Jacobs Institute of Women's Health
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An Analysis of Risk Factors for Sensorineural Hearing Loss in Children With Sickle Cell Disease
No full textOBJECTIVES: The prevalence of sensorineural hearing loss (SNHL) is higher among children with sickle cell disease (SCD). This study aims to describe potential hematologic and other risk factors for SNHL in this population. STUDY DESIGN: Retrospective case series. SETTING: Tertiary hospital. METHODS: Using ICD codes for hearing loss and CPT codes for audiometry, we analyzed demographic, hematologic, treatment, and audiometric data in SCD patients at Children\u27s National Medical Center between 2000 and 2018. SNHL was defined as a 4-frequency bone conduction (BC) pure-tone average (PTA) ≥15 decibels. Univariate and multivariate linear regression analyses were used to study the association between changes in pure-tone average and study variables. A random intercept mixed-effects regression analysis was utilized to examine the PTA trend in patients with 3 or more audiograms. RESULTS: We identified 201 SCD patients under 18 years old with complete audiograms. Eighty-seven percent were homozygous for hemoglobin SS, of which 21.7% had unilateral and 13.4% had bilateral sensorineural hearing loss. Tobramycin (coef: 19.76, 95% CI: 10.73-28.78, P \u3c0.001) and hydroxyurea (coef: 3.75, 95% CI: 0.27-7.12, P =0.017) were significantly associated with an increased bone conduction pure-tone average (BC PTA), while the incidence of iron overload was associated with a decreased BC PTA (Coef=-7.96, 95% CI: -14.91, -1.01, P =0.012). The pure-tone average trend analysis showed a decline in bone conduction over time (-0.2, 95% CI: -0.3 to -0.07, P =0.001). However, the trend analysis predicted an increase in BC PTA for those who used hydroxyurea for \u3e5 years (0.4, 95% CI: 0.1-0.8, P =0.020) and those with a history of avascular necrosis (0.6, 95% CI: 0.3-1.0, P \u3c0.001). CONCLUSION: Children with SCD may be at high risk for SNHL. No single morbidity was associated with an increase in bone conduction PTA. Hydroxyurea use was associated with increased bone conduction PTA, while iron overload was associated with decreased bone conduction PTA. The etiology of SNHL in SCD is likely multifactorial. Routine audiometric studies are recommended for children with SCD, especially before and after starting new treatments
Vegan Diet, Greenhouse Gas Emissions, and Cumulative Energy Demand: A Secondary Analysis of a Randomized Clinical Trial
No full textRespect Relationships, Remember Roles, and Realize Reasons: Ethics Tasks Relevant to Intervention Principles
No full textExperience-dependent plasticity to visual sequences in mouse anterior cingulate cortex reflects familiarity
No full textAnterior cingulate cortex (ACC) is a prefrontal area implicated in functions including cognitive control, attention, and prediction. Mouse ACC receives input from the visual system and uses visual information to direct behavior. While extensive work has described experience-dependent plasticity in mouse V1, less is known about how ACC itself adapts to visual experience. Our previous work demonstrated that visual sequences, presented across days, can drive plasticity in the timing of visually evoked responses in mouse ACC. However, it is not known whether this plasticity ( sequence plasticity ) reflects familiarity to the first stimulus in a sequence or expectation of subsequent stimuli - a distinction that is critically important for understanding its functional significance. We recorded visually evoked responses in awake, head-fixed female and male mice trained with visual sequences across days. Visual sequences drove plasticity in ACC, expressed through a change in response timing, that reflects familiarity to the first stimulus. In addition, experience-dependent plasticity could be induced using single-orientation stimuli. Together, these findings suggest that sequence plasticity in ACC does not in fact require sequences, but rather reflects a broader phenomenon that we term stimulus-specific response plasticity in timing (SRPT). Our prior work demonstrated that ACC plasticity is impaired in a mouse model of Angelman syndrome (AS). Here, AS model mice showed abnormal responses to familiar visual stimuli in ACC, despite normal plasticity in V1. Together, this work demonstrates how mouse ACC adapts to familiar visual stimuli and describes impaired ACC function in a mouse model of a neurodevelopmental disorder. Our prior work established that familiar visual sequences can drive experience-dependent sequence plasticity in mouse anterior cingulate cortex (ACC). However, it is not known whether this plasticity reflects familiarity or expectation. Here, we show that sequence plasticity in ACC reflects familiarity, and is part of a broader phenomenon that can be driven by familiar visual stimuli other than sequences. In addition, our findings suggest impaired ACC function in a mouse model of the neurodevelopmental disorder Angelman syndrome. Overall, this work describes how mouse ACC adapts to encode familiar visual stimuli and demonstrates that this process is impaired in a mouse model of a neurodevelopmental disorder
Using WhatsApp for vaccine promotion in low- and middle-income countries: practitioner-informed perspectives
No full textZoonotic Escherichia coli and urinary tract infections in Southern California
No full textExtraintestinal pathogenic Escherichia coli (ExPEC) is the leading cause of urinary tract infections (UTIs) worldwide and may be transmitted from food animals to humans via contaminated meat. However, the contribution of zoonotic ExPEC strains to UTIs in metropolitan areas remains unclear. We estimated the proportion of UTIs attributable to zoonotic ExPEC across eight Southern California counties. Between 2017 and 2021, we collected 12,616 E. coli isolates from retail meat and 23,483 from UTI patients, sequencing a representative subset of 5,728 isolates. Using a Bayesian latent class model trained with 17 host-associated genetic markers, we inferred the host origin of each isolate. Demographic, clinical, and antimicrobial resistance profiles were compared between meat isolates and clinical isolates inferred to be of human or food-animal origin. Most UTI patients were female (88%), with a median age of 50 years; 37% were Hispanic and 31% non-Hispanic white. Zoonotic ExPEC strains accounted for 18% of UTIs overall, rising to 21.5% in high-poverty neighborhoods. Women had a higher zoonotic proportion than men (19.7% vs 8.5%, P \u3c 0.001). Among men, those with zoonotic infections were older than those with non-zoonotic infections (median 73.0 vs 65.0 years, P = 0.028). These findings underscore the contribution of zoonotic ExPEC to the UTI burden in Southern California and the need for targeted interventions to reduce risk in vulnerable communities.IMPORTANCEUrinary tract infections (UTIs) are among the most common bacterial infections worldwide and are primarily caused by Escherichia coli. While E. coli is known to colonize both humans and food-producing animals, the extent to which zoonotic strains impact human disease remains poorly understood. Emerging evidence suggests that food animals may serve as an underrecognized reservoir for extraintestinal pathogenic E. coli (ExPEC). In this study, we used a genomic attribution model to quantify the contribution of zoonotic strains to UTIs in Southern California. We found that approximately 18% of E. coli UTIs were likely attributable to food animals. Individuals living in high-poverty neighborhoods had a 1.6-fold increased risk of zoonotic UTIs compared to those in low-poverty areas. These findings highlight zoonotic transmission as an important driver of UTIs and suggest that reducing ExPEC in food-animal reservoirs could help lower disease burden and address health disparities
Lessons learned from the support of the International Atomic Energy Agency, International Agency for Research on Cancer and World Health Organization to develop National Cancer Control Plans in low- and middle-income countries
No full textBACKGROUND: The International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC) and World Health Organization (WHO) assist countries in building and strengthening their cancer control capacity. This support includes guidance to Member States to set priorities for national cancer control through the development and implementation of National Cancer Control Plans (NCCPs). Our aim was to identify the lessons learned from the support United Nations (UN) agencies provide to develop NCCPs in low- and middle-income countries (LMICs) to support the development of guidance. METHODS: We developed a questionnaire based on a review of the NCCP literature and conducted semi-structured interviews with 11 Member States that received UN agency support between 2020 and 2023 and five IAEA Programme Officers who coordinated UN support. We coded the transcripts inductively and performed a thematic analysis of the data. RESULTS: Three main themes were identified, each with their own barriers and enablers to develop NCCPs: coordination of NCCP development; method; and governance. We discuss each of these challenges and offer recommendations for Member States and UN agencies to further improve the development process of national cancer control strategies. We selected Kenya as a case study to show an example of good practice. CONCLUSION: This paper complements a sister study conducted by the International Cancer Control Partnership which assessed challenges of developing NCCPs for countries that received a different type of support. Both studies contribute to the growing body of NCCP literature following the 2025 global review of NCCPs. POLICY SUMMARY: The lessons learned from the IAEA-IARC-WHO support to develop NCCPs will inform policies, programmes and practices in cancer control planning and implementation in LMICs, as well as the development of a common methodology for UN agencies to provide NCCP support
A longitudinal mediated examination of legal, commercial, and individual determinants of cannabis and derived cannabis use behaviors and consequences among US young adults
No full textBACKGROUND: Cannabis and derived intoxicating cannabis product (DICP; e.g., delta-8 tetrahydrocannabinol [THC]) use is increasing, particularly among young adults. We examined how state cannabis and DICP laws and cannabis advertisement exposure impact cannabis/DICP risk perceptions and use motives and how those, in turn, impact cannabis and DICP behaviors (use, frequency, intentions) and consequences. METHODS: We analyzed two waves (2023-2024) of longitudinal survey data among 3,437 US young adults ages 18-34 (∼50 % past-month cannabis use by design). Multivariable regressions assessed direct and indirect associations via parallel mediation. RESULTS: Participants in states with legal (vs. illegal) non-medical cannabis had lower DICP use motives, higher odds of cannabis-only use (vs. neither or both), and used cannabis more frequently; associations with use behaviors were mediated by cannabis/DICP motives and risk perceptions. More restrictive delta-8 THC laws were associated with higher odds of cannabis-only use (vs. neither or both). More digital cannabis ad exposure and less exposure to traditional/store-based ads were associated with lower risk perceptions and higher use motives, odds of cannabis/DICP use, use intentions, and consequences; associations were mediated by cannabis/DICP use motives and/or risk perceptions. Lower cannabis/DICP risk perceptions and higher use motives were associated with higher odds of using each respective substance, co-use, and intentions. Using cannabis/DICPs more frequently was associated with experiencing more cannabis consequences; cannabis/DICP frequency mediated associations of cannabis state laws, advertising exposure, and motives with cannabis consequences. CONCLUSIONS: These pathways underscore how laws and marketing shape use, supporting interventions targeting risk perceptions and motives to reduce harm
A Geospatial Analysis of the Association between the Period Prevalence of Sarcoidosis and Environmental Toxins in Massachusetts
No full textRelationships Between Objective Laryngostroboscopic Measures and Patient Ratings With Treatment Recommendations for Patients With Presbylarynges
No full textOBJECTIVES/HYPOTHESES: To use principal component analysis (PCA), including objective laryngostroboscopic measures and patient-reported quality of life and symptom severity ratings from initial evaluations of patients with presbylarynges as an initial step toward developing a framework for streamlining specific treatment recommendations, especially for those who might benefit initially from procedural intervention (PI), as well as patient compliance with those recommendations. RESEARCH DESIGN: The design was retrospective, analytical, observational, and cross-sectional. METHODS: One hundred eighteen patients with presbylarynges evaluated by one laryngologist participated. Variables included normalized glottal gap area (NGGA), normalized true vocal fold width (NTVFW), total bowing index (Total BI) from single laryngostroboscopic images, multi-item ratings [Glottal Function Index (GFI), Voice-Related Quality of Life (V-RQOL)], single-item ratings (effort, weakness, hoarseness, swallowing, and breathing), and age. Associations between variables and treatment recommendation were assessed using bivariate tests followed by multinomial logistic regression, and between variables and compliance using bivariate tests followed by binomial logistic regression. RESULTS: V-RQOL, GFI, effort, weakness, and hoarseness significantly differed between treatment groups. More severe ratings of GFI, V-RQOL, effort, weakness, and hoarseness were associated with greater odds of either intervention being recommended over observation. More severe hoarseness ratings were associated with greater odds of recommending PIs over voice therapy (VT). Two principal components (PC1, PC2) were revealed. PC1 represented patient satisfaction with voice quality and less severe vocal symptoms. PC2 represented laryngeal impairment. Using a multivariable logistic model (PC1, PC2, and sex), lower values of PC1 and being male were associated with greater odds of being recommended for either intervention compared with observation. None of the predictors considered were significantly associated with compliance. CONCLUSIONS: This initial attempt using data from a single clinic found significant differences in patient ratings between treatment options and significant associations between variables associated with treatment recommendation. The associations were ultimately not predictive for either treatment recommendations or compliance for patients with presbylarynges