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Travel Healthy, a mobile app for participatory surveillance among U.S. international travelers
Get PDFBackground: Global travel plays a role in the spread of infectious diseases. Existing travel surveillance programs collect data before and after trips, resulting in data incompleteness and recall bias. We developed the Travel Healthy mobile app to address these gaps, by enabling U.S. travelers to report daily symptom surveys including GPS location. The app offers traveler tools, including outbreak notices, a travel wallet, and a malaria medication reminder.
Methods: We developed Travel Healthy following a user-centric approach. We recruited study participants through an online platform and at the Travelers' Advice and Immunization Center at Massachusetts General Hospital, between July 2023 and August 2024. We analyzed demographic, GPS, and self-reported symptom data from the first 50 participants. Data were collected starting one day before the trip and ending three days after. A post-travel feedback survey was performed.
Results: Participants visited 204 locations in Asia, Africa, the Americas, and Europe. Mean age was 33 years and 66 % were female. The most common purposes of travel were leisure and/or business, with 46 (92 %) of participants listing these as traveling reasons. A total of 755 daily symptom surveys were entered, with 105 reporting symptoms, corresponding to 29 of the 50 (58 %) participants. Among all symptoms with GPS data, 58 % were upper respiratory symptoms, 25 % were gastrointestinal (clustered in South Asia), and 17 % were other. Post-travel questionnaires showed that participants found the application easy to use.
Conclusion: This pilot study underscores the potential of participatory surveillance tools to complement traditional public health surveillance methods for travel-related illness.No embarg
Disparities in Geographic Access to Cardiac Rehabilitation Among Socially Vulnerable Communities
Get PDFBackground: There is a dearth of research examining geographic disparities in access to cardiac rehabilitation (CR). We evaluated whether disparities in geographic access to CR exist among socially vulnerable communities, using the Social Vulnerability Index (SVI).
Methods: Among 3113 US counties, we investigated relationships between SVI and number of hospitals with CR per 100 000 adults, modeled with SVI as a linear variable, and SVI and distance to the nearest county with CR facilities, modeled using spline terms for SVI. We used multivariable zero-inflated negative binomial regression modeling adjusted for county population, CR eligibility, percentage without health insurance, metropolitan status, and availability of existing health care infrastructure. We explored whether these relationships changed in the context of rurality.
Results: After adjustment, as SVI increased by 1 percentile, number of hospitals with CR per 100 000 adults decreased by 1.2% (P<0.001). For distance to CR, individual spline terms were not significant in our adjusted model; however, the overall predicted distance to CR increased as SVI increased. When stratified by metropolitan status, these relationships not only persisted but also intensified in rural counties. As SVI increased by 1 percentile, the odds of a county containing a CR facility decreased by 0.9% in metropolitan counties (P=0.002) versus 2.2% in rural counties (P<0.001).
Conclusion: More socially vulnerable communities experienced worse geographic access to CR facilities. This access disparity intensified in rural communities. Our findings call for reducing barriers to CR access among socially vulnerable and rural communities, potentially through virtual or hybrid models of CR.No embarg
Super-large bore catheter in the treatment of large vessel occlusions: initial multicenter experience
No full textPurpose: Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs).
Objective: To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available.
Methods: A multicenter observational study was conducted across 12 comprehensive stroke centers in the United States. Efficacy outcomes included the first pass effect (FPE) and successful reperfusion. FPE was defined as a first MT pass achieving a modified Treatment in Cerebral Infarction (mTICI) score of ≥2c. Successful reperfusion was defined as final mTICI score ≥2c. Safety outcomes involved device-related complications, symptomatic intracranial hemorrhage (sICH), and inpatient mortality. Functional outcomes included modified Rankin Scale (mRS) score at discharge and delta National Institutes of Health Stroke Scale (NIHSS) score.
Results: Fifty patients were included. The most common LVO was the first segment of the middle cerebral artery in 31/50 cases (62%). The C-92 reached the thrombus in 41 patients (82%). Median puncture-to-thrombus and puncture-to-reperfusion times were 15 min (IQR 10-25) and 26 min (IQR 15-49), respectively. FPE was achieved in 25/50 (50%) cases, and in 25/41 (61%) cases when the C-92 reached the thrombus. Successful reperfusion occurred in 36/41 patients (88%). There were no vessel perforations, or sICH. Distal embolization occurred in 4/50 (8%) cases, and 4/50 (8%) died. The mRS score at discharge was 3 (IQR 2-6), and the delta NIHSS score was 8 (IQR 5-12).
Conclusion: The C-92 catheter demonstrated a safe profile achieving an overall FPE rate of 50%, and favorable functional outcomes in 88% of cases.Purpose: Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs).
Objective: To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available.
Methods: A multicenter observational study was conducted across 12 comprehensive stroke centers in the United States. Efficacy outcomes included the first pass effect (FPE) and successful reperfusion. FPE was defined as a first MT pass achieving a modified Treatment in Cerebral Infarction (mTICI) score of ≥2c. Successful reperfusion was defined as final mTICI score ≥2c. Safety outcomes involved device-related complications, symptomatic intracranial hemorrhage (sICH), and inpatient mortality. Functional outcomes included modified Rankin Scale (mRS) score at discharge and delta National Institutes of Health Stroke Scale (NIHSS) score.
Results: Fifty patients were included. The most common LVO was the first segment of the middle cerebral artery in 31/50 cases (62%). The C-92 reached the thrombus in 41 patients (82%). Median puncture-to-thrombus and puncture-to-reperfusion times were 15 min (IQR 10-25) and 26 min (IQR 15-49), respectively. FPE was achieved in 25/50 (50%) cases, and in 25/41 (61%) cases when the C-92 reached the thrombus. Successful reperfusion occurred in 36/41 patients (88%). There were no vessel perforations, or sICH. Distal embolization occurred in 4/50 (8%) cases, and 4/50 (8%) died. The mRS score at discharge was 3 (IQR 2-6), and the delta NIHSS score was 8 (IQR 5-12).
Conclusion: The C-92 catheter demonstrated a safe profile achieving an overall FPE rate of 50%, and favorable functional outcomes in 88% of cases.No embarg
Minimal clinical impact of embolization to new territory on outcomes in medium vessel occlusion strokes treated with mechanical thrombectomy: a retrospective multicenter study
No full textBackground: Mechanical thrombectomy (MT) is established as an effective treatment for large vessel occlusion strokes, but its efficacy and safety for medium vessel occlusions (MeVOs) remain less clear. This study examines the impact of periprocedural embolization to a new vascular territory (ENT) on clinical outcomes in patients with MeVO stroke treated with MT.
Methods: A multicenter, retrospective analysis was conducted using the MAD-MT (Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy) registry, including 2122 patients with MeVO stroke w-ho underwent MT between September 2017 and July 2023. ENT was defined as filling defects in previously unaffected territories, excluding embolization near the original occlusion, observed on final angiographic runs after retrieval of the primary thrombus. The associations between ENT, procedural variables, and 90-day clinical outcomes were evaluated, including functional independence (modified Rankin Scale (mRS) scores of 0-2), excellent outcomes (mRS 0-1), mortality, and hemorrhagic complications.
Results: ENT occurred in 2.9% (63/2122) of patients. Longer onset-to-arterial puncture time (adjusted OR 1.03; 95% CI 1.01 to 1.05; P=0.002) and a greater number of passes (adjusted OR 1.15; 95% CI 1.01 to 1.32; P=0.032) were associated with increased ENT risk, while excellent recanalization (thrombolysis in cerebral infarction (TICI) scale score 2c-3) was associated with reduced ENT risk (adjusted OR 0.41; 95% CI 0.23 to 0.72; P=0.002). ENT was not associated with poorer functional independence, mortality, or hemorrhagic complications.
Conclusions: ENT during MT for MeVO stroke occurs infrequently and does not significantly affect the clinical outcomes. These findings suggest ENT risk should not deter clinicians from performing MT in patients with MeVO. Further prospective studies are needed to validate these results.No embarg
Paramagnetic rim lesion formation is predicted by the initial gadolinium-enhancing lesion diameter
No full textBackground: Paramagnetic rim lesions (PRLs) are a magnetic resonance imaging (MRI) marker of compartmentalized intraparenchymal inflammation.
Objectives: The primary objective was to investigate clinical, demographic, and MRI factors that may be predictive of the future formation of PRL.
Methods: This is a retrospective analysis of longitudinal data. Patients were included if they had ⩾1 gadolinium-enhancing lesion on any historical MRI and follow-up scan(s) ⩾6 months afterward on a standardized 3T MRI using the filtered phase component of a susceptibility-sensitive sequence ("SWAN"). Regression and machine-learning models were used to identify the predictive ability of demographic, clinical, immunological, treatment-related, and MRI predictors of PRL formation.
Results: A total of 64 patients having 229 contrast-enhancing lesions (CELs) were included. Among all predictors, the diameter of the initial enhancing lesion was the most influential for determining subsequent PRL formation; every millimeter increase in diameter increased the risk of PRL formation by 44%. Other factors did not contribute additional information; the administration of steroids was not associated with any effect.
Conclusions: The long-axis diameter of a CEL is the best translational predictor of subsequent PRL formation at follow-up. This measure holds promise as a method to identify patients at high risk of chronic active lesion formation during the acute inflammatory window.No embarg
Association between Health-Related Social Needs and Telehealth Use Among Adults with Type 2 Diabetes: The 2022 Health Information National Trends Survey
No full textBackground:
Digital health can improve outcomes for adults with type 2 diabetes (T2D).Use of digital health tools, however, varies considerably across different patient populations. How health related social needs (HRSN) impact digital health use among adults with T2D is largely unknown.
Methods:
Data from the 2022 Health Information National Trends Survey were analyzed to investigate the association between HRSN and digital health use among American adults with T2D. HRSN variables of interest included self-reports of food insecurity, housing instability, and transportation challenges. Primary outcomes of digital health use included self-reported use of telehealth and patient portals during the previous year. Multivariate logistic regression analysis was used to estimate the association between HRSN and digital health use while controlling for age, sex, and race.
Results:
Among 1,304 adults with T2D (mean age 62.4 years, 56.4% women), 18.2% reported food insecurity, 12.6% housing instability, and 15.4% transportation challenges. In this study population, 47.8% reported telehealth use, and 56.1% reported portal use in the past year. Food insecurity was associated with increased telehealth use (OR 1.91, 95% CI 1.12–3.27) as were , individuals with housing and transportation challenges more likely to use telehealth. While individuals with T2D with all three HRSN were less likely to use the patient portal, none of these associations reached statistical significance after adjusting for age, sex, and race.
Conclusion:
In this study of U.S. adults with T2D, differential relationships between HRSN and digital health use were observed. The higher telehealth utilization among individuals with health-related social needs may suggest that it is more of an essential digital health tool than the patient portal is for persons who experience HRSN.Master of Science in Clinical Investigation2 years6/17/202
Predicting survival in atrial fibrillation: results from SAGE-AF
Get PDFBackground: Using Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) data, determine how well the rich mix of demographic, clinical history, geriatric assessments, and clinically adjudicated events can predict two-year survival.
Methods: Subjects were recruited from participating outpatient practices if they had non-valvular AF, were 65 or over with CHA2DS2-VASc scores of at least 2, and were candidates for anticoagulation. Demographics, clinical history, and geriatric qualities of life were assessed by interview and medical records review using standardized protocols and repeated at one and two years. Events identified were abstracted and submitted for adjudication using standard definitions of events and categories. Non-mortality event categories included hospitalizations (cardiovascular, bleeding, other), bleeding (major, clinically relevant non-major, minor), and seven major adverse cardiovascular events.
Results: The 1245 subjects experienced 1960 events, primarily hospitalizations (935) and/or bleeding (817); 114 subjects (9.2%) died during two years of follow-up. Events initially abstracted to more than one category (172) were combined, resulting in 1788 unique incidents. Most subjects had zero or one event (69%) and fewer than 7% had more than 3 types. Most variables were significant in bivariate analysis. Using multiple logistic regression with two-year survival as the outcome variable, the best-fit model included event number and type, number of unique incidents, and number of bleeding events (R2 = 0.511, C = 93.1) with sensitivity = 97.9% and specificity = 44.7%.
Conclusions: Two-year survival was high. This model, if validated, could have major implications for treatment of patients with AF. Patients in the large group with no or one event are at very low risk of death (under 2%). The small group with high risk for further complications, including death, deserve reassessment to determine if this trajectory can be altered.No embarg
Pediatric Primary Care Physicians' Perceptions of, and Processes for, Pediatric Blood Pressure Screening, Follow-Up, and Hypertension Management
No full textBackground/Objectives: Pediatric hypertension is an important and impactful condition. The 2017 American Academy of Pediatrics clinical practice guidelines provide recommendations for identifying and managing this condition within primary care. However, the perspectives and self-described practices of physicians are largely absent in the current evidence base. We aim to fill this gap through our qualitative investigation of physicians' perceptions and practices related to the screening, follow-up, and management of primary pediatric hypertension. Methods: We conducted semi-structured interviews with pediatric and family medicine physicians from the largest healthcare system in central Massachusetts. The interviews explored physicians' perceptions, and practices related specifically to pediatric blood pressure screening, follow-up for high blood pressures, and management of primary hypertension. We used rapid qualitative analysis to synthesize data into the resulting themes. Results: Eleven interviews were conducted. Resulting themes included: (1) physicians are generally concerned about pediatric hypertension and familiar with guidelines, but other concerns often take precedence, (2) blood pressure screening occurs mainly during yearly well visits, (3) physicians do not trust high blood pressure readings, (4) follow-up after high blood pressure readings varies, and (5) primary care physicians typically refer to specialists for hypertension management. Conclusions: This study expands current literature by providing salient context to the state of pediatric blood pressure screening, follow-up, and primary hypertension management after the 2017 guidelines among primary care physicians affiliated with an academic medical center. Our findings related to physicians' trust in electronic health record flags and the utility of follow-up by school nurses warrant further investigation.No embarg
Physical activity and quality of life among breast cancer survivors: Pink SWAN
Get PDFPurpose: To describe physical activity (PA) trajectories across 10 years post-breast cancer diagnosis and examine their association with quality of life (QoL).
Methods: Participants from the longitudinal Study of Women's Health Across the Nation who developed incident breast cancer completed the Quality of Life in Adult Cancer Survivors scale (QLACS) which has 12 domains. Breast cancer survivors (BCS) with at least one post-diagnosis measure of the Kaiser Physical Activity Survey (PA) were included (n = 96). We estimated metabolic equivalents of task minutes per week (MET-min/week) for the two most frequent sport/exercise activities. Group-based trajectory modeling determined PA trajectories over 10 years post-diagnosis. Analysis of covariance assessed associations between PA trajectory group and the three QLACS domains with the worst scores (fatigue, pain, and recurrence-related distress), adjusted for PA and other relevant covariates.
Results: There were four post-diagnosis PA trajectories: consistently very low/no PA ("inactive," 11.5%); consistently some, but below aerobic PA guideline ("below guideline," 48.9%); generally met aerobic PA guideline with a slight decline ("met guideline," 22.2%); and exceeded aerobic PA guideline ("exceeded guideline," 18.8%). In adjusted models, the below guideline group reported more fatigue than the met or exceeded groups and more pain than the met guideline group, but there were no group differences in recurrence-related distress.
Conclusion: The majority of BCS did not meet the aerobic PA guideline over 10 years post diagnosis. BCS who met the aerobic PA guideline reported less fatigue and pain compared to those who did not meet the guideline in adjusted analyses, suggesting a negative association between PA and QoL.No embarg
Somatic function of the Argonaute protein Aubergine is essential for neuromuscular development and function in Drosophila [preprint]
No full textThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Background: The PIWI-interacting RNA (piRNA) pathway is the primary defense against the deleterious activity of transposable elements (TEs), a role classically assigned to the germline. We recently discovered that the retrotransposon Copia is a negative regulator of synaptogenesis at the Drosophila larval neuromuscular junction (LNMJ) [1]. Here, we investigated whether the piRNA pathway regulates Copia in this somatic context.
Methods: Analysis of existing sequencing data revealed the expression of piRNA pathway components in somatic tissues [2]. We focused on Aubergine ( aub ), a core PIWI-clade Argonaute. We utilized CRISPR generated aub reporter lines and confocal microscopy to confirm the enrichment of AUB at the LNMJ and next generation sequencing coupled with digital PCR to validate the upregulation of TEs in aub knockdown larvae and adult tissues.
Results: Data from genetic reporters and antibody staining show that AUB is expressed and localized to the LNMJ. Tissue-specific knockdown of aub at the LNMJ resulted in increased TE expression, including Copia . In contrast to the synaptic overgrowth seen with Copia depletion [1], aub reduction caused a decrease in synapse number and impaired motor function and lifespan. These phenotypes are consistent with the upregulation of Copia , a negative regulator of synapse growth.
Conclusions: Our findings demonstrate that AUB functions somatically at the LNMJ to repress TEs, thereby ensuring proper neuromuscular development and function. This work establishes a physiological role for the piRNA pathway in a somatic tissue, linking TE repression to neuromuscular development.No embarg