Jacobs Institute of Women's Health
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Promoting iron folic acid consumption using social norms as a mechanism of change in the Reduction in Anemia through Normative Innovations (RANI) project: a randomized controlled trial
No full textBACKGROUND: More than 60% of women of reproductive age in Odisha, India are anemic. The national long-term efforts in reducing anemia have focused mostly on the supply side, with a paucity of campaigns on the demand side. Social norms serve as significant determinants of human behavior, but there are few interventions that adopt a social-norms approach to reducing anemia. An intervention was implemented to change descriptive, injunctive, and collective social norms to improve iron folic acid consumption behaviors among women of reproductive age. METHODS: A longitudinal cluster randomized controlled trial was conducted to collect data at baseline, six months later at midline, and a year after that at end-line. All villages in our study area were formed into clusters, randomly assigned to either the treatment (50 clusters with 130 villages) or the control (39 clusters with 109 villages) arm. Women were eligible for inclusion if they aged between15 and 49, spoke Odiya, and did not plan to move in the next year. Women living in treatment communities received the intervention package that comprised community-based education sessions, health communication videos, and hemoglobin testing. RESULTS: Data analyses included 2,061 women in the treatment arm and 2,049 women in the control arm enrolled in the trial at baseline. Hierarchical linear models revealed that all three types of social norms improved significantly more in treatment than in control communities (all p\u27s \u3c 0.001) at midline. Two of the norms (descriptive and collective but not injunctive norms) predicted iron folic acid consumption at end-line. The relative improvement in iron folic acid consumption over time was significantly greater in treatment communities (p \u3c.001). CONCLUSIONS: It appears that a social norms-based intervention can change longer-term iron and folic acid consumption behaviors to reduce anemia. Future practice may merit having norms-based strategies to promote adherence to micronutrient supplementation and medical guidelines among women. This demand-side approach will be particularly useful in resource-limited settings where the health system is inadequately prepared to procure and distribute supplements. TRIAL REGISTRATION: This trial was registered with Clinical Trials Registry- India (CTRI) (CTRI/2018/10/016186) on 29 October 2018
International Observerships in Global Neurosurgery: Overview and Analysis of a 40-Year Experience at Barrow Neurological Institute
No full textThis article provides an overview of the Barrow Neurological Institute international observership and visiting scholars program, one of the oldest and largest international neurosurgical observership programs in the world, and discusses its past, present, and future directions. Background information was collected from the program manager and through one-on-one interviews with the program\u27s founders and current chairman. A survey was administered to past observers to capture feedback. Interviews were summarized, descriptive statistical analysis was performed on quantitative survey data, and a thematic analysis was completed for qualitative data. Since 2006, 686 neurosurgeons, residents, and medical students from more than 64 countries have traveled to Barrow Neurological Institute for an observership. Five hundred and seventy (86.2%) of 661 observers with historical data on country of origin came from high-income countries or upper middle-income countries, 91 (13.7%) from lower middle-income countries, and none from low-income countries (LICs). Of 94 observers who completed the feedback survey, 67 (71%) specialized in cerebrovascular and 21 (22%) in spine. Most observers (70%) were self-funded. Cost (38%) and time (25%) were considered the greatest barriers to observership. Despite the barriers, 93% would recommend the observership to a colleague. Future aspirations for the program include fully funded observerships geared toward neurosurgeons from lower middle-income countries and LICs. Next steps for the program are better inclusion of observers from lower middle-income countries and LICs and expanded research and mentorship opportunities. Future work should investigate the effect of observership programs on career path and brain drain
Sector-, Season-, and Country-Specific NO-Associated Health Benefits from NO Emission Reductions
No full textLong-term exposure to NO is associated with elevated risks for pediatric asthma and premature death. Despite national policies targeting NO\u27s main source, NO emissions, its global health burden remains high. Here, we use the air quality model GEOS-Chem adjoint with TROPOspheric Monitoring Instrument (TROPOMI)-based satellite downscaling to estimate that long-term NO exposure is responsible for 2.07 (95% CI 0.91-2.70) million pediatric asthma cases and 1.98 (95% CI 0.52-2.86) million deaths globally in 2019. We attribute these to anthropogenic NO emissions by sector, country, and season using the adjoint model and provide a recommendation for the most impactful sector and season for NO emission controls in each G20 country. Discrepancies exist between the health benefits incurred by emission reductions and the emission sector distributions, particularly in countries with emitters adjoining population centers. For example, we find that, if Russian anthropogenic NO emissions were reduced uniformly by 10% across all sectors, the energy sector, 31% of annual NO emissions, would account for 47% of pediatric asthma and 49% of premature death health benefits. The season in which these emission reductions occur also affects the magnitude of the health benefit, as seen by the fact that Russian wintertime NO emission reductions alone are responsible for approximately one-third of the annual health benefits for each health outcome. We present the unique results for each of the G20 members to showcase how a country\u27s NO emission reductions can be most impactful in reducing the global NO-associated health burden
Association Between Physician Assistant Program Characteristics and Student Diversity
No full textINTRODUCTION: Diversity within the health professions workforce can improve patient satisfaction and enhance team productivity. As the physician assistant (PA) profession grows, PA educational programs have struggled to achieve greater diversity. Recent literature identified top performing PA programs in achieving diverse student cohorts. This study examined the associations between PA program characteristics and successful recruitment and graduation of students from underrepresented minority (URM) groups. METHODS: Program characteristics from the 2019 PA Education Association Program Survey and Faculty Survey were obtained (n = 141 programs). Programs were categorized as exemplary or nonexemplary in recruiting and graduating diverse student cohorts according to prior literature. Univariate and multivariate logit regression specifications identified program characteristics associated with exemplary status. RESULTS: Programs of longer duration and those with a greater percentage of URM faculty were more likely to be exemplary (2.2 and 2.5 percentage point increase in likelihood, respectively). Positive but not statistically significant associations were also observed between exemplary status and programs that did not require an admissions test and those with greater percentages of the faculty who identified as Asian, Hispanic, or underrepresented in medicine. DISCUSSION: Having faculty from URM backgrounds may influence PA programs\u27 success in improving student cohort diversity. Other program characteristics, including absence of admissions testing requirements, may also shape student diversity. These findings can inform PA and other health professions programs as they develop approaches to increase racial and ethnic diversity among their students
Transcriptome-wide association study of alternative polyadenylation identifies susceptibility genes in non-small cell lung cancer
No full textAlternative polyadenylation (APA) plays a crucial role in cancer development and prognosis. However, the molecular characteristics of APA related to non-small cell lung cancer (NSCLC) susceptibility remain understudied, especially in East Asian populations. In this study, we constructed an atlas of APA-regulated 3\u27 untranslated region (3\u27UTR) and profiled its genetic regulation in 747 lung tissue samples (including tumors and paired normal tissues) from 417 NSCLC Chinese patients. We verified a significant global shortening of 3\u27UTRs in tumor samples compared to normal samples and underscored the value of APA-regulation as a prognostic marker. The 3\u27UTR APA quantitative trait loci (3\u27aQTL) was identified by regressing the percentage of distal poly(A) site usage index (PDUI) value on genetic variants. We found that a significant proportion 3\u27aQTLs are independent of genetic regulation of expression and are specific in Chinese. We also conducted a 3\u27UTR APA transcriptome-wide association study (3\u27aTWAS) by integrating the APA regulation atlas with a genome-wide association study (GWAS) for NSCLC involving 7035 cases and 185,413 cancer-free controls. We identified NSCLC-associated genes, highlighting TUBB, TEAD3, and PPP1R10. Combining the consistent results from colocalization analysis, differential APA analysis, and survival analysis, we provide novel evidence for the role TUBB APA regulation in NSCLC and identified potential upstream regulators. Overall, our study profiled the APA regulation and highlighted the substantial role of APA in NSCLC carcinogenesis and prognosis in East Asian populations
Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children with Severe Malaria-Associated Acute Kidney Injury
No full textAcute kidney injury (AKI) remains a common cause of preventable death in low-resource settings because of cost and lack of dialysis access. AKI occurs in 24-59% of children with severe malaria, and when severe malaria-associated acute kidney injury (SM-AKI) is complicated by hyperkalemia, mortality approaches 40%. Treatment of these children with severe anemia becomes challenging as packed red blood cells (pRBCs) have high potassium (K+) loads. We describe a protocol using the novel manual single-lumen alternating microbatch (mSLAMB) dialysis system to deplete pRBCs of K+, hypothesizing that this system can decrease K+ \u3e80% in 20 minutes. Herein, we ran pRBC aliquots through the mSLAMB system using diffusive clearance. Three cycles were completed in each of four experiments. K+ was measured at baseline and after every cycle to calculate K+ reduction. Active ultrafiltration was performed to control net volumes, assessed as percentage of blood volume reduction and hematocrit rise. We reduced K+ in pRBC aliquots by a median of 93.2% (interquartile range [IQR], 89.9-95.1) in a median of 20.5 minutes (IQR, 17.8-23.1) per experiment. Greatest median K+ reduction occurred in cycle 1 (80.9%; IQR, 80.8-80.9), with minimal additional clearance achieved by cycle 3. Median hematocrit rise at experiment conclusion was 2.5% (IQR, 1.8-3.3). We conclude that mSLAMB dialysis consistently and effectively removed \u3e80% of K+ from pRBCs in just over 20 minutes and facilitated volume control. Further studies are assessing transfusion risks in children with SM-AKI and hyperkalemia as this technique may allow for safer resuscitation
Cyclohexanone and metabolites exposure in critically Ill neonates and children
No full textBACKGROUND: Cyclohexanone is a volatile organic compound known to be toxic to humans and animals, used in the medical setting as a solvent sealer for intravenous (IV) fluid administration devices. We aimed to determine exposure sources as well as plasma and urine levels of cyclohexanone and metabolites in critically ill infants and children. METHODS: We prospectively enrolled children in a single center pediatric intensive care unit (ICU) (n = 66), and conducted a secondary analysis of a multicenter trial in premature neonates (n = 69). Cyclohexanone and its predominant metabolites, trans-1,2-cyclohexanediol and trans-1,4-cyclohexanediol, were measured serially in medical fluids, plasma, and urine. RESULTS: Cyclohexanone was detected in all IV solutions used in standard ICU care (IV fluids, medications, dialysate and red blood cell bags, n = 53 fluid samples). Cyclohexanone and metabolites were higher in urine versus plasma in both cohorts. In premature neonates, plasma and urine cyclohexanone concentrations were highest on day of randomization, while metabolite concentrations were highest on days 7-14. CONCLUSIONS: Currently, cyclohexanone may represent an inevitable exposure to children who require intensive care inclusive of IV fluid and medication administration devices. Further studies are needed to develop replacement or mitigation strategies for cyclohexanone exposure in the vulnerable neonatal and pediatric ICU populations. IMPACT: Direct bloodstream exposure to cyclohexanone in the hospital environment has been poorly described in the healthcare setting. Cyclohexanone was present in all tested types of intravenous solutions used in standard intensive care (intravenous fluids, medications, dialysate and stored red blood cell bags). In a single center pediatric intensive care unit cohort and a multicenter neonatal intensive care unit cohort, cyclohexanone and its metabolites were detected in every blood and urine sample tested. In a multicenter neonatal intensive care unit cohort, plasma and urine cyclohexanone concentrations were highest on day 1 of admission and metabolite concentrations were highest on days 7-14
Machine learning approach for dosage individualization of azithromycin in children with community-acquired pneumonia
No full textAIMS: The uncertainty about the efficacy and safety of currently used azithromycin dosing regimens in children warrants individualized therapy. The area under the plasma concentration-time curve over 24 h (AUC) of azithromycin correlates best with its effectiveness. The aim of this study was to evaluate the ability of machine learning (ML) to predict the AUC of azithromycin in children with community-acquired pneumonia. METHODS: Various ML algorithms were used to build ML models based on simulated pharmacokinetic profiles from a published population pharmacokinetic model. A priori-ML model predicted AUC using patients\u27 characteristics and after the trough concentration (C) became available, a posteriori-ML model was built for improved prediction. Statistical methods and pharmacodynamic (PD) evaluation methods were used to evaluate the ML model\u27s predictive accuracy in a real-world study. ML-optimized doses were evaluated by calculating the probability of PD target attainment in virtual trials compared with guideline-recommended doses. RESULTS: The AUC can be predicted by priori-ML model using the CatBoost algorithm with dosing regimen and two covariates as predictors (weight, alanine aminotransferase) before initial administration. A posteriori-ML model using CatBoost algorithm was built with adding C as a predictor. In real-world validation, the mean absolute prediction error of the priori-ML and posteriori-ML models was less than 30%. The accuracy (determining whether the PD target is met) of the priori-ML model was 76.3%, whereas that of the posteriori-ML model increased to 90.4%. CONCLUSIONS: ML models were established to predict the AUC of azithromycin successfully and could be used for individual dose adjustment in children before treatment and after obtaining C
Can social protection contribute to social connectedness in contexts of forced displacement and crisis? Lessons from Jordan\u27s labelled cash transfer for education
No full textSocial protection programming can help address gender- and lifecycle-specific vulnerabilities, particularly in humanitarian contexts. Although adolescents are disproportionately affected by crises, there remains limited evidence about how such programming can mitigate risks they face, including social isolation. This article explores how a \u27cash-plus\u27 social protection response enhances refugee adolescents\u27 social connectedness and contributes to broader social cohesion and sustainable peace. Mixed-methods data collected during the Covid-19 pandemic with 996 Syrian adolescents living in Jordanian host communities involved beneficiaries and non-beneficiaries of Hajati, UNICEF\u27s unconditional cash transfer. Explicitly labelled to promote adolescent education, Hajati also encourages enrolment in an adolescent empowerment programme, Makani (My Space), designed to foster resilience and social connectedness. Survey results were mixed, finding evidence of modest improvements among beneficiaries on a subset of social connectedness and resilience outcomes. Hajati beneficiaries (particularly girls and older adolescents, aged 15-18) report higher levels of family support and better coping with pandemic stressors. Among younger adolescents (12-14) and girls, beneficiaries were more likely to report having a trusted adult, and greater social support from non-family adults. Beneficiary status was not associated with measures of peer connectedness or perceived social cohesion. Qualitative interview findings, however, indicate beneficiaries enjoy stronger peer networks, partly due to participating in group-based programming. Overall, programme participation helped girls (and, less so, boys) cope with pandemic stressors, while strengthening adolescent social connectedness through opportunities for in-person and online interaction. We conclude with suggestions on how to strengthen programming to promote social cohesion and sustainable peace
Outcomes of reoperation following failed laser ablation surgery for epilepsy in pediatric patients
No full textOBJECTIVE: There are significant challenges in the surgical management of pharmacoresistant epilepsy. Laser interstitial thermal therapy (LITT) has emerged as a less invasive alternative to resection. However, seizure persistence or recurrence following LITT is not uncommon, and there is currently a lack of guidance and consensus on the best way to manage seizure recurrence after LITT for different epilepsy etiologies in children, or for the use of LITT when open resection has left residual epileptogenic tissue. The objective of this study was to assess the outcomes of secondary epilepsy surgery after failed initial LITT. METHODS: The authors performed a retrospective chart review of patients who underwent secondary epilepsy surgery after failed LITT at Children\u27s National Hospital. RESULTS: A total of 36 patients were treated with LITT, and 4 were excluded due to the palliative purpose of LITT. Thirteen of 32 patients (40.6.%) achieved Engel I, 1 patient (3.1%) achieved Engel II, and 18 patients (56.2%) had poor outcomes (Engel III-IV). Of these 32 patients, 9 (28.1%) underwent reoperation after their first laser ablation surgery due to a recurrence of epilepsy. Seven patients had a second laser ablation, and 2 patients underwent open resection. Of these 9 patients, 3 (33.3%) had Engel I outcomes, and 6 (66.7%) had poor seizure outcomes (Engel III-IV). When considering only patients who had repeat LITT for reoperation, 2 of 7 (28.6%) of these patients achieved seizure freedom (Engel I). Of the 32 patients, short-term complications were transient oculomotor (n = 1, 3.1%) or trochlear (n = 1, 3.1%) nerve deficit, which entirely resolved within 6 months, and superior quadrantanopia (n = 1, 3.1%) after initial LITT. CONCLUSIONS: Although LITT has shown promising results in treating pharmacoresistant epilepsy, the recurrence of seizures necessitates further evaluation and consideration of reoperation, which may result in seizure freedom. Repeat LITT is a low-risk option for secondary surgery after seizure recurrence