Jacobs Institute of Women's Health
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Identifying individuals at risk for weight gain using machine learning in electronic medical records from the United States
No full textAIMS: Numerous risk factors for the development of obesity have been identified, yet the aetiology is not well understood. Traditional statistical methods for analysing observational data are limited by the volume and characteristics of large datasets. Machine learning (ML) methods can analyse large datasets to extract novel insights on risk factors for obesity. This study predicted adults at risk of a ≥10% increase in index body mass index (BMI) within 12 months using ML and a large electronic medical records (EMR) database. MATERIALS AND METHODS: ML algorithms were used with EMR from Optum\u27s de-identified Market Clarity Data, a US database. Models included extreme gradient boosting (XGBoost), random forest, simple logistic regression (no feature selection procedure) and two penalised logistic models (Elastic Net and Least Absolute Shrinkage and Selection Operator [LASSO]). Performance metrics included the area under the curve (AUC) of the receiver operating characteristic curve (used to determine the best-performing model), average precision, Brier score, accuracy, recall, positive predictive value, Youden index, F1 score, negative predictive value and specificity. RESULTS: The XGBoost model performed best 12 months post-index, with an AUC of 0.75. Lower baseline BMI, having any emergency room visit during the study period, no diabetes mellitus, no lipid disorders and younger age were among the top predictors for ≥10% increase in index BMI. CONCLUSION: The current study demonstrates an ML approach applied to EMR to identify those at risk for weight gain over 12 months. Providers may use this risk stratification to prioritise prevention strategies or earlier obesity intervention
Advancing early risk prediction for preterm neonates with late-onset sepsis: a step toward precision medicine
No full textPsychosocial predictors of diabetes self-efficacy in young adults with youth-onset type 2 diabetes
No full textThe aim of this study was to identify psychosocial factors associated with, and predictive of, diabetes self-efficacy (DSE) in young adults with youth-onset type 2 diabetes (T2D), a vulnerable, understudied group. In this observational, longitudinal study (T1 = baseline, T2 = 1 year later), 348 participants in the TODAY2 multi-center study of youth-onset T2D, completed valid measures of: diabetes self-efficacy, beliefs about medicines, depression and anxiety symptoms, diabetes distress, attitudes, self-management support, and need insecurities. Multivariable logistic regression models evaluated independent associations of each psychosocial factor with the likelihood of being in the high/low DSE tertile groups. Multivariable linear regression models assessed associations with DSE as a continuous variable. Participants\u27 mean age was 26 years, 67.9% were women, mean diabetes duration was 12.4 years, with mean of 2.5 diabetes-related complications. Greater self-care support increased the odds of high DSE at T2. Beliefs that medicines are overused, moderate-to-severe depressive or anxiety symptoms, and unmet material needs, decreased the odds of high DSE at T2. More support, fewer depressive and anxiety symptoms, and fewer unmet material needs at T1 predicted T2 DSE scores. Cognitions (beliefs that medicines are overused), emotions (depressive/anxiety symptoms), and social factors (self-management support, unmet material needs), were significant longitudinal predictors of DSE in young adults with youth-onset T2D. These potentially modifiable factors should be considered when screening for, and designing, interventions to enhance DSE, to improve health behaviors and forestall the development of complications in this at-risk group
Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries: a TQIP analysis
No full textPURPOSE: Frailty has gained recognition as a crucial determinant of patient outcomes following traumatic spinal injury (TSI), particularly due to its increasing incidence in elderly populations. The aim of the current investigation was therefore to compare the ability of several frailty scores to predict adverse outcomes in surgically managed isolated TSI patients without spinal cord injury. METHODS: All adult patients (18 years or older) who suffered an isolated TSI due to blunt trauma, and required surgical management, were extracted from the 2013-2021 Trauma Quality Improvement Program database. The ability of the Orthopedic Frailty Score (OFS), the Hospital Frailty Risk Score (HFRS), the 11-factor (11-mFI) and 5-factor (5-mFI) modified frailty index, as well as the Johns Hopkins Frailty Indicator to predict adverse outcomes was compared based on the area under the receiver-operating characteristic curve (AUC). Subgroup analyses were also performed on patients who were ≥ 65 years old and those who were injured due to a ground-level fall (GLF). RESULTS: A total of 39,449 patients were selected from the TQIP database. The 5-mFI and 11-mFI outperformed all other frailty scores when predicting in-hospital mortality (5-mFI AUC: 0.73) (11-mFI AUC: 0.73), any complication (5-mFI AUC: 0.65) (11-mFI AUC: 0.65), and FTR (5-mFI AUC: 0.75) (11-mFI AUC: 0.75). Among the 14,257 geriatric patients, however, the OFS demonstrated the highest predictive ability for in-hospital mortality (AUC: 0.65). The OFS (AUC: 0.64) also performed on the same level as both the 5-mFI (AUC: 0.63) and the 11-mFI (AUC: 0.63) when predicting FTR in this population. Among the 9616 patients who were injured due to a GLF, the OFS performed on par with the 5-mFI and 11-mFI when predicting in-hospital mortality and FTR. CONCLUSION: Simpler scores like the 5-factor modified Frailty Index and Orthopedic Frailty Score outperform or perform on par with more complicated frailty scores when predicting mortality, complications, and failure-to-rescue in surgically managed isolated traumatic spinal injury patients without spinal cord injury, particularly among geriatric patients and those injured in a GLF
Leveraging U = U in Interventions for Black Women Living With HIV: A Scoping Review and Call To Action
No full textUltrasound-guided interstitial photothermal therapy generates improved treatment responses in a 9464D model of neuroblastoma
No full textWe describe the use of ultrasound image guidance to improve treatment outcomes when administering interstitial photothermal therapy (I-PTT), an experimental cancer treatment modality. I-PTT is a promising thermal therapy for tumors using intratumorally injected nanoparticle-based photothermal agents activated by an interstitially placed laser diffuser. We hypothesized that ultrasound-based image guidance yields improved tumor treatment outcomes in terms of tumor regression and survival by improving the accuracy of the placement of the laser fiber and nanoparticles within a tumor and facilitating more precise PTT delivery. To test this hypothesis, we assessed the effect of ultrasound-guided I-PTT (US I-PTT) on neuroblastoma, an aggressive solid tumor of childhood, using the 9464D syngeneic model in C57BL/6 mice. US I-PTT using Prussian blue nanoparticles activated by an interstitial cylindrical laser diffuser generated an equivalent in vivo thermal dose as blinded, non-image-guided I-PTT (B I-PTT). However, US I-PTT resulted in significantly higher treatment accuracy compared to B I-PTT, attributable to the image guidance. Importantly, this improved accuracy translated to improved treatment outcomes wherein mice treated with US I-PTT exhibited significantly improved tumor regression, tumor-free survival, and long-term survival compared to mice treated with B I-PTT. Further, histological analyses of the tumors post-PTT confirmed the advantages conferred by US I-PTT over B I-PTT for tumor control. These proof-of-concept results demonstrate the value of using ultrasound guidance for I-PTT treatment and the translational implications of this approach to provide a more accurate and effective treatment for neuroblastoma
Can Non-Thymomatous Late-Onset Myasthenia Gravis Benefit From Thymectomy? A Systematic Review and Meta-Analysis
No full textBACKGROUND: Thymectomy is beneficial for treating early-onset acetylcholine receptor antibody-positive myasthenia gravis (MG); however, its effects on late-onset MG (LOMG) remain less well understood. Given the increasing incidence of MG among the population 50 years old and above, addressing the question of whether thymectomy is effective for this age group is critically important. This study aimed to assess the present evidence for the efficacy of thymectomy in LOMG and identify potential characteristics that may predict the treatment response. METHODS: Four electronic databases were searched from their inception to September 10, 2024. Six studies with both thymectomy and medical therapies in LOMG patients, along with another 14 studies with only a surgical group, were enrolled in the meta-analysis. The primary outcome was the response (remission and minimal manifestations status) to thymectomy in LOMG. RESULTS: In LOMG, response in the surgical group was greater than in the medical therapies alone group (OR = 1.42 [0.86-2.35], p = 0.169), but not significantly. However, subgroup analysis showed that when the age of MG onset was ≥ 45 years old or the age at thymectomy was ≥ 50 years old, thymectomy appeared better than medical therapies alone (OR = 1.92 [1.06-3.48], p = 0.031). Across all 20 studies, 34% (24%-44%) of LOMG patients improved with thymectomy. A higher response was observed in patients with a preoperative duration of less than 3 years from diagnosis [39% (16%-65%), p \u3c 0.001, q \u3c 0.001]. CONCLUSION: Thymectomy may be a potentially effective treatment for LOMG, particularly in patients who undergo the procedure soon after diagnosis. A randomized controlled study for LOMG patients is needed
Changing Epidemiology of Pediatric Pulmonary Exacerbations in Cystic Fibrosis
No full textRATIONALE: The introduction of elexacaftor/tezacaftor/ivacaftor (ETI), a highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy, to younger ages and the COVID-19 pandemic have significantly reduced pulmonary exacerbations requiring hospitalization among children with CF. OBJECTIVE: To assess demographic and clinical characteristics of children and young adults with CF hospitalized for pulmonary exacerbations before and after pediatric ETI approval. METHODS: A retrospective chart review was conducted at five United States CF Foundation-accredited care centers. Hospitalization data from children and young adults with CF in 2018 and 2022 were analyzed. RESULTS: Hospitalizations decreased from 471 cases (241 individuals) in 2018 to 163 cases (110 individuals) in 2022. The racial distribution shifted, with more hospitalized patients identifying as people of color in 2022 (28% vs. 14%; p = 0.018). A greater proportion of hospitalized children in 2022 had two non-F508del mutations compared with children hospitalized in 2018 (38% vs. 19%) and were less likely to be infected with methicillin-resistant Staphylococcus aureus (MRSA). Comparing 2022-2018, children on CFTR modulator therapy, including ETI (76%), showed reduced infections with Pseudomonas aeruginosa and Achromobacter xylosoxidans. CONCLUSIONS: The decline in hospitalizations for pulmonary exacerbations likely reflects the benefits of ETI therapy, as a higher proportion of children and young adults hospitalized in 2022 had two non-F508del mutations and were not eligible for ETI. A greater percentage of those hospitalized in 2022 identified as belonging to minority racial groups, highlighting ongoing health disparities in the ETI era. Additionally, there were notable changes in the microbiological characteristics between 2018 and 2022
Characterization of the Genomic Landscape in HPV-positive Cervical and Head and Neck Squamous Cell Carcinomas by Whole Genome Next Generation Sequencing
No full textBACKGROUND/AIM: In this study, we provide a comprehensive characterization of HPV-positive primary cervical cancers (CC) and HPV-positive head and neck squamous cell carcinomas (HNSCC) through whole genome next-generation sequencing. Human papillomavirus (HPV) infection, recognized as a definitive human carcinogen, is increasingly acknowledged for its role in development of human cancers. HPV-driven cervical cancers are among the leading causes of cancer-related deaths worldwide, while HPV-driven head and neck cancers exhibit distinct biological and clinical characteristics. Recent data has provided convincing evidence that HPV-related cervical cancer, like HPV head and neck cancer also predict better outcomes, with viral integration patterns further predicting disease related outcomes. MATERIALS AND METHODS: We designed an experimental study that encompasses four pairs of HPV-positive patient samples with controls, utilizing state-of-the-art Next Generation Sequencing (NGS) technology including whole genome sequencing, transcriptome sequencing and virus integration. RESULTS: Multiple mutated genes, including TTN, COL6A3, and FLNA, were identified shared between CC and HNSCC. Additionally, we observed a notable proportion of pathways affected by oncogenic alterations, particularly in the RTK-RAS and NOTCH pathways, in both CC and HNSCC. Furthermore, we discovered a shared down-regulation of the Hedgehog signaling pathway based on transcriptome expression analysis in KEGG. We also identified RUNX2 and TFPI as sites of virus integration, and upstream as well as downstream pathway modulators, and represent potential targets for therapeutic interventions. CONCLUSION: Overall, this study showed a thorough comparison between CC and HNSCC from multiple aspects, including gene variations, oncogenic pathways, KEGG enrichment and virus integration sites. However, further studies, which involve larger patient cohorts should be undertaken to further support these findings
The Heterogeneous Clinical Manifestations of Atopic Dermatitis Across Diverse Patient Populations
No full textAtopic dermatitis (AD) presents with a wide range of clinical manifestations with variable distribution, morphology, chronicity, and severity that may differ across ethnic and racial groups. A scoping literature review was conducted and included all studies of the clinical manifestations of adult AD in diverse populations. Promoting awareness of the heterogeneous clinical manifestations of AD may benefit the diagnosis, treatment, and characterization of eczema