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The Role of Artificial Intelligence in Obesity Risk Prediction and Management: Approaches, Insights, and Recommendations
No full textGreater than 650 million individuals worldwide are categorized as obese, which is associated with significant health, economic, and social challenges. Given its overlap with leading comorbidities such as heart disease, innovative solutions are necessary to improve risk prediction and management strategies. In recent years, artificial intelligence (AI) and machine learning (ML) have emerged as powerful tools in healthcare, offering novel approaches to chronic disease prevention. This narrative review explores the role of AI/ML in obesity risk prediction and management, with a special focus on childhood obesity. We begin by examining the multifactorial nature of obesity, including genetic, behavioral, and environmental factors, and the limitations of traditional approaches to predict and treat morbidity associated obesity. Next, we analyze AI/ML techniques commonly used to predict obesity risk, particularly in minimizing childhood obesity risk. We shift to the application of AI/ML in obesity management, comparing perspectives from healthcare providers versus patients. From the provider’s perspective, AI/ML tools offer real-time data from electronic medical records, wearables, and health apps to stratify patient risk, customize treatment plans, and enhance clinical decision making. From the patient’s perspective, AI/ML-driven interventions offer personalized coaching and improve long-term engagement in health management. Finally, we address key limitations and challenges, such as the role of social determinants of health, in embracing the role of AI/ML in obesity management, while offering our recommendations based on our literature review
Corrigendum to “Cardiac Manifestations and Outcomes of COVID-19 Vaccine-Associated Myocarditis in the Young in the USA: Longitudinal Results From the Myocarditis After COVID Vaccination (Maciv) Multicenter Study” (Eclinicalmedicine (2024) 76, (S2589537024003882), (10.1016/J.Eclinm.2024.102809))
No full textDetails of corrigendum: In Figure 5, in the acute presentation section, it was stated that the greatest risk is in males aged 16–30 years after 2nd and 3rd dose. However, this should have said that the greatest risk is in males aged 16–30 years after the 1st or 2nd dose. This was a typographical error. This correction does not alter the main results or conclusions of the paper. Figure 5 has been updated with the correction.[Figure presented] Additionally, Co-authors Jocely Y. Ang and Yamuna Sanil are currently listed under affiliation ‘ab’. However, their correct affiliation is ‘ae’. Jyoti K. Patel is currently listed under ‘ae’. However, JKP\u27s correct affiliation is ‘ab’. There was an error in their site affiliation which was accidentally overlooked. The corrected affiliation list appears as follows: Supriya S. Jain,a,∗ Steven A. Anderson,b Jeremy M. Steele,c Hunter C. Wilson,d Juan Carlos Muniz,e Jonathan H. Soslow,f Rebecca S. Beroukhim,g Victoria Maksymiuk,a Xander Jacquemyn,h Olivia H. Frosch,i Brian Fonseca,j Ashraf S. Harahsheh,k Sujatha Buddhe,l Ravi C. Ashwath,m Deepika Thacker,n Shiraz A. Maskatia,o Nilanjana Misra,p Jennifer A. Su,q Saira Siddiqui,r Danish Vaiyani,s Aswathy K. Vaikom-House,t M.Jay Campbell,u Jared Klein,v Sihong Huang,w ChristopherMathis,x Matthew D.Cornicelli,y MadhuSharma,z Lakshmi Nagaraju,aa Jyoti K. Patel,ab Santosh C. Uppu,ac Preeti Ramachandran,ad Jocelyn Y. Ang,ae Frank Han,af Jason G. Mandell,ag Jyothsna Akam-Venkata,ah Michael P. DiLorenzo,ai Michael Brumund,aj Puneet Bhatla,ak Parham Eshtehardi,al Karina Mehta,am Katherine Glover,c Matthew L. Dove,d Khalifah A. Aldawsari,e Anupam Kumar,f Spencer B. Barfuss,g Adam L. Dorfman,i Prashant K. Minocha,j Alexandra B. Yonts,k Jenna Schauer,l Andrew L. Cheng,q Joshua D. Robinson,y Zachary Powell,t Shubhika Srivastava,n Anjali Chelliah,r Yamuna Sanil,ae Lazaro E. Hernandez,v Lasya Gaur,h Michael Antonchak,ak Marla Johnston,aj Jonathan D. Reich,b Narayan Nair,b Elizabeth D. Drugge,a and Lars Grosse-Wortmannam aDepartment of Pediatrics, Division of Cardiology, New York Medical College-Maria Fareri Children\u27s Hospital at Westchester Medical Center, Valhalla, NY, USA bThe U.S. Food and Drug Administration, Silver Spring, MD, USA cYale University School of Medicine, New Haven, CT, USA dEmory University School of Medicine, Sibley Heart Center, Atlanta, GA, USA eNicklaus Children\u27s Hospital, Miami, FL, USA fVanderbilt University Medical Center, Nashville, TN, USA gDepartment of Cardiology, Boston Children\u27s Hospital, Boston, MA, USA hDepartment of Pediatrics, Johns Hopkins School of Medicine, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD, USA iUniversity of Michigan Medical School, C.S. Mott Children\u27s Hospital, Ann Arbor, MI, USA jChildren\u27s Hospital Colorado, Aurora, CO, USA kChildren\u27s National Hospital and the George Washington University School of Medicine & Health Sciences, WA, USA lSeattle Children\u27s Hospital, Seattle, WA, USA mUniversity of Iowa Stead Family Children\u27s Hospital, Iowa City, IA, USA nNemours Children\u27s Health/Nemours Cardiac Center, Wilmington, DE, USA oLucile Packard Children\u27s Hospital, Stanford, Palo Alto, CA, USA pCohen Children\u27s Medical Center, Northwell Health, New York, USA qChildren\u27s Hospital of Los Angeles, Los Angeles, CA, USA rGoryeb Children\u27s Hospital, Morristown, NJ, USA sThe Children\u27s Hospital of Philadelphia, Philadelphia, PA, USA tThe University of Oklahoma Health Science Oklahoma City, Oklahoma, USA uDivision of Pediatric Cardiology, Department of Pediatrics, Duke University, Durham, NC, USA vJoe DiMaggio Children\u27s Hospital, Hollywood, FL, USA wBetz Congenital Health Center, Helen DeVos Children\u27s Hospital, Grand Rapids, MI, USA xChildren\u27s Mercy Kansas City, Kansas City, MO, USA yAnn & Robert H. Lurie Children\u27s Hospital of Chicago, Chicago, IL, USA zThe Children\u27s Hospital at Montefiore Bronx, New York, USA aaUC Davis Children\u27s Hospital, Sacramento, CA, USA abRiley Hospital for Children, Indianapolis, IN, USA acThe University of Texas Health Science Center, Children\u27s Heart Institute, Houston, TX, USA adKentucky Children\u27s Hospital, University of Kentucky, Lexington, KY, USA aeChildren\u27s Hospital of Michigan, Detroit, MI, USA afUniversity of Illinois College of Medicine, Peoria, IL, USA agUniversity of Rochester-Golisano Children\u27s Hospital, Rochester, NY, USA ahUniversity of Mississippi Medical Center, Jackson, MS, USA aiColumbia University, New York, NY, USA ajLouisiana State University Health Sciences Center, Children\u27s Hospital New Orleans, New Orleans, LA, USA akNYU Langone Health, Hassenfeld Children\u27s Hospital, New York, NY, USA alNorthside Hospital Heart Institute, Atlanta, GA, USA amDivision of Cardiology, Department of Pediatrics, Oregon Health and Science University-Doernbecher Children\u27s Hospital, Portland, OR, US
“What Program Directors Think” VI: Results of the 2024 Survey of the APDR Part 2
No full textRationale and Objectives The Association of Program Directors in Radiology (APDR) surveys its members for data gathering on impediments to resident education, variations in resource allocation and recent changes to the American Board of Radiology (ABR) certifying examination. Materials and Methods This was an observational, cross-sectional study using a Web-based survey. Members of the 2022–2023 Annual Survey Committee developed survey questions resulting in 40 items, including demographic data. The survey was distributed by email to all active members of the APDR in January and February of 2024. In this paper, challenges and potential solutions to residency education, current state of resource allocation, PD’s opinion on return of the ABR’s oral examination, and procedural skills necessary for graduating trainees are presented. Results The total survey response rate was 31% (84/247). The top five challenges to education were high clinical volumes (88%), insufficient protected time for teaching (64%), remote reaching on clinical rotations (58%) and high focus on relative value units (RVU) (50%). Proposed solutions included dedicated teaching faculty on the rotation schedule, RVU balancing to better value teaching, incentivize on-site faculty, universal, validated teaching resources and increasing the number of residency slots. The results of this survey were presented at the annual Association of Academic Radiology meeting in Boston, MA (April 2024). Conclusion Survey results find that a quarter of radiology PDs do not receive the full administrative time allocation mandated by the ACGME. The majority of the respondents favor the transition to the ABR oral examination and approve of the 10 procedures created by the APDR Procedures Taskforce. The greatest challenges facing Radiology residency education are a shortage of the radiology workforce, high clinical volumes impeding the balance between education and clinical work, and a lack of engagement and desire for remote work on the part of teaching faculty. Potential solutions to the challenges in Radiology residency education that are likely to decrease burnout and promote faculty interest in education include standardizing work RVUs to account for teaching, developing a cadre of dedicated in-person teaching faculty granted clinical RVU reductions, and facilitating asynchronous teaching
Pediatric Epilepsy Division Resources: Scope of Practice and Opportunities to Work at the Top of Your License
No full textThe National Association of Epilepsy Centers (NAEC) guidelines for level 3 and 4 epilepsy centers has emphasized the importance of an interdisciplinary team but left specifics to the individual centers. To our knowledge, no guidelines exist that define the ideal state for resourcing comprehensive epilepsy care. Therefore, we surveyed pediatric epilepsy centers to describe the current state and scope of personnel resources across the US. The Pediatric Epilepsy Research Consortium sent a 52-item survey to directors of 130 NAEC level 3 and 4 pediatric and pediatric/adult centers. The survey queried the number of various professionals, volume of work, distribution of tasks throughout the division, and programmatic offerings. Fourteen questions were specific to behavioral health care, leaving 38 questions specific to our survey. Medians were reported to minimize effects of asymmetric distributions across larger centers and because maximum values were occasionally collected as a range. Data was available from 50 centers (response rate = 38 %). The size of neurology divisions was evenly distributed with 34 % of respondents from small (1–7 neurologists), 34 % from medium (8–15 neurologists), and 32 % from large divisions (16 or more neurologists). Our survey identified several opportunities to shift tasks between personnel (i.e. from MD/DO/APPs to registered nurses (RNs), from RNs to resource specialists) to allow individuals to work to the top of their license, including preparing refills for provider signature, seizure safety education, completion of school forms, and medication prior authorization. Allocation of more resources and using our existing resources more efficiently has the potential to benefit epilepsy patients and families, providers, and pediatric health systems
An Examination of Demographic Involvement in Minimally Invasive Glaucoma Surgery and Cataract Surgery Clinical Trials: A Systematic Review
No full textBackground: Glaucoma is the leading cause of global irreversible blindness, and it disproportionately affects people of African descent, in addition to having slightly higher prevalence rates in females. Glaucoma is a group of diseases that are characterized by progressive and irreversible damage to the optic nerve, leading to eventual blindness without proper treatment. There are a number of interventions available to treat glaucoma, including MIGS, of which usage has drastically increased due to its safety and efficacy. However, with minority populations, such as people of African descent, having the highest disease burden, it remains critical to evaluate the diversity of clinical trial populations that are used in the study of glaucoma treatments. The objective of this study is to compare the representation of Black and other ethnic minorities, as well as female participants, between cataract surgery (CS), minimally invasive glaucoma surgery (MIGS), and MIGS and cataract surgery (MACS) trials. Methods: This analysis consisted of publicly available data on MIGS, CS, and MACS clinical trials from 2005 to 2017, using ClinicalTrials.gov as well as prevalence data sourced from the CDC. Data reporting and synthesis adhered to PRISMA guidelines. This study focuses on sex rather than gender, as this is how data was reported on ClinicalTrials.gov. The primary outcome was the participation-to-prevalence ratio (PPR) of each clinical trial. A PPR between 0.8 and 1.2 represents adequate representation, while a PPR less than 0.8 or greater than 1.2 can signify under- or over-representation, respectively. Results: A total of 21 trials were included in this review, comprising 3330 clinical trial participants: 7 CS trials (N = 570), 13 MIGS trials (N = 1577), and 9 MACS trials (N = 1183). All of the clinical trials included data on sex, while only 14 reported race data and 7 reported ethnicity data. The overall PPR of female participants was 1.00, with CS, MIGS, and MACS clinical trials having PPRs of 0.99, 1.00, and 1.00, respectively. On the other hand, the overall PPR of Black participants was 0.44, with CS, MIGS, and MACS clinical trials having PPRs of 0.27, 0.62, and 0.22, respectively. Further analysis demonstrated that the PPR of Black participants in trials sponsored by medical device companies and medical centers or universities was 0.41 and 1.25, respectively. The study was registered with Prospero CRD420251152586. Conclusions: Cataract surgery, MIGS, and MIGS and cataract surgery clinical trials under-represent Black individuals and appropriately represent females. Due to the disproportionate amount of Black individuals impacted by glaucoma, this lack of representation raises concerns about the applicability of the clinical trials to these populations. Understanding clinical trial disparities in the representation of minority races is a key first step toward promoting advancements in diversity and equitable healthcare. Clinical trials in the future need to make a genuine effort to include minority groups to improve the generalizability of results
Investigating Age-Stratified Outcomes Following Surgical Fixation of Humeral Shaft Fractures in the Elderly
No full textPurpose: As the global population ages, fractures among elderly individuals are increasing, with humeral shaft fractures (HSFs) comprising 3% of long bone fractures. While chronological age has been shown to influence surgical outcomes in elderly patients, there is paucity of literature examining age-specific differences in outcomes for HSF management. Given variations in bone quality, comorbid conditions, and functional status among elderly patients, an age-stratified approach may be necessary. This study aims to compare in-hospital outcomes following HSF fixation across geriatric age groups to inform treatment strategies. Methods: The National Inpatient Sample database (2015–2021) was queried for patients with HSFs and subsequent fixation. Patients were stratified into three groups: \u3c65, 65–79, and ≥ 80 years. Multivariate logistic regression assessed associations between each age group and adverse outcomes. A secondary analysis was done comparing patients ≥ 80 with those aged 65–79. Results: A total of 5,276 patients were included in the three-group analysis. Both the 65–79 and ≥ 80 cohorts had higher odds of extended length of stay (eLOS), non-home discharge (NHD), and acute kidney injury (AKI). Only the ≥ 80 group was associated with increased odds of in-hospital mortality. After excluding those \u3c 65, 2,777 patients remained for the two-group analysis. The ≥ 80 group was associated with increased odds of mortality, eLOS, and NHD compared to patients aged 65–79. Conclusion: Our study underscores the importance of considering an age-stratified approach to surgical management of HSFs in the elderly. These results provide further information for clinicians to help guide patients and family in clinical decision making for geriatric HSFs
Facial Neuromodulator Expectations of Treatment Naïve Millennials
No full textAs the millennial generation increasingly dominates the consumer landscape of facial neuromodulator treatments, a comprehensive understanding of their perceptions is crucial for tailoring effective aesthetic medical practices. However, there is currently a lack of comprehensive understanding of millennials\u27 knowledge, attitudes, and expectations regarding facial neuromodulator treatments. We aim to understand millennials’ perceptions and expectations regarding neuromodulator treatments. We conducted a cross-sectional survey to uncover the perceptions and expectations of millennials towards facial neuromodulator treatments. Of the 150 participants, the primary reasons for considering treatment were the desire to look good for one’s age (48%) and to appear more youthful (26%). The main reasons for not pursuing treatment were the belief that it was not yet necessary (57%) and concerns about safety or side effects (11%). Millennials were most interested in treating their forehead (75%), lateral canthal area (49%), and glabella (39%). Expectations varied in terms of treatment outcomes, recovery times, and result duration. Most respondents anticipated a positive impact on self-esteem (52%) and would “probably” or “definitely” disclose undergoing treatments to their friends and peers (65%). Herein, we reveal a complex landscape of millennial understanding of and expectations towards facial neuromodulator treatments. The findings underscore the necessity for physicians to engage in detailed patient education and adapt communication strategies to align with millennial expectations and values. A better understanding of millennials’ expectations may guide clinical practices and allow dermatologists to significantly improve patient satisfaction and outcomes, driving forward the field of aesthetic medicine
Impaired Pre-Operative Ambulatory Capacity in Patients Undergoing Elective Endovascular Infrarenal Abdominal Aortic Aneurysm Repair Is Associated With Increased Peri-Operative Death
No full textObjective: While ambulatory capacity is a readily assessable clinical indicator of functional status, its association with outcomes after endovascular aneurysm repair (EVAR) remains underexplored. This study aimed to investigate the association between pre-operative ambulatory status and outcomes following elective EVAR. Methods: A retrospective review of the multi-institutional Vascular Quality Initiative database was conducted for all patients who underwent elective infrarenal EVAR from 2009 – 2022. Patients were categorised into independent ambulation and impaired ambulation groups. A propensity score matched analysis was performed to produce two well matched cohorts in a 1:1 ratio without replacement. The primary outcome was 30 day death. Secondary outcomes included one year survival and in hospital major complications. Results: Among 11 474 patients, 10 539 (91.8%) were independently ambulatory pre-operatively. Propensity score matching resulted in 885 matched pairs. The impaired ambulation group, although older (mean 77.6 vs. 76.3 years; p = .001), showed comparable baseline characteristics. Post-operatively, the impaired ambulation group had higher cumulative in hospital complications and death as well as 30 day death. Even after adjustment for age, impaired pre-operative ambulation was associated with increased in hospital and 30 day death (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.26 – 3.95; p = .006). Multivariable analysis demonstrated increasing cumulative risk of 30 day death in the setting of impaired pre-operative ambulatory status with age \u3e 75 years requiring post-operative red blood cell transfusion \u3e 2 units (HR 5.75, 95% CI 2.09 – 15.88; p \u3c .001). Beyond 30 days, impaired pre-operative ambulation was not associated with increased one year death (HR 1.09, 95% CI 0.81 – 1.48; p = .57). Conclusion: Among patients who underwent elective infrarenal EVAR in this matched analysis, impaired pre-operative ambulatory capacity was associated with an increased risk of in hospital and 30 day death, further compounded by advanced age and post-operative transfusion. As such, a threshold higher than the traditional size criteria should be considered in shared decision making when determining options for the management of abdominal aortic aneurysm in this high risk cohort
Selected 2024 Highlights in Congenital Cardiac Anesthesia
No full textThis article reviews the highlights of pertinent literature of interest to the congenital cardiac anesthesiologist published in 2024. Following a search of the United States National Library of Medicine PubMed database, several topics emerged where significant contributions were made in 2024. The current authors considered the following topics noteworthy to be included in this review: anesthetic management for aspiration thrombectomy in pediatric patients with congenital heart disease, the role of corticosteroids in congenital heart surgery, regional anesthesia for congenital cardiac surgery, and point-of-care coagulation testing in pediatric cardiac surgery