Jacobs Institute of Women's Health
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Analysis of deep learning-based segmentation of lymph nodes on full-dose and reduced-dose body CT
No full textOBJECTIVES: The performance of fully automated deep learning-based models for the detection and segmentation of lymph nodes (LNs) on full- and simulated reduced-dose CT was validated. METHODS: A total of 15,341 LNs were annotated in 151 patient CTs (age 52 ± 14 years, 87 males) from the public TCIA NIH CT Lymph Nodes dataset. Two 3D nnU-Net models were trained on 90 CT scans: (1) only full dose CTs (NoAugmentation), and (2) both full- and reduced-dose CTs (Augmentation). Dose reduction from 75% to 5% of the full-dose was simulated using a noise-addition tool. Performance was validated on the remaining 61 CTs and an external TCIA Mediastinal LNQ dataset (120 CTs, 64 females). RESULTS: On 61 full-dose CTs, the Augmentation model detected all LNs with 67.3% precision and 84.6% sensitivity. For all LNs and large nodes (short axis diameter ≥ 8 mm), Dice Similarity Coefficient (DSC) was 0.83 ± 0.07 and 0.80 ± 0.14, while Hausdorff Distance (HD) error was 1.47 ± 0.91 mm and 3.2 ± 2.28 mm, respectively. Performance decreased with dose reduction (p \u3c 0.01), reaching 73.8% detection sensitivity and 0.75 DSC at 5% dose. Statistically significant differences between Augmentation vs. NoAugmentation models were seen for all nodes (p \u3c 0.001) and small nodes (p \u3c 0.05) at 10% and 5% doses. On the external LNQ dataset, the Augmentation model attained a DSC of 0.76 ± 0.12 and HD of 4.7 ± 3.23 (p \u3c 0.01) for all LNs. CONCLUSION: Degraded image quality impacted nodal delineation on reduced-dose CT. Performance improved when a model trained on both full- and reduced-dose CTs was used
Pre- and post-move exposure to air pollution and neighborhood socioeconomic status
No full textINTRODUCTION: Nearly 10 % of the U.S. population moves in a given year. We aimed to examine differences in neighborhood socioeconomic status (nSES) and ambient air pollution concentrations before and after a residential move, whether change varies by distance of the move, and whether moving is a potential source of bias in estimating relationships between contextual exposures and outcomes. METHODS: We used data from participants in the Atherosclerosis Risk in Communities (ARIC) Study with geocoded addresses at Visit 2 (Visit 2; 1990-1992) and Visit 3 (Visit 3; 1993-1995). We quantified nSES using the 1990 census and estimated concentrations of fine particulate matter (PM), ozone (O) and nitrogen dioxide (NO). We defined short-distance and long-distance movers as having moved less and more than the median move distance of 4.3 miles, respectively. We quantified Visits 2 to 3 change in nSES and air pollution for short and long-distance movers, examined change in air pollution after accounting for temporal trends, and conducted a quantitative bias analysis to estimate the bias introduced by not accounting for moving in example studies of PM and health. RESULTS: On average, compared to non-movers, short-distance movers relocated to neighborhoods with better nSES and similar air pollution concentrations, while long-distance movers relocated to neighborhoods with worse nSES but lower exposure to air pollution. The quantitative bias analysis suggested there was little to no bias in the PM-health relationship from not accounting for relocation, likely due to relatively little overall difference in PM exposures observed with relocation. CONCLUSIONS: Change in nSES and air pollution with a residential move differs by move distance. However, not accounting for relocation may not lead to significant bias in the relationship with the health outcome. Understanding the extent to which contextual exposures change after a move can clarify whether accounting for bias due to relocation is necessary
Patient Navigation for Cancer Care in Sub-Saharan Africa: A Scoping Review
No full textCancer is a major health threat in sub-Saharan Africa (SSA). Patient navigation has emerged as a strategy to address this, but the scope and impact of patient navigation for cancer care in SSA remains unclear. We aimed to comprehensively map the existing literature on patient navigation interventions for cancer care in SSA. A scoping review was conducted using a standardized 3-step search strategy. Eligible studies involved a patient navigation intervention for cancer care in SSA. Data were extracted on study, participant and navigator characteristics, intervention outcomes and implementation barriers and facilitators. Twenty-two studies describing 20 distinct interventions across 10 countries were included. Most studies were descriptive, focused on breast and cervical cancers and targeted the treatment stage of care. Navigator roles included patient education, psychosocial support, care coordination, and attenuation of patient barriers to care. Patient navigation appeared feasible, acceptable, and beneficial across a variety of study populations in this setting, but limited funding was a commonly reported barrier to maintenance. Cancer patient navigation is a promising strategy to improve cancer outcomes in SSA. Strategic investment is needed to support sustainable scale-up and maximize the impact of cancer patient navigation in the region
Two Decades of Medical Education Scholarship: Mapping Collaboration and Thematic Shifts Using Web of Science (2000-2019)
No full textINTRODUCTION: The field of medical education (ME) has grown substantially over the past decades, yet questions remain about its scope and boundaries. This study examines how research topics and institutional collaborations have evolved in ME from 2000 to 2019. METHODS: Adopting a post-positivist stance and using bibliometric network analyses, we examined metadata from 31,338 publications across 22 core ME journals indexed in the Web of Science. We analyzed trends in institutional collaboration and the development of research themes. Extracted metadata included authors\u27 institutional affiliations and KeyWords Plus (n = 18,218). Bibliometric analyses were conducted using VOSviewer, a widely used tool for network mapping. We generated co-authorship networks to trace institutional collaboration and co-word networks to identify thematic clusters. RESULTS: Co-authorship networks revealed increasing collaboration, with U.S. institutions remaining central and Canadian and Dutch institutions gaining prominence. Co-word analyses identified three stable clusters-teaching and learning, quantitative, and psychosocial-with teaching and learning dominant across all periods and the quantitative cluster expanding in recent years. DISCUSSION: Findings show the consolidation of teaching and learning as the foundation of ME, alongside diversification through quantitative and psychosocial themes. Growing collaborations suggest the field\u27s maturation, though geographic imbalances persist. Limitations include reliance on a restricted set of Web of Science journals, which overrepresent English-language and highly cited publications, and the use of KeyWords Plus as a proxy for themes. This study offers an evidence-based mapping of ME\u27s evolution and provides a framework for future research on the interdisciplinary and global dynamics of the field
Prevalence of Menstrual Inequity in a Pediatric Emergency Department
No full textSTUDY OBJECTIVE: Between 10-25% of adolescents in the United States experience menstrual inequity, or insufficient access to menstrual products or education. The emergency department (ED), which often serves as a safety net for adolescent health access, has been identified as a strategic venue for public health interventions. The Child Opportunity Index (COI) is a validated, multidimensional neighborhood measure of structural opportunity that can impact child health and development. Therefore, the purpose of this project was to measure the prevalence of menstrual inequity in a pediatric ED and examine associations with the COI. METHODS: This cross-sectional study analyzed electronic survey data from adolescents 13-21 years old who visited a pediatric ED from January 2024-February 2025. Participants were included if they had started menstruation and responded to validated questions that assessed menstrual inequity. Home addresses were geocoded into census tracts and linked to COI version 3.0. The prevalence of menstrual inequity was calculated, and logistic regression was used to measure associations between menstrual inequity and COI. RESULTS: One-third reported experiencing menstrual inequity during the past 12 months. Patients living in areas with low neighborhood opportunity had higher odds of experiencing menstrual inequity than those in high opportunity areas. CONCLUSION: Menstrual inequity is common among adolescent pediatric ED patients, particularly among those from low-resourced neighborhoods. Future work should explore increasing advocacy efforts at the institutional level through menstrual product drives and distribution, as well as larger, national-level efforts to influence policy changes
Clonal Hematopoiesis and Major Adverse Cardiac Events in People With HIV: Insights From the REPRIEVE Trial
No full textBACKGROUND: People with HIV (PWH) experience higher cardiovascular disease event rates not fully explained by traditional risk factors. Clonal hematopoiesis of indeterminate potential (CHIP), an emerging risk factor for cardiovascular disease in the general population, has been reported to be more prevalent in PWH. METHODS: Using high-coverage targeted CHIP sequencing in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) cardiovascular disease prevention trial, we investigated whether CHIP increases the risk of major adverse cardiovascular events (MACE) among PWH, as well as whether HIV-associated factors were associated with greater CHIP prevalence among PWH. We analyzed whole-exome and targeted sequencing from 4490 PWH without known cardiovascular disease; 1653 (36.8%) were female, and 2039 (45.4%) were Black. MACE was defined by including cardiovascular death, myocardial infarction, hospitalization for unstable angina, stroke, transient ischemic attack, peripheral artery disease, revascularization, or death from an undetermined cause. RESULTS: A total of 837 (18.6%) had CHIP driver mutations, with 385 (8.6%) at variant allele fraction ≥2% and 61 (1.4%) at variant allele fraction ≥10%. Although overall CHIP was not associated with MACE, the presence of large CHIP (variant allele fraction ≥10%) was associated with increased odds for the first occurrence of myocardial infarction or cardiac catheterization, or revascularization, despite low overall event rates. Adjustments for pitavastatin treatment did not attenuate this association. Furthermore, a larger CHIP clone size was associated with lower CD4 nadir and with increased risk of MACE. CONCLUSIONS: In PWH in the REPRIEVE trial who were low-to-moderate risk for incident cardiovascular disease, CHIP was not associated with increased prospective risk of MACE. However, a large CHIP was associated with increased risk of myocardial infarction and revascularization. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02344290
Safety and Immunogenicity of an rVSV Lassa Fever Vaccine Candidate
No full textBACKGROUND: No vaccine is currently available for Lassa fever, a viral hemorrhagic disease that is estimated to cause thousands of deaths each year in western Africa. A replication-competent recombinant vesicular stomatitis virus-vectored vaccine encoding a Lassa virus (LASV) glycoprotein complex, rVSVΔG-LASV-GPC, has been developed, but data on its safety and immunogenicity are limited. METHODS: In this phase 1, double-blind trial conducted in the United States and Liberia, we randomly assigned healthy adults (18 to 50 years of age) to receive rVSVΔG-LASV-GPC or placebo intramuscularly. Participants received a single vaccine dose of 2×10 plaque-forming units (PFU), 2×10 PFU, 2×10 PFU, or 2×10 PFU or placebo or received two vaccine doses of 2×10 PFU or placebo, within a window of 6 to 20 weeks. The side-effect profile was assessed according to the incidence of solicited and unsolicited adverse events (primary end point). Because Lassa fever can cause sensorineural hearing loss, hearing acuity was measured before and after the injection. Secondary end points were levels of binding antibodies against LASV glycoprotein, neutralizing antibodies, and vaccine vector-derived viral RNA and PFU in plasma, urine, and saliva. RESULTS: A total of 114 adults were enrolled. No serious vaccine-related adverse events were reported. The vaccine caused minimal local reactions and dose-dependent, mild-to-severe early-onset systemic reactogenicity events that were transient. No hearing loss was detected. All doses induced robust long-lasting cellular and humoral (binding and neutralizing) responses that cross-reacted against common LASV lineages. No infectious vaccine virus particles were found in plasma, urine, or saliva. CONCLUSIONS: The rVSVΔG-LASV-GPC vaccine resulted in transient local and systemic reactogenicity events but no hearing loss or serious adverse events. The vaccine had immunogenicity over a wide dose range in healthy adults in the United States and Liberia. (Funded by the Coalition for Epidemic Preparedness Innovations and the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT04794218; Pan African Clinical Trials Registry number, PACTR2021106625781067.)
Estimation of pre-Fontan pulmonary vascular resistance in children with single ventricle heart disease at the Glenn stage: a multicenter study
No full textThe Fontan procedure, employed in the management of children with single ventricle congenital heart disease, continues to present long-term complications. Notably, certain complications associated with this procedure are linked to imbalances in the distribution of hepatic blood flow. One promising strategy to address this challenge involves employing a digital twin to simulate diverse Fontan configurations. The objective is to identify an optimal design that ensures balanced hepatic blood flow and minimizes power losses. However, successful implementation depends on accurate, patient-specific estimates of pulmonary vascular resistance (PVR) for each lung at the pre-Fontan (Glenn) stage. In clinical practice, only the total PVR is typically measured, via catheterization using the Fick principle, but individual lung resistances can be derived by combining pressure data from catheterization (Cath) with flow data from cardiac magnetic resonance imaging (CMR). Still, notable discrepancies exist: Fick-based total PVR often differs significantly from Cath-CMR-based PVR due to differences in flow quantification, and neither method can distinguish between proximal and distal resistances within the Glenn pathway. An alternative method for estimating PVR was previously developed using a computational fluid dynamics (CFD) optimization framework. This method demonstrated a favorable correlation with PVR estimates derived from Cath-CMR, although it was not directly compared to clinical PVR values derived using the Fick principle. In this study, we compare three methods for calculating PVR, namely Fick-based, Cath-CMR-based, and CFD-based, using patient data from three independent institutions. Our results show that Fick-based PVR values are, on average, significantly lower than those obtained via the Cath-CMR and CFD methods. The CFD-based total PVR estimates show good agreement with the total Cath-CMR-based PVR. However, the elevated left proximal resistance present in the CFD method leads to a significant underestimation of the left lung resistance by the Cath-CMR method. This underscores the significance of incorporating proximal resistance in PVR estimation and supports the potential utility of the CFD-based method for preoperative planning in single ventricle patients
Accounting for social and environmental drivers of neurodevelopment: lessons from a pilot study in a pediatric Colombian cohort
No full textBACKGROUND: Child neurodevelopment is shaped by complex social, environmental, and biological factors. Few studies have characterized these factors in Latin American populations. We aimed to evaluate the impact of social and environmental factors on neurodevelopmental outcomes in 5-6-year-old children from three geographic locations in Colombia. METHODS: Our pilot, cross-sectional study included 105 typically developing Colombian children from two urban cities and one rural municipality. Measures assessed domains of IQ (Wechsler Preschool and Primary Scale of Intelligence-WPPSI), executive functioning, psychosocial functioning, and a range of home environmental factors. We compared outcomes across locations and the impact of covariates using linear regression models. RESULTS: Including covariates, adjusted mean WPPSI IQ was significantly lower in children living in a rural town (80.41 ± 2.07) compared to either city (96.30 ± 2.76; 91.69 ± 2.90). Maternal education, location, dietary diversity, and home resources explained 46% of the variance in IQ. Outcomes in other domains were significantly different, but functioning was all within age expectations across groups. CONCLUSION: Significant disparities in cognitive and other outcomes exist among typically developing Colombian children, influenced by location, maternal education, and home resources. Future research should ensure well-matched control populations and use culturally appropriate, validated assessments to minimize social, cultural, and environmental confounding. IMPACT: Maternal education, dietary diversity, total home resources, and location account for approximately 50% of the neurodevelopmental variability of children from urban and rural Colombian cohorts. Typically developing children from a rural community in Colombia have a lower Full-Scale IQ than peers from urban cities, even after including multiple covariates. Future research should continue to study the multiple factors that impact neurodevelopment, particularly in low- and middle-income countries. Well-matched control populations and the use of culturally appropriate, validated assessments are important to minimize confounding factors in neurodevelopmental outcomes research, as statistical correction is not sufficient to fully account for these differences
A Novel Framework for Developing Milestones to Measure Competency Across Physical Therapy Education
No full textBACKGROUND AND PURPOSE: Competency-based education (CBE) has gained widespread acceptance as an effective approach for preparing learners to meet societal health needs. At the American Physical Therapy Association (APTA) Pediatrics Education Summit III, several work groups were formed to develop resources supporting CBE implementation in physical therapy. This study aims to present the work of 1 group to explore the development of educational milestones for a physical therapy curricula framework. METHOD/MODEL DESCRIPTION AND EVALUATION: The educational milestone work group conducted a focused literature review to identify theories, models, and frameworks related to CBE and milestone development across health care professions. Through an iterative, multi-stage, and consensus-driven process, the group defined stages of knowledge and skill acquisition and learner performance descriptors. Feedback was solicited from a CBE expert advisory panel, and the framework was subsequently reviewed and refined based on the panel\u27s input. OUTCOMES: The work group developed an educational milestone framework, defining 6 stages of learners\u27 developmental progression across the physical therapist learner continuum: professional through post-professional. Building on these stages, the group identified 10 descriptors that can be used to describe milestones of learner performance, including knowledge, skills, and attitudes for specific competence and associated competencies. DISCUSSION AND CONCLUSION: This novel framework offers 1 approach to developing milestones that describe learner performance. It identifies and describes developmental stages to track learner progression and descriptors that can serve as a resource for physical therapy educators as they work to describe milestones for competence across professional and post-professional physical therapist education