UNC System Math Pathways’ Digital Course Enhancement Collaboration to Improve Equity, Instruction, and Access During the COVID-19 Pandemic

This study examines how faculty members and students evaluated, perceived, and used a digital course content collection developed to support high quality remote instruction during the Covid-19 pandemic. The collections were the result of a multi-institutional, collaborative effort within the University of North Carolina System to support its students and faculty. Using surveys from faculty and demographically identified students enrolled in their classes, the authors evaluate the perceived utility and impact of the open educational resource collections. Faculty members rated the collections highly and typically found utility in at least some of the components of the collections. They found activities, videos and assessments to be the most useful tools. Students generally responded positively to the classes using the collections. While students who identified as minority found the materials useful or beneficial, they did not do so in proportional numbers to non-minority students

Enacting boundaries or building bridges? Language and engagement in food-energy-water systems science

Scientific study of issues at the nexus of food–energy–water systems (FEWS) requires grappling with multifaceted, “wicked” problems. FEWS involve interactions occurring directly and indirectly across complex and overlapping spatial and temporal scales; they are also imbued with diverse and sometimes conflicting meanings for the human and more-than-human beings that live within them. In this paper, we consider the role of language in the dynamics of boundary work, recognizing that the language often used in stakeholder and community engagement intended to address FEWS science and decision-making constructs boundaries and limits diverse and inclusive participation. In contrast, some language systems provide opportunities to build bridges rather than boundaries in engagement. Based on our experiences with engagement in FEWS science and with Indigenous knowledges and languages, we consider examples of the role of language in reflecting worldviews, values, practices, and interactions in FEWS science and engagement. We particularly focus on Indigenous knowledges from Anishinaabe and the language of Anishinaabemowin, contrasting languages of boundaries and bridges through concrete examples. These examples are used to unpack the argument of this work, which is that scientific research aiming to engage FEWS issues in working landscapes requires grappling with embedded, practical understandings. This perspective demonstrates the importance of grappling with the role of language in creating boundaries or bridges, while recognizing that training in engagement may not critically reflect on the role of language in limiting diversity and inclusivity in engagement efforts. Leaving this reflexive consideration of language unexamined may unknowingly perpetuate boundaries rather than building bridges, thus limiting the effectiveness of engagement that is intended to address wicked problems in working landscapes

Personalised progression prediction in patients with monoclonal gammopathy of undetermined significance or smouldering multiple myeloma (PANGEA): a retrospective, multicohort study

BACKGROUND: Patients with precursors to multiple myeloma are dichotomised as having monoclonal gammopathy of undetermined significance or smouldering multiple myeloma on the basis of monoclonal protein concentrations or bone marrow plasma cell percentage. Current risk stratifications use laboratory measurements at diagnosis and do not incorporate time-varying biomarkers. Our goal was to develop a monoclonal gammopathy of undetermined significance and smouldering multiple myeloma stratification algorithm that utilised accessible, time-varying biomarkers to model risk of progression to multiple myeloma. METHODS: In this retrospective, multicohort study, we included patients who were 18 years or older with monoclonal gammopathy of undetermined significance or smouldering multiple myeloma. We evaluated several modelling approaches for predicting disease progression to multiple myeloma using a training cohort (with patients at Dana-Farber Cancer Institute, Boston, MA, USA; annotated from Nov, 13, 2019, to April, 13, 2022). We created the PANGEA models, which used data on biomarkers (monoclonal protein concentration, free light chain ratio, age, creatinine concentration, and bone marrow plasma cell percentage) and haemoglobin trajectories from medical records to predict progression from precursor disease to multiple myeloma. The models were validated in two independent validation cohorts from National and Kapodistrian University of Athens (Athens, Greece; from Jan 26, 2020, to Feb 7, 2022; validation cohort 1), University College London (London, UK; from June 9, 2020, to April 10, 2022; validation cohort 1), and Registry of Monoclonal Gammopathies (Czech Republic, Czech Republic; Jan 5, 2004, to March 10, 2022; validation cohort 2). We compared the PANGEA models (with bone marrow [BM] data and without bone marrow [no BM] data) to current criteria (International Myeloma Working Group [IMWG] monoclonal gammopathy of undetermined significance and 20/2/20 smouldering multiple myeloma risk criteria). FINDINGS: We included 6441 patients, 4931 (77%) with monoclonal gammopathy of undetermined significance and 1510 (23%) with smouldering multiple myeloma. 3430 (53%) of 6441 participants were female. The PANGEA model (BM) improved prediction of progression from smouldering multiple myeloma to multiple myeloma compared with the 20/2/20 model, with a C-statistic increase from 0·533 (0·480-0·709) to 0·756 (0·629-0·785) at patient visit 1 to the clinic, 0·613 (0·504-0·704) to 0·720 (0·592-0·775) at visit 2, and 0·637 (0·386-0·841) to 0·756 (0·547-0·830) at visit three in validation cohort 1. The PANGEA model (no BM) improved prediction of smouldering multiple myeloma progression to multiple myeloma compared with the 20/2/20 model with a C-statistic increase from 0·534 (0·501-0·672) to 0·692 (0·614-0·736) at visit 1, 0·573 (0·518-0·647) to 0·693 (0·605-0·734) at visit 2, and 0·560 (0·497-0·645) to 0·692 (0·570-0·708) at visit 3 in validation cohort 1. The PANGEA models improved prediction of monoclonal gammopathy of undetermined significance progression to multiple myeloma compared with the IMWG rolling model at visit 1 in validation cohort 2, with C-statistics increases from 0·640 (0·518-0·718) to 0·729 (0·643-0·941) for the PANGEA model (BM) and 0·670 (0·523-0·729) to 0·879 (0·586-0·938) for the PANGEA model (no BM). INTERPRETATION: Use of the PANGEA models in clinical practice will allow patients with precursor disease to receive more accurate measures of their risk of progression to multiple myeloma, thus prompting for more appropriate treatment strategies. FUNDING: SU2C Dream Team and Cancer Research UK

Comparison of CT and Dixon MR Abdominal Adipose Tissue Quantification Using a Unified Computer-Assisted Software Framework

Purpose: Reliable and objective measures of abdominal fat distribution across imaging modalities are essential for various clinical and research scenarios, such as assessing cardiometabolic disease risk due to obesity. We aimed to compare quantitative measures of subcutaneous (SAT) and visceral (VAT) adipose tissues in the abdomen between computed tomography (CT) and Dixon-based magnetic resonance (MR) images using a unified computer-assisted software framework. Materials and Methods: This study included 21 subjects who underwent abdominal CT and Dixon MR imaging on the same day. For each subject, two matched axial CT and fat-only MR images at the L2-L3 and the L4-L5 intervertebral levels were selected for fat quantification. For each image, an outer and an inner abdominal wall regions as well as SAT and VAT pixel masks were automatically generated by our software. The computer-generated results were then inspected and corrected by an expert reader. Results: There were excellent agreements for both abdominal wall segmentation and adipose tissue quantification between matched CT and MR images. Pearson coefficients were 0.97 for both outer and inner region segmentation, 0.99 for SAT, and 0.97 for VAT quantification. Bland–Altman analyses indicated minimum biases in all comparisons. Conclusion: We showed that abdominal adipose tissue can be reliably quantified from both CT and Dixon MR images using a unified computer-assisted software framework. This flexible framework has a simple-to-use workflow to measure SAT and VAT from both modalities to support various clinical research applications

Addressing Relationship Health Needs in Primary Care: Adapting the Marriage Checkup for Use in Medical Settings with Military Couples

The overall objective of this study was to pilot the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency tailored to a military population, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic. The MC was revised to fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-min appointments), and military-relevant material was added to the content. IBHCs working in primary care were then trained to offer the intervention. Thirty participants were enrolled in the study and completed a relationship checkup and one-month follow-up questionnaires. Analysis of post-test and one-month follow-up data showed statistically significant improvements in participants’ marital health compared to pre-treatment. The MC intervention appeared to be well received by both couples and IBHCs

The Marriage Checkup: Adapting and Implementing a Brief Relationship Intervention for Military Couples

Given the significant negative impact of relationship distress on the health and well being of members of the military, preventative and accessible care is needed in order to provide crucial relationship support to service members and their families. This paper presents the rationale, key considerations, and feasibility for adapting the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic serving an active duty military population. We detail the adapted MC protocol, which was revised to contain military-centric content and fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-minute appointments). IBHCs working in primary care were trained to offer the intervention at two air force bases. Twenty couples and 1 individual have completed the MC and a 1-month follow-up assessment. The MC intervention appeared to be well-received by both couples and IBHCs. In this paper, we provide specific guidance for clinicians and providers who are interested in integrating the Marriage Checkup into their practice

The Marriage Checkup: Adapting and Implementing a Brief Relationship Intervention for Military Couples

Given the significant negative impact of relationship distress on the health and well being of members of the military, preventative and accessible care is needed in order to provide crucial relationship support to service members and their families. This paper presents the rationale, key considerations, and feasibility for adapting the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic serving an active duty military population. We detail the adapted MC protocol, which was revised to contain military-centric content and fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-minute appointments). IBHCs working in primary care were trained to offer the intervention at two air force bases. Twenty couples and 1 individual have completed the MC and a 1-month follow-up assessment. The MC intervention appeared to be well-received by both couples and IBHCs. In this paper, we provide specific guidance for clinicians and providers who are interested in integrating the Marriage Checkup into their practice

Addressing Relationship Health Needs in Primary Care: Adapting the Marriage Checkup for Use in Medical Settings with Military Couples

The overall objective of this study was to pilot the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency tailored to a military population, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic. The MC was revised to fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-min appointments), and military-relevant material was added to the content. IBHCs working in primary care were then trained to offer the intervention. Thirty participants were enrolled in the study and completed a relationship checkup and one-month follow-up questionnaires. Analysis of post-test and one-month follow-up data showed statistically significant improvements in participants’ marital health compared to pre-treatment. The MC intervention appeared to be well received by both couples and IBHCs

Criticality: A New Concept of Severity of Illness for Hospitalized Children.

OBJECTIVES: To validate the conceptual framework of criticality, a new pediatric inpatient severity measure based on physiology, therapy, and therapeutic intensity calibrated to care intensity, operationalized as intensive care unit (ICU) care. DESIGN: Deep neural network analysis of a pediatric cohort from the Health Facts® (Cerner Corporation, Kansas City, MO) national database. SETTING: Hospitals with pediatric routine inpatient and ICU care. PATIENTS: Children cared for in the ICU (n = 20,014), and in routine care units without an ICU admission (n = 20,130) from 2009 – 2016. All patients had laboratory, vital sign, and medication data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A calibrated, deep neural network used physiology (laboratory tests and vital signs), therapy (medications), and therapeutic intensity (number of physiology tests and medications) to model care intensity, operationalized as ICU (versus routine) care every 6 hours of a patient’s hospital course. The probability of ICU care is termed the Criticality Index. First, the model demonstrated excellent separation of criticality distributions from a severity hierarchy of 5 patient groups: routine care, routine care for those who also received ICU care, transition from routine to ICU care, ICU care, and high intensity ICU care. Second, model performance assessed with statistical metrics was excellent with an AUC for the ROC of 0.95 for 327,189 6-hour time periods, excellent calibration, sensitivity = 0.817, specificity = 0.892, accuracy = 0.866, and precision = 0.799. Third, the performance in individual patients with >1 care designation indicated 88.03% (95% CI: 87.72, 88.34) of the Criticality Indices in the more intensive locations were higher than the less intense locations. CONCLUSION AND RELEVANCE: The Criticality Index is a quantification of severity of illness for hospitalized children using physiology, therapy, and care intensity. This new conceptual model is applicable to clinical investigations and predicting future care needs