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Thematic review and illustrative videos of aggressive vertebral column hemangioma management: illustrative cases
Get PDFBACKGROUND Aggressive vertebral hemangiomas (AVHs) are benign vascular lesions that can exhibit locally invasive behavior. Because of their rarity, standardized treatment guidelines are lacking. We present 2 surgically managed cases, supplemented with intraoperative video, and conduct a thematic literature review evaluating treatment strategies.
OBSERVATIONS A 66-year-old female presented with low back pain radiating to the groin and gait instability. MRI demonstrated an L1 AVH. She underwent T12–L2 laminectomy, instrumented stabilization, and cement augmentation, followed by radiotherapy. Marked pain relief and functional improvement were reported. The second patient, a 14-year-old male, presented to his pediatrician with neck pain, hand weakness, and paresthesias. He sustained a fall at school and was brought to the emergency department with quadriparesis. Imaging revealed a C4–6 AVH with a C5 pathological fracture. Emergency C4–6 corpectomy, laminectomy, and posterior fixation were performed. Proximal upper extremity function partially recovered, but hand and lower extremity motor deficits persisted. A literature review demonstrated the importance of surgery and highlighted the roles of radiotherapy, cement augmentation, embolization, and alcohol-based injections in nonoperative and multimodal management.
LESSONS AVH management should be tailored based on location, extent of neural compression, and symptom severity. Surgical intervention remains central in cases with neurological compromise or instability. https://thejns.org/doi/10.3171/CASE2565
Relationships between upper extremity neuromuscular function and patient-reported outcomes among individuals with a history of glenohumeral labral repair
Get PDFBackground Patient-reported outcomes (PROs) are essential components of contemporary healthcare practices, which allow clinicians to effectively monitor clinical outcomes. Objectively measured neuromuscular impairments have been reported among individuals with glenohumeral labral repair, yet their relationship with PROs is unclear. Understanding those relationships would help clinicians explain clinical meaning of such impairments from a patient-oriented perspective. The objective of this study was to determine the relationships between objective metrics of upper extremity neuromuscular function and PROs in individuals with glenohumeral labral repair.
Methods 16 individuals with a history of glenohumeral labral repair (13 males/3 females, age: 24.1 ± 5.5 years, time from surgery: 36.3 ± 33.3 months) volunteered. Neuromuscular functions, characterized by shoulder abduction and wrist flexion maximal voluntary isometric contraction (MVIC) torque, Hoffmann reflex (spinal pathway), and active motor threshold (AMT, corticospinal pathway) of the upper extremity muscles, were assessed bilaterally. Pain, physical activity level, Disability of Arm, Shoulder and Hand (DASH) questionnaire, Oxford Shoulder Score (OSS), and Veteran’s Rand 12-Item Health Survey (VR-12) were used to quantify self-reported upper extremity function and global health, encompassing both mental and physical components. Bivariate correlations and multiple linear regression were used to identify the variance explained by neuromuscular outcomes in each PRO.
Results Involved limb wrist flexion MVIC torque moderately correlated with DASH (r = −.523, p = .045). AMT of middle deltoid moderately correlated with OSS (ρ = .570, p = .021). Age and current activity level explained 73.2% variance in the VR-12 physical component (adjusted R2 = .732, p < .001). Age moderately correlated with the VR-12 mental component (ρ = .550, p = .027).
Conclusions Greater involved limb wrist flexor strength, corticospinal excitability of the middle deltoid, as well as greater age and lesser activity level explained better perceived function and health. These results support the clinical relevance of muscle strength and neural function to patient recovery from glenohumeral labral repair
Design and implementation of an action plan for justice, equity, diversity, and inclusion within the Clinical Genome Resource
Get PDFHow might members of a large, multi-institutional research and resource consortium foster justice, equity, diversity, and inclusion as central to its mission, goals, governance, and culture? These four principles, often referred to as JEDI, can be aspirational—but to be operationalized, they must be supported by concrete actions, investments, and a persistent long-term commitment to the principles themselves, which often requires self-reflection and course correction. We present here the iterative design process implemented across the Clinical Genome Resource (ClinGen) that led to the development of an action plan to operationalize JEDI principles across three major domains, with specific deliverables and commitments dedicated to each. Active involvement of consortium leadership, buy-in from its members at all levels, and support from NIH program staff at pivotal stages were essential to the success of this effort. The ClinGen JEDI action plan that resulted from our process is a living document and roadmap whose target goals and deliverables will continue to evolve. Here, we offer a transparent account of how a large, multi-site biomedical research consortium achieved this, as well as the challenges and opportunities we encountered on this first step in our journey toward enacting JEDI principles in our sphere of influence. We hope that others seeking to engage in this work will gain valuable insights from our process, experience, and lessons learned
Navigating Economic Turbulence: Property Tax Reassessment Cycles as a Strategic Financial Management Tool During Recessions
Get PDFProperty taxes serve as the largest own-source revenue source for local governments in the United States. Unlike property values, which fluctuate with the economy, assessed values—the foundation of property taxes—are not routinely updated and reassessments often occur infrequently. The timing of these reassessments holds significant implications, particularly during economic fluctuations. For instance, reassessing during periods of depressed property values can result in reduced revenues, necessitating rate hikes or service cutbacks. Therefore, counties may strategically time reassessments to mitigate adverse financial effects. This study investigates whether property reassessment delays served as strategic financial management tools in North Carolina counties from 2000 to 2019. The findings indicate that counties did employ reassessment timing strategically, particularly in the periods immediately following recessions. Moreover, counties that delayed reassessments exhibited marginally higher property valuation compared to those that did not delay
Development of clinical research networks in rural America: Our experience from the Accelerating COVID-19 Therapeutic Interventions and Vaccines-1 trialau
Get PDFRural America remains deeply under-represented in clinical trials. St Lawrence Health (SLH) was the sole rural site and one of the top recruiters in the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-1 trial, which was a large international trial that studied the efficacy of three immune modulators in hospitalized patients with COVID-19. In this article, we analyze the structural and clinical factors that enabled SLH’s success in the context of previously described barriers to research participation in rural areas. We conclude with lessons learned from the SLH experience and offer a broader replicable model for developing clinical research capacity in rural areas. SLH’s success in ACTIV-1 can be attributed to early and sustained support from the ACTIV-1 network, a small and integrated inpatient COVID-19 treatment team, regular and consistent communication between this team and the clinical research team at SLH, and SLH’s ongoing support and development of its clinical research department. SLH was, in turn, able to overcome several known barriers to implementation of clinical trials at community sites, including lack of provider time and a lack of trained research and clinical staff, and its experience in ACTIV-1 offers a replicable model for developing clinical research capacity in rural communities
Correction: Multimodal contrastive learning on rs-fMRI to quantify whole-brain network recovery after hypothalamic hamartoma surgery
Get PDFCorrection to: Multimodal contrastive learning on rs-fMRI to quantify whole-brain network recovery after hypothalamic hamartoma surger
Premedical Education Experiences of First-Generation College Graduates
Get PDFFirst-generation undergraduate students are underrepresented in medicine and face challenges that affect their application and matriculation to medical school. To understand the barriers and available support at the individual, interpersonal, and organizational levels for first-generation students in premedical programs. This qualitative study was part of a larger project on professional identity formation among US medical students from low socioeconomic backgrounds with a focus on first-generation undergraduate students. Semistructured online interviews of 48 students (37 of whom were first-generation students) from 27 US medical schools were conducted from November 1, 2021, through April 30, 2022, and secondary analyses regarding their premedical experiences were performed. Interviews were recorded, transcribed, deidentified, assigned an alphanumeric code, and analyzed using an inductive thematic approach from June 1 through December 30, 2024. Participants were offered a $20 gift card in appreciation for their time. Experiences of students identifying as first-generation college students in premedical training. Main outcomes included themes and subthemes at the individual, interpersonal, and organizational levels constructed from interview data. Bronfenbrenner’s ecological systems theory was used as a guiding interpretive framework to analyze participants’ experiences within their broader social and environmental contexts. This model allowed examination of how individual perspectives were shaped by interactions across personal, social, and structural contexts. The team engaged in reflexive discussions, memos, and consensus-based refinement to identify key themes. Among 37 participants identified as first-generation students, 21 (56.8%) identified as female (mean [SD] age, 27.3 [2.8] years). One participant (2.7%) identified as American Indian or Alaska Native; 7 (18.9%) as Hispanic, Latino, or Spanish origin; 8 (21.6%) as non-Hispanic Asian or Asian American; 9 (24.3%) as non-Hispanic Black or African American; and 12 (32.4%) as non-Hispanic White. Analyses revealed key themes across all 3 levels of the ecological systems model: individual, interpersonal, and organizational. Individual themes included personal and family background, such as financial instability and lack of clinical exposure. Interpersonal themes included access to premedical advisors, faculty mentors, and peer networks. Organizational themes included limited institutional resources and pathway programs. In this qualitative study of first-generation students, financial instability, limited medical school–related social connections and resources, and unfamiliarity with academic systems were found to uniquely burden these students. By identifying and improving resources such as tailored mentorship, individualized advising, and participation in pathway programs, medical schools can help reduce structural barriers for aspiring physicians who are first-generation college students
Neighborhood evictions, household children, and preterm birth among Black birthing people
Get PDFBackground Neighborhood evictions are a key component of community-level housing instability and disproportionately impact communities of color. Increased neighborhood evictions may be associated with increased preterm birth (PTB). Previous research suggests familial distress as a potential driver of increased PTB among Black birthing parents exposed to high neighborhood eviction rates. In this study, we explore whether the association of neighborhood evictions with PTB differs depending on the presence or absence of children in the household during pregnancy. Methods We used information from 400 Black participants in the Newborn Epigenetics Study in Durham, NC. Our primary exposure, neighborhood eviction rate, was defined as the participant’s block group eviction rate during the year of last menstrual period. Preterm birth, defined as gestational age < 37 completed weeks at delivery was based on information abstracted from medical records at delivery. Using logistic regression, we estimated the change in odds of preterm birth associated with a 1 SD increase in neighborhood eviction rate. Models were adjusted for educational attainment, relationship status, participant age at delivery, and proportion of block group households below the federal poverty line. To determine whether associations between neighborhood evictions and preterm birth differ depending on household composition, we stratified the study sample by presence of children in the household during pregnancy (0, ≥ 1 children). Results Among the total sample, we observed an increase in odds of preterm birth for every 1-SD increase in neighborhood eviction rate (OR: 1.21, 95% CI: 0.83, 1.73). Association between neighborhood eviction rate and preterm birth differed by household composition. Increased neighborhood eviction rates were associated with increased odds of PTB among participants with children in the household (OR: 1.89, 95% CI: 1.09, 3.28), but not among participants without children in the household (OR: 0.85, 95% CI: 0.49, 1.39). Conclusions We found that higher neighborhood evictions increase odds of preterm birth among Black birthing parents living with children. Our findings support the prioritization of Black families and communities for interventions to prevent evictions and promote housing stability
Centering Community Engagement in a Hypertension Clinical Trial: Strategies to Engage Rural Black Patients in the Southeastern Collaboration to Improve Blood Pressure Control
Get PDFBlack Americans residing in rural communities are often excluded from clinical trials for hypertension, despite having a high prevalence of the disease and frequent complications. This report describes our research team’s experience to support recruitment and retention of rural Black patients with uncontrolled hypertension in the southeastern United States in a cluster-randomized clinical trial. While the focus of this report is on enrollment and engagement, the strategies employed were grounded in long-standing community-engaged research efforts and guided by principles of trust-building, transparency, and shared leadership. We share the challenges encountered and reflect on lessons learned to inform future approaches that authentically engage historically excluded and under-represented communities as active partners in research
Associations Between Dietary Intakes of Omega-3 Fatty Acids, Blood Levels, and Pain Interference in People with Migraine: A Path Analysis of Randomized Trial Data
Get PDFBackground/Objectives: Increasing evidence supports the hypothesis that dietary intervention can improve pain among individuals with headaches, including migraine, a highly prevalent condition that can be disabling. Non-pharmacologic treatments for migraine are particularly attractive. In this secondary analysis of 182 participants enrolled in a randomized controlled trial of a dietary intervention designed to increase omega-3 (n-3) compared with a control diet, we examined the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), both thought to decrease inflammatory processes. Methods: Path models with two time points (baseline and 16 weeks after randomization), were used to test the relationships between exposures of n-3 blood levels and self-reported dietary intake on outcomes of pain interference using the PROMIS pain interference scale and the Headache Impact Test (HIT-6). Model building was based on our published conceptual model. Results: Good fit was demonstrated for both models (EPA model: CFI = 0.984, RMSEA = 0.039, and SRMR = 0.045; DHA model: CFI = 0.981, RMSEA = 0.040, and SRMR = 0.040). Both EPA and DHA in the blood at 16 weeks were associated with lower levels of pain interference, but the effect for EPA was stronger (B = −0.56, p < 0.001 for EPA, and B = −0.43, p = 0.057 for DHA). Conclusions: Our findings are consistent with an indirect pathway linking diet to pain interference through blood levels of EPA and DHA in migraine