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Protective Factors and Strength-Based Services: Impacts on Long-Term Youth Reoffending
Get PDFThe Youth Protective Factors Study is an unprecedented, multistate, multiyear examination of which risk and protective factors are most significant when it comes to reoffending—especially for more serious offenses—among youth ages 10 to 23 in the juvenile justice system. This brief is the second in a series that shares key findings from the study to inform juvenile justice supervision, case planning, and service strategies aimed at improving public safety and youth outcomes.
Decades of research have shown that addressing the dynamic risk factors underlying youth delinquency, such as negative peer influences, attitudes that support crime, and inadequate supervision at home, is crucial for reducing recidivism. Over the last decade, some practitioners have expressed concerns about the potential limitations of such “deficit”-based approaches and have become interested in whether focusing on youths’ strengths could yield equal, if not greater, benefits for improving their outcomes. Despite this interest, little is known about the impact of positive youth development, strength-enhancing, and asset-based approaches on youth reoffending. The Youth Protective Factors Study addresses this gap by examining protective factors and strength-based services for youth in the justice system in selected counties across three states.
Read the first brief, Youth Reoffending: Prevalence and Predictive Risk Factors in Two States, here : https://doi.org/10.13028/219x-vs03This grant was funded by the National Institute of Justice #2020-JF-FS-0005. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.No embarg
Systematic Review of Interventions in Early Pregnancy Among Pregnant Individuals at Risk for Hyperglycemia
Get PDFObjective: The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section).
Data sources: We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 - 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial."
Study eligibility criteria: Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English.
Study appraisal and synthesis methods: We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type.
Results: 21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes.
Conclusions: Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations.No embarg
Survival following cardiac arrest is associated with lower spontaneous echo contrast of cardiac chamber blood. A retrospective analysis of echocardiograms from a large cardiac arrest study
No full textStudy Objectives - Spontaneous echo contrast (SEC) is visible as smoke-like wisps during echocardiography and represents a pre-clotting state. Digital greyscale measurements provide an objective measure of the degree of SEC in cardiac chamber blood. We speculate that the digital greyscale prognosticates survival following out of hospital cardiac arrest. Study Design/Methods - Multi-center, retrospective review of digitally recorded echocardiographic images from patients presenting to the emergency department following OHCA. Echo images were reviewed blinded to all clinical information for the presence of SEC using adjudication. The degree of SEC was measured using a digital analysis tool to quantify the greyscale of cardiac chamber blood. Primary outcome was survival to hospital discharge and secondary outcomes included other survival endpoints. Univariate and multivariate methods were used to measure association between SEC, greyscale measurements and survival. Results/Findings - Of the 717 patients enrolled in the study, 32.2% demonstrated SEC. Survival to hospital admission was less common for patients with SEC (9.6% vs 17.4%, p=0.0065. Survival to hospital discharge was less common in patients with SEC, but the difference did not reach statistical significance. Right ventricular (RV) greyscale measurements outperformed other cardiac chamber measurements. Patients with higher RV greyscale were less likely to demonstrate ROSC (OR 0.21, 0.05-0.85, p=0.0291) and survive to hospital admission (OR 0.14, 0.02-0.14, p=0.0230). Median digital greyscale measurements of right ventricular cardiac chamber blood were lowest for patients who survived to hospital discharge (29) and increased for those who survived to hospital admission (33), demonstrated ROSC (37) or died in the ED without ROSC (45). CONCLUSION: SEC is common following cardiac arrest. Patients with higher digital greyscale measurement of right ventricular cardiac chamber blood were less likely to demonstrate ROSC or survival to hospital admission. Right ventricular greyscale measurements could be useful in prognosticating survival following cardiac arrest.No embarg
Integrating Symbolic Regression for Generalizable and Interpretable Machine Learning in Cardiovascular Risk Prediction
No full textIntroduction:
Cardiovascular disease (CVD) risk prediction is crucial for timely, targeted risk factor modification. Machine learning
(ML) is often applied to CVD risk prediction to improve diagnosis and treatment but with modest performance [1]
and limited interpretability - often requiring large datasets with a risk of overfitting. Enhancing the generalizability
and interpretability of CVD risk prediction ML models is critical for their broad adoption and clinical deployment.
We explored the integration of symbolic regression (SR) with random forests (RF) to address this challenge.
Methods:
We analyzed 518,389 patients in the UMass Memorial Clarity data lake research database. These patients had at least
one clinical encounter between Oct 1, 2017 and Nov 1, 2018, without any indication of death or CVD during that time
based on ICD-10 codes. [2] Demographic features (e.g., age, race/ethnicity) and known risk factors (e.g., diagnoses,
lab results) were extracted from the electronic health records. Pre-processing included examination of
missing/spurious data, imputation using MissForest, one-hot encoding, and aggregation of laboratory and diagnostic
features by condition and measured quantity. We developed and validated a gpu-accelerated SR-enhanced RF
(SReRF), motivated by prior work hybridizing SR with decision trees, [3] to predict 5-year CVD risk. Performance
metrics included precision, recall, F1, area under the ROC curve (AUROC), and area under the precision-recall curve
(AUPRC). We did a 75-25 split for training/testing data and tuned an RF using cross validation and grid search.
Results:
The patient cohort had a mean (SD) age of 48.6 (18.7), with 5.8% CVD events observed in the 5-year window. SReRF
yielded superior performance compared with classical RF. Specifically, classical RF had an AUROC (SD) of 0.79
(0.0027), AUPRC 0.18 (0.0027), and F1 0.27 (0.0032), compared with SReRF’s AUROC of 0.82 (0.0023), AUPRC
0.20 (0.0034), and F1 0.29 (0.0034). Here, SDs were computed using 500 bootstrapped samples of the test set. Visual
examination of PR curves indicated that the SReRF’s performance improvement was substantial for thresholds
associated with lower recall values, but modest for higher recall thresholds. Also, whereas the classical RF overfit the
training set, the SReRF had nearly identical performance on both training and test sets. The main predictors in SReRF
(higher in the decision trees) were age, HDL and LDL cholesterol, hypertension, atrial fibrillation, chronic obstructive
pulmonary disease, obesity, albumin, creatinine, and self-reported Hispanic/Latinx ethnicity.
Discussion and Conclusion:
This study demonstrates promising results of integrating symbolic regression with random forest for CVD risk
prediction. We found that SReRF outperformed classic RF. The top SReRF predictors align with known risk factors
for CVD, adding face validity and reinforcing its potential clinical utility. Further, the symbolic expressions that
determined splits produced compact and meaningful relationships between predictors, improving model
interpretability. Expressions revealed the simultaneous presence of related comorbidities (e.g., hyperlipidemia and
hypertension) and non-linear relationships between numerical predictors (e.g. age and LDL). Of note, ethnicity
(Hispanic/Latinx) among identified main predictors may reflect underlying disparities in social determinants of health
or biological risk factors. Despite recognized advantages of SR, limitations exist, including long training time,
difficulty handling missing data, and limited scalability with high-dimension features. Future models will address
these issues, include enhanced pre-processing, computational optimization, additional clinical features (e.g.
medications), and be evaluated against other contemporary ML techniques. In conclusion, SReRF represents a
promising, interpretable, and generalizable approach for CVD risk prediction, with strong potential for implementation
in clinical settings, especially those with a high demand for transparency in predictive modeling.
References
1. Soares C, Kwok M, Boucher K, et al. Performance of Cardiovascular Risk Prediction Models Among People
Living With HIV: A Systematic Review and Meta-analysis. JAMA Cardiol. 2023;8(2):139–149.
2. https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1078.90/expansion/Latest
3. Fong, Kei Sen, and Mehul Motani. 2024. “Symbolic Regression Enhanced Decision Trees for Classification
Tasks.” Proceedings of the AAAI Conference on Artificial Intelligence 38 (11): 12033–42.Research reported in this poster was supported by NHLBI of the National Institutes of Health under award number T32HL171799.No embarg
Clinical Management of Sleep Disturbances in Post-9/11 Men and Women Veterans: A 20-year Prospective Cohort Study
Get PDFIntroduction: Sleep disorders and chronic conditions that are comorbid with disordered sleep represent a high burden to the U.S. population, and Veterans have a particularly high risk for disordered sleep. Sleep disorders also present differently by sex and there is a rapidly growing proportion of women Veterans. Among the most recent Veteran cohort (i.e., discharged post-9/11), the extent of sleep disorders and how those conditions are managed is unknown. The objectives were to characterize the frequency of sleep assessment, diagnosis, and treatment among post-9/11 Veterans served by the Veterans Health Administration (VA), the timing of sleep management, and to determine if there were sex-based disparities in all sleep care.
Methods: This prospective cohort study included all post-9/11 Veterans who enrolled in VA care, and completed ≥ 1 outpatient encounter, 10/1/2001-9/30/2021. Diagnostic and procedural codes, health factors, and dates were used to extract variables for assessment (e.g., behavioral, polysomnography), diagnoses (i.e., insomnia, sleep-related breathing [SRBD], comorbid insomnia and SRBD [COMISA], sleep-related movement [SRMD], or Other disorders), treatment of insomnia or SRBD, and time to sleep assessment, diagnosis, and treatment. Logistic regressions assessed likelihood of sleep care by sex.
Results: The final sample included 1,113,633 patients (12% women, 61% White). Overall, 39% had sleep disorders - 27% with SRBD, 18% with insomnia, 8% with COMISA, 2% with SRMD, and 6% with Other. Men were more likely to have any diagnosis, especially SRBD. Women were assessed up to one year later than men and had greater odds of insomnia or SRMD. Women also had greater odds of insomnia treatment and those with SRBD were 31% less likely to receive treatment than men.
Conclusions: As managing sleep health is central to patient-centered care, concerted efforts are required to implement existing VA guidelines concerning sleep, bridging men and women Veteran's sleep needs with available resources.No embarg
Microglia-astrocyte crosstalk regulates synapse remodeling via Wnt signaling
Get PDFAstrocytes and microglia are emerging key regulators of activity-dependent synapse remodeling that engulf and remove synapses in response to changes in neural activity. Yet, the degree to which these cells communicate to coordinate this process remains an open question. Here, we use whisker removal in postnatal mice to induce activity-dependent synapse removal in the barrel cortex. We show that astrocytes do not engulf synapses in this paradigm. Instead, astrocytes reduce contact with synapses prior to microglia-mediated synapse engulfment. We further show that the reduced astrocyte-synapse contact is dependent on the release of Wnts from microglia downstream of neuron-to-microglia fractalkine ligand-receptor (CX3CL1-CX3CR1) signaling. These results demonstrate an activity-dependent mechanism by which microglia instruct astrocyte-synapse interactions, providing a permissive environment for microglia to remove synapses. We further show that this mechanism is critical to remodel synapses in a changing sensory environment and that this signaling is upregulated in several disease contexts.No embarg
Learning From the Beyond-Human Animal: Wildlife Encounters in Veterans With PTSD
No full textAnimal-assisted interventions (AAI) are a type of interaction between humans and other species with a goal of advancing human health. Native American teachings provide a lens of human relations with nature in which beyond-human animals can provide important teachings for human persons. As part of a larger study, Veterans with post-traumatic stress disorder (PTSD) were introduced to a series of nature and wildlife immersion experiences. In this paper, we report on the use of a journaling exercise in which participants were asked to identify a meaningful animal at a wildlife sanctuary and describe what they learned from that animal. Thirteen participants completed journal reflections during two separate sessions at the sanctuary for a total of 25 journal entries. Data were analyzed qualitatively yielding three themes: self-affirmation: "have more confidence in myself"; calm attentiveness within one's environment: "don't be afraid to check out new situations"; and strength and perseverance: "do not give up." The findings support Native American teachings that other species can provide guidance for humans and also extend the field of AAI through providing potential avenues for therapeutic approaches that can be evaluated with different populations.No embarg
Advancing Equitable Participation in Pediatric Clinical Trials Through Cognitive Interviewing
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Spontaneous Resolution of Follicular Lymphoma in an Elderly Caucasian Patient Undergoing Uninvolved Radiation Therapy for Recurrent Merkel Cell Carcinoma: A Case Report
Get PDFMerkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy with an annual incidence rate of less than one case per 100,000 person-years in the United States, up to 59% of which have a reported risk of loco-regional and distant metastasis. While wide local excision with sentinel lymph node biopsy is the gold standard for the initial management of localized MCC, adjuvant radiation therapy is commonly utilized as a supplemental treatment modality for these patients as well. Here we present the case of a Caucasian woman in her 90s with recurrent MCC and concurrent grade 3A follicular lymphoma who received 6700 cGy of radiation therapy over two months for her recurrent MCC, which led to complete clearance of her uninvolved-site follicular lymphoma likely via an abscopal effect. While its exact mechanism needs to be further studied, the abscopal effect is thought to be a process in which radiation therapy of a malignant proliferation leads to destruction of the same malignancy in uninvolved sites. However, to our knowledge, the resolution of uninvolved-site follicular lymphoma in response to radiation therapy of a different malignancy such as MCC is not previously reported.No embarg
Outcomes of post-exam reviews for nursing and health sciences students: An integrative review
No full textBackground: Post-exam reviews allow students to analyze their exams and receive faculty feedback on their performance. Feedback may help avoid attrition in nursing programs, which is important to address in the face of national nursing shortages and because attrition disproportionally affects students from several underrepresented groups.
Purpose: The purpose of this integrative review was to synthesize evidence about outcomes of post-exam reviews for nursing and health science students based on Knowles' (1978) theory of adult learning.
Methods: An integrative review of the literature as described by Whittemore and Knafl (2005) was undertaken. Multiple databases were searched in June 2024; ancestry searching was also used. Data were analyzed using the constant comparison method.
Results: Nine studies met inclusion criteria. Four themes emerged from the data: looking back, looking in, looking forward, and general satisfaction. Most outcomes were positive (such as increased grades), although some potentially negative outcomes (such as incivility) were identified.
Conclusions: Nursing faculty should seriously consider implementing post-exam reviews in their courses, structuring the reviews to avoid potentially negative outcomes such as incivility.No embarg