Jacobs Institute of Women's Health
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The Association Between Meeting Physical Activity Guidelines and Anxiety Following the COVID-19 Pandemic; NHIS, 2020 and 2022
Get PDFSummary of the Rockwood Classification of AC Separation
No full texthttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1022/thumbnail.jp
Molecular profiling of basal cell carcinoma of the prostate: A case report and literature review
No full textProstate basal cell carcinoma (BCC) is a rare pathologic variant with a poorly understood molecular profile. Here, we describe a case of prostate BCC and compare its genetic alterations to cases in the literature. After presenting with hematuria, our patient underwent definitive radical prostatectomy for his localized biopsy-proven BCC. Somatic and germline testing revealed mutations in PIK3R1, KMT2D, and NOTCH1, and MUTYH, NBN, and MSH3, respectively. Upon literature review, we found that prostate BCC mutations disrupt cell growth, epigenetic regulation, and cell fate determination. With no consensus guidelines available, experimental targeted therapies have shown promise for prostate BCC management
Psychometric Validation of the Subject Sleep Diary in Patients with Moderate-to-Severe Atopic Dermatitis
No full textINTRODUCTION: A subject sleep diary (SSD) capturing 14 sleep parameters was developed to assess daily fluctuations in atopic dermatitis (AD)-associated sleep disturbance. This study aimed to evaluate the psychometric properties of the SSD using data including all randomized patients from the phase 3 ARCADIA 1 (NCT03985943) and ARCADIA 2 (NCT03989349) trials of nemolizumab in adults and adolescents (age ≥ 12 years) with moderate-to-severe AD. METHODS: Reliability, validity, and responsiveness of the SSD were evaluated, and its relationship with the single-item Sleep Disturbance Numerical Rating Scale (SD NRS) was examined using the equipercentile linking method. RESULTS: In ARCADIA 1 (N = 941), most SSD parameters showed good test-retest reliability (intraclass correlations ≥ 0.70) in patients with stable scores over 1 week on sleep disturbance or itch measures. The SSD parameters of wakefulness after sleep onset (WASO), total awake time (TWT), sleep efficiency (SE), number of times (NWASO-AD) and duration (WASO-AD) of AD-related WASO, and sleep quality/refresh (SQR) showed moderate or strong correlations (r = 0.30-0.66) at baseline, in the expected direction; with the SD NRS and at least one of the measures assessing itch and skin disease-related quality of life (Pruritus Categorical Scale, Peak Pruritus NRS, Average Pruritus NRS, and Dermatology Life Quality Index). Correlations with measures assessing distal concepts were weak for most sleep parameters. Sleep onset latency (SOL), WASO, TWT, SE, NWASO-AD, WASO-AD, and SQR demonstrated good known-groups validity at baseline and week 16, and showed responsiveness based on most anchors used in the analysis. Values of the same percentile rankings for the SD NRS and each SSD parameter were identified. Comparable results were obtained using ARCADIA 2 data (N = 787). CONCLUSIONS: The results provided evidence that the SSD, particularly its SOL, WASO, TWASO, TWT, SE, NWASO-AD, WASO-AD, and SQR parameters, is reliable and valid to measure multidimensional concepts of sleep disturbance in clinical studies. CLINICAL TRIAL REGISTRATION: NCT03985943, NCT03989349
Summary of Research: Comparable Efficacy and Safety of Brodalumab in Obese and Nonobese Patients with Psoriasis: Analysis of Two Randomized Controlled Trials
No full textObesity is associated with increased psoriasis severity and reduced effectiveness of psoriasis treatments. This is a summary of a research article that reports a study evaluating the efficacy and safety of brodalumab (a subcutaneous injectable therapy) in participants with and without obesity who have moderate-to-severe psoriasis. Data were analyzed from two large, phase 3 clinical trials (AMAGINE-2 and AMAGINE-3) of participants with psoriasis who were treated with brodalumab or another subcutaneous injectable therapy, ustekinumab. After brodalumab treatment for 52 weeks, participants with obesity experienced similar rates of skin clearance to those without obesity (90% improvement: 88% versus 85%; 100% improvement: 65% versus 73%, respectively). Brodalumab safety profiles were generally similar between participants with and without obesity. This study demonstrated that brodalumab is effective and safe for treating moderate-to-severe psoriasis, regardless of obesity status
SARS-Cov-2 vaccination strategies in hospitalized recovered COVID-19 patients: a randomized clinical trial (VATICO Trial)
No full textThe impact on immunogenicity and efficacy of SARS-CoV-2 vaccination in people with prior COVID-19 could differ depending on timing of vaccination and number of doses. The VATICO study randomized 66 hospitalized recovered COVID-19 individuals to receive either immediate or deferred vaccination, with one or two doses of mRNA SARS-CoV-2 vaccines. We measured binding and neutralizing antibodies against SARS-CoV-2 at enrollment and longitudinally. Median (IQR) time from SARS-CoV-2 infection to first vaccination was 68 (53-75) days in the immediate group, and 151 (137-173) days in the deferred group. At week 48, timing or number of vaccine doses did not influence the change in antibody levels relative to baseline. Adherence to the assigned vaccine regimen was lower in the deferred group, particularly in participants receiving two doses. Although the study ultimately lacked adequate power to draw firm conclusions, these results suggest possible benefits of prompt vaccination after recovery from COVID-19
Microsoft HoloLens 2 vs. tablet-based augmented reality and 3D printing for fronto-orbital reconstruction of craniosynostosis: a case study
No full textBACKGROUND: Craniosynostosis is a congenital condition characterized by the premature fusion of cranial sutures, leading to potential complications such as abnormal skull growth, increased intracranial pressure, and cognitive delays. Traditionally, open cranial vault reconstruction (OCVR) has been used to treat this condition. However, it is highly subjective and greatly dependent on the surgeon\u27s expertise, which can lead to residual deformities and the need for reoperation. Effective preoperative planning can greatly improve surgical outcomes, although the major challenge is accurately translating this plan into the clinical setting. Recently, augmented reality (AR) and 3D printing have emerged as promising technologies to facilitate this endeavor. In this work, we propose three alternatives, leveraging these technologies, to guide the precise repositioning of remodeled bone fragments in the patient. METHODS: The three guidance methods are AR on a tablet, AR with Microsoft HoloLens 2, and 3D-printed spacers. The accuracy of each method was assessed by measuring the deviation of each bone fragment from the virtual surgical plan (VSP) in a simulated environment using 3D-printed phantoms based on a 14-month-old boy with trigonocephaly. The same assessment was also performed during his actual surgery. RESULTS: All three guidance methods demonstrated similar levels of accuracy, with mean placement errors below 1 mm in all cases. The AR systems allowed for real-time adjustments, enhancing precision. Statistical analysis showed no significant differences in error rates between the different methods or attempts. CONCLUSIONS: Integrating AR and 3D printing into craniosynostosis surgery holds great potential for improving OCVR. While 3D-printed spacers are useful when digital technologies are unavailable, AR-based methods provide more comprehensive guidance. Nevertheless, our study suggests that the choice may depend more on the specific clinical context, user-specific skills, and available resources rather than on a clear superiority of one method over the others
Emergency Medical Services (EMS) Clinician Perspectives on the Pediatric Observation Priority Score (POPS)
No full textOBJECTIVES: Approximately 50% of children assessed by emergency medical services (EMS) in the United States (U.S.) have no emergent needs. The lack of validated triage tools to identify children at low risk of deterioration without transport is one reason that children have not been included in most alternative disposition programs. The Pediatric Observation Priority Score (POPS) is a triage tool incorporating vital signs and clinical observations. British prehospital studies show the POPS accurately identifies low-acuity children. The POPS has not been assessed in the U.S. Our objective was to determine whether U.S. EMS clinicians find the POPS acceptable, appropriate, and feasible. METHODS: We conducted a mixed methods study with EMS clinicians. Participants were provided with an overview of the POPS then completed a survey using the validated Acceptability, Appropriateness, and Feasibility of Implementation Measures (12 Likert-scale questions [1 = strongly disagree to 5 = strongly agree]). We calculated mean question scores. A PhD-trained facilitator conducted cognitive interviews with a subset of participants to explore their perception of the POPS. Multiple investigators coded transcripts until we reached thematic saturation. RESULTS: We recruited 100 participants (51% paramedics, 48% emergency medical technician (EMTs)) with a median (IQR) of 5 years (3, 9) clinical experience. Individual question mean scores across all domains ranged from 4.4-4.6. Paramedic and EMT responses were similar. 10 participants completed interviews and agreed the POPS was acceptable, appropriate, and feasible. Positive themes from analysis included: (1) ease of use and (2) helpful additional tool. Facilitators to implementation included (1) embedding the POPS in documentation systems (2) with a force function, (3) positive messaging, and (4) incorporating the POPS in protocols. Implementation barriers included (1) resistance to mandatory documentation, (2) undermining professional standing, (3) impaired rapport with patients, (4) uncertainty about integration with protocols, (5) and concern about legal liability. Participants suggested changes in wording and question order to improve usability. CONCLUSIONS: Prehospital clinicians in the U.S. find the POPS acceptable, appropriate, and feasible for implementation with minor modifications. Further research is needed to determine whether EMS clinicians can accurately apply the POPS in controlled and field settings before implementation
Salivary gland adenoid cystic carcinoma presenting as a large metastatic hepatic mass: a case report
No full textBACKGROUND: Salivary gland tumors are rare, representing 6-8% of head and neck tumors. Adenoid cystic carcinoma represents approximately 10% of salivary gland tumors. The preferential sites of metastases are the lung and bone, followed by the brain and liver. Liver metastasis as the initial clinical manifestation of parotid gland adenoid cystic carcinoma is very rare. CASE PRESENTATION: We report the case of a 29-year-old African American male patient with a metastatic salivary gland tumor who presented initially with a large hepatic mass. He complained of right upper quadrant pain and early satiety. Abdominal computed tomography revealed hepatomegaly with a large mass centered in the left lobe measuring 14 cm. A computed tomography scan revealed innumerable bilateral pulmonary nodules measuring up to 8 mm, favoring metastases. Initial histopathological examination of the liver biopsy specimens revealed a well-differentiated carcinoma characterized by a distinctive myxoid stroma, consistent with metastatic adenoid cystic carcinoma. The patient underwent transcatheter arterial chemoembolization and was discharged with a hematology-oncology follow-up. A presumptive diagnosis of stage IV adenoid cystic carcinoma with lung and liver metastases was made. The patient was given cisplatin and vinorelbine. CONCLUSION: Metastatic parotid gland adenoid cystic carcinoma with initial clinical manifestation as a liver mass is very rare and was pathologically confirmed in this patient by its histological appearance. This case emphasizes the need for clinicians to consider salivary gland tumors in the differential diagnosis of unexplained hepatic lesions
Reckoning with the past: a qualitative analysis of medical students describing their formative experiences with weight bias
No full textINTRODUCTION: Most healthcare providers exhibit weight bias (i.e., negative assumptions, beliefs, or discriminatory acts toward someone based on their weight/body size) in their interactions with patients with obesity. Such bias can be exacerbated in medical training and may lead to reduced healthcare utilization and worsened patient outcomes. This study explored reflections of pre-clinical medical students on formative experiences they perceived to be related to their newly identified implicit weight bias. METHOD: Seven hundred and sixteen second-year medical students completed the Weight Implicit Association Test (IAT) between April 2019-April 2022 and were instructed to write a reflective response based on their results. Of this sample, 212 students described experiences from childhood in their reflections, and these participant quotes were pulled for analysis. Inductive coding techniques were used to identify themes that were generated from medical students\u27 reflections on formative experiences using the software program Dedoose Version 8.3.35. RESULTS: The identified themes highlighted medical students\u27 own struggles with weight management and body dissatisfaction in childhood, a fear of having obesity, the prioritization of a healthy (i.e., thin) body and the stigmatization of larger bodies, and the influence of culture of origin on thin-ideal internalization. Results recognize the manifold experiences that these medical students have before entering their formalized medical training. DISCUSSION: Despite the proven negative impact on patient care caused by clinician weight bias there is a paucity of medical training programs that address weight bias. This research highlights the need for a more intentional educational curriculum to counteract the deeply rooted implicit weight bias existent in some future healthcare providers