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Submissions from 2023

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International Analgesia and Sedation Weaning and Withdrawal Practices in Critically Ill Adults: The Adult Iatrogenic Withdrawal Study in the ICU, Scott Bolesta, Lisa Burry, Marc M. Perreault, Céline Gélinas, Kathryn E. Smith, Rebekah Eadie, Federico C. Carini, and Katrianna Saltarelli

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Sedation and Shivering Management After Cardiac Arrest, Bram J. Geller, Carolina B. Maciel, Teresa L. May, and Jacob C. Jentzer

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Do the Risks of ECMO Outweigh the Potential Benefits, Bram J. Geller and Sean van Diepen

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External validation of the CREST model to predict early circulatory-etiology death after out-of-hospital cardiac arrest without initial ST-segment elevation myocardial infarction, Zana Haxhija, David B. Seder, Teresa L. May, Christian Hassager, Hans Friberg, Gisela Lilja, Ameldina Ceric, Niklas Nielsen, and Josef Dankiewicz

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Derivation and Validation of a New Equation for Estimating Free Valproate Concentration in Critically Ill Adult Patients., Ji Tong Liu, Caitlin S Brown, Kristin C Mara, Richard R. Riker, Alejandro A Rabinstein, Gilles L Fraser, Teresa May, Kaitlin J Armstrong, David Seder, and David J Gagnon

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Building an Extracorporeal Cardiopulmonary Resuscitation Program at a High-volume Extracorporeal Membrane Oxygenation Center, Peter C. Michalakes, Walter F. DeNino, Claire B. Jara, Maxwell E. Afari, and Bram J. Geller

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Buprenorphine Continuation During Critical Illness Associated With Decreased Inpatient Opioid Use in Individuals Maintained on Buprenorphine for Opioid Use Disorder in a Retrospective Study, Aurora Quaye, Chelsea Wampole, Richard R. Riker, David B. Seder, William J. Sauer, Janelle M. Richard, Wendy Y. Craig, and David J. Gagnon

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Inhaled mRNA therapy for treatment of cystic fibrosis: Interim results of a randomized, double-blind, placebo-controlled phase 1/2 clinical study, S M. Rowe, J B. Zuckerman, D Dorgan, J Lascano, K McCoy, M Jain, M S. Schechter, S Lommatzsch, V Indihar, N Lechtzin, K McBennett, C Callison, C Brown, T G. Liou, K D. MacDonald, S Z. Nasr, S Bodie, M Vaughn, E B. Meltzer, and A J. Barbier

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Decreased circulating CD73 and adenosine deaminase are associated with disease severity in hospitalized patients with COVID-19, Jonathan Rud, Richard R. Riker, Ashley Eldridge, Christine Lord, Joanne T. deKay, Teresa L. May, David Gagnon, Douglas Sawyer, Sergey Ryzhov, and David B. Seder

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Gaps in Cystic Fibrosis Care Are Associated with Reduced Lung Function in the U.S. Cystic Fibrosis Foundation Patient Registry, Edmund H. Sears, Alexandra C. Hinton, Sara Lopez-Pintado, Christine W. Lary, and Jonathan B. Zuckerman

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Implications of Structural Brain Injury in ARDS, David Seder

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Beyond antibiotic prescribing rates: first-line antibiotic selection, prescription duration, and associated factors for respiratory encounters in urgent care, Allan M. Seibert, Carly Schenk, Whitney R. Buckel, Payal K. Patel, Nora Fino, Valoree Stanfield, Adam L. Hersh, and Eddie Stenehjem

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Intensive Care Interventions Among Children With Toxicologic Exposures to Cardiovascular Medications, Michael D. Simpson, C James Watson, James D. Whitledge, Michael C. Monuteaux, and Michele M. Burns

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Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report, Van-Khue Ton, Manreet K. Kanwar, Borui Li, Vanessa Blumer, Song Li, Elric Zweck, Shashank S. Sinha, Maryjane Farr, and Andrew Schwartzman

Submissions from 2022

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Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation: The SETPOINT2 Randomized Clinical Trial, Julian Bösel, Wolf-Dirk Niesen, Farid Salih, Nicholas A. Morris, Jeremy T. Ragland, Bryan Gough, Hauke Schneider, Jan-Oliver Neumann, David Y. Hwang, Phani Kantamneni, Michael L. James, William D. Freeman, Venkatakrishna Rajajee, Chethan Venkatasubba Rao, Deepak Nair, Laura Benner, Jan Meis, Christina Klose, Meinhard Kieser, José I. Suarez, Silvia Schönenberger, and David B. Seder

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Early vs Standard Approach to Tracheostomy and Functional Outcome Among Patients With Severe Stroke Receiving Mechanical Ventilation-Reply, Julian Bösel, Silvia Schönenberger, and David B. Seder

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Prospective Validation of Sedation Scale Scores That Identify Light Sedation: A Pilot Study, Caitlin Brown, Pasquale Joseph Marotta, Richard R. Riker, Ashley D. Eldridge, Gilles L. Fraser, and Teresa L. May

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Level of sedation in critically ill adult patients: a protocol for a systematic review with meta-analysis and trial sequential analysis, Ameldina Ceric, Johan Holgersson, Teresa May, Markus B. Skrifvars, Johanna Hästbacka, Manoj Saxena, Anders Aneman, Anthony Delaney, Michael C. Reade, Candice Delcourt, Janus Jakobsen, and Niklas Nielsen

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Cardiac Arrest Treatment Center Differences in Sedation and Analgesia Dosing During Targeted Temperature Management, Ameldina Ceric, Teresa L. May, Anna Lybeck, Tobias Cronberg, David B. Seder, Richard R. Riker, Christian Hassager, Jesper Kjaergaard, Zana Haxhija, Hans Friberg, Josef Dankiewicz, and Niklas Nielsen

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Influence of circulatory shock at hospital admission on outcome after out-of-hospital cardiac arrest, Joachim Düring, Martin Annborn, Josef Dankiewicz, Allison Dupont, Sune Forsberg, Hans Friberg, Karl B. Kern, Teresa L. May, John McPherson, Nainesh Patel, David B. Seder, Pascal Stammet, Kjetil Sunde, Eldar Søreide, Susann Ullén, and Niklas Nielsen

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Precision Care in Cardiac Arrest: ICECAP (PRECICECAP) Study Protocol and Informatics Approach, Jonathan Elmer, Zihuai He, Teresa May, Elizabeth Osborn, Richard Moberg, Stephanie Kemp, Jesse Stover, Ethan Moyer, Romergryko G. Geocadin, and Karen G. Hirsch

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Pursuing Excellence: Innovations in Designing an Interprofessional Clinical Learning Environment, Cecile M. Foshee, Heather Walsh, Thomas E. Van der Kloot, Christy K. Boscardin, Laurinda Calongne, Nicole S. Telhiard, Catherine Ullman, Coleen Backus, and Sarah E. Peyre

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Pilot Study of an Encounter Decision Aid for Lung Cancer Screening, Mayuko Ito Fukunaga, Akshu Balwan, Jaclyn A. Janis, Caitlin Gutheil, Jason Yahwak, and Paul K. Han

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Evaluation of the safety of a novel peripheral vasopressor pilot program and the impact on central line placement in medical and surgical intensive care units, Kristen Marti, Christopher Hartley, Elizabeth Sweeney, John Mah, and Nicholas Pugliese

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Impact of community-level socioeconomic disparities on quality of life after burn injury: A Burn Model Systems Database study, Stephanie Mason, Emma Gause, Kara McMullen, Sha'Chia Murphy, Stephen Sibbett, Radha Holavanahalli, Jeffrey Schneider, Nicole Gibran, and Lewis E. Kazis

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Cardiac Arrest Treatment Center Differences in Sedation and Analgesia Dosing During Targeted Temperature Management, Teresa L. May, David B. Seder, and Richard R. Riker

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Letter to the Editor: "Midodrine to liberate ICU patients from intravenous vasopressors: Another negative fixed-dose trial"., Richard R Riker and David J Gagnon

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Comment: A Review of Pharmacologic Neurostimulant Use During Rehabilitation and Recovery After Brain Injury, Richard R. Riker, Paige Weaver, and David J. Gagnon

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Bronchial penetration of migrated Temporary Epicardial Pacing Wire with bronchoscopic extraction, Christopher G. Roy and Nicholas A. Pozzessere

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Coronary Angiographic Findings For Out-of-Hospital Cardiac arrest Survivors Presenting With Nonshockable Rhythms and no ST Elevation Post Resuscitation, D B. Seder

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Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study, Chelsea Wampole, Ariel McKenna, Richard R. Riker, Teresa L. May, David B. Seder, Dawn Abram, Gilles L. Fraser, and David J. Gagnon

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Analgesia and Sedation in Critically Ill Patients With Burns, Paige Weaver

Submissions from 2021

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DEspR neutrophils are associated with critical illness in COVID-19, Joanne T. deKay, Ivette F. Emery, Jonathan Rud, Ashley Eldridge, Christine Lord, David J. Gagnon, and Teresa L. May

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Hispanic/Latino-Serving Hospitals Provide Less Targeted Temperature Management Following Out-of-Hospital Cardiac Arrest, Nicholas A. Morris, Michael Mazzeffi, Patrick McArdle, Teresa L. May, Greer Waldrop, Sarah M. Perman, James F. Burke, and Steven M. Bradley

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Urinary stone disease prevalence and associations in cystic fibrosis., Jeremy F Wright, Wendy Craig, F L Lucas, David S Goldfarb, Jonathan B Zuckerman, and Eric N Taylor

Submissions from 2020

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The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest: an explorative International Cardiac Arrest Registry 2.0 study., Florian Ebner, Richard R Riker, Zana Haxhija, David B Seder, Teresa L May, Susann Ullén, Pascal Stammet, Karen Hirsch, Sune Forsberg, Allison Dupont, Hans Friberg, John A McPherson, Eldar Søreide, Josef Dankiewicz, Tobias Cronberg, and Niklas Nielsen

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Amantadine and Modafinil as Neurostimulants During Post-stroke Care: A Systematic Review, David J. Gagnon, Angela M. Leclerc, Richard R. Riker, Caitlin S. Brown, Teresa May, Kristina Nocella, Jennifer Cote, Ashley Eldridge, and David B. Seder

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Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: A real-world analysis of national administrative claims., Bram J Geller, Srinath Adusumalli, Steven C Pugliese, Sameed Ahmed M Khatana, Ashwin Nathan, Ido Weinberg, Michael R Jaff, Taisei Kobayashi, Jeremy A Mazurek, Sameer Khandhar, Lin Yang, Peter W Groeneveld, and Jay S Giri

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Functional outcomes associated with varying levels of targeted temperature management after out-of-hospital cardiac arrest - An INTCAR2 registry analysis., Jesper Johnsson, Josefine Wahlström, Josef Dankiewicz, Martin Annborn, Sachin Agarwal, Allison Dupont, Sune Forsberg, Hans Friberg, Robert Hand, Karen G Hirsch, Teresa May, John A McPherson, Michael R Mooney, Nainesh Patel, Richard R Riker, Pascal Stammet, Eldar Søreide, David B Seder, and Niklas Nielsen

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Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation: The PEARL Study, Karl B. Kern, Peter Radsel, Jacob C. Jentzer, David B. Seder, Kwan S. Lee, Kapildeo Lotun, Rajesh Janardhanan, Dion Stub, and Chiu-Hsieh Hsu

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Postgraduate Training Options for Advanced Practice Providers in General and Trauma/Surgical Critical Care, Angela M. Leclerc, Sarah Vanderlin, Melissa Ricker, Annika Kay, and Aimee Abide

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Serum soluble receptor for advanced glycation end-products (sRAGE) in infants with bronchiolitis: Associations with acute severity and recurrent wheeze., Jason T Patregnani, Michimasa Fujiogi, Carlos A Camargo, Bonnie A Brooks, Claire E Hoptay, Jonathan M Mansbach, Stephen J Teach, Robert J Freishtat, and Kohei Hasegawa

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Delirium-Beyond the CAM-ICU., Richard R Riker and Gilles L Fraser

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Heparin-induced thrombocytopenia with thrombosis in COVID-19 adult respiratory distress syndrome, Richard R. Riker, Teresa L. May, Gilles L. Fraser, David J. Gagnon, Mahesh Bandara, Wesley R. Zemrak, and David B. Seder

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Response to The challenges of diagnosing heparin-induced thrombocytopenia in patients with COVID-19, Richard R. Riker, Teresa L. May, Gilles L. Fraser, David J. Gagnon, Mahesh Bandara, Wes Zemrak, and David B. Seder

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Early cerebral edema after cardiac arrest and its ramifications., Jonathan Rud, Teresa L May, Richard R Riker, and David B Seder

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Changes in EBUS procedures and molecular yields at MMC 2013-2017, Joseph Scrobola and Edmund Sears

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Intubation of the COVID-19 Patient, Edmund Sears

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Cystic Fibrosis Telemonitoring in a Small Rural Maine Cohort: A Feasibility Study, Edmund Sears, Philip Stone, Alicia Murray, and Thomas Desjardins

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Serum Glial Fibrillary Acidic Protein in Acute Stroke, David B. Seder

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Evaluation of Serial Biomarkers in Intermediate Risk Acute Pulmonary Embolism Patients, Hilamber Subba, Ariel McKenna, and Joel Wirth

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Vasopressin-Induced Hyponatremia in Patients with Aneurysmal Subarachnoid Hemorrhage: A Case Series, Hilamber Subba, Richard Riker, Susan Dunn, Teresa May, David Gagnon, and David Seder

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Nordihydroguaiaretic acid reduces secondary organ injury in septic rats after cecal ligation and puncture., Michael E Zubrow, Susan S Margulies, and Nadir Yehya

Submissions from 2019

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The Influence of Therapeutics on Prognostication After Cardiac Arrest., Sachin Agarwal, Nicholas Morris, Caroline Der-Nigoghossian, Teresa May, and Daniel Brodie

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Neurocardiac risk stratification 6 hours after resuscitation from cardiac arrest, A Bilkanovic, Z Haxhija, L Lucas, J Dziodzio, R R. Riker, T May, H Friberg, and D B. Seder

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Support for antibiotic prophylaxis during targeted temperature management after cardiac arrest: Heating up or cooling down?, David J Gagnon and David B Seder

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Sleep disruption and delirium in the pediatric CICU., Jillian Gregory, Anna Brown, and Sapna Kudchadkar

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Effects of Personalized Risk Information on Patients Referred for Lung Cancer Screening with Low-Dose CT., Paul K J Han, Christine Lary, Adam Black, Caitlin Gutheil, Hayley Mandeville, Jason Yahwak, and Mayuko Fukunaga

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An Analysis of Psychoactive Medications Initiated in the ICU but Continued Beyond Discharge: A Pilot Study of Stewardship., Nicole Lynn Kovacic, David J Gagnon, Richard R Riker, Sijin Wen, and Gilles L Fraser

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Prospective assessment of sedation scales and wakefulness in medical and neurological ICU patients., Pasquale Marotte, Caitlin Brown, Teresa May, Richard Riker, and Gilles Fraser

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Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths., Teresa L May, Robin Ruthazer, Richard R Riker, Hans Friberg, Nainesh Patel, Eldar Soreide, Robert Hand, Pascal Stammet, Allison Dupont, Karen G Hirsch, Sachin Agarwal, Michael J Wanscher, Josef Dankiewicz, Niklas Nielsen, David B Seder, and David M Kent

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Do we need continuous electroencephalography after cardiac arrest?, Teresa May, Richard R. Riker, and David Seder

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Evaluation the transition from dexmedetomidine to enteral clonidine in adult ICU patients., Nicholas Pozzessere, Richard Riker, Gilles Fraser, David Gagnon, Jonathan Rud, Allison Fluke, and Elizabeth Glisic

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Pupillometry data 6 hours after ROSC predicts poor outocome after cardiac arrest., Richard Riker, Tyler Nussinow, Mary Sawyer, Bailey West, Philip Stone, Ashley Eldridge, Teresa May, and David Seder

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Tracheostomy Practices in Neurocritical Care., David B Seder

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A woman with nonresolving fever and bilateral pulmonary infiltrates., Philip C Stone, Edmund H Sears, and Jonathan B Zuckerman

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Low-dose compared to manufacturer-recommended dose four-factor prothrombin complex concentrate for acute warfarin reversal., Wesley Zemrak, Francis Manuel, Kathryn E Smith, Stephen Rolfe, Timothy Hayes, Robert L Trowbridge, Brian Carlone, and David Seder

Submissions from 2018

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Interpreting and Implementing the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption Clinical Practice Guideline., Michele C Balas, Gerald L Weinhouse, Linda Denehy, Gerald Chanques, Bram Rochwerg, Cheryl J Misak, Yoanna Skrobik, John W Devlin, and Gilles L Fraser

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Derivation and validation of the CREST model for very early prediction of circulatory etiology death in patients without ST-segment-elevation myocardial infarction after cardiac arrest., Karen E Bascom, John Dziodzio, Samip Vasaiwala, Michael Mooney, Nainesh Patel, John McPherson, Paul McMullan, Barbara Unger, Niklas Nielsen, Hans Friberg, Richard R Riker, Karl B Kern, Christine W Duarte, and David B Seder

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Response by Bascom and Seder to Letter Regarding Article, "Derivation and Validation of the CREST Model for Very Early Prediction of Circulatory Etiology Death in Patients Without ST-Segment-Elevation Myocardial Infarction After Cardiac Arrest"., Karen E Bascom and David B Seder

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Exploring probiotic use in a regional cystic fibrosis consortium., K D Gonzalez, J B Zuckerman, E H Sears, B S Prato, M Guill, Wendy Craig, C Milliard, E Parker, T Lever, M M Griffin, and L W Leclair

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Azithromycin for Early Pseudomonas Infection in Cystic Fibrosis. The OPTIMIZE Randomized Trial., Nicole Mayer-Hamblett, George Retsch-Bogart, Margaret Kloster, Frank Accurso, Margaret Rosenfeld, Gary Albers, Philip Black, Perry Brown, AnneMarie Cairns, Stephanie D Davis, Gavin R Graff, Gwendolyn S Kerby, David Orenstein, Rachael Buckingham, Bonnie W Ramsey, and OPTIMIZE Study Group

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Complications of long and intermediate term venous catheters in cystic fibrosis patients: A multicenter study., Teresa L May, Alex H Gifford, Thomas Lahiri, Adam Black, Janet Trang, Alexandra G Cornell, Karyll Gonzalez, Scott Morin, Mark Napier, Christine W Duarte, and Jonathan B Zuckerman

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Complex Legacy of the Target Temperature Management Trial., Teresa L May, Richard R Riker, and David B Seder

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Long-term risk of seizures among cardiac arrest survivors., Nicholas A Morris, Teresa L May, Melissa Motta, Sachin Agarwal, and Hooman Kamel

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Use of ceftolozane-tazobactam in a cystic fibrosis patient with multidrug-resistant pseudomonas infection and renal insufficiency., Katie Stokem, Jonathan B Zuckerman, David P Nicolau, Minkey Wungwattana, and Edmund H Sears

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Use of Masks in Patients with Cystic Fibrosis., Jonathan B Zuckerman and Lisa Saiman

Submissions from 2017

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ICU clinicians underestimate breathing discomfort in ventilated subjects., Andrew P Binks, Steven Desjardin, and Richard Riker

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Development of a Traumatic Brain Injury (TBI) Order Set at Maine Medical Center, Sarah Bockian, Emily Esslinger, and Martha Weatherhead

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What is the role of oral prostacyclin pathway medications in pulmonary arterial hypertension management?, Rama El Yafawi and Joel A Wirth

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Repurposing valproate, enteral clonidine, and phenobarbital for comfort in adult ICU patients: a literature review with practical considerations., David J Gagnon, Gabriel V Fontaine, Richard R Riker, and Gilles L Fraser

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Stroke and myocardial infarction following bronchial artery embolization in a cystic fibrosis patient., Matt Hoffman, Joseph P Gerding, and Jonathan B Zuckerman

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Five-year trends of critical care practice and outcomes., Craig M Lilly, Sunil Swami, Xinggang Liu, Richard R Riker, and Omar Badawi

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The implementation of targeted temperature management: an evidence-based guideline from the Neurocritical Care Society., Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, and Neeraj Badjatia

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Outcomes in Cardiac Arrest Vary by Center After Correction for Case Mix and Severity of Illness., Teresa May, Philip Stone, Gill Fraser, Richard Riker, and David Seder

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Cefepime-induced neurotoxicity: a systematic review., Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, and Gilles L Fraser

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Emergency neurological life support: airway, ventilation, and sedation., Venkatakrishna Rajajee, Becky Riggs, and David B. Seder

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Valproate protein binding is highly variable in ICU patients and not predicted by total serum concentrations: a case series and literature review., Richard R Riker, David J Gagnon, Colman Hatton, Teresa May, David B Seder, Katie Stokem, and Gilles L Fraser

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Caution warranted regarding transfusion for subarachnoid hemorrhage., Richard R Riker and David B Seder

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Airway management and mechanical ventilation in acute brain injury., D B Seder and J Bösel

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Does medication safety and diversion education improve medication securement practices in SCU compared to current practice?, Natasha Stankiewicz

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Guidelines for family-centered care in neuro-ICU populations: caveats for routine palliative care., Michel T Torbey, Gretchen M Brophy, Panayiotis N Varelas, Julian Bösel, Edward Manno, Mary Kay Bader, Jose I Suarez, David Seder, and W David Freeman

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Low-dose prothrombin complex concentrate for warfarin-associated intracranial hemorrhage with INR less than 2.0., Wesley R Zemrak, Kathryn E Smith, Stephen S Rolfe, Teresa May, Robert L Trowbridge, Timothy L Hayes, Gene A Grindlinger, and David B Seder

Submissions from 2016

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Clinafloxacin for treatment of Burkholderia cenocepacia infection in a cystic fibrosis patient, Akshu Balwan, David P Nicolau, Minkey Wungwattana, Jonathan B Zuckerman, and Valerie Waters

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Heart Rate and the Post Cardiac Arrest Syndrome: Another Clue to Individualizing Care?, Karen Bascom, Richard R Riker, and David B Seder

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Managing the patient with pulmonary hypertension: specialty care centers, coordinated care, and patient support., Murali M Chakinala, Maribeth Duncan, and Joel Wirth

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Clinical and research considerations for patients with hypertensive acute heart failure: a consensus statement from the Society for Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group., Sean P Collins, Phillip D Levy, Jennifer L Martindale, Mark E Dunlap, Alan B Storrow, Peter S Pang, Nancy M Albert, G Michael Felker, Gregory J Fermann, Gregg C Fonarow, Michael M Givertz, Judd E Hollander, David E Lanfear, Daniel J Lenihan, JoAnn M Lindenfeld, W Frank Peacock, Douglas B. Sawyer, John R Teerlink, and Javed Butler

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Clinical and research considerations for patients with hypertensive acute heart failure: a consensus statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group., Sean P Collins, Phillip D Levy, Jennifer L Martindale, Mark E Dunlap, Alan B Storrow, Peter S Pang, Nancy M Albert, G Michael Felker, Gregory J Fermann, Gregg C Fonarow, Michael M Givertz, Judd E Hollander, David J Lanfear, Daniel J Lenihan, JoAnn M Lindenfeld, W Frank Peacock, Douglas B. Sawyer, John R Teerlink, and Javed Butler

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Intended and unintended consequences of constraining clinician prescribing: the case of antipsychotics., John W Devlin, Pamela Smithburger, Jason M Kane, Gilles L. Fraser, and Yoanna Skrobik

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The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement : A Statement for Healthcare Professionals from the Neurocritical Care Society., Herbert I Fried, Barnett R Nathan, A Shaun Rowe, Joseph M Zabramski, Norberto Andaluz, Adarsh Bhimraj, Mary McKenna Guanci, David B Seder, and Jeffrey M Singh