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In March 2020, the University of Hawaii John A. Burns School of Medicine suspended in person clinical teaching due to the SARS-CoV-2 (COVID) pandemic. During this period, virtual cases, telehealth participation, and online cases were incorporated into medical education. We have examined the effects of educational outcomes of third and fourth year students throughout clerkship performance, national standardized test scores, and our local fourth year OSCE examination. We found that USMLE step 2 scores were higher in the COVID-affected group. Patient logs in the COVID-affected group were lower for internal medicine, family medicine, OBGYN, and psychiatry clerkships. Clerkship performance grades in the COVID-affected group were lower for OBGYN and higher for surgery and psychiatry, but not different in other clerkships. USNBME subject specific examination scores in the COVID-affected group were higher for internal medicine, surgery, family medicine and psychiatry, but not different in all other specialties. For the fourth year OSCE, students in the COVID-affected group performed better on note taking and worse on physical examination. Future investigations will be needed to explore how our COVID-affected medical students perform in residency and beyond.
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In this study, we employed various machine learning models to predict metabolic phenotypes, focusing on thyroid function, using a dataset from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. Our analysis utilized laboratory parameters relevant to thyroid function or metabolic dysregulation in addition to demographic features, aiming to uncover potential associations between thyroid function and metabolic phenotypes by various machine learning methods. Multinomial Logistic Regression performed best to identify the relationship between thyroid function and metabolic phenotypes, achieving an area under receiver operating characteristic curve (AUROC) of 0.818, followed closely by Neural Network (AUROC: 0.814). Following the above, the performance of Random Forest, Boosted Trees, and K Nearest Neighbors was inferior to the first two methods (AUROC 0.811, 0.811, and 0.786, respectively). In Random Forest, homeostatic model assessment for insulin resistance, serum uric acid, serum albumin, gamma glutamyl transferase, and triiodothyronine/thyroxine ratio were positioned in the upper ranks of variable importance. These results highlight the potential of machine learning in understanding complex relationships in health data. However, it's important to note that model performance may vary depending on data characteristics and specific requirements. Furthermore, we emphasize the significance of accounting for sampling weights in complex survey data analysis and the potential benefits of incorporating additional variables to enhance model accuracy and insights. Future research can explore advanced methodologies combining machine learning, sample weights, and expanded variable sets to further advance survey data analysis.
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Aprendizaje Automático , Fenotipo , Glándula Tiroides , Humanos , Glándula Tiroides/metabolismo , Masculino , Femenino , Persona de Mediana Edad , Adulto , Encuestas Nutricionales , Pruebas de Función de la Tiroides , Curva ROC , Redes Neurales de la ComputaciónRESUMEN
BACKGROUND: Asian gastric cancer patients have higher long-term survival rates post-gastrectomy. This study compares 30-day post-gastrectomy outcomes between Asians and non-Asians. METHODS: Gastric cancer patients undergoing elective gastrectomies were identified in 2014-2019 NSQIP datasets (n â= â1,438). Demographics, comorbidities, and postoperative outcomes were analyzed. RESULTS: Asians had lower odds of total gastrectomy (AOR â= â0.52, p â= â0.003), age ≥65 (AOR â= â0.60, p â= â0.006), smoking history (AOR â= â0.35, p â< â0.001), dyspnea (AOR â= â0.25, p â= â0.01), and hypoalbuminemia (AOR â= â0.62, p â= â0.025); they also had lower BMI (p â< â0.001). Postoperative outcomes were not significantly different aside from a shorter median length of hospital stay in days (LOS) (Asians: 7 (6, 11); non-Asians: 8 (6, 11); p â< â0.001). CONCLUSIONS: Asian gastric cancer patients have significantly lower odds of having select preoperative comorbidities and have shorter hospital LOS.
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Adenocarcinoma , Neoplasias Gástricas , Humanos , Adenocarcinoma/patología , Tiempo de Internación , Comorbilidad , Complicaciones Posoperatorias/etiología , Gastrectomía/efectos adversos , Estudios RetrospectivosRESUMEN
INTRODUCTION: With severely inflamed gallbladders, laparoscopic cholecystectomy can be difficult and may require procedures like subtotal cholecystectomy (SC). Few studies exist comparing SC and total cholecystectomy (TC) in the setting of severe biliary inflammation. This meta-analysis aims to compare SC and TC for difficult gallbladders. METHODS: Medline-OVID, Embase-OVID, and Cinahl were searched including only studies comparing SC to TC for difficult gallbladders. Primary outcome was CBD injury. Secondary outcomes included bile leak, duodenal injury, retained stone, bleeding, intraabdominal collection, wound infection, reoperation, and mortality. RESULTS: Ten studies were included. Compared to TC, SC significantly lowered the risk for CBD injury (0 â% vs. 1.6 â%, RR 0.30, 95%CI 0.10-0.87) but increased risk of bile leaks (RR 3.5, 95%CI 1.79-6.84), postoperative ERCP (RR 2.86, 95%CI 1.53-5.35), intraabdominal collections (RR 2.55, 95%CI 1.32-4.93), and reoperation (RR 2.92, 95%CI 1.14-7.47). CONCLUSION: SC is a reasonable alternative to difficult gallbladders that may decrease the risk of CBD injuries. Knowing both approaches is crucial to manage the difficult gallbladder while minimizing harm. Further studies are needed to understand the value of SC for difficult cholecystectomy.
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Colecistectomía , Humanos , Colecistectomía/métodos , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Colecistitis/cirugíaRESUMEN
The widespread use of WhatsApp as a communication tool makes it a candidate platform to facilitate the delivery of educational materials to radiology trainees in Eastern Africa. The aim of this pilot program is to assess the novel approach of using WhatsApp as a learning tool in pediatric radiology for residents in Kenya, Rwanda, Tanzania and Uganda. We recruited radiology residents to participate in a 3-month case-based pediatric radiology learning module that was delivered through WhatsApp to personal cell phones. Residents were presented with a multiple choice question once a week. Once they submitted their answer, the correct answer and explanations for each choice were provided. Questionnaires investigated comfort with reading pediatric radiology imaging, perception of the module content and convenience of the approach. Of the 72 participants, 40 (56%) responded to all 12 questions and both questionnaires, of whom 22 (55%) reported little to no comfort before the module and feeling very comfortable after. Confidence decreased with the number of incorrect answers. There was no correlation between the number of correct answers and the year level of the resident. Participants reported that the module was useful for learning pediatric radiology, found the material moderately difficult and found the application convenient for learning. Pediatric radiology educational content delivered over WhatsApp to residents in Eastern Africa is perceived as beneficial and convenient. This interactive learning platform provides opportunities for mentorship and enhanced learning of pediatric radiology.
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Internado y Residencia , Radiología , Entrenamiento Simulado , Humanos , Niño , Proyectos Piloto , Radiología/educación , TanzaníaRESUMEN
OBJECTIVE: Evaluate injury trends in Brazilian Jiu Jitsu (BJJ) participation by presenting to U.S. emergency departments over a 10-year period and formulate an injury profile. METHODS: The U.S. Consumer Product Safety Commission's (CPSC) National Electronic Injury Surveillance System (NEISS) database was queried for martial arts related injuries from 1 January 2012 to 31 December 2021. Codes and narratives were examined to compile data for patients sustaining BJJ-related injuries. RESULTS: From 1 January 2012 to 31 December 2021 there were 7,722 (NE = 282,315) ED-diagnosed martial arts related injuries with 911 (NE = 36,023) BJJ-related injuries identified. Regression analysis demonstrated an increasing trend in the annual incidence of Brazilian Jiu Jitsu injuries presenting to the ED (R2 = 0.934; SE = 2.069: p < .0001). Average age was 25.68 years of age (range 4-83). The most common injury diagnoses were sprains/strains and other/not listed at 27.68% and 26.39%. The most commonly injured body parts were the upper trunk, and the shoulder comprising 13.66% and 12.14% of injured body parts, respectively. The most commonly fractured region was toes, at 14.15% of all fractures. The most common dislocations occurred at the shoulder and knee, at 32.49% and 28.45% of dislocations, respectively. The most common mechanisms of injury specifically identified were indeterminate contact between players, fall onto ground, or fall onto another player comprising 18.62% and 17.17%, of injuries, respectively. CONCLUSION: There was an increasing trend of BJJ-related injuries presenting to U.S. Emergency Departments. The most common diagnoses and body parts injured were sprains/strains and upper trunk and shoulder, respectively. The most commonly fractured and dislocated regions were toes and shoulder, respectively. The most common mechanisms of injury were indeterminate contact or falling. This study provides novel information concerning trends in injury and injury profiles for Brazilian Jiu Jitsu related injuries.
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Traumatismos en Atletas , Fracturas Óseas , Luxaciones Articulares , Artes Marciales , Esguinces y Distensiones , Humanos , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Traumatismos en Atletas/epidemiología , Brasil/epidemiología , Artes Marciales/lesiones , Servicio de Urgencia en Hospital , Fracturas Óseas/epidemiologíaRESUMEN
BACKGROUND: Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations. OBJECTIVE: To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment. METHOD: We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods. RESULTS: Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial. CONCLUSION: Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials.
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Enfermedad de Alzheimer , Disfunción Cognitiva , Humanos , Estados Unidos , Enfermedad de Alzheimer/psicología , Escolaridad , Poblaciones Minoritarias, Vulnerables y Desiguales en Salud , HawaiiRESUMEN
Many health and health disparities studies require population prevalence information of various race groups, but the estimation of single-race population sizes using the US Census data has been challenging. For each Census race group, Census only provides the counts of those reported being single race ("race alone") and those reported of that specific race regardless of whether the individuals were multiracial or not ("race alone or in (any) combination"). The issue of how to classify Census multiracial individuals is especially important for the state of Hawai'i due to its large multiracial population. The current study developed the Stepwise Proportional Weighting Algorithm (SPWA) for single-race population estimation using US Census data for major race groups in the Census and their nested detailed races. Additionally, given that "partial Native Hawaiian" has often been treated as "Native Hawaiian" in health disparities studies in Hawai'i, the algorithm can also adjust for the unique partial Native Hawaiian race categorization. This paper describes the estimation process with the SPWA and demonstrates its ability to estimate single-races for the 5 most common race groups in Hawai'i. This new methodology addresses an important concern regarding how to classify multiracial individuals to strengthen health and health disparities research in Hawai'i.
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Censos , Disparidades en el Estado de Salud , Humanos , Hawaii/epidemiología , PrevalenciaRESUMEN
Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i.
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Distribución por Edad , Grupos Raciales , Distribución por Sexo , Humanos , Asiático/etnología , Asiático/estadística & datos numéricos , Pueblo Asiatico/etnología , Pueblo Asiatico/estadística & datos numéricos , Hawaii/epidemiología , Estados Unidos/epidemiología , Blanco/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricos , Censos , Nativos de Hawái y Otras Islas del Pacífico/etnología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricosRESUMEN
Although mRNA-based COVID-19 vaccines reduce the risk of severe disease, hospitalization and death, vaccine effectiveness (VE) against infection and disease from variants of concern (VOC) wanes over time. Neutralizing antibodies (NAb) are surrogates of protection and are enhanced by a booster dose, but their kinetics and durability remain understudied. Current recommendation of a booster dose does not consider the existing NAb in each individual. Here, we investigated 50% neutralization (NT50) titers against VOC among COVID-19-naive participants receiving the Moderna (n = 26) or Pfizer (n = 25) vaccine for up to 7 months following the second dose, and determined their half-lives. We found that the time it took for NT50 titers to decline to 24, equivalent to 50% inhibitory dilution of 10 international units/mL, was longer in the Moderna (325/324/235/274 days for the D614G/alpha/beta/delta variants) group than in the Pfizer (253/252/174/226 days) group, which may account for the slower decline in VE of the Moderna vaccine observed in real-world settings and supports our hypothesis that measuring the NT50 titers against VOC, together with information on NAb half-lives, can be used to dictate the time of booster vaccination. Our study provides a framework to determine the optimal time of a booster dose against VOC at the individual level. In response to future VOC with high morbidity and mortality, a quick evaluation of NAb half-lives using longitudinal serum samples from clinical trials or research programs of different primary-series vaccinations and/or one or two boosters could provide references for determining the time of booster in different individuals. IMPORTANCE Despite improved understanding of the biology of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the evolutionary trajectory of the virus is uncertain, and the concern of future antigenically distinct variants remains. Current recommendations for a COVID-19 vaccine booster dose are primarily based on neutralization capacity, effectiveness against circulating variants of concern (VOC), and other host factors. We hypothesized that measuring neutralizing antibody titers against SARS-CoV-2 VOC together with half-life information can be used to dictate the time of booster vaccination. Through detailed analysis of neutralizing antibodies against VOC among COVID-19-naive vaccinees receiving either of two mRNA vaccines, we found that the time it took for 50% neutralization titers to decline to a reference level of protection was longer in the Moderna than in the Pfizer group, which supports our hypothesis. In response to future VOC with potentially high morbidity and mortality, our proof-of-concept study provides a framework to determine the optimal time of a booster dose at the individual level.
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Vacunas contra la COVID-19 , COVID-19 , Humanos , Semivida , SARS-CoV-2/genética , COVID-19/prevención & control , Anticuerpos Neutralizantes , Anticuerpos Antivirales , VacunaciónRESUMEN
BACKGROUND: Most studies of progressive supranuclear palsy (PSP) have been conducted in White populations. OBJECTIVE: The objective of this study was to identify whether differences exist for patients with PSP among Whites, East Asians (EAs), and Native Hawaiians/Pacific Islanders (NHPIs) in Hawaii. METHODS: We conducted a single-center, retrospective study of patients meeting Movement Disorder Society probable PSP criteria (2006-2021). Data variables included age of onset and diagnosis, comorbidities, and survival rate. Variables were compared across groups using Fisher's exact test, Kruskal-Wallis rank sum test, and log-rank tests. RESULTS: A total of 94 (59 EAs, 9 NHPIs, 16 Whites, and 10 Others) patients were identified. Mean age ± standard deviation (in years) of symptom onset/diagnosis were both youngest in NHPIs (64.0 ± 7.2/66.3 ± 8.0) followed by Whites (70.8 ± 7.6/73.9 ± 7.8), then EAs (75.9 ± 8.2/79.2 ± 8.3) (P < 0.001). Median survival from diagnosis was significantly lower (P < 0.05) in NHPIs (2 years) compared with EAs (4 years) and Whites (6 years). CONCLUSIONS: There may be racial disparities for PSP, and studies are needed to identify genetic, environmental, and socioeconomic contributions. © 2023 International Parkinson and Movement Disorder Society.
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Trastornos del Movimiento , Parálisis Supranuclear Progresiva , Humanos , Hawaii/epidemiología , Trastornos del Movimiento/epidemiología , Trastornos del Movimiento/etnología , Trastornos del Movimiento/mortalidad , Nativos de Hawái y Otras Islas del Pacífico , Estudios Retrospectivos , Parálisis Supranuclear Progresiva/epidemiología , Parálisis Supranuclear Progresiva/etnología , Parálisis Supranuclear Progresiva/mortalidad , Blanco , Población Blanca , Pueblos del Este de Asia , Persona de Mediana Edad , Anciano , Anciano de 80 o más AñosRESUMEN
Chimeric antigen receptor-associated hemophagocytic lymphohistiocytosis (HLH)-like toxicities (LTs) involving hyperferritinemia, multiorgan dysfunction, coagulopathy, and/or hemophagocytosis are described as occurring in a subset of patients with cytokine release syndrome (CRS). Case series report poor outcomes for those with B-cell acute lymphoblastic leukemia (B-ALL) who develop HLH-LTs, although larger outcomes analyses of children and young adults (CAYAs) with B-ALL who develop these toxicities after the administration of commercially available tisagenlecleucel are not described. Using a multi-institutional database of 185 CAYAs with B-ALL, we conducted a retrospective cohort study including groups that developed HLH-LTs, high-grade (HG) CRS without HLH-LTs, or no to low-grade (NLG) CRS without HLH-LTs. Primary objectives included characterizing the incidence, outcomes, and preinfusion factors associated with HLH-LTs. Among 185 CAYAs infused with tisagenlecleucel, 26 (14.1%) met the criteria for HLH-LTs. One-year overall survival and relapse-free survival were 25.7% and 4.7%, respectively, in those with HLH-LTs compared with 80.1% and 57.6%, respectively, in those without. In multivariable analysis for death, meeting criteria for HLH-LTs carried a hazard ratio of 4.61 (95% confidence interval, 2.41-8.83), controlling for disease burden, age, and sex. Patients who developed HLH-LTs had higher pretisagenlecleucel disease burden, ferritin, and C-reactive protein levels and lower platelet and absolute neutrophil counts than patients with HG- or NLG-CRS without HLH-LTs. Overall, CAYAs with B-ALL who developed HLH-LTs after tisagenlecleucel experienced high rates of relapse and nonrelapse mortality, indicating the urgent need for further investigations into prevention and optimal management of patients who develop HLH-LTs after tisagenlecleucel.
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Linfoma de Burkitt , Linfohistiocitosis Hemofagocítica , Leucemia-Linfoma Linfoblástico de Células Precursoras B , Receptores Quiméricos de Antígenos , Humanos , Niño , Adulto Joven , Linfohistiocitosis Hemofagocítica/etiología , Estudios Retrospectivos , Receptores de Antígenos de Linfocitos T , Leucemia-Linfoma Linfoblástico de Células Precursoras B/complicaciones , Linfoma de Burkitt/complicaciones , Enfermedad CrónicaRESUMEN
OBJECTIVES: This study describes the prevalence of mild cognitive impairment (MCI) across different aspects of social isolation among adults 65 years or older. METHODS: In this cross-sectional study, we utilized the Wave 3 data from the National Social Life, Health, and Aging Project (NSHAP). MCI was defined as a Montreal Cognitive Assessment (MoCA) score less than 23. Prevalence of MCI was calculated for above and below average social disconnectedness (SD), perceived isolation (PI), and demographic variables age, gender, race/ethnicity, education, and household income. RESULTS: The overall prevalence [and 95% confidence interval] of MCI was 27.5% [25.5-29.6]. The high prevalence of MCI was found in those who had above average SD (32.0% [29.1-34.9]), above average PI (33.3% [29.7-36.8]), were older in age (43.1% [38.9-47.3]), male (28.7% [25.9-31.5]), Black (61.1% [52.5-69.6]), had less than a high school education (66.3% [58.9-73.8]), or were in the lowest income group (46.2% [39.7-52.7]). Those with above average SD or PI had a higher prevalence of MCI in almost all demographics, compared to those with below average SD or PI. Those who were Black or African American or had less than a high school education did not have a greater prevalence of MCI when SD was above average. DISCUSSION: This current study adds to the body of literature that links SD and PI to MCI and sheds light on the possible existing socio-demographic disparities. Groups with greater than average SD or PI tend to have a higher prevalence of MCI. Further studies are needed to establish a causal association of SD and PI with MCI.