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Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study.
No full textBackgroundLimited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation.ObjectivesTo describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year.Study designThe Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up.ResultsAmong 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score.ConclusionsTreatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated
Development of predictive models for all individual questions of SRS-22R after adult spinal deformity surgery: a step toward individualized medicine.
No full textPurposeHealth-related quality of life (HRQL) instruments are essential in value-driven health care, but patients often have more specific, personal priorities when seeking surgical care. The Scoliosis Research Society-22R (SRS-22R), an HRQL instrument for spinal deformity, provides summary scores spanning several health domains, but these may be difficult for patients to utilize in planning their specific care goals. Our objective was to create preoperative predictive models for responses to individual SRS-22R questions at 1 and 2 years after adult spinal deformity (ASD) surgery to facilitate precision surgical care.MethodsTwo prospective observational cohorts were queried for ASD patients with SRS-22R data at baseline and 1 and 2 years after surgery. In total, 150 covariates were used in training machine learning models, including demographics, surgical data and perioperative complications. Validation was accomplished via an 80%/20% data split for training and testing, respectively. Goodness of fit was measured using area under receiver operating characteristic (AUROC) curves.ResultsIn total, 561 patients met inclusion criteria. The AUROC ranged from 56.5 to 86.9%, reflecting successful fits for most questions. SRS-22R questions regarding pain, disability and social and labor function were the most accurately predicted. Models were less sensitive to questions regarding general satisfaction, depression/anxiety and appearance.ConclusionsTo the best of our knowledge, this is the first study to explicitly model the prediction of individual answers to the SRS-22R questionnaire at 1 and 2 years after deformity surgery. The ability to predict individual question responses may prove useful in preoperative counseling in the age of individualized medicine. These slides can be retrieved under Electronic Supplementary Material
COVID-19 Diagnosis and SARS-CoV-2 Strain Identification by a Rapid, Multiplexed, Point-of-Care Antibody Microarray.
No full textAntigen tests to detect SARS-CoV-2 have emerged as a promising rapid diagnostic method for COVID-19, but they are unable to differentiate between variants of concern (VOCs). Here, we report a rapid point-of-care test (POC-T), termed CoVariant-SPOT, that uses a set of antibodies that are either tolerant or intolerant to spike protein mutations to identify the likely SARS-CoV-2 strain concurrent with COVID-19 diagnosis using antibodies targeting the nucleocapsid protein. All reagents are incorporated into a portable, multiplexed, and sensitive diagnostic platform built upon a nonfouling polymer brush. To validate CoVariant-SPOT, we tested recombinant SARS-CoV-2 proteins, inactivated viruses, and nasopharyngeal swab samples from COVID-19 positive and negative individuals and showed that CoVariant-SPOT can readily distinguish between two VOCs: Delta and Omicron. We believe that CoVariant-SPOT can serve as a valuable adjunct to next-generation sequencing to rapidly identify variants using a scalable and deployable POC-T, thereby enhancing community surveillance efforts worldwide and informing treatment selection
Embryonic exposure to PFAS causes long-term, compound-specific behavioral alterations in zebrafish.
No full textPer- and polyfluoroalkyl substances (PFAS) are commonly used as surfactants and coatings for industrial processes and consumer products. These compounds have been increasingly detected in drinking water and human tissue, and concern over their potential effects on health and development is growing. However, relatively little data are available for their potential impacts on neurodevelopment and the degree to which different compounds within this class may differ from one another in their neurotoxicity. The present study examined the neurobehavioral toxicology of two representative compounds in a zebrafish model. Zebrafish embryos were exposed to 0.1-100uM perfluorooctanoic acid (PFOA) or 0.01-1.0uM perfluorooctanesulfonic acid (PFOS) from 5 to 122 h post-fertilization. These concentrations were below threshold for producing increased lethality or overt dysmorphologies, and PFOA was tolerated at a concentration 100× higher than PFOS. Fish were maintained to adulthood, with behavioral assessments at 6 days, 3 months (adolescence) and 8 months of age (adulthood). Both PFOA and PFOS caused behavioral changes in zebrafish, but PFOS and PFOS produced strikingly different phenotypes. PFOA was associated with increased larval motility in the dark (100uM), and enhanced diving responses in adolescence (100uM) but not adulthood. PFOS was associated with a reversed light-dark response in the larval motility test (0.1-1uM), whereby the fish were more active in the light than the dark. PFOS also caused time-dependent changes in locomotor activity in the novel tank test during adolescence (0.1-1.0uM) and an overall pattern of hypoactivity in adulthood at the lowest concentration (0.01uM). Additionally, the lowest concentration of PFOS (0.01uM) reduced acoustic startle magnitude in adolescence, but not adulthood. These data suggest that PFOS and PFOA both produce neurobehavioral toxicity, but these effects are quite distinct from one another
Implementation and Applications of Virtual Imaging Trials in Computed Tomography
No full textVirtual imaging is a powerful tool that offers an alternative to clinical trials by simulating medical image acquisitions. Virtual trials allow for the generation of large data sets without the need for human subjects, and generated images can be compared to ground truth which is not known in clinical trials. The goal of this thesis is to build upon prior work in developments of virtual trials and utilize them for cardiac and abdominal CT imaging applications. In particular, integration tools were developed to enable automatic CT simulation for large scale trials. With these tools, a pilot study was conducted to investigate the effects of image acquisition parameters on cardiac CT quantifications, laying the groundwork for a comprehensive evaluation. Further, a virtual trial was performed to objectively evaluate photon-counting CT in terms of the image quality improvements and liver lesion detectability. This study provided valuable information about how photon-counting CT can be effectively implemented in the clinic. These studies demonstrated the viability of virtual trials for medical imaging research.</p
Essays on Shareholder Voting
No full textThis dissertation consists of two essays on shareholder voting. In the first chapter, I develop a structural model of shareholder voting in the presence of blockholders. I show theoretically that there is an ambiguous relationship between a blockholder's bias — the extent to which it is influenced by factors beyond firm value, such as conflicts of interest with management — and its support rate — the probability that it votes according to management's recommendations. To recover the voting preferences of the "Big Three" passive investors, I structurally estimate the model using voting data on compensation proposals. While the Big Three are more likely to vote with management, my estimates do not uniformly indicate that they are biased. My results challenge the narrative that the growth in passive investing harms corporate governance.The second chapter represents joint work with Alon Brav, Wei Jiang, and Tao Li. We study mutual fund voting in proxy contests using a rich dataset constructed from regulatory filings. We use our dataset to address the ongoing debate over the effect of passive investing on corporate governance. Consistent with existing studies, we show that relative to active funds, passive funds are more likely to side with management, but we provide several important qualifications. For example, passive funds research SEC materials more often than active funds, and they appear equally informed about firm fundamentals. Overall, we conclude that passive funds remain engaged shareholders.</p
Validity and Reliability of the Korean Version of the Women's Toileting Behavior Scale.
No full textPURPOSE:The purpose of this study was to investigate the validity and reliability of the Korean version of the Toileting Behavior Scale (KTBS) to assess women's toileting behavior related to urinary elimination. METHODS:The original English version, the Toileting Behavior: Women's Elimination Behaviors scale, was translated into Korean with forward and backward translation. Examinations of internal consistency reliability, construct validity using exploratory factor analysis and confirmatory factor analysis, item convergent validity, and discriminant validity were conducted with SPSS/WIN 23.0 and AMOS/WIN 23.0 software. Concurrent validity was examined with the International Consultation on Incontinence Questionnaire-Short Form. RESULTS:Cronbach α for the overall scale was 0.78, and the 5 subscales ranged from 0.79 to 0.94. The exploratory factor analysis revealed 5 factors for the 17-item scale. Confirmatory factor analysis supported good convergent and discriminant values (λ=0.49-0.96, critical ratio=4.51-15.68>1.97, P<0.05, construct reliability=0.72-0.97). The concurrent validity was supported by correlation with the International Consultation on Incontinence Questionnaire-Short Form (r=0.146, P=0.011). CONCLUSION:The KTBS (17 items) is an appropriate tool to measure older Korean women's toileting behavior with good validity and reliability
Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management: Analysis of 479 Patients With Minimum 2-Year Follow-Up.
No full textStudy designRetrospective review of prospective multicenter adult spinal deformity (ASD) database.ObjectiveTo compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients.Summary of background dataOperative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD.MethodsInclusion criteria: ≥18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments.ResultsFour hundred seventy-nine patients were included (OP:258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP: 0.609 ± 0.093, NONOP: 0.600 ± 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 ± 0.345 vs. 1.256 ± 0.286, respectively, P ConclusionThe operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management.Level of evidence3
Neurologic Deficits Have a Negative Impact on Patient-Related Outcomes in Primary Presentation Adult Symptomatic Lumbar Scoliosis Surgical Treatment at One-Year Follow-up.
No full textStudy designA retrospective analysis of prospective, multicenter National Institute of Health clinical trial.ObjectiveThe aim of this study was to assess the rate of neurologic complications and impact of new neurologic deficits on 1-year postoperative patient-reported outcomes (PROs).Summary of background dataThere are limited studies evaluating the impact of new neurologic deficits on PROs following surgery for primary presentation adult lumbar scoliosis.MethodsPatients were divided into two groups: new postoperative neurological deficit (Def) or no deficit (NoDef). Preoperative and 1-year follow-up PROs were analyzed [Scoliosis Research Society (SRS) Questionnaire, Oswestry Disability Index (ODI), Short Form-12 Physical/Mental Health Composite Scores (PCS/MCS), and back/leg pain Numerical Rating Scale (NRS)].ResultsOne hundred forty-one patients: 14 Def (9.9%), 127 NoDef (90.1%). No differences were observed in demographic, radiographic, or PRO data between groups preoperatively. Def group had longer surgical procedures (8.3 vs. 6.9 hours, P = 0.030), greater blood loss (2832 vs. 2606 mL, P = 0.022), and longer hospitalizations (10.6 vs. 7.8 days, P = 0.004). NoDef group reported significant improvement in all PROs from preop to 1-year postoperative. Def group only had improvement in SRS Pain (2.7 preop to 3.4 postop, P = 0.037) and self-image domains (2.7 to 3.6, p = 0.004), and NRS back pain (6.6 to 3.2, P = 0.004) scores with significant worsening of NRS leg pain (4.1 to 6.1, P = 0.045). Group comparisons of 1-year postop PROs found that Def group reported more NRS leg pain (6.1 vs. 1.7, P ConclusionWe found a 9.9% rate of new neurologic deficits following surgery for symptomatic primary presentation adult lumbar scoliosis, much higher than previous studies. Most neurologic deficits improved by 1-year follow-up, but appeared to have a dramatic negative impact on PROs, with increased postoperative leg pain and greater patient-perceived pathology reported in patients experiencing neurological deficits compared with those who did not.Level of evidence3