Overlapping Structures in Sensory-Motor Mappings

This paper examines a biologically-inspired representation technique designed for the support of sensory-motor learning in developmental robotics. An interesting feature of the many topographic neural sheets in the brain is that closely packed receptive fields must overlap in order to fully cover a spatial region. This raises interesting scientific questions with engineering implications: e.g. is overlap detrimental? does it have any benefits? This paper examines the effects and properties of overlap between elements arranged in arrays or maps. In particular we investigate how overlap affects the representation and transmission of spatial location information on and between topographic maps. Through a series of experiments we determine the conditions under which overlap offers advantages and identify useful ranges of overlap for building mappings in cognitive robotic systems. Our motivation is to understand the phenomena of overlap in order to provide guidance for application in sensory-motor learning robots

Exploring the Depths of Health Literacy Are We Teaching This and Why Does It Matter?

Background: Why does Health Literacy Matter? Healthcare practitioners often work with older persons with low health literacy without realizing that this issues limiting the success of their interventions. They may also lack awareness of the serious impact that low health literacy can have, since it is associated with lower reported health status, increased hospitalizations, and increased morbidity (Levasseur & Carrier, 2011). The current US healthcare system places increase demands on consumers to manage their own health (Smith & Gutman, 2011). Educators in the health professions must instill a sense of responsibility in future practitioners to understand the important role they play in promoting health literacy. Students in the health professions must acquire the tools necessary to empower their older adult and other clients using health literacy principles. Poster presented at the 65th annual scientific meeting of Gerontological Society of America in San Diego, California

A psychology based approach for longitudinal development in cognitive robotics.

A major challenge in robotics is the ability to learn, from novel experiences, new behavior that is useful for achieving new goals and skills. Autonomous systems must be able to learn solely through the environment, thus ruling out a priori task knowledge, tuning, extensive training, or other forms of pre-programming. Learning must also be cumulative and incremental, as complex skills are built on top of primitive skills. Additionally, it must be driven by intrinsic motivation because formative experience is gained through autonomous activity, even in the absence of extrinsic goals or tasks. This paper presents an approach to these issues through robotic implementations inspired by the learning behavior of human infants. We describe an approach to developmental learning and present results from a demonstration of longitudinal development on an iCub humanoid robot. The results cover the rapid emergence of staged behavior, the role of constraints in development, the effect of bootstrapping between stages, and the use of a schema memory of experiential fragments in learning new skills. The context is a longitudinal experiment in which the robot advanced from uncontrolled motor babbling to skilled hand/eye integrated reaching and basic manipulation of objects. This approach offers promise for further fast and effective sensory-motor learning techniques for robotic learning

Faculty Development As a Tool to Impact Culturally Competent Care of Sexual and Gender Minorities

Presentation: 5:39 Background: This poster focuses on the integration of faculty development of sexual and gender identity health knowledge and skill into health education. There is a gap in inclusion of this content in health professional curriculum. While awareness of LGBTQ+ population health has been indirectly addressed within curriculum, a consistent approach targeting all coursework and faculty can increase culturally competent care of patients that identify as LGBTQ+. Faculty confidence, awareness, and experience regarding knowledge, respectful terminology, and skill directly impacts the likelihood of students becoming culturally competent practitioners. Objectives: The objectives of this poster are to share outcomes of faculty development. This poster will: ● Discuss integration of faculty roles in academia and health profession accreditation standards with theories of cultural competence and humility inclusive of sexual and gender minorities; ● Describe a faculty development program to build foundational understanding of respectful terminology to optimize trust and respect when conversing with/about individuals within sexual and gender minority populations; ● Demonstrate changes in knowledge, awareness, skill, and perceived comfort with sexual and gender minority communities following participation in the program. Methods/ Research: Monthly structured learning sessions were paired with 20-30 minute mentoring check-ins with Sexual and Gender Minorities Education and Training (SG-MET) faculty to address components of LGBTQ+ inclusive curriculum. Pre, mid, and post surveys, composed of open and close-ended questions, assessed satisfaction and changes in knowledge, awareness, and perception of skills. Standardized assessments of sexual and gender minority knowledge, experience and clinical skills were completed and collected anonymously through an electronic survey system to protect the faculty’s identification. Conclusions/ Impact: This faculty development program provides pilot data to suggest that this is an effective way to increase knowledge, awareness, and skills in the area of sexual and gender minority health content delivery and practice to impact healthcare disparities in these populations.https://jdc.jefferson.edu/sexandgenderhealth/1001/thumbnail.jp

The Impact of Student Hotspotting on Patients & the Jefferson Health System

Introduction “Super-utilizers”, patients with five or more hospital admissions in the past year, account for half of all healthcare expenditures and present a significant financial burden to our healthcare system. In Pennsylvania “super-utilizers” result in $1.25 billion of healthcare spending and Philadelphia has the highest number of “super-utilizers” in the state. To address this crisis, Jefferson University serves as one of four new national hubs for student hotspotting. Teams of interprofessional health professions students along with faculty and staff advisors enroll “super-utilizers” and provide targeted interventions to address social determinants of health, reduce hospitalizations and improve patient outcomes. Methods To examine the impact of this program on patients, objective healthcare outcomes were obtained from EPIC. Costs were obtained from the hospital Care Coordination team and national average figures to examine the impact on the Jefferson health system. Data were collected from six months pre-, during, and post-intervention for the hotspotting intervention group and for a matched control group of non-program participants. Pre- and post-intervention analysis was performed using random effects Poisson regression. Results Pre- and post-intervention analysis found a 6% reduction in ED visits, 48% reduction in the number of outpatient visits, 18% reduction in total days in hospital, and 14% reduction in 30 day readmissions for the intervention vs. the control group. Average total costs of care decreased for both the experimental and control group with a 36% cost reduction per patient in the intervention group. Conclusion Participation in student hotspotting is a promising way to help address the needs of “super-utilizes”. Student hotspotting appears to have a positive impact on reducing the costs of care and improving health outcomes for high utilizer patients

Leading an Interprofessional Geriatric Clinical Skills Fair: A Train the Trainer Seminar

Objectives • Practice teaching skills related to interprofessional education (IPE) and geriatric competencies • Formulate an Action Plan and prepare to introduce an Interprofessional Geriatric Clinical Skills Fair at their own institutions • Recognize essential elements of a measurement tool that evaluates the effectiveness of an Interprofessional Geriatric Clinical Skills Fai

Sensitive MRD detection from lymphatic fluid after surgery in HPV-associated oropharyngeal cancer

PURPOSE: Our goal was to demonstrate that lymphatic drainage fluid (lymph) has improved sensitivity in quantifying postoperative minimal residual disease (MRD) in locally advanced human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) compared with plasma, and leverage this novel biofluid for patient risk stratification. EXPERIMENTAL DESIGN: We prospectively collected lymph samples from neck drains of 106 patients with HPV (+) OPSCC, along with 67 matched plasma samples, 24 hours after surgery. PCR and next-generation sequencing were used to quantify cancer-associated cell-free HPV (cf-HPV) and tumor-informed variants in lymph and plasma. Next, lymph cf-HPV and variants were compared with TNM stage, extranodal extension (ENE), and composite definitions of high-risk pathology. We then created a machine learning model, informed by lymph MRD and clinicopathologic features, to compare with progression-free survival (PFS). RESULTS: Postoperative lymph was enriched with cf-HPV compared with plasma (P \u3c 0.0001) and correlated with pN2 stage (P = 0.003), ENE (P \u3c 0.0001), and trial-defined pathologic risk criteria (mean AUC = 0.78). In addition, the lymph mutation number and variant allele frequency were higher in pN2 ENE (+) necks than in pN1 ENE (+) (P = 0.03, P = 0.02) or pN0-N1 ENE (-) (P = 0.04, P = 0.03, respectively). The lymph MRD-informed risk model demonstrated inferior PFS in high-risk patients (AUC = 0.96, P \u3c 0.0001). CONCLUSIONS: Variant and cf-HPV quantification, performed in 24-hour postoperative lymph samples, reflects single- and multifeature high-risk pathologic criteria. Incorporating lymphatic MRD and clinicopathologic feature analysis can stratify PFS early after surgery in patients with HPV (+) head and neck cancer. See related commentary by Shannon and Iyer, p. 1223

Introducing Interprofessional Education (IPE) Grand Rounds: Lessons from a New Student-led IPE Initiative

Learning Objectives • Describe 2-3 benefits for enhancing student exposure to real world collaborative practice teams • Develop an action plan for starting an IPE Interest Group at your institution • Describe 3 practical tips for implementing an IPE Grand Round

Cell-free DNA ultra-low-pass whole genome sequencing to distinguish malignant peripheral nerve sheath tumor (MPNST) from its benign precursor lesion: A cross-sectional study

BACKGROUND: The leading cause of mortality for patients with the neurofibromatosis type 1 (NF1) cancer predisposition syndrome is the development of malignant peripheral nerve sheath tumor (MPNST), an aggressive soft tissue sarcoma. In the setting of NF1, this cancer type frequently arises from within its common and benign precursor, plexiform neurofibroma (PN). Transformation from PN to MPNST is challenging to diagnose due to difficulties in distinguishing cross-sectional imaging results and intralesional heterogeneity resulting in biopsy sampling errors. METHODS AND FINDINGS: This multi-institutional study from the National Cancer Institute and Washington University in St. Louis used fragment size analysis and ultra-low-pass whole genome sequencing (ULP-WGS) of plasma cell-free DNA (cfDNA) to distinguish between MPNST and PN in patients with NF1. Following in silico enrichment for short cfDNA fragments and copy number analysis to estimate the fraction of plasma cfDNA originating from tumor (tumor fraction), we developed a noninvasive classifier that differentiates MPNST from PN with 86% pretreatment accuracy (91% specificity, 75% sensitivity) and 89% accuracy on serial analysis (91% specificity, 83% sensitivity). Healthy controls without NF1 (participants = 16, plasma samples = 16), PN (participants = 23, plasma samples = 23), and MPNST (participants = 14, plasma samples = 46) cohorts showed significant differences in tumor fraction in plasma (P = 0.001) as well as cfDNA fragment length (P \u3c 0.001) with MPNST samples harboring shorter fragments and being enriched for tumor-derived cfDNA relative to PN and healthy controls. No other covariates were significant on multivariate logistic regression. Mutational analysis demonstrated focal NF1 copy number loss in PN and MPNST patient plasma but not in healthy controls. Greater genomic instability including alterations associated with malignant transformation (focal copy number gains in chromosome arms 1q, 7p, 8q, 9q, and 17q; focal copy number losses in SUZ12, SMARCA2, CDKN2A/B, and chromosome arms 6p and 9p) was more prominently observed in MPNST plasma. Furthermore, the sum of longest tumor diameters (SLD) visualized by cross-sectional imaging correlated significantly with paired tumor fractions in plasma from MPNST patients (r = 0.39, P = 0.024). On serial analysis, tumor fraction levels in plasma dynamically correlated with treatment response to therapy and minimal residual disease (MRD) detection before relapse. Study limitations include a modest MPNST sample size despite accrual from 2 major referral centers for this rare malignancy, and lack of uniform treatment and imaging protocols representing a real-world cohort. CONCLUSIONS: Tumor fraction levels derived from cfDNA fragment size and copy number alteration analysis of plasma cfDNA using ULP-WGS significantly correlated with MPNST tumor burden, accurately distinguished MPNST from its benign PN precursor, and dynamically correlated with treatment response. In the future, our findings could form the basis for improved early cancer detection and monitoring in high-risk cancer-predisposed populations