Jacobs Institute of Women's Health
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Early Postnatal Polymerase Chain Reaction Testing in the Identification of Perinatal Transmission of Hepatitis C Virus
No full textIn this study, a single hepatitis C virus (HCV) RNA at 2-6 months was sensitive and specific (86.7% and 95% confidence interval [CI], 62.1%-96.3% and 100% and 95% CI, 98.8%-100%, respectively) in identifying perinatal transmission of HCV. No cases of perinatal infection requiring treatment were missed
SRT-H: A hierarchical framework for autonomous surgery via language-conditioned imitation learning
No full textResearch on autonomous surgery has largely focused on simple task automation in controlled environments. However, real-world surgical applications demand dexterous manipulation over extended durations and robust generalization to the inherent variability of human tissue. These challenges remain difficult to address using existing logic-based or conventional end-to-end learning strategies. To address this gap, we propose a hierarchical framework for performing dexterous, long-horizon surgical steps. Our approach uses a high-level policy for task planning and a low-level policy for generating low-level trajectories. The high-level planner plans in language space, generating task-level or corrective instructions that guide the robot through the long-horizon steps and help recover from errors made by the low-level policy. We validated our framework through ex vivo experiments on cholecystectomy, a commonly practiced minimally invasive procedure, and conducted ablation studies to evaluate key components of the system. Our method achieves a 100% success rate across eight different ex vivo gallbladders, operating fully autonomously without human intervention. The hierarchical approach improved the policy\u27s ability to recover from suboptimal states that are inevitable in the highly dynamic environment of realistic surgical applications. This work demonstrates step-level autonomy in a surgical procedure, marking a milestone toward clinical deployment of autonomous surgical systems
Scholarly Success of Orthopaedic Surgeons Participating in Traveling Fellowships
No full textBACKGROUND: Orthopaedic traveling fellowship programs provide surgeons with valuable opportunities for professional growth and specialized learning. However, there has been limited research on the impact of such programs on scholarly success and career advancement. The aim of this study was to evaluate the demographic, academic, and scholarly outcomes of traveling fellowship participants. METHODS: This study was a retrospective analysis of orthopaedic surgeons who participated in a traveling fellowship program from 1989 to 2024. Demographic and academic characteristics were collected for each traveling fellowship recipient, including residency program attended, fellowship specialty, fellowship institution, academic rank, current practice environment, and leadership roles. The Scopus database was used to determine individual H-indices and number of publications. Other characteristics included board position in a major orthopaedic society, National Institutes of Health (NIH) research funding, Orthopaedic Research and Education Foundation (OREF) grant recipient, advanced degrees, and editorial board position in an orthopaedic journal. Descriptive and regression statistics were used for the study. RESULTS: Of the 558 physicians who participated in an orthopaedic traveling fellowship, demographic and academic information was available for 506 of them (90.7%). Of these, the majority (96.6%) only completed 1 traveling fellowship. Predominantly, recipients were male (90.7%) and White (79.1%) and had completed a sports fellowship (33.0%). Current practicing environment was often academic (76.5%), with most holding the rank of professor (51.0%). Seventy-two participants (14.2%) had a leadership role as chair and 48 (9.5%) were division chiefs. Participants had an average H-index of 35.7 and averaged 169.9 publications. One hundred seventy-three fellowship recipients (34.2%) received an OREF grant and 67 (13.2%) received NIH research funding. Fellowship participants who received an OREF grant or NIH funding were more likely to have a higher faculty rank, higher H-index, and an increase in the number of publications (p \u3c 0.001 for all). CONCLUSION: The lessons, skills, and knowledge from traveling fellowships appear to play an important role in shaping the academic and scholarly career of orthopaedic surgeons. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence
Suboptimal Patient-Provider Communication About Undetectable = Untransmittable and HIV Transmission Risk in Australia and the US
No full textThe Undetectable = Untransmittable (U = U) campaign aims to raise global awareness that people living with HIV whose viral load is undetectable cannot sexually transmit HIV. Healthcare providers are uniquely positioned to disseminate the U = U message. Our study explored patient-provider communication about U = U and HIV risk from the perspectives of gay, bisexual, and other men living with HIV (MLHIV) and healthcare providers engaged in HIV treatment and prevention service delivery. We conducted 40 semi-structured interviews with key informants recruited through HIV community-based and professional organizations in Australia (n = 20) and the US (n = 20). Key informants included 20 MLHIV and 20 providers. Data were analyzed thematically. MLHIV were cisgender men aged 29-67 years (M[SD] = 52[13.1]). Providers were cisgender adults aged 30-65 years (M[SD] = 38[9.0]). MLHIV preferred that providers use clear and direct language to explain U = U. When prompted to explain U = U as they would to patients, 8 of 10 Australian and 4 of 10 US providers used language consistent with those preferences. MLHIV, especially US MLHIV, reported that their providers\u27 explanation of the U = U message was often absent, ambiguous, or inaccurate in practice. Such suboptimal communication aligned with the skepticism about U = U and concerns about patient behavior (e.g., adherence) expressed by several providers in the study. Providers relayed multiple reservations regarding new World Health Organization recommendations about informing patients that low-level viremia (detectable viral load ≥ copies/mL) conferred almost zero risk. Many Australian and US providers would benefit from training developed in collaboration with people living with HIV to improve patient-provider communication about U = U and HIV transmission risk
Variation in Acute Pain Management of Youth with Non-Fatal Firearm Injuries
No full textOBJECTIVE: Firearm injuries are a leading cause of morbidity among youth, yet acute pain management practices have not been well characterized. Our objective was to evaluate acute pain medication administration by key sociodemographic characteristics and injury severity after non-fatal firearm injuries. METHODS: We performed a retrospective cross-sectional analysis utilizing Pediatric Health Information System at 40 US children\u27s hospitals from 2016-2021. We included inpatient and ED only encounters for patients 0-21 years old with a firearm injury diagnosis. The main outcome was administration of analgesic medications: none, non-opioid only, or at least one opioid. We included sociodemographic and injury severity score. Multivariable logistic regression was utilized to determine characteristics associated with the outcome. RESULTS: We included 4,924 patients with non-fatal firearm injuries. By ED discharge vs. admission, 39.0% vs. 3.5% received no analgesia. For the 2,522 patients discharged from the ED, younger children were more likely to receive no analgesia. Non-Hispanic White and Hispanic patients were more likely to receive no analgesia compared to non-Hispanic Black patients (aOR 1.67 [95% CI 1.31, 2.31]; aOR 1.53 [1.18, 1.98], respectively). Receipt of opioids was lower among 5-9-year-old patients (aOR 0.40 [0.29, 0.54]), females (aOR 0.77 [0.62, 0.97]), and non-Hispanic White (aOR 0.59 [0.62, 0.75) and Hispanic patients (aOR 0.52 [0.40, 0.67]). CONCLUSION: Among youth with non-fatal firearm injuries, analgesia administration varied greatest in the ED discharged population. This suggests a need for further investigation into pain management practices focused on differences and potential undertreatment of pain in youth with non-fatal firearm injury
Bridge to Stability: A Recovery and Employment Program for Homeless Individuals in Washington D.C.
No full textIn Washington, D.C. the total number of homeless individuals in 2024 was 5,616 people (Homelessness in D.C., n.d.). Amongst this population, substance misuse is 1.5% higher in homeless populations versus low-income peoples with housing (Mosel, 2025). This increased vulnerability to substance use disorder (SUD) significantly contributes to a cycle of relapsing, unemployment, and housing instability. Our program, Bridge to Stability, works to address two interconnected challenges: substance use disorder and chronic homelessness. By combining shelter, rapid access to treatment, peer mentorship, and job training, this intervention creates a structured and inclusive bridge to long-term recovery for homeless populations experiencing SUD. This program is held at The Aston, which is a former GW dormitory that was converted into a homeless shelter in 2024. Our target population is homeless individuals living in Ward 2 that are experiencing SUD. The Aston has an existing program, known as The Friendship Place. However, this program does not extensively address treatment and services for SUD. Through our program, all residents at The Aston will be screened to assess for current SUD. Participants will then engage in peer-led mentorship and assertive community therapy to build trust and support recovery. Job training lectures will be taught by GW Professors, and peer mentorship groups will be used to inspire individuals. Through partnerships with organizations such as Whitman-Walker and DC Central Kitchen, this program empowers participants to take care of their health, build workforce skills, and transition towards long-term independence. Our intervention is grounded by the Social Ecological Model, which aims to understand the interconnectedness of human health behaviors by breaking down multiple social levels, including individual, interpersonal, organizational, community, and policy. The overall goal of our program is to create a healthy and informative environment that helps get people back on their feet.https://hsrc.himmelfarb.gwu.edu/dchapp/1027/thumbnail.jp
Organ Failure, Endotoxin Activity, and Mortality in Septic Shock
No full textIMPORTANCE: The relationship between endotoxin activity, organ failure, and mortality is not well understood. OBJECTIVE: To test whether the combination of endotoxin activity and organ failure identifies patients at higher risk of death from sepsis and determine the relationship to previously described sepsis phenotypes. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational study in four ICUs enrolling critically ill patients with septic shock. MAIN OUTCOMES AND MEASURES: Endotoxin activity assay (EAA) results, Sequential Organ Failure Assessment (SOFA), and multiple organ dysfunction (MODS) and 28-day mortality. RESULTS: We enrolled 90 patients aged 25-95 years and set an EAA cutoff of greater than or equal to 0.6 together with SOFA greater than 11 or MODS greater than 9 to define endotoxic septic shock (ESS). At baseline mean EAA was 0.64 (sd = 0.19), whereas mean SOFA and MODS were 10.3 (sd 3.2) and 5.8 (sd 3.1), respectively. EAA greater than or equal to 0.6 and SOFA greater than 11 were present in 20 patients (23.3%) and these patients had 60% mortality. EAA greater than or equal to 0.6 and SOFA less than or equal to 11 occurred in 31 (36.0%) with mortality 12.9%. Of the 35 remaining patients with EAA less than 0.6, 29 (33.7%) had SOFA less than or equal to 11 and 5 of them (17.2%) died. Only six patients (7.0%) had EAA less than 0.6 and SOFA greater than 11 and none died (p \u3c 0.001). All patients with MODS greater than 9 also had EAA greater than or equal to 0.6 (12 patients) with 75% mortality. EAA greater than or equal to 0.6 with MODS less than or equal to 9 occurred in 39 patients with 17.9% mortality (p \u3c 0.001). ESS (EAA ≥ 0.6 together with SOFA \u3e 11 or MODS \u3e 9) occurred in 21 patients and they had significantly higher mortality (57.1% vs. 15.9%, p \u3c 0.001) compared with non-ESS, with a relative risk for death of 3.58 (95% CI, 1.86-6.91). Among ESS patients, 7 (33.3%) had δ phenotype, whereas only 4 (5.8%) had δ among non-ESS (p = 0.001). CONCLUSIONS AND RELEVANCE: ESS compromises patients with the highest mortality rate from sepsis. Such patients are most appropriate for trials testing anti-endotoxin therapy for improving survival
Longitudinal Metabolic Trajectories in Diabetes Prevention Program Participants Reveal Subgroups With Varying Micro- and Macrovascular Complication Risks
No full textOBJECTIVE: Type 2 diabetes (T2D) and its associated complications develop heterogeneously over decades, but few studies span the progression from prediabetes to clinical events. We investigated whether long-term metabolic trajectories beginning in prediabetes delineate subgroups with differential complication risk. RESEARCH DESIGN AND METHODS: Clinical data from 1,732 Diabetes Prevention Program/Outcomes Study participants (follow-up 19 years) were analyzed across 12 phenotypes. Tensor decomposition was used to capture longitudinal patterns, and Gaussian mixture modeling to define longitudinal clusters. Cluster-specific complications were quantified with Cox and logistic regression. RESULTS: Four clusters emerged. Clusters 1 and 2 (73% of participants) maintained stable glycemia, blood pressure, and lipids. Although 49% and 71% developed T2D respectively, cumulative micro- and macrovascular events remained low. Cluster 3 (12%) showed the steepest rise in insulin resistance and hyperglycemia, with 92% of the subgroup progressing to T2D and a markedly higher rate of retinopathy (odds ratio [OR] 8.8, 95% CI 3.9-20.1) and neuropathy (OR 3.4, 95% CI 2.1-5.5). Cluster 4 (15%) presented with baseline microalbuminuria often prior to the development of T2D (73%). It was distinguished by progressive estimated glomerular filtration rate decline and a doubling of cardiovascular events (hazard ratio 2.0, 95% CI 1.4-3.0), despite serum lipids comparable with other groups. CONCLUSIONS: Two-thirds of individuals with prediabetes follow metabolically resilient trajectories, whereas distinct insulin-resistant or renal-dysfunction trajectories precede micro- or macrovascular complications, respectively. The optimal window for macrovascular complication prevention in individuals with prediabetes microalbuminuria may precede progression to T2D