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Wu, C. C., and T. Chang. "Rank-Ordered Multifractal Analysis (ROMA) of probability distributions in fluid turbulence." Nonlinear Processes in Geophysics 18, no. 2 (April 13, 2011): 261–68. http://dx.doi.org/10.5194/npg-18-261-2011.
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Abstract. Rank-Ordered Multifractal Analysis (ROMA) was introduced by Chang and Wu (2008) to describe the multifractal characteristic of intermittent events. The procedure provides a natural connection between the rank-ordered spectrum and the idea of one-parameter scaling for monofractals. This technique has successfully been applied to MHD turbulence simulations and turbulence data observed in various space plasmas. In this paper, the technique is applied to the probability distributions in the inertial range of the turbulent fluid flow, as given in the vast Johns Hopkins University (JHU) turbulence database. In addition, a new way of finding the continuous ROMA spectrum and the scaled probability distribution function (PDF) simultaneously is introduced.
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Balabanov, Roman, Lev Usov, Alexei Troshin, Vladimir Vlasenko, and Vladimir Sabelnikov. "A Differential Subgrid Stress Model and Its Assessment in Large Eddy Simulations of Non-Premixed Turbulent Combustion." Applied Sciences 12, no. 17 (August 25, 2022): 8491. http://dx.doi.org/10.3390/app12178491.
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We present a new subgrid stress model for the large eddy simulation of turbulent flows based on the solution of transport equations for stress tensor components. The model was a priori term-by-term calibrated against an open DNS database on forced isotropic turbulence (Johns Hopkins University database). After that, it was applied in a large eddy simulation of non-premixed turbulent combustion. To demonstrate the impact of the new subgrid stress model on scalar fields, we excluded the backward effect of heat release on the subgrid stresses, considering an isothermal reaction (i.e., diluted mixture; the density variations associated with chemical heat release can be neglected) and a Burke–Schumann reaction sheet approximation. A periodic box filled with a homogeneous turbulent velocity field and a three-layer top-hat mixture fraction field was studied. Four simulations were performed in which a fixed model for mixture fraction and its variance was combined with either the proposed subgrid stress model or one of the standard models, including Smagorinsky, dynamic Smagorinsky and WALE. Qualitatively correct backscatter was observed in a simulation with the new model. The differences in the statistics of the mixture fraction and reactive component fields caused by the new subgrid stress model were analyzed and discussed. The importance of using an advanced subgrid stress model was highlighted.
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Pumir, Alain, Haitao Xu, and Eric D. Siggia. "Small-scale anisotropy in turbulent boundary layers." Journal of Fluid Mechanics 804 (August 31, 2016): 5–23. http://dx.doi.org/10.1017/jfm.2016.529.
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In a channel flow, the velocity fluctuations are inhomogeneous and anisotropic. Yet, the small-scale properties of the flow are expected to behave in an isotropic manner in the very-large-Reynolds-number limit. We consider the statistical properties of small-scale velocity fluctuations in a turbulent channel flow at moderately high Reynolds number ($Re_{\unicode[STIX]{x1D70F}}\approx 1000$), using the Johns Hopkins University Turbulence Database. Away from the wall, in the logarithmic layer, the skewness of the normal derivative of the streamwise velocity fluctuation is approximately constant, of order 1, while the Reynolds number based on the Taylor scale is $R_{\unicode[STIX]{x1D706}}\approx 150$. This defines a small-scale anisotropy that is stronger than in turbulent homogeneous shear flows at comparable values of $R_{\unicode[STIX]{x1D706}}$. In contrast, the vorticity–strain correlations that characterize homogeneous isotropic turbulence are nearly unchanged in channel flow even though they do vary with distance from the wall with an exponent that can be inferred from the local dissipation. Our results demonstrate that the statistical properties of the fluctuating velocity gradient in turbulent channel flow are characterized, on one hand, by observables that are insensitive to the anisotropy, and behave as in homogeneous isotropic flows, and on the other hand by quantities that are much more sensitive to the anisotropy. How this seemingly contradictory situation emerges from the simultaneous action of the flux of energy to small scales and the transport of momentum away from the wall remains to be elucidated.
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Rao, P., C. P. Caulfield, and J. D. Gibbon. "Nonlinear effects in buoyancy-driven variable-density turbulence." Journal of Fluid Mechanics 810 (November 25, 2016): 362–77. http://dx.doi.org/10.1017/jfm.2016.719.
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We consider the time dependence of a hierarchy of scaled $L^{2m}$-norms $D_{m,\unicode[STIX]{x1D714}}$ and $D_{m,\unicode[STIX]{x1D703}}$ of the vorticity $\unicode[STIX]{x1D74E}=\unicode[STIX]{x1D735}\times \boldsymbol{u}$ and the density gradient $\unicode[STIX]{x1D735}\unicode[STIX]{x1D703}$, where $\unicode[STIX]{x1D703}=\log (\unicode[STIX]{x1D70C}^{\ast }/\unicode[STIX]{x1D70C}_{0}^{\ast })$, in a buoyancy-driven turbulent flow as simulated by Livescu & Ristorcelli (J. Fluid Mech., vol. 591, 2007, pp. 43–71). Here, $\unicode[STIX]{x1D70C}^{\ast }(\boldsymbol{x},t)$ is the composition density of a mixture of two incompressible miscible fluids with fluid densities $\unicode[STIX]{x1D70C}_{2}^{\ast }>\unicode[STIX]{x1D70C}_{1}^{\ast }$, and $\unicode[STIX]{x1D70C}_{0}^{\ast }$ is a reference normalization density. Using data from the publicly available Johns Hopkins turbulence database, we present evidence that the $L^{2}$-spatial average of the density gradient $\unicode[STIX]{x1D735}\unicode[STIX]{x1D703}$ can reach extremely large values at intermediate times, even in flows with low Atwood number $At=(\unicode[STIX]{x1D70C}_{2}^{\ast }-\unicode[STIX]{x1D70C}_{1}^{\ast })/(\unicode[STIX]{x1D70C}_{2}^{\ast }+\unicode[STIX]{x1D70C}_{1}^{\ast })=0.05$, implying that very strong mixing of the density field at small scales can arise in buoyancy-driven turbulence. This large growth raises the possibility that the density gradient $\unicode[STIX]{x1D735}\unicode[STIX]{x1D703}$ might blow up in a finite time.
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LÜTHI, BEAT, MARKUS HOLZNER, and ARKADY TSINOBER. "Expanding theQ–Rspace to three dimensions." Journal of Fluid Mechanics 641 (December 10, 2009): 497–507. http://dx.doi.org/10.1017/s0022112009991947.
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The two-dimensional space spanned by the velocity gradient invariantsQandRis expanded to three dimensions by the decomposition ofRinto its strain production −1/3sijsjkskiand enstrophy production 1/4ωiωjsijterms. The {Q;R} space is a planar projection of the new three-dimensional representation. In the {Q; −sss; ωωs} space the Lagrangian evolution of the velocity gradient tensorAijis studied via conditional mean trajectories (CMTs) as introduced by Martínet al. (Phys. Fluids, vol. 10, 1998, p. 2012). From an analysis of a numerical data set for isotropic turbulence ofReλ~ 434, taken from the Johns Hopkins University (JHU) turbulence database, we observe a pronounced cyclic evolution that is almost perpendicular to theQ–Rplane. The relatively weak cyclic evolution in theQ–Rspace is thus only a projection of a much stronger cycle in the {Q; −sss; ωωs} space. Further, we find that the restricted Euler (RE) dynamics are primarily counteracted by the deviatoric non-local part of the pressure Hessian and not by the viscous term. The contribution of the Laplacian ofAij, on the other hand, seems the main responsible for intermittently alternating between low and high intensityAijstates.
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Cahan, Mitchell Aaron. "The Johns Hopkins Swallowing Center database." Dysphagia 7, no. 1 (March 1992): 36–39. http://dx.doi.org/10.1007/bf02493419.
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Kanov, Kalin, Randal Burns, Cristian Lalescu, and Gregory Eyink. "The Johns Hopkins Turbulence Databases: An Open Simulation Laboratory for Turbulence Research." Computing in Science & Engineering 17, no. 5 (September 2015): 10–17. http://dx.doi.org/10.1109/mcse.2015.103.
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Lee, Daniel J., Lawrence Lustig, Margaret Sampson, Jill Chinnici, and John K. Niparko. "Effects of Cytomegalovirus (CMV) Related Deafness on Pediatric Cochlear Implant Outcomes." Otolaryngology–Head and Neck Surgery 133, no. 6 (December 2005): 900–905. http://dx.doi.org/10.1016/j.otohns.2005.08.013.
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OBJECTIVE: Human cytomegalovirus (CMV) is a commonly recognized viral cause of perinatal sensorineural hearing loss. CMV-infected infants are also at risk for developmental neurological deficits. This retrospective study assesses the impact of CMV-induced deafness on pediatric cochlear implant outcomes. STUDY DESIGN AND SETTING: Thirteen patients from the Johns Hopkins pediatric cochlear implant database were identified with CMV-related deafness. A retrospective review of the medical records of the Johns Hopkins Hospital was performed. RESULTS: The mean age at implantation was 5.6 years. Follow-up audiometric data ranged from 6 to 48 months postoperatively. Mean speech perception scores were 4.5 (out of 6) following implantation. CONCLUSION: We have shown that cochlear implants can provide useful speech comprehension to patients with CMV-related deafness. Speech recognition scores were within the range established by our overall pediatric implant population. SIGNIFICANCE: This observation underscores the importance of a multidisciplinary rehabilitation program following implantation in these patients at risk for cognitive delay. EBM RATING: C
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Caturegli, Patrizio, Edward F. McCarthy, J. Brooks Jackson, and Ralph H. Hruban. "The Pathology Residency Program of the Johns Hopkins University School of Medicine: A Model of Its Kind." Archives of Pathology & Laboratory Medicine 139, no. 3 (March 1, 2015): 400–406. http://dx.doi.org/10.5858/arpa.2013-0629-hp.
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Context The Department of Pathology of the Johns Hopkins University pioneered in the late 19th century the application of the scientific method to the study of medicine and fostered the development of residency training programs. Objective To trace the history of the Johns Hopkins Pathology Residency Program and assess with quantifiable outcomes the performance of former residents. Design We reviewed archival and departmental records from September 1899 to June 2014 to create a database of pathology residents. We then analyzed resident in-service examinations, American Board of Pathology examinations, and career paths. Results In 115 years the department trained 555 residents who came from 133 medical schools located in 23 countries. Residents performed well on the in-service examinations, obtaining mean scaled total scores that were significantly better (P = .02) than those of the national peer groups. Residents (371 of 396, 94%) passed their boards typically at the first attempt, a percentage pass that was higher than the national average for both anatomic (P < .001) and clinical (P = .002) pathology. Approximately half of the residents went into private practice, whereas a third followed an academic career. Of the latter group, 124 (75%) became professors of pathology, 31 (19%) chairs of pathology departments, 10 (6%) deans of medical schools, 5 (3%) were elected into the National Academy of Sciences, and 1 won the Nobel prize. Conclusions While maintaining its original core values, the Johns Hopkins Pathology Residency Program has trained physicians to be outstanding researchers, diagnosticians, and leaders in pathology.
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Miller, Karin Paige, Patrick A. Brown, B. Douglas Smith, Jonathan Webster, Helen Powell, and Amy S. Duffield. "Acute Leukemia and COVID-19: The Johns Hopkins Experience." Blood 138, Supplement 1 (November 5, 2021): 4046. http://dx.doi.org/10.1182/blood-2021-153474.
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Abstract Introduction: At the beginning of the COVID-19 pandemic in the United States, some states combated viral spread via lockdowns. In Maryland, where Johns Hopkins Hospital (JHH) is located, the closures began with public schools (March 12, 2020; 3/12/20); followed by bars, restaurants, movie theaters, gyms and gatherings of >50 people (3/16/20) with 250 Maryland State Police troopers being activated to aid in enforcement. All non-essential businesses were closed on 3/23/20, with a statewide "stay-at-home order" announced on 3/30/20. At this time, we anecdotally noted a decline in the number of adult patients presenting to JHH with new diagnoses of acute leukemia (AL). In this retrospective study, we quantified changes in new AL diagnoses over this period. Methods: The study was approved by the JHH IRB. All patients with new presentations of AL undergo diagnostic flow cytometry (FC) analysis at our institution on peripheral blood and/or bone marrow samples. The FC database was searched for new diagnoses of adult (≥ 18 years) and pediatric (<18 years) AL during the following timeframes: [1] 3/13-6/10/20 (90 days after the first announced restriction) and [2] 2/11-3/12/20 (30 days prior to the first restriction). The database was searched for the same time periods in 2019 (3/13-6/10/19 and 2/10-3/12/19). A diagnosis of AL was considered new if the patient had not previously been diagnosed with AL or evolved to AL from an underlying myeloid neoplasm. Clinical data were collected from the electronic medical record. We used a Fisher's exact test to compare the distribution of new patients in the 30 days prior and 90 days following the announced COVID-19 restrictions in Maryland in 2020 to that of new patients in the corresponding time periods for 2019. The Cochran-Armitage test was used to compare trends in new patients with AL in the 30 days prior and 90 days following COVID-19 restrictions, as compared to the same time period in 2019. Statistical significance was defined as a p-value <0.05. Results: Between 3/13- 6/10/20, there were 25 new diagnoses of AL (11 women/14 men) with a median age of 51 years (range: 2.6 - 89 years; 10 pediatric/15 adult). During the same 90 day period in 2019, there were 32 new diagnoses of AL (18 women/14 men) with a median age of 63 years (range: 8 - 93 years; 2 pediatric/30 adult). Figure 1 shows the distribution of new AL diagnoses in adult patients by date of presentation. This decrease was most pronounced in the first 30 days, in which only one new adult patient with AL presented to JHH. The distribution of adult patients diagnosed in the 30 days prior and 90 days following the March 2020 restrictions was significantly different from the corresponding time period in 2019 (p=0.03); however, the overall trend of new adult AL diagnoses in the 30 days prior and the 90 days following the March 2020 restrictions was not significantly different from the corresponding time period in 2019 (p= 0.77). Of note, many patients with AL reported symptoms that overlapped with those of COVID-19 including fatigue (40%), dyspnea (35%) and fever (22%). 35.1% of patients diagnosed with AL after restrictions had no characteristic symptoms of COVID-19, as compared to 12.5% of patients diagnosed with AL during this period in 2019 (Table 1). Discussion: These data suggest that new presentations of adult AL were delayed by COVID-19-related restrictions. Given the acuity of AL, this delay may have affected clinical outcomes. Interestingly, pediatric new AL cases did not decrease during this time period. The reasons are unclear, though parents appear to have remained willing to seek care for their children even during the uncertain days at the beginning of the pandemic, perhaps due to the media reporting that COVID-19 infection was less aggressive in young people. Given the possibility of additional lockdowns due to COVID-19 variants or new pandemics, these data highlight the importance of encouraging patients to seek care in the event of illness, screening patients for both infectious and non-infectious disease, and ensuring that routine medical care remains accessible. Figure 1 Figure 1. Disclosures Brown: Kura: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Takeda: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; KIte: Membership on an entity's Board of Directors or advisory committees. Webster: AmGen: Consultancy; Pfizer: Consultancy.
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Beaton, Rachael L., Suzanne Werner, Arik W. Mitschang, Gerard Lemson, Aniruddha Thakar, Anne-Marie Weijmans, Joel R. Brownstein, et al. "APOGEE-centric Ananke Simulations in a SciServer SQL Database." Research Notes of the AAS 6, no. 6 (June 15, 2022): 125. http://dx.doi.org/10.3847/2515-5172/ac7808.
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Abstract Modern galaxy simulations have reached the complexity required to create sophisticated mock catalogs. Ananke is a set of nine mock catalogs constructed from synthetic surveys of three Milky Way-like galaxies from the Latte suite of FIRE simulations. Ananke provides observed quantities for comparison with modern large-scale stellar surveys. In SDSS-IV DR17, mock catalogs for the Apache Point Galactic Evolution Experiment (APOGEE) were built from Ananke synthetic surveys as a Value-Added Catalog, but were only provided as large flat files (∼>10's GB). Here we announce an >40 Tb SQL database for nine APOGEE-specific mock catalogs and describe additions to the data model necessary for effective user queries. The catalogs can be accessed on the free, science platform, SciServer—supported by the Institute for Data Intensive Engineering and Science at the Johns Hopkins University (IDIES); SciServer supports server-side analysis with commonly used coding languages and tools.
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Graham, Elizabeth, Andrew L. Thorne-Lyman, Dave Love, Elizabeth Nussbaumer, Martin Bloem, Jillian Fry, Monica Pasqualino, and Jessica Fanzo. "Food-Based Dietary Guidelines Make Seafood a Priority, Sustainability an Afterthought." Current Developments in Nutrition 4, Supplement_2 (May 29, 2020): 139. http://dx.doi.org/10.1093/cdn/nzaa042_004.
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Abstract Objectives National food-based dietary guidelines (FBDGs) are adapted by governments reflecting their nation's food system and specific nutrition context, with varied approaches by country. Seafood is commonly included as one of many items in a “meat” or “animal-source” food group. It is currently unclear whether FBDG recommendations for seafood are achievable for the food supply, equitable for people, or sustainable for the planet. We seek to (1) Review the specific recommendations of national FBDGs related to seafood intake, quantifying the amount of seafood recommended for adults (2) Document the rationale for seafood consumption and mentions of sustainability (3) Estimate the supply required to meet recommendations and compare it with national fish production for each country. Methods The Food and Agriculture Organization (FAO) FBDG database was used to identify 92 countries with officially recognized FBDGs. Extracted data include (1) Recommended consumption of seafood (amounts, standard portion size, frequency of consumption and species/type) and (2) Mentions of sustainability. To calculate the fish supply needed to fulfill recommendations, conversions from cooked portions to raw (grams) seafood weights were used. These converted figures were then compared against that from FAO FishStat and the Sea Around Us database, and gaps/surpluses by country were identified. Mentions of sustainability were evaluated in terms of specific mention of fish vs. more generic recommendations. Results Out of 92 FBDGs, 77 mentioned seafood. Out of 40 high-income country's FBDG, 35 countries have a seafood servings per week recommendation, but only 23 provide serving size recommendations. Final presented results will illustrate the differences in the supply of seafood needed to meet recommended consumption levels. Sustainability was mentioned in eight guidelines independently of seafood and five additional mentioned seafood and sustainability together. Implications for sustainability of seafood production and global trade and nutritional status of populations will be discussed. Conclusions Seafood is systematically noted for healthy diets but rarely based on sustainable limits nor linked to sustainable goals. Funding Sources Johns Hopkins Bloomberg Distinguished Professor Fund, Johns Hopkins Center for a Livable Future.
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Fan, Xiayang, Bing Li, and Yuanyuan Xiu. "International Trade of Masks and COVID-19 Pandemic Containment." Journal of Environmental and Public Health 2022 (July 9, 2022): 1–13. http://dx.doi.org/10.1155/2022/2156950.
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This study analyzes the impact of the exports of China’s masks and other antivirus supplies on the people from the importing countries who are subject to the severe pandemic during the coronavirus disease 2019 (COVID-19) pandemic. Our main data include the COVID-19 cases data of countries around the world published by Johns Hopkins University and the data of China’s exports of masks or other antivirus supplies to these countries from the Chinese Customs Database. Using cross-sectional data of about 180 countries and multiple regression analysis, we find that the antivirus supplies from China have played an important role in combating the COVID-19 pandemic. Specifically, China’s masks are shipped to countries around the world, and these masks can improve the recovery rate and protect people against the COVID-19 pandemic. Our findings are relevant to global efforts in the COVID-19 pandemic containment.
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Radhakrishnan, Archana, Youngjee Choi, Zackary Berger, Craig Evan Pollack, Sydney Morss Dy, and Kimberly S. Peairs. "Implementation of a novel primary care-centered clinic for survivorship care." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 41. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.41.
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41 Background: Patients often face challenges in transitioning to the survivorship stage of cancer care and coordinating with primary care. Prior research has highlighted the uncertainty in who provides survivorship care, leaving patients “lost in transition”. Integrating primary care providers (PCP) into cancer care offers one potential solution. Expanding traditional PCP roles to participating throughout the cancer continuum and familiarizing PCPs with cancer patients’ needs can address this gap. We describe an innovative model of incorporating PCPs to delivering primary care to cancer survivors at a large academic institution. Methods: As one part of a plan to address an identified need for improving survivorship care for cancer patients at Johns Hopkins, PCPs and cancer survivorship care experts developed the Primary Care for Cancer Survivors clinic (PCCS) in 11/2015. The clinic receives referrals from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center and patients are seen for either a one-time consultation or can transition their primary care to the clinic. We also are creating a database of internal and external referrals to meet the specific needs identified by patients. We descriptively analyzed the utilization of PCCS from 11/2015 through 9/2016. Results: A total of 35 patients have been seen at PCCS. The average age of patients was 56.8 (SD 12.4) and 32 were female and 3 were male. 24 patients identified as white, 8 black, 1 Asian, and 2 others. Most patients transitioned their PC to the clinic (n = 30). The majority of patients had breast (n = 19) and colorectal cancer (n = 5); 10 patients had metastatic disease (3 have deceased). Commonly, referrals were made to physical therapy, including pelvic rehabilitation and lymphedema management, and nutrition counseling. Conclusions: Patients with a wide variety of cancers and at all stages of disease were seen for survivorship care in the PCCS clinic. Integrating nutrition care, psychosocial support, exercise programs, and palliative care were key early factors in meeting patients’ needs. Continuing to assess and meet survivors’ individual needs and build referral networks are important next steps in the development of the clinic.
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Ebrahimian, Shayan, Cory Lee, Zachary Tran, Sara Sakowitz, Syed Shahyan Bakhtiyar, Arjun Verma, Areti Tillou, Peyman Benharash, and Hanjoo Lee. "Association of frailty with outcomes of resection for colonic volvulus: A national analysis." PLOS ONE 17, no. 11 (November 8, 2022): e0276917. http://dx.doi.org/10.1371/journal.pone.0276917.
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Background With limited national studies available, we characterized the association of frailty with outcomes of surgical resection for colonic volvulus. Methods Adults with sigmoid or cecal volvulus undergoing non-elective colectomy were identified in the 2010–2019 Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins indicator which utilizes administrative codes. Multivariable models were developed to examine the association of frailty with in-hospital mortality, perioperative complications, stoma use, length of stay, hospitalization costs, non-home discharge, and 30-day non-elective readmissions. Results An estimated 66,767 patients underwent resection for colonic volvulus (Sigmoid: 39.6%; Cecal: 60.4%). Using the Johns Hopkins indicator, 30.3% of patients with sigmoid volvulus and 15.9% of those with cecal volvulus were considered frail. After adjustment, frail patients had higher risk of mortality compared to non-frail in both sigmoid (10.6% [95% CI 9.47–11.7] vs 5.7% [95% CI 5.2–6.2]) and cecal (10.4% [95% CI 9.2–11.6] vs 3.5% [95% CI 3.2–3.8]) volvulus cohorts. Frailty was associated with greater odds of acute venous thromboembolism occurrences (Sigmoid: AOR 1.50 [95% CI 1.18–1.94]; Cecal: AOR 2.0 [95% CI 1.50–2.72]), colostomy formation (Sigmoid: AOR 1.73 [95% CI 1.57–1.91]; Cecal: AOR 1.48 [95% CI 1.10–2.00]), non-home discharge (Sigmoid: AOR 1.97 [95% CI 1.77–2.20]; Cecal: AOR 2.56 [95% CI 2.27–2.89]), and 30-day readmission (Sigmoid: AOR 1.15 [95% CI 1.01–1.30]; Cecal: AOR 1.26 [95% CI 1.10–1.45]). Frailty was associated with incremental increase in length of stay (Sigmoid: +3.4 days [95% CI 2.8–3.9]; Cecal: +3.8 days [95% CI 3.3–4.4]) and costs (Sigmoid: +$7.5k [95% CI 5.9–9.1]; Cecal: +$12.1k [95% CI 10.1–14.1]). Conclusion Frailty, measured using a simplified administrative tool, is associated with significantly worse clinical and financial outcomes following non-elective resections for colonic volvulus. Standard assessment of frailty may aid risk-stratification, better inform shared-decision making, and guide healthcare teams in targeted resource allocation in this vulnerable patient population.
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Jurgutis, Arnoldas, Laura Kubiliutė, Arvydas Martinkėnas, Jelena Filipova, and Alfridas Bumblys. "Poliligotumo paplitimo dinamika ir ambulatorinių sveikatos priežiūros paslaugų suvartojimas klaipėdos apskrities kaimo ir miesto populiacijose." Sveikatos mokslai 23, no. 1 (January 5, 2013): 173–78. http://dx.doi.org/10.5200/sm-hs.2013.031.
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The aim of the study: to evaluate multi-morbidity dynamics, and needs of out-patient health care services in rural and urban areas in Klaipeda region during years 2009-2011.An observational retrospective study was performed using non-personalized population data from the Klaipeda TerritorialSickness Fund database. The research population included approximately 410 000 patients, enlisted to 44 primary health care institutions in Klaipeda region during the years 2009-2011. Johns Hopkins ACG system was used to group the population into six Resource Utilization Bands (RUB) which range from non-users (RUB 0) to a very high co-morbidity group (RUB 5). The study revealed that during the investigation period (2009-2011) prevalence of multi-morbidity (RUB 5) increased from 9.5/1000 to 9.6/1000 patients (statistically insignificant). In year 2009 and 2010 more multi-morbid patients were in urban population (p<0.05), but the trend of multi-morbidity prevalence in rural and urban populations was statistically insignificant. Patients from urban areas used more specialist (secondary and tertiary health care) services when compared with rural population.
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Martin-Barreiro, Carlos, John A. Ramirez-Figueroa, Xavier Cabezas, Víctor Leiva, and M. Purificación Galindo-Villardón. "Disjoint and Functional Principal Component Analysis for Infected Cases and Deaths Due to COVID-19 in South American Countries with Sensor-Related Data." Sensors 21, no. 12 (June 14, 2021): 4094. http://dx.doi.org/10.3390/s21124094.
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In this paper, we group South American countries based on the number of infected cases and deaths due to COVID-19. The countries considered are: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Peru, Paraguay, Uruguay, and Venezuela. The data used are collected from a database of Johns Hopkins University, an institution that is dedicated to sensing and monitoring the evolution of the COVID-19 pandemic. A statistical analysis, based on principal components with modern and recent techniques, is conducted. Initially, utilizing the correlation matrix, standard components and varimax rotations are calculated. Then, by using disjoint components and functional components, the countries are grouped. An algorithm that allows us to keep the principal component analysis updated with a sensor in the data warehouse is designed. As reported in the conclusions, this grouping changes depending on the number of components considered, the type of principal component (standard, disjoint or functional) and the variable to be considered (infected cases or deaths). The results obtained are compared to the k-means technique. The COVID-19 cases and their deaths vary in the different countries due to diverse reasons, as reported in the conclusions.
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Thai, Quoc-Anh, Shaan M. Raza, Gustavo Pradilla, and Rafael J. Tamargo. "Aneurysmal Rupture without Subarachnoid Hemorrhage: Case Series and Literature Review." Neurosurgery 57, no. 2 (August 1, 2005): 225–29. http://dx.doi.org/10.1227/01.neu.0000166535.59056.fa.
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ABSTRACT OBJECTIVE: Although an aneurysmal rupture typically presents on computed tomographic (CT) imaging as only subarachnoid hemorrhage (SAH), it may be associated with intraparenchymal hemorrhage (IPH), intraventricular hemorrhage (IVH), or subdural hemorrhage. On rare occasions, however, an aneurysmal rupture may present with IPH or IVH without SAH. METHODS: The Division of Cerebrovascular Neurosurgery at The Johns Hopkins Medical Institutions maintains a prospective database of all patients treated for intracranial aneurysms at this institution since 1991. Using this database, we identified patients with ruptured aneurysms who presented with IPH or IVH in the absence of SAH on CT imaging. RESULTS: Eight hundred twenty-two patients with radiographically documented ruptured aneurysms were admitted from January 1991 through June 2004. Of these, nine patients presented with IPH only, three with IPH and IVH, and one with IVH only, for a total of 13 cases. There were seven posterior communicating artery, four middle cerebral artery, one basilar apex, and one posterior cerebral artery aneurysms. The incidence of aneurysmal rupture with IPH and/or IVH without SAH is 1.6% CONCLUSION: Initial presentation of a ruptured aneurysm without SAH is rare and may have a multifactorial cause attributable to the timing of CT imaging, physiological parameters, or location of the aneurysm. Patients presenting with a head CT scan revealing IPH in the temporal lobe or with IVH should be considered for an urgent workup of a ruptured aneurysm, even in the absence of diffuse SAH.
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Ibrahim, Mohd S., Nurulhuda M. Hassan, Aniza A. Aziz, Harmy M. Yusoff, Nor K. Esa, Mokhairi Makhtar, Nor Iza A. Rahman, et al. "Clinical manifestations of COVID-19; what have we learned from the global database?" Bangladesh Journal of Medical Science 21, no. 3 (May 21, 2022): 702–9. http://dx.doi.org/10.3329/bjms.v21i3.59588.
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Background: There is a need to analyze a worldwide database of the coronavirus disease of 2019 (COVID-19) pandemic.This may prove valuable to facilitate better strategies and planning on prevention, screening, surveillance, early diagnosis, containment and treatments. Method: We extracted 14,259 case reports of COVID-19 dated 11th November 2019 to 18th March 2020 from Johns Hopkins University Repository Online Databaseof 58 countries. After extensive data preprocessing, a multi-disciplinary expert researcherthen conducted series of vetting to categorizefree-text description of symptoms into discreet standardizedcategories.Continuous variables were presented by using median and inter-quartile range whereas categorical variables were presented by frequency and percentage. Result: A total of 2191 cases (15.4%) were included for demographic analysis. The median age was46 years (IQR26 years) with 787 (35.9%) cases involved patients aged of 60 and above while patients less than18 years of age were reported in 79 (3.6%) cases. Majority of the patients were males (n=1227, 56.7%). There were a total of 20standardized categories ofCOVID-19symptoms.The most prevalent were fever (74.8%), nonproductive cough (42.2%), fatigue (13.1%), sore throat (12.8%) and shortness of breath (11.7%). Other symptoms with frequency of more than 1% were chest discomfort, nasal congestion, muscular pain, chills and rigors, headache, diarrhoea, expectoration and joint pain. Other more uncommon symptoms reported include loss of appetite, conjunctivitis, toothache and abdominal pain. Asymptomatic manisfestations were reported in 8 cases (1.0%).All population are susceptible to COVID-19 especially the older age group. There were 20 standardized categories of symptoms wherefever, non-productive cough, fatigue, sore throat and shortness of breath were the most commonly reported. Conclusion: Findings of this study contribute to a deeper understanding on COVID-19 and may prove useful for researchers to better-design screening and surveillance strategies via more accurate risk-prediction modelling. Bangladesh Journal of Medical Science Vol. 21 No. 03 July’22 Page: 702-709
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Hoover-Fong, Julie E., Adekemi Y. Alade, S. Shahrukh Hashmi, Jacqueline T. Hecht, Janet M. Legare, Mary Ellen Little, Chengxin Liu, et al. "Achondroplasia Natural History Study (CLARITY): a multicenter retrospective cohort study of achondroplasia in the United States." Genetics in Medicine 23, no. 8 (May 18, 2021): 1498–505. http://dx.doi.org/10.1038/s41436-021-01165-2.
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Abstract Purpose Achondroplasia is the most common short stature skeletal dysplasia (1:20,000–30,000), but the risk of adverse health outcomes from cardiovascular diseases, pain, poor function, excess weight, and sleep apnea is unclear. A multicenter retrospective natural history study was conducted to understand medical and surgical practices in achondroplasia. Methods Data from patients with achondroplasia evaluated by clinical geneticists at Johns Hopkins University, A.I. duPont Hospital for Children, McGovern Medical School UTHealth, and University of Wisconsin were populated into a REDCap database. All available retrospective medical records of anthropometry (length/height, weight, occipitofrontal circumference), surgery, polysomnography (PSG), and imaging (e.g., X-ray, magnetic resonance imaging) were included. Results Data from 1,374 patients (48.8% female; mean age 15.4 ± 13.9 years) constitute the primary achondroplasia cohort (PAC) with 496 subjects remaining clinically active and eligible for prospective studies. Within the PAC, 76.0% had a de novo FGFR3 pathologic variant and 1,094 (79.6%) had one or more achondroplasia-related surgeries. There are ≥37,000 anthropometry values, 1,631 PSGs and 10,727 imaging studies. Conclusion This is the largest multicenter achondroplasia natural history study, providing a vast array of medical information for use in caring for these patients. This well-phenotyped cohort is a reference population against which future medical and surgical interventions can be compared.
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Qiu, Yanrong, Kaihuai Liao, Yanting Zou, and Gengzhi Huang. "A Bibliometric Analysis on Research Regarding Residential Segregation and Health Based on CiteSpace." International Journal of Environmental Research and Public Health 19, no. 16 (August 15, 2022): 10069. http://dx.doi.org/10.3390/ijerph191610069.
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Considerable scholarly attention has been directed to the adverse health effects caused by residential segregation. We aimed to visualize the state-of-the-art residential segregation and health research to provide a reference for follow-up studies. Employing the CiteSpace software, we uncovered popular themes, research hotspots, and frontiers based on an analysis of 1211 English-language publications, including articles and reviews retrieved from the Web of Science Core Collection database from 1998 to 2022. The results revealed: (1) The Social Science & Medicine journal has published the most studies. Roland J. Thorpe, Thomas A. LaVeist, Darrell J. Gaskin, David R. Williams, and others are the leading scholars in residential segregation and health research. The University of Michigan, Columbia University, Harvard University, the Johns Hopkins School of Public Health, and the University of North Carolina play the most important role in current research. The U.S. is the main publishing country with significant academic influence. (2) Structural racism, COVID-19, mortality, multilevel modelling, and environmental justice are the top five topic clusters. (3) The research frontier of residential segregation and health has significantly shifted from focusing on community, poverty, infant mortality, and social class to residential environmental exposure, structural racism, and health care. We recommend strengthening comparative research on the health-related effects of residential segregation on minority groups in different socio-economic and cultural contexts.
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Sur, Daniel, Cristina Lungulescu, Irina-Ioana Puscariu, Simona Ruxandra Volovat, Madalina Preda, Elena Adriana Mateianu, and Cristian Virgil Lungulescu. "Immunotherapy-Related Publications in Colorectal Cancer: A Bibliometric Analysis." Healthcare 10, no. 1 (December 31, 2021): 75. http://dx.doi.org/10.3390/healthcare10010075.
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Patients with microsatellite-instability-high (MSI-H) or mismatched repair-deficient colorectal cancer (CRC) appear to be responsive to checkpoint inhibitors. This study aimed to assess research trends in CRC immunotherapy. Publication patterns of articles covering immunotherapies in CRC in the Web of Science Core Collection database were retrospectively examined using VOS viewer software (version 1.6.16) prior to 25 May 2021. Ultimately, 3977 records were identified that were published between 1975 and 2021, which received a total of 128,681 citations (an average of 32.36 citations per item), with a noticeable rise in 2014. The majority of articles were published in the US (35.8%), China (17.7%), and Germany (9.4%). Publications mainly originated from the Institut National de la Santé Et De La Recherche Medicale Inserm, followed by the University of Texas System and Harvard University; however, Johns Hopkins University received the most citations (18,666 for 69 publications). The Journal of Clinical Oncology issued the most publications (n = 146), while the most referenced item (7724 citations) was published in the New England Journal of Medicine in 2012. The most common keywords were associated with tumors (expression and microsatellite instability) or immune system components (t-cells/dendritic cells). The findings demonstrate the scientific community’s interest in the MSI-H subtype of colorectal tumors and how immunotherapy may be employed more successfully to treat metastatic CRC.
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GEETHA, DUVURU, PHILIP SEO, CARLA ELLIS, MICHAEL KUPERMAN, and STUART M. LEVINE. "Persistent or New Onset Microscopic Hematuria in Patients with Small Vessel Vasculitis in Remission: Findings on Renal Biopsy." Journal of Rheumatology 39, no. 7 (June 1, 2012): 1413–17. http://dx.doi.org/10.3899/jrheum.111608.
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Objective.Hematuria is considered a sign of active renal disease in patients with small-vessel vasculitis. In patients who are in apparent clinical remission, presence of persistent or new-onset microscopic hematuria may reflect active vasculitis, damage, or other glomerular pathology.Methods.We identified 74 patients from the Johns Hopkins Renal Pathology database between 1995 and 2009 with the diagnosis of pauciimmune glomerulonephritis (GN). Among them we identified 9 who were in clinical remission and underwent a renal biopsy for evaluation of persistent or new-onset hematuria.Results.Nine patients with small-vessel vasculitis, 8 antineutrophil cytoplasmic antibody (ANCA)-positive and 1 ANCA-negative, underwent a renal biopsy at variable time periods after remission of vasculitis (6 to 164 months) for persistent microscopic hematuria (n = 6) or new-onset microscopic hematuria (n = 3). All patients were in apparent clinical remission at the time of renal biopsy. Of the 3 patients presenting with new-onset hematuria, 2 had crescentic IgA nephropathy and 1 had healed crescentic pauciimmune GN. Of the 6 patients with persistent hematuria, 2 had arteriosclerosis, 2 had focal segmental glomerulosclerosis, and 2 had global and segmental glomerulosclerosis and healed crescentic GN, and none had active vasculitis.Conclusion.Microscopic hematuria in patients with renal vasculitis otherwise in remission could represent chronic glomerular injury from prior episode of vasculitis or may represent new glomerular pathology. Renal biopsy should be considered in these patients to guide therapy.
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Sareh, Sohail, Ramsey Ugarte, Vishal Dobaria, Joseph Hadaya, Joseph Sirody, John C. McCallum, Christian de Virgilio, and Peyman Benharash. "Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis." American Surgeon 86, no. 10 (October 2020): 1312–17. http://dx.doi.org/10.1177/0003134820964230.
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Frailty has been shown to portend worse outcomes in surgical patients. Our goal was to identify the impact of frailty on outcomes and resource utilization among patients undergoing minor lower extremity amputation in the United States. Using the Nationwide Readmission Database, we identified all adults undergoing a minor amputation between 2010 and 2015, and assessed 90-day outcomes, including readmission, reamputation, mortality, and cumulative hospitalization costs. Frailty was defined by International Classification of Diseases codes consistent with the ten frailty clusters as defined by the Johns Hopkins Adjusted Clinical Group System. Multivariable regression models were developed for risk adjustment. An estimated 302 798 patients (mean age = 61.8 years) were identified, of which 15.2% were categorized as Frail. Before adjustment, frailty was associated with increased rates of readmission (44% vs. 36%, P < .001) and in-hospital mortality (4% vs. 2%, P < .001). Frailty was also associated with increased cumulative costs of care ($39 417 vs. $27 244, P < .001). After risk adjustment, frailty remained an independent predictor of readmission (Adjusted odds ratio [AOR] 1.18, CI 1.14-1.23), in-hospital mortality (AOR 1.48, CI 1.34-1.65), and incremental costs (+$7 646, CI $6927-$8365). Frailty is an independent marker of worse outcomes following minor foot amputation, and may be utilized to direct quality improvement efforts.
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Herman, Joseph M., Michael J. Swartz, Charles C. Hsu, Jordan Winter, Timothy M. Pawlik, Elizabeth Sugar, Ray Robinson, et al. "Analysis of Fluorouracil-Based Adjuvant Chemotherapy and Radiation After Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreas: Results of a Large, Prospectively Collected Database at the Johns Hopkins Hospital." Journal of Clinical Oncology 26, no. 21 (July 20, 2008): 3503–10. http://dx.doi.org/10.1200/jco.2007.15.8469.
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PurposeTo examine the efficacy of adjuvant chemoradiotherapy after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PC) in patients undergoing resection at Johns Hopkins Hospital (JHH; Baltimore, MD).Patients and MethodsBetween August 30, 1993, and February 28, 2005, a total of 908 patients underwent PD for PC at JHH. A prospective database was reviewed to determine which patients received fluorouracil (FU) -based CRT. Excluded patients had metastatic disease, died 60 or fewer days after PD, received preoperative therapy, an experimental vaccine, adjuvant chemotherapy or radiation alone. The final cohort includes 616 patients.ResultsThe median follow-up was 17.8 months (interquartile range, 9.7 to 33.5 months). Overall median survival was 17.9 months (95% CI, 16.3 to 19.5 months). Groups were similar with respect to tumor size, nodal status, and margin status, but the CRT group was younger (P < .001), and less likely to present with a severe comorbid disease (P = .001). Patients with carcinomas larger than 3 cm (P = .001), grade 3 and 4 (P < .001), margin-positive resection (P = .001), and complications after surgery (P = .017) had poor long-term survival. Patients receiving CRT experienced an improved median (21.2 v 14.4 months; P < .001), 2-year (43.9% v 31.9%), and 5-year (20.1% v 15.4%) survival compared with no CRT. After controlling for high-risk features, CRT was still associated with improved survival (relative risk = 0.74; 95% CI, 0.62 to 0.89).ConclusionThese data suggest that adjuvant concurrent FU-based CRT significantly improves survival after PD for PC when compared with patients not receiving CRT. These data support the use of combined adjuvant CRT for PC.
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Oni, Tijesunimi, Manuela Plazas Montana, Mamie Myo Thant, Sarah Baghdadi, Jaanvi Mahesh, Sophie M. Lanzkron, and Rakhi P. Naik. "Risk of Pregnancy-Related Venous Thromboembolism in Black Women with Sickle Cell Trait." Blood 138, Supplement 1 (November 5, 2021): 2044. http://dx.doi.org/10.1182/blood-2021-148711.
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Abstract Background: Select inherited thrombophilias have been shown to potentiate the risk of venous thromboembolism (VTE) during pregnancy and the post-partum period. Sickle cell trait (SCT) is associated with an increased risk of VTE in the general Black population; however, prior studies investigating the risk of pregnancy-related VTE among women with SCT have been limited by an overall low number of VTE events. We, therefore, designed a retrospective cohort enriched for pregnancy-related VTE events among Black women at Johns Hopkins Hospital to address this question. Methods: We generated a cohort enriched for pregnancy-related VTE at Johns Hopkins or affiliate hospitals from 2009-2019 by using EPIC and an internal ObGyn database to identify Black women ≥18 years with at least 1 pregnancy encounter in addition to at least 1 VTE-related ICD-10 diagnosis code or comprehensive VTE-related search term. All charts were manually reviewed to confirm hemoglobinopathy status and to verify the presence or absence of a VTE event during pregnancy or 6 weeks post-partum. Individuals with sickle cell disease, history of VTE prior to index pregnancy, catheter-related or superficial vein thrombosis only, or unknown pregnancy VTE outcome were excluded. Results: A total of 418 women were included for analysis. The mean age at pregnancy was 30 years (range 18-48), and the prevalence of SCT was 6.7%, which is similar to the prevalence in the general Black American population. Thirty-seven women (8.9%) were confirmed to have a pregnancy-related VTE event. Among those with VTE, SCT carriers demonstrated a higher proportion of pulmonary embolism (PE), unusual vein thrombosis, and antepartum VTE events compared to women with HbAA (Table 1), though numbers were small. After adjusting for age, the risk of VTE was 2.9-fold (95% CI 1.1-7.9) higher among pregnant Black women with SCT compared to those without. Conclusions: In this enriched cohort, SCT was associated with an increased risk of pregnancy-related VTE among Black women. The pattern of pregnancy-related VTE was different in individuals with SCT compared to those with HbAA, with SCT demonstrating a higher proportion of PE and antepartum events. The higher risk of PE compared to isolated DVT is similar to the pattern observed in prior population-based studies of SCT. Because the prevalence of SCT is high and the overall risk of VTE in pregnancy is low, future studies are needed to determine whether routine thromboprophylaxis is warranted for select high-risk pregnant women with SCT. Figure 1 Figure 1. Disclosures Lanzkron: Novartis: Research Funding; CSL Behring: Research Funding; Shire: Research Funding; Novo Nordisk: Consultancy; Imara: Research Funding; Bluebird Bio: Consultancy; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; GBT: Research Funding. Naik: Rigel: Research Funding.
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Correa-Agudelo, Esteban, Tesfaye B. Mersha, Adam J. Branscum, Neil J. MacKinnon, and Diego F. Cuadros. "Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States." International Journal of Environmental Research and Public Health 18, no. 8 (April 12, 2021): 4021. http://dx.doi.org/10.3390/ijerph18084021.
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We characterized vulnerable populations located in areas at higher risk of COVID-19-related mortality and low critical healthcare capacity during the early stage of the epidemic in the United States. We analyze data obtained from a Johns Hopkins University COVID-19 database to assess the county-level spatial variation of COVID-19-related mortality risk during the early stage of the epidemic in relation to health determinants and health infrastructure. Overall, we identified highly populated and polluted areas, regional air hub areas, race minorities (non-white population), and Hispanic or Latino population with an increased risk of COVID-19-related death during the first phase of the epidemic. The 10 highest COVID-19 mortality risk areas in highly populated counties had on average a lower proportion of white population (48.0%) and higher proportions of black population (18.7%) and other races (33.3%) compared to the national averages of 83.0%, 9.1%, and 7.9%, respectively. The Hispanic and Latino population proportion was higher in these 10 counties (29.3%, compared to the national average of 9.3%). Counties with major air hubs had a 31% increase in mortality risk compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19-related mortality risk also had lower critical care capacity than the national average. The disparity in health and environmental risk factors might have exacerbated the COVID-19-related mortality risk in vulnerable groups during the early stage of the epidemic.
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Koo, Malcolm. "Systemic Lupus Erythematosus Research: A Bibliometric Analysis over a 50-Year Period." International Journal of Environmental Research and Public Health 18, no. 13 (July 2, 2021): 7095. http://dx.doi.org/10.3390/ijerph18137095.
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Bibliometric analysis is a well-established approach to quantitatively assess scholarly productivity. However, there have been few assessments of research productivity on systemic lupus erythematosus (SLE) to date. The aim of this study was to analyze global research productivity through original articles published in journals indexed by the Web of Science from 1971 to 2020. Bibliometric data was obtained from the Science Citation Index Expanded in the Web of Science Core Collection database. Only original articles published between 1971 and 2020 on SLE were included in the analysis. Over the 50-year period, publication production in SLE research has steadily increased with a mean annual growth rate of 8.0%. A total of 44,967 articles published in 3435 different journals were identified. The journal Lupus published the largest number of articles (n = 3371; 8.0%). A total of 148 countries and regions contributed to the articles. The global productivity ranking was led by the United States (n = 11,244, 25.0%), followed by China (n = 4893, 10.9%). A three-field plot showed that the Oklahoma Medical Research Foundation and the Johns Hopkins University together contributed 18.5% of all articles from the United States. A co-occurrence network analysis revealed five highly connected clusters of SLE research. In conclusion, this bibliometric analysis provided a comprehensive overview of the status of SLE research, which could enable a better understanding of the development in this field in the past 50 years.
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Sethia, Rishabh, Thomas F. Kerwin, and Gregory J. Wiet. "Performance Assessment for Mastoidectomy: State of the Art Review." Otolaryngology–Head and Neck Surgery 156, no. 1 (October 3, 2016): 61–69. http://dx.doi.org/10.1177/0194599816670886.
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Objective The aim of this report is to provide a review of the current literature for assessment of performance for mastoidectomy, to identify the current assessment tools available in the literature, and to summarize the evidence for their validity. Data Sources The MEDLINE database was accessed via PubMed. Review Methods Inclusion criteria consisted of English-language published articles that reported use of a mastoidectomy performance assessment tool. Studies ranged from 2007 to November 2015 and were divided into 2 groups: intraoperative assessments and those performed with simulation (cadaveric laboratory or virtual reality). Studies that contained specific reliability analyses were also highlighted. For each publication, validity evidence data were analyzed and interpreted according to conceptual definitions provided in a recent systematic review on the modern framework of validity evidence. Conclusions Twenty-three studies were identified that met our inclusion criteria for review, including 4 intraoperative objective assessment studies, 5 cadaveric studies, 10 virtual reality simulation studies, and 4 that used both cadaveric assessment and virtual reality. Implications for Practice A review of the literature revealed a wide variety of mastoidectomy assessment tools and varying levels of reliability and validity evidence. The assessment tool developed at Johns Hopkins possesses the most validity evidence of those reviewed. However, a number of agreed-on specific metrics could be integrated into a standardized assessment instrument to be used nationally. A universally agreed-on assessment tool will provide a means for developing standardized benchmarks for performing mastoid surgery.
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Camargo, Tiane, Mariane Camargo Priesnitz, Luciana Maria Fontanari Krause, and Marina Bezerra Da Silva. "Longitudinal Analysis Of Patents On Colorectal Cancer." International Journal for Innovation Education and Research 7, no. 11 (November 30, 2019): 1051–61. http://dx.doi.org/10.31686/ijier.vol7.iss11.1966.
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Colorectal cancer is epidemiologically relevant worldwide because it is the fourth leading cause of death from cancer. This study aims to present the mapping of technologies related to colorectal cancer. The search took place during the months of May and June 2019. The Leans database was used, which collects global patent information. The search occurred through the term "colorectal cancer", inserted in the title or abstract fields. Patents with publication date between January 1, 2000 and June 1, 2019 were selected. Only the patents granted and those filed were filtered (patent application; granted patent). A total of 6,850 patents were identified, of which 5,445 (79.48%) correspond to patents filed and 1,405 (20.51%) are patents granted in the period from 2000 to 2019. In 2000, 47 patents on colorectal cancer were published. The quantitative growth of technologies filed and granted was constant. In 2017 there was a total of 911 applications, indicating a growth of 1938.29% in relation to the year 2000. The first patent of the period was on the APC gene mutation, associated with colorectal cancer in families of Ashkenazi Jews, developed by Laken and collaborators (2000), and belongs to Johns Hopkins University, Baltimore, Maryland, in the United States. It can be concluded that the mapping of patents is important to trace a panorama of the world technological advance, as well as it can also be used as an instrument to identify scientific articles that cite patents developed in a given time space.
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Vasconcelos, Giovani L., Antônio M. S. Macêdo, Raydonal Ospina, Francisco A. G. Almeida, Gerson C. Duarte-Filho, Arthur A. Brum, and Inês C. L. Souza. "Modelling fatality curves of COVID-19 and the effectiveness of intervention strategies." PeerJ 8 (June 23, 2020): e9421. http://dx.doi.org/10.7717/peerj.9421.
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The main objective of the present article is twofold: first, to model the fatality curves of the COVID-19 disease, as represented by the cumulative number of deaths as a function of time; and second, to use the corresponding mathematical model to study the effectiveness of possible intervention strategies. We applied the Richards growth model (RGM) to the COVID-19 fatality curves from several countries, where we used the data from the Johns Hopkins University database up to May 8, 2020. Countries selected for analysis with the RGM were China, France, Germany, Iran, Italy, South Korea, and Spain. The RGM was shown to describe very well the fatality curves of China, which is in a late stage of the COVID-19 outbreak, as well as of the other above countries, which supposedly are in the middle or towards the end of the outbreak at the time of this writing. We also analysed the case of Brazil, which is in an initial sub-exponential growth regime, and so we used the generalised growth model which is more appropriate for such cases. An analytic formula for the efficiency of intervention strategies within the context of the RGM is derived. Our findings show that there is only a narrow window of opportunity, after the onset of the epidemic, during which effective countermeasures can be taken. We applied our intervention model to the COVID-19 fatality curve of Italy of the outbreak to illustrate the effect of several possible interventions.
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Buta, Brian, and Anne Newman. "Characterizing Physical Resilience in Older Adults: Insights From Secondary Analyses in Three Clinical Groups." Innovation in Aging 4, Supplement_1 (December 1, 2020): 752–53. http://dx.doi.org/10.1093/geroni/igaa057.2712.
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Abstract Resilience is defined as the ability of a physiologic system to recover from a stressor that has pushed the system into a state far from its original state of equilibrium. The level of resilience can be understood by whether or not the system’s essential identity and function are retained following the stressor. The study of resilience in older adults has potential to provide clinically relevant insights into our understanding of who will or will not recover when encountering a stressful medical procedure, especially those common to older patients. The main Study of Physical Resilience and Aging (SPRING) at Johns Hopkins includes prospective data collection of determinants, phenotypes, surrogates, dynamic stimulation measures, and outcomes of resiliency among older persons undergoing knee replacement surgery, or the initiation of hemodialysis, or bone marrow transplantation. SPRING also includes analyses of existing data sources to inform these prospective studies. This symposium briefly presents the conceptual framework and design of SPRING, and focuses on the results of secondary analyses from three existing data sets that mirror the ongoing stressor studies: FORCE-TKR (knee/joint replacement, N=9006), CHOICE (dialysis initiation, N=487), and a database of patients undergoing treatment for hematologic malignancies (bone marrow transplantation, N=1011). For each clinical population, we present results on phenotypic and/or biomarker trajectories, as well as the factors associated with resilience phenotypes and how these are predictive of clinical outcomes. These analyses display the utility of resilience phenotypes for predicting risk of adverse outcomes and complement the new data being collected in our main study.
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Brown, Jeremiah R., Meagan E. Stabler, Devin M. Parker, Luca Vricella, Sara Pasquali, JoAnna K. Leyenaar, Andrew R. Bohm, et al. "Biomarkers improve prediction of 30-day unplanned readmission or mortality after paediatric congenital heart surgery." Cardiology in the Young 29, no. 8 (July 10, 2019): 1051–56. http://dx.doi.org/10.1017/s1047951119001471.
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AbstractObjective:To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.Methods:Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.Results:Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).Conclusions:Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
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Pennock, Pamela E. "David Herzberg. Happy Pills: From Miltown to Prozac. Baltimore: Johns Hopkins Univerity Press, 2008.Andrea Tone. The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York: Basic Books, 2008." Social History of Alcohol and Drugs 24, no. 1 (January 2010): 59–61. http://dx.doi.org/10.1086/shad24010059.
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Setubi, Armel F., Esther Nakoya, Annie-Flore K. Tchougene, and Xavier-Gabriel Fopokam. "The Impact of COVID-19 Vaccine Coverage on Deaths Outcome in Africa, Subregional Differences and the need for a Renewed Multi-level Effort." Iberoamerican Journal of Medicine 4, no. 2 (March 17, 2022): 83–91. http://dx.doi.org/10.53986/ibjm.2022.0015.
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Introduction: SARS-CoV-2 continues to raise health and socio-economical concerns globally. The recent discovery of the B.1.1.529 (Omicron) variant with its critical mutations has heightened the debate about the need for a better global vaccination rollout to prevent the emergence of new SARS-CoV-2 strains. Optimizing vaccine rollout in Africa is crucial for the management of the pandemic and preventing the rise of new strains. To better direct efforts and interventions it is important to know what parts of the continent necessitate more attention. Material and Methods: 30 African countries were grouped in five geographical subregions, six countries for each subregion. Data on confirmed cases, doses administered, fully vaccinated, and deaths were extracted from the Johns Hopkins Coronavirus Resource Center database. The ANOVA test evaluated differences in means for these variables classified by subregions. The correlation test and the linear regression examined the relationship between these independent variables and total deaths. Results: There was a significant regional difference in confirmed cases (P<0.0001), and in fully vaccinated (P=0.01) across the five subregions. The overall model showed that there is a significant regional difference in the three variables’ effect on total deaths (P<0.0001). The linear regression indicated an association between the total number of deaths in relation to the confirmed cases, doses administered, and fully vaccinated (P<0.0001). Discussion: This study indicates that a relation exists between total deaths and the variables confirmed cases, doses administered, and fully vaccinated. More importantly, African countries grouped in geographical subregions perform differently in terms of vaccine rollout, and that offers insights for better and oriented interventions.
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Hadaya, Joseph, Zachary Tran, Yas Sanaiha, Esteban Aguayo, Vishal Dobaria, Marcella Calfon Press, and Peyman Benharash. "Impact of frailty on short term outcomes, resource use, and readmissions after transcatheter mitral valve repair: A national analysis." PLOS ONE 16, no. 11 (November 18, 2021): e0259863. http://dx.doi.org/10.1371/journal.pone.0259863.
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Background Treatment options for mitral regurgitation range from diuretic therapy, to surgical and interventional strategies including TMVR in high-risk surgical candidates. Frailty has been associated with inferior outcomes following hospitalizations for heart failure and in open cardiac surgery. Objective The purpose of the present study was to evaluate the impact of frailty on clinical outcomes and resource use following transcatheter mitral valve repair (TMVR). Methods Adults undergoing TMVR were identified using the 2016–2018 Nationwide Readmissions Database, and divided into Frail and Non-Frail groups. Frailty was defined using a derivative of the Johns Hopkins Adjusted Clinical Groups frailty indicator. Generalized linear models were used to assess the association of frailty with in-hospital mortality, complications, nonhome discharge, hospitalization costs, length of stay, and non-elective readmission at 90 days. Average marginal effects were used to quantify the impact of frailty on predicted mortality. Results Of 18,791 patients undergoing TMVR, 11.6% were considered frail. The observed mortality rate for the overall cohort was 2.2%. After adjustment, frailty was associated with increased odds of in-hospital mortality (AOR 1.8, 95% CI 1.2–2.6), corresponding to an absolute increase in risk of mortality of 1.1%. Frailty was associated with a 2.7-day (95% CI 2.1–3.2) increase in postoperative LOS, and $18,300 (95% CI 14,400–22,200) increment in hospitalization costs. Frail patients had greater odds (4.4, 95% CI 3.6–5.4) of nonhome discharge but similar odds of non-elective 90-day readmission. Conclusions Frailty is independently associated with inferior short-term clinical outcomes and greater resource use following TMVR. Inclusion of frailty into existing risk models may better inform choice of therapy and shared decision-making.
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Haji-Maghsoudi, Saiedeh, Majid Sadeghifar, Ghodratollah Roshanaei, and Hossein Mahjub. "The Impact of Control Measures and Holiday Seasons on Incidence and Mortality Rate of COVID-19 in Iran." Journal of Research in Health Sciences 20, no. 4 (December 6, 2020): e00500-e00500. http://dx.doi.org/10.34172/jrhs.2020.35.
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Background: Preventive measures on the COVID-19 pandemic is an effective way to control its spread. We aimed to investigate the effect of control measures and holiday seasons on the incidence and mortality rate of COVID-19 in Iran. Study design: An observational study. Methods: The daily data of confirmed new cases and deaths in Iran were taken from the Johns Hopkins University COVID-19 database. We calculated weekly data from 19 Feb to 6 Oct 2020. To estimate the impact of control measures and holiday seasons on the incidence rate of new cases and deaths, an autoregressive hidden Markov model (ARHMM) with two hidden states fitted the data. The hidden states of the fitted model can distinguish the peak period from the non-peak period. Results: The control measures with a delay of one-week and two-week had a decreasing effect on the new cases in the peak and non-peak periods, respectively (P=0.005). The holiday season with a two-week delay increased the total number of new cases in the peak periods (P=0.031). The peak period for the occurrence of COVID-19 was estimated at 3 weeks. In the peak period of mortality, the control measures with a three-week delay decreased the COVID-19 mortality (P=0.010). The expected duration of staying in the peak period of mortality was around 6 weeks. Conclusions: When an increasing trend was seen in the country, the control measures could decline the incidence and mortality related to COVID-19. Implementation of official restrictions on holiday seasons could prevent an upward trend of incidence for COVID-19 during the peak period.
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Webster, Jonathan A., Leo Luznik, Hua-Ling Tsai, Philip H. Imus, Amy E. DeZern, Keith W. Pratz, Mark J. Levis, et al. "Allogeneic transplantation for Ph+ acute lymphoblastic leukemia with posttransplantation cyclophosphamide." Blood Advances 4, no. 20 (October 20, 2020): 5078–88. http://dx.doi.org/10.1182/bloodadvances.2020002945.
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Abstract Allogeneic blood or marrow transplantation (alloBMT) is standard of care for adults with Philadelphia chromosome–positive acute lymphoblastic leukemia (Ph+ ALL) in first complete remission (CR1). The routine pretransplant and posttransplant use of tyrosine kinase inhibitors (TKIs) has dramatically improved outcomes, but the optimal conditioning regimen, donor type, and TKI remain undefined. The bone marrow transplant database at Johns Hopkins was queried for adult patients with de novo Ph+ ALL who received alloBMT using posttransplantation cyclophosphamide (PTCy) as a component of graft-versus-host disease (GVHD) prophylaxis from 2008 to 2018. Among transplants for Ph+ ALL, 69 (85%) were performed in CR1, and 12 (15%) were performed in second or greater remission (CR2+). The majority of transplants (58%) were HLA haploidentical. Nearly all patients (91.4%) initiated TKI posttransplant. For patients in CR1, the 5-year relapse-free survival (RFS) was 66%. The use of nonmyeloablative conditioning, absence of measurable residual disease (MRD) according to flow cytometry at transplant, and the use of dasatinib vs imatinib at diagnosis were associated with improved overall survival (OS) and RFS. Neither donor type nor recipient age ≥60 years affected RFS. When analyzing all transplants, alloBMT in CR1 (vs CR2+) and the absence of pretransplant MRD were associated with improved RFS. Most relapses were associated with the emergence of kinase domain mutations. The cumulative incidence of grade 3 to 4 acute GVHD at 1 year was 9%, and moderate to severe chronic GVHD at 2 years was 8%. Nonmyeloablative alloBMT with PTCy for Ph+ ALL in an MRD-negative CR1 after initial treatment with dasatinib yields favorable outcomes.
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Leonov, Alexander, Oleg Nagornov, and Sergey Tyuflin. "Modeling of Mechanisms of Wave Formation for COVID-19 Epidemic." Mathematics 11, no. 1 (December 29, 2022): 167. http://dx.doi.org/10.3390/math11010167.
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Two modifications with variable coefficients of the well-known SEIR model for epidemic development in the application to the modeling of the infection curves of COVID-19 are considered. The data for these models are information on the number of infections each day obtained from the Johns Hopkins Coronavirus Resource Center database. In our paper, we propose special methods based on Tikhonov regularization for models’ identification on the class of piecewise constant coefficients. In contrast to the model with constant coefficients, which cannot always accurately describe some of infection curves, the first model is able to approximate them for different countries with an accuracy of 2–8%. The second model considered in the article takes into account external sources of infection in the form of an inhomogeneous term in one of the model equations and is able to approximate the data with a slightly better accuracy of 2–4%. For the second model, we also consider the possibility of using other input data, namely the number of infected people per day. Such data are used to model infection curves for several waves of the COVID-19 epidemic, including part of the Omicron wave. Numerical experiments carried out for a number of countries show that the waves of external sources of infection found are ahead of the wave of infection by 10 or more days. At the same time, other piecewise constant coefficients of the model change relatively slowly. These models can be applied fairly reliably to approximate many waves of infection curves with high precision and can be used to identify external and hidden sources of infection. This is the advantage of our models.
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Ghanem, Paola, Joseph Murray, Melinda Hsu, David Ettinger, Josephine Feliciano, Patrick Forde, Christine Hann, et al. "296 A comprehensive clinical and genomic characterization of long-term responders receiving immune checkpoint blockade for metastatic non-small cell lung cancer." Journal for ImmunoTherapy of Cancer 9, Suppl 2 (November 2021): A320. http://dx.doi.org/10.1136/jitc-2021-sitc2021.296.
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BackgroundFive-year survival analyses of patients receiving immune checkpoint inhibitors (ICIs) for metastatic non-small cell lung cancer (NSCLC) have demonstrated continued clinical benefit compared to chemotherapy.1 2 Our study aims at understanding and defining the unique clinical and genomic underpinnings of a durable response to ICI in advanced NSCLC.MethodsWe conducted a retrospective case-control study using information abstracted from a Johns Hopkins IRB-approved database of NSCLC patients treated with an ICI-containing regimen. We defined long-term responders (LR) as patients who have achieved an overall survival (OS) of at least 3 years. We identified a comparison arm (C) of patients whose OS was less than a year. Univariate and multivariate analyses of the clinical and molecular characteristics were conducted between the LR and C groups using IBM Statistical Package for Social Sciences version 25.ResultsA cohort of 89 patients were included; 41 patients as LR and 48 as C. Mean duration of ICI was 21.6 months and 3.5 months for LR and C, respectively. On univariate analysis, there was no statistically significant difference in age, sex, race, histology or treatment characteristics between arms. However, ECOG performance status (PS) of 2 (p=0.011) and evidence of liver metastases were independently associated with a shorter response to ICI (p=0.012). Increased PD-L1 expression was significantly associated with likelihood of LR status (OR= 1.018, p=0.027). 65.9% (n=27) of LR patients developed an immune-related adverse event (irAE), of which 20 patients required discontinuation of therapy. In the C arm, 16.7% (n=8) of patients developed an irAE of which 4 patients required discontinuation. On multivariate analysis, including age, sex, race, ethnicity, smoking status, BMI, PS, liver and brain metastases as well as the presence of common oncogenic molecular alterations, PS of < 2 was statistically significantly associated with an OS ≥3 years (OR=16.7, p= 0.017). Molecular profiling was completed in 53 patients (LR=29, C=24). Common molecular alterations were identified in 28 out of 53 patients (LR=16, C=12). KRAS mutation was assessed in 34 patients (LR=16, C=18) and was associated with LR status versus C (Fisher’s exact test value p=0.0386).ConclusionsOur retrospective study assessing multiple clinical and molecular determinants of patients with long-term response to immune checkpoint blockade, identified PS at diagnosis and KRAS mutation status to be associated with long-term response. Current efforts are ongoing to interrogate more deeply molecular features of LR, as well as their relationship to clinical aspects of a sustained benefit from ICI in NSCLC.ReferencesBorghaei H, et al. Five-year outcomes from the randomized, phase III trials checkMate 017 and 057: nivolumab versus docetaxel in previously treated non–small-cell lung cancer. Journal of Clinical Oncology 0, JCO.20.01605, doi:10.1200/jco.20.01605 (2021)Reck M, et al. Five-year outcomes with pembrolizumab versus chemotherapy for metastatic non-small-cell lung cancer with PD-L1 tumor proportion score ≥ 50. J Clin Oncol 39:2339–2349, doi:10.1200/jco.21.00174 (2021)Ethics ApprovalThe retrospective case-control study has obtained ethics approval from the Institutional Review Board at the Johns Hopkins School of Medicine.
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Shahrestani, Shane, Nolan Brown, Julian Gendreau, and Gabriel Zada. "SURG-41. MACHINE LEARNING PREDICTS THE INFLUENCE OF FRAILTY ON THE CLINICAL MANAGEMENT OF NEUROFIBROMATOSIS TYPE 1: A MIXED-EFFECTS MODELING STUDY USING THE NATIONWIDE READMISSIONS DATABASE." Neuro-Oncology 24, Supplement_7 (November 1, 2022): vii260. http://dx.doi.org/10.1093/neuonc/noac209.1005.
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Abstract Recent literature has highlighted the association of frailty with significantly higher rates of morbidity and mortality in patients with CNS neoplasms. However, there is a paucity of research regarding the effects of frailty as it relates to neurocutaneous disorders, namely NF1. In this study we evaluated the role of frailty in NF1 patients and compared its predictive utility to that of the Elixhauser Comorbidity Index (ECI). Namely, we used the Nationwide Readmissions Database from 2016 to 2017 to select for those patients with a diagnosis of NF1 who underwent neurosurgical resection of an intracranial tumor. Patient frailty was queried through the use of the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining indicator. ECI scores were collected for these patients for measurement of comorbidities. Propensity score matching was performed for age, sex, ECI, insurance type, median income by ZIP code, and yielded 60 frail and 60 non-frail patients. Receiver operating characteristic (ROC) curves were created for relevant complications, including mortality, non-routine discharge, cost in top quartile, length of stay [LOS] in top quartile, and readmission, using comorbidity indices as predictor values. The area under the curve (AUC) of each ROC served as a proxy for model performance. Following matching of the groups, frail patients still had an increased average hospital cost ($85,441.67±$59,201.09) compared to non-frail patients ($49,321.77±$50,705.80)(p=0.010). Similar trends were also found for LOS between frail (23.1±14.2 days) and non-frail patients (10.7±10.5 days)(p=0.0020). For each complication of interest, ROC curves plotted showed frailty performing as well as ECI and the combination of Frailty+ECI (p >0.05). Frailty+ECI (AUC: 0.924)outperformed the model using only ECI (AUC: 0.842, p=0.027). These findings suggest that frailty is as efficacious as ECI in predicting complications including mortality, non-routine discharge, readmission, and high cost in patients who underwent resection of intracranial lesions associated with NF1.
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Marrone, Kristen, Jiajia Zhang, Josephine Louella Feliciano, Patrick M. Forde, Christine L. Hann, Ronan Joseph Kelly, David S. Ettinger, et al. "Immune checkpoint inhibition in elderly non-small cell lung cancer patients." Journal of Clinical Oncology 36, no. 5_suppl (February 10, 2018): 137. http://dx.doi.org/10.1200/jco.2018.36.5_suppl.137.
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137 Background: Age-related changes in the immune system are dynamic and complex. Use of anti-PD-1/PD-L1 therapy in advanced non-small cell lung cancer (NSCLC), with median patient age of 71, has rapidly become standard of care. Understanding how senescent remodeling of the immune system may affect outcomes with anti-PD-1/PD-L1 therapy is poorly understood. Although trends in phase III clinical trials of anti-PD-1/PD-L1 therapy suggest a potential lack of clinical efficacy in patients ≥ 75 years of age, the proportion of treated patients in this age range was low. The use and outcomes of these agents in this population treated in clinical practice has not been reported. Methods: The Johns Hopkins Upper Aerodigestive Diseases Malignancies and Immunotherapy Database was queried for all patients treated with anti-PD-1/PD-L1 agents as part of a clinical trial or as standard of care, from 2007 to 2017. Patients ≥ 75 years old were assessed for demographic, response, toxicity and survival data as of September 2017. Results: Of the 275 patients in our database, 144 NSCLC patients had received an anti-PD-1/PD-L1 agent alone or in combination with another immune checkpoint inhibitor (52%). Of those 144 patients, 20 patients were ≥ 75 years of age at time of anti-PD-1/PD-L1 therapy initiation (14%), with a median age of 81 years (range: 75-90). Of those 20 patients, 19 received anti-PD1 monotherapy (95%); 1 patient received combination anti-PD-1 with an anti-KIR. 14 of the 20 patients (70%) received therapy in second line or beyond; 6 received anti-PD-1 monotherapy as first line therapy. No significant difference in median survival for 1st line or ≥2nd line group was seen (12.7m vs 15.3m; p = 0.92). A median of 5.5 doses were administered (range 1-24). Reasons for off therapy included: progressive NSCLC (9; 45%), consent withdrawal (1; 5%) and adverse events (6; 30%) with 4 patients who remain on therapy (20%). Conclusions: Anti-PD-1/PD-L1 therapy is now standard of care in NSCLC, a malignancy of the elderly. Translational evaluation of how immune system senescent remodeling affects outcome and toxicity is needed. Further analysis of immunologic and genomic data will be presented and compared to the overall population in our database at the time of presentation.
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Mesfin, Addisu, Mostafa H. El Dafrawy, Amit Jain, Hamid Hassanzadeh, John P. Kostuik, Mesfin A. Lemma, and Khaled M. Kebaish. "Surgical outcomes of long spinal fusions for scoliosis in adult patients with rheumatoid arthritis." Journal of Neurosurgery: Spine 22, no. 4 (April 2015): 367–73. http://dx.doi.org/10.3171/2014.10.spine14365.
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OBJECT In this study, the authors compared outcomes and complications in patients with and without rheumatoid arthritis (RA) who underwent surgery for spinal deformity. METHODS The authors searched the Johns Hopkins University database for patients with RA (Group RA) and without RA (Group NoRA) who underwent long spinal fusion for scoliosis by 3 surgeons at 1 institution from 2000 through 2012. Groups RA and NoRA each had 14 patients who were well matched with regard to sex (13 women/1 man and 12 women/2 men, respectively), age (mean 66.3 years [range 40.5–81.9 years] and 67.6 years [range 51–81 years]), follow-up duration (mean 35.4 months [range 1–87 months] and 44 months [range 24–51 months]), and number of primary (8 and 8) and revision (6 and 6) surgeries. Surgical outcomes, invasiveness scores, and complications were compared between the groups using the nonpaired Student t-test (p < 0.05). RESULTS For Groups RA and NoRA, there were no significant differences in the average number of levels fused (10.6 [range 9–17] vs 10.3 [range 7–17], respectively; p = 0.4), the average estimated blood loss (2892 ml [range 1300–5000 ml] vs 3100 ml [range 1700–5200 ml]; p = 0.73), or the average invasiveness score (35.5 [range 21–51] vs 34.5 [range 23–58]; p = 0.8). However, in Group RA, the number of major complications was significantly higher (23 vs 11; p < 0.001), the number of secondary procedures was significantly higher (14 vs 6; p < 0.001), and the number of minor complications was significantly lower (4 vs 12; p < 0.001) than those in Group NoRA. CONCLUSIONS Long spinal fusion in patients with RA is associated with higher rates of major complications and secondary procedures than in patients without RA.
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Balaji, Aanika, Jiajia Zhang, and Jarushka Naidoo. "4401 Incidence, management, and outcomes of immune-related adverse events (irAEs): an analysis of a multidisciplinary toxicity team for cancer immunotherapy related irAEs." Journal of Clinical and Translational Science 4, s1 (June 2020): 73. http://dx.doi.org/10.1017/cts.2020.239.
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OBJECTIVES/GOALS: This study aims to assess the outcomes of a new virtual multidisciplinary immune-related toxicity (IR-tox) team implemented at Johns Hopkins Hospital. In particular, to understand if the IR-tox team’s input reduced the number of inpatient hospitalizations for irAEs for referred patients. METHODS/STUDY POPULATION: Since August 2017, nearly 250 patient referrals to the IR-tox team have been created and stored in an electronic database. Through retrospective chart review, hospitalization and irAE management data will be collected for these patients to assess whether rates for suspected irAEs have decreased. These rates will be compared against historical controls. We will assess the features of hospitalized patients, their immunotherapy regimens, and management to identify high-risk groups who may require early intervention. Additionally, we aim to understand what patient features are associated with IR-Tox team referral and subsequent hospitalization. RESULTS/ANTICIPATED RESULTS: The IR-tox team provided a new multidisciplinary channel to help physicians diagnose and manage complex irAEs. The goal of the team was the reduce the number of irAE-related hospitalizations as, historically, 85% of high-grade irAEs have required hospitalization. A clinically meaningful reduction is defined as lowering the hospitalization rate to 75%. Planned analyses includes calculating the hospitalization rate, using descriptive statistics to summarize patient features, multivariate analyses to understand features associated with both IR-Tox team referral and hospitalization, and computing the relative risk reduction to assess the efficacy of subspecialist referral implementation. DISCUSSION/SIGNIFICANCE OF IMPACT: IrAEs are challenging to diagnose and treat. They contribute to a notable proportion of hospitalizations in those treated with immunotherapy. With expanding use of immunotherapy, widespread implementations of IR-Tox teams may help reduce hospitalizations and costs associated with care for irAEs.
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Tai, Katherine Yuxi, Jad El Abiad, Carol Morris, Adam Levin, and Mark Christopher Markowski. "Efficacy of receptor tyrosine kinase inhibitors (RTKIs) and immunotherapy (PD-1/PD-L1) for treatment of osseous vs. soft tissue metastases of renal cell carcinoma (RCC)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e16094-e16094. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e16094.
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e16094 Background: Checkpoint inhibitors and RTKIs have changed the standard of care in metastatic RCC. However, anecdotal evidence suggests these therapies may be less effective for treating bone metastases than soft tissue metastases. Our study aimed to evaluate this potential difference in treatment response between osseous and visceral metastases. Methods: Our institutional Cancer Registry database was queried for RCC patients treated at Johns Hopkins Hospital from 1997-2017 (n = 2212). 68 patients were identified with measurable bone and soft tissue metastatic disease who were treated with RTKIs and/or PD-1 inhibitors over the study period. The extent of metastasis was quantified at the time of therapy initiation, 3 mos., 6 mos., and 1 yr. Changes in disease status from baseline were categorized as partial response (PR), complete response (CR), stable (S), mixed (M) or progressive disease (PD) based upon RECISTv1.1 and MDA criteria for soft tissue and bone metastases, respectively. These categories were further organized into Controlled Disease (PR, CR, S) or Evidence of Progression (M, PD) in order to generate a generalized linear effects model with visceral response as the independent variable and bone response as the dependent. Results: Visceral response correlates with bone response at 3 (p = 0.005, n = 76) and 6 months (p = 0.017, n = 48). At 3 mos. 46 patients were treated with RTKI and 30 with PD-1. At 6 mos. 31 patients were treated with RTKI and 17 with PD-1. Of patients with controlled visceral disease, only 19% had progression in bone at 3 mos. (32% at 6 mos.). Of patients with progression in soft tissue, 42% had controlled bone disease at 3 mos. (41% at 6 mos.). Conclusions: This suggests that, contrary to anecdotal reports of a divergent response to biologic therapy, osseous metastases do not appear to respond worse than soft tissue metastases upon treatment with these agents. [Table: see text]
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Kaplunenko, Yaryna. "Psychological First Aid: Experience of International Organizations." Psychology and Psychosocial Interventions 3 (March 3, 2021): 36–41. http://dx.doi.org/10.18523/2617-2348.2020.3.36-41.
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The turbulent shocks of recent decades—man-made and natural disasters, political instability, pandemics, and military conflicts—highlight the need for psychosocial support for victims. To plan and train those who can provide it, a number of guidelines have been developed at the global and national levels, within international medical organizations that can minimize the impact of the crisis and start the recovery process. The article presents the definition of the concept of Psychological First Aid (PFA), describes the key aspects, structure, time limits, and principles of activity; a description of three leading models of first psychological assistance in the context of international medical organizations: the World Health Organization (WHO), Doctors Without Borders (Médecins Sans Frontières, MSF), and the Johns Hopkins Center for Public Health Preparedness, USA. The RAPID model of first aid and key competencies for psychosocial workers involved in helping victims are described. The principles and techniques of PFA meet four basic standards: they are based on the results of research of risks and resilience after injury; they are practical and suitable for use in the “field”; they meet the age characteristics of development; they take into account cultural differences. The chronogram of mental reactions to a stressful event and the provision of PFA to victims within international medical organizations is divided into four phases which should be taken into account in the organization of psychosocial support. The RAPID model is based on five aspects designed to alleviate acute stress: Rapport and Reflective listening; Assessment of needs; Prioritization; Intervention; Disposition. If control over bodily reactions, emotions, and thoughts in the victims are restored, the narrative of the event is completed and accompanied by appropriate reactions, emotions are accepted, self-esteem and self-confidence are restored, and a sense of the future appears, we can say that the person has successfully adapted to the traumatic event and is ready to move on.
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Shahrestani, Shane, Nolan J. Brown, Ben A. Strickland, Joshua Bakhsheshian, Seyed Mohammadreza Ghodsi, Tasha Nasrollahi, Michela Borrelli, Julian Gendreau, Jacob J. Ruzevick, and Gabriel Zada. "The role of frailty in the clinical management of neurofibromatosis type 1: a mixed-effects modeling study using the Nationwide Readmissions Database." Neurosurgical Focus 52, no. 5 (May 2022): E3. http://dx.doi.org/10.3171/2022.2.focus21782.
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OBJECTIVE Frailty embodies a state of increased medical vulnerability that is most often secondary to age-associated decline. Recent literature has highlighted the role of frailty and its association with significantly higher rates of morbidity and mortality in patients with CNS neoplasms. There is a paucity of research regarding the effects of frailty as it relates to neurocutaneous disorders, namely, neurofibromatosis type 1 (NF1). In this study, the authors evaluated the role of frailty in patients with NF1 and compared its predictive usefulness against the Elixhauser Comorbidity Index (ECI). METHODS Publicly available 2016–2017 data from the Nationwide Readmissions Database was used to identify patients with a diagnosis of NF1 who underwent neurosurgical resection of an intracranial tumor. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining indicator. ECI scores were collected in patients for quantitative measurement of comorbidities. Propensity score matching was performed for age, sex, ECI, insurance type, and median income by zip code, which yielded 60 frail and 60 nonfrail patients. Receiver operating characteristic (ROC) curves were created for complications, including mortality, nonroutine discharge, financial costs, length of stay (LOS), and readmissions while using comorbidity indices as predictor values. The area under the curve (AUC) of each ROC served as a proxy for model performance. RESULTS After propensity matching of the groups, frail patients had an increased mean ± SD hospital cost ($85,441.67 ± $59,201.09) compared with nonfrail patients ($49,321.77 ± $50,705.80) (p = 0.010). Similar trends were also found in LOS between frail (23.1 ± 14.2 days) and nonfrail (10.7 ± 10.5 days) patients (p = 0.0020). For each complication of interest, ROC curves revealed that frailty scores, ECI scores, and a combination of frailty+ECI were similarly accurate predictors of variables (p > 0.05). Frailty+ECI (AUC 0.929) outperformed using only ECI for the variable of increased LOS (AUC 0.833) (p = 0.013). When considering 1-year readmission, frailty (AUC 0.642) was outperformed by both models using ECI (AUC 0.725, p = 0.039) and frailty+ECI (AUC 0.734, p = 0.038). CONCLUSIONS These findings suggest that frailty and ECI are useful in predicting key complications, including mortality, nonroutine discharge, readmission, LOS, and higher costs in NF1 patients undergoing intracranial tumor resection. Consideration of a patient’s frailty status is pertinent to guide appropriate inpatient management as well as resource allocation and discharge planning.
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Hadaya, Joseph, Yas Sanaiha, Catherine Juillard, and Peyman Benharash. "Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States." PLOS ONE 16, no. 7 (July 23, 2021): e0255122. http://dx.doi.org/10.1371/journal.pone.0255122.
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Background Frailty has been recognized as an independent risk factor for inferior outcomes, but its effect on emergency general surgery (EGS) is understudied. Objective The purpose of the present study was to define the impact of frailty on risk-adjusted mortality, non-home discharge, and readmission following EGS operations. Methods Adults undergoing appendectomy, cholecystectomy, small bowel resection, large bowel resection, repair of perforated ulcer, or laparotomy within two days of an urgent admission were identified in the 2016–2017 Nationwide Readmissions Database. Frailty was defined using diagnosis codes corresponding to the Johns Hopkins Adjusted Clinical Groups frailty indicator. Multivariable regression was used to study in-hospital mortality and non-home discharge by operation, and Kaplan Meier analysis to study freedom from unplanned readmission at up to 90-days follow-up. Results Among 655,817 patients, 11.9% were considered frail. Frail patients most commonly underwent large bowel resection (37.3%) and cholecystectomy (29.2%). After adjustment, frail patients had higher mortality rates for all operations compared to nonfrail, including those most commonly performed (11.9% [95% CI 11.4–12.5%] vs 6.0% [95% CI 5.8–6.3%] for large bowel resection; 2.3% [95% CI 2.0–2.6%] vs 0.2% [95% CI 0.2–0.2%] for cholecystectomy). Adjusted non-home discharge rates were higher for frail compared to nonfrail patients following all operations, including large bowel resection (68.1% [95% CI 67.1–69.0%] vs 25.9% [95% CI 25.2–26.5%]) and cholecystectomy (33.7% [95% CI 32.7–34.7%] vs 2.9% [95% CI 2.8–3.0%]). Adjusted hospitalization costs were nearly twice as high for frail patients. On Kaplan-Meier analysis, frail patients had greater unplanned readmissions (log rank P<0.001), with 1 in 4 rehospitalized within 90 days. Conclusions Frail patients have inferior clinical outcomes and greater resource use following EGS, with the greatest absolute differences following complex operations. Simple frailty assessments may inform expectations, identify patients at risk of poor outcomes, and guide the need for more intensive postoperative care.
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Ledet, Elisa, Emmanuel S. Antonarakis, Colin Pritchard, William B. Isaacs, and A. Oliver Sartor. "Germline heterozygous BLM mutations and prostate cancer risk." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 321. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.321.
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321 Background: The BLM gene encodes a RecQ DNA helicase that is involved in homologous recombination. Biallelic BLM inactivation leads to Bloom syndrome, an inherited genetic disorder marked by chromosomal instability and multiple cancer susceptibilities. Conflicting studies have suggested that heterozygous BLM mutation carriers may have an increased risk of various cancers. Here we explored the role of germline pathogenic BLM mutations in prostate cancer. Methods: Prostate cancer patients with heterozygous BLM mutations were assembled from Tulane Cancer Center (TCC), Johns Hopkins Hospital (JHH) and University of Washington (UW). BLM germline mutations were identified either through commercial germline testing (Invitae), the UW-BROCA panel, or whole-exome sequencing. Corresponding tumor tissue was analyzed by DNA sequencing for somatic alterations. Population level control data were obtained from the Genome Aggregation Database (gnomAD). Results: 6 BLM germline carriers were identified among 985 advanced prostate cancer case; 2/295 TCC patients, 2/172 JHH patients, and 2/518 UW patients. Overall, pathogenic BLM mutations were detected in 0.609% (6/985) of prostate cancer cases. All mutations were loss-of-function truncating lesions (splicing or nonsense alterations). No Ashkenazi BLM mutations were observed. The population frequency of pathogenic or likely pathogenic BLM alterations detected in gnomAD was 0.025% (31/124,589). Compared to gnomAD controls, the relative risk of BLM mutations in prostate cancer patients was 24.3 (95% CI 10.2 to 58.2; P < 0.0001). One family had a pathogenic splice variant in BLM that cosegregated with disease in three of three cases with lethal/high risk prostate cancer. Tumor DNA sequencing was possible in 5 of 6 BLM carriers; no case demonstrated LOH or additional somatic BLM mutations. Interestingly, 2/5 cases on tumor sequencing also had bi-allelic BRCA2 inactivation. Conclusions: Germline BLM mutations may play a role in prostate cancer risk. Given the role of BLM in chromosomal stability and evidence of concurrent BRCA2 inactivation in a subset of cases, larger cohorts and functional analyses will be critical for better understanding the role of BLM in prostate cancer.
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Shankar, Bairavi, Jiajia Zhang, Durrant Barasa, Patrick M. Forde, Josephine Louella Feliciano, Kristen Marrone, Ronan Joseph Kelly, et al. "Multisystem immune-related adverse events from anti-PD-1/PD-L1 in patients with lung cancer: Incidence, clinical patterns, management, and outcomes." Journal of Clinical Oncology 37, no. 8_suppl (March 10, 2019): 84. http://dx.doi.org/10.1200/jco.2019.37.8_suppl.84.
Full textAbstract:
84 Background: Anti-PD-1/PD-L1 immune checkpoint inhibitors (ICIs) for cancer may cause immune-related adverse events (irAEs). Large clinical trials and meta-analyses have identified the spectrum of single organ-specific irAEs that may occur with these agents. However, patients treated with these agents may develop irAEs involving multiple organ systems. The prevalence and clinical patterns of multi-system irAEs and their management have yet to be elucidated. Methods: Patients with lung cancer treated with either PD-1/PD-L1 monotherapy or PD-1/PD-L1-based combinations at Johns Hopkins Hospital were identified. Clinical, radiologic and pathologic data were stored in an IRB-approved database. irAEs were identified through retrospective chart review and confirmed by a multidisciplinary team. Multi-system irAEs were defined as irAEs in +1 organ system. Patients with multi-system irAEs, their clinical patterns, management and outcomes were identified. Results: 319 patients were identified (NSCLC: 299, 93.7%; SCLC: 20, 6.3%) and received treatment with either PD-1/PD-L1 monotherapy (197, 61.8%) or combinations (122, 38.2%: + chemotherapy = 42; +immunotherapy = 41; +other = 39). Of these patients, 77 (24.1%) developed 1 irAE, and 16 (5%) developed multi-system irAEs (2 irAEs: 14; 3 irAEs: 2). The most common irAEs were pneumonitis (42, 13.2%), dermatitis (11, 3.4%), and hypothyroidism (9, 2.8%). The most common multi-system irAEs was pneumonitis/dermatitis (3, 3.9%). Patients who developed dermatitis, colitis, or hypothyroidism were most likely to develop multi-system irAEs (all p < 0.05). Management and outcome data for individual and multi-system irAEs will be presented. Conclusions: Patients treated with ICIs may develop multi-system irAEs. In the first report of this clinical entity, we identified that 5% of lung cancer patients treated with PD-1/PD-L1 developed multi-system irAEs, and that those who developed dermatitis, colitis, or hypothyroidism were most likely to develop multi-system events. These data have important implications for interdisciplinary patient management in the era of cancer immunotherapy.