooter Wright, M; Nobuhara, C; Reese, M; Acker, L; Bullock, WM; Colin, BJ; Devinney, MJ; Moretti, EW; Moul, JW; Ohlendorf, B; Laskowitz, DT; Waligorska, T; Shaw, LM; Whitson, HE; Cohen, HJ; Mathew, JP; MADCO-PC Investigators,
MLA Citation
Berger, Miles, et al. “Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.Ann Clin Transl Neurol, vol. 9, no. 2, Feb. 2022, pp. 155–70. Pubmed, doi:10.1002/acn3.51499.
URI
https://scholars.duke.edu/individual/pub1509218
PMID
35104057
Source
pubmed
Published In
Annals of Clinical and Translational Neurology
Volume
9
Published Date
Start Page
155
End Page
170
DOI
10.1002/acn3.51499

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay.

ABSTRACT: This retrospective, cross-sectional study of U.S. hospitals in Medicare's Inpatient Quality Reporting Program aimed to determine whether variation in Sepsis/Septic Shock (Bundle SEP-1) compliance is linked to hospital size and measures of safety and operational efficiency. Two thousand six hundred and fifty-three acute care hospitals in Medicare's Hospital Compare online database were included in the study. Relationships between SEP-1 bundle compliance, hospital size, and indices of operational excellence (including Patient Safety Index [PSI-90], average length of stay [ALOS] and readmission rate) were analyzed. SEP-1 compliance score was inversely associated with staffed bed number (r = -.14, p < .001), PSI-90 (r = -.01, p < .001), and ALOS (r = -.13, p < .001) in a multivariate analysis. Hospitals in the lowest versus highest quartile by bed number had SEP-1 compliance score of 49.8 ± 20.2% versus 46.9 ± 16.8%, p < .001. Hospitals in the lowest versus highest quartile for SEP-1 score had an ALOS of 5.0 ± 1.2 days versus 4.7 ± 1.1 days and PSI-90 rate of 1.03 ± 0.22 versus 0.98 ± 0.16, p < .001 for both. Although this does not establish a causal relationship, it supports the hypothesis that the ability of hospitals to successfully implement SEP-1 is associated with superior performance in key measures of operational excellence.
Authors
Rodriguez-Homs, LG; Masoud, SJ; Mosca, MJ; Jawitz, OK; O'Brien, C; Mosca, PJ
MLA Citation
Rodriguez-Homs, Larissa G., et al. “Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay.J Healthc Qual, vol. 43, no. 6, Nov. 2021, pp. 347–54. Pubmed, doi:10.1097/JHQ.0000000000000295.
URI
https://scholars.duke.edu/individual/pub1500446
PMID
34734919
Source
pubmed
Published In
J Healthc Qual
Volume
43
Published Date
Start Page
347
End Page
354
DOI
10.1097/JHQ.0000000000000295

Research Areas:

Cancer Vaccines
Carcinoma, Merkel Cell
Immunity, Cellular
Immunotherapy
Lymph Node Excision
Melanoma
Sarcoma
Surgery
T-Lymphocytes