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Addressing Adverse Childhood Experiences in Granville and Vance Counties Through the Use of School-Based Interventions
Full text linkGranville and Vance Counties in North Carolina face significant challenges related to food insecurity, economic stability, and the mental health of the youth within these communities. In Vance County, 17.8% of children experience food insecurity, exceeding the state average of 14.9%, while unemployment rates in Granville (5.6%) and Vance (7.5%) surpass the state average of 4.5% (NCIPH, 2023). Additionally, 25% of students report symptoms of anxiety and depression, which highlights the urgent need for early intervention (2021).
Limitations in policy and funding impact efforts to reduce Adverse Childhood Experiences (ACEs), emphasizing the need for advocacy to enhance mental health support and improve resource allocation. Research indicates that students suspended between the grades 7-12 have an increased risk of incarceration by the age of 26 (Hemez et al., 2021). This emphasizes the importance of school-based interventions and data-driven policies. By fostering partnerships and implementing CQI, this initiative aims to enhance long-term health outcomes by disrupting cycles of trauma and strengthening resilience with the communities of Granville and Vance Counties.
The project implements a data-based coordinated strategy with community partnership, with policy advocacy and continuous quality improvement (CQI) to decrease ACEs effects while enhancing mental well-being. The initiative focuses on early intervention combined with specific support services and inclusive program design to construct resilience while decreasing disparities and enhancing long-term health results. The approach focuses on creating lasting systems changes and sustainable infrastructure to tackle structural inequities, which will produce better health outcomes for children and families in these rural counties.Master of Public Healt
Injectable Tumoricidal Neural Stem Cell-Laden Hydrogel for Treatment of Glioblastoma Multiforme—An In Vivo Safety, Persistence, and Efficacy Study
Full text linkBackground/Objectives: Glioblastoma multiforme (GBM) is the most common high-grade primary brain cancer in adults. Despite efforts to advance treatment, GBM remains treatment resistant and inevitably progresses after first-line therapy. Induced neural stem cell (iNSC) therapy is a promising, personalized cell therapy approach that has been explored to circumvent challenges associated with the current GBM treatment. Methods: Herein, we developed a chitosan-based (CS) injectable, biodegradable, in situ forming thermo-responsive hydrogel as a cell delivery vehicle for the treatment of GBM. Tumoricidal neural stem cells were encapsulated in the injectable CS hydrogel as stem cell therapy for treatment of post-surgical GBM. In this report, we investigated the safety of the injectable CS hydrogel in an immune-competent mouse model. Furthermore, we evaluated the persistence and efficacy of iNSC-laden CS hydrogels in a post-surgical GBM mouse model. Results: The injectable CS hydrogel was well tolerated in mice with no signs of chronic local inflammation. Induced neural stem cells (iNSCs) persisted in the CS hydrogels for over 196 days in comparison to 21 days for iNSCs (cell injection) only. GBM recurrence was significantly slower in mice treated with iNSC-laden CS hydrogels with a 50% increase in overall median survival in comparison to iNSCs (cell injection) only. Conclusions: Collectively, we demonstrated the ability to encapsulate, retain, and deliver iNSCs in an injectable CS hydrogel that is well tolerated with better survival rates than iNSCs alone
Pembrolizumab and axitinib induced pathological complete response in metastatic clear cell renal cell carcinoma with inferior vena cava thrombus: A case report
Full text linkClear cell renal cell carcinoma is the predominant subtype of kidney cancer. With distant metastasis, the overall survival rate for patients with renal cell carcinoma decreases significantly compared to localized disease. However, pembrolizumab plus axitinib combination is safe and improves long-term survival. Herein, we report a case of a pathological complete response from systemic pembrolizumab plus axitinib therapy in a 57-year-old male with locally advanced renal cell carcinoma with extensive kidney, inferior vena cava, and hepatic invasion, as well as metastatic disease to the retroperitoneal lymph nodes and lung. After 2-years of systemic treatment, there was absent radiographic evidence of renal cell carcinoma in the lung. The patient underwent right radical nephrectomy, adrenalectomy, partial hepatectomy, and inferior vena cava ligation. Pathology indicated no evidence of tumor consistent with a pathological complete response. This case highlights the possibility of a pathological complete response with pembrolizumab plus axitinib in metastatic renal cell carcinoma and potential disparate findings between radiological response and pathological response
Automated tools for systematic review screening methods: an application of machine learning for sexual orientation and gender identity measurement in health research
Full text linkObjective: Sexual and gender minority (SGM) populations experience health disparities compared to heterosexual and cisgender populations. The development of accurate, comprehensive sexual orientation and gender identity (SOGI) measures is fundamental to quantify and address SGM disparities, which first requires identifying SOGI-related research. As part of a larger project reviewing and synthesizing how SOGI has been assessed within the health literature, we provide an example of the application of automated tools for systematic reviews to the area of SOGI measurement. Methods: In collaboration with research librarians, a three-phase approach was used to prioritize screening for a set of 11,441 SOGI measurement studies published since 2012. In Phase 1, search results were stratified into two groups (title with vs. without measurement-related terms); titles with measurement-related terms were manually screened. In Phase 2, supervised clustering using DoCTER software was used to sort the remaining studies based on relevance. In Phase 3, supervised machine learning using DoCTER was used to further identify which studies deemed low relevance in Phase 2 should be prioritized for manual screening. Results: 1,607 studies were identified in Phase 1. Across Phases 2 and 3, the research team excluded 5,056 of the remaining 9,834 studies using DoCTER. In manual review, the percentage of relevant studies in results screened manually was low, ranging from 0.1 to 7.8 percent. Conclusions: Automated tools used in collaboration with research librarians have the potential to save hundreds of hours of human labor in large-scale systematic reviews of SGM health research
Suicide Risk Estimation in Bipolar Disorder Using N200 and P300 Event-related Potentials and Machine Learning: A Pilot Study
Full text linkBackground Individuals with bipolar disorder (BD) face an elevated suicide risk. While machine learning (ML) has been used for risk estimation in BD, early predictors like demographics, past attempts, and self-reports are limited by their inability to provide individualized risk estimation, overemphasis on past attempters, and susceptibility to personal biases, underscoring the need for effective, objective markers. Event-related potentials (ERPs), widely studied in suicide research, remain unexplored in ML applications for BD. This pilot study applies ML to N200 and P300 components from a response inhibition paradigm to estimate suicide risk in BD. Methods We collected N200 and P300 peak amplitude and latency data from 57 Type I BD individuals (22 attempters and 35 non-attempters). Our two-stage ML approach employed adaptive Lasso logistic regression for feature selection, followed by deep feedforward neural network (DNN) modeling for classification. For post-hoc analysis, we used explainable AI to interpret ERP feature importance in top-performing DNN predictions. Results Key features were exclusively identified from latency data. Notably, N200 latency DNN models effectively distinguished attempters from non-attempters, achieving AUCs of 78.2%– 89.3%. For these models, explainable AI pinpointed a right visual hemifield Go stimuli-induced ERP from the left-parietal region as the most predictive. Conclusion Our ERP-ML approach showed promising preliminary results, with N200 latency identified as a potential suicide marker in BD. Larger samples are required to validate these results. While findings are sample-specific, the methodological approach may have broader applicability and could inform future research to refine clinical strategies for detecting high-risk BD individuals
Cancer misinformation misguided altruism May 2024
No full textWe examined whether social cue prompts and policies would lead to more intervening and less sharing of cancer treatment misinformation among US adults in May 2024. Participants were a convenience sample of US adults recruited through Prolific
Feasibility, Acceptability, and Outcomes of Project Rally: Pilot Study of a YMCA-Based Pickleball Program for Cancer Survivors
Full text linkBackground: Physical activity helps cancer survivors ameliorate physiological and psychosocial effects of disease and treatments. However, few cancer survivors meet physical activity recommendations, with many facing barriers such as limited interest, enjoyment, and social support. It is critical to develop enjoyable and supportive physical activity programs to improve well-being among the growing population of cancer survivors. Pickleball is increasingly popular due to its unique combination of physical activity, friendly competition, and social interaction, making it a promising strategy to increase and sustain physical activity in cancer survivorship. Objective: We examined feasibility, acceptability, and preliminary outcomes in a single-arm pilot study of Project Rally, a YMCA-based pickleball program for adult cancer survivors. Results: Twenty-one cancer survivors and seven family or friend partners enrolled in Project Rally with a targeted program duration of 3–7 months. All programming and study assessments occurred at a single YMCA with coaching and supervision from a YMCA exercise trainer and certified pickleball coach. Feasibility and acceptability were strong and met a priori targets for recruitment, retention, intervention adherence, and ratings of program aspects. Participants demonstrated significant increases in physical activity and improvements in aspects of fitness, physical functioning, and social support. Conclusion: These results will inform further development of the Project Rally program to increase physical activity and improve cancer survivorship outcomes, including efforts to expand the program’s scale and reach more survivors via community-based delivery
Women's experiences and acceptability of self-administered, home delivered, intravaginal 5-Fluorouracil cream for cervical precancer treatment in Kenya
Full text linkInnovative strategies are essential to meet the World Health Organization's 90/70/90 cervical cancer elimination targets, aiming for 90% access to precancer treatment globally by 2030. In low-and middle-income countries (LMICs) where most cervical cancer cases occur, access to precancer treatment is severely limited. Scalable solutions like self-administered topical therapies can help close this gap. In a recent Phase I trial (ClinicalTrials.gov NCT05362955), we demonstrated safety and adherence to self-administered intravaginal 5% 5-Fluorouracil (5FU) cream as an adjuvant therapy for cervical precancer among women living with HIV (WLWH) in rural Kenya. To understand women's experiences with self-administered 5FU, we evaluated the acceptability of this intervention among trial participants. All 12 participants from the Phase I trial completed a structured questionnaire and in-depth semi-structured interviews in their preferred language, focusing on their experiences with 5FU self-administration, challenges faced, and overall acceptability of the intervention, including whether they would use it again or recommend it to someone who needed it. Quantitative data were analyzed using descriptive statistics. In the qualitative study, acceptability was defined as “the perception that a given treatment is agreeable, palatable, or satisfactory.” A thematic analysis was conducted using five dimensions of acceptability: content, complexity, comfort, delivery, and credibility. The mean age was 43.9 years (SD 4.4), and seven (58%) had primary education or less. While some participants reported feelings of uncertainty when they started using 5FU, at the end of the study, all 12 participants strongly agreed that the cream was safe and were confident they used it correctly. Most participants (91.7%) experienced no discomfort with the vaginal applicator, and most reported using tampons overnight after 5FU use, as recommended. Qualitative findings revealed that favorable perceptions of self-administered 5FU were driven by its ease of use, the discrete nature of the treatment, and the comfort of home application. The main challenges included correctly measuring the study drug, finding a private place at home to self-administer, and the need to use condoms during treatment. Compared to their previous ablation or excision treatments, participants found 5FU to be less painful, and all would prefer a self-administered treatment instead of a procedure if it were an option. Self-administered intravaginal 5FU as an adjuvant treatment for cervical precancer among women living with HIV in Kenya was highly acceptable. Randomized studies of 5FU and other topical therapies in LMICs are needed to evaluate their use in closing the current precancer treatment gaps in these settings
Intrinsic Spatial Scales of River Stores and Fluxes and Their Relative Contributions to the Global Water Cycle
Full text linkThe Earth's rivers vary in size across several orders of magnitude. Yet, the relative significance of small upstream reaches compared to large downstream rivers in the global water cycle remains unclear, challenging the determination of adequate spatial resolution for observations. Here, we use monthly simulations of river stores and fluxes to investigate the intrinsic spatial scales of the global river water cycle. We frame these scale‐dependent river dynamics in terms of observational capabilities, assessing how the size of rivers that can be resolved influences our ability to capture key global hydrologic stores and fluxes. By filtering reaches by estimated river widths, we quantify the relative contribution of global river reaches by size and estimate that over 17% of global discharge to ocean and nearly 9% of the world's river storage lies within rivers smaller than 100 m—hence revealing both strengths and limitations of current observational capabilities. Plain Language Summary The world's rivers come in many different sizes, from narrow streams to wide rivers flowing to the ocean. In order to make future plans for how rivers of different sizes should be observed from space, monitored by river gages, or represented in models, we use global simulations of river flow and volume to analyze how small and large rivers contribute to Earth's water cycle. By estimating river widths at all global rivers, we assess if different strategies for observing rivers would accurately capture key river fluxes and stores worldwide. We find that the world's smallest rivers, those narrower than 100 m, contain 9% of global river storage and contribute 17% of global discharge to the ocean, highlighting the need to monitor and model small rivers. Key Points We assess how river spatial scale influences contributions to the global water cycle using long‐term river discharge simulations Rivers narrower than 100 m contribute over 17% of discharge to the global oceans and 9% of global river storage We highlight the importance of accounting for contributions from Earth's small rivers, which may be challenging to accurately observ
Prognostic and molecular multi-platform analysis of CALGB 40603 (Alliance) and public triple-negative breast cancer datasets
Full text linkTriple-negative breast cancer (TNBC) is an aggressive and heterogeneous disease that remains challenging to target with traditional therapies and to predict risk. We provide a comprehensive characterization of 238 stage II-III TNBC tumors with paired RNA and DNA sequencing data from the CALGB 40603 (Alliance) clinical trial, along with 448 stage II-III TNBC tumors with paired RNA and DNA data from three additional datasets. We identify DNA mutations associated with RNA-based subtypes, specific TP53 missense mutations compatible with potential neoantigen activity, and a consistently highly altered copy number landscape. We train exploratory multi-modal elastic net models of TNBC patient overall survival to determine the added impact of DNA-based features to RNA and clinical features. We find that mutations and copy number show little to no prognostic value, while RNA expression features, including signatures of T cell and B cell activity, along with stage, improve stratification of TNBC survival risk