Medicine and Health Sciences Commons^™

Optimizing Initial Screening For Colorectal Cancer Detection With Adherence Behavior, Sarah Yini Gao, Yan He, Ruijie Zhang, Zhichao Zheng, Shao Wei Lam Lam, Emile Tan

Research Collection Lee Kong Chian School Of Business

Background: Two-stage screening programs are widely adopted for early colorectal cancer (CRC) detection, where individuals receiving positive outcomes in the first-stage (initial) test are recommended to undergo a second-stage test (colonoscopy) for further diagnosis. Methods: We study the initial test design—the selection of cutoffs for reporting test outcomes—to balance the trade-off between screening effectiveness (i.e., CRC and polyp detection) and efficiency (i.e., colonoscopy costs), incorporating the fact that not all individuals follow up with a colonoscopy after receiving positive outcomes. We integrate the Bayesian persuasion framework with information avoidance to model this problem and apply it to Singapore's CRC screening …

Unbound Bilirubin And Risk Of Severe Neurodevelopmental Impairment In Extremely Low Birthweight Newborns, Cody C Arnold, Ivana Maric, Ronald J Wong, Jon E Tyson, David K Stevenson

Faculty, Staff and Student Publications

Background: Unbound bilirubin (UB) was measured on day 5 ± 1 in 1101 ELBW newborns in the Aggressive vs Conservative Phototherapy randomized controlled trial. We accessed this dataset to quantify the UB-mediated risk of severe neurodevelopmental impairment (sNDI) in extremely low birthweight (ELBW) newborns.

Methods: UB levels were standardized within laboratories as z-score percentiles. A dichotomous UB exposure variable was based on sharply increased risk of sNDI at the 85th percentile (UBz>85th). Targeted maximum likelihood estimation with ensemble machine learning (TMLE + ML) and logistic regression (LR) were used to estimate sNDI risk attributable to UBz>85th.

Results: UB …

Utility Of Whole-Slide Imaging For Rapid Evaluation Of Thyroid Fna: A Multireader Prospective Study, Mohammed S Ahmed, Dianna Klippel-Almaraz, Sara E Amin, Gloria H Sura, Uma Rani Kundu, Wendong Yu, Jogn M Stewart, Qiong Gan, Savitri Krishnamurthy

Faculty, Staff and Student Publications

Background: Rapid on-site evaluation (ROSE) of thyroid fine-needle aspiration biopsy (FNAB) improves diagnostic adequacy and facilitates ancillary molecular testing. In this prospective, multireader study, the authors evaluated the feasibility of using whole-slide images (WSIs) for ROSE to determine specimen adequacy and preliminary categorization (according to The Bethesda System for Reporting Thyroid Cytopathology [Bethesda]) of image-guided thyroid FNABs compared with conventional light-microscopic (LM) examination of the same specimens in a referral cancer center.

Methods: The authors evaluated 98 ultrasound-guided thyroid FNAB cases. Smears were stained with Papanicolaou and Diff-Quik and were scanned at ×20 magnification using a Leica Aperio CS2 scanner. …

Examining The Impact Of Area Deprivation On Endovascular Stroke Therapy Access, Joseph N Samaha, Ngoc Mai Le, Emmanuel C Ebirim, Rania Abdelkhaleq, Sergio A Salazar Marioni, Muhammad Bilal Tariq, Ananya Iyyangar, Anjan Nagesh, Hussain Azeem, Arash Niktabe, Sunil A Sheth

Faculty, Staff and Student Publications

Background: Equitable access to health care is heavily affected by socioeconomic factors. However, the effects of such disparities in accessing life-saving treatments remain incompletely characterized. Here we explore the impact of disparities on access to endovascular treatments for large vessel occlusion acute ischemic stroke.

Methods: From our prospectively maintained multihospital registry, we identified patients with large vessel occlusion acute ischemic stroke from January 2019-June 2020. Patient addresses and zip codes were matched to census-tract level area deprivation index (ADI) scores that were obtained from Neighborhood Atlas. ADI is a validated neighborhood-level measure that uses variables such as income, education, and …

Does Stem Design Affect Primary Stability Of Splined Tapered Fluted Stems? A Biomechanical Cadaver Study, Shuyang Han, Daniel C Mascarenhas, Camryn A Pletka, Jonathan E Gold, Sabir K Ismaily, Matthew Cao, Matthew W Brewer, Robert Frangie, Philip C Noble, David Rodriguez-Quintana

Faculty, Staff and Student Publications

Background: Tapered fluted stems are an excellent solution for revision hip arthroplasty following periprosthetic fractures. However, existing implant designs differ in terms of the number of splines, taper angle, and cross-sectional design, and there is a lack of knowledge on the biomechanical effect of these design variations. Therefore, the objective of this study was to compare the primary stability of two representative stem designs and the extent and distribution of stem-bone contact in a periprosthetic fracture model. It was hypothesized that a greater number of splines would lead to greater stability.

Methods: There were six pairs of cadaver femora included …

Role Of Exchange Proteins Directly Activated By Camp Signaling In Vascular Remodeling, Xiaodong Cheng, Hua Liu, Wenbo Zhang, Wenli Yang, Fang Mei

Faculty, Staff and Student Publications

Vascular remodeling is a complex process involving the coordinated actions of multiple cellular signaling pathways in various cell types, leading to structural and functional changes in blood vessels. These changes can be adaptive, as in wound healing, or maladaptive, as seen in chronic vascular diseases such as atherosclerosis, hypertension, and retinopathy. Exchange proteins directly activated by cAMP (EPACs) are key players in cAMP-mediated cell signaling, distinct from the more traditionally studied protein kinase A pathway. EPAC proteins are guanine nucleotide exchange factors for the small G proteins Rap1 and Rap2. Recent studies have also revealed noncanonical functions of EPAC1 involving …

Intraoperative Pain Management Shared Decision Making With A Patient With A Complex Pain And Mental Health History: A Case Report, Aubrey Samost-Williams, Jerry Wang, Casey Horani, Eric J Thomas, Robert J Volk

Faculty, Staff and Student Publications

Shared decision making is where the patient and clinician come together to decide on the appropriate course of action in a patient's medical care based on their goals, preferences, and values. Typically, decision making in anesthesia remains more paternalistic, with clinicians making decisions for patients. However, there is a move towards embracing a shared decision making model. We present here a case report of using shared decision making principles to develop a pain and anxiety management plan in a patient with chronic pain and a complex mental health history. A 40-year-old female with a history of chronic pain, bipolar disorder, …

Ixekizumab Improves Signs, Symptoms, And Quality Of Life In Patients With Axial Spondyloarthritis Irrespective Of Symptom Duration, Victoria Navarro-Compán, John D Reveille, Proton Rahman, José A Maldonado-Cocco, Marina Magrey, Rebecca Bolce, Tommaso Panni, Andris Kronbergs, Martin Rudwaleit

Faculty, Staff and Student Publications

Introduction: The objective of this study was to assess treatment response to ixekizumab, an interleukin-17A antagonist, by shorter versus longer symptom duration (< 5 years vs. ≥ 5 years) in patients with radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA) up to 52 weeks.

Methods: This post hoc analysis used data from three randomized, placebo-controlled trials including patients with r-axSpA from COAST-V [biologic disease-modifying anti-rheumatic drug (bDMARD)-naïve] and COAST-W (tumor necrosis factor inhibitor-experienced) and patients with nr-axSpA from COAST-X (bDMARD-naïve). Patients received ixekizumab (80 mg every 2 or 4 weeks) or placebo through Week 16 and ixekizumab to Week 52. Assessments included the Assessment in SpondyloArthritis international Society 40% improvement (ASAS40) and Axial Spondyloarthritis Disease Activity Score (ASDAS) low disease activity …

Code Telestroke: On The Necessity Of Formalizing Training In Telestroke For Future Vascular Neurologists, Amanda L Jagolino-Cole, Christina Mijalski, Amy Katherine Guzik

Faculty, Staff and Student Publications

No abstract provided.

Beyond Frequency Of Use: Exploring Additional Metrics For Quantifying Cocaine Use And Their Relation To Life Functioning And Treatment Outcome, Samantha Ellis, Rachel Sun, Angela Heads, Jin Ho Yoon, Heather Webber, Joy Schmitz, Margaret Wardle

Faculty, Staff and Student Publications

Background: Frequency of use - the number of days of use - is the most common metric for quantifying cocaine use and the most common target of treatment. However, frequency may not capture all important aspects of cocaine use. This study examined how other aspects of cocaine use (typical amount spent, variability etc.) relate to life functioning and cocaine use disorder (CUD) treatment outcomes.

Method: This is a secondary analysis of 3 clinical trials for CUD, N = 207 for the life functioning analysis and N = 173 for the outcomes analysis. Eight metrics of use were calculated from baseline …

Is Our Assessment Of Bias In Academics … Biased?, Sunil A Sheth, Ashutosh P Jadhav, Tudor G Jovin

Faculty, Staff and Student Publications

No abstract provided.

Endovascular Thrombectomy Technique Optimization: A Svin Registry Analysis, Joseph N Samaha, Ritesh Bajaj, Ngoc Mai Le, Hussain Azeem, Ananya S Iyyangar, Diogo C Haussen, Jay Dolia, Jonathan A Grossberg, Mahmoud Mohammaden, Ameer E Hassan, Wondwossen G Tekle, Samantha E Miller, Hamzah M Saei, Santiago Ortega-Gutierrez, Milagros Galecio-Castillo, Jorge Cespedes, Nashwa Abdelhakim, Preethi Reddi, Johanna T Fifi, Shahram Majidi, Manisha Koneru, Linda Zhang, Jane Khalife, Mohamad Abdalkader, Thanh N Nguyen, Guilherme Dabus, Italo Linfante, Brijesh P Mehta, Joy Sessa, Mohammad A Jumaa, Rebecca M Sugg, Guillermo Linares, Alhamza R Al-Bayati, David S Liebeskind, Raul G Nogueira, Sunil A Sheth

Faculty, Staff and Student Publications

Background: Achieving excellent recanalization (Modified Thrombolysis in Cerebral Infarction 2c/3) in fewer attempts improves clinical outcomes. Previous studies suggest that switching techniques after a failed first pass may enhance reperfusion rates. This study evaluates whether technique switching improves subsequent reperfusion in a large multicenter registry.

Methods: We analyzed retrospective and prospective SVIN (Society of Vascular and Interventional Neurology) registry data from 12 US centers (October 2014-December 2021) involving endovascular therapy for M1 or internal carotid artery-terminus (ICA-T) occlusions. Patients with at least 2 recanalization attempts using stent retriever (SR), contact aspiration (CA), or combined technique (CT) were included. Primary outcome …

Immune Impacts Of Fire Smoke Exposure, Mary M Johnson, Abhinav Kaushik, Olivia A Kline, Eric M Smith, Xiaoying Zhou, Yagiz Pat, Laura Buergi, Juan Aguilera, Shifaa Alkotob, Elisabeth M Simonin, Alberto Favaro, Miguel Couto, Oscar Bennett, R Sharon Chinthrajah, Ella Parsons, Mohamed Shamji, Marshall Burke, Melissa Bondy, Mubeccel Akdis, Cezmi A Akdis, Kari C Nadeau

Faculty, Staff and Student Publications

Fire smoke exposure has become a global health concern and is associated with increased morbidity and mortality. There is a lack of understanding of the specific immune mechanisms involved in smoke exposure with preventative and targeted interventions needed. After exposure to fire smoke, which includes PM2.5, toxic metals and per- and polyfluoroalkyl substances (PFAS), epidemiology-based studies demonstrate increases in respiratory (e.g. asthma exacerbations), cardiac (e.g. myocardial infarctions, arrhythmias), neurologic (e.g. stroke) and pregnancy-related (e.g. low birthweight, premature births) outcomes. However, mechanistic studies exploring how smoke exposure disrupts cellular homeostasis are lacking. Therefore, we collected blood from smoke-exposed individuals (n …

Outcomes In Systemic Sclerosis-Associated Interstitial Lung Disease Based On Serological Profiles With A Focus On Anticentromere And Anti-Rna Polymerase Iii Antibodies, Elizabeth R Volkmann, Shervin Assassi, Christopher P Denton, Rozeta Simonovska, Steven Sambevski, Margarida Alves, Elana J Bernstein

Faculty, Staff and Student Publications

Objective: We aimed to compare the progression of systemic sclerosis-associated interstitial lung disease (SSc-ILD) based on serological status.

Methods: In a posthoc analysis of the SENSCIS trial (nintedanib vs placebo in SSc-ILD; ClinicalTrials.gov: NCT02597933), we analyzed the rate of decline in forced vital capacity (FVC) over 52 weeks in 3 subsets: (1) positive for anticentromere antibody (ACA), (2) positive for anti-RNA polymerase III antibody (ARA), and (3) negative for ACA, ARA, and antitopoisomerase I antibody (ATA).

Results: Among study participants who underwent baseline serological evaluation, 32/549 (5.8%) were ACA positive, 98/528 (18.6%) were ARA positive, and 127/526 (24.1%) were …

Variability Between Full-Length Lateral Radiographs And Standard Short Knee Radiographs When Evaluating Posterior Tibial Slope In Revision Acl Patients: Response, Alfred A Mansour

Faculty, Staff and Student Publications

No abstract provided.

Diminished Long-Term Vaccine Antibody Persistence In Perinatally Youth Living With Hiv On Cart, German A Contreras, Morouge M Alramadhan, Gloria P Heresi, Abel Castro, James R Murphy

Faculty, Staff and Student Publications

No abstract provided.

Evaluation Of A Theoretical And Experiential Training Programme For Allied Healthcare Providers To Prescribe Exercise Among Persons With Multiple Sclerosis: A Co-Designed Effectiveness-Implementation Study, Yvonne C. Learmonth, Georgios Mavropalias, Kym Wansbrough

Research outputs 2022 to 2026

Background: Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting and prescribing this effective treatment. We implemented an online evidence-based educational programme and evaluated the effect, acceptability, appropriateness, and feasibility of the programme in improving HCP confidence, knowledge, and attitudes towards remote exercise prescription to persons with MS. Methods: Physiotherapists and exercise physiologists were recruited and received the educational programme (online theory and 16-week experience of prescribing …

Appreciating The Lotp Study: Further Refining Scope-Of-Practice Analysis., Eduardo Rivé Lockwood

Ambulatory and Primary Care Articles

No abstract provided.

Accordance And Conflict Between Religious And Scientific Precautions Against Covid-19 In 27 Societies, T. Samore, D.M.T. Fessler, A.M. Sparks, C. Holbrook, L. Aarøe, C.G. Baeza, M.T. Barbato, P. Barclay, R. Berniūnas, J. Contreras-Garduño, B. Costa-Neves, M.P. Grazioso, P. Elmas, P. Fedor, Li, Norman P., R. Fernández-Morales, L. Garcia-Marques, P. Giraldo-Perez, P. Gul, F. Habacht

Research Collection School of Social Sciences

Meaning-making systems underlie perceptions of the efficacy of threat-mitigating behaviors. Religion and science both offer threat mitigation, yet these meaning-making systems are often considered incompatible. Do such epistemological conflicts swamp the desire to employ diverse precautions against threats? Or do individuals—particularly individuals who are highly reactive to threats—hedge their bets by using multiple threat-mitigating practices despite their potential epistemological incompatibility? Complicating this question, perceptions of conflict between religion and science likely vary across cultures; likewise, pragmatic features of precautions prescribed by some religions make them incompatible with some scientifically-based precautions. The COVID-19 pandemic elicited diverse precautions thus providing an opportunity …

Disseminated Herpes Zoster Encephalitis Induced By Low-Dose Corticosteroids., Natalie Soliman, Britney Le, Kelly M Kimball, Dawn Merritt

Ambulatory and Primary Care Articles

No abstract provided.

Integrating Accelerated Medical School Programs With Extended Family Medicine Residency Programs: Innovations In Length Of Training., Bryce A Ringwald, Jennifer L Middleton, Stephen Auciello

Medical Education Articles

No abstract provided.

Testing Measurement Invariance Of Self-Report And Interview Measures Of Borderline Personality Disorder Across Ethnic/Racial Groups Of Inpatient Adolescents, Salome Vanwoerden, Eric D Sumlin, Veronica Mclaren, Carla Sharp

Faculty, Staff and Student Publications

Borderline personality disorder (BPD) is a severe mental disorder that onsets during adolescence. Research examining sociocontextual differences in BPD presentation is limited and provides mixed results, highlighting the importance of further investigation and the evaluation of potential measure effects. This study assessed measurement invariance of two widely used adolescent measures (self-report—the Borderline Personality Features Scale for Children and semistructured interview—Childhood Interview of Diagnostic and Statistical Manual Borderline Personality Disorder) of BPD. Comparisons across inpatient psychiatric settings (n = 521 at a private inpatient; n = 378 at a public inpatient) and across self-identified Hispanic/Latinx (n = 193), Black …

Launching! To Adulthood, A Culturally Adapted Treatment Program For Military-Dependent Autistic Young Adults And Their Military Parents: A Pilot Study, Antonio F Pagán, Jordan Kenemore, Maj Mark Ahlenius, Linda Hernandez, Stephen Armstrong, Katherine A Loveland, Ron Acierno

Faculty, Staff and Student Publications

Introduction: Military-dependent young adults (17-25 years old) with autism spectrum disorder (ASD) face significant barriers to accessing services during their transition to adulthood. Frequent relocations, disrupted care, and limited ASD-tailored interventions exacerbate the challenges for these families, with many young adults experiencing a "service cliff" as they age out of pediatric care and school-based services. Addressing these gaps is critical, particularly given the rising mental health challenges and executive dysfunction in this population. This study evaluates the preliminary efficacy of an adapted telehealth intervention, the Military-Launching! program, designed to support young adults with ASD and their military families.

Materials and …

¡Iniciando! La Adultez (Launching! To Adulthood): A Cultural And Linguistic Adaptation Of A Group Therapy Program For Young Adults With Autism Spectrum Disorder Transitioning To Adulthood, Antonio F Pagán, Katherine A Loveland, Ron Acierno

Faculty, Staff and Student Publications

Objectives: The transition to adulthood is a formative period of development for young adults with autism spectrum disorder (ASD), as they work towards independence and managing adult responsibilities. While evidence-based interventions have been developed for young adults with ASD, they have rarely been culturally and linguistically adapted for the Latino, Spanish-speaking community. The present study provided initial feasibility and acceptability data for a therapy program for Latino young adults with ASD transitioning to adulthood and their Spanish-speaking parents.

Methods: The culturally adapted and translated intervention, called ¡Iniciando! la Adultez, is a 10-week therapy program based on an evidence-based treatment ( …

Automated Instance Segmentation And Registration Of Spinal Vertebrae From Ct-Scans With An Improved 3d U-Net Neural Network And Corner Point Registration, James Hill, Muhammad Rizwan Khokher, Chuong Nguyen, Matt Adcock, Ron Li, Stuart Anderson, Thomas Morrell, Tim Diprose, Olivier Salvado, Dadong Wang, Guan K. Tay

Research outputs 2022 to 2026

This paper presents a rapid and robust approach for 3D volumetric segmentation, labelling, and registration of human spinal vertebrae from CT scans using an optimised and improved 3D U-Net neural network architecture. The network is designed by incorporating residual and dense interconnections, followed by an extensive evaluation of different network setups by optimising the network components like activation functions, optimisers, and pooling operations. In addition, the network architecture is optimised for varying numbers of convolution layers per block and U-Net levels with fixed and cascading numbers of filters. For 3D virtual reality visualisation, the segmentation output of the improved 3D …

Work While You Learn: Evaluating A Paid Employment Model For Postgraduate Midwifery Students In Diverse Contexts, Sadie Geraghty, Kirstie Balding, Sheena Mcchlery, Sarah Hay

Research outputs 2022 to 2026

Background: Postgraduate midwifery student employment models are lacking robust evaluation of how the paid employment model serves as a workforce strategy in Western Australia. Aim: The aim of this study was to evaluate a paid employment model for postgraduate midwifery students, that was implemented in metropolitan, rural, and regional areas in a Western Australian context. Methods: A convergent parallel design collected both quantitative and qualitative data. This study used a survey design with quantitative and qualitative questions within a well-established process evaluation framework. Results: All midwifery students reported benefits of the paid model of employment, which included financial stability while …

A Pestel-Swot Matrix Analysis Of Sustainable Aquafeed Sector: A Case Of Kenya's Fish Feed Sector, Esther Magondu, Lucy Njogu, Kevin Ouko, Jimmy B. Mboya, Mavindu Muthoka, Rodrigue Yossa, Jonathan Munguti, Mary A. Opiyo, Menaga Meenakshisundaram, Chrysantus M. Tanga, Kevin Obiero

All Peer-Reviewed Publications

Global demand for seafood continues to rise, positioning aquaculture as a critical pathway for improving food security, nutrition, and rural livelihoods. In Kenya, the aquaculture sector remains constrained by structural challenges, with fish feed accounting for 60%–70% of production costs and limiting sectoral growth, particularly for smallholder farmers. This review critically analyzes Kenya's fish feed sector through an integrated PESTEL-SWOT framework, drawing on a scoping review of academic literature, policy reports, and sector development studies. The paper highlights key macro-level drivers, including fragmented policy implementation, dependency on imported ingredients, and climate-related risks, and connects these with internal industry dynamics such …

Assessing The Impact Of Tungiasis On Children's Quality Of Life In Kenya, Lynne Elson, Berrick Otieno, Abneel K. Matharu, Naomi Riithi, Esther Jebor Chongwo, Francis Mutebi, Hermann Feldmeier, Jürgen Krücken, Ulrike Fillinger, Amina Abubakar

All Peer-Reviewed Publications

Tungiasis is a neglected tropical skin disease caused by the sand flea, Tunga penetrans which penetrates the skin causing considerable pain and itching. In this cross-sectional study we aimed to assess its impact on the quality of life of school children in Kenya. School pupils (198) aged 8-14 years with tungiasis were randomly selected and interviewed using a tungiasis-specific quality of life instrument (TLQI). The caregivers of each infected pupil and 199 randomly selected caregivers of uninfected pupils were interviewed using the proxy KIDscreen52 to assess their child's general health-related quality of life (HR-QoL). Generalized linear models were used to …

The Outcomes Of A Structured Bowel Management Programme On Childhood Functional Constipation: A Retrospective Pre – Post Intervention Study, Gunilla Flankegård, Peter Wide, Evalotte Mörelius

Research outputs 2022 to 2026

Aim: The purpose of this study was to describe and evaluate the effectiveness of a six-month structured bowel management programme (SBMP) for children with therapy-resistant functional constipation (FC). Method: A retrospective review of medical records with a pre-post design was conducted at an outpatient paediatric clinic in Sweden. Bowel frequency, stool form, faecal incontinence, and abdominal pain were compared before and after the intervention. Predictive factors for successful discharge and duration of care through long-term follow-up were calculated. Results: Of the 142 children enrolled in the SBMP, 132 completed the programme. Despite previous FC therapy resistance, the SBMP achieved a …

The Luminos Project: Co-Designing A Short-Stay Suicide Support Model For Young People, Aims Hansen, Samantha Speirs, Kirsten Panton, Jacinta Freeman, Zrinka Highfield, Kieren Marshall, Eleanor Tighe, Laura Hemming, Bep Uink, Francis Mitrou, Vu Vuong, Ashleigh Lin

Research outputs 2022 to 2026

Background: Suicide was the leading cause of death among young Australians aged 15–24 years old in 2023, with 392 lives lost. The continued high numbers of youth suicide demand urgent exploration of alternative approaches to suicide intervention in this population. The United Kingdom-based suicide service Maytree offers an innovative short-term stay for people experiencing suicidal thoughts. Grounded by the Maytree model-of-care, the aim of the current study was to co-design a short-stay service responsive to the specific needs of suicidal young people. Methods: Semi-structured and focus group interviews with young people (n = 38), caregivers (n = 11) and key …