Jacobs Institute of Women's Health
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Neonatal Spinal Cord Injury
No full textNeonatal spinal cord injury is rare, and diagnosis is often delayed. The causes of spinal cord injury are quite broad including mechanical trauma, ischemia in the prenatal or perinatal period, iatrogenic causes, or other etiologies such as spinal abnormalities or neoplasms. The perinatal history and specific physical examination findings can suggest a diagnosis of neonatal spinal cord injury, which warrants confirmation by magnetic resonance imaging. Management involves supportive care and physical and occupational therapy. Early recognition is paramount to determine the specific cause, manage clinical complications, and prevent continued injury to the spinal cord. In this review, we provide 4 case examples that demonstrate the complex clinical presentations of neonatal spinal cord injury and, at times, the uncertainty of finding a specific mechanism of injury
Artificial Intelligence for Response Assessment in Pediatric Neuro-Oncology (AI-RAPNO), part 1: review of the current state of the art
No full textArtificial intelligence (AI) has the potential to enable more precise, efficient, and reproducible interpretation of medical imaging data to improve patient care in paediatric neuro-oncology. Paediatric brain tumours present distinct histopathological, molecular, and clinical challenges that require tailored AI solutions. Recent advances have led to paediatric-specific AI tools for tumour segmentation, treatment response evaluation, recurrence prediction, toxicity assessment, and integrative multimodal analysis. These innovations have the potential to improve diagnostic accuracy, streamline workflows, and inform personalised treatment strategies. However, clinical implementation remains hindered by challenges related to data heterogeneity, model generalisability, and integration into clinical practice. In this Policy Review, we highlight key developments, challenges, and priority areas for imaging-based AI for paediatric neuro-oncology. Our goal is to provide oncology practitioners with a focused overview of current capabilities, unmet needs, and future directions at the intersection of AI and paediatric neuro-oncology
Endothelial βII Spectrin Deletion Exacerbates Inflammation and Impairs Tissue Regeneration in Ischemic-Diabetic Skin Wound Healing
No full textImpaired lower extremity wound healing due to diabetes presents a significant societal burden, as 25% of diabetic wounds lead to major amputations. While TGF-β has been extensively studied in diabetic wound healing, the role of βII spectrin (SPTBN1), a known adapter of SMAD3 in the canonical TGF-β signalling pathway, remains unexplored. Single-cell RNA sequencing analysis revealed an increase in SPTBN1 expression in endothelial cells from non-diabetic skin to diabetic skin and ulcers. We found that silencing SPTBN1 in human umbilical vein endothelial cells (HUVECs) suppressed endothelial sprouting and tube formation. Based on these findings, we hypothesised that SPTBN1 regulates diabetic wound healing by modulating angiogenesis. To test this, we created Sptbn1 endothelial-specific conditional knockout (Sptbn1) mice and used the well-established streptozocin-induced diabetic excisional dorsal wound model. Interestingly, while Sptbn1 mice showed delayed wound healing, the delay was not due to impaired angiogenesis, but rather due to excessive inflammation. Inflammation persisted in Sptbn1 mice when it resolved in controls, as evidenced by higher numbers of neutrophils, inflammatory monocytes and greater iNOS staining intensity in the wound beds. Additionally, Sptbn1 wounds had significantly less granulation tissue and fewer fibroblasts in the regenerative phase. Collectively, these findings suggest that βII spectrin in endothelial cells is a potential therapeutic target in chronic diabetic wound healing
Supportive Care for Patients Receiving Maintenance Hemodialysis: Why Nephrologists Should Care and What They Can Do
No full textRespect Relationships, Remember Roles, and Realize Reasons: Ethics Tasks Relevant to Intervention Principles
No full textThe Burden of Articulation: Why Overvaluing Parents\u27 Reasons May Disadvantage Those We Seek to Protect
No full textClinical Performance of a Novel Point-of-Care High-Sensitivity Cardiac Troponin I Assay
No full textBACKGROUND: High-sensitivity cardiac troponin (hs-cTn) assays performed in the central laboratory have long turnaround times. This study evaluates the clinical performance of a novel bedside point-of-care (POC) hs-cTnI assay (i-STAT® hs-TnI) to aid in the diagnosis of myocardial infarction (MI). METHODS: A prospective multisite cohort study involving emergency department (ED) patients with symptoms suggestive of acute coronary syndrome was conducted at 28 sites across the United States. Serial whole blood samples were collected at 0-1 h and \u3e1-3 h from ED presentation. Primary outcome was MI or non-MI. Sensitivity, specificity, and negative predictive value (NPV) for MI were calculated with 97.5% lower confidence limits (LCL) using the female, male, and overall 99th percentile upper reference limit (URL, 13, 28, and 21 ng/L, respectively). Post hoc analysis was also conducted for initial measurements below the limit of quantification (LoQ, 2.9 ng/L) and \u3c5.0 ng/L. RESULTS: The cohort included 3582 patients, median age 59 y, 64% female. MI incidence was 8.6%. Sensitivity and specificity at \u3e1-3 h were 96.6% (LCL 91.7%) and 82.1% (80.2%) using the female URL; 90.7% (LCL 84.1%) and 83.9% (LCL 81.4%) using the male URL; and 92.4% (LCL 88.3%) and 85.6% (LCL 84.2%) using the overall URL. NPVs for MI of initial hs-cTnI measurement
A Social Norms Intervention to Improve Vaccination Intentions: Outcomes from the Happy Baby Program in the Slum Areas of Varanasi, India
No full textThe extent to which social norms can be changed through social media and whether those changes affect behaviors are questions raised in this paper. Using the Theory of Normative Social Behavior, we do so in the context of promoting childhood immunization in slum areas in India, where rates remain critically low. We used a quasi-experimental design to compare outcomes across three arms: a no-intervention Control Arm (n = 602), a Vaccine Arm (n = 626) that received information about vaccines through text, audio, and video on WhatsApp, and a Wellness Arm (n = 651) that received information about vaccines and wellness (breastfeeding, handwashing, and nutrition) in the same format and frequency as the Vaccine Arm. Longitudinal data were collected at baseline and end-line from all three arms. Significant improvements in descriptive and injunctive norms about vaccination, self-efficacy, and vaccination intentions were observed in the Vaccine Arm, compared to the Control Arm. The two (descriptive and injunctive) norms also improved significantly in the Wellness Arm, compared to the Control Arm. Changes in self-efficacy and descriptive norms also affected changes in intentions. These findings provide a pathway for future interventions, to improve social norms as a way to improve vaccination. We discuss a few mechanisms for doing so
Anchored Matching-Adjusted Indirect Comparison of the Long-Term Maintenance of Efficacy of Tralokinumab and Lebrikizumab in Patients with Moderate-to-Severe Atopic Dermatitis
No full textINTRODUCTION: Atopic dermatitis (AD) is a chronic skin disease largely driven by interleukin (IL)-13, which is targeted by tralokinumab and lebrikizumab. Effective, long-term treatments are needed, and head-to-head studies comparing these available therapeutics have yet to be conducted. This analysis indirectly compared the maintenance of efficacy of tralokinumab and lebrikizumab at week 52 in week-16 responders. METHODS: An anchored matching-adjusted indirect comparison was performed using individual patient data (IPD) from the ECZTRA 1 and ECZTRA 2 tralokinumab trials and aggregate data from the ADvocate 1 and ADvocate 2 lebrikizumab trials, with IPD weighted to match ADvocate baseline and week-16 characteristics. Week-16 responders, patients achieving 75% reduction in Eczema Area and Severity Index (EASI-75) or Investigator Global Assessment 0 or 1 (IGA 0/1) with an ≥ 2-point improvement from baseline, were re-randomized to active treatment every 2 weeks (Q2W), every 4 weeks (Q4W), or placebo Q2W for the 36-week maintenance period. Week 52 efficacy outcomes included IGA 0/1, EASI-75, 90% reduction in EASI (EASI-90), EASI percentage improvement, and pruritus numerical rating scale 4-point improvement (pruritus 4pt) from baseline. Response differences relative to placebo for endpoints of interest were calculated between tralokinumab and lebrikizumab for Q2W and Q4W dosing to compare maintenance of efficacy at week 52 among week 16-responders. RESULTS: Differences in efficacy endpoints between tralokinumab and lebrikizumab were not statistically significant; within Q2W dosing, tralokinumab versus lebrikizumab response rate differences at week 52 numerically favored tralokinumab (IGA 0/1: 1.2%, EASI-75: 19.8%, EASI-90: 1.5%, EASI percentage improvement from baseline: 3.3%, pruritus 4pt: 17.6%) while Q4W differences were more variable (IGA 0/1: -20.5%, EASI-75: 15.7%, EASI-90: -8.5%, EASI percentage improvement from baseline: -0.5%, pruritus 4pt: -2.7%). CONCLUSIONS: Comparable maintenance of efficacy was observed between tralokinumab and lebrikizumab after 52 weeks of treatment among patients meeting response criteria at week 16
Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study
No full textOur objective was to examine the role of structural racism and economic disadvantage in perinatal health inequities using the Environmental influences on Child Health Outcomes Cohort. Participants\u27 addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02 weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx-White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)) among Latinx participants. A one-quartile increase in Black-White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes