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A Global Health Reciprocal Innovation grant programme: 5-year review with lessons learnt
(BMJ Publishing, 2023) Ruhl, Laura J.; Kiplagat, Jepchirchir; O'Brien, Rishika; Wools-Kaloustian, Kara; Scanlon, Michael; Plater, David; Thomas, Melissa R.; Pastakia, Sonak; Gopal-Srivastava, Rashmi; Morales-Soto, Nydia; Nyandiko, Winstone; Vreeman, Rachel C.; Litzelman, Debra K.; Laktabai, Jeremiah; Medicine, School of Medicine
Unilateral approaches to global health innovations can be transformed into cocreative, uniquely collaborative relationships between low-income and middle-income countries (LMICs) and high-income countries (HIC), constituted as 'reciprocal innovation' (RI). Since 2018, the Indiana Clinical and Translational Sciences Institute (CTSI) and Indiana University (IU) Center for Global Health Equity have led a grants programme sculpted from the core elements of RI, a concept informed by a 30-year partnership started between IU (Indiana) and Moi University (Kenya), which leverages knowledge sharing, transformational learning and translational innovations to address shared health challenges. In this paper, we describe the evolution and implementation of an RI grants programme, as well as the challenges faced. We aim to share the successes of our RI engagement and encourage further funding opportunities to promote innovations grounded in the RI core elements. From the complex series of challenges encountered, three major lessons have been learnt: dedicating extensive time and resources to bring different settings together; establishing local linkages across investigators; and addressing longstanding inequities in global health research. We describe our efforts to address these challenges through educational materials and an online library of resources for RI projects. Using perspectives from RI investigators funded by this programme, we offer future directions resulting from our 5-year experience in applying this RI-focused approach. As the understanding and implementation of RI grow, global health investigators can share resources, knowledge and innovations that have the potential to significantly change the face of collaborative international research and address long-standing health inequities across diverse settings.
Regional 4D Cardiac Magnetic Resonance Strain Predicts Cardiomyopathy Progression in Duchenne Muscular Dystrophy
(medRxiv, 2023-11-08) Earl, Conner C.; Jauregui, Alexa M.; Lin, Guang; Hor, Kan N.; Markham, Larry W.; Soslow, Jonathan H.; Goergen, Craig J.; Pediatrics, School of Medicine
Background: Cardiomyopathy (CMP) is the leading cause of death in Duchenne muscular dystrophy (DMD). Characterization of disease trajectory can be challenging, especially in the early stage of CMP where onset and clinical progression may vary. Traditional metrics from cardiovascular magnetic resonance (CMR) imaging such as LVEF (left ventricular ejection fraction) and LGE (late gadolinium enhancement) are often insufficient for assessing disease trajectory. We hypothesized that strain patterns from a novel 4D (3D+time) CMR regional strain analysis method can be used to predict the rate of DMD CMP progression. Methods: We compiled 115 short-axis cine CMR image stacks for n=40 pediatric DMD patients (13.6±4.2 years) imaged yearly for 3 consecutive visits and computed regional strain metrics using custom-built feature tracking software. We measured regional strain parameters by determining the relative change in the localized 4D endocardial surface mesh using end diastole as the initial reference frame. Results: We first separated patients into two cohorts based on their initial CMR: LVEF≥55% (n=28, normal cohort) and LVEF<55% (n=12, abnormal cohort). Using LVEF decrease measured two years following the initial scan, we further subclassified these cohorts into slow (ΔLVEF%≤5) or fast (ΔLVEF%>5) progression groups for both the normal cohort (n=12, slow; n=15, fast) and the abnormal cohort (n=8, slow; n=4, fast). There was no statistical difference between the slow and fast progression groups in standard biomarkers such as LVEF, age, or LGE status. However, basal circumferential strain (Ecc) late diastolic strain rate and basal surface area strain (Ea) late diastolic strain rate magnitude were significantly decreased in fast progressors in both normal and abnormal cohorts (p<0.01, p=0.04 and p<0.01, p=0.02, respectively). Peak Ea and Ecc magnitudes were also decreased in fast progressors, though these only reached statistical significance in the normal cohort (p<0.01, p=0.24 and p<0.01, p=0.18, respectively). Conclusion: Regional strain metrics from 4D CMR can be used to differentiate between slow or fast CMP progression in a longitudinal DMD cohort. These results demonstrate that 4D CMR strain is useful for early identification of CMP progression in patients with DMD. Clinical Perspective: Cardiomyopathy is the number one cause of death in Duchenne muscular dystrophy, but the onset and progression of the disease are variable and heterogeneous. In this study, we used a novel 4D cardiovascular magnetic resonance regional strain analysis method to evaluate 40 pediatric Duchenne patients over three consecutive annual visits. From our analysis, we found that peak systolic strain and late diastolic strain rate were early indicators of cardiomyopathy progression. This method offers promise for early detection and monitoring, potentially improving patient outcomes through timely intervention and management.
Digital Radiographic Analysis of Mineral Density of Adjacent Alveolar Bone in Relation to the Molar Translation Rate After Use of Retromolar Implant Anchorage
(1997) Sim, Yeongsuk; Roberts, W. Eugene; Analoui, Mostafa; Hohlt, William F.; Katona, Thomas R.; Shanks, James C., Jr.
Molar translation using retromolar implants provides an unique opportunity to measure the rate of orthodontic tooth movement, because implants do not permit any reactive movement from the force. Contrast-corrected digital radiography was utilized to investigate the rate of molar translation related to the mineral density of adjacent alveolar bone. It was hypothesized that the rate of molar translation was inversely correlated with bone mineral density ahead of the moving tooth. Periapical radiographs were obtained every six months during 24 months of active treatment of eight patients (age: 24 to 48 years). Distance from three reference points (crown tip, mid-root, apex) and mineral density of four circular areas in front of the translating molar were analyzed for correlation. The primary method of analysis was the use of Pearson correlation coefficients between rate change and bone mineral density, and between rate change and age. The results showed that rate change of molar translation at the root apex was inversely correlated to the mineral density of adjacent alveolar bone. The correlations were not significant when examining the rate over the first six months; however, the correlations were significant after the second follow-up evaluation at 12 months. The correlation was also significant when using the overall means up to last follow-up visit. However, patient age was not significantly related to the rate of molar translation in this study.
A Novel Framework for Optimizing Efficiency and Education in Microsurgical Breast Reconstruction
(Wolters Kluwer, 2023-11-27) Lester, Mary E.; Berns, Jessica; Dawson, Steven; Newsom, Keeley; Hartman, Brett; Hassanein, Aladdin H.; Surgery, School of Medicine
Deep inferior epigastric perforator (DIEP) flaps are becoming the most frequent choice for autologous breast reconstruction. There are many benefits to DIEP flaps, but the procedures can be lengthy and have a steep learning curve. The balance of efficiency and education can be difficult to achieve. A framework was implemented to focus on both efficiency and education at each stage of the DIEP flap procedure. The author's methods to improve efficiency include a two-team approach with assigned roles for faculty and residents. The roles are consistent across the institution. Methods to enhance education include practice in a laboratory-based microsurgical training course and assigning goals for the rotation. Trainees include independent and integrated plastic surgery residents without microsurgical fellows. Bilateral DIEPs are performed with two attendings, and unilateral DIEPs, with one attending. A retrospective review identified patients undergoing DIEP flap reconstruction from 2017 to 2020. Outcome measures include operative time and complications, which are comparable to previously published data. Focusing on education allows residents to learn each stage of the case. The authors present a framework for training residents in DIEP flap reconstruction to optimize efficiency and education.
A Cephalometric Study of Velar Height as a Function of Voice Fundamental Frequency in the Normal Speaker
(1975) Simons, Charles Morris
An understanding of velar activity during vowel utterance has resulted from the use of several methods of study and observation. Both acoustic and perceptual methods have been used to describe velar activity. Acoustic characteristics have been related to nasality. Perceptual studies have enumerated variation in judged severity of nasality. Cinefluorographic techniques have been used to investigate the effects of vocal effort and fundamental frequency on velar movement. Intra-oral photographic techniques have also been employed to understand this relationship. Due to conflicting reports from the several techniques, the present study was undertaken to utilize a new approach of still cephalometric radiographs during sound production. The purpose of the present study was to use a cephalometric procedure to investigate velar height and velopharyngeal gap as a function of fundamental frequency in normal subjects. Four levels of fundamental frequency (10%, 25%, 50%, and 75% of the subject's total vocal range) at constant vocal effort were performed by 11 normal adult males on sequences of the vowel /a/. Each subject was carefully trained to utter the vowel sound at each of the four pitch levels as computed by a Honeywell Visicorder. A v-u meter indicated constancy of vocal effort. A lateral cephalometric headplate was taken under each of the four vocal pitch conditions. Velar height and velopharyngeal gap were measured by means of an acetate tracing from each headplate. The measurements were submitted for statistical interpretation. Major findings included: 1. Tracings and measurements could be done accurately. 2. Vocal fundamental frequency productions were accurate. 3. Vocal effort could be maintained constant. 4. No significant difference between pitch levels for either velar height or velopharyngeal gap was indicated. 5. Highly significant differences in measurements of velar height and velopharyngeal gap were noted between subjects. 6. No significant correlation between 75% and 10% pitch levels was indicated by a Pearson product-moment correlation. 7. A significant correlation between 25%, 50% and 75% levels was evidenced.