Johnson, Matthew P.

Background Failure of conventional imaging to detect pancreatic ductal adenocarcinoma (PDA) at its visually occult pre-diagnostic stage is a primary barrier to improving its otherwise poor rate of survival. Objective To develop and validate the Radiomics-based Early Detection MODel (REDMOD), an AI framework to identify subvisual radiomic signatures of pre-diagnostic PDA on standard-of-care CT. Designs REDMOD was trained on a multi-institutional cohort (n=969; 156 pre-diagnostic, 813 control) and tested on an independent set (n=493; 63 pre-diagnostic, 430 control), simulating a low prevalence (~1:6) early detection paradigm. The fully automated framework couples AI-driven segmentation with a heterogeneous ensemble architecture trained on a 40-feature radiomic signature derived from Synthetic Minority Over-sampling Technique (SMOTE)-balanced data. A tunable Youden Index-optimised classification threshold enables performance calibration without retraining. Validation included direct comparison with radiologists, longitudinal test–retest analysis and external specificity validation across two independent cohorts (n=539 and n=80). Results On an independent test set (n=493), REDMOD identified occult PDA (AUC 0.82; 73.0% sensitivity) at a median 475-day lead time. This represented nearly twofold higher sensitivity than radiologists (38.9%; p<0.001), which grew to nearly threefold (68.0% vs 23.0%) at >24 months lead time. REDMOD showed strong longitudinal stability (90–92% concordance) and generalisable specificity across multi-institutional (81.3%; n=539) and public (87.5%; n=80) datasets. Mechanistic analyses confirmed predictive power derived principally from multi-scale wavelet-filtered textural features (90% of selected signature), which outperformed unfiltered features (AUC 0.82 vs 0.74; p=0.007) in capturing subvisual architectural disruptions. Conclusions REDMOD is an automated, mechanistically grounded, longitudinally stable, externally validated AI that surpasses radiologists for PDA detection at its visually occult pre-diagnostic stage. These attributes position it for prospective validation in high-risk cohorts, a necessary step towards shifting the paradigm from late-stage symptomatic diagnosis to proactive pre-clinical interception.

An ST-segment elevation myocardial infarction is a life-threatening condition within the spectrum of acute coronary syndrome, with well-recognized implications for short-term and long-term health outcomes. Retrospective review of our institutional electronic health records identified patterns of inaccurate acute coronary syndrome diagnostic assignment, including the presence of erroneous ST-segment elevation myocardial infarction diagnoses in discharge records. Such erroneous diagnoses in the durable health record may increase risk to patients through inadequate risk assessment and inappropriate follow-up care. Misapplication of a shortcut in our electronic health record system for rapidly ordering emergent cases was identified as a potential cause of the quality gap. To address this issue, a nurse-led quality improvement project was developed by using the define, measure, analyze, improve, and control framework. The project intervention decreased the percentage of patients with erroneous diagnoses from 24% to 7% and marginally improved nursing staff satisfaction. Our project successfully addressed an institutional quality concern. Our goal of reducing erroneous discharge diagnoses with minimal disruption to our existing practice was achieved, positively affecting our patients. Including both nurse leaders and frontline health care workers ensured the success of our project.

The COVID-19 pandemic caused unprecedented disruption of social networks and negatively impacted social determinants of health (SDoH, e.g., economic stability, mental health, health care access) among African Americans. The FAITH! (Fostering African-American Improvement in Total Health!) Program, an academic-community partnership with African American churches, pivoted to pandemic-related impacts on health behaviors of African Americans. This exploratory, cross-sectional study examined associations between multilevel factors influencing difficulty maintaining a healthy lifestyle during the early pandemic phase, including mental/emotional health and COVID-19 hardships (e.g., job/food/housing insecurity, paying utilities). An online survey was distributed via FAITH!-affiliated churches and social media. Logistic regression (odds ratios [ORs], adjusted for age/gender) and associated 95% confidence intervals [CIs]) examined associations between difficulty maintaining a healthy lifestyle and multilevel factors. Greater than half of respondents reported difficulty maintaining a healthy lifestyle (N = 169, 54% [91/169]). Adjusted odds of having difficulty maintaining a healthy lifestyle were greater for those reporting mental/emotional health issues (high-stress OR 4.0; 95% CI [1.9,8.9], p < .001); occasional symptoms of depression (OR 3.7; 95% CI [01.9,7.7]; p < .001); anger (OR 2.5; 95% CI [1.2,5.4]; p = .044), and anxiety (OR 2.8; 95% CI [1.4,6.0]; p = .008)). COVID-19 hardships of job insecurity (OR 1.4.; 95% CI [0.7, 2,8]; p = .015), difficulty paying rent (OR 4.4; 95% CI [2.1,9.9]; p < .001) or difficulty paying for food/utilities (OR 5.4; 95% CI [2.6,11.7]; p < .001) were associated with difficulty maintaining a healthy lifestyle. Our study revealed the negative impact of mental/emotional health and COVID-19 hardships on maintaining a healthy lifestyle among African Americans. This could inform SDoH-focused lifestyle interventions during future public health crises.

Background Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease program with structured lifestyle interventions to reduce morbidity and mortality. The American Heart Association cardiovascular health (CVH) framework measures health‐promoting behaviors and clinical factors, but it has not been rigorously evaluated in the CR setting. Methods This retrospective cohort study analyzed patients attending CR from January 2018 to September 2020. Patients were evaluated at baseline (pre‐CR) and completion (post‐CR) using 3 clinical factors (blood pressure, cholesterol, and hemoglobin A1c) and 4 health behaviors (smoking, body mass index, physical activity, and diet). CVH score was computed as a composite of each Life's Simple 7 component by assigning 0 points for poor, 1 point for intermediate, or 2 points for ideal (range 0–14 points). CVH scores were further categorized as poor (0–6 points), intermediate (7–8 points), and ideal (9–14 points). Missing data in the analysis were accounted for using a multiple imputation procedure. Results Patients (N=937) were aged 64.0±13.4 years old, 34% women, and attended 11±12 CR sessions. Pre‐CR, 97.2% had poor CVH scores, 2.8% had intermediate scores, and none met ideal CVH criteria. Post‐CR, there was a reduction in poor scores across all metrics except for hemoglobin A1c, which increased (40.6%–43.5%). Younger patients showed improvement in hemoglobin A1c, while older patients improved in body mass index and blood pressure. Conclusions Our study demonstrates the efficacy of CR in improving CVH but underscores the need for better blood glucose management. Tailored interventions based on age and sex may further optimize outcomes for CR participants.

Abstract Background: Rectosigmoid endometriosis (RSE) presents with a diverse array of MRI findings that impact surgical planning. No standardized reporting and data system has been established for RSE. Purpose: We propose a novel MRI scoring system designed to predict the likelihood of muscularis propria (MP) involvement in RSE, which would, in turn, influence surgical planning. Material and Methods: The records of patients with bowel endometriosis treated surgically from May 2018 to June 2022 were retrieved. Surgery was classified as partial thickness discoid, full thickness discoid, or segmental resection. Each pre-treatment MRI was scored based on the mutual agreement of two abdominal radiologists (reference score). The MRI score was defined as (1) score 0: no evidence of RSE, (2) score 1: minimal tethering involving the serosal surface without MP involvement, (3) score 2: intermediate soft tissue thickening involving the rectosigmoid colon with indeterminate MP involvement, or (4) score 3: definite mushroom cap sign or definite MP involvement. In the reader study, two radiologists independently scored each exam. The area under the curve (AUC) was evaluated for predicting the need for segmental or full thickness discoid resection. Results: The cohort consisted of 95 patients (median age: 36 years); 16, 14, 30, and 35 patients had MRI score 0, 1, 2, and 3, respectively. Patients with MRI scores 3 and 2 underwent partial thickness discoid (6% vs 50%), full thickness discoid (6% vs 17%), and segmental resection (89% vs 33%), respectively. All patients with MRI scores 1 or 0 either underwent partial thickness discoid resection or did not undergo rectosigmoid surgery. The AUCs were 92.2%, 84.5% and 93.9% for MRI scores of the reference, reader 1, and 2, respectively. Conclusion: Our MRI scoring system based on suspected depth of bowel invasion showed good diagnostic performance to predict the type of surgical intervention needed. Summary Statement This novel MRI scoring system for rectosigmoid endometriosis is a concise and qualitative scale based on suspected depth of bowel wall invasion to best guide operative planning.

Background: Cardiac rehabilitation (CR) is essential to secondary cardiovascular disease prevention and management of cardiac patients. Despite its proven benefits, CR remains underutilized with enrollment and completion rates ranging from 10-30% in the US. Yet, there is a scarcity of nationally representative data among diverse populations on socioeconomic differences in barriers and beliefs of CR participation and delivery mode preferences. Hypothesis: The perceptions (barriers, beliefs), CR delivery mode preferences, and CR utilization (prior enrollment) varies by socioeconomic status (SES) among CR-eligible individuals. Methods: We conducted an anonymous national electronic survey from March 2023 to January 2024 of individuals self-reporting a prior CR-eligible diagnosis. The 22-item CR Barriers Scale assessed perceived barriers to CR enrollment and participation using a 5-point Likert scale (strongly disagree to strongly agree). A 13-item, validated questionnaire assessed 4 subscales pertaining to patients’ beliefs about CR, each rated on a 5-point Likert scale (strongly disagree to strongly agree): perceived necessity, concerns about exercise, practical barriers and perceived suitability. CR delivery mode preferences were ascertained (eg, virtual, at-home, etc.). Mean barriers and belief scores as well as delivery mode preferences were stratified by SES. Low SES was defined as ≤ high school education, Medicaid insurance, or uninsured. High SES was defined as > high school education and non-Medicaid health insurance. Responses were analyzed using descriptive statistics with R software. Results: A total of 466 participants completed the survey (38.1% women, 30.6% minoritized racial/ethnic group, 29.6% low SES, 95% response rate) ( Table 1 ). The majority indicated prior enrollment in CR (81.5%) with no difference by SES. CR barrier scores did not differ significantly by SES (p=0.331) ( Table 2 ). Beliefs about CR perceived necessity and perceived suitability differed by SES (p<0.001 and p=0.025), but beliefs regarding concerns about exercise and practical barriers did not. The low SES group reported a higher preference for completely at-home CR compared to the high SES group (33.6% vs 7.4%, p<0.001). Conclusion: Our findings suggest that CR beliefs varied by SES while utilization did not. For CR-eligible patients experiencing socioeconomic disadvantage, at-home CR may be a preferred alternative to center-based CR to increase CR participation and adherence.

Background SynthesiZed Improved Resolution and Concurrent nOise reductioN (ZIRCON) is a multi-kernel synthesis method that creates a single series of thin-slice computed tomography (CT) images displaying low noise and high spatial resolution, increasing reader efficiency and minimizing partial volume averaging. Purpose To compare the diagnostic performance of a single set of ZIRCON images to two routine clinical image series using conventional CT head and bone reconstruction kernels for diagnosing intracranial findings and fractures in patients with trauma or suspected acute neurologic deficit. Material and Methods In total, 50 patients underwent clinically indicated head CT in the ER (15 normal, 35 abnormal cases). A non-reader neuroradiologist established the reference standard. Three neuroradiologists reviewed two routine clinical series (head and bone kernels) and a single ZIRCON series, detecting intracranial findings or fractures and rating confidence (0–100). Sensitivity, specificity, and jackknife free-response receiver operating characteristic (JAFROC) figure of merit (FOM) were compared (limit of non-inferiority: −0.10). Results ZIRCON and conventional images demonstrated comparable performance for fractures (sensitivity: 51.5% vs. 54.5%; specificity: 40.2% vs. 34.2%) and intracranial findings (sensitivity: 88.2% vs. 91.4%; specificity: 77.2% vs. 73.7%).The estimated difference of JAFROC FOM demonstrated ZIRCON non-inferiority for acute pathologies overall (0.003 [95% CI=−0.051–0.057]) and fractures (0.048 [95% CI=−0.050–0.145]) but not for intracranial findings alone (−0.024 [95% CI=−0.100–0.052]). Conclusion Thin-slice, low noise, and high spatial resolution images can be created to display intracranial findings and fractures replacing multiple images series in head CT with similar performance. Future studies in more patients and further algorithmic development are warranted.

Abstract Background African-American (AA) women are less likely to achieve ideal cardiovascular (CV) health compared with women of other racial/ethnic subgroups, primarily due to structural and psychosocial barriers. A potential psychosocial construct relevant to ideal CV health is the superwoman schema (SWS). Purpose We explored whether the SWS was associated with perceived stress, CV risk factors, and overall CV health among AA women. Methods This cross-sectional analysis of the FAITH! Heart Health+ Study was conducted among AA women with high cardiometabolic risk. Pearson correlation evaluated associations between SWS and CV risk factors (e.g., stress, hypertension, diabetes, etc.). The 35-item SWS questionnaire includes five domains. Stress was measured by the 8-item Global Perceived Stress Scale (GPSS). CV health was assessed using the American Heart Association Life’s Simple 7 (LS7) rubric of health behaviors/biometrics. Data acquisition spanned from February to August 2022. Results The 38 women included in the analysis (mean age 54.3 [SD 11.5] years) had a high CV risk factor burden (71.1% hypertension, 76.3% overweight/obesity, 28.9% diabetes, 39.5% hyperlipidemia). Mean GPSS level was 7.7 (SD 5.2), CV health score 6.7 (SD 1.8), and SWS score 60.3 (SD 18.0). Feeling an “obligation to help others” and “obligation to present an image of strength” had strongest correlations with GPSS score among all SWS domains (r = 0.51; p = .002 and r = 0.39; p = .02, respectively). Correlation among the SWS domains and traditional CV risk factors was not statistically significant. Conclusion Our findings suggest that an obligation to help others and to project an image of strength could be contributing to stress among AA women.

Abstract Background Despite advances in cardiovascular (CV) care, African American adults experience worse CV disease (CVD) outcomes than White adults, warranting the investigation of CVD prediction biomarkers. Plasma ceramides are bioactive lipids that are biomarkers of adverse cardiovascular risk for both primary and secondary prevention. However, racial/ethnic differences in ceramide levels and their link to CV health (CVH) in African American adults remain underexplored. Purpose This study aimed to: 1) assess the association between ceramide scores and CVH and atherosclerotic CVD (ASCVD) risk among African American adults and 2) compare ceramide scores between African American and White adults. Methods Health surveys and ceramides measurements were conducted for African American and White adults, both recruited from population-based observational study cohorts. Ten-year pooled cohort risk ASCVD scores were calculated based on American College of Cardiology guidelines. CVH was assessed using Life’s Essential 8 (LE8) scores, as per American Heart Association rubrics. CV risk factors in the two cohorts were compared using Chi-squared tests. Linear regression and Pearson correlation assessed the association between ceramide, LE8, and ASCVD risk scores. Linear regression, adjusted for age and sex, compared ASCVD risk and ceramide scores between the two cohorts. Results In total, 58 African American (mean age [SD] 54.5 [11.9] years, 67.9% women) and 1103 White (mean age [SD] 64.5 [11.9] years, 52.1% women) adults were included (Table 1). Compared to White adults, African American adults had a higher prevalence of overweight/obesity (92.9% vs 33.6%; p&lt;0.001), hypertension (69.6% vs 42.5%; p&lt;0.001), diabetes (30.4% vs 12.2%; p&lt;0.001), and hyperlipidaemia (42.9% vs 30.0%; p=0.03). No difference in mean ASCVD risk was observed between the African American (12.8% [SD 10.4]) and White (12.6% [SD 11.1]) cohorts (p= 0.91). African American adults had lower 18:0 (0.08 [0.03] vs 0.10 [0.04] μmol/L) and 24:1 (0.91 [0.31] vs 1.17 [0.33] μmol/L) ceramides compared to White adults (p&lt;0.001). Ceramide scores among African American adults were not associated with LE8 scores (p=0.077) or ASCVD risk scores (r=-0.12, p=0.428). Adjusting for age and sex, African American adults had lower ceramide scores compared to White adults (mean [SD] 1.90 [1.97] vs 3.48 [2.88], p=0.006). Conclusions In our study comparing African American and White adults in the community, the association observed between ceramide scores and CVH or ASCVD risk scores in the African American cohort did not reach statistical significance. Interestingly, despite a more suboptimal cardiometabolic profile, African American adults had lower ceramide scores compared to White adults. Our findings suggest that ceramide profiles may not accurately reflect cardiovascular risk in African American adults, warranting further exploration of alternative sphingolipid biomarkers of risk for this population.