Bio

Honors & Awards


  • ESPN Academic All-American, NCAA - Volleyball (Nov 2008)
  • Hodson Trust Scholar, Johns Hopkins University (2004-2008)

Membership Organizations


  • WAM: Women and Medicine, President
  • Arbor Free Clinic, Ophthalmology Clinic Coordinator

Education & Certifications


  • Bachelor of Arts, Johns Hopkins University (2008)

Clerkships


  • 2013 Spring - FAMMED 301A Family Medicine Core Clerkship (SUMC, O'Connor, IHS, community sites, and rural sites)
  • 2013 Summer - FAMMED 364E Subinternship in Family Medicine
  • 2013 Summer - OBGYN 300A Obstetrics and Gynecology Core Clerkship
  • 2012 Spring - ANES 306P Comprehensive Neonatal and Pediatric ICU Core Clerkship
  • 2012 Spring - OPHT 398A Elective in Ophthalmology
  • 2012 Spring - SURG 300A General Surgery Clerkship
  • 2012 Summer - OPHT 302A Bay Area Ophthalmology Course: Fundamentals in Clinical and Visual Science
  • 2012 Winter - NENS 301A General Neurology Core Clerkship
  • 2012 Winter - OPHT 300E Ophthalmology Clerkship
  • 2012 Winter - SURG 300A General Surgery Clerkship
  • 2011 Autumn - MED 300A General Medicine Core Clerkship
  • 2011 Autumn - PEDS 300A Child Health Clerkship
  • 2011 Summer - MED 313A Ambulatory Medicine
  • 2011 Summer - PEDS 300A Child Health Clerkship

Stanford Advisors


Service, Volunteer and Community Work


  • Arbor Free Clinic, Stanford School of Medicine (9/14/2009)

    Location

    Menlo Park

Research & Scholarship

Research Projects


  • Prevalence of Visual Field Defects and Optic Nerve Characteristics Suspicious for Glaucoma in School-Aged Chinese Children (MedScholars Project)
  • Continuation Proposal: Prevalence of Visual Field Defects and Optic Nerve Characteristics Suspicious for Glaucoma in School-Aged Chinese Children (MedScholars Project)

Professional

Work Experience


  • Research, Johns Hopkins University (8/18/2008 - 7/15/2009)

    Determining complement activation and lipoprotein deposition in the Retinal Pigmented Cell layer as a pathogenic mechanism in Age-related Macular Degeneration
    Protein expression profiles of tumors in Von-Hippel Lindau disease patients
    Protein expression profiles of melanoma tumors in the eye

    Location

    Baltimore, MD

Publications

Journal Articles


  • Academic productivity and its relationship to physician salaries in the University of California Healthcare System. Southern medical journal Fijalkowski, N., Zheng, L. L., Henderson, M. T., Moshfeghi, A. A., Maltenfort, M., Moshfeghi, D. M. 2013; 106 (7): 415-421

    Abstract

    To evaluate whether physicians with higher academic productivity, as measured by the number of publications in Scopus and the Scopus Hirsch index (h-index), earn higher salaries.This was a cross-sectional study. Participants were ophthalmologists, otolaryngologists, neurosurgeons, and neurologists classified as "top earners" (>$100,000 annually) within the University of California (UC) healthcare system in 2008. Bibliometric searches on Scopus were conducted to retrieve the total number of publications and Hirsch indices (h-index), a measure of academic productivity. The association between the number of publications and h-index on physicians' total compensation was determined with multivariate regression models after controlling for the four specialties (ophthalmology, otolaryngology, neurosurgery, and neurology), the five institutions (UC San Francisco, UC Los Angeles, UC San Diego, UC Irvine, and UC Davis), and academic rank (assistant professor, associate professor, and professor).The UC healthcare system departments reported 433 faculty physicians among the four specialties, with 71.6% (n = 310) earning more than $100,000 in 2008 and classifying as top earners. After controlling for the specialty, institution, and ranking, there was a significant association between the number of publications on salary (P < 0.000001). Scopus number of publications and h-index were correlated (P < 0.001). Scopus h-index was of borderline significance in predicting physician salary (P = 0.12). Physicians with higher Scopus publications had higher total salaries across all four specialties. Every 10 publications were associated with a 2.40% increase in total salary after controlling for specialty, institution, rank, and chair.Ophthalmologists, otolaryngologists, neurosurgeons, and neurologists in the UC healthcare system who are more academically productive receive greater remuneration.

    View details for DOI 10.1097/SMJ.0b013e31829b9dae

    View details for PubMedID 23820322

  • Validation of a grading system for lateral nasal wall insufficiency. Allergy & rhinology (Providence, R.I.) Tsao, G. J., Fijalkowski, N., Most, S. P. 2013; 4 (2): e66-8

    Abstract

    This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.

    View details for DOI 10.2500/ar.2013.4.0054

    View details for PubMedID 24124639

  • Decreased membrane complement regulators in the retinal pigmented epithelium contributes to age-related macular degeneration JOURNAL OF PATHOLOGY Ebrahimi, K. B., Fijalkowski, N., Cano, M., Handa, J. T. 2013; 229 (5): 729-742

    Abstract

    Dysregulated complement is thought to play a central role in age-related macular degeneration (AMD) pathogenesis, but the specific mechanisms have yet to be determined. In maculae of AMD specimens, we found that the complement regulatory protein, CD59, was increased in regions of uninvolved retinal pigmented epithelium (RPE) of early AMD, but decreased in the RPE overlying drusen and in geographic atrophy, an advanced form of AMD. While CD46 immunostaining was basolaterally distributed in the RPE of unaffected controls, it was decreased in diseased areas of early AMD samples. Since oxidized low-density lipoproteins (oxLDL) collect in drusen of AMD and are a known complement trigger, we treated ARPE-19 cells with oxLDL and found that cellular CD46 and CD59 proteins were decreased by 2.9- and nine-fold (p < 0.01), respectively. OxLDLs increased complement factor B mRNA and Bb protein, but not factor D, I or H. OxLDLs increased C3b, but not C3a, C5 or C5b-9. C5b-9 was increased by 27% (p < 0.01) when the medium was supplemented with human serum, which was sufficient to induce poly(ADP-ribose) polymerase cleavage, a marker of apoptosis. The decreased levels of CD46 and CD59 were in part explained by their release in exosomal and apoptotic membranous particles. In addition, CD59 was partially degraded through activation of IRE1?. Collectively, these results suggest that a combination of impaired complement regulators results in inadequately controlled complement by the RPE in AMD that induces RPE damage.

    View details for DOI 10.1002/path.4128

    View details for Web of Science ID 000316326100009

    View details for PubMedID 23097248

  • Fever Literacy and Fever Phobia CLINICAL PEDIATRICS Wallenstein, M. B., Schroeder, A. R., Hole, M. K., Ryan, C., Fijalkowski, N., Alvarez, E., Carmichael, S. L. 2013; 52 (3): 254-259

    Abstract

    To identify the percentage of parents who define the threshold for fever between 38.0°C and 38.3°C, which has not been reported previously, and to describe parental attitudes toward fever and antipyretic use.Thirteen-question survey study of caregivers.Overall, 81% of participants defined the threshold for fever as <38.0°C, 0% correctly defined fever between 38.0°C and 38.3°C, and 19% defined fever as >38.3°C. Twenty percent of children brought to clinic for a chief complaint of fever were never truly febrile. Ninety-three percent of participants believed that high fever can cause brain damage. For a comfortable-appearing child with fever, 89% of caregivers reported that they would give antipyretics and 86% would schedule a clinic visit.Our finding that 0% of parents correctly defined fever is both surprising and unsettling, and it should inform future discussions of fever between parents and clinicians.

    View details for DOI 10.1177/0009922812472252

    View details for Web of Science ID 000317849900007

    View details for PubMedID 23349363

  • The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Pershing, S., Moshfeghi, D. M. 2013; 44 (2): 133-139

    Abstract

    To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

    View details for DOI 10.3928/23258160-20130313-06

    View details for PubMedID 23510039

  • Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine CURRENT EYE RESEARCH Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2013; 38 (2): 283-291

    Abstract

    To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.

    View details for DOI 10.3109/02713683.2012.754902

    View details for Web of Science ID 000314900400008

    View details for PubMedID 23330739

  • More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's Isotopic response in an Asian female Fijalkowski N, Wysong A, Kuu P, Chang A 2012; 3 (2): 24-28
  • Advanced Glycation Endproduct Changes to Bruch's Membrane Promotes Lipoprotein Retention by Lipoprotein Lipase AMERICAN JOURNAL OF PATHOLOGY Cano, M., Fijalkowski, N., Kondo, N., Dike, S., Handa, J. 2011; 179 (2): 850-859

    Abstract

    Lipoprotein particles accumulate in Bruch's membrane before the development of basal deposits and drusen, two histopathologic lesions that define age-related macular degeneration (AMD). We therefore, sought to determine which molecules could participate in lipoprotein retention. Wild-type or lipoprotein lipase-deficient mice were injected with low-dose D-galactose or PBS subcutaneously for 8 weeks to induce advanced glycation endproduct (AGE) formation. Some mice were also injected with the AGE breaker phenacylphiazolium bromide and D-galactose. Rhodamine-labeled low-density lipoproteins were injected into mice, and the fluorescence was measured up to 72 hours later. AGEs, proteoglycans, and other lipid-retaining molecules were evaluated by IHC. Lipoprotein lipase distribution was assessed in AMD samples by IHC. D-galactose-treated mice retained lipoproteins in the retinal pigment epithelial and Bruch's membrane to a greater extent than either PBS- or phenacylphiazolium bromide/D-galactose-treated mice at 24 and 72 hours after injection (P ? 0.04). Immunolabeling for carboxymethyllysine, biglycan, and lipoprotein lipase was found in D-galactose-treated mice only. Mice deficient for lipoprotein lipase treated with D-galactose did not retain lipoproteins to any measureable extent. Human AMD samples had lipoprotein lipase labeling within drusen, basal deposits, and the choroid. Mice treated with D-galactose to induce AGE formation in Bruch's membrane retain intravenously injected lipoproteins. Our results suggest that lipoprotein retention in Bruch's membrane is mediated by lipoprotein lipase.

    View details for DOI 10.1016/j.ajpath.2011.04.010

    View details for Web of Science ID 000298307200031

    View details for PubMedID 21801873

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