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Clinical Applications of Artificial Intelligence in Corneal Diseases
Get PDFWe evaluated the clinical applications of artificial intelligence models in diagnosing corneal diseases, highlighting their performance metrics and clinical potential. A systematic search was conducted for several disease categories: keratoconus (KC), Fuch’s endothelial corneal dystrophy (FECD), infectious keratitis (IK), corneal neuropathy, dry eye disease (DED), and conjunctival diseases. Metrics such as sensitivity, specificity, accuracy, and area under the curve (AUC) were extracted. Across the diseases, convolutional neural networks and other deep learning models frequently achieved or exceeded established diagnostic benchmarks (AUC > 0.90; sensitivity/specificity > 0.85–0.90), with a particularly strong performance for KC and FECD when trained on consistent imaging modalities such as anterior segment optical coherence tomography (AS-OCT). Models for IK and conjunctival diseases showed promise but faced challenges in heterogeneous image quality and limited objective training criteria. DED and tear film models benefited from multimodal data yet lacked direct comparisons with expert clinicians. Despite high diagnostic precision, challenges from heterogeneous data, a lack of standardization in disease definitions, imaging acquisition, and model training remain. The broad implementation of artificial intelligence must address these limitations to improve eye care equity
Training Volume and Training Frequency Changes Associated with Boston Marathon Race Performance
Get PDFBackground Physical training influences competitive marathon performance, including training volume and training frequency changes (TFCs) pre-race. Training intensity distribution (i.e., steady-state, quality sessions, interval training) and cross-training contribute to volume and TFCs that may influence performance. Objective The aim of this study is to assess the relationships among training and TFCs preceding the 2022 Boston Marathon and race performance. Methods Adult 2022 Boston Marathon registrants were contacted via email 1 month pre-race. Athletes reported demographics, training/racing experience, and training pre-race. TFCs were calculated by comparing two timeframes: 12–4 and 4–0 month pre-race training. Official race performance was obtained from chip timing data and demographics. Separate linear regressions were used to assess the effects of training and cross-training in 12–4 and 4–0 months pre-race and TFCs on performance, accounting for experience and demographics. Results In total, 917 athletes were included (female: n = 495, 3:53 ± 0:37 h race times, 64.4 ± 24 km/week weekly distance; male: n = 422; 3:35 ± 0:39 h race times, 67.6 ± 26.2 km/week weekly distance). Higher running distance/week, running sessions/week (n), quality sessions/week (“hard sessions”; n), average distance in the 12–4 and 4–0 months pre-race (p ≤ 0.050), and more cross-training (p < 0.001) in the 4–0 months pre-race were associated with faster times and performance. Runners with TFCs of decreased running sessions/week (p = 0.035) had faster times and better performance versus athletes who maintained/increased volume. Conclusion Habitually higher training exposure 12–4 and 4–0 months, but relatively reduced training frequency 4–0 months pre-race, contributed to better marathon performance
A Cross-Sectional Study of Salivary Cortisol, Alpha Amylase, and Measures of Psychological Distress in Children Undergoing Dental Procedures
Get PDFBackground/Objectives: Dental fear and anxiety are areas of concern in clinical pediatric dentistry, often leading to treatment avoidance and negative oral-health consequences. Cortisol and alpha amylase, measurable in saliva, have been proposed as biomarkers of stress and may provide an objective means of assessing and monitoring distress over time. This study examined measures of psychological and physiological distress in pediatric patients undergoing dental procedures and their correlation. Methods: 7-to-17-year-old new patients scheduled for a dental procedure or orthodontic bonding completed a psychological battery assessing dental fear (using Children’s Fear Survey Schedule—Dental Subscale), stress (Perceived Stress Scale), and dental anxiety (Modified Children Dental Anxiety Scale). Before the dental appointment, we assessed anticipated pain intensity, heart rate (HR), and collected two saliva samples to quantify cortisol and alpha amylase. Correlations between psychological and physiological measures were assessed with Pearson’s correlation and treatment groups were compared with independent t-tests. Results: Out 34 participants (12.8 ± 2.7 y/o, 52.9% females, 73.5% pediatric patients and 26.5% orthodontic patients), 38.2% endorsed moderate anxiety; 85.3% reported moderate to high stress; and 29.6% indicated dental fear. Psychological distress was not influenced by procedure type. Dental fear positively correlated with dental anxiety (p < 0.001) and HR (p < 0.001); dental anxiety positively correlated with anticipated pain (p = 0.010) and HR (p = 0.003); stress positively correlated with HR (p = 0.006). Even if 72.2% of participants had cortisol value outside normal range and those with greater stress exhibited elevated cortisol, cortisol and alpha amylase levels (measured on n = 18) were not correlated with psychological variables. Conclusions: Cortisol and alpha amylase levels were not correlated with psychological measures in a cross-sectional study on pediatric patients undergoing dental procedures
Inequality, information, and income tax policy preferences in Austria and Germany
Get PDFAbstract Inequality has increased over recent decades in many advanced industrial democracies, but taxes have rarely become more progressive. One possible explanation for the lack of a policy response is that, despite rising inequality, voters support higher taxes on incomes weakly, if at all. Using original representative surveys in Austria and Germany, we elicit voters’ preferences over the progressivity of income tax policy and examine whether exposing them to accurate information about inequality affects those preferences. Voters, we find first, express an abstract preference for progressivity but concretely support tax plans that are only somewhat more progressive than the status quo in Austria and less progressive than the status quo in Germany. Second, we find evidence that certain kinds of information about inequality moderately increase progressive tax preferences in Germany; however, we find no equivalent effects in Austria. While information on inequality does seem able to affect tax policy views in certain contexts, it seems unlikely that lack of this information can fully account for the lack of rising redistribution through the income tax system in the face of increasing inequality
Accelerometer-measured physical activity, sedentary behavior, and mortality among cancer survivors: the Women’s Health Accelerometry Collaboration
Get PDFBACKGROUND: Data on prospective associations of accelerometer-measured physical activity (PA), sedentary behavior (SB), and mortality among cancer survivors are lacking. Our study examined accelerometer-measured daily PA (including light, moderate-to-vigorous PA [MVPA], total PA, and steps), SB (sitting time and mean bout duration), and mortality among cancer survivors in the Women's Health Accelerometry Collaboration (WHAC). METHODS: Postmenopausal women in WHAC who reported a cancer diagnosis ≥1 year prior to wearing an ActiGraph GT3X+ on the hip for ≥4 of 7 days from 2011-2015 were included. Outcomes included all-cause, cancer, and cardiovascular disease (CVD) mortality. Covariate-adjusted Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for each PA and SB measure in association with mortality. RESULTS: Overall, 2,479 cancer survivors (mean [SD] age, 74.2 [6.7] years) were followed for 8.3 years. For all-cause mortality (n = 594 cases), every 78.1 min/day in light PA, 96.5 min/day in total PA, 102.2 min/day in sitting time, and 4.8 min in sitting bout duration had HRs (95%CIs) of 0.92 (0.84-1.01), 0.89 (0.80-0.98), 1.12 (1.02-1.24) and 1.04 (0.96-1.12), respectively. Linear associations for cancer mortality (n = 168) and CVD mortality (n = 109) were not statistically significant except for steps (HR per 2,469 steps/day=0.66, 95%CI: 0.45-0.96) and sitting time (HR = 1.30, 95%CI: 1.02-1.67) for CVD mortality. Nonlinear associations showed benefits of MVPA (for all-cause and CVD mortality) and steps (all-cause mortality only) maximized around 60 min/day and 5,000 steps/day, respectively. CONCLUSIONS: Among postmenopausal cancer survivors, higher PA and lower SB was associated with reduced hazards of all-cause and CVD mortality
Physical Activity Patterns According to Demographic, Social, and Clinical Correlates Among Breast Cancer Survivors
Get PDFINTRODUCTION: Moderate to vigorous physical activity (MVPA) after breast cancer diagnosis is associated with improved survivorship. However, differences in MVPA by race among breast cancer survivors are not well described in population-based studies. METHODS: We analyzed data from Carolina Breast Cancer Study Phase 3 (n = 2994, 50% Black) participants to evaluate the trajectory of MVPA from pre-diagnosis to 18-month post-diagnosis. Participants self-reported MVPA at baseline (pre-diagnosis) and 6- and 18-month post-diagnosis and were classified as having any MVPA (> 0 min/week) or no MVPA. Associations between MVPA and demographic, social, and clinical variables were estimated using multivariable logistic regression. RESULTS: At baseline, 84.0% of participants reported any MVPA pre-diagnosis, which dropped to 55.4% at 6-month post-diagnosis, then rebounded to 85.1% by 18-month post-diagnosis. Among those who had no MVPA pre-diagnosis, 32.5% and 71.0% became active at 6- and 18-month post-diagnosis, respectively. Higher income [adjusted odds ratio (aOR) = 1.33, 95% confidence interval (CI) (1.02, 1.74) > $30K vs. < 15K], lower body mass index [aOR = 1.30, 95% CI (1.00, 1.73) < 25 vs. > 30], low area deprivation [aOR = 1.35, 95% CI (1.08, 1.67) vs. high], high area assets [aOR = 1.54, 95% CI (1.23, 1.93) vs. low], and stage I breast cancer [aOR = 1.72, 95% CI (1.22, 2.43) vs. 3 or 4] were associated with any MVPA at 18-month post-diagnosis. CONCLUSION: We identified several demographic and social correlates of any MVPA at 18-month post-diagnosis, and together with established clinical correlates (such as late disease), these factors may contribute to breast cancer disparities
Pan-cancer immune and stromal deconvolution predicts clinical outcomes and mutation profiles
Get PDFTraditional gene expression deconvolution methods assess a limited number of cell types, therefore do not capture the full complexity of the tumor microenvironment (TME). Here, we integrate nine deconvolution tools to assess 79 TME cell types in 10,592 tumors across 33 different cancer types, creating the most comprehensive analysis of the TME. In total, we found 41 patterns of immune infiltration and stroma profiles, identifying heterogeneous yet unique TME portraits for each cancer and several new findings. Our findings indicate that leukocytes play a major role in distinguishing various tumor types, and that a shared immune-rich TME cluster predicts better survival in bladder cancer for luminal and basal squamous subtypes, as well as in melanoma for RAS-hotspot subtypes. Our detailed deconvolution and mutational correlation analyses uncover 35 therapeutic target and candidate response biomarkers hypotheses (including CASP8 and RAS pathway genes)
Performance of 8 Smoking Metrics for Modeling Survival in Head and Neck Squamous Cell Carcinoma
Get PDFImportance: Cigarette smoking is a strong risk factor for mortality in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). However, little evidence supports which smoking metric best models the association between smoking and survival in HNSCC. Objective: To determine which smoking metric best models a linear association between smoking exposure and overall survival (OS) in patients with HNSCC. Design, Setting, and Participants: A retrospective multicenter cohort study of 6 clinical epidemiological studies was performed. Five were part of the Human Papillomavirus, Oral and Oropharyngeal Cancer Genomic Research (VOYAGER) consortium. Participants included patients 18 years and older with pathologically confirmed HNSCC. Data were collected from January 2002 to December 2019, and data were analyzed between January 2022 to November 2024. Main Outcomes and Measures: The primary outcome was OS. The performance of 8 smoking metrics, including pack-years, duration, and log cig-years (calculated as log10[cigarettes smoked per day + 1] × number of years smoked) for modeling OS were compared. Metric performance was measured by the strength of association in Cox proportional hazard models, linearity based on P for linear trend, Akaike information criterion (AIC; lower value indicates better model fit), and visual assessment of spline curves. Secondary outcomes included modeling OS in clinicodemographic subgroups and HNSCC anatomic subsites. Exploratory outcomes included cancer-specific survival and noncancer survival. Results: In total, 8875 patients with HNSCC (2114 [24%] female; median [IQR] age, 61 [54-69] years) were included. Of 8 smoking metrics evaluated, smoking duration (adjusted hazard ratio [aHR], 1.11 [95% CI, 1.03-1.19]) and log cig-years (aHR, 1.11 [95% CI, 1.04-1.18]) had the highest aHRs; both had a statistically significant linear association with OS. Log cig-years had the lowest AIC linear value and the most visually linear spline curve when modeling OS. Duration and log cig-years outperformed pack-years for modeling OS regardless of age, smoking status, and cancer stage. Both performed well in lip and oral cavity, laryngeal (only duration was significant), and human papillomavirus-negative oropharyngeal subsites. In an exploratory analysis, duration had the highest aHR (1.15 [95% CI, 1.02-1.29]), and log cig-years had the lowest AIC linear value when modeling noncancer survival. Conclusions and Relevance: In this cohort study, smoking duration and log cig-years best modeled a linear relationship with OS for patients with HNSCC. Both metrics maintained robust performance within specific clinicodemographic subgroups and anatomic subsites. Although most HNSCC survival models control for smoking exposure using smoking status or pack-years, duration and log cig-years may be superior metrics to account for the effects of smoking on survival
Colorism and Health Inequities among Black Americans: A Biopsychosocial Perspective.
Get PDFThe mechanisms generating skin-tone-based health inequities among ethnic Black Americans remain poorly understood. To address this gap, our study advances a novel biopsychosocial model of embodied colorism-related distress. We test this model with survey and biomarker data from a community sample of working-age Black adults from Nashville, Tennessee (2011-2014; N = 627). Relying on self-rated, interviewer-rated, and discordant skin tone measures, our analyses reveal that Black adults who perceive themselves as dark-skinned tend to have a lower sense of mattering and shorter telomeres, a biomarker of accelerated cellular degradation and aging, relative to their peers who perceive their skin to be lighter. These patterns hold across various social contexts and regardless of interviewer-rated skin tone, indicating that subjective skin tone may be a particularly robust gauge of colorism-related stress processes. Our study reveals critical and previously unexplored biopsychosocial mechanisms linking colorism to health inequity
Mortality Outcomes Surveillance: Coroner/Medical Examiner Report Data (2018 Update)
No full textMortality Outcomes Surveillance: Coroner/Medical Examiner Report Data (2018 Update) details the data abstracted from decedent coroner/medical examiner reports